In vivo evaluation of the potential protective effects of prolactin against damage caused by methylmercury

Non-biodegradable metals such as mercury accumulate in living organisms during life (bioaccumulation) and also within trophic webs (biomagnification) and may reach high concentrations in humans. The contamination of humans by mercury in drinking water and food may be common, in particular in riverside communities that have a diet rich in fish. In vitro studies of human cell lines exposed to the cytotoxic and mutagenic effects of methylmercury have shown that prolactin has potential cytoprotective properties and may act as a co-mitogenic factor and inhibitor of apoptosis. The present in vivo study investigated the protective potential of prolactin against the toxic effects of methylmercury in the mammal Mus musculus. Histological and biochemical analyses, together with biomarker of genotoxicity, were used to verify the protective potential of prolactin in mice exposed to methylmercury. The reduction in kidney and liver tissue damage was not significant. However, results of biochemical and genotoxic analyses were excellent. After prolactin treatment, a significant reduction was observed in biochemical parameters and mutagenic effects of methylmercury. The study results therefore indicated that prolactin has protective effects against the toxicity of methylmercury and allowed us to suggest the continuation of research to propose prolactin in the future, as an alternative to prevent the damage caused by mercury, especially in populations that are more exposed.

Suicide postvention in psychiatry

Introduction

During their career and sometimes during their training psychiatrists have to deal with the suicide of patients and have also to help other colleagues and families to cope with the situation. Suicide postvention should be integrated in psychiatric training and better implemented in both psychiatric and community contexts.

Objectives

To discuss the concept of suicide postvention in Psychiatry. To discuss the importance of addressing suicide postvention in psychiatric settings including during specialized training of Psychiatry residents.

Methods

MEDLINE and PubMed databases searches for peer-reviewed studies, published in the last ten years, using combinations of the key-words suicide postvention and psychiatry. Selection of the relevant studies according to the study aims.

Results

The literature search retrieved a total of 44 papers. All the articles that didn´t refer to the studied topic were excluded. Relevant articles discussing suicide postvention were selected, comprising a total of 22 articles. The reviewed papers discuss different contexts and strategies of suicide postvention that will be explored and critically discussed.

Conclusions

Addressing the topic of suicide postvention and implementing support programs and training in this field is crucial to psychiatry trainees, psychiatrists and other mental health professionals that integrate multidisciplinary teams, patients and their families and also to the community as a whole. Future research in this field can help to improve suicide postvention across different settings.

Disclosure

No significant relationships.

The coronavirus pandemic impact on involuntary hospitalization

Introduction

Compulsory admission is the last line of intervention in individuals who suffer from severe mental disorders, based on the principles of therapeutic need and social protection. In Portugal, the law configures this measure as a hospitalization by court order. The SARS-CoV-2 coronavirus is a global public health emergency, with multifaceted consequences for people’s lives and health. Several studies are showing a great impact of the pandemic on the overall mental health.

Objectives

The aim is to assess the impact of the pandemic on the number of involuntary hospitalizations, their socio-demographic and clinical characteristics, and study the differences between 2019 and 2020.

Methods

Consultation of all patient’s clinical files that were involuntarily admitted in Hospital Magalhães Lemos during 2019 and 2020. Statistical analysis of data.

Results

The authors claim to investigate the impact of the pandemic on involuntary hospitalizations, the factors of admission and decompensation and other clinical characteristics, by comparing the involuntary hospitalizations during 2019 and 2020. The authors believe that the number of compulsory admissions increased significantly with the pandemic. They also believe that factors such as increased or relapsed consumption of alcohol and drugs, suicide attempts, missed appointments and long-term injectable medication are at the root of this increase in 2020.

Conclusions

This study helps to analyze the impact of the new coronavirus on compulsory hospitalizations and allows to understand the main factors that aggravate the underlying pathologies. Thus, understanding the targets of greater attention from psychiatrists to avoid the decompensation of patients in times of pandemic in which we currently live.

Disclosure

No significant relationships.

Quality of Life and Characterization of Patients With Atopic Dermatitis in Portugal: The QUADEP Study

Objectives: To investigate the quality of life (QOL) of and to characterize patients with atopic dermatitis (AD) in Portugal. Methods: This was a cross-sectional study of patients with AD and other eczemas. Skindex-29, Skindex-teen, and the Childhood Atopic Dermatitis Impact Scale (CADIS) were the instruments used to assess QOL in adults, teenagers, and children, respectively. The SF-12 was also used, and disease severity was evaluated using the Patient-Oriented SCORAD (PO-SCORAD) instrument. Associations with QOL were assessed based on the odds ratio (OR). P values <.05 and 95%CIs were considered statistically significant. Results: The study population comprised 162 participants aged 0.5-74 years. We found that 37.3% of AD patients consider their disease disabling and that more than half of the patients feel stigmatized by society. The mean Skindex score for AD was 39.68, and the impact on QOL was severe in 44%. “Symptoms” was the most affected category in adults. AD was moderate to severe in 87% of the sample. One of the factors that most influenced poorer QOL in AD was age: with increasing age, the Skindex is likely to increase (OR, 1.03; 95%CI, 1.00-1.06). “Considering the disease a disability” was also associated (OR, 6.72; 95%CI, 2.56-17.63). QOL worsens with increasingly affected body area (OR, 1.07; 95%CI, 1.03-1.11) and the presence of edema (OR, 2.0; 95%CI, 1.23-3.40). Conclusions: This is the first study to provide data on QOL in patients with AD in Portugal. Our data show an expected negative impact. More awareness-raising activities are needed to increase knowledge, decrease stigmatization, and, consequently, address the factors involved in the QOL of patients with AD.

Circulating microRNAs as potential biomarkers for genetic generalized epilepsies: a three microRNA panel

BACKGROUND AND PURPOSE

Genetic generalized epilepsies (GGEs) encompass a group of syndromes of mainly genetic causes, characterized by the involvement of both hemispheres. MicroRNAs (miRNAs) are small non-coding RNAs with a critical role in the regulation of neuronal biological processes through gene expression modulation. Dysregulated miRNA expression has been shown in epilepsy. Due to their stability in biological fluids like serum, miRNAs have assumed a prominent role in biomarker research. Our aim was to evaluate circulating levels of three miRNAs in GGE patients and assess their putative diagnostic value.

METHODS

MiR-146a, miR-155 and miR-132 were quantified by real-time polymerase chain reaction in the serum of 79 GGE patients (47 women, 32 men, 35.1 ± 12.4 years) and 67 healthy individuals (41 women, 26 men, 42.4 ± 10.1 years). Relative expression values were calculated using the 2^-ΔΔCt method. Receiver operating characteristic curve analysis was performed to assess diagnostic value. MiRNA expression was correlated with clinicopathological features.

RESULTS

Serum levels of miR-146a and miR-155 were significantly upregulated in GGE patients relative to controls (3.13 and 6.05, respectively). Combined miR-146a, miR-155 and miR-132 serum levels performed well as a diagnostic biomarker, discriminating GGE patients from controls with an area under the curve of 0.85, 80% specificity and 73% sensitivity.

CONCLUSIONS

Our results indicate that miR-146a, miR-155 and miR-132 may partake in GGE epileptogenesis. A panel of three circulating miRNAs with potential value as a GGE biomarker is reported for the first time. Novel biomarkers may help to identify new treatment targets and contribute to improved patients' quality of life through earlier diagnosis and a more precise prognosis.

Full mtDNA genome sequencing of Brazilian admixed populations: A forensic-focused evaluation of a MPS application as an alternative to Sanger sequencing methods

The use of Massive Parallel Sequencing (MPS) techniques have been proposed by the forensic community as an alternative to Sanger sequencing methods in routine forensic casework analysis regarding mitochondrial DNA (mtDNA). Interesting features of MPS include high throughput, ability to simultaneously genotype a significant number of samples by barcoding techniques, processing automation, reduced time and costs, among others. Advantages include the capability of generating full mtDNA genome sequences versus usual techniques, usually limited to hypervariable or control regions exclusively. In this work, 96 reference single-source samples from three different Brazilian cities were subjected to full mtDNA genome sequencing by MPS techniques using an early-access version of Precision ID mtDNA Whole Genome Panel on an Ion Torrent PGM platform (Thermo Fisher Scientific, Waltham, MA, USA). Complete, high-quality sequences were obtained and sequencing performance was evaluated via four different metrics. As a subset of evaluated samples have been previously submitted for Sanger sequencing of the control region, a comparative analysis of both methods' results was conducted in order to compare technique adequacy within a forensic context. Even though this study is one of the first to report full mtDNA genome sequences for Brazilian admixed populations, the observed haplotypes exhibit a predominance of Native American and African maternal lineages in the studied sample set, reproducing results described in the literature for control regions only. Interpopulation analysis among Brazilian and 26 worldwide populations was also carried out. The results indicate that MPS-generated full mtDNA genome sequences may have great utility in forensic real casework applications, with a pronounced gain of genetic information and discrimination power provided by coding region evaluation and the enhanced capacity of heteroplasmies determination. Database construction and other relevant factors concerning implementation of such techniques in Brazilian forensic laboratories are also discussed.

Intravenous immunoglobulin in lupus panniculitis

Systemic lupus erythematosus (SLE) is a disease of unknown cause that may involve one or many organ or systems. Skin involvement is a major feature in this disease, and a wide variety of skin conditions may be present. Lupus erythematosus panniculitis (LEP) constitutes a rare form of cutaneous lupus characterized by recurrent nodular or plaque lesions that can vary from a benign and mild course to a more disfiguring disease. Initial therapy includes corticosteroids, antimalarials, and azathioprine and, in refractory cases, two antimalarials in association, mycophenolate mofetil, or other immunomodulators. Intravenous immuglobulin (IVIG) is used in many autoimmune disorders, like in SLE, although clinical trials have not yet taken place. In this report, we review skin manifestations of SLE and their treatment, IVIG, and finally a case of LEP successfully treated with IVIG when other therapy modalities failed.

Situação epidemiológica da brucelose bovina no Estado de Mato Grosso

Caracterizou-se a brucelose bovina em Mato Grosso por meio de um estudo transversal realizado em 2003 para auxiliar na implementação do Programa Nacional de Controle e Erradicação da Brucelose e Tuberculose. No Estado, estratificado em quatro circuitos pecuários, foram amostrados 13.684 animais, provenientes de 1.152 rebanhos. O protocolo de testes utilizado foi o da triagem com o teste do antígeno acidificado tamponado e os soros reagentes foram testados pelo 2-mercaptoetanol (ME) e concomitantemente retestados pelo teste de Rosa Bengala para resultado conclusivo. As prevalências de focos e de animais infectados foram: 41,2% [38,0-44,4%] e 10,2% [7,4-13,1%], respectivamente. Nos circuitos produtivos, as prevalências de focos foram 36,9% [29,2-45,2%], 27,2% [22,8-32,1%], 40,4% [38,8-46,2%] e 50,3% [44,5-56,1%]; e as prevalências de animais 7,9% [3,0-12,9%], 4,1% [2,8-5,4%], 8,1% [5,2-11,1%] e 15,3% [9,2-21,3%], respectivamente, para os circuitos 1, 2, 3 e 4. Os fatores de risco (odds ratio, OR) associados à condição de foco no Estado foram: exploração de gado de corte (OR= 1,8 [1,2-2,5]), exploração mista (OR=1,8 [1,2-2,7]), número de fêmeas no rebanho de 11 a 50 (OR=4,8 [1,1-20,8]), número de fêmeas no rebanho acima de 51 (OR=6,8 [1,6-29,0]), ocorrência de aborto (OR=1,7 [1,3-2,2]). A brucelose está homogeneamente distribuída no Estado, o que permite uniformidade de medidas sanitárias. Adicionalmente, sugere-se a intensificação da vacinação de fêmeas para todo o Estado.

Communication of information to patients with inflammatory bowel disease: A European Collaborative Study in a multinational prospective inception cohort

BACKGROUND AND AIMS

Communication to patients of information about their disease has become increasingly important in modern medicine, and particularly with chronic nonfatal disorders like inflammatory bowel disease (IBD), but the subject is not adequately researched or understood.

METHODS

We studied the media and preferences for communication of information in a multi-national community-based inception cohort of European and Israeli patients with IBD and 10 years follow-up, using structured questionnaires categorizing demographics, disease status, current and preferred sources of information, use of electronic media, role of patients' associations, and satisfaction level.

RESULTS

The 917 patients completing the questionnaire were derived from northern (60%) and southern (40%) countries. The mean age was 48.3 years (62% under 50 years); 51% were males; 67% had ulcerative colitis, 33% Crohn's disease. Sixty-six percent of patients designated the specialist as their primary source of information, 77% indicated satisfaction with their current information, and 65% reported not receiving information about medical treatment in the past year. Patient concerns were about new research into their illness (64%), medical treatments (58%), risks and complications (51%) and genetics (42%). Preferred sources of information were paper bulletin (76%), electronic media (30%) and international organization (79%). Diagnosis (ulcerative colitis or Crohn's disease), gender, education level and country impacted significantly on patients' choices.

CONCLUSIONS

In providing health care information to patients with IBD their individual attitudes and preferences must be considered. There should be greater roles for IBD patients' associations and international IBD-research organizations, and an increasing use of electronic media.

Dysplasia and cancer in inflammatory bowel disease 10 years after diagnosis: results of a population-based European collaborative follow-up study

OBJECTIVE

To determine dysplasia and cancer in the 1991-2004 European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort.

PATIENTS AND METHODS

A patient questionnaire and a physician per patient form were completed for each of the 1,141 inflammatory bowel disease patients (776 ulcerative colitis/365 Crohn's disease) from 9 centers (7 countries) derived from the EC-IBD cohort. Rates of detection of intestinal cancer and dysplasia as well as extra-intestinal neoplasms were computed.

RESULTS

Patient follow-up time was 10.3 +/- 0.8 (range 9.4-11) years. The mean age of the whole group of IBD patients was 37.8 +/- 11.3 (range 16-76) years. Thirty-eight patients (3.3%; 26 with ulcerative colitis/12 with Crohn's disease, 21 males/17 females, aged 61.3 +/- 13.4, range 33-77 years), were diagnosed with 42 cancers. Cancers occurred 5.4 +/- 3.3 (range 0-11) years after inflammatory bowel disease diagnosis. Colorectal cancer was diagnosed in 8 (1 Crohn's disease and 7 ulcerative colitis patients--0.3 and 0.9% of the Crohn's disease and ulcerative colitis cohort, respectively) of 38 patients and 30 cancers were extra-intestinal. Four of 38 patients (10.5%) were diagnosed as having 2 cancers and they were younger compared to patients with one cancer (p = 0.0008). There was a trend for a higher prevalence of intestinal cancer in the northern centers (0.9%) compared to southern centers (0.3%, p = NS). Southern centers had more cases of extra-intestinal cancer compared to northern centers (2 vs. 3.8%, p = 0.08). Ten patients (0.9%; 8 with ulcerative colitis/2 with Crohn's disease, 8 males, aged 62.3 +/- 14.1 years) had colorectal dysplasia.

CONCLUSIONS

In the first decade of the EC-IBD Study Group cohort follow-up study, the prevalence of cancer was as expected with most patients having a single neoplasm and an extra-intestinal neoplasm. In northern centers there was a trend for more intestinal cancers, while in southern centers there was a trend for more extra-intestinal cancers compared to northern centers.

Effect of creatine on swimming velocity, body composition and hydrodynamic variables

AIM

Creatine supplementation (CS) has been reported to increase body weight and improve performance during high intensity, short duration, exercise tasks. However, none of the published studies has investigated the influence of CS on performance related hydrodynamic variables during swimming. To investigate the effect of oral CS on swimming velocity, body composition and hydrodynamic variables during the period of final preparation of competitive junior female swimmers.

METHODS

In a double blind and randomized manner, 16 female swimmers, were supplemented with 20 g day(-1) of creatine monohydrate (CS group), or a maltodextrin placebo (PL group) for 21 days. Just pre- and post-21 days of supplementation, subjects performed 2x25 swimming bouts at maximum velocity with a 3 min recovery between bouts. The variables measured were 25 m swimming velocity (MSV(25)); active drag force (D(f)); hydrodynamic coefficient (C(x)); power output (P(o)). Body measures were also analysed: body weight (kg), fat-mass (% FAT), body water (% H(2)O), and fat free mass (FFM).

RESULTS

Significant differences were observed in hydrodynamic values: the CS group showed a significant reduction (approximately =25%), in D(f), C(x) and P(o) values, when comparing pretest with post-test. No differences were found in variables related to body composition and performance between CS group and PL group, as well as for CS group during the experimental period.

CONCLUSIONS

These data suggest that 21 days of CS produced significant effects on gross and/or propelling efficiency during swimming in female athletes. However, CS did not influence performance, body weight and body composition.

Hemodynamic, autonomic and neurohormonal behaviour of familial amyloidotic polyneuropathy and neurally mediated syncope patients during supine and orthostatic stress

Orthostatic intolerance (OI) syndromes are frequent and share symptoms like dizziness and orthostatic syncope. Their pathophysiology however seems to be different. The aim of our work was to evaluate autonomic and hemodynamic behaviour in patients with familial amyloidotic polyneuropathy and neurally mediated syncope in supine position and after acute orthostatic passive stress. We studied 12 patients with autonomic failure (group A), 12 patients with neurally mediated syncope (group B) and 16 aged matched normal controls (group C), in supine position and during the first 10 min of head-up tilt test (HUTT). Beat-by-beat blood pressure and heart rate were continuously monitored and digitised at 500 Hz. The baroreceptor alfa-index gain (vagal reflex-BRG), high frequency of RR variability (HFRR, vagal tonus) and low frequency of systolic arterial pressure variability (LFSAP, sympathetic tone) were calculated. Catecholamines, plasma brain (BNP) and atrial natriuretic (ANP) peptides were also measured. Hemodynamic data were derived and calculated by the non-invasive modelflow method. During supine position, cardiac output (CO) and stroke volume (SV) were similar in all groups. Mean arterial pressure (MAP) and BNP were higher in group A. Noradrenaline (NOR), BRG, HFRR and LFSAP were extremely low in this group. BRG and adrenaline (ADR) were higher in group B than in controls. Within the first 10 min of HUTT, there was a huge drop of CO, SV and MAP in group A, maintenance of very low levels of neurohormones and lack of autonomic function. HR, LFSAP and ADR had a higher rise at HUTT in group B compared with controls (p<0.01) but a significant decrease of BRG was noted (p<0.05). ANP or BNP did not change with tilt in any group. Different orthostatic intolerance syndromes may show important hormonal, autonomic and hemodynamic differences during supine rest and enhanced after passive orthostatism.

Phenotype at diagnosis predicts recurrence rates in Crohn's disease

BACKGROUND

In Crohn's disease (CD), studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning.

AIMS

To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis.

METHODS

A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease.

RESULTS

A total of 358 were classified for phenotype at diagnosis, of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence (hazard ratio 1.54 (95% confidence interval (CI) 1.13-2.10)) whereas age >/=40 years at diagnosis was protective (hazard ratio 0.82 (95% CI 0.70-0.97)). Colonic disease was a protective characteristic for resective surgery (hazard ratio 0.38 (95% CI 0.21-0.69)). More frequent resective surgical recurrences were reported from Copenhagen (hazard ratio 3.23 (95% CI 1.32-7.89)).

CONCLUSIONS

A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.

Protective Effect of Superoxide Dismutase Against Hair Graying in a Mouse Model¶

Oxygen free radicals play a role in the aging process, and the protective effect of various antioxidants has been intensively studied, in particular for cutaneous aging. Besides hereditary factors, free radical-mediated damage to melanocytes of the hair follicle has been considered as a mechanism for aging of the hair. It was the aim of this study to evaluate the role of photosensitization reactions for hair graying and to demonstrate potential protective effects of superoxide dismutase (SOD). Mice with black hair were depilated with the fingertips on a surface of 6 x 2.5 cm on both sides of the dorsum. The right side received five applications of a SOD-containing gel before exposure to psoralen (concentration 0.5 mg/mL) plus UV-A (365 nm, 4 J/cm2). The left side was pretreated in the same way with a gel free of SOD. When the hair started growing again, the SOD-protected side was covered with black hair, whereas the hair on the vehicle-treated side was gray or white in 27 of the 30 animals studied. The 0.01% SOD concentration was as protective as the 0.1% concentration. Heat-inactivated SOD, applied in another five animals, was not protective. Using fluorescent labeling of the SOD with fluorescein isothiocyanate, epifluorescence microscopy and digital imaging processing, we show that SOD applied to the skin surface penetrates through the follicular appendages, as well as through the unbroken stratum corneum. Our findings suggest that superoxide radicals, generated by interaction of UV-A light with the sensitizer, initiated the formation of secondary products with well-known DNA-damaging effects, such as lipid peroxidation products and tumor necrosis factor alpha. SOD prevented the damage to melanocyte DNA by dismutating superoxide. Photosensitization may be another mechanism for hair graying, which can be influenced by antioxidants. Given the large number of exogenous and endogenous sensitizers, this mechanism deserves further study for human hair graying.

Temporal arteritis presenting with scalp ulceration

We report the case of a 75-year-old-woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible. This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.