The role of parental stress on emotional and behavioral problems in offspring: a systematic review with meta-analysis

OBJECTIVE

Empirical evidence underscores an association between parental stress and emotional and behavioral problems in offspring. However, a comprehensive systematic review or meta-analysis on this topic is lacking. Thus, this study aims to address the scientific inquiry: Is there a relationship between parental stress and emotional/behavioral problems in children?

SOURCES

This systematic review with a meta-analysis surveyed PubMed, PsycINFO, and the Biblioteca Virtual em Saúde between August and September 2021. The present search combined terms (school-age children) AND (parental stress OR parenting stress OR family stress) AND (emotional and behavioral problems OR internalizing and externalizing problems). Eligibility criteria encompassed cross-sectional, cohort, and case-control studies published within the last five years, exploring the association between parental stress (stressful life events and parenthood-related stress disorders) and emotional/behavioral problems in school-age children. PROSPERO ID CRD42022274034.

SUMMARY OF THE FINDINGS

Of the 24 studies meeting all inclusion criteria (n = 31,183) for the systematic review, nine were eligible for inclusion in the meta-analysis. The meta-analysis revealed an association between parental stress and emotional problems (COR: 0.46 [95 % CI: 0.27 - 0.61], p < 0.001, Heterogeneity = 89 %) as well as behavioral problems (COR: 0.37 [95 % CI: 0.27 - 0.46], p < 0.001, Heterogeneity = 76 %).

CONCLUSIONS

These findings indicate that parental stress predicts emotional/behavioral problems in school-age children. Since these problems are related to long-term negative effects in adulthood, these results are crucial for preventing mental health problems in offspring and for screening and managing parental stress.

Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia

The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM10, PM2.5, O3, NO2, NO and NOX) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO2/FiO2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM10, NO2, NO and NOX, while higher exposure to NO2, NO and NOX was associated with lower SpO2/FiO2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO2/FiO2) in these patients were significantly related to exposure to air pollution.

Diagnostic capacity of SD-OCT segmented ganglion cell complex versus retinal nerve fiber layer analysis for congenital glaucoma

PURPOSE

To compare the diagnostic performance of circumpapillary retinal nerve fiber layer (cpRNFL) analysis versus segmented ganglion cell complex analysis both by spectral-domain optical coherence tomography (SD-OCT) in children with primary congenital glaucoma (PCG).

METHODS

Participants were 40 children diagnosed with PCG and 60 healthy children. Ophthalmological data collected (for one eye per child) were cup-disc ratio (C/D) and axial length (AL). SD-OCT with automated segmentation was used to measure the thicknesses and volumes of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). For the cpRNFL measurements conventional S-D OCT software was used and the capacity of each method to discriminate between normal and glaucomatous eyes was compared.

RESULTS

Mean age was 11.20 ± 3.94 years for the glaucoma patients and 10.90 ± 2.46 years for controls (p = 0.64). All measurements were reduced (thinner) in the glaucoma group, significantly so for: cpRNFL, GCL, IPL and outer-superior and outer-inferior quadrant mRNFL. According to their areas under the receiver operating characteristics curve (AUC), temporal superior cpRNFL (0.869) and outer superior GCL (0.840), IPL (0.799), and mRNFL (0.767) showed the better diagnostic capacity. No differences were observed in AUCs for the most discriminatory cpRNFL and macular measurements.

CONCLUSION

Segmented macular layer analysis shows a good capacity to discriminate between normal and glaucomatous eyes; which is comparable to that of cpRNFL analysis in children with PCG.

Genome size of two cebus species (primates: platyrrhini) with a fertile hybrid and their quantitative genomic differences

Genome size or C-value is defined as the total amount of DNA contained within a haploid chromosome set and is regarded as a species-specific constant. Speciation among neotropical primates seems to be accompanied by marked quantitative changes in DNA content. A direct correlation between genome size and the presence of heterochromatin has also been proposed. In this work, we analyzed the genome of a female fertile hybrid between Cebus libidinosus and C. nigritus using interspecies comparative genomic hybridization (iCGH), in order to detect quantitative differences between the hybrid and the parental genomes. We also estimated the genome sizes of C. libidinosus and C. nigritus. Both species, considered subspecies of C. apella until 2001, have a highly homologous karyotype but are easily distinguishable at the chromosomal level due to the noncentromeric heterochromatin block on C. libidinosus chromosome 11. Our findings on C-value quantification support the species status for C. libidinosus and C. nigritus, each having a different genome size. The iCGH analysis of the hybrid revealed quantitative differences in comparison to both parental species. The hybrid genome contains a greater amount of DNA in the heterochromatic blocks related to those in the genomes of both parental species. In view of observations in previous and the present work, some hypotheses about genome dynamics of neotropical primates are proposed and discussed.

Chromosome painting in two genera of South American monkeys: species identification, conservation, and management

Cytogenetic studies showed that a number of New World primate taxa, particularly the genera Alouatta, Aotus, and Callicebus, have highly derived karyotypes. Cytogenetics in these primates, at every level of analysis, has contributed to the recognition of species and revealed that their number was certainly underestimated by researchers relying solely on traditional morphological data. Further attention was drawn to Alouatta and Aotus because they are characterized by translocations of the Y chromosome to autosomes, generating multiple sex chromosome systems. Here we present a report on the hybridization of human chromosome-specific paints on metaphases from 4 individuals originally assigned to Alouatta caraya and 1 individual of Aotuslemurinus. This is only the third karyotype studied with chromosome painting out of more than 10 known karyomorphs in Aotus. The banded chromosomes matched those of karyotype II as defined by Ma et al. [1976a], and we were able to more precisely assign the origin of the sample to A. l. griseimembra. Our results on the Argentinean Alouatta caraya samples were generally comparable to the banding and hybridization pattern of previous studies of A. caraya including the presence of an X(1)X(1)X(2)X(2)/X(1)X(2)Y(1)Y(2) sex chromosome system. The karyotype of the Brazilian Alouatta sample labeled as A. caraya differs from the 3 Argentinean samples by at least 10 chromosome rearrangements. The diploid number, G banding, and hybridization pattern of this female cell line was almost identical to previous painting results on Alouatta guariba guariba. Therefore we must conclude that this cell line is actually from an A. guariba guariba individual. The contribution of cytogenetic tools in identifying species or in this case assigning individuals or cell lines to their precise taxonomic allocation is stressed. Gathering further molecular cytogenetic data on New World primates should be conservation and management priorities.

Cebus paraguayanus and Cebus nigritus (Primates, Platyrrhini): a comparative genomic hybridization analysis

Primate genomes show a great karyological variability while the DNA content variation is scarce. The biggest genome size occurs in Cercophitecus cephus (Catarrhini, Cercophitecidae) with 5.26 pg whereas the smallest one is described for Callicebus torquatus (Platyrrhini, Callithricidae) with 2.26 pg. Over the last 20 years different authors have been studying the Platyrrhini genomes on a chromosomal level. Among them, Cebus (Cebidae) being considered the most ancestral and conserved karyotype in relation to human karyotype has been extensively studied. Cebus genome sizes range from 3.40 to 3.98 pg. The species that inhabit Argentina, where they reach the most southern natural distribution, Cebus paraguayanus (CPA) and Cebus nigritus (CNI), have been extensively studied with classical cytogenetic comparisons focusing on banding pattern behavior. In the present study we performed comparative genomic hybridization (CGH) between these two closely related species with the aim of going a step further in the dissection of Cebus genomes. CGH evidenced that the DNA imbalances between them involved different genome regions, i.e. preferentially repetitive DNA in CPA and coding or very disperse DNA in CNI. Particularly, CNI showed species-specific DNA in more than 9 chromosomal pairs with a red/green (r/g) ratio ranging from 1.7 to 4, meaning that CNI presents at least twice as much DNA than CPA in those chromosomal segments. CPA showed species-specific DNA in the telomeric region of at least 3 chromosomal pairs with an r/g ratio of 0.5. They also showed a DNA gain in the chromosomal pairs with extracentromeric heterochromatin. Our findings modify the widespread idea of considering the heterochromatin proportion as the only difference between CPA and CNI. In Cebus then, the diversification process could be mediated by little changes in DNA content accompanied by a euchromatin-heterochromatin interaction although maintaining a minimum proportion like the one observed in CNI.

Management of Larynx and Trachea Donors

INTRODUCTION

Laryngeal transplantation is a possibility for patients with irreversible laryngeal disease, such as complex trauma and larynx cancer. The objective of performing this procedure was to solve problems that these patients face with a laryngectomy. The medical literature has reviews about larynx transplantations, but almost nothing about the larynx donor. The following is our experience on management of these donors.

MATERIALS AND METHODS

Selection criteria was as follows: (1) 18-50 years old; (2) gender and ABO blood type matched between donor and recipient; (3) No abuse of tobacco, cocaine, and marijuana, (4) tracheal intubation time <3 days; and (5) time in the intensive care unit <7 days. The preservation was simple hypothermia with larynx infusion via the carotid artery with University of Wisconsin solution.

RESULTS

Between 2001 and 2006, we managed 25 donors, among whom 12 grafts were discarded. The 13 larynx donors were of average age 27.2 +- 7.9 years and their cause of death was head trauma. Each was of male and 12 were multiorgan donors. Three donors had previous consumption of tobacco and 2 donors of marijuana. There were 2 cases of acute rejection episodes. Graft survival rate at 2 years was 90%.

DISCUSSION

These donors may have differences from other multiorgan donors: (1) they do not require strict fluid management; (2) vasoactive agents may be used in higher doses than in organ donors, and (3) the larynx tolerates hemodynamic instability. It was necessary to use some donors who had used addictive substances, showing that some selection criteria may be flexible. There was no conflict between thoracic surgeons and larynx surgeons. The priority always was for life-saving organs. Family consent was sometimes difficult because of the retrieval times and body donor reconstruction. The larynx surgery retrieval demanded an additional 2-5 hours during routine multiorgan donor surgery, and always the family asked about body reconstruction. The body appearance was always preserved.

Karyological diagnosis of Cebus (Primates, Platyrrhini) in captivity: detection of hybrids and management program applications

Genetic data are very important for conservation programs in wild population as well as in captive conditions. Primates in zoos or breeding centers are often maintained in groups without geographic origin or genetic heritage information. These lead to the incorrect assignment of species and introduce an artificial reproductive barrier, which in turn constitutes inadequate management of the colonies. A karyological analysis of specimens from a Primate Reproduction Center, considered as Cebus apella (Platyrrhini), was performed. Cell cultures were conducted from peripheral blood samples following standard cytogenetic methods. A fluorescence in situ hybridization (FISH) procedure was applied in mitotic metaphases using two probes: A specific probe of the extracentromeric heterochromatin (He+) of Cebus, and a human chromosome 21 probe. The latter was chosen due to the known homeology with the euchromatic region limiting with 11qHe+ of Cebus. The species status was determined for at least half of the animals and identified a hybrid specimen using this combined FISH protocol. This procedure is an accurate diagnostic methodology for taxonomic determinations and, therefore can be used for management of reproduction in colonies.

Interstock-induced mechanism of increased growth and salt resistance of orange (Citrus sinensis) trees

Interstocks improve the growth and salt resistance of lemon (Citrus limon (L.) Burm. f.) trees, but their effects on orange (Citrus sinensis (L.) Osbeck) trees are unknown. We grew 'Cleopatra' mandarin (CM) seedlings, budded trees of 'Salustiano' orange (SAO) on CM, 'Valencia Late' orange (VLO) on CM (VLO/CM), and interstock trees VLO/SAO/CM in pots of sand watered with nutrient solution containing 5 (control) or 50 mM NaCl for 12 weeks. Plants were harvested on six successive occasions and the time trends in relative growth rate (RGR) and its components were estimated by fitting a Richards function regression to the harvest data. At low and high salinities, the VLO/SAO/CM combination had higher mean RGR than VLO/CM. Under control conditions, the increase in RGR caused by the interstock was the result of an increase in leaf mass fraction (LMF; leaf dry mass/plant dry mass ratio). Increases in net assimilation rate on a leaf mass basis (NARm) and LMF contributed equally to the increase in RGR in saline conditions, their growth response coefficients being 0.52 and 0.48, respectively. The structural modifications, specific leaf area (SLA) and leaf area ratio (LAR; leaf area:plant dry mass ratio), had a slight influence on the reduction in RGR by salinity. However, NARm had a large influence on RGR, except in CM. The interstock-induced mechanism increased biomass allocation to the assimilatory organs and, under saline conditions, increased Cl- and Na+ allocations to roots. Thus, the flux of ions to the leaves was either delayed or reduced or both. The dilution of imported ions by foliar growth reduced ion concentrations in leaves, resulting in higher NARm, which together with higher LMF, increased RGR.

Improvement in growth and salt resistance of lemon (Citrus limon) trees by an interstock-induced mechanism

Interstocks can reduce toxic ion accumulations in leaves of budded citrus trees, but the mechanism is not understood. We grew sour orange (Citrus aurantium L.; SO) seedlings, budded trees of 'Salustiano' orange (Citrus sinensis L. Osbeck; SAO) on SO, 'Verna' lemon (Citrus limon L. Burm. f; VL/SO) and interstock trees (VL/SAO/SO) in pots of sand watered with nutrient solution containing 5 (control) or 50 mM NaCl (saline treatment) for 12 weeks. Plants were harvested in six successive harvests and time trends in relative growth rate (RGR) and its components were estimated by fitting a Richards function regression to the harvest data. The VL/SAO/SO trees in saline conditions had higher mean RGR than VL/SO trees in control conditions. Increases in both net assimilation rate on a leaf mass basis (NARw) and leaf mass fraction (LMF) contributed equally to a twofold increase in RGR of VL/SAO/SO trees in saline conditions. In control conditions, the increase in RGR caused by the interstock had growth response coefficients of GRC(NARw) = 0.20 and GRC(LMF) = 0.80. Structural modifications-specific leaf area, leaf area ratio and LMF-had a slight influence on the salt-induced changes in RGR, whereas NARw had a large influence. Salinity decreased root mass fraction (RMF) and increased stem mass fraction (SMF). In contrast, the interstock decreased SMF and increased LMF and RMF. The VL/SAO/SO trees had the highest RMF and proportionally higher Cl- and Na+ allocations in roots than the other plant types. In saline conditions, reductions in leaf ion transport rate and dilution of imported ions by foliar growth nearly halved ion accumulations in leaves of VL/SAO/SO trees.

Nitrogen budget in Scenedesmus obliquus cultures with artificial wastewater

Semicontinuous cultures of Scenedesmus obliquus in artificial wastewater, recycled into proteins about 33% and 25% of the dissolved nitrogen missing from the medium 24 h after harvesting 50% and 70% of the culture, and replacing the volume harvested with fresh medium. The residual dissolved nitrogen concentrations were 25% and 43% of the initial, respectively, with an imbalance in the mass budget close to 17 and 20 mg N l(-1) d-1. Most or all the nitrogen missing was found in an ammonia trap located at the air vent of the closed cultures, showing that an important role of microalgae in wastewater treatment is that of favouring NH3 stripping due to the photosynthesis-induced pH increases.

[Gastric schwannoma. Report of a case]

Gastric schwannoma is a rare and benign neurogenic tumor. Diagnosis of this entity is uncertain previous to surgery, being this tumor localized in the sub-mucosa. Final diagnosis is achieved by surgical removal and histological examination.

[Esophageal varices sclerosis in portal hypertension caused by portal thrombosis secondary to protein C deficiency]

Portal thrombosis is a rare entity classified as idiopathic in 50% of the cases, being protein C deficiency a known cause. We present two cases complicated with portal hypertension diagnosed through sonography and protein C determined though laboratory technics. Complicating esophageal varices sclerosed and follow up at seven months and ten years respectively, satisfactory clinical evolution observed.

Hypercholesterolemia in children

Coronary heart disease is the leading cause of death in Puerto Rico. Enough evidence exists to believe that coronary heart disease begins during the pediatric age. There has been and increased interest in recent years about the rationale for detection and treatment of hypercholesterolemia in children. Blood samples of 506 patients ages 3 to 17 were analyzed for plasma cholesterol level using the method RA-1000 Technicon. Measurement of cholesterol, blood pressure and Quetelex index were obtained during the sampling. Family history, and past history were also determined to compare the relationship between positive family history for coronary heart disease and cholesterol value. Based on these samples we concluded that 30% of the sampled population had high cholesterol values for age.

[Gastroduodenitis and Helicobacter pylori in uremic patients]

We studied 26 patients (p) with end stage renal failure (RF) and 26 healthy volunteers (HV) to investigate the prevalence of Helicobacter pylori (Hp) and its relation with chronic gastritis (CG) and chronic duodenitis (CD). We analyzed 312 gastric and duodenal mucosal biopsies stained with H & E and Giemsa. Categorical data were assessed by the X2 and Fisher's exact test. Probability values of p < 0.05 were considered significant. Endoscopic lesions correlated with histological gastritis and duodenitis and Hp was positive in antrum of 6/8p (75%) (p < 0.05). The prevalence of Hp was 54.5% (15/26p) in RF and 47.2% (12/26s) in HV. Hp was found more frequently in pathological mucosa (p < 005.). CG of the antrum and CD were more commonly in RF (88.5% vs 69.5% and 42.3% vs 23.1% respectively). HP was more frequently located in the antrum than in body and duodenum in both groups (p < 0.05). Chronic gastritis of the body was more frequently in HV (p < 0.05). Active chronic antral gastritis and superficial gastritis were more frequently associated to Hp. Hp was associated to chronic inflammatory gastroduodenal diseases in both groups and may be a cofactor in its pathogenesis. We recommended Hp treatment before renal transplantation.

[Heterotopic pancreas]

Heterotopic pancreas is a rare entity, usually asymptomatic, and found incidentally during laparotomy, when symptomatic it is for some complication, gastric obstruction, gastrointestinal hemorrhage, Meckel's diverticulum, obstructive jaundice. We report four patients, with this diagnostic and make a bibliographic review of this entity.

[Oral cholecystosonography. A method to establish the diagnosis of minute cholesterol calculi]

We have studied five patients with clinical symptoms and/or ultrasonography with sludge-like irregularities, but not conclusive for gallstones. The layering of bile and floating of cholesterol gallstones induced manly by administration of oral cholecystographic contrast, has been well demonstrated since 1933. These 5 patients were given doses of iopanoic acid. The day after we performed other ultrasonography--oral cholecystosonography method. With this second cholecystosonography was demonstrated inside the gallbladder en layer or a line of hyperechogenic little floating spots of cholesterol gallstones.