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This study has two main objectives: to describe the prevalence of undetected chronic obstructive pulmonary disease (COPD) in a clinical sample of smokers with severe mental illness (SMI), and to assess the value of the Tobacco Intensive Motivational Estimated Risk tool, which informs smokers of their respiratory risk and uses brief text messages to reinforce intervention.
A multicenter, randomized, open-label, and active-controlled clinical trial, with a 12-month follow-up. Outpatients with schizophrenia (SZ) and bipolar disorder were randomized either to the experimental group—studied by spirometry and informed of their calculated lung age and degree of obstruction (if any)—or to the active control group, who followed the 5 A’s intervention.
The study sample consisted of 160 patients (71.9% SZ), 78.1% of whom completed the 12-month follow-up. Of the patients who completed the spirometry test, 23.9% showed evidence of COPD (77.8% in moderate or severe stages). TIMER was associated with a significant reduction in tobacco use at week 12 and in the long term, 21.9% of patients reduced consumption and 14.6% at least halved it. At week 48, six patients (7.3%) allocated to the experimental group achieved the seven-day smoking abstinence confirmed by CO (primary outcome in terms of efficacy), compared to three (3.8%) in the control group.
In this clinical pilot trial, one in four outpatients with an SMI who smoked had undiagnosed COPD. An intensive intervention tool favors the early detection of COPD and maintains its efficacy to quit smoking, compared with the standard 5 A’s intervention.
Onchocerca lupi is a parasitic filarioid and the causative agent of canine ocular onchocercosis, a zoonotic disease of domestic dogs with sporadic reports in humans. A 13-year-old dog with no travel history outside of Israel was presented to an ophthalmology veterinary clinic in Israel with severe right ocular and periocular disease. After surgical exploration, thin helminths were removed from the dorsal sclera of the eye and identified as Onchocerca lupi by polymerase chain reaction according to the cytochrome c oxidase subunit I (cox1), reduced nicotinamide adenine dinucleotide dehydrogenase subunit 5 (nad5) and 12S rRNA genes. Phylogenetic trees and haplotype networks of the cox1 and nad5 genes confirmed the circulation of two genotypes: genotype 1 with worms from dogs, cats and humans from both the Old and New Worlds, and genotype 2 with specimens from Portugal and Spain. The Israeli sequences clustered in genotype 1 and were identical to O. lupi from the USA. Evidence of two genotypes separated geographically sheds light on the phylogeography and evolution of this zoonotic pathogen, and suggests a diverse pathology observed in different regions of the world.
To assess empathic and aversive emotional responses of excessive players of violent video games, both 20 male gamers and 20 controls, age and education matched were examined with functional MRI.
The examinations focused on resting state activity, voxelbased morphometry and the functional scanning of diverse aspects of emotional processing. The actual fMRI-scans were performed under presentation of pictures taken from the IAPS. To put the obtained fMRI-results in a broader context, the participants were examined with psychometrically.
The first-person-shooter players, half of whom fulfilled the criteria of computer game dependency, scored significantly higher (p ≤ .05) in 4 out of 6 factors of aggressiveness as measured by the FAF. The general aggression scale of the FAF correlates significantly positively (p≤ .05; r=−.515) with the Perspective Taking Scale of the Interpersonality Reactivity Index (IRI), while a couple of the FAF-Subscales correlate likewise with the Empathic Response Scale.
Within the measurement of resting state activity, differences in the Default Mode-network between players and controls could be shown. The excessive gamers exhibited significant differences within the ACC as compared to controls. This cluster significantly correlates with the FAF-Subscale for self aggression/depression. The calculation of ANOVA design of the functional experiment with picture presentation did not reveal differences in terms of group level. Yet, the analysis of the singular conditions has shown differences in the fusiform gyrus. This may point to unbalanced material for stimulation in terms of visual procession of facial presentations.
The fMRI-results are discussed against the background of the psychometric findings.
We compared the effectiveness of a multi-component intervention with usual care to treat postnatal depression among low-income mothers in primary care clinics in Santiago, Chile.
Randomised controlled trial. Two hundred and thirty mothers with major depression attending primary care clinics were randomly allocated to either a multi-component intervention or usual care. The multi-component intervention involved a psychoeducational group, systematic monitoring and treatment compliance support, and pharmacotherapy if needed. Data were analysed on an intention-to-treat basis. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months post randomisation.
Approximately 90% of randomised women completed assessments. There was a marked difference in all outcome measures at 3 months, in favour of the multi-component intervention. However, these differences between groups decreased after 3 months. In our primary analysis, the adjusted difference in mean EPDS between the two groups at 3 months was -4.5, 95% C.I. -6.3 to -2.7, p<0.001. There was a sharp decline in the proportion of women on antidepressants after 3 months in both groups.
This intervention considerably improved the outcome of depressed low-income mothers compared to usual care for the first 3 months. However, some of these clinical gains were not maintained thereafter, most likely because a large proportion stopped taking medication. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.
Major depressive disorder is a serious mental disorder with high prevalence and recurrence rate. Once depression is diagnosed, effective pharmacological treatments must be rapidly initiated. Depression etiology and responsiveness to antidepressants have been related to the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Depressed subjects do not respond equally to the same drug. This variability could be explained by interindividual genetic differences related to HPA axis, including CRHR1 receptor.
To associate the salivary cortisol levels, prior to antidepressant treatment, and the CRHR1 rs242939 polymorphism with the response to therapy with fluoxetine.
We performed a pharmacogenetic prospective longitudinal study including clinic follow-up, endocrine and genetic evaluations. After diagnosis, patients started the pharmacotherapy. the severity of the disease and clinical response were evaluated by the Hamilton Depression Rating Scale (HAM-D). Rapid and slow responses were considered as reductions in the HAM-D scores of at least 50% at the third and eight weeks respectively.
157 patients were recruited. Salivary cortisol levels at 8:00AM were lower in rapid responders than in not responders (p-value = 0.0122). No differences were observed after eight weeks of treatment. the rs242939 polymorphism was in Hardy Weinberg equilibrium (p = 0,24) and was significantly associated with early response (p = 0.019). there was no association after two month of therapy.
Discussion and conclusions:
Alterations in the CRHR1 receptor may significantly impact the regulation of stress response. the association observed in this study may be related with some refractoriness in the regulation of CRHR1 gene in non responders.
Journeys have been considered life-changing experiences since the first chronicles of humanity. Interest towards the relationship between travels and mental illness started off with the publication, in 1897, of Les aliénés voyageurs.
We report the case of a 52-year-old gentleman, married and without children, who works as a couch driver and has no past medical records. During a holiday trip, at his arrival to Saint Petersburg, he first experienced haze and cognitive and memory failures, along with malaise and sweating. The day after, while visiting the Hermitage museum, he underwent forthright auditive hallucinations, diffusion of thought phenomena and harm delusions. After ruling out diagnosable organic causes through CT scan, MRI and blood analyses including immunologic studies, he was put on olanzapine 10 mg/day with total symptomatic remission within 2 weeks.
Stendhal syndrome, described back in 1989 by Dr. Magherini, refers to anxious, somatic and psychotic symptoms affecting tourists who visit Florence. The celebrated author, himself, experienced intense emotions due to an overdose of beauty at the Italian city. Further clinical pictures related to journeys include Jerusalem Syndrome and Way of Saint James Syndrome. Another entity, Paris Syndrome, differentially affects Japanese visitors, disappointed with the actual experience of visiting the French city.
During journeys, people often abandon everyday life in order to open up to unknown sights and feelings. These can eventually, lead to certain sorts of mental illness.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Catatonia is a rare but potentially lethal neuropsychiatric syndrome. Despite its historical association with schizophrenic disorders, it is more frequent in affective ones, and is currently considered an independent pathological entity. The basis of the treatment, regardless of the cause, is the use of benzodiazepines and electroconvulsive therapy (ECT), without a clear consensus on the combined treatment. Regarding ECT, the frequency and number of effective sessions has not been clearly established. Therefore, clinical evolution is the main factor to be considered in order to determinate the appropriate treatment regimen, although the daily application of ECT is preferred, at least for the first week. We report the case of a 41-year-old patient with paranoid schizophrenia, who presented with a benzodiazepine resistant catatonic syndrome. The clinical picture included stupor, mutism, negativism, severe stiffness, catalepsy, waxy flexibility and diaphoresis, with slight CPK increase but with no other extrapyramidal symptoms, fever more than 39 and hemodynamic instability, which allowed to exclude a neuroleptic malignant syndrome. A blood analysis, lumbar puncture, CT, EEG and viral serologies were performed with inconclusive results. The patient required ICU admission and ECT treatment and we used the Bush-Francis Catatonia Rating Scale to evaluate the evolution of symptoms. Six daily treatments with ECT led to an almost full recovery of the patient. Further case series regarding the clinical management of this syndrome are needed, in order to reach consensus on an effective ECT regimen.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Taenia solium is the most common parasite infection of the brain, causing neurocysticercosis and typically found in rural communities with free-ranging pigs. Identification of transmission in rural areas is essential for its control. Risk factors and transmission of the parasite were evaluated in three rural Venezuelan communities (Valle del Rio and Potrero Largo, Cojedes state; and Palmarito, Portuguesa state) by a questionnaire (112 households) and coprological (492 samples) and serological (433 human and 230 porcine sera) analysis, respectively. Typical risk factors were found in all three communities: free-foraging pig husbandry, deficient sanitary conditions, high open defecation and ignorance of the parasite life cycle. Coprological examinations revealed a high level of soil-transmitted parasites. Importantly, two T. solium adult worm carriers were identified in each of the three communities. Anti-metacestode antibodies and the HP10 secreted metacestode glycoprotein were detected at significant levels in human and porcine sera in Valle del Rio, Potrero Largo and Palmarito. In conclusion, these communities may be considered to be endemic for taeniasis/cysticercosis, and the instigation of an appropriate control programme is recommended.
Background: Cerebellar atrophy is characterized by loss of cerebellar tissue, with evidence on brain imaging of enlarged interfolial spaces compared to the foliae. Genetic ataxias associated with cerebellar atrophy are a heterogeneous group of disorders. We investigated the prevalence in Canada and the diagnostic yield of whole exome sequencing (WES) for this group of conditions. Methods: Between 2011 and 2017, WES was performed in 91 participants with cerebellar atrophy as part of one of two national research programs, Finding of Rare Genetic Disease Genes (FORGE) or Enhanced Care for Rare Genetic Diseases in Canada (Care4Rare). Results: A genetic diagnosis was established in 58% of cases (53/91). Pathogenic variants were found in 24 known genes, providing a diagnosis for 46/53 participants (87%), and in four novel genes, accounting for 7/53 cases (13%). 38/91 cases (42%) remained unsolved. The most common diagnoses were channelopathies in 12/53 patients (23%) and mitochondrial disorders in 9/53 (17%). Inheritance was autosomal recessive in the majority of cases. Additional clinical findings provided useful clues to some of the diagnoses. Conclusions: This is the first report on the prevalence of genetic ataxias associated with cerebellar atrophy in Canada, and the utility of WES for this group of conditions.
We present the case of hot semi-detached Algols showing photometric cycles longer than the orbital period. The evidence indicating that this long cycle might be due to a magnetic dynamo operating in the rapidly rotating donor star is examined.
Echinococcus granulosus is an important zoonotic parasite that is distributed worldwide. The EG95 vaccine was developed to assist with control of E. granulosus transmission through the parasite's livestock intermediate hosts. The vaccine is based on a recombinant antigen encoded by a gene which is a member of a multi-gene family. With the recent availability of two E. granulosus draft genomes, we sought to map the eg95 gene family to the genomes. We were unable to map unequivocally any of the eg95 gene family members which had previously been characterized by cloning and sequencing both strands of genomic DNA fragments. Our inability to map EG95-related genes to the genomes has revealed limitations in the assembled sequence data when utilized for gene family analyses. This study contrasts with the expectations expressed in often high-profile publications describing draft genomes of parasitic organisms, highlighting deficiencies in currently available genomic resources for E. granulosus and provides a cautionary note for research which seeks to utilize these genome datasets.
Functionalization of silicone rubber films with lysozyme was achieved by grafting copolymerization and its chemical activation allowing the covalent immobilization of the enzyme. The new materials were characterized by means of Fourier-transform infrared spectroscopy, differential scanning calorimetry, thermogravimetric analysis, contact angle, atomic force microscopy, and mechanical properties of films. The enzymatic activity of films was studied by a suspension of lyophilized Micrococcus lysodeikticus. The activity test was inquired at different pH and temperatures, exhibiting enzymatic activity 20 °C above the free lysozyme, and at pH = 5 where the free lysozyme did not show activity.
To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.
We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.
PARTICIPANTS AND SETTING
Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.
Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.
In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).
Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination.
We investigate here the effect of the selection function on the metallicity distribution function (MDF) as well as on the vertical metallicity gradient by studying similar lines-of-sight using four different spectroscopic surveys (APOGEE, LAMOST, RAVE and Gaia-ESO) which have different targeting strategies and therefore different selection functions. We create mock fields for each survey using two stellar population synthesis models, GALAXIA and TRILEGAL. The effects of the selection function are studied in detail by applying the selection function to the two models and comparing the MDF as well as vertical metallicity gradients of the selected sources with that of the underlying sample. We find a negligible selection function effect on the MDF as well as on the vertical metallicity gradients for APOGEE, RAVE and LAMOST, and estimate a mean vertical metallicity gradient of -0.241±0.028 dex kpc−1.
The purpose of this paper is to describe the development and initial accomplishments of a training program of young leaders in community mental health research as part of a Latin American initiative known as RedeAmericas. RedeAmericas was one of five regional ‘Hubs’ funded by the National Institute of Mental Health (NIMH) to improve community mental health care and build mental health research capacity in low- and middle-income countries. It included investigators in six Latin American cities – Santiago, Chile; Medellín, Colombia; Rio de Janeiro, Brazil; and Córdoba, Neuquén, and Buenos Aires in Argentina – working together with a team affiliated with the Global Mental Health program at Columbia University in New York City. One component of RedeAmericas was a capacity-building effort that included an Awardee program for early career researchers in the mental health field. We review the aims of this component, how it developed, and what was learned that would be useful for future capacity-building efforts, and also comment on future prospects for maintaining this type of effort.
The effect on the mechanical properties at room temperature of Li and Ag additions to the Fe–Al (40 at.%)-based alloy produced by conventional casting were evaluated in this work. Alloying elements were added into a previously molted Fe–(40 at.%) aluminum-based alloy, stirred, and then cast into sand molds to directly produce tensile specimens. To determine the mechanical properties, tensile tests and hardness measurements were performed. The additions of both Ag and Li showed an increase in ductility and tensile strength of the intermetallic alloys. In addition, hardness was substantially increased with the Li addition. Lithium additions promoted a solid solution hardening, whereas 3 at.% of Ag additions promoted ductility due to a microstructural modification and to the formation of a soft Ag3Al phase. Characterization by both optical and electronic microscopy, energy dispersive spectroscopy microanalysis, and x-ray diffraction supported the mechanical characterization.