Effects of different temperature-humidity indexes on milk traits of Holstein cows: A 10-year retrospective study

Test-day records (n = 723,091) collected between 2012 and 2021 from 43,015 Holstein cows at 157 farms located in northern Italy were used to study the effects of heat load on milk production and composition a posteriori. The data consisted of milk yield (kg/d), traditional gross composition traits, somatic cell score (SCS), differential somatic cell count (%), milk β-hydroxybutyrate (BHB, mmol/L), milk urea (mg/dL), and milk fatty acid composition (g/100 g of milk). Test-day records were then associated with their relative temperature-humidity indexes (THI) calculated using historical environmental data registered by weather stations. Indexes were created using either yearly or summer THI data. The yearly indexes included the average daily THI (adTHI) and the maximum daily THI (mdTHI) measured throughout the whole year, and the summer indexes focused on 3 mo only (June-August) and included the average daily summer THI (adTHIs), the maximum daily summer THI (mdTHIs), and the average daily THI of the hottest 4 h of the day (adTHI4h; 1200-1600 h). All indexes had significant effects on the majority of milk traits analyzed, with, in particular, adTHI and mdTHI being highly significant in explaining the variation of all traits. Milk yield started to decline at a higher THI compared with protein and fat content. The reduction in fat ceased in the elevated THI experienced during the summer months, as demonstrated by adTHIs, mdTHIs, and adTHI4h. The cows had a tendency for increased BHB concentration with elevated THI, suggesting a greater risk of negative energy balance in presence of heat stress. Furthermore, the concentration of the de novo fatty acids C14:0 and C16:0 was reduced in higher THI, reflecting altered mammary gland activity upon elevated heat load and stress. Milk SCS tended to increase with higher adTHIs, mdTHIs, and adTHI4h. The use of yearly indexes is recommended when investigating the effects of heat load on milk composition, whereas summer indexes are suggested when investigating traits influenced by extreme conditions, such as SCS and milk yield. With global temperatures expected to further rise in the upcoming decades, early and easy identification of cows or herds suffering from heat stress, such as through changes in milk composition, is crucial for timely intervention. Adapting measures to mitigate such effects of elevated THI on milk yield and composition is a necessity for the dairy industry to prevent detrimental impacts on dairy production.

Does the age of milk affect its mid-infrared spectrum and predictions?

Milk of dairy species commonly undergo standardized official analyses, these that may require chemical preservation and transportation to a certified laboratory. In this context, storage duration is an important factor that can potential affect both milk chemical analyses and its mid-infrared spectrum. We analysed milk samples at different time points/ages to assess repeatability and reproducibility of mid-infrared predicted traits (e.g., fat and protein). Using spectral data, we also evaluated the ability of spectroscopy coupled with chemometrics to discriminate samples according to their age. Although the main components of milk remained consistently reproducible across age (days), changes in the spectrum due to sample aging and deterioration of the matrix were detectable. Using a discriminant analysis, we achieved a classification accuracy of 77% in validation. Predicting milk age using mid-infrared spectra is feasible, allowing for sample monitoring within circuits where maximum reliability is needed, e.g., bulk or individual milk samples for legal/official use or payment systems.

Link between supercurrent diode and anomalous Josephson effect revealed by gate-controlled interferometry

In Josephson diodes the asymmetry between positive and negative current branch of the current-phase relation leads to a polarity-dependent critical current and Josephson inductance. The supercurrent nonreciprocity can be described as a consequence of the anomalous Josephson effect -a φ0-shift of the current-phase relation- in multichannel ballistic junctions with strong spin-orbit interaction. In this work, we simultaneously investigate φ0-shift and supercurrent diode efficiency on the same Josephson junction by means of a superconducting quantum interferometer. By electrostatic gating, we reveal a direct link between φ0-shift and diode effect. Our findings show that spin-orbit interaction in combination with a Zeeman field plays an important role in determining the magnetochiral anisotropy and the supercurrent diode effect.

The effect of first-lactation calving season, milk production, and morphology on the survival of Simmental cows

Longevity in dairy and dual-purpose cattle is a complex trait which depends on many individual and managerial factors. The purpose of the present study was to investigate the survival (SURV) rate of Italian Simmental dual-purpose cows across different parities. Data of this study referred to 2 173 primiparous cows under official milk recording that calved between 2002 and 2020. Only cows linearly classified for type traits, including muscularity (MU) and body condition score (BCS) were kept. Survival analysis was carried out, through the Cox regression model, for different pairwise combinations of classes of milk productivity MU, BCS, and calving season. Herd-year of first calving was also considered in the model. SURV (0 = culled; 1 = survived) at each lactation up to the 6th were the dependent variables, so that, for example, SURV2 equal to 1 was attributed to cows that entered the 2nd lactation. Survival rates were 98, 71, 63, 56, and 53% for 2nd, 3rd, 4th, 5th, and 6th lactation, respectively. Results revealed that SURV2 was not dependent on milk yield, while in subsequent parities, low-producing cows were characterized by higher SURV compared to high-producing ones. Additionally, cows starting the lactation in autumn survived less (47.38%) than those starting in spring (53.49%), suggesting that facing the late gestation phase in summer could increase the culling risk. The present study indicates that SURV in Italian Simmental cows is influenced by various factors in addition to milk productivity. However, it is important to consider that in this study all first-calving cows culled before the linear evaluation - carried out between mid- and late lactation in this breed - were not accounted for. Finding can be transferred to other dual-purpose breeds, where the cows' body conformation and muscle development - i.e. meat-related features - are often considered as important as milk performance by farmers undertaking culling decisions.

Acute amnestic syndrome in fornix lesions: a systematic review of reported cases with a focus on differential diagnosis

Introduction

Acute amnestic syndrome is an uncommon clinical presentation of neurological disease. Differential diagnosis encompasses several syndromes including Wernicke-Korsakoff and transient global amnesia (TGA). Structural lesions of the fornix account for a minority of cases of acute amnestic syndromes. Etiology varies from iatrogenic injury to ischemic, inflammatory, or neoplastic lesions. A prompt diagnosis of the underlying pathology is essential but challenging. The aim of this review is to systematically review the existing literature regarding cases of acute amnestic syndrome associated with non-iatrogenic lesions of the fornix.

Methods

We performed a systematic literature search on PubMed, Scopus, and Web of Science up to September 2023 to identify case reports and case series of patients with amnestic syndrome due to fornix lesions. The systematic review was conducted according to PRISMA guidelines. The research was limited to articles written in English. Cases of fornix damage directly ascribable to a surgical procedure were excluded.

Results

A total of 52 publications reporting 55 cases were included in the review. Focusing on acute/subacute onset, vascular etiology was highly prevalent, being responsible for 78% of cases, 40/55 (74%) of which were due to acute ischemic stroke. The amnestic syndrome was characterized by anterograde amnesia in all patients, associated with retrograde amnesia in 27% of cases. Amnesia was an isolated presentation in most cases. Up to two thirds of patients had persistent memory deficits of any severity at follow-up.

Discussion

Acute amnestic syndrome can be rarely caused by fornix lesions. In most cases of acute/subacute presentation, the etiology is ischemic stroke, mainly caused by strokes involving the subcallosal artery territory. The differential diagnosis is challenging and a distinction from common mimics is often difficult on a clinical basis. A high index of suspicion should be maintained to avoid misdiagnosis and provide adequate acute treatment to patients with time-dependent disease, also employing advanced neuroimaging. More research is needed to better understand the outcome and identify prognostic factors in patients with amnestic syndrome due to fornix lesions.

Minerals and essential amino acids of bovine colostrum: Phenotypic variability and predictive ability of mid- and near-infrared spectroscopy

Colostrum quality and volume are fundamental for calves because it is the primary supplier of antibodies and the first source of energy, carbohydrates, lipids, proteins, minerals, and vitamins for the newborn. Assessing the detailed composition (i.e., AA and mineral content) of bovine colostrum (BC) on-line and at a reasonable cost would help dairy stakeholders such as farmers or veterinarians for precision feeding purposes and industries producing preparations containing BC such as foodstuff, supplements, and medicaments. In the present study we evaluated mid- (MIRS) and near-infrared spectroscopy (NIRS) prediction ability for AA and mineral composition of individual BC. Second, we the investigated the major factors affecting the phenotypic variability of such traits also evaluating the correlations with the Ig concentration. Results demonstrated that MIRS and NIRS were able to provide sufficiently accurate predictions for all the AA. The coefficient of determination in external validation (R2V) fell, in fact, within the range of 0.70 to 0.86, with the exception of Ile, His, and Met. Only some minerals reached a sufficient accuracy (i.e., Ca, P, S, and Mg; R2V ≥ 0.66) using MIRS, and also S (R2V = 0.87) using NIRS. Phenotypically, both parity and calving season affected the variability of these BC composition traits. Heifers' colostrum was the one with the greatest concentration of Ca and P, the 2 most abundant minerals. These minerals were however very low in cows calving in summer compared with the rest of the year. The pattern of AA across parities and calving season was not linear, likely because their variability was scarcely (or not) affected by these effects. Finally, samples characterized by high IgG concentration were those presenting on average greater concentration of AA. Findings suggest that infrared spectroscopy has the potential to be used to predict certain AA and minerals, outlining the possibility of implementing on-site analyses for the evaluation of the broad-sense BC quality.

Sign reversal of the Josephson inductance magnetochiral anisotropy and 0-π-like transitions in supercurrent diodes

The recent discovery of the intrinsic supercurrent diode effect, and its prompt observation in a rich variety of systems, has shown that non-reciprocal supercurrents naturally emerge when both space-inversion and time-inversion symmetries are broken. In Josephson junctions, non-reciprocal supercurrent can be conveniently described in terms of spin-split Andreev states. Here we demonstrate a sign reversal of the Josephson inductance magnetochiral anisotropy, a manifestation of the supercurrent diode effect. The asymmetry of the Josephson inductance as a function of the supercurrent allows us to probe the current-phase relation near equilibrium, and to probe jumps in the junction ground state. Using a minimal theoretical model, we can then link the sign reversal of the inductance magnetochiral anisotropy to the so-called 0-π-like transition, a predicted but still elusive feature of multichannel junctions. Our results demonstrate the potential of inductance measurements as sensitive probes of the fundamental properties of unconventional Josephson junctions.

How animal milk and plant-based alternatives diverge in terms of fatty acid, amino acid, and mineral composition

The decline in fresh milk in the Western world has in part been substituted by an increased consumption of plant-based beverages (PBB). These are often marketed as healthy and sustainable alternatives to milk and dairy foodstuff, although studies have suggested PBB to be of lower nutrient quality. The current study considered different brands of almond-, oat-, rice-, coconut- and soya-based beverages for a comparative analysis and found that they indeed presented lower contents of total protein, lipids, amino acids, and minerals than cow and goat milk. The only exception was given by soya-based beverages which approximated the protein content (3.47% vs. 3.42 and 3.25% in cow and goat milk, respectively) and amino acid composition of animal milk, and also demonstrated high mineral content. The natural presence of phyto-compounds in PBB characterised as antinutrients and their potential to exacerbate the issue of low nutrient quality by lowering bioavailability have been discussed.

Mid-infrared spectroscopy for large-scale phenotyping of bovine colostrum gross composition and immunoglobulin concentration

Immunoglobulin G is the fundamental antibody for acquisition of passive transfer of immunity in ruminant newborns. Colostrum, in fact, must be administered as soon as possible after birth to ensure a successful transfer of IgG from the dam to the calf. Assessment of colostrum Ig concentration and gross composition via gold standards is expensive, time consuming, and hardly implementable for large-scale investigations. Therefore, in the present study we evaluated the predictive ability of mid-infrared spectroscopy (MIRS) as an indirect determination method. A total of 714 colostrum samples collected within 6 h from parturition from Italian Holstein cows, 30% primiparous and 70% pluriparous, were scanned using a benchtop spectrometer after dilution in pure water. The prediction models were developed by correlating spectral information with the reference measurements: IgG concentration (93.54 ± 33.87 g/L), total Ig concentrations (102.82 ± 35.04 g/L), and content of protein (14.71 ± 3.51%), fat (4.61 ± 3.04%), and lactose (2.36 ± 0.51 mg/100 mg). We found a good to excellent performance in prediction of colostrum IgG concentration and traditional composition traits in cross-validation (R2CV ≥ 0.92) and a promising and good predictive ability in external validation with R2V equal to 0.84, 0.89, and 0.74 for IgG, protein, and fat, respectively. In the case of IgG and protein content, for example, the coefficient of determination in external validation was greater than 0.84. The other Ig fractions, A and M, presented insufficient prediction accuracy likely due to their extremely low concentration compared with IgG (4.56 and 5.06 g/L vs. 93.54 g/L). The discriminant ability of MIRS-predicted IgG and protein content was outstanding when trying to classify samples according to the quality level (i.e., low vs. high concentration of IgG). In particular, the cut-off that better discriminate low- from high-quality colostrum was 75.40 g/L in the case of the MIRS-predicted IgG and 13.32% for the MIRS-predicted protein content. Therefore, MIRS is proposed as a rapid and cheap tool for large-scale punctual IgG, protein, and lactose quantification and for the screening of low-quality samples. From a practical perspective, there is the possibility to install colostrum models in the MIRS benchtop machineries already present in laboratories in charge of official milk testing. Colostrum phenotypes collected on an individual basis will be useful to breeders for the definition of specific selection strategies and to farmers for management scopes. Finally, our findings may be relevant for other stakeholders, given the fact that colostrum is an emerging ingredient for the animal and human food and pharmaceutical industry.

Invited review: Bovine colostrum, a promising ingredient for humans and animals-Properties, processing technologies, and uses

Mammalian colostrum, known as "liquid gold," is considered a valuable source of essential nutrients, growth factors, probiotics, prebiotics, antibodies, and other bioactive compounds. Precisely for this reason, bovine colostrum (BC) is an emerging ingredient for the feed, food, and pharmaceutical industries, being nowadays commercially available in a variety of forms in several countries. Moreover, quite a large number of functional foods and supplements for athletes, human medicines, pet nutrition plans, and complementary feed for some livestock categories, such as piglets and calves, contain BC. The amount of BC yielded by a cow after calving represents approximately 0.5% of the yearly output in dairy breeds. For its nutritional properties and low availability, BC is characterized by a greater market value and an increasing demand compared with other by-products of the dairy sector. However, information regarding the market size of BC for the food and pharmaceutical industries, as well as future developments and perspectives, is scarcely available in the scientific literature. This lack can be attributed to industrial secrecy as well as to the relatively small scale of the BC business when compared with other dairy products, which makes the BC market limited, specific, and intended for a restricted audience. From a legal perspective, regulations assign BC to the large family of milk-derived powders; thus, collecting specific production data, as well as import-export trend information, is not straightforward and can result in unprecise estimates. Given that the interest in BC is increasing in different fields, it is important to have an overview of the production steps and of pros and cons of this emerging ingredient. The present narrative review discloses why BC has started to be considered a product rather than a by-product of the dairy industry. Moreover, the present document aims to summarize the existing methodologies used to assess BC quality in terms of immunoglobulin concentration, the different applications of BC in the industry, and the BC processing technologies. Finally, a panoramic view of the current international market is provided for the first time for this dairy product.

Udder health-related traits in cow milk: phenotypic variability and effect on milk yield and composition

The milk differential somatic cell count (DSCC) has been proposed in recent years as a mean by which to better monitor the udder health status (UHS) in dairy cows. Milk DSCC is the amount of polymorphonuclear neutrophils and lymphocytes contributing to the total somatic cell count (SCC) and can be determined on a routine basis in individual milk samples subjected to official analysis. In the present study, 522 865 milk test-day records of 77 143 cows were scrutinised to identify factors affecting the variability of both DSCC and SCC in Holstein Friesian, Jersey, Simmental and Rendena cows through linear mixed models. The fixed effects were breed, parity, lactation stage, sampling season, and all the first-order interactions of breed. Cow and herd-test-date were considered as random. Subsequently, four UHS groups were created (1: SCC ≤ 200 000 cells/mL and DSCC ≤ 65%; 2: SCC ≤ 200 000 cells/mL and DSCC > 65%; 3: SCC > 200 000 cells/mL and DSCC > 65%; 4: SCC > 200 000 cells/mL and DSCC ≤ 65%) to compare milk yield and quality. Milk SCS and DSCC differed across lactation, parity, sampling season and breed. In particular, Simmental cows had the lowest SCC and Jersey the lowest DSCC. Depending on the breed, UHS affected daily milk yield and composition to a different extent. The UHS group 4, i.e. the one grouping test-day records with high SCC and low DSCC, presented the lowest estimate of milk yield and lactose content no matter the breeds. Our findings support that udder health-related traits (SCS and DSCC) are useful information to improve udder health at individual cow and herd levels. Moreover, the combination of SCS and DSCC is useful to monitor milk yield and composition.

How heat stress conditions affect milk yield, composition, and price in Italian Holstein herds

An edited data set of 700 bulk and 46,338 test-day records collected between 2019 and 2021 in 42 Holstein-dominated farms in the Veneto Region (North of Italy) was available for the present study. Information on protein, fat and lactose content, somatic cell count, and somatic cell score was available in bulk milk as well as individual test-day records, whereas urea concentration (mg/dL), differential somatic cell count (%), and milk yield (kg/d) were available for test-day records only. Milk features were merged with meteorological data retrieved from 8 weather stations located maximum 10 km from the farms. The daily and weekly temperature-humidity index (THI; wTHI) and maximum daily (MTHI) and weekly temperature-humidity index were associated with each record to evaluate the effect of heat stress conditions on milk-related traits through linear mixed models. Least squares means were estimated to evaluate the effect of THI and, separately, of MTHI on milk characteristics correcting for conventional systematic factors. Overall, heat stress conditions lowered the quality of both bulk milk and test-day records, with fat and protein content being greatly reduced, and somatic cell score and differential somatic cell count augmented. Milk yield was not affected by either THI or MTHI in this data set, but the effect of elevated THI and MTHI was in general stronger on test-day records than on bulk milk. Farm-level economic losses of reduced milk quality rather than reduced yield as consequence of elevated THI or MTHI was estimated to be between $23.57 and $43.98 per farmer per day, which is of comparable magnitude to losses resulting from reduced production. Furthermore, MTHI was found to be a more accurate indicator of heat stress experienced by a cow, explaining more variability of traits compared with THI. The negative effect of heat stress conditions on quality traits commences at lower THI/MTHI values compared with milk yield. Thus, a progressive farmers' income loss due to climatic changes is already a reality and it is mainly due to deterioration of milk quality rather than quantity in the studied area.

Floral colour variation of Nicotiana glauca in native and non-native ranges: Testing the role of pollinators' perception and abiotic factors

Invasive plants displaying disparate pollination environments and abiotic conditions in native and non-native ranges provide ideal systems to test the role of different ecological factors driving flower colour variation. We quantified corolla reflectance of the ornithophilous South American Nicotiana glauca in native populations, where plants are pollinated by hummingbirds, and in populations from two invaded regions: South Africa, where plants are pollinated by sunbirds, and the Balearic island of Mallorca, where plants reproduce by selfing. Using visual modelling we examined how corolla reflectance could be perceived by floral visitors present in each region. Through Mantel tests we assessed a possible association between flower colour and different abiotic factors. Corolla reflectance variation (mainly along medium to long wavelengths, i.e. human green-yellow to red colours) was greater among studied regions than within them. Flower colour was more similar between South America and South Africa, which share birds as pollinators. Within invaded regions, corolla reflectance variation was lower in South Africa, where populations could not be distinguished from each other by sunbirds, than in Spain, where populations could be distinguished from each other by their occasional visitors. Differences in corolla colour among populations were partially associated with differences in temperature. Our findings suggest that shifts in flower colour of N. glauca across native and invaded ranges could be shaped by changes in both pollination environment and climatic factors. This is the first study on plant invasions considering visual perception of different pollinators and abiotic drivers of flower colour variation.

Clinical characteristics of 80 subjects with KCNQ2-related encephalopathy: Results from a family-driven survey

Variants of KCNQ2 are associated with a wide spectrum of disorders, ranging from Self-limiting Neonatal Epilepsy (SelNE) to Early Onset Developmental and Epileptic Encephalopathy (KCNQ2-DEE). Comorbidities associated with this end of the spectrum have been seldomly described and their impact on the life of patients and their families is yet to be investigated. Collaborating with caregivers from different European family associations, we have developed a questionnaire aimed at investigating the onset and frequency of epileptic seizures, anti-seizure medications (ASM), hospitalizations, stages of development, and comorbidities. Responses from 80 patients, 40 males, from 14 countries have been collected. Median age 7.6 years (4 months - 43.6 years). Of 76 epileptic patients (93.6%), 55.3% were seizure-free with a mean age at last seizure of 26.7 months. Among patients with active epilepsy, those older have a lower frequency of seizures (p > 0.05). We were able to identify three different clusters of varying severity (Mild, Severe, Profound), based on neurodevelopmental features and symptoms, excluding epilepsy. Patients in a higher severity cluster had a higher mean number of comorbidities, which had a higher impact on families. Notably, patients in different clusters presented different epilepsy onset and courses. This study constitutes the most extensive data collection of patients with KCNQ2-DEE, with a focus on comorbidities in a wide age group. The participation of caregivers helps to define the impact of the disease on the lives of patients and families and can help identify new primary and secondary outcomes beyond seizures in future studies.

Invited review: Iodine level in dairy products-A feed-to-fork overview

The theme of iodine in the dairy sector is of particular interest due to the involvement and the interconnection of several stakeholders along the dairy food chain. Iodine plays a fundamental role in animal nutrition and physiology, and in cattle it is an essential micronutrient during lactation and for fetal development and the calf's growth. Its correct use in food supplementation is crucial to guarantee the animal's recommended daily requirement to avoid excess intake and long-term toxicity. Milk iodine is fundamental for public health, being one of the major sources of iodine in Mediterranean and Western diets. Public authorities and the scientific community have made great efforts to address how and to what extent different drivers may affect milk iodine concentration. The scientific literature concurs that the amount of iodine administered through animal feed and mineral supplements is the most important factor affecting its concentration in milk of most common dairy species. Additionally, farming practices related to milking (e.g., use of iodized teat sanitizers), herd management (e.g., pasture vs. confinement), and other environmental factors (e.g., seasonality) have been identified as sources of variation of milk iodine concentration. Overall, the aim of this review is to provide a multilevel overview on the mechanisms that contribute to the iodine concentration of milk and dairy products.

Chronic graft vs. host disease and hypogammaglobulinemia predict a lower immunological response to the BNT162b2 mRNA COVID-19 vaccine after allogeneic hematopoietic stem cell transplantation

OBJECTIVE

Due to the high mortality rate of COVID-19, the assessment of BNT162b2 SARS-CoV-2 mRNA vaccine (Pfizer-BioNTech) efficacy in allogeneic hematopoietic stem cell transplant (HSCT) recipients is mandatory.

PATIENTS AND METHODS

We conducted a single-center pilot study with the main objective of evaluating the immunogenicity of the BNT162b2 mRNA vaccine in 31 hematological patients who underwent hematopoietic stem cell transplantation within the previous 12 months and/or were affected by chronic graft-vs.-host-disease (cGVHD), by the assessment of antibody levels at 30-45 days after the second dose of vaccine.

RESULTS

After the second dose of vaccine, 23 out of 31 patients (74%) showed a positive immune response. The presence of severe cGVHD or Ig deficiency identified 7 out of 8 (85%) of non-responders. The median absolute cluster of differentiation 19 (CD19) count was significantly lower in non-responders vs. responders (109/µl vs. 351/µl). Underlying pathology, comorbidities, type of donor, time intervals from transplant and cluster of differentiation 3/cluster of differentiation 4/cluster of differentiation 8 (CD3/CD4/CD8) subsets were not significantly associated with an effective immune response to vaccination.

CONCLUSIONS

Despite the limited sample of patients enrolled, our findings suggest that hypogammaglobulinemia and cGVHD could be associated with poor humoral response to the BNT162b2.

Implementation gaps of the Portuguese National Health Plan: a stakeholders’ perception analysis

Background

The Portuguese National Health Plan (PNS) 2012-2016, extended to 2020, was the strategic health document shaping the direction of intervention within the Health System. The National Institute of Health Doutor Ricardo Jorge (INSA) is the institution responsible for carrying out its final evaluation. To underpin PNS final evaluation a multistep process was designed.

Methods

A mixed methods study using a convenience sample was implemented to assess stakeholders’ perception about five PNS dimensions: dissemination, communication, implementation, impact, and evaluation. For this purpose, two different tools were used. Semi-structured interviews with former health policy managers were conducted. In addition, an online survey was designed and widely distributed to additional stakeholders. From October 2019 to February 2020, data was collected using two separate instruments. Integral transcriptions of the interviews were made. Qualitative content analysis and quantitative descriptive analysis were used.

Results

A total of 12 interviews and 179 valid surveys were obtained. Regarding stakeholders’ perception about PNS implementation process, there was an overall positive recognition about the strategic and operational relevance of the PNS, as a common dialogue platform and a tool for health improvements both for health status and health system function in Portugal. Among pointed implementation barriers, management was mentioned as the major constraint, mainly due to shortage of human and financial resources to carry out the recommended interventions within the PNS timeline.

Conclusions

As part of the evaluation process the research team found relevant gain knowledge of the wider context in which PNS was developed and implemented, based on stakeholders’ perception. Their considerations are important not only to support the definition of the questions and criteria for PNS final evaluation, but also to highlight key issues for the future policy cycle.

Key messages

Digital Health Literacy in the Training of Informal Caregivers – Community Intervention

Background

Health Literacy allows optimizing healthy lifestyles and preventive and health protective behaviors (DGS, 2019). Low literacy can lead to a greater number of hospitalizations, a more frequent use of emergency services and a lower prevalence of preventive attitudes in the field of health. Internet-based interventions could have a positive impact on informal caregivers, reducing the geographical barrier, promoting self-efficacy in managing their own emotions, reducing burden.

Aim

Contribute to the training of informal caregivers of a primary health care unit in Lisbon, through the promotion of digital health literacy.

Methods

The Community Intervention project was carried out in the context of a home visit, focusing on 11 informal caregivers, through the presentation of an interactive digital manual. It was based on the methodology of health planning, through the elaboration of a diagnosis of the situation, definition of priorities, setting of objectives, selection of strategies, operational preparation and evaluation (Imperatori & Giraldes, 1993).

Results

It was found that not all informal caregivers have access to the internet or digital technologies, and it was necessary to deliver the printed manual. Caregivers who accessed the interactive digital manual rated its content as very important, having accessed the suggested links without difficulty. The possibility of forwarding the digital manual to other caregivers was valid for all.

Conclusions

Digital technologies promote communication in terms of health promotion, contributing to universal access and digital training in health, giving individuals the opportunity to increase care for their own health. The creation of digital health tools must be directed to the characteristics of the population. For individuals with low digital literacy, simple technologies must be created and for those who cannot or do not want to use digital tools, adequate alternatives must be created.

Key messages

• Primary care health professionals may use digital technologies to promote health literacy.

• Vulnerable groups with low digital health literacy need support to increase access to digital technology that can promote health literacy.

Informal caregivers’ profile needs: where do we stand?

Background

Non-communicable diseases’ increase and demographic ageing require a solution to manage long-term care (1), where informal caregivers are key actors (2). Optimization in policies designed to support their caregiving role is needed. Portugal is an aged country with high prevalence of family that take care of dependent relatives. ‘Informal caregivers’ profile in Lisbon County: a health community approach’ is a nurse-led research project designed to meet these challenges with the main aim: to develop a profile on informal caregivers in Lisbon county.

Methods

Reporting the descriptive phase, a survey containing health/social questions was submitted to a non-probabilistic representative sample of careers, aged 18 years old or above in about 300 caregiver’s caring dependent persons resident in Lisbon, in 2021. Univariate descriptive analysis was performed.

Results

Married and retired women’ caring for a parent were the most typical informal caregiver profile (n = 13, 4%). The majority do not have support from social services (n = 209, 61%). Two thirds live with the cared-for person (n = 219, 64%). Almost half (n = 150, 44%) have a university degree and only few planned the transition to a caregiver role (n = 13, 4%). No more than 10% had access to support programs (n = 71, 20%).

Conclusions

Caregivers’ unmet needs can complexify societal mechanisms relying on their work. Addressing these needs will be key to develop a strategy focused on supporting informal caregivers’ priorities.

References

1. Zigante, V. (2018). Informal care in Europe: exploring formalisation, availability and quality. Publications Office of the European Union. https://doi.org/10.2767/78836.

2. Crisp, N. (Coord.) (2014). Um futuro para a saúde - todos temos um papel a desempenhar. Fundação Calouste Gulbenkian. https://www.gulbenkian.pt

Key messages

• Caregivers profile needs will be key support a strategy on informal caregivers’ priorities.

• No more than 10% of informal caregivers in a relevant European County had access to support programs.

Key issues for implementation of Genomics in Healthcare: a Policy Brief

Issue/problem

Healthcare (HC) can significantly benefit from genomic information for earlier, accurate diagnosis, effective personalized treatment with less adverse events, and accurate profiling of individuals for disease prevention. However, European countries are currently at variable maturity stages regarding the implementation of genomic medicine (GM) in healthcare, hindering the equitable delivery of personalized medicine to citizens across borders.

Description of the problem

The European 1+Million Genomes Initiative (1+MG) aims to provide cross-border access to quality genomic information and related clinical data, to advance data-driven research and HC solutions to benefit citizens. This initiative is encouraging countries to develop national GM strategies, but guidance for successful implementation is needed. In this context, the Beyond 1 Million Genomes, a supporting action to the 1+MG initiative, organized three Country Exchange Visits (CEV) to discuss critical issues, share experiences and best practices, for the implementation of sustainable GM strategies in healthcare.

Results

The United Kingdom, Estonia and Finland, which have advanced GM programs, hosted CEV describing progress and lessons learnt. Representatives of 1+MG signatory countries participated in these events and were able to present country level progress. The resulting Policy Brief (PB) captures key issues discussed at the CEVs, with real-life examples, and proposes policy recommendations for the successful implementation of GM in European healthcare systems.

Lessons

Sustainable GM implementation in HC systems requires: 1) Patient and citizens trust and engagement; 2) Sustainable infrastructure and data regulation, with solid ethical and legal frameworks; 3) Capacity building of healthcare professionals; 4) A strong ecosystem involving all stakeholders, and encouraging synergies between healthcare, research and industry to promote continuous innovation.

Key messages

• The implementation of GM in healthcare will take countries further towards making personalized medicine a reality, with remarkable health and socioeconomic benefits for patients and healthcare systems.

• Promoting cooperation, capacity building and sharing of best practices is crucial to reduce asymmetries between countries, which constrains effective and equitable cross-border personalized medicine.

Acute rapamycin rescues the hyperexcitable phenotype of accumbal medium spiny neurons in the valproic acid rat model of autism spectrum disorder

We previously demonstrated that prenatal exposure to valproic acid (VPA), an environmental model of autism spectrum disorder (ASD), leads to a hyperexcitable phenotype associated with downregulation of inward-rectifying potassium currents in nucleus accumbens (NAc) medium spiny neurons (MSNs) of adolescent rats. Aberrant mTOR pathway function has been associated with autistic-like phenotypes in multiple animal models, including gestational exposure to VPA. The purpose of this work was to probe the involvement of the mTOR pathway in VPA-induced alterations of striatal excitability. Adolescent male Wistar rats prenatally exposed to VPA were treated acutely with the mTOR inhibitor rapamycin and used for behavioral tests, ex vivo brain slice electrophysiology, single-neuron morphometric analysis, synaptic protein quantification and gene expression analysis in the NAc. We report that postnatal rapamycin ameliorates the social deficit and reverts the abnormal excitability, but not the inward-rectifying potassium current defect, of accumbal MSNs. Synaptic transmission and neuronal morphology were largely unaffected by prenatal VPA exposure or postnatal rapamycin treatment. Transcriptome analysis revealed extensive deregulation of genes implied in neurodevelopmental disorders and ionic mechanisms exerted by prenatal VPA, which was partially reverted by postnatal rapamycin. The results of this work support the existence of antagonistic interaction between mTOR and VPA-induced pathways on social behavior, neurophysiological phenotype and gene expression profile, thus prompting further investigation of the mTOR pathway in the quest for specific therapeutic targets in ASD.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Human amniotic fluid stem cell-extracellular vesicles as paracrine candidates to rejuvenate cardiomyocyte renewal

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Genova

Background

Reactivation of cardiomyocyte renewal represents a milestone for cardiac regeneration. While broadly active in the early neonatal mammalian myocardium, such mechanism is lost soon after birth, with transition to defective repair. We previously showed that human amniotic fluid stem cells (hAFS) possess cardioprotective and cardioactive paracrine potential in a preclinical adult mouse model of myocardial infarction (MI)1, by sustaining cardiomyocyte cell cycle re-entry up to DNA duplication.

Purpose

Here we analyse whether hAFS secretome formulations, namely hAFS-conditioned medium (hAFS-CM) over extracellular vesicles (hAFS-EVs) separated from that, can enhance cardiomyocyte renewal in vitro and in vivo.

Methods

hAFS were obtained by leftover samples of prenatal screening amniocentesis and primed under 1% O2 preconditioning to enrich hAFS-CM and hAFS-EVs with cardioactive factors. hAFS-EVs were concentrated from hAFS-CM by serial ultracentrifugation. hAFS-EVs were profiled by electron microscopy, nanoparticle tracking analysis, proteomics and RNA sequencing (RNAseq). Neonatal mouse ventricular cardiomyocytes (mNVCM) were enzymatically isolated from R26pFUCCI2 mice with fluorescent tagging of cell-cycle by nuclear signal (G1-phase by Cdt1-mCherry; S-G2-M-phases by Geminin-mVenus1)2. mNVCM were stimulated by hAFS-CM or hAFS-EVs to identify the most promising formulation for further analysis in a R26pFUCCI2 4-day-old MI mouse model via intra-peritoneal delivery, according to principles of laboratory animal care and in compliance with authorization from the Italian Ministry of Health.

Results

hAFS-EVs sustained R26pFUCCI2 mNVCM transition from S- to M-phase by 2.1-fold (*p<0.05) in vitro, while triggering cytokinesis by 4.5-fold (*p<0.05) increase by Aurora B kinase expression at midbodies. Treated mNVCM showed disorganized expression of cardiac α-actinin, suggesting cytoskeletal re-arrangements prior to cell renewal, with significant down-regulation (0.6-fold, ****p<0.0001) of Cofilin-2 (CFL-2) an actin cytoskeleton regulator antagonizing cardiomyocyte proliferation3. RNAseq on hAFS-EVs revealed some of the mostly enriched microRNAs (miRNAs) targeting CFL-2 (miR-93-5p; miR-152-3p; miR-200b-3p; miR-429; miR-199a-3p; miR-20a-5p; miR-425-5p), while proteomics reported enrichment of a secreted form of Agrin, an important mediator for neonatal heart regeneration4. hAFS-EVs increased cardiomyocyte S- to M phase transition by 1.8-fold (*p<0.05) in the mouse neonatal left ventricle 3 days post-MI.

Conclusions

Our current findings suggest that EVs secreted by developmentally juvenile hAFS may be endowed with relevant potential to support cardiomyocyte renewal for future paracrine therapy in regenerative medicine with putative molecular candidate(s) of action in their cargo content including Agrin and non-coding miRNAs.

TOO MUCH OF NOT ENOUGH: Exploring Lack of Fear and Its Consequences

Introduction

Fear is an unpleasant emotional response to perceiving a threat causing physiological changes. Humans feel fear for positive motives, as it plays a crucial role in our survival. Just as the right balance in life is ideal, pathological fear is often described in one of its exaggerations, of having too much. However, lack of fear or “hypophobia” can be just as devastating and debilitating. This can be demonstrated in the analogy between those who feel no pain who also demonstrate increased risk and decreased life expectancy.

Objectives

The authors aim to explore the concept of fear, discussing currently known physiological mechanisms in order to explain the effects that alterations of these mechanisms can have on fear responses, namely lack of fear, and subsequently the consequence of this on mental health.

Methods

A brief non-systematized literature review was performed based on works most pertinent to the topic discussed.

Results

Muted fear responses have been mentioned in the literature, principally associated with medical conditions affecting the physiological fear pathways, including Urbach-Wiethe disease. Amygdala damage provokes abnormal fear reactions and reduced fear experience. This appears to be similar to what is seen in psychopathy, where abnormalities in the limbic system produce abnormal fear responses.

Conclusions

Any extreme can cause havoc on a well-balanced machine. Just as the excess of fear results in mental issues such as anxiety, a lack of fear can also be debilitating. Those demonstrating less fear could help investigators better understand mental health disorders that have been demonstrated to be mediated by similar processes.

Disclosure

No significant relationships.

BAD NEWS FOR HYPOCHONDRIACS: Covid-19 Associated Aggravation of Somatic Symptom Disorder with Psychotic Depression

Introduction

The Covid-19 pandemic has brought with it far-reaching consequences that affect the mental health of a significant population. Those suffering from somatic symptom disorder (SSD) present a significant focus on physical symptoms, with excessive thoughts and behaviours, to an extent that results in major distress and dysfunction. Aggravation of SSD could be associated with various stressors, including the current pandemic, and culminate in an increased severity of the base presentation.

Objectives

The authors present the case of an elderly man with previous diagnosis of SSD which began to aggravate and evolve into a depressive psychotic state, precipitated by the beginning of the Covid-19 pandemic.

Methods

The authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question as well as presenting a clinical case as compliment.

Results

With the pandemic overwhelming the globe, the literature has demonstrated a significant correlation with aggravation of mental health and psychiatric cases. The patient in question was previously followed in consultation for SSD. With the pandemic acting as precipitating stressor, the patient demonstrated a significant aggravation in his base presentation with the development of psychotic depression. He was subsequently hospitalized with implementation of psychotherapeutic and psychopharmacological methods, with remission of the psychotic state, with poor response of the SSD.

Conclusions

External stressors are an important influence on psychiatric disorders. Whenever potential life stressors, especially those that exert influence on a global scale, the psychiatrist should be attentive to the possibility of significant aggravation of a stabilized clinical picture and offer support.

Disclosure

No significant relationships.

YOU’VE BEEN CATFISHED: An exploration of social deception on online platforms

Introduction

Life is a stage in which we are all actors and online we can choose who we want to be. Catfishing is a modern phenomenon in which individuals present themselves online as someone they are not as a means of engaging with others through an idealized avatar. This term has gained prominence since its portrayal in documentary and television series. With the emergence of catfishing, an expectation of betrayal in online relationships is anticipated with increasing caution being exercised by those that engage in online forums.

Objectives

The authors aim to explore this phenomenon and explore what personality traits might be associated with those who engage in catfishing others and in those that fall for the dupe.

Methods

A review of the recent literature on the topic with focus on that which is most relevant to the theme was included.

Results

The literature demonstrates that catfishing is an increasing trend as our online social interaction also increases. Catfishing appears to exist on a scale, where approximately 80% of the online population engage in some form, by means of amplifying their social status. Those with low self-esteem, poor self-worth with and a need to connect and to be validated were most susceptible.

Conclusions

The internet permits anonymity where trading “real world” skins with digital ones creating avatars in order to seek what is desired. Catfishing raises questions about the nature of the human self and the role it plays in deception. Understanding how patients use the internet may provide insight into how personality acts on a stage of total anonymity.

Disclosure

No significant relationships.

ONLY IN DREAMS: a case report of sleep deprivation psychosis

Introduction

Sleep is essential for an adequate neurobiological functioning, being implicated in several cognitive functions. Even in healthy individuals, sleep deprivation can lead to a number of psychopathological changes, including perceptual distortions, hallucinations and delusions. Thus, the resulting clinical picture may be similar to a psychotic disorder.

Objectives

To present a clinical case of psychotic symptomatology induced by sleep deprivation.

Methods

Patient’s clinical file consultation and literature review using the search engine Pubmed® and the keywords: “sleep deprivation”, “sleep loss” and “psychosis”.

Results

We present the case of a 41-year-old woman with a history of an episode of mood changes with psychotic symptoms that was preceded by a period of total insomnia. No psychotropic drugs since then and no relapses. In May 2020, she was admitted in psychiatry department due to clinical picture composed by significant psychomotor slowing, drowsiness, slowed speech, verbal visual, tactile and auditory hallucinations accompanied by grandiose delusions. These symptoms were preceded by total insomnia with one week of duration. In the hospital was administered quetiapine 100mg and lorazepam 2.5mg to aid in the recovery of sleep deprivation and concomitantly aripiprazole 15mg was prescribed. The patient presented a rapid and significant clinical improvement. Currently, it is without any type of medication and without psychopathological changes.

Conclusions

The clinical picture present in this case report was triggered after a significant period of sleep deprivation. Thus, it illustrates the role that sleep has in the development of psychiatric symptomatology, sometimes difficult to differentiate from psychiatric disorders.

Disclosure

No significant relationships.

FALLING FOR FADS? Diagnostic and therapeutic fads in Psychiatry

Introduction

Psychiatry is not immune to the effects of trends and fads, which are ideas that elicit short-lived enthusiasm, are quickly adopted, and abandoned when they fail to live up to expectations. Trends meet a deeply felt need to explain, or at least name, what would alternatively be unexplainable human suffering.

Objectives

The authors aim to explore the trends and fads that have occurred in psychiatric diagnostic and treatment throughout history and assess if any modern trends can be identified as well as assessing the effects or consequences of these.

Methods

The authors conducted a non-systematized literature review with focus on those articles most pertinent to the topic in question.

Results

The literature demonstrates that fads and trends not only plague fashion and diet, but also psychiatry. Trends in psychotherapeutic options can be observed by the swing from psychoanalysis to psychopharmacological focus. Overdiagnosis is one of the consequences of these trends, and can be seen from hysteria, schizophrenia, multiple personality disorder, attention-deficit and hyperactivity disorder to gender identity disorder. These trends impact the way diagnosis are made and the treatments implemented.

Conclusions

Fads in psychiatry have occurred not only on the edge, but in the very mainstream of theory and practice. A balance is called for, with caution needed in order not to fall into the temptation of the fad, however, an open mind should also be maintained when cutting-edge treatments and theories emerge. The sensible antidote to falling for fads and trends in psychiatry is commitment to evidence-based medicine.

Disclosure

No significant relationships.

Catatonia and dementia: a case report

Introduction

Catatonia is a neuropsychiatric disorder characterized by motor, behavioral and autonomic changes. It is associated with several psychiatric disorders, including dementia. Catatonia is an underdiagnosed syndrome, so it is important to draw attention to it. Here, we review a case of a patient admitted to our psychiatric department with a clinical presentation compatible with catatonia. After proper treatment, further assessment revealed dementia.

Objectives

This work aims to describe a case of catatonia in a patient with dementia.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Catatonia is a disorder that was already been described as part of several types of dementia. We present a 69-year-old female patient, admitted to our psychiatric department with clinical presentation compatible with catatonia. To admission, she presented some typical complications resulting from long immobility such as pressure ulcers and nutritional deficiencies. During the hospitalization, she developed a urinary infection and there was the need to tube feeding. She was treated with benzodiazepines and improved. Further assessment revealed dementia.

Conclusions

Catatonia in dementia is not uncommon, although it is an underdiagnosed syndrome, and when treated early and properly it has a good prognosis.

Disclosure

No significant relationships.

MURDEROUS MYTHOMANIA: Psychopathology of lying – Apropos a Clinical Case

Introduction

The capacity for lying is a common human phenomenon with evolutionary explanations, in which one seeks to deceive usually to avoid harmful or undesired consequences. The spectrum of lies is vast and varies from the content to the motivation. Pathological lying has the potential to affect mental evaluations thus motivating an important discussion regarding this behaviour.

Objectives

The authors aim to explore the psychopathological concept and spectrum of pathological lies, from their underlying motives to their implications and challenges in psychiatric diagnosis with recourse to a clinical case example.

Methods

A review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present the clinical case of a middle-aged female who presented with mythomania which included the fabrication of having attempted murder.

Results

The literature demonstrates a relationship between compulsive lying and personality disorders. Head trauma and other central nervous system issues may also play a role. Some traits may facilitate the detection of deception, such as dramatic and unmotivated constructs with a positive self-portrayal. The clinical case description correlates the personality factors associated with mythomania, namely antisocial personality disorder, differing from the typical presentation as her fabrications portrayed her negatively.

Conclusions

The implication of pathological lying is that it may interfere with mental assessment thus altering, by way of deception, the psychiatric evaluation as lies may be difficult to detect upon a first evaluation. The psychiatrist should be alerted to the possibility of fabrication when dealing with a patient with predisposing factors.

Disclosure

No significant relationships.

Role of migration in the development of a first episode of psychosis

Introduction

Currently, there is scientific evidence supporting the relationship between socio-environmental factors and the onset of a first episode of psychosis (FEP). In this context, the phenomenon of migration, seen as a negative life experience, may become an important risk factor in developing a psychotic disorder (PD). In Europe, the impact of this phenomenon is growing and, therefore, it’s necessary to provide a proper answer to these individual’s mental health problems.

Objectives

Identify which phases of this migration process are most important in the development of a FEP and what are the more significant socio-environmental factors in each phase.

Methods

Bibliographic research in Pubmed database using the terms “Migration” and “First Episode Psychosis”.

Results

Research confirms that migrants have a 2 to 3-fold increased risk of developing a PD. This risk will be even higher in the refugee population. Pre- and post-migration factors demonstrated to be more important than factors related with the migration process itself. In the pre-migration phase highlight factors like the lower parental social class and a previous trauma. In the post-migration phase highlight factors like discrimination, social disadvantage and a mismatch between expectations and reality.

Conclusions

Literature is unanimous in considering migrant status as an independent risk factor for the development of FEP, possibly due to the outsider’s role in society. Thus, despite the growing interest in Biological Psychiatry, this work demonstrates that socio-environmental factors are very preponderant in the development of these disorders and because of that further investigation is still necessary.

Disclosure

No significant relationships.

The meaning in life and smart technology of older adults during the Covid-19 pandemic: A cross-cultural qualitative study

Introduction

The exponential increase of the older segment of the population (1) is coinciding with the growing challenges of a digital society in different socio-cultural contexts (2).

Objectives

This exploratory study aims to analyze older adult perspectives of how smart technology influenced their meaning in life during the Covid-19 Public Health Emergency period, using qualitative research at a cross-national level.

Methods

Three hundred and fifty one community-dwelling older participants aged 65-87 years were included in the study. Participants were Italian, Mexican, Portuguese and Spanish. All the narratives went through a process of content analysis.

Results

Findings of content analysis produced six themes: Meaningful relations, rewarding activities, spirituality, health and safety-related support, self-growth, and physical activity. Smart technology was important in promoting significant relations for Mexican older adults (71.3%), rewarding activities for Portuguese older adults (57.1%), spirituality for Spanish older participants (71.6%), and physical activity for Italian older adults (29.5%).

Conclusions

This study indicated that smart technology during the Health Emergency period was important for the meaning in life of older populations, mostly by facilitating meaningful relations, rewarding activities and spirituality. Future interventions with older adults during pandemic periods should consider the diversity of themes associated with increasing older adult well-being, from a cross-cultural perspective. 1. von Humboldt S & Leal I. The old and the oldest old: Do they have different perspectives on adjustment to aging?. Int J Gerontol; 9:156-160. 2. von Humboldt S et al. Does spirituality really matter? - A study on the potential of spirituality to older adult’s adjustment to aging. Jpn Psychol Res, 56;114-125.

Disclosure

No significant relationships.

“Walking with myself by my side” - non-medical use of Ketamine

Introduction

Ketamine, synthesized in 1962 as phencyclidine derivate, is denominated a “dissociative anesthetic” because of its side-effects, such as dissociative episodes and psychotic-like symptoms, which have limited its applicability on clinical practice. Otherwise, in the last decades the non-medical use of ketamine has been growing and today is one of the most popular illicit substances consumed between adolescents and young adults.

Objectives

Increasing the knowledge and understanding of the factors related to crescent use of ketamine and the experiences and consequences associated to its consumption.

Methods

Clinical interview with patients diagnosed with ketamine use disorder and bibliographic research in Pubmed database using the terms “Ketamine use” and “Ketamine addiction”.

Results

Pat et al. (2002) describes a clinical case of a young male, diagnosed with substance use disorders, specifically alcohol and cocaine use disorders, that started a treatment with ketamine. After the treatment, pleasant depersonalization experiences contributed to the development of patient’s ketamine dependence. Other patient’s reports confirm the association of ketamine use with psychedelic effects and dissociative episodes and pointed these effects as main reason for its consumption.

Conclusions

The adverse effects that limited the medical use of ketamine are the same that promote its utilization with recreational purposes by adolescents and young adults in parties and nightclubs. About the ketamine dependence, the literature is scarce and doesn´t clearly identify a physical withdrawal syndrome, pointing only to a serious psychological dependence. Thus, with the crescent non-medical use of ketamine, it’s urgent to develop an intervention plan directed to this problem.

Disclosure

No significant relationships.

Psychogenic epidemic - mass hysteria phenomena in Portugal

Introduction

Mass hysteria also called mass psychogenic illness (MPI), defined as a social phenomenon, consists of collective anxiety due to a perceived threat and can culminate in a cascade of symptoms suggestive of organic disease without an identifiable cause. Its history dates back to the 14th century and impacts people from all cultures and regions of the world. Before the 20thcentury, MPI emerged across Europe, often in socially isolated convents, in highly stressful environments.

Objectives

The aim of this study is to explore the available literature on mass hysteria phenomena in Portugal, historical origins, applications and eventual position in modern psychiatric semiology.

Methods

Non-systematic review of literature published in Medline/Pubmed. Search terms included: mass hysteria, nocebo, groupthink, emotional contagion.

Results

In Portugal two great phenomena of mass hysteria were described. In 1917, the “sun miracle” occurred, where thousands of individuals reported having seen the sun rotating in the sky and changing its size and colours. Years later, more than 300 students from 14 schools described the same symptoms: dizziness, dyspnea and rash, without an identifiable cause. In common these young people had “sugar strawberries”. In May 2006, the young people in the television series were infected with a vírus, and clinical picture was similar to that presented by young people in real life. For the first time, a fictional illness on television triggered an illness in real life.

Conclusions

More studies should be carried out on these phenomena as their early recognition can have a tremendous impact on the ease of identification, diagnosis and treatment.

Disclosure

No significant relationships.

Older adults and sexual well-being: A qualitative study in Portugal and Slovenia

Introduction

Beyond living longer, it is increasingly important to live with more and better health during aging (1). Sexual well-being (SWB) was found to contribute to health and well-being in old age and is highly under-researched in the older population (2).

Objectives

This study aims to analyze SWB in a cross-cultural way through older Portuguese and Slovenian older samples.

Methods

We interviewed 136 older participants with an average age of 71.6 years old. Participants were Portuguese and Slovenian and lived in the community. Participants were subjected to semi-structured interviews and these were subjected to a content analysis process.

Results

The content analysis indicated nine themes related to SWB: self-reported good health; demonstrations of love; non-sexual joint activities; overall well-being and quality of life; partner support; positive self-image; being independent and active; sexual compatibility; and masturbation. Portuguese older adults experience their SWB associated mainly with self-reported good health and demonstrations of love, while Slovenians older adults associate their SWB mainly with non-sexual joint activities and overall well-being and quality of life.

Conclusions

The themes found in this study are fundamental evidence for cultural interventions and guidelines outlining in the context of sexual health in aging, mainly due to the scarcity of knowledge of SWB among older adults. 1.von Humboldt S et al. Sexual expression in old age: How older adults from different cultures express sexually? Sex Res Social Policy. 2020;1-15. 2.von Humboldt S et al. Are older adults satisfied with their sexuality? Outcomes from a cross-cultural study. Educ Gerontol. 2020;46:284-293.

Disclosure

No significant relationships.

THAT’S SO CRINGE: Exploring the Concept of Cringe or Vicarious Embarrassment and Social Pain

Introduction

The word cringe has suffered alterations in its colloquial application, with its most recent version, adopted by generation Z and millennials, as a response to embarrassment or social awkwardness by proxy. This odd emotion is interesting in that it translates a vicarious embarrassment which is elicited whenever one is in the presence of a social blunder, public failures and threats to another’s social integrity.

Objectives

The authors aim to explore the novel concept of cringe, briefly discussing what is currently known about the emotional response. A potential correlation between empathy and cringe is discussed as well as the hypothesis that certain psychiatric disorders such as personality disorder may demonstrate altered cringe responses.

Methods

The authors propose a non-systematized brief literature review on works most pertinent to the topic.

Results

Formal and structured studies into the concept of cringe are far and few between, however, the literature does demonstrate that, the neural pathways of how social closeness affects our experience of cringe are starting to be explored. The concept of cringe, has also been described as a vicarious social pain. Exploration into the empathy pathways and their abnormalities, may demonstrate the underlying construct of cringe. Lack of this feeling may be present in those with empathy alterations, such as is seen in antisocial personality disorder.

Conclusions

Cringe is an uncomfortable feeling that surges when in the presence of someone suffering socially. Understanding this oddity may permit further understanding of empathy pathways as well as exploring the neural abnormalities of those who do not feel cringe.

Disclosure

No significant relationships.

Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report

Introduction

The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance.

Objectives

Clinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research.

Methods

Bibliographic research using Pubmed®. Clinical file consultation and patient interviews.

Results

Heightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people.

Conclusions

Intense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.

Disclosure

No significant relationships.

Anorexia Nervosa and Gender Dysphoria: A Clinical Case

Introduction

Eating disorders (ED) and gender dysphoria (GD) are associated with a change in body perception. Therefore, body dissatisfaction plays a common and central role in these disorders. In GD, body image concerns are related to the features of the biological sex. In ED, body dissatisfaction comes from a distorted perception of weight and body shape and plays an important role in the development and maintenance of the psychopathology.

Objectives

To present and discuss the clinical case of a patient with a previous diagnosis of GD who presented with a clinical condition suggesting a restrictive anorexia nervosa (AN).

Methods

Patient´s clinical files consultation and literature review using Pubmed and the keywords: eating disorders and gender dysphoria.

Results

We present the case of a 25-year-old patient who was living in a shelter for victims of domestic violence and was admitted for severe restrictive AN. The patient was discharged after 40 days and medicated with sertraline, diazepam and olanzapine, as well as her previous medication (hormonal therapy): cyproterone, finasteride, estradiol, oxybutynin.

Conclusions

Although studies on this subject are still scarce, there has been some progress and the literature recognizes the coexistence of these conditions. However ED symptoms in patients with GD could have a different meaning: they may represent a dysfunctional coping strategy adopted to block features of the biological sex. Therefore health professionals may take a more holistic approach to body image. Additional studies will be necessary, allowing the establishment of cause-consequence interactions between weight loss and psychopathology related to GD.

Disclosure

No significant relationships.

Folie à deux: contagious mental illness? Report of a clinical case

Introduction

Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists.

Objectives

The aim of this article is to report a clinical case of folie à deux, between na inducer son and an induced mother. Review the nosological significance of folie à deux and to explore the disorder among patients with psychosis.

Methods

Search in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.

Results

We presente a case of folie à deux between na inducer son 28 years old and the induced, his mother. They were found to be sharing similiar delusional beliefs. The patient has assumed the role of “man of the house” since his father’s death.

Conclusions

Many years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists. Its recognition and correct referral for a rare diagnosis, such as folie a deux, are extremely important.

Disclosure

No significant relationships.

Stereotactic ablative body radiotherapy of ventricular tachycardia. Single italian centre experience

Funding Acknowledgements

Type of funding sources: None.

Background

Ventricular tachycardia (VT) is a life-threatening condition. Usual management of VT is based on anti-arrhythmic drugs or catheter ablation. In this scenario, stereotactic body radiation therapy (SBRT) is arising as an attractive non-invasive alternative for the treatment of VT in some patients (pts).

Purpose

The aim of this study was to assess safety, feasibility and outcomes of SBRT in fragile pts admitted in our centre for VT storms.

Methods

Pts with implantable cardioverter-defibrillator (ICD), presenting with VT storms and not responsive to drugs or suitable for catheter ablation were enrolled for SBRT. All pts underwent a computed tomography (CT) and an 18F-fluorodeoxyglucose positron emission (FDG PET)-CT scan in order to detect a possible area of scar responsible of the VT. All pts had also an electrophysiological study and ventricular programmed stimulation inducing clinical VT while wearing a multi-electrodes ECG vest. Merging the CT scan imagines and the VT 3D reconstruction, we identified the possible circuit of the VT and its exit sites. Treatment planning was performed for a total dose of 21-25 Gy delivered in a single session. For the first year, follow-up (FU) were scheduled every 3 months since the SBRT treatment. Toxicity was prospectively assessed.

Results

From January 2020 to March 2021, we treated 6 (5 males) pts. Mean age was 78±4. NYHA class was II for 3 pts, 2 were class III and only one pts was class IV. Four pts had an ischaemic heart disease background, two had dilated cardiomyopathy (DCM). Mean ejection fraction (EF) was 31±6%. The mean FU was 17 months, with the longest of 23 months. Of these 6 pts, only one died because of end stage heart failure, no VT/VF were recorded on his ICD. This was the pts with DCM and class NYHA IV at the time of procedure. Of the 5 pts remaining, 2/5 reported new therapies delivered by their ICDs. One pts had a single ICD shock during acute urine tract infection and sepsis at one month since SBRT. ICD interrogation documented inappropriate shock on fast conducted atrial fibrillation. No VTs have been recorded after 7 months. The other pts was admitted after 5 months since SBRT. The ICD showed appropriate therapies on VTs. This pts had the biggest scar volume compared to the others (anterior wall of the left ventricle with aneurysmatic apex). On the other 3 pts, no VTs were recorded by ICDs. Of these 3 pts, interestingly, 2 had class NYHA III and the mean EF 28.6±3%. The overall outcome with no appropriate ICD shocks due to VTs is above 70%. No radiotherapy toxicity was documented.

Conclusion

To the best of our knowledge this is one of the biggest groups of pts treated with this technology and the longest FU so far, of a single centre in Italy. SBRT seems to be a safe and feasible approach to treat fragile pts with VTs when not suitable for standard catheter ablation or responsive to medications. It also shows a good outcome even in pts with more advanced heart failure.