Mental health during ecological crisis: translating and validating the Hogg Eco-anxiety Scale for Argentinian and Spanish populations

BACKGROUND

Eco-anxiety is increasingly recognized as a shared experience by many people internationally, encompassing fear of environmental catastrophe and anxiety about ecological crises. Despite its importance in the context of the changing climate, measures for this construct are still being developed in languages other than English.

METHODS

To contribute to global eco-anxiety research, we translated the Hogg Eco-Anxiety Scale (HEAS) into Spanish, creating the HEAS-SP. We validated this measure in samples from both Argentina (n = 990) and Spain (n = 548), performing measurement invariance and confirmatory factor analyses. Internal consistency of the scale and score stability over time were investigated through reliability analyses. Differences in eco-anxiety across sociodemographic variables were explored through Student's t-tests and Pearson's r tests.

RESULTS

The four-factor model of the HEAS-SP comprising affective and behavioural symptoms, rumination, and anxiety about personal impact demonstrated excellent model fit. We found good internal consistency for each subscale, and established measurement invariance between Spanish and Argentine samples, as well as across genders and participants' age. Spanish participants reported higher scores on the affective symptoms and personal impact anxiety factors compared to the Argentinian sample. Also, men reported lower levels than women on the subscales of affective symptoms, rumination, and personal impact anxiety. It was found that the relationship between both age and personal impact anxiety and age and affective symptoms varies significantly depending on the gender of the individuals. Younger participants tended to report higher scores on most dimensions of eco-anxiety.

CONCLUSIONS

These findings enhance the global initiative to investigate, explore and therefore comprehend eco-anxiety by introducing the first valid and reliable Spanish-language version of this psychometric instrument for its use within Spanish and Argentinian populations. This study augments the body of evidence supporting the robust psychometric properties of the HEAS, as demonstrated in prior validations for Australian, Turkish, Portuguese, German, French, and Italian populations.

Heparin-Bonded Expanded Polytetrafluoroethylene Is a Solution for Infrapopliteal Revascularization in the Absence of an Adequate Autologous Vein Graft

BACKGROUND

To analyze the outcomes of heparin-bonded expanded polytetrafluoroethylene (HePTFE) graft as an alternative conduit in infrapopliteal revascularization of chronic limb-threatening ischemia (CLTI) in the absence of an autologous vein conduit.

METHODS

A single-center retrospective analysis of patients with CLTI submitted to infrapopliteal bypasses with autologous vein graft (VEIN group) or HePTFE graft (HePTFE group) was implemented. Primary end points were freedom from CLTI at 12 months and recurrence of CLTI at 3 years. Secondary end points included freedom from major amputation, amputation-free survival (AFS), survival, and primary (PP) and secondary patency (SP) rates at 3 years of follow-up.

RESULTS

A total of 348 limbs submitted to infrapopliteal bypasses, 214 with venous graft and 134 with HePTFE graft, were followed-up for a median of 25 months. Most patients of the HePTFE group were male (69%), with a median age of 76 years (interquartile range [IQR] 15). Fifty-nine percent of the limbs of the HePTFE group had Wound grade ≥2, being 46% of them infected. Eighty-eight percent were GLASS stage III. Freedom from CLTI was not significantly different between HePTFE and VEIN groups (75% vs. 84%, adjusted hazard ratio [aHR] 0.88, confidence interval [CI] 0.66-1.18, P = 0.401). Recurrence of CLTI was higher in the HePTFE group (42% vs.18% at 3 years; aHR 2.82, CI 1.59-5.00, P < 0.001). The VEIN group achieved higher rates of freedom from major amputation (87% vs.69% at 3 years; aHR 2.21, CI 1.31-3.75, P = 0.003) and AFS (59% vs. 37% at 3 years; aHR 1.39, CI 1.02-1.88, P = 0.036), but no significance in survival (aHR 1.10, CI 0.72-1.66, P = 0.667). Patency rates were inferior in the HePTFE group, with 2-year PP and SP rates of 52% vs. 74%, and 76% vs. 90%, respectively (PP: aHR 1.70, CI 1.11-2.59, P = 0.014; SP: aHR 2.51, CI 1.42-4.42, P = 0.001).

CONCLUSIONS

Infrapopliteal bypass with autologous vein graft is the gold standard to treat CLTI limbs. HePTFE graft should be regarded as an alternative for complex infrapopliteal revascularization when lacking an autologous vein conduct.

Baseline characteristics of a European patient population with difficult-to-treat depression (RESTORE-LIFE) treated with adjunctive vagus nerve stimulation

BACKGROUND

Major depressive disorder is a complex heterogeneous disorder. Treatment is especially challenging for patients with "difficult-to-treat depression" (DTD): a less stigmatizing and more clinically relevant framework defining depression that continues to cause significant burden despite usual treatment efforts.

METHODS

RESTORE-LIFE is a prospective, observational, multicenter, post-market study being conducted in Europe and is designed to reflect real-world clinical application of adjunctive Vagus Nerve Stimulation Therapy (VNS) for DTD. Baseline characteristics of RESTORE-LIFE patients were analyzed and compared to published treatment-resistant depression (TRD) trials.

RESULTS

This analysis includes the initial 98 RESTORE-LIFE patients who commenced treatment with VNS. Patients had a mean of 11.4 failed anti-depressant treatments, 1.1 suicide attempts, 87 % had prior electroconvulsive therapy, and 36 % had an endocrine/metabolic comorbidity. On average, disease severity was comparable to that in TRD trials (n = 15,463). However, RESTORE-LIFE patients appear to have been experiencing DTD for a longer duration and their DTD was characterized by a lack of positive mental health and meaningfulness of life, to a greater degree than by excess of negative mood. Despite high comorbidity rates in RESTORE-LIFE, VNS implantation was performed safely with no discontinuations due to surgical adverse events.

LIMITATIONS

RESTORE-LIFE enrolls any patient receiving adjunctive VNS for DTD. Prescription of VNS may be biased by differences in practices amongst sites and countries.

CONCLUSIONS

The present analysis offers insight into contemporary real-world use of VNS Therapy for DTD in Europe representing a comprehensive characterization of DTD and how this population may differ from those in the TRD literature.

Exploring Suspected Diagnoses in Elderly Patients: A Case Study of Potential Necrotizing Otitis Externa

Necrotizing otitis externa (NOE) is a rare invasive infection affecting the EAC and the base of the skull. This condition is more prevalent in the elderly, diabetics, and immunocompromised individuals, often attributed to the bacterium Pseudomonas aeruginosa. In this case report, we present the clinical scenario of a 90-year-old woman with a history of diabetes and epilepsy. Initially admitted with acute pyelonephritis, fever, and prostration, she subsequently developed left facial paralysis during treatment. Cranial computed tomography (CT) revealed inflammation in the middle ear and bone erosion of the facial nerve canal. The examination by the Department of Ear, Nose, and Throat (ENT) describes that NOE would be the most likely diagnosis. Given the patient's comorbidities and the severity of the disease, the treatment was initiated empirically and later adjusted based on the culture and sensitivity results with ceftazidime. NOE is a critical condition requiring early diagnosis and interdisciplinary collaboration due to the associated risk of complications. Adequate glycemic control is imperative, and the judicious use of antibiotics is crucial in light of escalating resistance.

Validating a measure for eco-anxiety in Portuguese young adults and exploring its associations with environmental action

BACKGROUND

Worsening environmental conditions may amplify people's emotional responses to an environmental crisis (eco-anxiety). In Portugal, young people seem to be especially concerned about climate change. However, this phenomenon needs to be interpreted using accurate instruments. Thus, this study aimed to validate the Portuguese version of the Hogg Eco-Anxiety Scale (HEAS) in young adults and examine the associations among eco-anxiety, sociodemographic characteristics, and pro-environmental behaviours.

METHODS

A survey was administered to 623 Portuguese university students aged between 18 and 25 years. The survey included our Portuguese translation of the HEAS (obtained through a back-translation and pretesting process), a sociodemographic assessment, and questions related to pro-environmental behaviours. Confirmatory factor analysis was conducted to assess the construct validity of the Portuguese version of the HEAS, and global fit indices were used to assess whether the original four-dimensional structure of the scale was reproduced. The reliability of the Portuguese version of the HEAS was evaluated by Cronbach's alpha and the intraclass correlation coefficient. Measurement invariance examined sex differences in scale interpretation. Linear regressions were used to detect whether sociodemographic variables predict eco-anxiety and whether eco-anxiety predicts pro-environmental behaviours.

RESULTS

The factorial structure of the original scale was replicated in the Portuguese version of the HEAS, showing good internal consistency, reliability over time and strict invariance between men and women. A higher paternal education level predicted greater eco-anxiety in children. Two dimensions of eco-anxiety-namely, rumination and anxiety about personal impacts on the environment-predicted higher engagement in pro-environmental behaviours.

CONCLUSIONS

The translated scale is an appropriate tool to measure eco-anxiety in the Portuguese context and should be used to collect evidence to drive environmental and health policies. An individual's education level should be considered a determinant of their emotional response to environmental conditions. Importantly, eco-anxiety can act as a protective emotional response to preserving the planet.

Autonomic dysregulation, cognition and fatigue in people with depression and in active and healthy controls: observational cohort study

BACKGROUND

Autonomic nervous system (ANS) dysregulation might be relevant to the pathophysiology of fatigue and cognitive impairment in depression and perhaps should be considered when making prescribing decisions.

AIMS

To determine the relationship of self-reported ANS symptoms with fatigue, cognition and prescribed medication in people with a diagnosis of depression, in comparators without depression but with other mental health, neurodevelopmental or neurodegenerative disorders (active controls) and in healthy controls.

METHOD

Cross-sectional analysis of an opportunistic sample from England. Self-reported data were collected on demographics, diagnosis, medication, ANS symptoms (Composite Autonomic Symptom Scale-31, COMPASS-31) and fatigue (Visual Analogue Scale for Fatigue, VAS-F). A subsample completed cognitive tests (THINC-it), including the subjective Perceived Deficits Questionnaire five-item version (PDQ-5). Spearman's correlation and mediation models were used to explore the relationship between COMPASS-31, VAS-F and PDQ-5 scores.

RESULTS

Data were obtained for 3345 participants, 22% with depression. The depression group had significantly (P < 0.01) more severe autonomic dysregulation as measured by COMPASS-31 scores (median 30) than active (median 23) and healthy controls (median 10). The depression group had significantly higher symptom severity (P < 0.01) than both control groups on the VAS-F and PDQ-5. Overall, there was a significantly positive correlation (P < 0.01) between COMPASS-31, VAS-F scores (Spearman's rho r_s = 0.44) and PDQ-5 scores (r_s = 0.56). COMPASS-31 scores mediated greater symptom severity on the VAS-F and PDQ-5 for those with depression. COMPASS-31 scores remained significantly different between the depression group and both control groups independently of medication.

CONCLUSIONS

People with a diagnosis of depression report worse fatigue and cognition than active and healthy comparators; this appears to be mediated by ANS dysregulation.

Low-energy amplitude-modulated electromagnetic field exposure: Feasibility study in patients with hepatocellular carcinoma

BACKGROUND

Patients with advanced hepatocellular carcinoma (HCC) and poor liver function lack effective systemic therapies. Low-energy electromagnetic fields (EMFs) can influence cell biological processes via non-thermal effects and may represent a new treatment option.

METHODS

This single-site feasibility trial enrolled patients with advanced HCC, Child-Pugh A and B, Eastern Cooperative Oncology Group 0-2. Patients underwent 90-min amplitude-modulated EMF exposure procedures every 2-4 weeks, using the AutEMdev (Autem Therapeutics). Patients could also receive standard care. The primary endpoints were safety and the identification of hemodynamic variability patterns. Exploratory endpoints included health-related quality of life (HRQoL), overall survival (OS). and objective response rate (ORR) using RECIST v1.1.

RESULTS

Sixty-six patients with advanced HCC received 539 AutEMdev procedures (median follow-up, 30 months). No serious adverse events occurred during procedures. Self-limiting grade 1 somnolence occurred in 78.7% of patients. Hemodynamic variability during EMF exposure was associated with specific amplitude-modulation frequencies. HRQoL was maintained or improved among patients remaining on treatment. Median OS was 11.3 months (95% confidence interval [CI]: 6.0, 16.6) overall (16.0 months [95% CI: 4.4, 27.6] and 12.0 months [6.4, 17.6] for combination therapy and monotherapy, respectively). ORR was 24.3% (32% and 17% for combination therapy and monotherapy, respectively).

CONCLUSION

AutEMdev EMF exposure has an excellent safety profile in patients with advanced HCC. Hemodynamic alterations at personalized frequencies may represent a surrogate of anti-tumor efficacy. NCT01686412.

Depression in Sjögren's syndrome mediates the relationship between pain, fatigue, sleepiness, and overall quality of life

Objectives

Sjögren's syndrome (SS) includes many extra-glandular symptoms such as fatigue, pain, sleepiness and depression, which impact on quality of life (QoL). These symptoms also influence each other and could be linked by autonomic nervous system (ANS) dysregulation. Our aim was to model the role of putative predictive variables, including depression in the relationships between ANS function, fatigue, and QoL in SS.

Methods

Cross-sectional analysis of self-reported data from the multicentre UK primary SS registry. The Composite Autonomic Symptom Scale (COMPASS) was used to assess autonomic function, the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and the EuroQol-5 Dimension (EQ-5D) to assess QoL. Validated scales were used for other clinical variables. Using multiple regression analysis and structural equation modelling (SEM), we investigated how the QoL of people with SS is impacted by the direct and indirect effects of fatigue, sleepiness, depression, symptom burden and ANS function, and their interactions.

Results

Data was obtained for 1046 people with SS, 56% COMPASS completers. Symptoms of ANS dysregulation were common. Participants with ANS dysregulation had more severe depression, anxiety, dryness, fatigue, pain, sleepiness and QoL (P < 0.01 for all). Depression, anxiety, dryness, and pain were independent predictors of ANS function in the multiple regression model (P < 0.05 for all). ANS function could not be included in the SEM. The SEM model had good fit to the data (comparative fit index = 0.998) and showed that, in people with SS, depression mediates the effects of pain, fatigue and sleepiness on QoL.

Conclusion

Our results show that diagnosing and treating depression in people with SS could have direct positive impact on QoL, and significantly ameliorate the impact of fatigue and pain.

An Epithelioid Hemangioma Camouflaged As Radial Aneurysm

Epithelioid hemangioma (EH) is an uncommon benign vascular lesion usually present as subcutaneous nodules in the head and neck area. Sometimes, these lesions can occur in the peripheral arteries, and when they do, they can be mistaken for aneurysmal dilatations of that respective vessel. We report a case of a 43-year-old male who underwent surgical recession of a radial aneurysm, which after anatomopathological examination, revealed an EH.

Valuing Mundane Manifestations of Rare, but Underdiagnosed, Diseases in Portugal: The Example of McArdle Disease

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Barriers and facilitators to implementation of the interoperable Survivorship Passport (SurPass) v2.0 in 6 European countries: a PanCareSurPass online survey study

PURPOSE

Long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) is essential to improve and maintain their quality of life. The Survivorship Passport (SurPass) is a digital tool which can aid in the delivery of adequate LTFU care. During the European PanCareSurPass (PCSP) project, the SurPass v2.0 will be implemented and evaluated at six LTFU care clinics in Austria, Belgium, Germany, Italy, Lithuania and Spain. We aimed to identify barriers and facilitators to the implementation of the SurPass v2.0 with regard to the care process as well as ethical, legal, social and economical aspects.

METHODS

An online, semi-structured survey was distributed to 75 stakeholders (LTFU care providers, LTFU care program managers and CCSs) affiliated with one of the six centres. Barriers and facilitators identified in four centres or more were defined as main contextual factors influencing implementation of SurPass v2.0.

RESULTS

Fifty-four barriers and 50 facilitators were identified. Among the main barriers were a lack of time and (financial) resources, gaps in knowledge concerning ethical and legal issues and a potential increase in health-related anxiety in CCSs upon receiving a SurPass. Main facilitators included institutions' access to electronic medical records, as well as previous experience with SurPass or similar tools.

CONCLUSIONS

We provided an overview of contextual factors that may influence SurPass implementation. Solutions should be found to overcome barriers and ensure effective implementation of SurPass v2.0 into routine clinical care.

IMPLICATIONS FOR CANCER SURVIVORS

These findings will be used to inform on an implementation strategy tailored for the six centres.

Intervention Programs for First-Episode Psychosis: A Scoping Review Protocol

Early intervention programs for first-episode psychosis aim to intervene in the early stages of the disease. They are essential to prevent and delay the progression of the illness to a more advanced stage, but information about their characteristics is not systematized. The scoping review considered all studies of first-episode psychosis intervention programs, regardless of their context (hospital or community), and explored their characteristics. The scoping review was developed according to the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. The PCC mnemonic (population, concept, and context) addressed research questions, the inclusion and exclusion criteria, and the search strategy. The scoping review sought to identify the literature that meets the predefined inclusion criteria. The research was conducted in the following databases: Web of Science Core Collection, MEDLINE, CINAHL Complete and PsycINFO, Scopus, Cochrane Library, and JBI Evidence Synthesis. The search for unpublished studies included OpenGrey (a European repository) and MedNar. It used sources in English, Portuguese, Spanish, and French. It included quantitative, qualitative, and multi-method/mixed methods studies. It also considered gray or unpublished literature. After removing duplicates, two independent reviewers extracted the relevant information after selecting the articles. If there were disagreements, a third reviewer was used. The researchers have developed a tool based on the JBI model that will allow them to extract the relevant information for the review. The results are presented schematically in narratives and tables. This scoping review maps first-episode psychosis intervention programs by identifying their characteristics, participants, and specific implementation contexts and allows researchers to create multicomponent programs tailored to different contexts.

Perinatal mental health counselling programme: A scoping review

OBJECTIVE

To map the evidence on a Perinatal Mental Health Counselling Programme, identifying its characteristics, participants, and outcomes.

METHODS

This review followed the guidelines of the Joanna Briggs Institute and PRISMA-ScR. Published and unpublished studies, from 2011 to 2021, written in English, Portuguese or Spanish were included.

RESULTS

Despite the high number of articles identified, only nine articles were included in the final analysis, mainly from Iran, Italy and one Portuguese study. All articles referred to community health care centres and hospitals. The sessions varied between 6 and 16 and lasted 30-90 min. The method used was either individual and/or group, with weekly or monthly sessions or whenever deemed necessary throughout the evaluation. Different techniques were found, but emotional management, problem-solving, relaxation and mindfulness techniques were highlighted. Participants are pregnant women, partners, or family members. All articles suggest a decrease in the levels of stress, anxiety, and depression after the counselling intervention.

CONCLUSION

Perinatal counselling programme have varied characteristics and mental health nurses are potential facilitators.

Psychoeducation Programs to Reduce Preoperative Anxiety in Adults: A Scoping Review

BACKGROUND

Surgical procedure is a critical event that causes anxiety for patients. One of the possible intervention strategies to reduce anxiety in the preoperative period is psychoeducation.

METHODS

A scoping review was conducted according to the JBI methodology and PRISMA-ScR to map knowledge about psychoeducation programs to reduce preoperative anxiety in adults. The data were extracted by the researchers, according to the objective of the study. Finally, the data synthesis was presented in narrative format and tables.

RESULTS

four studies were included in the review with different characteristics of psychoeducation programs. The approach of these programs consisted of teaching about anxiety, instruction and training in anxiety control techniques. The contents referred to included the surgical process and intervention techniques to reduce anxiety. Program sessions lasted from 45 to 150 min, with a frequency of 1 to 6. The assessment instrument used was the State-Trait Anxiety Inventory. The dynamisers were nurses, psychotherapists and clinical psychologists.

CONCLUSIONS

Psychoeducation programs can be useful and effective in reducing anxiety. More studies are needed to confirm these results.

Caso raro de um Schwannoma no pé – Relato de caso

Um schwannoma é uma lesão pouco frequente, sendo um tumor que deriva da bainha de mielina dos nervos periféricos; na maioria dos casos, este tumor é benigno e raramente se apresenta na região do pé e tornozelo. Os pacientes afetados por esse tipo de patologia são geralmente assintomáticos. Ainda assim, às vezes eles têm sintomas neurológicos sensoriais ou motores se o tumor for grande o suficiente para causar a compressão direta ou indireta do nervo afetado. Um paciente do gênero masculino de 55 anos se apresentou ao nosso departamento com inchaço não traumático e dor no aspecto lateral do pé direito e da perna. A ressonância magnética (RM) da perna direita revelou uma lesão bem-circunscrita, medindo 2,5 por 1 cm, mostrando hipointensidade nas sequências T1 e hiperintensidade em T2, compatível com um tumor superficial de células do nervo peronal. Foi realizada excisão cirúrgica da lesão e o exame histopatológico confirmou a suspeita inicial – Schwannoma do nervo peroneal superficial. O pós-operatório foi tranquilo, com melhora progressiva da dor e recuperação funcional completa sem déficits neurológicos. Exame clínico rigoroso associado aos exames de RM permitem diagnóstico adequado, bem como a exclusão de outras patologias com apresentação clínica semelhante. Assim, o cirurgião tem que estar atento a todos os dados para um diagnóstico e tratamento eficazes nesse tipo de patologia rara que não pode ser negligenciada.

Abstract P135: Specialized Pro-resolving Molecular Pathway Is Impaired In Resistance Arteries From Hypertensive Rats

Specialized pro-resolving mediators (SPMs), derived from essential fatty acids, are known to playa major role in the immune system, as immunoresolvents. SPMs reduce acute inflammatoryresponses and leads to the clearance of pathogens and dying cells. Although we have demonstratedthat lipoxin A4, biosynthesized from the 5-lipoxygenase (LOX-5), improved endothelium-dependent relaxation in resistance arteries from SHR, it is unknown if (1) SPMs molecularpathways are present in resistance arteries independent of immune system activation, and (2)whether this pathway is dysfunctional in SHR. We hypothesized that the synthesis and downstreamsignaling of LOX-5-derived SPMs are impaired in resistance arteries from SHR. Mesentericresistance arteries (MRA) from male SHR (14-weeks old, n=5) and Wistar Kyoto (WKY) (14-weeks old, n=4) were collected to assess protein expression using Western blotting analysis. SHR`sMRA showed an increase in COX-2 expression (400%) when compared to WKY (p<0.05),demonstrating an inflammatory state. However, there was a reduction in the total LOX-5expression (30%) (Fig.1). Interestingly, an 65% increase in phosphorylation of 5-LOX at Ser 271was observed in MRA from SHR (Fig. 1) Ser 271 is responsible for the pro-inflammatory effectsof LOX-5, leading to a reduction of lipoxin A4, but an increase in the synthesis of leukotrienes.Supporting our previous data, we observed that formyl peptide receptor, a receptor that recognizesSPMs, was 30% decreased in arteries from in SHR. Together, these data show that vascular tissuepresents with the “machinery” to synthesize SPMs, and the resolution of inflammation“machinery” is impaired in hypertension.

Energy efficiency of pulse shaping in electrical stimulation: the interdependence of biophysical effects and circuit design losses

Power efficiency in electrical stimulator circuits is crucial for developing large-scale multichannel applications like bidirectional brain-computer interfaces and neuroprosthetic devices. Many state-of-the-art papers have suggested that some non-rectangular pulse shapes are more energy-efficient for exciting neural excitation than the conventional rectangular shape. However, additional losses in the stimulator circuit, which arise from employing such pulses, were not considered. In this work, we analyze the total energy efficiency of a stimulation system featuring non-rectangular stimuli, taking into account the losses in the stimulator circuit. To this end, activation current thresholds for different pulse shapes and durations in cortical neurons are modeled, and the energy required to generate the pulses from a constant voltage supply is calculated. The proposed calculation reveals an energy increase of 14-51% for non-rectangular pulses compared to the conventional rectangular stimuli, instead of the decrease claimed in previous literature. This result indicates that a rectangular stimulation pulse is more power-efficient than the tested alternative shapes in large-scale multichannel electrical stimulation systems.

Lemierre's syndrome: case report of "the forgotten disease" in current COVID-19 pandemic

Lemierre's syndrome refers to infectious thrombophlebitis of the internal jugular vein developed as complication of an oropharyngeal infection. It is a rare syndrome, affecting otherwise healthy young adults, which may lead to sepsis complicated by septic embolization. Although there is a characteristic clinical picture, many modern physicians are unaware of this syndrome, leading it to be termed 'the forgotten disease'. The authors report a case of late diagnosis due to initial suspicion of COVID-19 and highlight the pitfalls on its diagnosis.

EVALUATION OF GLASS STAGE IN PATIENTS WITH CHRONIC LIMB THREATENING ISCHEMIA TREATED WITH AUTOGENOUS BYPASS GRAFTS

OBJECTIVE

To evaluate the relationship of GLASS stages with clinical outcomes in patients with chronic limb threatened ischemia (CLTI) submitted to distal bypasses using venous graft.

METHODS

A single-center retrospective analysis of patients with CLTI submitted to distal bypasses with vein graft between January 2012 and December 2019 were included. The primary end point was freedom from CLTI (amputation-free survival, with complete wound healing and without ischemic rest pain). Secondary end points included a composite outcome of recurrence (patients that achieved freedom from CLTI but developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events (MALE), limb-based patency (LBP) and primary and secondary patency rates.

RESULTS

A total of 190 patients were submitted to 211 distal bypasses with a median follow up of 30 months. Eighty percent of the cases had diabetes or end-stage kidney disease requiring dialysis. Most patients (63%) had major or extensive tissue loss (Wound class ≥ 2) with more than half of these with some degree of infection of the foot. Severe anatomic pattern (GLASS stage III) was predominant with a prevalence of 78%. There were no significant differences between GLASS I-II and GLASS III stage groups for all the outcomes analysed. About 80% of the 211 revascularized limbs were free from CLTI at 12 months. At 4 years of follow up we observed that 25% of the cases had recurrence of CLTI, 83% were free from major amputation and 61% were free from MALE. LBP, primary patency, and secondary patency were 79%, 80% and 93% at one year, and 64%, 65% and 81% at four years, respectively.

CONCLUSIONS

GLASS stage was not related with patency and clinical outcomes after distal bypasses with vein graft. Distal open revascularization presents excellent rates of freedom from CLTI with low rates of recurrence of CLTI, two key time-integrated outcomes of clinical disease severity in patients with CLTI.

Exploring the selective gray matter profile of autism spectrum disorder through Bayes Factor Modeling

Introduction

Despite decades of brain MRI research demonstrating atypical neuroanatomical substrate in patients with autism spectrum disorder (ASD), it remains unclear whether and to what extent disorder-selective neuroanatomical abnormalities occur in this spectrum. This, and the fact that multiple brain disorders report a common neuroanatomical substrate, makes transference and the application of neuroimaging findings into the clinical setting an open challenge.

Objectives

To investigate the selective neuroanatomical alteration profile of the ASD brain, we employed a meta-analytic, data-driven, and reverse inference-based approach (i.e.; Bayes fACtor mOdeliNg).

Methods

Eligible voxel-based morphometry data were extracted by a standardized search on BrainMap and MEDLINE databases (849 published experiments, 131 brain disorders, 22747 clinical subjects, 16572 x-y-z coordinates). Two distinct datasets were generated: the ASD dataset, composed of ASD-related data; and the non-ASD dataset, composed of all other clinical conditions data. Starting from the two unthresholded activation likelihood estimation (ALE) maps, the calculus of the Bayes fACtor mOdeliNg was performed. This allowed us to obtain posterior probability distributions on the evidence of brain alteration specificity in ASD.

Results

We revealed both cortical and cerebellar areas of neuroanatomical alteration selectivity in ASD. Eight clusters showed a selectivity value ≥ 90%, namely the bilateral precuneus, the right inferior occipital gyrus, left lobule IX, left Crus II, right Crus I, and the right lobule VIIIA (Fig. 1).

Conclusions

The identification of this neuroanatomical pattern provides new insights into the complex pathophysiology of ASD, opening attractive prospects for future neuroimaging-based interventions.

Disclosure

No significant relationships.

The burden associated with, and management of, difficult-to-treat depression in patients under specialist psychiatric care in the United Kingdom

BACKGROUND

Major depressive disorder (MDD) is common and often has sub-optimal response to treatment. Difficult-to-treat depression (DTD) is a new concept that describes 'depression that continues to cause significant burden despite usual treatment efforts'.

AIMS

To identify patients with likely DTD in UK secondary care and examine demographic, disease and treatment data as compared with 'non-DTD' MDD patients.

METHODS

Anonymised electronic health records (EHRs) of five specialist mental health National Health Service (NHS) Trusts in the United Kingdom were analysed using a natural language processing model. Data on disease characteristics, comorbidities and treatment histories were extracted from structured fields and using natural language algorithms from unstructured fields. Patients with MDD aged ⩾18 years were included in the analysis; those with presumed DTD were identified on the basis of MDD history (duration and recurrence) and number of treatments prescribed.

RESULTS

In a sample of 28,184 patients with MDD, 19% met criteria for DTD. Compared to the non-DTD group, patients with DTD were more likely to have severe depression, suicidal ideation, and comorbid psychiatric and/or physical illness, as well as higher rates of hospitalisation. They were also more likely to be in receipt of unemployment and sickness/disability benefits. More intensive treatment strategies were used in the DTD group, including higher rates of combination therapy, augmentation, psychotherapy and electroconvulsive therapy.

CONCLUSION

This study demonstrates the feasibility of identifying patients with probable DTD from EHRs and highlights the increased burden associated with MDD in these patients.

Photo2Video: Semantic-Aware Deep Learning-Based Video Generation from Still Content

Applying machine learning (ML), and especially deep learning, to understand visual content is becoming common practice in many application areas. However, little attention has been given to its use within the multimedia creative domain. It is true that ML is already popular for content creation, but the progress achieved so far addresses essentially textual content or the identification and selection of specific types of content. A wealth of possibilities are yet to be explored by bringing the use of ML into the multimedia creative process, allowing the knowledge inferred by the former to influence automatically how new multimedia content is created. The work presented in this article provides contributions in three distinct ways towards this goal: firstly, it proposes a methodology to re-train popular neural network models in identifying new thematic concepts in static visual content and attaching meaningful annotations to the detected regions of interest; secondly, it presents varied visual digital effects and corresponding tools that can be automatically called upon to apply such effects in a previously analyzed photo; thirdly, it defines a complete automated creative workflow, from the acquisition of a photograph and corresponding contextual data, through the ML region-based annotation, to the automatic application of digital effects and generation of a semantically aware multimedia story driven by the previously derived situational and visual contextual data. Additionally, it presents a variant of this automated workflow by offering to the user the possibility of manipulating the automatic annotations in an assisted manner. The final aim is to transform a static digital photo into a short video clip, taking into account the information acquired. The final result strongly contrasts with current standard approaches of creating random movements, by implementing an intelligent content- and context-aware video.

Case report: primary ciliary dyskinesia associated with Kartagener syndrome

INTRODUCTION: Primary ciliary dyskinesia is a ciliary mobility disorder, which is characterized by reduced or uncoordinated mobility of the cilia present in the respiratory epithelium. Consequently, mucociliary transport is impaired in the patient’s respiratory tract, making him susceptible to infections and stasis of recurrent secretions, and later to a hyperplasia of secretory cells. CASE REPORT: This article describes the case of a patient with primary ciliary dyskinesia associated with Kartagener syndrome. All the significant points that led to its early diagnosis (less than 3 years of age) will be highlighted, including clinical status, imaging tests, and genetic study. DISCUSSION: It is an autosomal recessive disease, and in half of the cases it is associated with Kartagener syndrome, which manifests classic signs of chronic sinusitis, situs inversus and bronchiectasis. Furthermore, it is also common to find persistent cough, dyspnea, otitis media, mouth breathing, nasal polyp, and even cardiac malformations in patients with the disease. The differential diagnosis for ciliary dyskinesia is important in order to investigate possible additional damage to the patient due to his clinical condition. Therefore, clinical investigation in conjunction with radiographs, CT scans and cytological exams are the main method for analyzing structural variations. Overall, this dysfunction is usually identified in late stages, so its study is necessary enough to help the early diagnosis of the pathology, contributing to the preservation of the pulmonary function of these patients.

Effect of exercise on phase angle in cancer patients: a systematic review

INTRODUCTION

Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITIONː This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials.

EVIDENCE SYNTHESIS

We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA.

CONCLUSIONS

There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.

RECURRENT VARICOSE VEINS FOLLOWING SMALL SAPHENOUS VEIN SURGERY: A 5-YEAR FOLLOW-UP DUPLEX ULTRASOUND STUDY

INTRODUCTION

Chronic venous disease (CVD) of the lower limbs is a very prevalent medical condition with important socioeconomic repercussions. Small saphenous vein (SSV) incompetence, although less frequent than great saphenous vein (GSV) incompetence, presents a more challenging treatment, with higher rates of complication and recurrence.

OBJECTIVES

To determine the incidence and associated risk factors of varicose veins recurrence in patients submitted, for the first time and exclusively, to SSV surgery with 5 years of follow-up.

METHODS

Retrospective analysis of all exclusively first-time SSV surgeries, at Angiology and Vascular Surgery Service of Hospital Beatriz Ângelo, between January 1st, 2013, and December 31st, 2014. In March 2019, the authors performed clinical and venous doppler ultrasound reassessment of all included patients.

RESULTS

A total of 23 limbs were evaluated, 56.5% were female and the mean age was 51.8 years. All patients were symptomatic and underwent ligation of the saphenopopliteal junction (SPJ), 26.1% and 43.5% had total and partial SSV stripping, respectively. After venous doppler ultrasound at 5-year follow-up, we found that 21.7% did not present a correct SPJ ligation due to failure to identify its location, with a statistically significant association between SPJ ligation and varicose vein recurrence. In follow-up, we also diagnosed GSV incompetence in 21.7% for the first time, which is in agreement with the fact that this is a chronic disease. Finally, we found that all patients with symptomatic recurrence at 5-year follow-up had CVD, however, some asymptomatic patients also had ultrasound changes.

CONCLUSION

Routine preoperative localization of the SPJ by doppler ultrasound guidance could have an impact in minimizing varicose vein recurrence. Imaging recurrence does not always translate into clinical recurrence. Because this is a chronic disease, patients should keep general care to prevent disease progression, even after surgery.

Direct tissue-sensing reprograms TLR4+ Tfh-like cells inflammatory profile in the joints of rheumatoid arthritis patients

CD4⁺ T cells mediate rheumatoid arthritis (RA) pathogenesis through both antibody-dependent and independent mechanisms. It remains unclear how synovial microenvironment impinges on CD4⁺ T cells pathogenic functions. Here, we identified a TLR4⁺ follicular helper T (Tfh) cell-like population present in the blood and expanded in synovial fluid. TLR4⁺ T cells possess a two-pronged pathogenic activity whereby direct TLR4⁺ engagement by endogenous ligands in the arthritic joint reprograms them from an IL-21 response, known to sponsor antibody production towards an IL-17 inflammatory program recognized to fuel tissue damage. Ex vivo, synovial fluid TLR4⁺ T cells produced IL-17, but not IL-21. Blocking TLR4 signaling with a specific inhibitor impaired IL-17 production in response to synovial fluid recognition. Mechanistically, we unveiled that T-cell HLA-DR regulates their TLR4 expression. TLR4⁺ T cells appear to uniquely reconcile an ability to promote systemic antibody production with a local synovial driven tissue damage program.

In order to identify how the synovial microenvironment impinges on CD4+ T cells pathogenic functions in Rheumatoid Arthritis (RA), Amaral-Silva examined RA patient blood and synovial fluif and identified the presence of a TLR4+ follicular helper T (Tfh) cell-like population. They provided mechanistic insight into how TLR4⁺ T cells uniquely reconcile an ability to promote systemic antibody production with a local synovial driven-tissue damage program.

Relationship between Heart Rate Variability and Functional Fitness in Breast Cancer Survivors: A Cross-Sectional Study

Background: Breast cancer is the most common malignancy among women worldwide. The treatments may also cause neuromuscular and skeletal disorders; therefore, the aim of this study was to verify the existence of a relationship between heart rate variability and different functional fitness parameters in women survivors of breast cancer. Methods: This cross-sectional study included 25 women survivors of breast cancer, with a mean ± SD age, height, and body mass of 50.8 ± 8.8 years, 1.6 ± 0.7 m, and 67.1 ± 12.3 kg, respectively. Patients underwent measurements of heart rate variability with time and frequency domain analyses, as well as a “30 s chair-stand test”, “6 min walking test”, “timed up and go test”, and “ball throwing test”. Results: A multiple linear regression analysis showed that from the heart rate variability frequency domain, high frequency explained 21% (R² = 0.21) of the “30 s chair-stand test” performance. Conclusion: The findings of this study highlight high frequency as a predictor of “30 s chair-stand test” performance, regardless of age and time after diagnosis, suggesting its usefulness as a clinical indicator of functionality in breast cancer survivors. This study presents a straightforward and non-invasive methodology predicting functional fitness in women breast cancer survivors potentially applicable to clinical practice.

Pancreaticopleural fistula: An insidious cause of pleural effusion –case report

Pancreaticopleural fistulas (PPF) are a rare etiology of pleural effusions. We describe a case of a 61-year-old man, with left chest pain with six months of progression who presented with a large volume unilateral pleural effusion. A thoracentesis was performed, which showed a dark reddish fluid(exudate) and high content of pancreatic amylase. After that an abdominal computed tomography (CT)and magnetic resonance cholangiopancreatography (MRCP) was done, revealing fistulous pathways that originated in the pancreas. The patient was admitted for conservative and endoscopic treatment by Endoscopic Retrograde Cholangiopancreatography (ERCP) and a prosthesis was placed on a fistulous path. He was discharged without complications, with the resolution of the pleural effusion and fistula.The interest of this case lies in the rarity of the event and absence of symptoms of the probable primary event (acute pancreatitis). The possible iatrogenic association with several drugs of his usual medication makes it even more complex.

The Impact of SARS-CoV-2 Viral Load on the Mortality of Hospitalized Patients: A Retrospective Analysis

Introduction

Coronavirus disease 2019 (COVID-19) has emerged worldwide since December 2019. The standard method for diagnosis is via nucleic acid amplification testing, usually with a reverse-transcription polymerase chain reaction (RT-PCR). Hospitalized infected individuals may require ventilation and may have higher mortality rates. We aim to evaluate the clinical impact of nasopharyngeal viral load on these outcomes.

Materials and methods

We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 17 March 2020 to 1 June 2020 at a tertiary care hospital. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from an RT-PCR assay applied to nasopharyngeal swab samples. We compared the clinical characteristics of survivors vs. non-survivors and assessed whether the viral load was independently associated with in-hospital 30-day mortality.

Results

We evaluated 197 patients. Thirty-day mortality was verified in 71 (36%) subjects. In the adjusted effects model, only the E-gene Ct value [odd ratio (OR) .873; confidence interval (CI) 95% .769-.992; p .037], age, the number of days of symptoms before admission, lactate dehydrogenase (LDH), and the oxygen saturation (SatO₂)-to-fraction of inspired oxygen (FiO₂) ratio remained significantly associated with 30-day mortality. There was no identified association between the viral loads and disease severity, the need for ventilation, or length of stay.

Discussion

Our results are, in part, concordant with previous papers. One possible limitation to our study is the fact that possibly included disproportionately more patients with poorer outcomes since hospitalization was required. Therefore, further research is required.

Conclusion

SARS-CoV-2 viral load on admission may be an independent predictor of 30-day mortality among hospitalized patients with COVID-19. Providing this information to clinicians could potentially be used to guide risk stratification. 

An Integrated 2D Ultrasound Phased Array Transmitter in CMOS With Pixel Pitch-Matched Beamforming

Emerging non-imaging ultrasound applications, such as ultrasonic wireless power delivery to implantable devices and ultrasound neuromodulation, require wearable form factors, millisecond-range pulse durations and focal spot diameters approaching 100 μm with electronic control of its three-dimensional location. None of these are compatible with typical handheld linear array ultrasound imaging probes. In this work, we present a 4 mm × 5 mm 2D ultrasound phased array transmitter with integrated piezoelectric ultrasound transducers on complementary metal-oxide-semiconductor (CMOS) integrated circuits, featuring pixel-level pitch-matched transmit beamforming circuits which support arbitrary pulse duration. Our direct integration method enabled up to 10 MHz ultrasound arrays in a patch form-factor, leading to focal spot diameter of ∼200 μm, while pixel pitch-matched beamforming allowed for precise three-dimensional positioning of the ultrasound focal spot. Our device has the potential to provide a high-spatial resolution and wearable interface to both powering of highly-miniaturized implantable devices and ultrasound neuromodulation.

Testing the plastic-wrapped composting system to dispose of swine mortalities during an animal disease outbreak

Composting has been used to dispose of animal mortalities and infected materials, such as manure and feed, during major animal disease outbreaks. In this study, we adapted the plastic-wrapped mortality composting system developed by the Canadian Food Inspection Agency during the 2004 highly pathogenic avian influenza outbreak to compost swine mortalities. The goals of the study were to evaluate the performance of the plastic-wrapped composting system to dispose of swine mortalities and to field test its ability to eliminate the spread of airborne pathogens through the aeration ducts. Two cover materials, ground cornstalks and woodchips, were tested using passively and actively aerated composting sheds. The mortalities were inoculated with Salmonella spp. and vaccine strains of Bovine herpesvirus-1 and Bovine viral diarrhea virus. Air samples collected from the upper aeration duct (air outlet) during the first 10 d of composting were negative for Salmonella and the viruses tested, which indicated that aerosol transmission of the pathogens was limited. The aeration plenum placed under the mortalities helped to keep conditions aerobic, as O₂ concentrations of both passively and actively aerated test units were above 11%. Actively aerated cornstalks had the highest degree-hours (1,462 °C h d^-1 ), which was followed by passively aerated cornstalks (1,312 °C h d^-1 ), actively aerated woodchips (1,303 °C h d^-1 ), and passively aerated woodchips (1,062 °C h d^-1 ). After a 7-wk composting period, all three pathogens were inactivated based on quantitative polymerase chain reaction test results. The mortalities were not inoculated with the African swine fever virus, but temperature data showed that if they were, the system had the potential to eliminate this virus.

MO647RENOPROTECTIVE EFFECT OF SGLT2 INHIBITORS AFTER FIVE YEARS OF TREATMENT: AN OBSERVATIONAL STUDY

Background and Aims

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, the most recent glucose lowering oral agents, prevent glucose and sodium reabsorption at proximal tubules. These drugs have the potential of nephroprotection by their glucose lowering effects, but also through direct renal effects, such as reducing intraglomerular pressure and suppressing the production of pro-inflammatory and pro-fibrotic factors. Several randomized control trials have demonstrated these effects with slowing chronic kidney disease progression. The aim of our study was to evaluate the effect of SGLT2 inhibitors on estimated glomerular filtration rate throughout five years of treatment.

Method

This was a retrospective observational and longitudinal study that included patients diagnosed with DM2 and treated with an iSGLT2 in a Diabetic Clinic. Demographic and clinical variables were collected, including HbA1c, disease duration and cardiovascular risk factors (CVRF). Patient glucose-control therapy as well as RAAS inhibitor drugs were gathered. The estimated Glomerular Filtration Rate (eGFR) by the formula CKD-EPI and albuminuria, using the urinary albumin-to-creatinine ratio, were evaluated at the iSGLT2 introduction date and at 6, 12, 24, 36, 48 and 60 months of treatment. Categorical variables are presented as frequencies and percentages, and continuous variables as means or medians for variables with skewed distributions. All reported p values are two-tailed, with a p value of 0.05 indicating statistical significance. A paired Student’s t-test or paired-sample test were performed for continuous variables and a chi-squared test was performed for categorical variables.

Results

A total of 205 patients, 54,6 % male, mean age 65,4 years, median baseline HbA1c 8,4% and median duration of DM2 14 years were studied. Of all patients, 94,1% had at least 1 CVRF, 71,2% hypertensive, 83,4% dyslipidemia, 48,8% obese, and 25,4% had past/current smoking habits. Regarding glucose-control therapy 17,1% were treated with one drug class and the remaining patients were treated with 2 or more classes. Among the patients 82,0% of them were taking metformin and 51,2% were on insulin therapy. Also, 56,6 % were on a RAAS inhibitor. Overall, 129 (62,9 %) patients received dapaglifozin therapy (5 or 10mg) and 76 (37,1%) empaglifozin (10 or 25mg). Regarding albuminuria at baseline, 37 patients had normal albuminuria (&lt;30mg/g), 18 patients had moderate albuminuria (30-300mg/g) and 6 patients had severe albuminuria (&gt;300mg/g). As for eGFR, 15,6 % patients had an eGFR between 30 and 60 and 84,4% patients had an eGFR greater than 60 ml/min/1,73m2. These clinical features were similar between the patients that received either SGLT2 inhibitor, with the exception of obesity being more prevalent in the dapaglifozin group (55,8 % vs 36,8%, p=0,009). Assessing the eGFR during the 5 years of treatment, a significant decrease was noticed in the first 6 months from an 82,3 to 78,6 ml/min/1,73m2 (p=0,002), followed by a significant increase in the second semester to 82,9 ml/min/1,73m2 (p&lt;0,001). Thereafter there is a slight increase in eGFR throughout the years, to a maximum of 84,1 ml/min/1,73m2 at 24 months and after a slow reduction to 80,6ml/min/1,73m2 in the end of the 5 years of SGLT2 inhibitor use.

Conclusion

This observational study shows that after an initial reduction in eGFR during the first 6 months of treatment, the use of iSGLT2 after five years slowed the decrease in eGFR, similar to what randomized control trials have demonstrated, promoting a renoprotective effect on type 2 diabetic patients.

Application of a sub-0.1-mm3 implantable mote for in vivo real-time wireless temperature sensing

There has been increasing interest in wireless, miniaturized implantable medical devices for in vivo and in situ physiological monitoring. Here, we present such an implant that uses a conventional ultrasound imager for wireless powering and data communication and acts as a probe for real-time temperature sensing, including the monitoring of body temperature and temperature changes resulting from therapeutic application of ultrasound. The sub-0.1-mm³, sub-1-nW device, referred to as a mote, achieves aggressive miniaturization through the monolithic integration of a custom low-power temperature sensor chip with a microscale piezoelectric transducer fabricated on top of the chip. The small displaced volume of these motes allows them to be implanted or injected using minimally invasive techniques with improved biocompatibility. We demonstrate their sensing functionality in vivo for an ultrasound neurostimulation procedure in mice. Our motes have the potential to be adapted to the distributed and localized sensing of other clinically relevant physiological parameters.

Gray matter reduction in high-risk subjects, recently diagnosed and chronic patients with schizophrenia: A revised coordinate-based meta-analysis

Introduction

Characterizing neuroanatomical markers of different stages of schizophrenia (SZ) to assess of how the disorder develops is extremely important for the clinical practice. It still remains uncertain how abnormalities are formed as SZ progresses.

Objectives

We reviewed and analyzed 113 voxel based morphometry studies on people at risk of or with schizophrenia to assess GM alterations at different stages of the disorder and to functionally characterize these GM variations.

Methods

We performed a meta-analysis of voxel-based morphometry studies of genetic and clinical high-risk subjects (g-/c-HR), recently diagnosed (RDSZ) and chronic SZ patients (ChSZ). We quantified gray matter (GM) changes associated with these four conditions and compared them with contrast and conjunctional data. We performed the behavioral analysis and networks decomposition of alterations to obtain their functional characterization.

Results

Compared to previous investigations, results reveal a robust cortical-subcortical, left-to-right homotopic progression of GM loss. The right anterior cingulate is the only altered region in all conditions. Contrast analyses show left-lateralized insular, amygdalar and parahippocampal GM reduction in RDSZ, which appears bilateral in ChSZ. An overlap between RDSZ and ChSZ is observed in the left insula, amygdala, precentral and inferior frontal gyri. Functional decomposition shows involvement of the salience network, with an enlargement of the sensorimotor network in RDSZ and the thalamus-basal nuclei network in ChSZ.

Conclusions

These results can help the research on diagnostic and neuroimaging biomarkers of SZ staging, as well as on the identification of new therapeutics neuroanotomic targets that could be addressed with focused magnetic or non-invasive electric stimulation.

Disclosure

No significant relationships.

Clinical Features and Prognostic Factors of 245 Portuguese Patients Hospitalized With COVID-19

Introduction Since the declaration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in March 2020, Portugal was considered a role model with regards to the first COVID-19 wave. However, a third wave started in 2021 started, turning the country into the worst in the world regarding new infections and death rate per capita in the last weeks of January 2021. No significant data regarding the country's first wave of hospitalized patients have been published. Those data may help understand the differences over time regarding patients and the clinical approach to them. Herein, we present data of COVID-19 patients hospitalized at the main tertiary hospital of the second-most affected county at the time and identify risk factors associated with disease progression and outcomes. Materials and methods We performed a prospective observational study of patients admitted with COVID-19 to a central hospital between March 20 and June 1, 2020. The primary endpoint of this study was 30-day mortality or the need for ventilatory support and the secondary outcomes were both outcomes individually. Results 245 patients were included, with a median age of 79 years, 52% males. Hypertension (n = 172) and dyslipidemia (n = 114) were the most frequent comorbidities. Half of the patients (n = 121) were treated with hydroxychloroquine. The primary outcome occurred in 114 patients; mortality at 30 days was 35%. Age (OR 1.05; 1.02-1.07) and active cancer (OR 3.89; 1.43-10.57) were associated with the primary outcome, with dyslipidemia being protective (OR 0.46; 0.25-0.80). Treatment with hydroxychloroquine or lopinavir/ritonavir was not associated with the main outcome. Patients who had been symptomatic for more than 7 days had lower mortality (OR 0.23; 0.09-0.63). Discussion In the present study, age and cancer were associated with higher mortality, as noted in prior articles. The population had a higher median age than reported in previous studies, which may explain the increased mortality. The protective association of dyslipidemia was not previously described. This association was not related to statin intake. Conclusion The reported high mortality of COVID-19 is rarely seen in other infectious diseases. Our elderly population probably reflects more reliably the incidence of COVID-19 in European countries with constricted age pyramids.