ACEs and mental health problems as suicidality predictors in Mexican adolescents

BACKGROUND

Various factors, including mental health comorbidity, family dysfunction, interpersonal violence, and community and social violence, cause suicidal behavior. Adverse Childhood Experiences (ACEs) encompass these risk factors and are correlated with mental health problems and suicidal behavior in Mexican adolescents.

METHODS

A survey was conducted among Mexican school-aged adolescents to measure ACEs, MHP symptoms, and suicidal behavior. A binary logistic regression was used to examine the relationship between these variables. The study was conducted with IRB approval, and all participants provided informed consent. Those at risk of suicide were referred for online psychological care.

RESULTS

7325 adolescents participated; 60 % were women, with an average age of 16 years (SD + 1), 87 % of the participants reported at least one ACE, 13 % symptoms of at least one MHP and 10 % suicidal behavior. MHP predictors of suicidal behavior were: conduct problems (OR = 5.67), symptoms of depression (OR = 3.27), obsessive-compulsive disorder (OR = 2.11), somatic problems (OR = 1.98), and attention deficit (OR = 1.69). EAI predictors were: live sexual violence (OR = 2.53), physical violence (OR = 2.21), negligence (OR = 2.05), bullying (OR = 2.10), and a family member with a mental health diagnosis (OR = 1.35). The cumulative effect of ACEs and MHP significantly increased the risk (OR = 78.08).

CONCLUSIONS

5 ACEs and 4 MHP were associated with suicidal behavior; their cumulative effect increased the risk to 78 times.

ACE-IQ extended version validation and ACE's frequency in Mexican adolescents

BACKGROUND

Adverse Childhood Experiences (ACEs) may have short, middle, and long-term consequences on people's development and physical and mental health. There is a need for information on this subject in low- and middle-income countries and a need to reduce recall bias in ACEs research worldwide.

OBJECTIVE

Hence our objectives were to translate, adapt and validate the Adverse Childhood Experiences extended version and to determine ACEs frequencies in a sample of Mexican adolescents.

PARTICIPANTS AND SETTING

A convenience sample of 5835 schooled Mexican adolescents (age: M = 16.13, SD = 1.32; 61.01 % females) from 20 states in Mexico completed a survey.

METHOD

A cross-sectional study was conducted with an extended version of the ACE-International Questionnaire (ACE-IQ), which assesses 23 ACEs organized into five categories: situations that cause household dysfunction, exposure to violence, violence from parents or guardians, interpersonal violence, and sociodemographic context.

RESULTS

Evidence of construct validity and reliability of the questionnaire was obtained, and 16 ACEs were included in the final ACE-IQ version. 90 % of adolescents had one or more ACEs. Neglect was the most experienced ACE reported by 73.30 % of the participants, with no significant difference by age, sex, or geographic region.

CONCLUSION

ACE-IQ questionnaire is a reliable and valid instrument to recommend its use for generating information on ACEs in studies on Mexican adolescents. The results on the frequency of ACEs revealed that 90 % of this schooled Mexican adolescent sample had experienced one or more ACEs, and about a third had experienced six or more.

Toxocara canis: Analysis of the kinetics of antigen release and antibody production in an in vivo model for the detection of past or present infection

Worldwide, Toxocara canis is an important zoonotic nematode of public health concern. This soil-transmitted helminth causes visceral larva and ocular larva migrans in paratenic hosts. The detection of T. canis larva migrans is complicated because current immunological tests detect only IgG antibodies, which can cross-react with antigens from other parasites and cannot distinguish between the past and present infection. Analysis of antigen release and antibody production could help improve the detection of larva migrans. Here, we report the kinetics of antigen release, IgM and IgG production in an in vivo model for the detection of past or present infection. We used four groups of seven mice: two groups infected orally with 50 or 100 embryonated eggs, and the other two infected intraperitoneally with 50 or 100 live larvae. We obtained blood samples at 0, 3, 7, and 14days and, then, every two weeks until day 140. Sandwich ELISA and indirect ELISA were performed for antigen capture and the detection of immunoglobulins, respectively. Mice inoculated with larvae developed an immune response faster than those inoculated with eggs. In all groups, antigen capture was positive starting at 3days until 140days post-inoculation (dpi). Detection of immunoglobulins was at 14 or 28dpi in mice inoculated with larvae or eggs, respectively. Negative IgM values were detected at days 98 and 112. The samples remained positive for IgG until the last day of the experiment. Data suggest that in mice inoculated with T canis eggs, some larvae did not hatch, others died or never reached the bloodstream. Based on our model, we propose that there is early infection when only antigens are present, and active larva migrans when antigen and immunoglobulins are detected, implying an immune response of the host against the antigen. Our study offers a view into the parasite-host relationship and enables us to infer if there are live larvae. Additionally, these findings provide a foundation for the diagnosis and differentiation of recent infection and active larva migrans.

Successful capture of Toxocara canis larva antigens from human serum samples

Background

Toxocara canis is a nematode that parasitizes dogs, while humans are paratenic hosts. When humans are infected the migrating larvae damage the liver, lungs and even the nervous system. Larva migrans diagnosis is based on immunological techniques; however, the commercial immunodiagnostic kits detect anti-T. canis antibodies which may cross-react with other parasites, mainly nematodes with extra-intestinal migration. Moreover, antibodies do not necessarily reflect an active infection; so detection and quantification of circulating antigens may provide appropriate and timely information for treatment, which prevents irreversible damage. Here we report the standardization of a monoclonal antibody based antigen capture ELISA to diagnose human toxocariasis without cross-reaction.

Methods

We developed anti-T. canis polyclonal antibodies in rabbits and a monoclonal antibody in mouse which did not cross-react with 15 antigens from several parasites. The sandwich ELISA standardization was performed using sera from mice experimentally infected. We tested the method using 29 positive and 58 negative human sera previously typified with a commercial kit, which detects antibodies.

Results

Only 5.0 μg/mL and 10 μg/mL polyclonal antibodies and monoclonal antibody, respectively, were needed in the sandwich ELISA standardization, detecting since 440 pg/mL larva antigens. Nine out of 29 antibody-positive sera were also positive for antigens and no false positive were found. Taking the antibody kit as the reference standard, the sensibility and specificity of the antigen test were 31% and 100%, respectively.

Conclusions

With these tools we established a detection threshold as low as 440 pg/mL antigen. Monoclonal antibody is specific, and did not cross-react with antigens from other parasites. Detection of circulating antigens helps provide appropriate and timely treatment and prevents irreversible damage.

Cancer treatment-induced oral mucositis: a critical review

Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.

Assessment of orofacial characteristics and oral pathology associated with cri-du-chat syndrome

OBJECTIVE

To obtain a deeper insight into the difficulties individuals with cri-du-chat syndrome experience by means of the analysis of the most common features and oral pathology observed in the subjects enrolled in the study.

SUBJECTS AND METHODS

Intra-oral and extra-oral features of a total of 33 patients with cri-du-chat syndrome (the larger sample so far analyzed) through their clinical and photographic examination. Models, orthopantomographies, and teleradiographies have been collected to establish a pattern as accurate as possible of the oral pathology associated with these patients.

RESULTS

The present descriptive study shows that patients with cri-du-chat syndrome present with a series of orofacial features such as mandibular retrognathism, high palate, and variable malocclusion, more commonly anterior open-bite. Most patients also present with perioral muscle relaxation with labial incompetence and short philtrum. As regards oral pathology, these patients suffer dental erosions provoked by gastroesophageal reflux and attritions because of intense day-and-night bruxism.

CONCLUSION

The odontologists' familiarity with the orofacial pathology associated with cri-du-chat syndrome and with the specific needs such disorder conveys should improve the quality of the buccodental treatment these professionals may offer to these patients.

A simple and inexpensive in vitro method for retrieving fertilized Toxocara canis eggs

The erratic migration of nematode larvae is potentially deleterious for humans, especially those produced by Toxocara roundworms. Diagnosis of human toxocariosis: visceral larva migrans depends on antibody detection against excretions-secretions (E/S) from Toxocara larvae by enzyme-linked immunosorbent assay. In the present work, we wish to propose a simple and cheap culture procedure for keeping T. canis female worms alive. We removed living worms from the small intestine of euthanized puppies at the Canine Control Centre "Culhuacan" in the Southern part of Mexico City. To ascertain the utility of the method, we compared the population size of fertilized eggs from both female worms kept in culture (FCM) and those obtained using uterus excision method (UEM). Operationally, a fertilized egg develops a larva after 1 month. Our results show that the culture method was superior at a ratio of 3:1 over UEM. FCM had advantages over UEM, such as (1) low probability of contamination with foreign antigens, (2) greater safety for infective egg manipulation, and (3) gave rise to a higher percentage of fertile eggs.