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da Silva HC, Vilete L, Coutinho ESF, Luz MP, Mendlowicz M, Portela CM, Figueira I, Ventura P, Mari JDJ, Quintana MI, Ribeiro WS, Andreoli SB, Berger W. The role of childhood cumulative trauma in the risk of lifetime PTSD: An epidemiological study. Psychiatry Res 2024; 336:115887. [PMID: 38642421 DOI: 10.1016/j.psychres.2024.115887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/11/2024] [Accepted: 03/29/2024] [Indexed: 04/22/2024]
Abstract
Cumulative trauma is usually devastating and can lead to severe psychological consequences, including posttraumatic stress disorder (PTSD). Exposure to various types of traumas, particularly during childhood, can be even more deleterious than the sheer number of events experienced. This epidemiological study is the first to investigate the impact of discrete childhood traumatic exposure on the risk of developing lifetime PTSD in a representative sample of the general population of the two biggest Brazilian cities. Participants were aged between 15 and 75 years old, living in São Paulo and Rio de Janeiro, Brazil, who had experienced traumatic events (N = 3,231). The PTSD diagnosis was assessed using the DSM-IV criteria through the version 2.1 of Composite International Diagnostic Interview. To operationalize childhood cumulative trauma, we considered the sum of 15 different childhood trauma categories that occurred before PTSD onset. The final multivariate logistic regression model indicated a strong relationship between the number of discrete types of childhood traumas and the likelihood of the lifetime PTSD development. The lifetime PTSD risk increased 28 % with each different type of childhood trauma when adjusted by confounds. Our study strengthens the evidence associating childhood cumulative trauma to increased lifetime PTSD risk.
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Affiliation(s)
- Herika Cristina da Silva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mariana Pires Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Carla Marques Portela
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jair de Jesus Mari
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, United Kingdom
| | - Maria Inês Quintana
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wagner Silva Ribeiro
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Paiva JM, Dos Santos Melani M, Marques ESN, Arcosy CV, Coutinho ESF, Ventura P, Berger W. The efficacy of internet-delivered cognitive-behavioral therapy for posttraumatic stress disorder according to the mean age of patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2024; 29:683-697. [PMID: 38083873 DOI: 10.1080/13548506.2023.2292478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/04/2023] [Indexed: 03/26/2024]
Abstract
Internet-delivered cognitive-behavioral therapy (I-CBT) is effective in treating post-traumatic stress disorder (PTSD) symptoms, offering enhanced accessibility and cost-effectiveness. However, it's important to note that these technologies may not be suitable for all age groups. Therefore, we conducted a systematic review and meta-analysis to determine if the effectiveness of I-CBT in treating PTSD varies based on the patients' mean age. We conducted a systematic review of the literature, focusing on randomized controlled trials (RCTs) in the ISI Web of Science, PubMed/MEDLINE, and PsycINFO databases. Following this, we performed a meta-analysis and evaluated the risk of bias using the Cochrane risk of bias quality assessment tool. In this study, we examined patient-related factors (civil or military status, age, and gender), clinical characteristics (baseline PTSD severity and type of trauma), and treatment characteristics (type of intervention, synchronous or asynchronous delivery, and the number of sessions) as independent variables. The dependent variable was the reduction in mean PTSD symptoms. Five RCTs out of 1,552 screened studies were included in this review, all of which showed some level of concern regarding potential bias. Our meta-analysis indicates that I-CBT is equally effective regardless of patients' mean age. Since all RCTs included only provide the mean age of the patients, further randomized controlled trials should address the effectiveness of I-CBT among different age groups.
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Affiliation(s)
- Jéssica Meirelles Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marina Dos Santos Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Schoenche Nunes Marques
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cheyenne von Arcosy
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paula Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Mendlowicz MV, Gekker M, Xavier Gomes de Araújo A, de Oliveira L, Pereira MG, Berger W, Pires da Luz M, Vilete LMP, Marques-Portella C, Figueira I, Reis da Silva Junior T. The top-100 cited articles on post-traumatic stress disorder: a historical bibliometric analysis. PSYCHOL HEALTH MED 2024; 29:453-472. [PMID: 36398923 DOI: 10.1080/13548506.2022.2147555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
This is a bibliometric analysis of the most-cited articles on post-traumatic stress disorder (PTSD) with the objective of identifying citation patterns for researchers, journals, centers, periods, topics, and nations. A search was conducted in Thomson Reuters' WoS Core Collection employing the expression TI = (posttraumatic stress disorder OR post-traumatic stress disorder OR PTSD). The 100 most-cited articles were downloaded, and the relevant data were extracted and analyzed. These studies had a total of 69,649 citations, ranging from a minimum of 360 to a maximum of 6029 citations, with an average of 696.49, a standard deviation of 720.92, mode of 369, and a median of 512. Eighty-eight percent of the most-cited articles on PTSD originated from the USA, with just six cities accounting for 52% of the publications and the Boston area alone responsible for almost one-fifth of the total output. The universities of Yale and Harvard headed the ranking of institutions with larger numbers of highly-cited articles. Female researchers represented 42.3% of all authors, 51% of the first authors, and 48% of the corresponding authors. The proportion of M.D. authors decreased significantly between the 1980-1999 (42%) and the 2000-2019 (27.2%) periods while that of Ph.D. authors increased from 44% to 57.4%. The most studied population was military veterans (28%). Female victims of sexual or physical violence, traumatized children, and adult survivors of childhood abuse were assessed in only 6-7% of the most-cited publications. Ten clinical trials evaluated psychological interventions but only three investigated pharmacotherapy. We concluded that influential research on PTSD remains centralized in the USA. A balanced gender representation in publications was found. There was a heavy reliance on combat veterans as the study population. Few highly-cited studies on the pharmacotherapy for PTSD were identified. Focused efforts are needed to address these challenges.
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Affiliation(s)
- Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói 24033-900, Brazil
| | - Márcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Alexandre Xavier Gomes de Araújo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Rua Marquês do Paraná, 303 - 3° andar do Prédio Anexo, Niterói 24033-900, Brazil
| | - Letícia de Oliveira
- Biomedical Institute, Universidade Federal Fluminense (UFF). Rua Prof. Hernani Pires de Mello, 101, Niterói 24210-130, Brazil
| | - Mirtes Garcia Pereira
- Biomedical Institute, Universidade Federal Fluminense (UFF). Rua Prof. Hernani Pires de Mello, 101, Niterói 24210-130, Brazil
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Mariana Pires da Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Liliane Maria Pereira Vilete
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
| | - Taylor Reis da Silva Junior
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Avenida Venceslau Brás, 71 fundos. Rio de Janeiro 22290-140, Brazil
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Von Arcosy C, Padilha M, Mello GL, Vilete L, Luz MP, Mendlowicz M, Serpa OD, Berger W. A bright side of adversity? A systematic review on posttraumatic growth among refugees. Stress Health 2023; 39:956-976. [PMID: 36949033 DOI: 10.1002/smi.3242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
Until the third trimester of 2022, 103 million people worldwide had been forced to leave their homes and become refugees. The traumatic experiences of refugees can lead not only to mental disorders but also to Posttraumatic Growth (PTG). (1) To find the variables positively and negatively associated with PTG in refugees. (2) To investigate the relationship between PTG and Posttraumatic Stress Disorder (PTSD) among refugees. We systematically searched Medline, Web of Knowledge, PsycInfo, Scopus, and PTSD Pubs for studies about PTG in refugees. Epidemiological studies using the Posttraumatic Growth Inventory. Grey literature, reviews, and meta-analysis. Risk of bias was assessed by the 'The Joanna Briggs Institute Prevalence Critical Appraisal Tool'. We included 24 studies investigating PTG and associated factors. The factors positively associated with PTG were social support, regular migration status, religiosity, satisfaction with life, time, and problem-focussed and emotion-focussed coping. The factors negatively associated with PTG were: irregular migration status, emotional suppression, and avoidance coping. Studies on PTG in refugees are essential to finding new ways to address mental health in this field. Few studies offered risk of bias, particularly regarding the sample selection. We conclude that PTG may be influenced by many factors and it would be of importance that the centres for support, as well as public policies, took that into account to foster the outcome and not only to focus on disease. This study was partially supported by CAPES and registered on PROSPERO (CRD42020215607).
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Affiliation(s)
- Cheyenne Von Arcosy
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Padilha
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriel Lorran Mello
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Pires Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Octavio Domont Serpa
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Portugal LCL, Ramos TC, Fernandes O, Bastos AF, Campos B, Mendlowicz MV, da Luz M, Portella C, Berger W, Volchan E, David IA, Erthal F, Pereira MG, de Oliveira L. Machine learning applied to fMRI patterns of brain activation in response to mutilation pictures predicts PTSD symptoms. BMC Psychiatry 2023; 23:719. [PMID: 37798693 PMCID: PMC10552290 DOI: 10.1186/s12888-023-05220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The present study aimed to apply multivariate pattern recognition methods to predict posttraumatic stress symptoms from whole-brain activation patterns during two contexts where the aversiveness of unpleasant pictures was manipulated by the presence or absence of safety cues. METHODS Trauma-exposed participants were presented with neutral and mutilation pictures during functional magnetic resonance imaging (fMRI) collection. Before the presentation of pictures, a text informed the subjects that the pictures were fictitious ("safe context") or real-life scenes ("real context"). We trained machine learning regression models (Gaussian process regression (GPR)) to predict PTSD symptoms in real and safe contexts. RESULTS The GPR model could predict PTSD symptoms from brain responses to mutilation pictures in the real context but not in the safe context. The brain regions with the highest contribution to the model were the occipito-parietal regions, including the superior parietal gyrus, inferior parietal gyrus, and supramarginal gyrus. Additional analysis showed that GPR regression models accurately predicted clusters of PTSD symptoms, nominal intrusion, avoidance, and alterations in cognition. As expected, we obtained very similar results as those obtained in a model predicting PTSD total symptoms. CONCLUSION This study is the first to show that machine learning applied to fMRI data collected in an aversive context can predict not only PTSD total symptoms but also clusters of PTSD symptoms in a more aversive context. Furthermore, this approach was able to identify potential biomarkers for PTSD, especially in occipitoparietal regions.
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Affiliation(s)
- Liana Catarina Lima Portugal
- Neurophysiology Laboratory, Department of Physiological Sciences, Roberto Alcantara Gomes Biology Institute, Biomedical Center, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 87 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Taiane Coelho Ramos
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
- Mídiacom Lab, Institute of Computing, Universidade Federal Fluminense, Av. Gal. Milton Tavares de Souza, s/n, São Domingos, Niterói, RJ, 24210-310, Brazil
| | - Orlando Fernandes
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Aline Furtado Bastos
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Bruna Campos
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro Vitor Mendlowicz
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana da Luz
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Carla Portella
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Isabel Antunes David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Fátima Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, 373 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
- Linpes, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Av. Venceslau Brás, 71 - Botafogo, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mirtes Garcia Pereira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, R. Prof. Hernani Pires de Mello, 101, São Domingos, Niterói, RJ, 24210-130, Brazil.
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Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MPD, Pires-Dias PRT, Marques-Portela C, Figueira I, Mendlowicz MV. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med 2023; 53:132-139. [PMID: 33849680 DOI: 10.1017/s0033291721001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
| | - Maria Luiza Garcia-Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
| | - Marcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires de Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Carla Marques-Portela
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
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Zakhour S, Sardinha A, Levitan M, Berger W, Nardi AE. Instruments for assessing sexual dysfunction in Arabic: A systematic literature review. Transcult Psychiatry 2022; 59:819-830. [PMID: 35818838 DOI: 10.1177/13634615221105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sexual health is relevant throughout a person's life; however, studying human sexuality is complex and requires particular care when working with individuals from different cultural and social backgrounds. Much of the research addressing this subject has been conducted in Western countries, and that in non-Western countries is generally based on small sample sizes. The biopsychosocial nature of sexuality and its dysfunctions should be taken into consideration given that it is indispensable when conducting and assessing sexual studies in different countries and cultures. Therefore, culturally sensitive studies that consider cultural contexts and determinants as well as social markers are needed. The topic of sexuality in Arab culture is still enigmatic. This enigma has impacted the advancement of sexual science and limited researchers, health care practitioners, and patients. Thus, the aim of this systematic literature review was to find and assemble all scales and questionnaires regarding human sexual health that have been translated into Arabic and validated in order to promote a critical analysis of the methods used in each instrument and to inform readers and researchers of the limits and potential of each scale. Electronic databases were systematically searched, and eight instruments were selected for inclusion: the Arabic Index of Premature Ejaculation (AIPE), the Sexual Health Inventory for Men (SHIM), the Arabic Female Sexual Function Index (ArFSFI), the Female Genital Self-Image Scale (AVFGSIS), the Arabic Arizona Sexual Experiences Scale (ASEX), the Egyptian Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), the Saudi Arabian Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire in Arabic (PSIQ-IR), and the Arabic Female Sexual Distress Scale (FSDS). All included instruments showed good validity and reliability for the target population. Future studies are needed to develop culturally sensitive instruments.
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Affiliation(s)
- Stephanie Zakhour
- Institute of Psychiatry (IPUB), Department of Psychiatry & Legal Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Reis T, Gekker M, Land MGP, Mendlowicz MV, Berger W, Luz MP, Vilete L, Figueira I, Araújo AXG. The growth and development of research on personality disorders: A bibliometric study. Personal Ment Health 2022; 16:290-299. [PMID: 35182026 DOI: 10.1002/pmh.1540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
Abstract
This study objective was to investigate publication trends on personality disorders (PD) and to identify patterns of historical development. Publication rates were determined using the Results by Year Timeline feature of PubMed. Time series autoregressive integrated moving average models were used to analyse the publication rates for PDs in quinquennial periods beginning in 1980 and ending in 2019 and to predict the number of publications in the 2024-2029 period. More than 300 articles on antisocial and borderline PD are being published each year, and the models suggest an accelerating growth rate. Approximately 100 articles are being published on average every year on schizotypal PD, and the regression model indicates linear growth in the near future. The mean number of publications per year for obsessive-compulsive, narcissistic and avoidant PDs is in the range of 10-30 with the corresponding models indicating linear growth. Fewer than 10 articles are being published each year on dependent, paranoid, histrionic and schizoid PD, whereas dependent PD shows modest growth and paranoid PD rates tended to stability, histrionic and schizoid PD exhibit declining rates. Personality disorders are a group of conditions with diverse etiological, prognostic, therapeutic, legal, research, social and cultural implications that influence publication rates.
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Affiliation(s)
- Taylor Reis
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Márcio Gekker
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Marcelo Gerardin Poirot Land
- Clinical Medicine Graduate Medical Program I Maternal and Child Health Graduate Program, Universidade Federal do Rio de Janeiro (UFRJ), 225 Rodolpho Paulo Rocco Avenue, building F, suite 5. University City, Fundão Island, Rio de Janeiro, Rio de Janeiro, 21941-905, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
| | - William Berger
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Liliane Vilete
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Ivan Figueira
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil
| | - Alexandre Xavier Gomes Araújo
- Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), 71 Venceslau Brás Avenue, Rio de Janeiro, Rio de Janeiro, 22290-140, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), 303 Marquês de Paraná Street, second floor, Niteroi, Rio de Janeiro, 24220-000, Brazil
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Kalaf J, Freire Coutinho ES, Mendlowicz M, Marques Portella C, Berger W, Pires Luz M, Volchan E, Rui Ventura P, Nascimento Júdice M, Alvarenga Flavio Blanco S, Meirelles Paiva J, Figueira I. STUCK IN A MOMENT: TONIC IMMOBILITY PREDICTS POOR QUALITY OF LIFE IN TREATED PTSD PATIENTS. Psychiat Danub 2022; 34:447-454. [DOI: 10.24869/psyd.2022.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Machado AV, Gonçalves RM, Gama CMF, Vilete LMP, Berger W, Passos RBF, Mendlowicz MV, Souza GGL, Pereira MG, Mocaiber I, de Oliveira L. The different impacts of COVID-19 on the mental health of distinct health care worker categories. J Health Psychol 2022; 28:434-449. [PMID: 36113021 PMCID: PMC10076179 DOI: 10.1177/13591053221120968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present study sought to explore the factors associated with the odds of having probable depression and posttraumatic stress disorder (PTSD) related to traumatic COVID-19 experiences and their impact on health care workers in distinct categories. In this cross-sectional study, 1843 health care workers (nurses, nurse technicians, physicians, physical therapists, and other healthcare workers) were recruited via convenience sampling. A survey was administered to obtain information regarding sociodemographic, occupational, and mental health status. Descriptive statistics and multivariable logistic regression were used for the analyses. Being a nurse technician was associated with an odds ratio of 1.76 for probable PTSD. No relation was observed between health care worker categories and the odds of probable depression. Additionally, being female and not receiving adequate PPE were related to greater odds of having probable PTSD and depression.
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Neumayer K, Kastler L, Laaber M, Roschger C, Lenz S, Lötsch-Gojo D, Berger W, Gruber A, Spiegl-Kreinecker S. P18.06.B ETS-Transcription Factor inhibitors are effective in TERT promoter mutated meningioma cells in vitro. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
TERT promoter mutations in meningiomas were recently found to be strongly prognostic and associated with malignant progression and risk of recurrence. As result, the mutation in the TERT promoter generates a binding site for E twenty-six (ETS) transcription factors. Consequently, ETS-transcription factor inhibition might represent a novel strategy to impede meningioma growth. In a prior study we could demonstrate effectiveness of the ETS-transcription factor inhibitor YK-4-279 in TERT promoter mutant meningiomas. Recently, TK216 the clinical derivative of YK-4-279 was developed. Therefore, we aimed to clarify whether TK216 might have an increased effect as compared to YK-4-279 in TERT promoter mutated meningioma cells in vitro.
Methods
A meningioma-derived cell line (BTL695) generated from a TERT promoter mutated (C228T) anaplastic meningioma served as cell model for the experiments. BTL695 was characterized by high telomerase activity and TERT mRNA expression as analysed by the TRAP assay and RT-PCR, respectively. Genomic aberrations were verified using Ion Torrent Oncomine Comprehensive Assay v3-based next-generation sequencing (NGS). The sensitivity of BTL695 to YK-4-279 and TK216 was determined using an MTT-based viability assay (EZ4U). To elucidate the effectiveness of TK216 on cell cycle and apoptosis, cells were stained with PI and annexin V, respectively, and measured by flow cytometry. The effect of TK216 on the protein expression of the cleaved poly(ADP-ribose) polymerase-1 (PARP-1), indicative for apoptosis, was investigated by western blot. Additionally, a TK216-resistant cell model (BTL695res) was generated and analysed by NGS.
Results
BTL695 was significantly more sensitive to TK216 as compared to YK-4-279 (p<0.0001) characterized by the distinctly lower IC50 value of TK216 exposed cells (0.7 µM TK216; 1.6 µM YK-4-279). Flow cytometry analysis revealed a TK216 induced G2M cell cycle arrest and increased apoptosis rate, which was additionally verified by the expression of cleaved PARP-1 expression using western blot. Genomic aberrations were found in 18 genes including NF2, CDKN2A/B, ARID1A and PTEN. Interestingly, although the majority of genomic alterations was persistent in the TK216 resistant cell model, a p53 mutation was newly acquired as compared to the parental cell line.
Conclusion
In summary, our results indicate that ETS transcription factor inhibition by TK216 exerts antitumour activity in our TERT promoter mutant meningioma cell model. Additionally, the sensitivity against TK216 is superior to YK-4-279 and therefore TK216 may represent a promising new therapeutic option for patients with aggressive, TERT promoter mutated meningioma.
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Affiliation(s)
- K Neumayer
- Department of Neurosurgery, Kepler University Hospital GmbH , Linz , Austria
| | - L Kastler
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - M Laaber
- Department of Neurosurgery, Kepler University Hospital GmbH , Linz , Austria
| | - C Roschger
- Department of Cardiovascular and Thoracic Surgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - S Lenz
- Clinical Institute of Pathology and Molecular Pathology, Kepler University Hospital GmbH , Linz , Austria
| | - D Lötsch-Gojo
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - W Berger
- Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna , Vienna , Austria
| | - A Gruber
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - S Spiegl-Kreinecker
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
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Mischkulnig M, Roetzer-Pejrimovsky T, Lötsch-Gojo D, Kastner N, Bruckner K, Prihoda R, Lang A, Martinez-Moreno M, Furtner J, Berghoff A, Woehrer A, Berger W, Widhalm G, Kiesel B. P07.04.B Heme biosynthesis factors and 5-ALA induced fluorescence: analysis of mRNA and protein expression in fluorescing and non-fluorescing gliomas. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The intraoperative visualization of adult-type diffuse gliomas with 5-aminolevulinic acid (5-ALA) induced fluorescence is widely used in the neurosurgical field. While visible 5-ALA induced fluorescence is found in the majority of high-grade gliomas, most low-grade gliomas lack visible fluorescence during surgery. Recently, the heme biosynthesis pathway was identified as crucial influencing factor for presence of visible fluorescence since it metabolizes 5-ALA to fluorescing Protoporphyrin IX (PpIX). However, the exact alterations within the heme biosynthesis pathway resulting in visible 5-ALA induced fluorescence in gliomas are still unclear. The aim of the present study was thus to compare the mRNA and protein expression of promising intramitochondrial heme biosynthesis enzymes/transporters in glioma tissue samples of different fluorescence behavior.
Material and Methods
A total of 19 strongly fluorescing and 21 non-fluorescing tissue samples from neurosurgical adult-type diffuse gliomas (WHO grades II-IV) were included in the current analysis. In these samples, we investigated the mRNA expression by quantitative real time PCR and protein expression using immunohistochemistry of the intramitochondrial heme biosynthesis enzymes Coproporphyrinogen Oxidase (CPOX), Protoporphyrinogen Oxidase (PPOX), Ferrochelatase (FECH) and the transporter ATP-binding Cassette Subfamily B Member 2 (ABCG2).
Results
Regarding mRNA expression analysis, we found a significantly decreased ABCG2 expression in fluorescing specimens compared to non-fluorescing samples (p=0.001), whereas no difference in CPOX, PPOX and FECH was present. With respect to protein expression, significantly higher levels of CPOX (p=0.005), PPOX (p<0.01) and FECH (p=0.003) were detected in fluorescing samples. Similar to mRNA expression analysis, the protein expression of ABCG2 (p=0.001) was significantly lower in fluorescing samples.
Conclusion
Distinct alterations of the analyzed heme biosynthesis factors were found primarily on protein level. Our data indicate that heme biosynthesis pathway activity in general is enhanced in fluorescing gliomas with upregulation of PpIX generating enzymes and decreased ABCG2 mediated PpIX efflux outweighing the also increased further metabolization of PpIX to heme. Intramitochondrial heme biosynthesis factors thus constitute promising pharmacological targets to optimize intraoperative 5-ALA fluorescence visualization of usually non-fluorescing tumors such as low-grade gliomas.
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Affiliation(s)
| | | | | | - N Kastner
- Medical University of Vienna , Vienna , Austria
| | - K Bruckner
- Medical University of Vienna , Vienna , Austria
| | - R Prihoda
- University Hospital of St. Poelten , St. Poelten , Austria
| | - A Lang
- Medical University of Vienna , Vienna , Austria
| | | | - J Furtner
- Medical University of Vienna , Vienna , Austria
| | - A Berghoff
- Medical University of Vienna , Vienna , Austria
| | - A Woehrer
- Medical University of Vienna , Vienna , Austria
| | - W Berger
- Medical University of Vienna , Vienna , Austria
| | - G Widhalm
- Medical University of Vienna , Vienna , Austria
| | - B Kiesel
- Medical University of Vienna , Vienna , Austria
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13
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Kastler L, Neumayer K, Laaber M, Roschger C, Lenz S, Lötsch-Gojo D, Berger W, Gruber A, Spiegl-Kreinecker S. P10.08.A Lipogenesis inhibition by fatostatin shows effectiveness in glioblastoma models highly expressing fatty acid synthase (FASN). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is the most common and most aggressive primary brain tumour in adults. Despite intensive treatment, the medium overall survival of GBM patients remains below 20 months after diagnosis. Therefore, new tumour specific targets allowing successful therapeutic treatment are needed to distinctly enhance GBM patient overall survival. Reprogramming of lipid metabolism leading to highly upregulated anabolic pathways, like phosphatidylinositol-3-kinase (PI3K)/AKT pathway and subsequently lipogenesis, is a hallmark of cancer cells including glioblastomas to meet increased energy demands for proliferation and cell growth. Accordingly, lipogenesis inhibition might be a promising strategy to impede GBM cell growth. Therefore, it was aim of our study to analyse the effect of the lipogenesis inhibitor fatostatin on downstream targets e.g. fatty acid synthase (FASN) and its impact on cell growth in GBM cells in vitro.
Material and Methods
In a cohort of 52 GBM-derived cell lines, FASN mRNA was investigated by qRT-PCR. The impact of fatostatin on cell viability (IC50) was analysed in selected cell lines using cell viability assays (Cell Titer Glo®). To elucidate whether fatostatin exposure affects cell migration, wound healing assays were performed. The effect of fatostatin on cell cycle and apoptosis was analysed by flow cytometry. Additionally, expression of FASN and level of phosphorylated AKT, the active form of AKT serine/threonine kinase, were examined before and after fatostatin treatment with qRT-PCR (mRNA) and Western blot (protein), respectively.
Results
FASN mRNA was found to be expressed at varying levels in our GBM-derived cell line cohort (n=52). Compared to normal astrocytes, FASN mRNA expression was significantly upregulated in GBM cells (p=0.0127). Furthermore, high FASN mRNA expression was significantly associated with higher sensitivity against fatostatin (p=0.0352). Regarding corresponding recurrences, the response to the inhibitor was shown to be persistent. Accordingly, the effectiveness of fatostatin treatment resulted in substantial downregulation of AKT phosphorylation and consequently in the induction of apoptosis and G2/M arrest of the cell cycle. In addition, a significant inhibition of the migration potential by fatostatin treatment was observed.
Conclusion
In summary, FASN expression represents a promising biomarker and therapy target within the lipid metabolism indicated by a significant sensitivity to fatostatin in FASN overexpressing GBM cell lines. Consequently, lipogenesis inhibition by fatostatin might be a promising novel therapeutic option in glioblastoma.
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Affiliation(s)
- L Kastler
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - K Neumayer
- Department of Neurosurgery, Kepler University Hospital GmbH , Linz , Austria
| | - M Laaber
- Department of Neurosurgery, Kepler University Hospital GmbH , Linz , Austria
| | - C Roschger
- Department of Cardiovascular and Thoracic Surgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - S Lenz
- Clinical Institute of Pathology and Molecular Pathology, Kepler University Hospital GmbH , Linz , Austria
| | - D Lötsch-Gojo
- Department of Neurosurgery, Medical University of Vienna , Vienna , Austria
| | - W Berger
- Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Medical University of Vienna , Vienna , Austria
| | - A Gruber
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
| | - S Spiegl-Kreinecker
- Department of Neurosurgery, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University , Linz , Austria
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Ries A, Flehberger D, Schelch K, Pirker C, Hoda M, Berger W, Grusch M. EP07.01-014 Mesothelioma-Associated Fibroblasts Enhance Mesothelioma Aggressiveness and Modulate Drug Response. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Gama CMF, de Souza Junior S, Gonçalves RM, Santos EDC, Machado AV, Portugal LCL, Passos RBF, Erthal FS, Vilete LMP, Mendlowicz MV, Berger W, Volchan E, de Oliveira L, Pereira MG. Tonic immobility is associated with posttraumatic stress symptoms in healthcare professionals exposed to COVID-19-related trauma. J Anxiety Disord 2022; 90:102604. [PMID: 35917747 PMCID: PMC9272678 DOI: 10.1016/j.janxdis.2022.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has exposed healthcare workers (HCW) to traumatic situations that might lead to the development of posttraumatic stress disorder (PTSD). An important vulnerability factor for PTSD is the peritraumatic tonic immobility (TI) reaction, an involuntary and reflexive defensive response evoked by an intense and inescapable threat. TI is largely understudied in humans and has not been investigated during trauma related to COVID-19. For HCW, the pandemic context might be experienced as an intense and potentially inescapable threat, i.e., an overwhelming situation. Here, we investigated if TI response occurred during traumatic events related to the pandemic and its association with posttraumatic stress symptoms (PTSS). An online survey of 1001 HCW investigated COVID-19-related traumatic experiences, TI and PTSS. TI was reported for all types of traumatic events, and multivariate regression models revealed that TI was significantly associated with PTSS severity. HCW who reported high TI scores exhibited an increase of 9.08 times the probability of having a probable diagnosis of PTSD. Thus, TI was evoked by pandemic-related traumatic situations and associated with PTSS severity and higher odds of a PTSD diagnosis. Tonic immobility occurrence should be screened, and psychoeducation about its reflexive biological nature should be introduced.
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Affiliation(s)
- Camila Monteiro Fabricio Gama
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Sérgio de Souza Junior
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Raquel Menezes Gonçalves
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Emmanuele da Conceição Santos
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Arthur Viana Machado
- Laboratório de Psicofisiologia Cognitiva, de Ciencias da NaturezaDepartamento de Ciências da Natureza, Instituto de Humanidades e Saúde, Universidade Federal Fluminense, Rua Recife s/no Jardim Bela Vista, 28890-000 Rio das Ostras, RJ, Brazil.
| | - Liana Catarina Lima Portugal
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil; Departamento de Ciências Fisiológicas, Instituto de Biologia Roberto Alcantara Gomes, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu 444, 5º andar, Vila Isabel, 20550-170 Rio de Janeiro, RJ, Brazil.
| | - Roberta Benitez Freitas Passos
- Departamento de Medicina Geral, Escola de Medicina e Cirurgia, Universidade Federal do Estado do Rio de Janeiro, Rua Mariz e Barros 775, 7a. enfermaria, Maracanã, 20270-004 Rio de Janeiro, RJ, Brazil.
| | - Fátima Smith Erthal
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Liliane Maria Pereira Vilete
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Instituto de Psiquiatria da UFRJ, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Mauro Vitor Mendlowicz
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil; Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense, Avenida Marquês de Paraná, 303, prédio anexo, 3º andar, Centro, 24030-215 Niteroi, RJ, Brazil.
| | - William Berger
- Instituto de Psiquiatria da UFRJ, Departamento de Psiquiatria e Saúde Mental, Universidade Federal do Rio de Janeiro, Avenida Venceslau Brás, 71, Fundos, Botafogo, 22290140 Rio de Janeiro, RJ, Brazil.
| | - Eliane Volchan
- Laboratório de Neurobiologia, Instituto de Biofísica Carlos Chagas Filho, Bloco G, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Ilha do Fundão 21949-900, RJ, Brazil.
| | - Leticia de Oliveira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
| | - Mirtes Garcia Pereira
- Laboratório de Neurofisiologia do Comportamento (LabNeC), Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello, 101, São Domingos, 24210-130 Niterói, RJ, Brazil.
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Paiva J, Melani M, Gonçalves RM, Luz MP, Mendlowicz MV, Figueira I, von Arcosy C, Ventura P, Berger W. Predictors of response to cognitive-behavioral therapy in patients with posttraumatic stress disorder: a systematic review. J bras psiquiatr 2022. [DOI: 10.1590/0047-2085000000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder. Even when treated with the first-line intervention, cognitive-behavioral therapy (CBT), 45% of the patients continue suffering from this disorder. Therefore, knowing the factors that could foresee who will respond to CBT would be of great value to the treatment of these patients. Thus, we have systematically reviewed the literature to identify the variables that could predict response to CBT in patients suffering from PTSD. Methods Following the PRISMA 2020 guidelines, we searched the electronic databases ISI Web of Science, Scopus, PsycINFO, MEDLINE, and PTSDpubs until November 2021. Two authors have independently conducted study selection and data extraction. Studies that examined possible predictors of response to therapy on a sample of adults (18-65 years), both genders, with and without comorbidities were considered eligible. The characteristics of the studies were synthesized in a table. The risk of bias was assessed by the Cochrane risk of bias quality assessment tool. Results Twenty-eight studies comprising 15 variables were selected. Among those, eight showed a low risk of bias, 19 showed some concerns, and one showed a high potential risk of bias. The therapeutic relationship was the only variable considered to be a predictor of a good response to therapy. All other variables showed conflicting results. Conclusions The most promising variable, although scientifically weak, is the therapeutic relationship. Additional randomized clinical trials should be conducted to clarify the role of this variable as a predictor of response to CBT in patients with PTSD.
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Campos B, Vinder V, Passos RBF, Coutinho ESF, Vieira NCP, Leal KB, Mendlowicz MV, Figueira I, Luz MP, Marques-Portela C, Vilete LMP, Berger W. To BDZ or not to BDZ? That is the question! Is there reliable scientific evidence for or against using benzodiazepines in the aftermath of potentially traumatic events for the prevention of PTSD? A systematic review and meta-analysis. J Psychopharmacol 2022; 36:449-459. [PMID: 35437077 DOI: 10.1177/02698811221080464] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most international guidelines suggest that benzodiazepines (BDZs) may be inefficient or iatrogenic in the aftermath of a potentially traumatic event (PTE). The goal of this study was to assess the strength of the evidence on whether the use of BDZs in the aftermath of a PTE negatively affects the incidence and severity of post-traumatic stress disorder (PTSD). METHODS We systematically scrutinized the ISI Web of Knowledge, MEDLINE, SCOPUS, and PTSDpubs electronic databases in addition to citation searching. We included original studies providing data about the development of PTSD in adults after BDZ administration in the aftermath of a PTE. We screened 387 abstracts and selected eight studies for the qualitative synthesis and seven for the meta-analysis. We performed two separate meta-analyses, one for randomized clinical trials (RCTs) and the other for cohort studies. Heterogeneity between studies was evaluated with Higgins I² statistic and tested using the χ². This study was registered at PROSPERO (number 127170). RESULTS The meta-analysis of the cohort studies showed an increased risk of PTSD in patients who received BDZs compared to those who did not (risk ratio (RR) = 1.53; 95% confidence interval (CI): 1.05-2.23) with a modest heterogeneity among studies (I2 = 41.8, p = 0.143). Regarding the RCTs, the combined measure revealed a tendency toward an increased severity of the PTSD symptoms (standardized mean difference (SMD): 0.24; 95% CI: 0.32-0.79). CONCLUSION The studies reviewed showed a possible harmful effect of BDZs when used immediately after a PTE. However, these conclusions were based on a small number of studies of poor to moderate methodological quality.
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Affiliation(s)
- Bruna Campos
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Vitor Vinder
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Evandro Silva Freire Coutinho
- National School of Public Health, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Institute of Social Medicine, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Norma Cavalcanti Pontilhão Vieira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Katherine Branco Leal
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carla Marques-Portela
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Liliane Maria Pereira Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Sipe JM, Bossa N, Berger W, von Windheim N, Gall K, Wiesner MR. From bottle to microplastics: Can we estimate how our plastic products are breaking down? Sci Total Environ 2022; 814:152460. [PMID: 34973311 DOI: 10.1016/j.scitotenv.2021.152460] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 05/14/2023]
Abstract
Microplastics (MPs) have become an emerging new pollutant of rising concern due to the exponential growth of plastics in consumer products. Most MP and nanoplastic pollution comes from the fragmentation of plastics through mechanical stress, chemical reactions and biological degradation that occurs during use and after disposal. Models predicting the generation and behavior of MP in the environment are developing, however there is lack of data to predict the rates of MP generation as a function of the abrasive forces. A method to deliver scalable, quantitative release rates of MPs during mechanical stress throughout a plastic's life cycle (e.g., sanding, chewing, river and ocean disposal) is described. A custom abrasion machine was built with features to provide data to calculate power input. The generation rate of MPs through abrasion was tested for the following 3D printed polymers: polylactic acid (PLA), polycarbonate (PC), thermoplastic polyurethane 85A (TPU), polyethylene glycol terephthalate (PETG), high-impact polystyrene (HIPS), and nylon. Each material underwent tensile strength material tests to identify which mechanical properties drive their abrasion rate. Abrasion rate was not observed to correlate to macroscopic mechanic properties. Results indicate that the order of abrasion from most to least were HIPS, nylon, PC, PLA, PETG, and then TPU. This study will help comprehend and provide data to understand generation rates of MPs from consumer plastic products and macro-plastic debris. This will be instrumental in helping to better understand the release of MPs and nanoplastics into the environment and to provide data for fate and transport models, especially in order to predict the amount of plastic entering water systems. MP generation rates and power inputs can be correlated with each plastic's use to inform which release the most MPs and how to better change these products in order to reduce pollution in water sources.
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Affiliation(s)
- Joana Marie Sipe
- Department of Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA
| | - Nathan Bossa
- Department of Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA
| | - William Berger
- Department of Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA; Department of Mechanical and Materials Engineering, Duke University, Durham, NC 27708, USA
| | - Natalia von Windheim
- Department of Mechanical and Materials Engineering, Duke University, Durham, NC 27708, USA
| | - Ken Gall
- Department of Mechanical and Materials Engineering, Duke University, Durham, NC 27708, USA
| | - Mark R Wiesner
- Department of Civil and Environmental Engineering, Duke University, Durham, NC 27708, USA.
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19
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Cosentino A, Odorizzi G, Berger W. Infected hip prosthesis in patient with suspected Covid-19 infection. Arthroplasty 2022; 3:3. [PMID: 34977465 PMCID: PMC7850715 DOI: 10.1186/s42836-020-00058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Infections following arthroplasty are one of the major risks during this type of surgery. Moreover, the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus Disease 2), has developed into an unprecedented pandemic, posing enormous pressure on health-care providers around the world. Case presentation Four and half years after right hip arthroplasty, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment. After carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E. coli. The patient underwent surgery by which the prosthesis was removed and a spacer was implanted. A therapy with Cefotaxim 2 g three times a day for 6 weeks was then set, and then a total arthroplasty was performed. During this period, the COVID-19 pandemic occurred and therefore the patient received nasal-throat swabbing two times, and both yielded negative results. However, 1 week after the final surgery, his respiratory conditions deteriorated and chest X-ray and CT scan showed images of ground-glass opacification patterns (GGO). Due to the clinical symptoms and the characteristic images of the instrumental examinations, the patient was transferred to an observation ward. Thereafter, two more swab tests gave negative results. The patient was then transferred to the ward for patients with typical symptoms of COVID-19 but with negative swab tests for 2 weeks and was subsequently discharged home. Conclusion The purpose of this case report was to point out the correct treatment of a PJI after the outbreak of COVID-19. Despite the ongoing COVID-19 pandemic, the guidelines in the case of periprosthetic hip infection further confirmed the correct management of the patient.
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Affiliation(s)
- A Cosentino
- F. Tappeiner Hospital, via Rossini 5, 39012, Meran, BZ Italy
| | - G Odorizzi
- F. Tappeiner Hospital, via Rossini 5, 39012, Meran, BZ Italy
| | - W Berger
- F. Tappeiner Hospital, via Rossini 5, 39012, Meran, BZ Italy
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20
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Blaiss M, Berger W, Chipps B, Hernandez-Trujillo V, Phipatanakul W, Steward K. Review of efficacy of ciclesonide for the treatment of asthma in children. Allergy Asthma Proc 2021; 42:461-470. [PMID: 34871153 DOI: 10.2500/aap.2021.42.210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Ciclesonide (CIC) is an inhaled corticosteroid (ICS) approved for the maintenance treatment of asthma in patients ages ≥ 12 years. The prodrug aspect of CIC is associated with a safety profile that may make it ideal for children. Objective: The objective was to summarize efficacy results from the eight phase III, randomized, double-blind, controlled trials in children with asthma conducted during CIC clinical development. Methods: Four trials compared CIC 40, 80, or 160 µg/day with placebo. Two trials compared CIC 160 µg/day with fluticasone propionate 200 µg/day, one trial compared CIC 80 or 160 µg/day with fluticasone 200 µg/day, and one trial compared CIC 160 µg/day with budesonide 400 µg/day. Results: The primary end point was met by at least two CIC doses versus placebo in the trials in which the primary end point was the change from baseline in lung function outcome (forced expiratory volume in 1 second [FEV1] % predicted or morning peak expiratory flow [PEF]). A trial that compared CIC with placebo did not meet the primary end point of superiority in time-to-first severe wheeze exacerbation or lack of improvement. The primary end point of noninferiority to the active control (fluticasone or budesonide) in the change from baseline in a lung function outcome (FEV1, morning PEF, evening PEF) was met with the CIC 160-µg dose in all active control trials. CIC generally demonstrated statistically significant improvements in forced expiratory flow at 25%-75% of forced vital capacity, asthma symptoms, rescue medication use, and asthma control when compared with placebo and noninferiority for these outcomes compared with fluticasone or budesonide. Conclusion: In children with asthma, once-daily CIC significantly improved large and small airway function, asthma symptoms, and asthma control, and reduced rescue medication use compared with placebo. CIC was comparable with other ICS used to treat asthma in children, which demonstrated its worth for the pediatric population.
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Affiliation(s)
- Michael Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta Georgia
| | - William Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, California
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
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21
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Blaiss M, Berger W, Chipps B, Hernandez-Trujillo V, Phipatanakul W, Steward K. Safety of ciclesonide in children with asthma: A review of randomized controlled trials. Allergy Asthma Proc 2021; 42:471-480. [PMID: 34871154 DOI: 10.2500/aap.2021.42.210085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Parental concerns about the adverse effects of asthma medications can lead to nonadherence and uncontrolled asthma in children. Ciclesonide (CIC) is a prodrug, with low oropharyngeal deposition and bioavailability that may minimize the risk of local and systemic adverse effects. CIC is U.S. Food and Drug Administration approved for asthma in children ages ≥ 12 years. Objective: To summarize safety results from the 13 phase II or III randomized controlled trials conducted in children with asthma during CIC clinical development. Methods: Four 12- to 24-week trials compared the safety of once-daily CIC 40, 80, or 160 µg/day with placebo; four 12-week trials compared the safety of CIC 80 or 160 µg/day with either fluticasone or budesonide; one 12-month trial compared the long-term safety of CIC 40, 80, or 160 µg/day with fluticasone; one 12-month trial compared growth velocity of CIC 40 or 160 µg/day with placebo; and three cross-over trials compared short-term growth velocity and hypothalamic-pituitary-adrenal (HPA) axis effects of CIC 40, 80, or 160 µg/day with placebo or fluticasone. Results: In all, 4399 children were treated with CIC. The incidence of treatment-emergent adverse events (AE) was similar among the CIC doses and between CIC and placebo in short-term studies and between CIC and fluticasone in the long-term safety study. No CIC-related serious AEs were reported in any study. The incidence of treatment-related oral candidiasis was low and similar between CIC (≤0.5%) and placebo (≤0.7%) or active controls (≤0.5%) in the short-term studies. There was no clinically relevant HPA axis suppression or reduction in growth velocity associated with CIC. Conclusion: Data from 13 studies demonstrate that CIC is associated with low rates of oropharyngeal AEs, with no indication of clinically relevant systemic effects in children with asthma. The favorable safety profile and demonstrated improvements in asthma control make CIC an ideal inhaled corticosteroid for the treatment of asthma in children.
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Affiliation(s)
- Michael Blaiss
- From the Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - William Berger
- Allergy and Asthma Associates of Southern California, Mission Viejo, California
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
| | - Vivian Hernandez-Trujillo
- Department of Pediatrics, Herbert Wertheim School of Medicine, Florida International University, Miami, Florida
| | - Wanda Phipatanakul
- Division of Immunology and Allergy, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
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22
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Magalhaes AA, Gama CMF, Gonçalves RM, Portugal LCL, David IA, Serpeloni F, Wernersbach Pinto L, Assis SG, Avanci JQ, Volchan E, Figueira I, Vilete LMP, Luz MP, Berger W, Erthal FS, Mendlowicz MV, Mocaiber I, Pereira MG, de Oliveira L. Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents. Psychol Res Behav Manag 2021; 14:1359-1369. [PMID: 34512046 PMCID: PMC8420784 DOI: 10.2147/prbm.s317343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. Methods The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). Results We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. Conclusion These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
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Affiliation(s)
- Andressa A Magalhaes
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Camila M F Gama
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Raquel M Gonçalves
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Liana C L Portugal
- Department of Physiological Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Isabel A David
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Fernanda Serpeloni
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Liana Wernersbach Pinto
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Simone G Assis
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil.,The Neurology Postgraduate Program, Hospital Gaffrée and Guinle, Unirio, RJ, 20270-901, Brazil
| | - Joviana Q Avanci
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Ivan Figueira
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Liliane M P Vilete
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana P Luz
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Fatima S Erthal
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Niterói, RJ, 24030-215, Brazil
| | - Izabela Mocaiber
- Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, 28890-000, Brazil
| | - Mirtes G Pereira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
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23
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Oliveira RD, Mendlowicz MV, Berger W, Luz MPD, Marques-Portella C, Figueira I, Araújo AXGD. Unnecessarily prolonged suffering: a case of missed diagnosis of post-traumatic stress disorder in a teaching hospital. J bras psiquiatr 2021. [DOI: 10.1590/0047-2085000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT We described a case in which a heavily-traumatized patient had been under psychiatric treatment for seven years (five of them in a university mental health clinic) but was never diagnosed with PTSD and, therefore, did not receive the proper treatment for a very long period. After the correct diagnosis was made and personalized treatment instituted, the patient has shown marked improvement in functionality and wellbeing. The key element in this case, was the adequacy of psychiatric training. Our report suggests that psychiatrists are not being adequately trained to identify traumatic events and to diagnose atypical cases of PTSD. With that in mind, we emphasize that theoretical modules on trauma and trauma-related disorders and practical training in specialized PTSD clinics should be incorporated into the psychiatric residency training programs wherever they may be missing, particularly in countries most impacted by violence. Furthermore, continuing medical education on trauma and PTSD should be provided by medical associations and journals to keep physicians updated on recent progress in the field.
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24
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Bossa N, Sipe JM, Berger W, Scott K, Kennedy A, Thomas T, Hendren CO, Wiesner MR. Quantifying Mechanical Abrasion of MWCNT Nanocomposites Used in 3D Printing: Influence of CNT Content on Abrasion Products and Rate of Microplastic Production. Environ Sci Technol 2021; 55:10332-10342. [PMID: 34264058 PMCID: PMC10084403 DOI: 10.1021/acs.est.0c02015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Manufactured nanomaterials (MNMs) are incorporated as "nanofillers" into consumer products to enhance properties of interest. Multiwalled carbon nanotubes (MWCNTs) are known for their unique properties and have many applications in polymers. However, the release of MWCNTs during the nanoenabled product life cycle is concerning. During the use phase, mechanical stresses can produce fragmented materials containing MNMs. The degree of MNM release, the resulting exposure to these materials, and the potential impacts of their release are active research topics. In this study, we describe methodological improvements to study the abrasion of plastics containing MNMs (nanocomposites) and report on characteristics of abrasion products produced and rates of microplastic production. The abrasion device developed for this work allows for the measurement of power inputs to determine scaled release rates. Abrasion rates for plastics used in 3D printing were found to be 0.27 g/m2/s for the PETG polymer and 0.3 g/m2/s for the 2% MWCNT-PETG nanocomposite. Embedded and protuberant MWCNTs appeared to impact the particle size, shape, hydrophobicity, and surface charge of the microplastics, while the inclusion of MWCNTs had a small effect on microplastic production. Measurements of power input to the abrasion process provided a basis for estimating microplastic production rates for these nanocomposites.
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Affiliation(s)
- Nathan Bossa
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
- Human & Environmental Health &Safety Group Materials Safety Unit, Leitat Technological Center, Carrer de la Innovació, 2, 08225, Terrassa, Spain
| | - Joana Marie Sipe
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
| | - William Berger
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
| | - Keana Scott
- Materials Measurement Science Division, National Institute of Standards and Technology, 100 Bureau Drive, MS-8372 Gaithersburg, MD 20899, United States
| | - Alan Kennedy
- US Army Engineer Research and Development Center, Environmental Laboratory, 3909 Halls Ferry Rd. Vicksburg, MS, USA
| | - Treye Thomas
- United States Consumer Product Safety Commission, 4330 East-West Highway, Bethesda, Maryland 20814, United States
| | - Christine Ogilvie Hendren
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
- Department of Geological and Environmental Sciences, Appalachian State University, 287 Rivers St, Boone, NC 28608, USA
| | - Mark R. Wiesner
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, 27708, USA
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25
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Duru F, Berger W, Saguner AM. A novel variant in the SLC4A3 gene with high penetrance in a family with short QT Syndrome. Europace 2021. [DOI: 10.1093/europace/euab116.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing sudden cardiac death (SCD). Current guidelines recommend genetic testing. Associated variants in KCNQ1, KCNH2, KCNJ2 and SLC4A3 genes have been reported.
Purpose
We report a family with a variant in the SLC4A3 gene with several presentations of SCD and high clinical penetrance of SQTS.
Methods
We performed a post-mortem genetic testing in the index patient in whom prior ECG was available. Subsequently, clinical and electrophysiological work-up and cascade screening (CS) of the detected suspected variant was carried out in available relatives.
Results
The index patient had suffered a SCD at the age of 17 (figure, upper panel, arrow). A previously registered ECG showed a shortened QTc of 340ms (figure, lower panel). Autopsy revealed no structural heart disease. Post-mortem genetic testing revealed variants in the LDB3, MYH7 and a novel heterozygous missense variant, p.(Ser1039Arg) also in the SLC4A3 gene. Although predictive bioinformatic algorithms (AlignGVGD, SIFT, MutationTaster, Polyphen2) showed conflicting classifications, family history was notable for SCD without post-mortem genetic work-up in three second degree relatives (figure, upper panel, patients 207, 208 and 305, age of death 33, 25 and 33 years respectively). CS was performed in first and second degree relatives of the index patient and was highly suggestive for disease association of the variant in the SLC4A3 gene with co-segregation in all clinically affected family members. Only one patient with the variant had a normal QTc (figure, upper panel, patient 202) of 407ms, however this patient was on regular QT-prolonging medication (risperidone and loperamide).
Conclusion
Genetic testing revealed a novel in the SLC4A3 gene, which was recently implicated in the pathogenesis of the SQTS. Although predictive bioinformatic algorithms yielded conflicting results, CS of family members suggests a likely pathogenicity (class IV) of the variant. Further CS or functional tests are necessary to establish causality. Abstract Figure. ECG of index patient and family tree
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - AM Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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26
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Grusch M, Pirker C, Hoda M, Berger W, Schelch K. MA06.04 FGF5 Expression in Malignant Pleural Mesothelioma: Impact on Cell Growth, Cisplatin Resistance and Patient Survival. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Reis T, Araújo AX, Mendlowicz V, Maia HG, Oliveira RP, Almeida RQH, da Luz MP, Vilete L, Berger W, Mendlowicz MV, Gekker M. The Jornal Brasileiro de Psiquiatria: A Bibliometric Survey of the one hundred most cited articles in the last 15 years. J bras psiquiatr 2021. [DOI: 10.1590/0047-2085000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: Bibliometrics is a group of statistical and mathematical methods employed to measure and analyze the quantity and the quality of scientific articles, books, and other forms of publications. The objective of the present study was to conduct a bibliometric analysis of the Jornal Brasileiro de Psiquiatria (JBP) by listing its 100 most highly cited articles in the scientific literature and identifying their main characteristics in terms of authorship and research topics and design. Methods: The 100 top-cited references in the JBP were identified through a search with Google Scholar. The main author, last author, corresponding author, the total number of authors, gender of the authors, year of publication, research institution, geographic origin, language, and the research design and subject of each reference were recorded and analyzed. Results: A marked increase in the number of citations in the last 15 years, a relatively balanced distribution of publications among the Brazilian states and research centers, absence of gender bias among authors, and a varied range of published topics suggest a good current editorial performance by the JBP. Relative lack of systematic reviews and longitudinal studies, dearth of articles published in the English language, and modest participation of foreign authors were points requiring improvement. Conclusion: The present study suggests that a survey of the 100 most cited articles in the JBP can provide a historical overview of the progress of this journal, as well as highlight the main obstacles, constraints, and challenges faced by its editors and authors.
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Affiliation(s)
- Taylor Reis
- Federal University of Rio de Janeiro, Brasil
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28
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Melani MS, Paiva JM, Silva MC, Mendlowicz MV, Figueira I, Marques-Portella C, Luz MP, Ventura PR, Berger W. Absence of definitive scientific evidence that benzodiazepines could hinder the efficacy of exposure-based interventions in adults with anxiety or posttraumatic stress disorders: A systematic review of randomized clinical trials. Depress Anxiety 2020; 37:1231-1242. [PMID: 33241637 DOI: 10.1002/da.23078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/24/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Exposure-based interventions (EBIs) are the first-line treatment for anxiety disorders and posttraumatic stress disorder. Although common, the association between EBIs and benzodiazepines is controversial. Therefore, we systematically reviewed the literature to evaluate if benzodiazepines could undermine the efficacy of EBIs in treating these disorders. METHODS We conducted a systematic review aiming for randomized clinical trials (RCTs) in ISI Web of Science, Scopus, PubMed/MEDLINE, and PsycINFO databases. We scrutinized the reference list of selected papers and other systematic reviews. Finally, we evaluated the methodological quality and the scientific evidence of the studies. RESULTS We screened 1,529 studies and included 12 RCTs in this review (all showing some concerns or high risk of bias). Benzodiazepines did not impact the efficacy of EBIs in nine studies at posttreatment, improved efficacy in two, and reduced it in one. In the follow-up, benzodiazepines (after its discontinuation) did not impact the efficacy in six studies and reduced it in five. The scientific level of evidence achieved was B for both phases. CONCLUSIONS Until now there is no definitive evidence that benzodiazepines could hinder the EBIs' efficacy for treating posttraumatic stress disorder and anxiety disorders.
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Affiliation(s)
- Marina S Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jéssica M Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Silva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carla Marques-Portella
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana P Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula Rui Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Duru F, Berger W, Saguner A. Two novel variants in the SLC4A3 gene in two families with Short QT Syndrome: the role of cascade screening. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing sudden cardiac death (SCD). Genetic testing is recommended according to current guidelines. Variants in KCNQ1, KCNH2, KCNJ2 and SLC4A3 genes have been reported in SQTS.
Purpose
We report implications of genetic testing and cascade screening (CS) in two families with phenotypical presentation of SQTS and novel genetic variants of unknown significance.
Methods
We performed a thorough clinical and electrophysiological work-up of the index patients of both families. In addition, genetic screening was conducted. Subsequently, segregation analysis of potentially pathogenic variants was carried out in available relatives.
Results
Index patient 1 presented with a history of recurrent syncope. His ECG showed a shortened QTc of 340ms. Family history was unremarkable. Structural heart disease was excluded by cardiac MRI and coronary angiography. Genetic testing detected a rare heterozygous missense variant in the KCNH2 gene (p.(Arg328Cys), frequency 0.053%), predicted to be pathogenic according to various prediction algorithms (Polyphen, SIFT, Align GVGD, mutation taster). CS of relatives did not confirm this variant as the causative mutation. Reanalysis of whole-exome sequencing data revealed a novel heterozygous missense variant, p.(Arg370Cys) in the recently identified SLC4A3 gene. A variant at the same position has previously been associated with SQTS. CS suggested disease association. The second index patient had a SCD at the age of 17. A previously registered ECG showed a shortened QTc of 340ms. Autopsy revealed no structural heart disease. Post-mortem genetic testing revealed variants in the LDB3, MYH7 and a novel heterozygous missense variant, p.(Ser1039Arg) also in the SLC4A3 gene. Family history was positive for SCD in three 2° relatives. The index patient's father had a positive phenotype with a QTc of 365ms. CS again suggested disease association of the variant in the SLC4A3 gene only.
Conclusion
Genetic testing revealed two novel variants in the SLC4A3 gene, which was recently implicated in the pathogenesis of the SQTS. Predictive bioinformatic algorithms to assess the pathogenicity of missense variants are of limited relevance, but genetic analysis of additional unaffected and affected family members may be instrumental to identify pathogenic DNA sequence variations.
Family tree index patients 1 and 2
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - F Duru
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A.M Saguner
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
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Arcosy CV, Vilete LMP, Marques-Portella C, Mendlowicz MV, Luz MP, Figueira I, Berger W. Possible outcomes of cumulative trauma in mental-health: a case report. J bras psiquiatr 2020. [DOI: 10.1590/0047-2085000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT To discuss the resilience factors that may have prevented a patient from developing post-traumatic stress disorder (PTSD) after exposure to a variety of severe potentially traumatic events. A thirty-eight-year-old civilian has been exposed to at least ten dramatic situations of violence in his work and personal life. He developed only a few mild post-traumatic symptoms after being exposed to a particularly gruesome incident during work. Even though the number and severity of potentially traumatic events may be alarming, this does not determine that the patient will inexorably develop PTSD, or other disorders. The study of protective factors is mandatory so that we can acknowledge and develop more effective ways to prevent and treat disorders.
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Kovacs B, Graf U, Magyar I, Baehr L, Maspoli A, Firat D, Berger W, Saguner AM. 1268A family with a novel variant in the SLC4A3 gene leading to short QT phenotype - the importance of whole-exome-sequencing and cascade screening. Europace 2020. [DOI: 10.1093/europace/euaa162.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
none
Introduction
Short QT syndrome (SQTS) is a rare, autosomal dominant disease causing ventricular fibrillation and sudden cardiac death. Genetic testing is recommended according to current guidelines. Mutations in KCNQ1, KCNH2, KCNJ2 and more recently SLC4A3 genes have been implicated in SQTS. These genes encode potassium channel subunits and a bicarbonate transporter regulating intracellular pH. A dominant mutation in this transporter can lead to increased intracellular pH and shortened action potential.
Purpose
We present a family with a short QT phenotype and recurrent syncope in whom a novel genetic variant was detected by whole-exome sequencing (WES), confirmed by cascade screening.
Methods
We performed a thorough work-up of the index patient including medical history, physical examination, 12-lead ECG, echocardiography, stress testing, coronary angiography, flecainide challenge, and genetic testing with NGS. QTc was determined using Bazett’s formula. CS of all 1° and two 2° relatives was performed.
Results
The ECG of the index patient showed a QTc of 340ms and characteristics compatible with a SQTS (figure). Clinical work-up was unremarkable. A first genetic search with next generation sequencing focusing on genes that have been previously involved in the pathogenesis of channelopathies detected a rare known heterozygous missense variant in the KCNH2 gene (Arg328Cys, frequency 0.053%), which was predicted to be pathogenic according to various prediction algorithms (Polyphen, SIFT, Align GVGD, mutation taster). ECG screening of all asymptomatic first-degree family members identified a SQT phenotype in the mother (QTc 355ms), but not in the father (QTc 380ms) and sister (410ms). The KCNH2 variant was found in the father and sister but not the affected mother, which excludes this variant as the causative mutation in this family. Therefore, reanalysis of WES data was performed and revealed a novel heterozygous missense variant p.(Arg370Cys) in the SLC4A3 gene, recently associated with SQTS. A mutation in this gene at the same position has been previously reported in SQTS. The p.(Arg370Cys) mutation was found in the mother but not in the unaffected father or sister. Furthermore the mutation was present in two affected maternal uncles (QTc 319ms and 342ms) supporting the assumption that this was the causative mutation in this family.
Conclusions
A novel genetic variant in the SLC4A3 gene leading to sQT phenotype could be detected using WES and cascade screening. Predictive bioinformatic algorithms to assess the pathogenicity of missense variants are of limited relevance, but genetic analysis of additional unaffected and affected family members may be instrumental to identify pathogenic DNA sequence variations.
Abstract Figure. Pedigree and ECGs of the family
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Affiliation(s)
- B Kovacs
- University Hospital Zurich, Zurich, Switzerland
| | - U Graf
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - I Magyar
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - L Baehr
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A Maspoli
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - D Firat
- University Hospital Zurich, Zurich, Switzerland
| | - W Berger
- University of Zurich, Institute of Medical Molecular Genetics, Zurich, Switzerland
| | - A M Saguner
- University Hospital Zurich, Zurich, Switzerland
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Stettner G, Knirsch U, Berger W, Graf U, Hendriks B, Seidl R, Bernert G, Behunova J, Laccone F, Weiss S. EP.113Infantile-onset CMT2Z is caused by two MORC2 gene mutations and is associated with a distinct phenotype. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abella B, Berger W, Blaiss M, Stiell I, Moellman J, Caterino J, Suner S, Kessler A, Du J, Klausner H. 310 IV Cetirizine Versus IV Diphenhydramine in Treatment of Acute Urticaria. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Donat JC, Lobo NDS, Jacobsen GDS, Guimarães ER, Kristensen CH, Berger W, Mendlowicz MV, Lima EDP, Vasconcelos AG, Nascimento E. Translation and cross-cultural adaptation of the International Trauma Questionnaire for use in Brazilian Portuguese. SAO PAULO MED J 2019; 137:270-277. [PMID: 31483012 PMCID: PMC9744007 DOI: 10.1590/1516-3180.2019.0066070519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The most recent editions of diagnostic manuals have proposed important modifications in posttraumatic stress disorder (PTSD) criteria. The International Trauma Questionnaire (ITQ) is the gold-standard measurement for assessing PTSD and complex PTSD in accordance with the model of the 11th International Classification of Diseases (ICD-11). OBJECTIVE The aim of this study was to adapt the ITQ for the Brazilian context. DESIGN AND SETTING The translation and cross-cultural adaptation of the ITQ for use in Brazilian Portuguese was performed in trauma research facilities in Porto Alegre, Rio de Janeiro and Belo Horizonte, Brazil. METHODS The adaptation followed five steps: (1) translation; (2) committee synthesis; (3) experts' evaluation through the content validity index (CVI) and assessment of interrater agreement though kappa statistics; (4) comprehension test with clinical and community samples (n = 35); and (5) final back-translation and authors' evaluation. RESULTS Two independent translations were conducted. While working on a synthesis of these translations, the committee proposed changes in six items to adapt idiomatic expressions or to achieve a more accurate technical fit. Both the expert judges' evaluation (CVI > 0.7; k > 0.55) and the pretest in the target population (mean comprehension > 3) indicated that the adapted items were adequate and comprehensible. The final back-translation was approved by the authors of the original instrument. CONCLUSION ITQ in its Brazilian Portuguese version achieved satisfactory content validity, thus providing a tool for Brazilian research based on PTSD models of the ICD-11.
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Affiliation(s)
- Júlia Candia Donat
- MSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Nathália dos Santos Lobo
- Psychology Undergraduate Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Gabriela dos Santos Jacobsen
- BSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Eduardo Reuwsaat Guimarães
- MSc. Psychologist and Researcher, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Christian Haag Kristensen
- PhD. Psychologist and Professor, Postgraduate Program on Psychology, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - William Berger
- PhD. Psychiatrist and Professor, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil.
| | - Mauro Vitor Mendlowicz
- PhD. Psychiatrist and Professor, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), and Department of Psychiatry and Mental Health, Universidade Federal Fluminense (UFF), Rio de Janeiro (RJ), Brazil.
| | - Eduardo de Paula Lima
- PhD. Psychologist and Postdoctoral Student, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Alina Gomide Vasconcelos
- PhD. Psychologist and Postdoctoral Student, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Elizabeth Nascimento
- PhD. Psychologist and Professor, Department of Psychology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
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Abstract
We reported a case of a 10-year-old girl who developed a PTSD-like syndrome after watching a horror movie. After 6 years, the now 16-year-old patient still fulfilled the DSM-IV criteria for PTSD, except for the trauma itself. We reviewed the scientific literature for case reports of PTSD-like syndrome induced by horror movies and found 13 cases. In only two was the presence of the DSM criteria confirmed. Watching horror movies may thus trigger PTSD-like syndromes in vulnerable viewers
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Norte CE, Volchan E, Vila J, Mata JL, Arbol JR, Mendlowicz M, Berger W, Luz MP, Rocha-Rego V, Figueira I, de Souza GGL. Tonic Immobility in PTSD: Exacerbation of Emotional Cardiac Defense Response. Front Psychol 2019; 10:1213. [PMID: 31178810 PMCID: PMC6543833 DOI: 10.3389/fpsyg.2019.01213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/08/2019] [Indexed: 01/26/2023] Open
Abstract
Among defensive behaviors, tonic immobility (TI) is considered the last defensive resort when life is at extreme risk. Post-Traumatic Stress Disorder (PTSD) is the main psychiatric consequence resulting from exposure to traumatic events. Increasing evidence indicate an association between peritraumatic tonic immobilility and severity of PTSD. Cardiac defense response, a reactivity to perceived danger or threat, has been studied by recording heart rate changes that follows the presentation of an unpredictable intense auditory aversive stimulus. The aim of this study was to investigate potential distinctiveness in cardiac defense response among PTSD patients who presented – compared to those that did not – TI reaction in the laboratory setting. Patients (N = 17) completed the TI questionnaire for signs of immobility elicited by passive listening to their autobiographical trauma script. After a while, they were exposed to an intense white noise, while electrocardiogram was recorded. The heart rate during the 80 s after the noise, subtracted from baseline, was analyzed. Higher reports of TI to the trauma script were associated with stronger and sustained heart rate accelerations after the noise. The effects on cardiac defense response add to increasing evidence that some PTSD patients are prone to repeated re-experiences of TI, which may implicate in a potentially distinct pathophysiology and even a new PTSD subtype.
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Affiliation(s)
- Carlos Eduardo Norte
- Institute of Psychology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jaime Vila
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Jose Luis Mata
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Javier R Arbol
- Department of Clinical Psychology, Universidad de Granada, Granada, Spain
| | - Mauro Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, Brazil
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Pires Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Rocha-Rego
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Araújo AXGD, Fontenelle LF, Berger W, Luz MPD, Pagotto LFADC, Marques-Portella C, Figueira I, Mendlowicz MV. Pre-traumatic vs post-traumatic OCD in PTSD patients: Are differences in comorbidity rates and functional health status related to childhood abuse? Compr Psychiatry 2018; 87:25-31. [PMID: 30195097 DOI: 10.1016/j.comppsych.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/29/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The goal of this study was to compare the clinical and functional status and the trauma-related characteristics of PTSD patients with comorbid OCD whose onset predated the index traumatic event (pre-traumatic OCD) with those of PTSD patient whose comorbid OCD only emerged after the exposure to the traumatic event (post-traumatic OCD). METHODS Sixty-three individuals with PTSD and comorbid OCD were evaluated with the Structured Clinical Interview for DSM-IV AXIS I Disorders and completed the Posttraumatic Stress Disorder Checklist - Civilian Version, the Beck Depression Inventory, the Beck Anxiety Inventory, the Trauma History Questionnaire and the 36-Item Short-Form Health Survey. RESULTS A history of childhood abuse was significantly more frequent among PTSD patients with pre-traumatic OCD (45.2%) than among their counterparts with post-traumatic OCD (16%). PTSD patients with pre-traumatic OCD had higher rates of psychiatric comorbidity in general and showed a lower functional health status in a physical domain (SF-36 Role Limitation due to Physical Health). In contrast, PTSD patients with post-traumatic OCD had a decreased functional health status in a psychological domain (SF-36 Emotional Well Being). The effect sizes were in the medium to large range. CONCLUSIONS A history of child abuse may be an important, but often neglected, factor accounting for clinical, functional, and trauma-related differences between pre-traumatic and posttraumatic OCD in PTSD patients.
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Affiliation(s)
- Alexandre Xavier Gomes de Araújo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil; School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Australia; D'Or Institute for Research and Education (IDOR), Brazil.
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | - Mariana Pires da Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | | | | | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Brazil
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Berger W, Blaiss M, Stiell I, Moellman J, Klausner H, Caterino J, Suner S, Kessler A, Du J. INTRAVENOUS (IV) CETIRIZINE SHOWS GREATER OVERALL BENEFIT TO IV DIPHENHYDRAMINE FOR ACUTE URTICARIA. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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da Silva HC, Furtado da Rosa MM, Berger W, Luz MP, Mendlowicz M, Coutinho ESF, Portella CM, Marques PIS, Mograbi DC, Figueira I, Ventura P. PTSD in mental health outpatient settings: highly prevalent and under-recognized. ACTA ACUST UNITED AC 2018; 41:213-217. [PMID: 30328959 PMCID: PMC6794137 DOI: 10.1590/1516-4446-2017-0025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To estimate the current prevalence of posttraumatic stress disorder (PTSD) and the diagnosis rate of this disorder ascertained by psychiatrists in training. METHODS We interviewed 200 adults under treatment in a university mental health outpatient clinic. The PTSD diagnoses obtained using the Structured Clinical Interview for DSM-IV (SCID-IV) were compared with the patients' medical records. RESULTS Forty-one patients (20.5%) were diagnosed with current PTSD, but only one of them (2.4%) had previously received this diagnosis. This study confirms that although PTSD is highly prevalent among mental health outpatients, it is remarkably underdiagnosed in teaching hospitals. CONCLUSIONS These findings suggest that psychiatrists in training may be failing to investigate traumatic events and their consequences and strongly indicate that trauma-related issues should be given more prominence in psychiatry curricula and psychiatrist training.
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Affiliation(s)
- Herika C da Silva
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maísa M Furtado da Rosa
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - William Berger
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mariana P Luz
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Mauro Mendlowicz
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Departamento de Psiquiatria e Saúde Mental, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Evandro S F Coutinho
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS), Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carla M Portella
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Pamela I S Marques
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Daniel C Mograbi
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Ivan Figueira
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Paula Ventura
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto de Psicologia, UFRJ, Rio de Janeiro, RJ, Brazil
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Gabler L, Gojo J, Lötsch D, Kirchhofer D, van Schoonhoven S, Stojanovic M, Schmidt HM, Ensle D, Czech T, Haberler C, Slavc I, Spiegl-Kreinecker S, Berger W. P04.51 TERT promoter mutation-driven TERT activation is mediated by ETS1 in BRAF V600E mutated glioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Gabler
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
- Comprehensice Cancer Center-Central Nervous System Tumors Unit, Medical University, Vienna, Austria
| | - J Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
| | - D Lötsch
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
| | - D Kirchhofer
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
| | - S van Schoonhoven
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
| | - M Stojanovic
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
| | - H M Schmidt
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
| | - D Ensle
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
| | - T Czech
- Department of Neurosurgery, Medical University, Vienna, Austria
| | - C Haberler
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
- Institute of Neurology, Medical University, Vienna, Austria
| | - I Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University, Vienna, Austria
- Institute of Neurology, Medical University, Vienna, Austria
| | | | - W Berger
- Department of Medicine I, Institute of Cancer Research, Medical University, Vienna, Austria
- Comprehensice Cancer Center-Central Nervous System Tumors Unit, Medical University, Vienna, Austria
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Loetsch D, Gojo J, Kirchhofer D, van Schoonhoven S, Pajtler K, Kool M, Haberler C, Czech T, Slavc I, Berger W. OS5.2 FGFR a novel target in malignant pediatric ependymoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Loetsch
- Institute of Cancer Research, Vienna, Vienna, Austria
| | - J Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - D Kirchhofer
- Institute of Cancer Research, Vienna, Vienna, Austria
| | | | - K Pajtler
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany, Heidelberg, Germany
| | - M Kool
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany, Heidelberg, Germany
| | - C Haberler
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - T Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - I Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - W Berger
- Institute of Cancer Research, Vienna, Vienna, Austria
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Gekker M, Coutinho ESF, Berger W, Luz MPD, Araújo AXGD, Pagotto LFADC, Marques-Portella C, Figueira I, Mendlowicz MV. Early scars are forever: Childhood abuse in patients with adult-onset PTSD is associated with increased prevalence and severity of psychiatric comorbidity. Psychiatry Res 2018; 267:1-6. [PMID: 29879599 DOI: 10.1016/j.psychres.2018.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 05/16/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
Childhood abuse and PTSD are independently associated with severe psychiatric comorbidity. We hypothesized that among patients with adult-onset PTSD, a history of child abuse was associated with increased prevalence and severity of comorbid mental disorders. Participants were 109 adult treatment-seeking patients, 23.9% of whom had a history of childhood sexual, physical or emotional abuse. The socio-demographic characteristics and comorbidity profile of PTSD patients with and without history of child abuse were compared using the two-tailed t-test and the chi-square test. PTSD patients with a history of child abuse had significantly higher average PCL-C hyperarousal [21.8 (SD = 3.6) vs 19.8 (SD = 3.5)] and BDI [35.7 (SD = 9.2) vs 29.1 (SD = 13.9)] scores, a significantly increased average number of lifetime [4.85 (SD = 1.43) vs 3.93 (SD = 1.33)] and current [4.46 (SD = 1.24) vs 3.75 (SD = 1.32)] comorbid disorders, and a greater prevalence of lifetime (73.1% vs 44.6%) and current (79.2% vs 46.7%) panic disorder/agoraphobia and of psychotic symptoms (73.1% vs 30.1%). All effect sizes were in the medium to large range. Adult-onset PTSD patients with a history of child abuse may represent a subgroup with a more severe form of the disorder that is associated with a more serious clinical course, treatment resistance and poorer outcome.
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Affiliation(s)
- Márcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Evandro Silva Freire Coutinho
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Epidemiology and Quantitative Methods in Health, Escola Nacional de Saúde Pública (ENSP-FIOCRUZ), Rio de Janeiro, Brazil
| | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Mariana Pires da Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Alexandre Xavier Gomes de Araújo
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, Rio de Janeiro, Brazil
| | | | - Carla Marques-Portella
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ). Rio de Janeiro, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, Rio de Janeiro, Brazil.
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Berger W. Politics and Professionalism. Ann Intern Med 2018; 169:203-204. [PMID: 30083713 DOI: 10.7326/l18-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- William Berger
- Medical College of Wisconsin, Milwaukee, Wisconsin (W.B.)
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Christe M, Fritschi J, Lämmle B, Tran TH, Marbet GA, Berger W, Duckert F. Fifteen Coagulation and Fibrinolysis Parameters in Diabetes Mellitus and in Patients with Vasculopathy. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661158] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryFifteen haemostasis parameters have been measured in 48 normal persons, 36 diabetics without and 44 with complications and 27 with peripheral arterial disease. Since the patients groups are older than normals, part of the differences are due to age. However, the differences are significant between normals and patients. They become highly significant for the diabetics with complications and nephropathy (Table 7). In diabetics without complications factor VIII functions, fibrinogen and thrombin time are related to age whereas there is a negative correlation for the fibrinolytic activity and antithrombin III. The diabetic complications shade off the correlations, which subsist only for VIIIR: CoF, VIIIR: Ag, ATIII and lysis before stasis. With Hbalc as dependent variable VIIIR:CoF is the only significant predictor variable in diabetics (Table 9).
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Affiliation(s)
- M Christe
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - J Fritschi
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - B Lämmle
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - T H Tran
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - W Berger
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
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Christe M, Gattlen P, Fritschi J, Lämmle B, Berger W, Marbet GA, Duckert F. The Contact Phase of Blood Coagulation in Diabetes Mellitus and in Patients with Vasculopathy. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe contact phase has been studied in diabetics and patients with macroangiopathy. Factor XII and high molecular weight kininogen (HMWK) are normal. C1-inhibitor and also α2-macroglobulin are significantly elevated in diabetics with complications, for α1-macroglobulin especially in patients with nephropathy, 137.5% ± 36.0 (p <0.001). C1-inhibitor is also increased in vasculopathy without diabetes 113.2 ± 22.1 (p <0.01).Prekallikrein (PK) is increased in all patients’ groups (Table 2) as compared to normals. PK is particularly high (134% ± 32) in 5 diabetics without macroangiopathy but with sensomotor neuropathy. This difference is remarkable because of the older age of diabetics and the negative correlation of PK with age in normals.
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Affiliation(s)
- M Christe
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - P Gattlen
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - J Fritschi
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - B Lämmle
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - W Berger
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Kantonsspital, Basel, Switzerland
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Fritschi J, Christe M, Lämmle B, Marbet GA, Berger W, Duckert F. Platelet Aggregation, β-Thromboglobulin and Platelet Factor 4 in Diabetes Mellitus and in Patients with Vasculopathy. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661186] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe have studied 155 subjects, 48 normals, 36 diabetics without complications, 44 with complications and 27 patients with macroangiopathy. β-Thromboglobulin (β-TG) and platelet factor 4 (PF4) are elevated in the patients groups. There is no correlation between the plasma levels of β-TG and the stages of either retinopathy or macroangiopathy or nephropathy. The difference is more marked between normals and diabetics with neuropathy (p = 0.026). The aggregation response to ADP and platelet activating factor (PAF) is enhanced at lower stimulator concentration. Using the β-TG, PF4 and aggregation values the discriminant analysis allows a distinction of several subgroups especially with nephropathy and neuropathy (Table 6).
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Affiliation(s)
- J Fritschi
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
| | - M Christe
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
| | - B Lämmle
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
| | - G A Marbet
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
| | - W Berger
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
| | - F Duckert
- The Gerinnungs- und Fibrinolyselabor, Zentrallabor, Kantonsspital, Basel, Switzerland
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Berger W, Sher E, Gawchik S, Fineman S. Safety of a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate in children: A randomized clinical trial. Allergy Asthma Proc 2018; 39:110-116. [PMID: 29490769 DOI: 10.2500/aap.2018.39.4116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The safety of a novel intranasal formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP) has been established in adults and adolescents with allergic rhinitis but not in children <12 years old. OBJECTIVE To evaluate the safety and tolerability of an intranasal formulation of AZE and FP in children ages 4-11 years with allergic rhinitis. METHODS The study was a randomized, 3-month, parallel-group, open-label design. Qualified patients were randomized in a 3:1 ratio to AZE/FP (n = 304) or fluticasone propionate (FP) (n = 101), one spray per nostril twice daily, and to one of three age groups: ≥4 to <6 years, ≥6 to <9 years, and ≥9 to <12 years. Safety was assessed by child- or caregiver-reported adverse events, nasal examinations, vital signs, and laboratory assessments. RESULTS The incidence of treatment-related adverse events (TRAEs) was low in both the AZE/FP (16%) and FP-only (12%) groups after 90 days' continuous use. Epistaxis was the most frequently reported TRAE in both groups (AZE/FP, 9%; FP, 9%), followed by headache (AZE/FP, 3%; FP, 1%). All other TRAEs in the AZE/FP group were reported by ≤1% of the children. The majority of TRAEs were of mild intensity and resolved spontaneously. Results of nasal examinations showed an improvement over time in both groups, with no cases of mucosal ulceration or nasal septal perforation. There were no unusual or unexpected changes in laboratory parameters or vital signs. CONCLUSION The intranasal formulation of AZE and FP was safe and well tolerated after 3 months' continuous use in children with allergic rhinitis.The study was registered on <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://ClinicalTrials.gov">ClinicalTrials.gov</ext-link> (NCT01794741).
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Affiliation(s)
- William Berger
- From the Allergy and Asthma Associates of Southern California, Mission Viejo, California, USA
| | - Ellen Sher
- Atlantic Allergy, Asthma and Immunology Associates of New Jersey, Ocean, New Jersey, USA
| | - Sandra Gawchik
- Asthma Allergy Associates, Glen Mills, Pennsylvania, USA
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Domarco O, Lötsch D, Schreiber J, Dinhof C, Van Schoonhoven S, García MD, Peinador C, Keppler BK, Berger W, Terenzi A. Self-assembled Pt 2L 2 boxes strongly bind G-quadruplex DNA and influence gene expression in cancer cells. Dalton Trans 2018; 46:329-332. [PMID: 27918050 DOI: 10.1039/c6dt03876j] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Supramolecular Pt(ii) quadrangular boxes bind native and G-quadruplex DNA motifs in a size-dependent fashion. Three Pt molecular squares of distinct size show biological activity against cancer cells and heavily influence the expression of genes known to form G-quadruplexes in their promoter regions. The smallest Pt-box displays less activity but more selectivity for a quadruplex formed in the c-Kit gene.
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Affiliation(s)
- O Domarco
- Universidade da Coruña, Departamento de Química Fundamental and Centro de Investigacións Científicas Avanzadas, Facultade de Ciencias, E-15071 A Coruña, Spain.
| | - D Lötsch
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Borschkegasse 8a, A-1090 Vienna, Austria
| | - J Schreiber
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Borschkegasse 8a, A-1090 Vienna, Austria
| | - C Dinhof
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Borschkegasse 8a, A-1090 Vienna, Austria
| | - S Van Schoonhoven
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Borschkegasse 8a, A-1090 Vienna, Austria
| | - M D García
- Universidade da Coruña, Departamento de Química Fundamental and Centro de Investigacións Científicas Avanzadas, Facultade de Ciencias, E-15071 A Coruña, Spain.
| | - C Peinador
- Universidade da Coruña, Departamento de Química Fundamental and Centro de Investigacións Científicas Avanzadas, Facultade de Ciencias, E-15071 A Coruña, Spain.
| | - B K Keppler
- University of Vienna, Institute of Inorganic Chemistry, Waehringerstrasse 42, A-1090 Vienna, Austria and Research Platform "Translational Cancer Therapy Research", University of Vienna and Medical University of Vienna, Vienna, Austria.
| | - W Berger
- Medical University Vienna, Department of Medicine I, Institute of Cancer Research and Comprehensive Cancer Center, Borschkegasse 8a, A-1090 Vienna, Austria and Research Platform "Translational Cancer Therapy Research", University of Vienna and Medical University of Vienna, Vienna, Austria.
| | - A Terenzi
- University of Vienna, Institute of Inorganic Chemistry, Waehringerstrasse 42, A-1090 Vienna, Austria and Research Platform "Translational Cancer Therapy Research", University of Vienna and Medical University of Vienna, Vienna, Austria.
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Gerstmayr J, Lang E, Falch D, Pirker C, Laszlo V, Dome B, Klepetko W, Hoda M, Berger W, Grusch M. MA 19.07 Does Loss of Smad7 Lead to Increased Aggressiveness of Malignant Pleural Mesothelioma? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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