Differences in physical activity in subjects with psychosis versus a control group

Introduction

Psychiatric illnesses are related with a reduced life expectancy and an increase of mortality rates (around 60%) mainly associated with cardiovascular diseases [1]. The high prevalence of obesity, metabolic syndrome, diabetes mellitus and tobacco use among these patients undoubtelly predispose to the impairment in physical health and mortaility increase. Regular physical activity in the general population is associated with a decrease in cardiovascular risk but litle is know about iss influence in some chronic and severe mental disorders like schizophrenia ^[2].

Objectives

To quantify the physical activity performed by a sample of subjects with psychosis, borth males and female, compared to a control group.

Methods

A sample composed of 141 patients with schizoprenia was compared to 103 healthy subjects as a control group. The International Physical Activity Questionnaire - Short Form (IPAQ) scale was applied to all participants. The time (minutes) of physical activity performed in a week (METs) was collected by each participant ^[3].

Results

The differences in the total physical activity Mets for the patients with schizophrenia were highly significant (p = 0.001), showing a lower degree of physical activity compared to the control group. A higher and significant percentage of sedentary lifestyle among the psychiatric group (64.5%), compared to 35.5% in the control group was found.

Conclusions

The group of pateints with Schizophrenia showed a significant higher sedentary lifestile including less physical activity. This finding could be highly related with a higher risk of cardiovascular disease and deterioration of the physical health.

Disclosure

No significant relationships.

Hormonal alterations due to antipsychotic-related hyperprolactinemia

Introduction

The use of antipsychotics (APS) is essential. Despite their great efficacy, some of them are associated with an increase in prolactin levels that can lead to hormonal changes needing to be identified and managed [1,2,3]. Hormonal changes use to have clinical implications including hypogonadism, infertility and sexual dysfunction

Objectives

To evaluate possible hormonal alterations and some clinical implications produced by hyperprolactinemia (HPRL) derived from the use of some antipsychotic compounds.

Methods

A complete fasting blood test was performed on a sample of 113 subjects (69 men and 44 women). 54% (n = 61) showed a normal prolactin level and 46% (n = 52) showed hyperprolactinaemia ( >50ng / ml). On the global sample, 39.8% (n = 45) was treated with some hyperprolactinemic drug , mostly risperidone and paliperidone.

Results

Some differences were found depending on the gender of the subjects. A highly significant inverse relationship between the values of prolactin and testosterone was found in males (p=0.020, r=-0.285). In females, increased prolactin level was significantly related to decreased cortisol values.

Conclusions

Antipsychotic-related Hyperprolactinaemia ( mainly risperidone and paliperidone) is related with a decrease in testosterone levels in males and with an increase in cortisol levels in females.

Disclosure

No significant relationships.

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.

O-104 Low SARS-CoV-2 positivity rate in women included in ART programs following the recommendations of the Spanish scientific societies on reproduction (SEF/ASEBIR)

Study question

What is the SARS-CoV-2 positivity rate following the Spanish Fertility Society (SEF)/Association for the Study of Reproductive Biology (ASEBIR) screening recommendations?

Summary answer

The SARS-CoV-2 positivity rate in the centers following the SEF/ASEBIR screening recommendations was 0.316% after the first survey and 0.364% after the second one

What is known already

Due to the Sars-Cov-2 pandemic, all the Medical Assisted Reproduction (MAR) centers in Spain had to interrupt their activity most of the time during the first pandemic wave. On April 27th activity was restarted, and SEF and ASEBIR jointly elaborated a guide describing their SARS-CoV-2 screening recommendations for MAR centers. This document aims to achieve a safe environment for patients and staff. It includes the possibility of screening patients through a targeted clinical interview and the use of reverse-transcriptase polymerase chain reaction (RT-PCR). The aim of this study is to quantify the SARS-CoV-2 positivity rate based on these recommendations.

Study design, size, duration

National multicenter cross-sectional study. Information was gathered from centers using an anonymous survey asking for aggregated data about the number of positive cases among screened patients, sent twice. The first survey covered the period April 27th - June 30th. Second survey covered July 1st - August 31st. Response rates among centres were 9% (29/319) and 6% (20/319), respectively. This study includes 2,695 and 4,068 screenings performed in the first and the second survey, respectively.

Participants/materials, setting, methods

The SEF/ASEBIR recommendations describe two screening strategies. Strategy (a) consists in a targeted clinical interview (TCI) evaluating clinical symptoms and exposure risk, first before starting the cycle, and before egg-retrieval, intrauterine insemination (IUI), and/or embryo transfer (ET). Suspicious cases could be confirmed by further RT-PCR testing. Strategy (b) consists in conducting the same first TCI, and a systematic RT-PCR testing before the medical procedure in all patients. All patients in both strategies have a TCI.

Main results and the role of chance

In the 1st survey, 1,177 screenings and 919 RT-PCR (78.07%) were performed before the egg-retrieval. One patient with a negative TCI and positive RT-PCR was detected, and the cycle was cancelled. 1,518 screenings and 1,161 RT-PCRs (76.48%) were performed before the ET/IUI. Two patients with a positive TCI were detected, one did not perform a RT-PCR, while the other resulted in a positive RT-PCR. Both cycles were cancelled. Besides, 5 patients with negative TCI performed a RT-PCR with a positive result; all 5 were cancelled. Overall, the SARS-CoV-2 positivity rate was 8/2533 (0.316%), of which 7/2533 (0.276%) were identified by RT-PCR testing.

The 2nd survey included 1,376 screenings and 1,009 RT-PCR (73.32%) performed before the egg-retrieval. Four patients with negative TCI and further positive RT-PCR were detected, and their cycle was cancelled. 2,692 screenings and 2,134 RT-PCR (79.27%) were performed before ET/IUI. Two patients had a positive TCI, one with a negative, the other with a positive RT-PCR testing; both cycles were cancelled. Besides, 8 patients with negative TCI, but positive RT-PCR testing, were detected and their cycles cancelled. Overall, the SARS-CoV-2 positivity rate was 14/3846 (0.364%), of which 13/3846 (0.338%) after positive RT-PCR testing.

Limitations, reasons for caution

The criteria for performing the RT-PCR testing were not the same in all MAR Centres or even in the same centre at different times. Due to the low response rate of the study, we should not extend these results to all the MAR Centres in Spain.

Wider implications of the findings

The results of the surveys suggest that the SEF/ASEBIR recommendations could be a good screening strategy for SARS-Cov-2 at MAR Centres. Further survey collected at different times of the pandemic are warranted, including new strategies for screening as antigen tests or vaccination status.

Trial registration number

Not applicable

Plunging ranula: an unusual multilocular presentation

A 32-year-old male patient who was HIV positive presented at the Wits Oral Health Centre complaining of a large swelling of the left submandibular region of three years' duration. The swelling was nontender, soft and doughy on palpation and appeared to be crossing the midline. Bilateral submandibular and submental lymphadenopathy was present. Intraorally the lesion caused considerable elevation of the floor of the mouth and impaired the flow of saliva. Fluid from the lesion was aspirated and the patient sent for MRI examination. These images revealed a multilocular cystic lesion causing disruption of the mylohyold muscle. The aspirate consisted of a thick, bloody fluid which tested positive for salivary amylase. A provisional diagnosis of plunging ranula was made. The multilocular nature of the lesion seen on MRI prompted a more extensive surgical approach in order to prevent recurrence. Consequently the sublingual gland was removed via an intraoral approach while the multilocular cyst was dissected by means of a submandibular approach in order to effect complete removal. Microscopic examination of the submitted specimen confirmed the clinical diagnosis of a plunging ranula.

The value of three-dimensional imaging in the detection of a case of double pathology in the right maxilla of a patient

A 14-year-old Black female was referred for management of an asymptomatic swelling in her right maxilla. The lesion measured 3cm across, was localised lateral to the right ala of the nose, felt bony hard in some areas and soft in others, and was continuous with the maxillary buccal plate. It occupied the right anterior vestibule but there was no palatal expansion. A panoramic radiograph showed a radiopaque lesion surrounded by a radiolucent periphery, but a lack of clarity prompted a computed tomographic scan. The latter revealed two separate lesions, one buccal and one palatal. The buccal lesion showed a well-defined radiolucency containing a radiopaque mass while the palatal lesion showed a small cystic area attached to the neck of an impacted tooth. Differential diagnoses of calcifying odontogenic cyst, adenomatoid odontogenic tumour or ameloblastic fibroodontoma and dentigerous cyst or odontogenic keratocyst were considered for the two lesions respectively. Enucleation of the buccal lesion and removal of the impacted tooth together with the overlying cyst presented no problem. Histologically the lesions were respectively diagnosed as a calcifying odontogenic cyst and a dentigerous cyst. Histological features are briefly described together with an historical review of the calcifying odontogenic cyst which has evoked much interest and controversy over the past five decades.

Effects of light intensity and temperature on Cylindrospermopsis raciborskii (Cyanobacteria) with straight and coiled trichomes: growth rate and morphology

Cylindrospermopsis raciborskii (Woloszynska) Seenayya et Subba Raju (Ordem Nostocales) is one of the most troublesome bloom-forming species in Brazil. Understanding the population dynamics of the different morphotypes of C. raciborskii (straight and coiled) could assist in the prediction of favourable conditions for the proliferation of this potentially toxin-producing species. The aim of the present study was to assess the effects of two different light intensities and temperatures on the growth rate and morphology of the trichomes of the straight and coiled morphotypes. For such, two non-toxin producing strains of C. raciborskii were used - one with a coiled trichome (ITEP31) and another with a straight trichome (ITEP28). The strains were cultured in BG-11 medium in a climatic chamber under controlled conditions. Two light intensities (30 and 90 µmol.m-2.s-1 ) were combined at temperatures of 21 and 31 °C and the growth rate and morphological changes were analysed. The morphotypes responded differently to the different temperatures and light intensities. Both strains exhibited faster growth velocities when submitted to higher light intensity and temperature. The lower temperature and higher luminosity hampered the development of both strains. Variations in cellular morphology and an absence of akinetes in both strains were related to the lower temperature (21 °C). The coiled morphotype demonstrated considerable phenotype plasticity, changing the morphology of trichome throughout its growth curve. Although molecular analysis does not sustain the separation of the morphotypes as distinct species, their different eco-physiological responses should be considered further knowledge of extreme importance for the population control of these potentially toxic organisms.

An assessment of the relative safety of dental x-ray equipment

Concern among patients, often prompted by medical practitioners, regarding the harmful effects of radiation caused by dental x-ray procedures, has caused several patients of the dental school of the University of Pretoria to refuse dental radiographic procedures. Buch and Fensham in a previous article demonstrated that radiation doses to the eyes and thyroid resulting from a single pantomogram constituted less than 10% of that which would be imparted by a transatlantic flight in terms of added natural background radiation. The authors in this study investigated doses to the same organs resulting from a full-mouth periapical series first using films and then digital imaging. Doses to the uterus resulting from these same examinations as well as from a pantomogram were also determined both with and without the use of a lead apron. Doses to the eye from a full-mouth examination using film compared favourably with those for a panoramic examination, but were much reduced when digital imaging techniques were employed. Doses to the uterus were small (equivalent to half a day of background radiation) for both a full-mouth examination using digital imaging, as well as for a pantomogram. However, from the results it would appear that there is little difference in the dose of scatter radiation to the uterus from a full-mouth examination whether or not a lead apron is used. The use of a lead apron for a pantomogram significantly reduces the dose to the uterus.

The challenges of clinical validation of emerging technologies: computer-assisted devices for surgery

Over the last decade, the use of computers and robotics in medicine has increased commensurate with emergent advances in technology. This article largely focuses on the challenges that the U.S. Food and Drug Administration faces when evaluating new technologies for entry into the market. How different categories of devices are categorized and what types of data have been used for regulatory approval or clearance are described. These are compared with expectations that the clinical community may have for these devices. A brief discussion of current regulatory thinking about these types of devices is also included.

FDA medical device approval: things you didn't learn in medical school or residency

The Food and Drug Administration (FDA) does more than regulate food and drug products. Through its medical device evaluation process, FDA affects every orthopedic surgeon's practice and every orthopedic patient every day. FDA regulations affect the development of each orthopedic device in some way, from the product's inception to its senescence, but the regulatory process and what the FDA's stamp of approval means are not part of the curriculum in medical school or residency. Each device follows a specific pathway from manufacture to physician use and patient care depending on the assessment of risk associated with the device or classes of devices. The evaluation of safety and effectiveness involves a complex process of biomechanical, engineering, preclinical, laboratory, clinical, and epidemiological assessment. How different types of devices get to the patient are reviewed, and the basics of the regulatory process are explained in this paper. Common myths are set straight, and FDA's concerns with "off-label" use are discussed. The role of the orthopedic surgeon in the regulatory process is also introduced.

Association of genetic markers within the KIT and KITLG genes with human male infertility

BACKGROUND

There is much evidence involving the KIT tyrosine kinase receptor and its ligand KITLG in the survival and proliferation of germ cells. Animal models and functional studies in humans suggest that this signalling pathway plays a role in male infertility.

METHODS

We studied three and two single-nucleotide polymorphisms (SNPs) (rs3819392, rs3134885, rs2237012, rs10506957 and rs995030) located within the genomic region of the KIT and KITLG genes, respectively. A total of 167 idiopathic infertile men (sperm counts <5 million spz/ml) and 465 unrelated healthy controls from the same geographical region were genotyped for these SNPs.

RESULTS

We found a statistically significant association of the rs3819392 polymorphism, which is located within the KIT gene, with idiopathic male infertility. In addition, a deviation from the Hardy-Weinberg equilibrium (HWE) law was observed for rs10506957 polymorphism within the KITLG gene only in the infertile group.

CONCLUSIONS

Our data indicate that the KIT/KITLG system may be involved in a low sperm count trait in humans.

Treatment of mucous cysts of the toes

The outcome of surgically treated mucous cysts of the foot is poorly documented in the orthopaedic literature. This study reports on the treatment of mucous cysts of the toes by simple excision and joint debridement. This is in contrast to treatment of similar lesions in the fingers which is often treated by excision of the cyst, joint debridement, and rotational flap. Following this procedure on 15 patients (15 cysts), at a minimum of 2 years postoperatively, only one cyst had recurred at 9 months. All patients were satisfied by the cosmetic appearance of their toe. The authors reviewed the available literature on this condition and suggest that this method of treatment provides good functional and cosmetic results with a minimal rate of recurrence.

Orthodontic radiographic procedures--how safe are they?

Parents of children subjected to radiographic procedures for orthodontic purposes occasionally express concern about possible radiation overdose to sensitive structures in the head and neck region. The following study was designed to determine this. Twenty Harshaw lithium fluoride thermoluminescent dosimeters (TLDs) were irradiated using a calibrated RT 100 X-ray source. These were read in a Toledo 654 TLD reader. The readings of all dosimeters fell within 10% on either side of the mean reading for the dosimeters. Twelve were finally selected which fell closest to the mean. Six of the TLDs were randomly selected and placed in a Rando female phantom in a position corresponding to the lens of the eye-3 in the left and 3 in the right eye. A standard pantomogram was taken of the phantom using an Orthophos machine. The TLDs were then replaced by another two groups of 3 in the same positions in the phantom and a lateral cephalogram taken on the same machine. The TLDs were read in the Toledo reader. Six of the 12 TLDs were then randomly selected for re-use. Three were placed in the phantom in the region of the thyroid and a pantomogram again taken. The procedure was repeated for a cephalogram and the TLDs again read. In all cases the readings of each group of 3 TLDs did not vary by more than 10% on either side of the mean readings. The TLD readings were then converted by means of a conversion factor to actual dose measurements. The doses to left and right eyes and to the thyroid were respectively found to be 0,0151, 0,0222 & 0,0896 mSv for the pantomogram and 0,0351, 0,0183 & 0,0177 mSv for the cephalogram--an almost insignificant dose in terms of the "background equivalent" concept.

Gardner's syndrome--the importance of early diagnosis: a case report and a review

Gardner's syndrome (familial polyposis coli) is a genetic condition characterised by colonic polyps that carry a 100% risk of malignancy if untreated. Early diagnosis, in which an astute and knowledgeable dentist can play an essential role, is therefore of paramount importance. The presence of multiple unerupted teeth provides the dentist with a major pointer to the possible presence of this disease, which may be provisionally diagnosed on the detection of two other obvious features, namely osteomas and cutaneous lesions. This fact is clearly illustrated by the accompanying case report. Extracolonic manifestations increase the morbidity and make treatment more difficult. The presence of large desmoid tumours may be a serious complicating factor. Gardner's syndrome may be accompanied by adenomas of the stomach and duodenum and very rarely by malignant tumours of the central nervous system. Regular surveillance by means of colonoscopies must be carried out on all individuals suspected of having the disease in order to implement timeous life-saving prophylaxis.

Reliability of the Hitachi sodium and potassium electrodes assessed

We compared the Hitachi 705 E sodium/potassium electrode system with the Radiometer flame photometer for measuring concentrations of sodium and potassium ions in serum and plasma. Our data show that the Hitachi results are slightly but significantly (less than 0.001) lower than the flame photometer results: Na+ 1.33 mmol/L for serum and 2.24 mmol/L for plasma; K+ 0.062 mmol/L for serum and 0.082 mmol/L for plasma. The magnitude of the bias varied considerably from day to day, ranging from -0.10 to 2.33 mmol/L for Na+ in serum and from 0.00 to 0.11 mmol/L for serum K+; for plasma specimens the corresponding ranges were -0.03 to 5.97 mmol/L and 0.00 to 0.17 mmol/L. These variations probably reflected difficulties in reproducing the calibration from day to day, because the daily means for a serum pool varied in parallel. We occasionally encountered serious problems with reproducibility.

Reliability of the Hitachi sodium and potassium electrodes assessed

We compared the Hitachi 705 E sodium/potassium electrode system with the Radiometer flame photometer for measuring concentrations of sodium and potassium ions in serum and plasma. Our data show that the Hitachi results are slightly but significantly (less than 0.001) lower than the flame photometer results: Na+ 1.33 mmol/L for serum and 2.24 mmol/L for plasma; K+ 0.062 mmol/L for serum and 0.082 mmol/L for plasma. The magnitude of the bias varied considerably from day to day, ranging from -0.10 to 2.33 mmol/L for Na+ in serum and from 0.00 to 0.11 mmol/L for serum K+; for plasma specimens the corresponding ranges were -0.03 to 5.97 mmol/L and 0.00 to 0.17 mmol/L. These variations probably reflected difficulties in reproducing the calibration from day to day, because the daily means for a serum pool varied in parallel. We occasionally encountered serious problems with reproducibility.

Microscopic changes in rat tongue following experimental cryosurgery

Histological changes were studied in the rat tongue for varying periods of time up to 14 days following the application of a cryoprobe to the dorsal surface of rat tongue. Within minutes of the application, focal subepithelial vesiculation and hyperemia occurred. At 3 h there was evidence of damage to capillary walls, resulting in hemorrhage. Arterioles and venules were thrombosed and there were degenerative changes in the muscle layer of their walls. At 6 h ventral epithelium showed evidence of damage. At this stage vessel walls were pavemented with neutrophilic polymorphonuclear leukocytes (PMN) and some of the latter were seen in the vessel walls. At 24 h abundant PMN, many of them necrotic, were present in the vessel walls, apparently unable to pass through them. At 48 h numerous PMN were seen adhering to degenerating muscle fibers. By 4 days necrotic changes extended through the full thickness of the tongue, but concurrently it was observed that the larger thrombosed vessels were becoming recanalized. At 5 days repair by granulation tissue was taking place and at 6 days the vasculature was virtually reconstituted. By 14 days healing was complete.