The Fragility of Scientific Rigour and Integrity in "Sped up Science": Research Misconduct, Bias, and Hype and in the COVID-19 Pandemic

During the early years of the COVID-19 pandemic, preclinical and clinical research were sped up and scaled up in both the public and private sectors and in partnerships between them. This resulted in some extraordinary advances, but it also raised a range of issues regarding the ethics, rigour, and integrity of scientific research, academic publication, and public communication. Many of the failures of scientific rigour and integrity that occurred during the pandemic were exacerbated by the rush to generate, disseminate, and implement research findings, which not only created opportunities for unscrupulous actors but also compromised the methodological, peer review, and advisory processes that would usually identify sub-standard research and prevent compromised clinical or policy-level decisions. While it would be tempting to attribute these failures of science and its translation solely to the "unprecedented" circumstances of the COVID-19 pandemic, the reality is that they preceded the pandemic and will continue to arise once it is over. Existing strategies for promoting scientific rigour and integrity need to be made more rigorous, better integrated into research training and institutional cultures, and made more sophisticated. They might also need to be modified or supplemented with other strategies that are fit for purpose not only in public health emergencies but in any research that is sped-up and scaled up to address urgent unmet medical needs.

Diet quality, asthma and airway inflammation in school-aged children

Summary

Background. Asthma is a major public health problem, with increasing prevalence in most countries, particularly among children. Poor dietary quality is also increasing in children, and evidence of the overall quality of children's food patterns effects on asthma is scarce. Methods. This cross-sectional analysis (660 children: 49.1% females, aged 7-12years) evaluated the association between diet quality and asthma (n = 56) and airway inflammation among school-aged children according to body mass index (BMI). Diet quality was assessed through the Healthy Eating Index (HEI)-2015, and categorized by tertiles. Higher scores represent a healthier diet. A questionnaire was used to enquire about self-reported medical diagnosis of asthma and asthma under medication. Lung function and airway reversibility were measured, and airway inflammation assessed measuring exhaled fractional nitric oxide (eNO). Two categories of BMI were considered: non-overweight/obese (p less than 85^th), (n = 491), and overweight/obese (p ≥ than 85^th), (n = 169). The associations between diet quality and asthma and airway inflammation were estimated using logistic regression models. Results. Non-overweight/obese children in 2^nd tertile of HEI-2015 score had decreased odds of having eNO ≥ 35ppb (OR 0.43, 95%CI 0.19-0.98), medical diagnosis of asthma (OR 0.18; 95%CI 0.04-0.84), and asthma treatment (OR 0.12; 95%CI 0.01-0.95), compared to children in the 1^st tertile. Conclusions. Our findings suggest that a higher diet quality associates with lower levels of airway inflammation and reduced prevalence of asthma among non-overweight/obese school-aged children.

Biologicals in severe chronic rhinosinusitis with nasal polyps: translation to clinical practice while waiting for head-to-head studies

Chronic rhinosinusitis with nasal polyps (CRSwNP) affects 1.0-2.6% of the population (1) and results in relevant direct and indirect costs. Recently, several randomized controlled trials (RCTs) with Type 2-targeting biologicals (anti-IL4Rα, anti-IL5R, anti-IL5 and anti-IgE) opened a new treatment field for patients refractory to first-line treatments (2,3).

Computational design of mechanically coupled axle-rotor protein assemblies

Natural molecular machines contain protein components that undergo motion relative to each other. Designing such mechanically constrained nanoscale protein architectures with internal degrees of freedom is an outstanding challenge for computational protein design. Here we explore the de novo construction of protein machinery from designed axle and rotor components with internal cyclic or dihedral symmetry. We find that the axle-rotor systems assemble in vitro and in vivo as designed. Using cryo-electron microscopy, we find that these systems populate conformationally variable relative orientations reflecting the symmetry of the coupled components and the computationally designed interface energy landscape. These mechanical systems with internal degrees of freedom are a step toward the design of genetically encodable nanomachines.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Long term left ventricular impairment after SARS-COV2 infection

Funding Acknowledgements

Type of funding sources: None.

Introduction

The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown.

Purpose

To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization.

Methods

 

This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis.

Results

 

A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS.

Conclusion

In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Long-term monitoring of these patients should be undertaken in order to timely detect late complications. Abstract Figure.

Automated healthcare-associated infection surveillance using an artificial intelligence algorithm

Healthcare-associated infections (HAIs) are among the most common adverse events in hospitals. We used artificial intelligence (AI) algorithms for infection surveillance in a cohort study. The model correctly detected 67 out of 73 patients with HAIs. The final model used a multilayer perceptron neural network achieving an area under receiver operating curve (AUROC) of 90.27%; specificity of 78.86%; sensitivity of 88.57%. Respiratory infections had the best results (AUROC ≥93.47%). The AI algorithm could identify most HAIs. AI is a feasible method for HAI surveillance, has the potential to save time, promote accurate hospital-wide surveillance, and improve infection prevention performance.

Elderly: Coping with sleep disorders

Introduction

Sleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.

Objectives

The aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.

Methods

An online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.

Results

Management of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.

Conclusions

This review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.

Cortical excitability and its modulation in obsessive-compulsive disorder - a systematic review

Introduction

Obsessive-Compulsive Disorder (OCD) is an incapacitating Neuropsychiatric condition characterized by the presence of obsessions and/or compulsions. Although the disorder’s phenotype is well described, its pathophysiology remains elusive (Aouizerate et al, 2004). Over the last decade, techniques to noninvasively study the brain’s neurophysiology, such as Transcranial Magnetic Stimulation (TMS), have found widespread use in psychiatric research. For OCD, single- and paired-pule TMS protocols have been used to explore abnormalities in motor cortex excitability and cortical neuroplasticity. Here we propose to systematically review and, where possible, metanalyse existing case-control studies that compared such measures in patients and healthy subjects.

Objectives

To systematically review and meta-analyse published case-control studies comparing cortical excitability measures, as measured by single- or paired-pulse TMS, in subjects with OCD and healthy controls.

Methods

We have conducted a systematic review of published literature (PROSPERO registration CRD42020201764) reporting measures of cortical excitability as measured by single or paired-pulse TMS, in patients with OCD and healthy controls. We searched 4 different electronic libraries (PubMed, Web of Science, EMBASE, PsycINFO). The resulting list of articles was reviewed, separately, by two researchers. Disagreements were discussed and resolved by consensus, until a final list of eligible articles was obtained.

Results

13 studies reporting motor cortex excitability measures were included in our final list. The total number of participants included in our analyses is 615 (349 OCD; 180 healthy subjects; 86 other conditions)

Conclusions

A sufficient number of studies was found to allow for metanalyses, currently ongoing.

A closer look to apathy

Introduction

Apathy is a neuropsychiatry syndrome, conceptualised as a loss of motivation free of altered consciousness, cognitive impairment or emotional distress, associated with a wide range of brain disorders such as Dementia, Major depression and schizophrenia. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures.

Objectives

The aim of this article is to review the concept of Apathy and clarify its nosology, pathopshysiology and treatment.

Methods

An online bibliographic search was carried out on PubMed and Medline using “Apathy” as a term.

Results

The literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. Analysis reveals that apathy is strongly associated with disruption particularly of anterior cingulate cortex (ACC), ventral striatum (VS) and nucleus accumbens (N acc). Remarkably, these changes are consistent across clinical disorders and imaging modalities, playing a crucial role in normal motivated behaviour.

Conclusions

The neuromodulator dopamine is heavily implicated in ACC and VS. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.

Effect of albumin, urea, lysozyme and mucin on the triboactivity of Ti6Al4V/zirconia pair used in dental implants

The titanium implant/zirconia abutment interface can suffer failure upon mechanical and biological issues, ultimately leading to the loss of the artificial tooth. The study of the effect of the organic compounds present in saliva on the tribological behavior of these systems is of utmost importance to understand the failure mechanisms and better mimic the in vivo conditions. The aim of the present work is to evaluate the effect of the addition of albumin, urea, lysozyme and mucin to artificial saliva, on the triboactivity of Ti6Al4V/zirconia pair commonly used in dental implants and then, compare the results with those obtained with human saliva. The solutions' viscosity was measured and the adsorption of the different biomolecules to both Ti6Al4V and zirconia was accessed. Tribological tests were performed using Ti6Al4V balls sliding on zirconia plates inside of a corrosion cell. Friction and wear coefficients were determined, and the open circuit potential (OCP) was monitored during the tests. Also, the wear mechanisms were identified. The presence of mucin in the artificial lubricant led to the lowest wear coefficients. The main wear mechanism was abrasion, independently of the used lubricant. Adhesive wear was observed for the systems without mucin. Tribocorrosion activity and wear coefficient were lower in the presence of mucin. None of the studied artificial lubricants mimicked the effect of human saliva (HS) on the tribological behavior of the studied pair since this lubricant led to the lowest friction coefficient and highest corrosion activity.

Association between the density and type of trees around urban schools and exhaled nitric oxide levels in schoolchildren

Summary

Greenspaces in school's neighbourhood represent an important environment to promote healthy development. The aim of this study was to assess the association between the density and type of trees around schools and exhaled Nitric Oxide (NO) levels in schoolchildren. Data on 845 children from 20 primary schools in Porto was analysed. Airway inflammation was assessed by measuring exhaled NO level. The density and type of trees were quantified within a 500 m buffer around schools. Associations were estimated using mixed-effect models. A significant association was observed between non-tree covered areas around schools and exhaled NO levels in schoolchildren (β = - 1.42, 95% CI - 2.84, - 0.001). Our results suggested that the presence of trees in school neighbourhoods may play a role in the biological mechanisms underlying the complex links between environment and airway inflammation.

Diagnostic yield of muscle biopsies in pediatric population: a tertiary center experience

INTRODUCTION

BACKGROUND AND AIM

Muscle biopsy is still an important exam on the investigation of neuromuscular diseases although data regarding its diagnostic yield can be disappointing. We aimed to analyze the diagnostic yield of muscle biopsies in the pediatric population.

PATIENTS AND METHODS

We retrospectively analyzed a tertiary Neuropathology laboratory database to identify patients (<18 years old), submitted to muscle biopsy between January 2015 and August 2019. Demographics, clinical presentation, diagnosis, treatment, and follow-up were evaluated. Descriptive statistical analysis was performed.

RESULTS

One-hundred and six patients were included, 52,8% (n = 56) were male. Median age at biopsy was 6 years (IQR 10 years). Patients were divided into 8 groups, according to clinical diagnostic suspicion: mitochondrial myopathies (n = 29), congenital myopathies (n = 9), inflammatory myopathies (n = 8), muscular dystrophies (n = 7), raised CK values in serum (n = 7), metabolic myopathies (n = 5), weakness /other neuromuscular symptoms (n = 30) and multiple clinical suspicions (n = 11). Biopsy was normal in 50 patients. Of the remaining, 27 displayed specific diagnostic features, with 88,9% (n = 24) allowing a definite diagnosis: muscular dystrophies (n = 7), metabolic myopathies (n = 5), congenital myopathies (n = 4), inflammatory myopathies (n = 4), mitochondrial myopathies (n = 3) and spinal muscular atrophy (n = 1). Histology led to a change of treatment in 4 patients, all diagnosed with inflammatory myopathies. Median length of follow-up was 1 year (IQR 2 years).

CONCLUSION

Biopsy diagnostic yield was 22,6%, and it was useful either in diagnostic or therapeutic approaches in 35,8%. Although advances of molecular techniques led to a decrease in muscle biopsy indications, it remains an important tool on the diagnosis of neuromuscular diseases.

Hydrogels as delivery systems for spinal cord injury regeneration

Spinal cord injury is extremely debilitating, both at physiological and psychological levels, changing completely the patient's lifestyle. The introduction of biomaterials has opened a new window to develop a therapeutic approach to induce regeneration after injury due to similarities with extracellular matrix. Particularly, hydrogels have the ability to support axonal growth and endogenous regeneration. Moreover, they can also act as potential matrixes in which to load and deliver therapeutic agents at injury site. In this review, we highlight some important characteristics to be considered when designing hydrogels as delivery systems (DS), such as rheology, mesh size, swelling, degradation, gelation temperature and surface charge. Additionally, affinity-based release systems, incorporation of nanoparticles, or ion-mediated interactions are also pondered. Overall, hydrogel DS aim to promote a sustained, controlled and prolonged release at injury site, allowing a targeted oriented action of the therapeutic agent that will be used.

Polyvinyl alcohol/chitosan wound dressings loaded with antiseptics

Wound care remains a challenge in healthcare. This work aimed to develop a new polyvinyl alcohol (PVA)/chitosan (Ch) based wound dressing able to ensure protection, hydration and a controlled release of antiseptics, as alternative to actual treatments. Two distinct formulations (1:1 and 3:1, w/w) were prepared, sterilized by autoclaving and characterized concerning surface morphology, degradation over the time, mechanical properties and hydrophilicity. Both dressings revealed adequate properties for the intended purpose. The dressings were loaded with chlorhexidine (CHX) and polyhexanide (PHMB) and the drug release profiles were determined using Franz diffusion cells. The release of PHMB was more sustained than CHX, lasting for 2 days. As the amounts of drugs released by PVA/Ch 1:1 were greater, the biological tests were done only with this formulation. The drug loaded dressings revealed antibacterial activity against S. aureus and S. epidermidis, but only the ones loaded with PHMB showed adequate properties in terms of cytotoxicity and irritability. The application of this elastic dressing in the treatment of wounds in a dog led to faster recovery than conventional treatment, suggesting that the material can be a promising alternative in wound care.

Effects of single and combined exposures of gold (nano versus ionic form) and gemfibrozil in a liver organ culture of Sparus aurata

In vitro methods have gained rising importance in ecotoxicology due to ethical concerns. The aim of this study was to assess the single and combined in vitro effects of gold, as nanoparticle (AuNPs) and ionic (Au⁺) form, and the pharmaceutical gemfibrozil (GEM). Sparus aurata liver organ culture was exposed to gold (4 to 7200 μg·L^-1), GEM (1.5 to 15,000 μg·L^-1) and combination 80 μg·L^-1 gold +150 μg·L^-1 GEM for 24 h. Endpoints related with antioxidant status, peroxidative/genetic damage were assessed. AuNPs caused more effects than Au⁺, increasing catalase and glutathione reductase activities and damaging DNA and cellular membranes. Effects were dependent on AuNPs size, coating and concentration. GEM damaged DNA at an environmentally relevant concentration, 1.5 μg·L^-1. Overall, the effects of the combined exposures were higher than the predicted, based on single exposures. This study showed that liver culture can be a useful model to study contaminants effects.

Prostate cancer, new treatment advances - immunotherapy

Prostate cancer (PCa) is the fourth most common cancer in the world and treatment is currently based on surgical removal and/or radiotherapy and/or hormone therapy. In the last few years' immunotherapy has become an important cancer treatment option. While the principles of immunotherapy evolved, only sipuleucel-T was approved by the Food and Drug Administration (FDA) which lead to further studies with other agents, starting a new era in immuno-oncology. A number of vaccines are under clinical investigation as well as checkpoint inhibitors. Despite the current enthusiasm, it is unlikely that any of the approaches alone can dramatically change PCa outcomes, but strategies combination is more promising and provide a reason for optimism. The goal of immunotherapy in PCa does not have to be the complete eradication of advanced disease, but rather the return to an immunologic equilibrium with an indolent disease state. With such concerted efforts, the future of immunotherapy in PCa looks brighter than ever, with many clinical trial results being published soon.

Medicinal cannabis, a medicine. Characterization of the reality in Portugal

Cannabis has been used over the centuries for medicinal purposes. The first evidence dates from the third millennium BC in India and Chinese Empire, due to its analgesic, antiemetic and anticonvulsant properties. Nevertheless, its use is also associated to manufacture industry - hemp - translating a widespread function. However, through time, it is its recreational, additive and illegal purposes are the ones that we most quickly associate with it. This stigmatized its use in society and neglected the benefits. Its only in the XX century with the discover of the of the endocannabinoid system that allowed a new vision on the theme, challenging and revolutionizing the, until then, ingrained classic vision. In fact, its benefits in several pathologies or clinical symptons are well documented today. In light of the current debate on the use of cannabis for medicinal purposes worldwide and recently in Portugal with new legislation, a review of the available literature is required to explain the national reality and its context in the international reality. Due to the clinical and social relevance of the theme, the authors aimed to study, collect and systematize information in order to uptodate the state of art in: innovation, potential indications for its therapeutic use; understand the existing legal framework in Portugal, for cannabinoids and for the previous phases, such as cultivation and production; understand and compare the international reality and that existing in Portugal, namely in Portuguese hospitals; and, understand what are the future perspectives for cannabis as a therapeutic line.

Key messages

Clinical and social relevance of the theme and its legal framework. What are the future perspectives for cannabis as a therapeutic line nd the stigma of using it.

Effects of mental practice strategies associated to physiotherapy on gait and risk of falls in Parkinson’s disease: a pilot study of a randomized clinical trial

Introduction Parkinson’s Disease (PD) is a degenerative disorder that interferes with the voluntary movements due to dysfunction of the basal ganglia and presenting with motor signals, such as the reduction of gait speed. This contributes to an increased risk of falls. In rehabilitation, mental practice (MP) has been shown to promote plastic modulation of neural circuits and improve motor learning, but the results of research with MP in PD are still ambiguous due to the diversity of intervention strategies.

Objectives To compare the effects of MP strategies associated to physiotherapy in gait and risk of falls in PD patients.

Methodology We performed a pilot study of a clinical randomized, single blind, trial, conducted in accordance with the consort checklist. Patients with idiopathic PD were included and allocated to four groups: Control group (CG); Group with mental practice guided by images (MPI); Group with mental practice guided by audio (MPA); group with mental practice without a guide (MPWG). The subjects of the experimental groups were submitted to 15 sessions of physiotherapy and mental practice, while the CG received only physiotherapy. The sessions were held 2 times per week, 40 minutes for physiotherapy and approximately 5-10 minutes for the corresponding mental practice protocol. Spatial-temporal parameters of gait were assessed with the 10 meters Walking Test (TC10m), and the risk of falls was evaluated with the Timed Up and Go (TUG) test.

Results The MPI group showed significant results for the parameters time (p = 0.027) and speed (p = 0.025) when compared with the results of the CG. No main effects for the group were observed concerning cadence and risk of falls had. Groups MPWG and MPA showed no significant results for the TC10m and TUG when compared with the CG.

Conclusion The results of this pilot study suggest that MP guided by images associated to physical therapy was more effective to increase the gait speed than the alternative strategies.

Cultural explanations of sleep paralysis: The spiritual phenomena

Introduction

Sleep paralysis (SP) is relatively frequent condition, occurring either at sleep onset or sleep offset. It occurs at least once in a lifetime in 40–50% of normal subjects. During SP, the patient experiences gross motor paralysis, while the sensory system is clear. Hypnogogic and hypnopompic hallucinations are common. This experience might be interpreted as a spiritual phenomenon in several cultures, each one with different interpretations and attributions.

Objective

The authors revisit the clinical presentation of sleep paralysis and how this sleep disorder is seen from a cultural perspective.

Aims

To describe several cultural interpretations of SP.

Methods

A literature review of the theme is shortly surveyed.

Results

It is very common during an episode of SP sensing the presence of menacing intruders in one's bedroom. Supernatural accounts of this hallucinated intruder are common across cultures. It has been traditionally labeled “ghost oppression” among the Chinese. In the Abruzzo region (Italy), the supernatural interpretation of the phenomena is called the Pandafeche attack. One study found that nearly half (48%) of the participants from the general Egyptian population believed their SP to be caused by the Jinn, a spirit-like creature. In Southwest Nigeria, Ogun Oru is a traditional explanation for nocturnal neuropsychiatric disturbances. The characteristics of the ‘a dead body climbed on top of me’ phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents.

Conclusions

Depending on the etiological interpretations of SP, which is largely culturally determined, patients react to the event in specific ways.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

P1721Determination of a predictive score of cardiogenic shock in acute coronary syndrome

Introduction

Cardiogenic shock is one of the leading causes of death in patients with acute coronary syndrome (ACS), reaching in-hospital mortality rates of 50%.

Purpose

To identify a predictive score of cardiogenic shock in patients with ACS.

Methods

We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of cardiogenic shock were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. Statistical analysis was conducted with SPSS 24.0.

Results

During this period, 4458 patients were admitted with ACS and 74 (1,7%) developed cardiogenic shock. In this subgroup, 59,5% were over 65 years of age, 63,5% were male and 93,2% presented with acute myocardial infarction with ST segment elevation. Also, 83,8% were in sinus rhythm at admission, 22,7% had creatinine>1,5 mg/dL and 17,9% had left ventricular ejection fraction (LVEF) <30%. The in-hospital mortality rate was 51,4%. LVEF <30% (p=0,018), creatinine>1,5 mg/dL (p=0,044) and absence of sinus rhythm at admission (p=0,041) were independent predictors of cardiogenic shock. A predictive score of this complication in patients with ACS was determined using the formula: 1,723 + 1,505 x (creatinine>1,5) + 4,483 x (LVEF <30%) – 2,094 x (sinus rhythm at admission). A cutoff of 0,58 was obtained with 44,4% sensitivity, 85,2% specificity and 85% discriminative power.

Conclusion

Cardiogenic shock occurred in 1,7% of patients admitted with ACS and was associated with a high mortality rate. We determined a predictive score of this complication with a good discriminative power, which included LVEF <30%, creatinine >1,5 mg/dL and the rhythm on admission's electrocardiogram. By taking into account clinical variables, this score can be used at a very early stage of admission, allowing risk stratification of developing cardiogenic shock in each patient. However, it needs validation to be applied in clinical practice.

Microplastic contamination in an urban estuary: Abundance and distribution of microplastics and fish larvae in the Douro estuary

Estuaries are productive environments used by many fish as nursery grounds. The initial stages of fishes are highly vulnerable to (a)biotic factors, and anthropogenic pressures, influencing fish larvae assemblages along the estuary. Microplastics (MPs < 5 mm) are particularly dangerous to early life stages of fishes because their ingestion can induce gut blockage, limiting food intake or exposing organisms to contamination due to MPs capacity to absorb pollutants. Present work aimed to investigate the contamination of an urban impacted estuary (Douro estuary, NW Portugal) by MPs, and study the abundance and distribution of MPs and fish larvae in this estuary. Monthly sampling surveys were performed from December 2016 to December 2017, in nine stations along the estuary. Sub-surface planktonic horizontal trawls were performed to collect fish larvae and MPs. Planktonic samples were sorted, and fish larvae identified. MPs density was determined using a protocol optimized in our laboratory. A total of 1498 fish larvae belonging to 32 taxa were collected, with a mean density of 11.66 fish larvae 100 m^-3. During the spring-summer period, it was observed the typical increase in the density and diversity of the larval assemblage. Diversity was generally low, with the high dominance of very few taxa, namely the common goby, Pomatoschistus microps. Different types of MPs were found, namely fibers, soft/hard plastic, colorful/transparent plastic, in a total of 2152 particles, with a mean density of 17.06 MPs 100 m^-3. Hard MPs and fibers were the most predominant types, representing 83% of the total MPs collected. In some months the number of MPs surpassed the number of fish larvae, with an average ratio of 1.0 fish larvae:1.5 MPs. Such results are concerning, highlighting that a higher availability of MPs may facilitate their ingestion by fish and therefore increase possible impacts in these communities.

Brain Atrophy Is Associated with Disability Progression in Patients with MS followed in a Clinical Routine

BACKGROUND AND PURPOSE

The assessment of brain atrophy in a clinical routine is not performed routinely in multiple sclerosis. Our aim was to determine the feasibility of brain atrophy measurement and its association with disability progression in patients with MS followed in a clinical routine for 5 years.

MATERIALS AND METHODS

A total of 1815 subjects, 1514 with MS and 137 with clinically isolated syndrome and 164 healthy individuals, were collected retrospectively. Of 11,794 MR imaging brain scans included in the analysis, 8423 MRIs were performed on a 3T, and 3371 MRIs, on a 1.5T scanner. All patients underwent 3D T1WI and T2-FLAIR examinations at all time points of the study. Whole-brain volume changes were measured by percentage brain volume change/normalized brain volume change using SIENA/SIENAX on 3D T1WI and percentage lateral ventricle volume change using NeuroSTREAM on T2-FLAIR.

RESULTS

Percentage brain volume change failed in 36.7% of the subjects; percentage normalized brain volume change, in 19.2%; and percentage lateral ventricle volume change, in 3.3% because of protocol changes, poor scan quality, artifacts, and anatomic variations. Annualized brain volume changes were significantly different between those with MS and healthy individuals for percentage brain volume change (P < .001), percentage normalized brain volume change (P = .002), and percentage lateral ventricle volume change (P = .01). In patients with MS, mixed-effects model analysis showed that disability progression was associated with a 21.9% annualized decrease in percentage brain volume change (P < .001) and normalized brain volume (P = .002) and a 33% increase in lateral ventricle volume (P = .004).

CONCLUSIONS

All brain volume measures differentiated MS and healthy individuals and were associated with disability progression, but the lateral ventricle volume assessment was the most feasible.