The utility of omega-3 fatty acids in depression

Introduction

Recent studies have reported therapeutic benefit from the use of omega-3 fatty acids (EPA and DHA) as adjunctive treatment of depression.

Objectives

The goal of this work is to assess the effectiveness and tolerability of dietary supplementation with omega-3 in the treatment of depressed patients.

Method

Prospective, descriptive, observational study in a general psychiatry outpatient clinic. Consecutive inclusion of depressed patients started on dietary supplementation with omega-3 because of partial response to antidepressants and/or intolerance to high doses or combination of antidepressant drugs between January and May 2015. Sociodemographic variables, clinical data and information about tolerability were recorded. Clinical response to treatment over time was assessed at 4–6 months follow up using the 5-item CGI (Clinical Global Impression) scale.

Results

We included 30 depressed patients started on omega-3. None of them reported side effects. Seventy-three percent of patients reported clinical improvement (40% much improvement, 33% some improvement). None of them got worse. We did not find association between clinical response and age, sex, type of depression nor duration of illness.

Conclusion

Despite the limitations of this study, our work support previous positive results on the use of omega-3 fatty acids (EPA and DHA) as adjunctive treatment of depression. Giving the safety of its use, clinicians might recommend omega-3 as adjunctive treatment of depression in cases with a partial response to antidepressants.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries

BACKGROUND

Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC).

METHODS

A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria.

RESULTS

Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female.

LIMITATIONS

Generalisability of findings outside of catchment areas is difficult to assess.

CONCLUSIONS

Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression.

Whole mitochondrial DNA sequencing in Alpine populations and the genetic history of the Neolithic Tyrolean Iceman

The Tyrolean Iceman is an extraordinarily well-preserved natural mummy that lived south of the Alpine ridge ~5,200 years before present (ybp), during the Copper Age. Despite studies that have investigated his genetic profile, the relation of the Iceman´s maternal lineage with present-day mitochondrial variation remains elusive. Studies of the Iceman have shown that his mitochondrial DNA (mtDNA) belongs to a novel lineage of haplogroup K1 (K1f) not found in extant populations. We analyzed the complete mtDNA sequences of 42 haplogroup K bearing individuals from populations of the Eastern Italian Alps - putatively in genetic continuity with the Tyrolean Iceman-and compared his mitogenome with a large dataset of worldwide K1 sequences. Our results allow a re-definition of the K1 phylogeny, and indicate that the K1f haplogroup is absent or rare in present-day populations. We suggest that mtDNA Iceman´s lineage could have disappeared during demographic events starting in Europe from ~5,000 ybp. Based on the comparison of our results with published data, we propose a scenario that could explain the apparent contrast between the phylogeographic features of maternal and paternal lineages of the Tyrolean Iceman within the context of the demographic dynamics happening in Europe from 8,000 ybp.

Ovarian simple cysts in asymptomatic postmenopausal women detected at transvaginal ultrasound: A review of literature

AIM: To answer some questions related to the problem of ovarian simple cysts in asymptomatic postmenopausal women.

METHODS: A literature search and systematic review using MEDLINE (PubMed) database from 1980 to 2014 was performed using the following terms: “simple cyst”, “postmenopause”, “postmenopausal”, “ultrasound”, “ovary”, “ovarian”, “asymptomatic”. Papers not related to the topic, reviews, letters to editor, opinion letter, commentaries and studies published in non-English language were excluded. Two authors then reviewed the full paper of all the studies initially selected. This review does not claim to be a meta-analysis. Therefore, meta-analysis statistics were not applied and PRISMA guidelines were not strictly followed. Simple descriptive statistics were used providing absolute numbers and corresponding percentages as well as range.

RESULTS: Nine papers were ultimately included in this review, accounting for 98899 postmenopausal women. We have found that ovarian simple cysts are relatively common in asymptomatic postmenopausal women (prevalence: 8.7%). The risk of malignancy is very low (0.19%). More than 90% of these cysts were smaller than 5 cm. Bilaterality rate ranged from 3.7% to 15%. Histologically, most cysts are serous cystadenomas (61%). When managed conservatively, a significant number resolve spontaneously (46.1%) or remain unchanged (39%).

CONCLUSION: According to these data, conservative management should be the first option to offer to these women.

Analytical methodology optimization to estimate the content of non-flavonoid phenolic compounds in Argentine propolis extracts

CONTEXT

Traditionally, the content of total phenolics (flavonoid phenolics (FP) and non-flavonoid phenolics (NFP)) and flavonoids (flavone/flavonol and flavonone/dihydroflavonol) in propolis has been determined by different methodologies. Until now, the percentage of total phenolic (TP) compounds that corresponds to FP and NFP, expressed in the same units by a spectrophotometric method, has not been determined.

OBJECTIVE

The current study proposes a quick and simple methodology that separates FP and NFP in propolis samples and determines TP, FP, and NFP by the same method.

MATERIALS AND METHODS

Propolis samples from five Argentine provinces (Tucumán, Santiago del Estero, Salta, Misiones, and Jujuy) were used. Extraction of TP from the propolis samples was carried out by maceration with 80% ethanol and quantified by Folin-Ciocalteu reagent (FC-R). Then, FP was precipitated with formaldehyde in acid medium. After centrifugation, NFP were determined in the supernatant using FC-R. FP content was calculated as the difference between the content of TP and NFP. The method was also validated using commercial flavonoids and chalcones.

RESULTS

FP recovery in all experiments was between 85.95% and 98.29%. Propolis from Tucumán had significantly higher amounts of total phenols than propolis from other provinces. SE5 showed higher content of FP (81.52%) followed by SA1 (74.75%). The propolis from TUC4, SA4, SE3, and MI showed the lowest FP content and highest content of NFP.

CONCLUSIONS

This method provides a simple, reliable, and specific spectrophotometric assay to estimate the content of NFP, FP, and TP in propolis samples.

Association of naturally occurring radionuclides in sludges from Drinking Water Treatment Plants previously optimized for their removal

The raw water used in Drinking Water Treatment Plants (DWTPs) can present high values of naturally occurring radionuclides. In order to reduce this content, the routine working conditions of DWTPs were successfully modified. This meant that those radionuclides were accumulated in the sludges generated, whose radioactive content was frequently above the exemption levels. It therefore becomes necessary to assess the association of naturally occurring radionuclides in the sludges for their potential use as agricultural fertilizers. Two approaches were studied: (a) the effect of different sequential extraction methods applied to a selected sludge; and (b) the effect of the different contents of inorganic complexes dissolved in the input water on the composition of the sludges generated by two DWTPs with different origins of their input water. Uranium and radium were mainly associated with the carbonated and reducible fractions, while (210)Po and (228)Th were associated with the residual fraction. There were differences between the two speciation methods, but the order of bioavailable radionuclides was roughly the same: (226)Ra≈(234,238)U>(228)Th>(210)Po. The major inorganic complexes content, mainly carbonate, in the raw water affected the radionuclide association. The greater the carbonate content in the raw water, the greater was the association of uranium and radium with the carbonated and easily reducible fractions.

Effect of Seasonality on Chemical Composition and Antibacterial and Anticandida Activities of Argentine Propolis. Design of a Topical Formulation

The effect of seasonality on Argentine propolis collected during one year on its phenolic and flavonoid content and on the growth of Gram-positive and Gram-negative antibiotic resistant bacteria and Candida species was evaluated. Extracts of propolis samples collected in the summer and spring showed higher phenolic and flavonoid contents than the samples collected in other seasons (5.86 to 6.06 mg GAE/mL and 3.77 to 4.23 mg QE/mL, respectively). The propolis collected in summer and autumn showed higher antibacterial activity (30 μg/mL) than the other samples (MIC values between 30 and 120 μg/mL). No antibacterial activity was detected against Gram-negative bacteria. Also, these extracts were able to inhibit the development of five Candida species, with MFC values of 15-120 μg/mL. Pharmaceutical formulations containing the more active propolis extract were prepared. The hydrogel of acrylic acid polymer containing summer propolis extract as an antimicrobial agent showed microbiological, physical and functional stability during storage for 180 days. The pharmaceutical preparation, as well as the propolis extracts, was active against Candida sp. and antibiotic-multi-resistant Gram-positive bacteria. These results reveal that propolis samples collected by scraping in four seasons, especially in summer in Calingasta, San Juan, Argentina, can be used to obtain tinctures and hydrogels with antibacterial and antimycotic potential for topical use.

Effect of seasonality on chemical composition and antibacterial and anticandida activities of Argentine propolis. Design of a topical formulation

The effect of seasonality on Argentine propolis collected during one year on its phenolic and flavonoid content and on the growth of Gram-positive and Gram-negative antibiotic resistant bacteria and Candida species was evaluated. Extracts of propolis samples collected in the summer and spring showed higher phenolic and flavonoid contents than the samples collected in other seasons (5.86 to 6.06 mg GAE/mL and 3.77 to 4.23 mg QE/mL, respectively). The propolis collected in summer and autumn showed higher antibacterial activity (30 microg/mL) than the other samples (MIC values between 30 and 120 microg/mL). No antibacterial activity was detected against Gram-negative bacteria. Also, these extracts were able to inhibit the development of five Candida species, with MFC values of 15-120 microg/mL. Pharmaceutical formulations containing the more active propolis extract were prepared. The hydrogel of acrylic acid polymer containing summer propolis extract as an antimicrobial agent showed microbiological, physical and functional stability during storage for 180 days. The pharmaceutical preparation, as well as the propolis extracts, was active against Candida sp. and antibiotic-multi-resistant Gram-positive bacteria. These results reveal that propolis samples collected by scraping in four seasons, especially in summer in Calingasta, San Juan, Argentina, can be used to obtain tinctures and hydrogels with antibacterial and antimycotic potential for topical use.

Enhancement of natural radionuclides in the surroundings of the four largest coal-fired power plants in Spain

The production of electricity in coal-fired power plants (CFPP) is considered a NORM (Naturally Occurring Radioactive Materials) activity because the coals they burn can present relatively high contents of the naturally occurring radionuclides. In this study, the main radiological impact pathways into the surrounding environments of the four largest coal-fired power plants in Spain were analyzed. These pathways are, first, atmospheric evacuations and wind resuspension and, second, effluent evacuations to nearby rivers or directly to the sea. The atmospheric releases of radionuclides were evaluated by the analyses of soil profiles in the vicinities of the CFPPs. No significant enhancement of radionuclides in the surface soil was observed at the points of maximum deposition of combustion gases, located from 4.3 to 13 km away depending on the considered CFPP. However, an increase of (40)K, (226)Ra, and (232)Th in the surface soils was observed in the first kilometre from the chimney for two CFPPs. This suggested that these radionuclides were released in particulate form. There was also a net influence of the climate in which the CFPPs were located. This was observed in the two CFPPs that were in dry environments, while no increase was observed in the other two, located in more humid environments. The liquid effluents released usually presented an enhancement of dissolved chemical species regarding the initial intake water. Enrichments of the (234,238)U and (226)Ra contents in the water used in the plants' routine procedures were observed, and of (210)Po in the wastewater of just one of the plants. In any case, this enhancement was below the parametric value for the Total Indicative Dose for the hypothetical human consumption of the released waters. As a consequence of these releases of radionuclides, local products destined for human consumption produced in the vicinity of the facilities might incorporate natural radionuclides by these pathways, finding no significant enhancement of the natural radionuclide contents due to the CFPPs.

Influence of alkali and alkaline earth elements on the uptake of radionuclides by Pleurototus eryngii fruit bodies

In the literature, there are many data available on radionuclide contents and their transfer to different species of mushrooms. There are some variables, however, which affect the transfer but are very difficult to observe in collected wild mushrooms. An example is the effect of different concentrations of alkali and alkaline earth elements in the soil. Modification of these concentrations in the soil solution has traditionally been used as a countermeasure to deal with radioactively contaminated areas. In the present work, fruiting bodies of Pleurotus eryngii, a saprophytic mushroom, were grown under controlled laboratory conditions, varying the content of alkali (potassium and cæsium) and alkaline earth (calcium and strontium) elements. The transfer of (134)Cs, (85)Sr, and (60)Co (added to the cultures) and of natural (210)Pb was analysed by increasing the content of each stable element considered. A significant, but nonlinear, enhancement of stable cæsium and (134)Cs was observed with increasing content of stable cæsium in the substrate/mycelium. The transfer of (85)Sr decreased with the addition of each stable cation, whereas the (60)Co and (210)Pb transfers were unaffected.

DNA aneuploidy as a topographic malignant transformation pattern in a pleomorphic adenoma of long-term evolution: a case report

Introduction

We present a case of long-term evolution of a submandibular pleomorphic adenoma. There is little information about topographic malignant transformation patterns of pleomorphic adenomas.

Case presentation

We extensively analyze a giant submandibular mixed tumor of 25-year evolution in a 57-year-old Caucasian woman. Deoxyribonucleic acid ploidy was evaluated in different superficial and deep areas using flow cytometry analysis and correlated with pathological and immunohistochemical characteristics. Superficial areas exhibited a typical histological pleomorphic adenoma pattern and were deoxyribonucleic acid diploid. Deep samples showed deoxyribonucleic acid aneuploidy, atypical histological benign features and expression of markers involved at an early-stage of malignant transformation, such as tumor protein 53 and antigen Ki67.

Conclusion

These findings revealed that deep tumor compartments may be involved in the initial stages of malignant transformation. Deoxyribonucleic acid ploidy analysis may provide an additional diagnosis tool and indicate 'uncertain' areas that require careful study to avoid diagnostic errors. Larger studies are needed to confirm our results and to evaluate the usefulness of the technique.

A brief dementia screener suitable for use by non-specialists in resource poor settings--the cross-cultural derivation and validation of the brief Community Screening Instrument for Dementia

OBJECTIVE

Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity.

METHODS

We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D.

RESULTS

Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region.

CONCLUSION

A brief version of the full CSI-D appears to share the favourable culture- and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care.

Analysis of the different source terms of natural radionuclides in a river affected by NORM (Naturally Occurring Radioactive Materials) activities

The present work studied the radioacitivity impact of a coal-fired power plant (CFPP), a NORM industry, on the water of the Regallo river which the plant uses for cooling. Downstream, this river passes through an important irrigated farming area, and it is a tributary of the Ebro, one of Spain's largest rivers. Although no alteration of the (210)Po or (232)Th content was detected, the (234,238)U and (226)Ra contents of the water were significantly greater immediately below CFPP's discharge point. The (226)Ra concentration decreased progressively downstream from the discharge point, but the uranium content increased significantly again at two sampling points 8 km downstream from the CFPP's effluent. This suggested the presence of another, unexpected uranium source term different from the CFPP. The input from this second uranium source term was even greater than that from the CFPP. Different hypotheses were tested (a reservoir used for irrigation, remobilization from sediments, and the effect of fertilizers used in the area), with it finally being demonstrated that the source was the fertilizers used in the adjacent farming areas.

Antlers of Cervus elaphus as biomonitors of ⁹⁰Sr in the environment

Adequate radioprotection of the environment requires the identification of biomonitors sensitive to the variation of its radionuclide content. Due to the chemical similarities between calcium and strontium, calcified tissues of mammals are considered to be good ⁹⁰Sr biomonitors. This work considered Cervus elaphus antlers which, being shed annually, can give information about the importance of radiostrontium contamination in an ecosystem in the time period required for the growth of the antler. The samples were collected at various points of W and SW Spain. The mean value of their ⁹⁰Sr content was (70 ± 43 (S.D.)) Bq/kg d.w., range (16-218) Bq/kg d.w., and the radionuclide was evenly distributed in the different parts of the antler. There was a good correlation between the antlers' ⁹⁰Sr content and the ⁹⁰Sr deposited in the soil. The antlers' content of ²²⁶Ra (from the natural uranium series) and the contents of some stable elements (Ca, Mg, Sr, and K) were also determined. The values for these stable elements were practically constant in the analyzed samples, and the concentrations measured decreased in the following order: Ca » Mg > K > Sr » ⁹⁰Sr > ²²⁶Ra.

The prevalence of coeliac disease is significantly higher in children compared with adults

BACKGROUND

Some limited studies of coeliac disease have shown higher frequency of coeliac disease in infancy and adolescence than in adulthood. This finding has remained unnoticed and not adequately demonstrated.

AIM

To assess whether there are age and gender differences in coeliac disease prevalence.

METHODS

A total of 4230 subjects were included consecutively (1 to ≥80 years old) reproducing the reference population by age and gender. Sample size was calculated assuming a population-based coeliac disease prevalence of 1:250. After an interim analysis, the paediatric sample was expanded (2010 children) due to high prevalence in this group. Anti-transglutaminase and antiendomysial antibodies were determined and duodenal biopsy was performed if positive. Log-linear models were fitted to coeliac disease prevalence by age allowing calculation of percentage change of prevalence. Differences between groups were compared using Chi-squared test.

RESULTS

Twenty-one subjects had coeliac disease (male/female 1:2.5). Coeliac disease prevalence in the total population was 1:204. Coeliac disease prevalence was higher in children (1:71) than in adults (1:357) (P = 0.00005). A significant decrease of prevalence in older generations was observed [change of prevalence by age of -5% (95% CI: -7.58 to -2.42%)]. In the paediatric expanded group (1-14 years), a decrease of coeliac disease prevalence was also observed [prevalence change: -17% (95% CI: -25.02 to -6.10)].

CONCLUSIONS

The prevalence of coeliac disease in childhood was five times higher than in adults. Whether this difference is due to environmental factors influencing infancy, or latency of coeliac disease in adulthood, remains to be demonstrated in prospective longitudinal studies.

First case of detection of Plasmodium knowlesi in Spain by Real Time PCR in a traveller from Southeast Asia

Previously, Plasmodium knowlesi was not considered as a species of Plasmodium that could cause malaria in human beings, as it is parasite of long-tailed (Macaca fascicularis) and pig-tailed (Macaca nemestrina) macaques found in Southeast Asia. A case of infection by P. knowlesi is described in a Spanish traveller, who came back to Spain with daily fever after his last overseas travel, which was a six-month holiday in forested areas of Southeast Asia between 2008 and 2009. His P. knowlesi infection was detected by multiplex Real time quantitative PCR and confirmed by sequencing the amplified fragment. Using nested multiplex malaria PCR (reference method in Spain) and a rapid diagnostic test, the P. knowlesi infection was negative. This patient was discharged and asymptomatic when the positive result to P. knowlesi was reported. Prior to this case, there have been two more reports of European travellers with malaria caused by P. knowlesi, a Finnish man who travelled to Peninsular Malaysia during four weeks in March 2007, and a Swedish man who did a short visit to Malaysian Borneo in October 2006. Taken together with this report of P. knowlesi infection in a Spanish traveller returning from Southeast Asia, this is the third case of P. knowlesi infection in Europe, indicating that this simian parasite can infect visitors to endemic areas in Southeast Asia. This last European case is quite surprising, given that it is an untreated-symptomatic P. knowlesi in human, in contrast to what is currently known about P. knowlesi infection. Most previous reports of human P. knowlesi malaria infections were in adults, often with symptoms and relatively high parasite densities, up to the recent report in Ninh Thuan province, located in the southern part of central Vietnam, inhabited mainly by the Ra-glai ethnic minority, in which all P. knowlesi infections were asymptomatic, co-infected with P. malariae, with low parasite densities and two of the three identified cases were very young children under five years old.