Polymorphisms and haplotypes of TOLLIP and MUC5B are associated with susceptibility and survival in patients with fibrotic hypersensitivity pneumonitis

INTRODUCTION AND OBJECTIVES

Hypersensitivity pneumonitis (HP) is an interstitial lung disease with diverse clinical features that can present a fibrotic phenotype similar to idiopathic pulmonary fibrosis (IPF) in genetically predisposed individuals. While several single nucleotide polymorphisms (SNPs) have been associated with IPF, the genetic factors contributing to fibrotic HP (fHP) remain poorly understood. This study investigated the association of MUC5B and TOLLIP variants with susceptibility, clinical presentation and survival in Portuguese patients with fHP.

MATERIAL AND METHODS

A case-control study was undertaken with 97 fHP patients and 112 controls. Six SNPs residing in the MUC5B and TOLLIP genes and their haplotypes were analyzed. Associations with risk, survival, and clinical, radiographic, and pathological features of fHP were probed through comparisons among patients and controls.

RESULTS

MUC5B rs35705950 and three neighboring TOLLIP variants (rs3750920, rs111521887, and rs5743894) were associated with increased susceptibility to fHP. Minor allele frequencies were greater among fHP patients than in controls (40.7% vs 12.1%, P<0.0001; 52.6% vs 40.2%, P = 0.011; 22.7% vs 13.4%, P = 0.013; and 23.2% vs 12.9%, P = 0.006, respectively). Haplotypes formed by these variants were also linked to fHP susceptibility. Moreover, carriers of a specific haplotype (G-T-G-C) had a significant decrease in survival (adjusted hazard ratio 6.92, 95% CI 1.73-27.64, P = 0.006). Additional associations were found between TOLLIP rs111521887 and rs5743894 variants and decreased lung function at baseline, and the MUC5B SNP and radiographic features, further highlighting the influence of genetic factors in fHP.

CONCLUSION

These findings suggest that TOLLIP and MUC5B variants and haplotypes may serve as valuable tools for risk assessment and prognosis in fibrotic hypersensitivity pneumonitis, potentially contributing to its patient stratification, and offer insights into the genetic factors influencing the clinical course of the condition.

Mother-child reporting discrepancies of child physical abuse: Associations with internalizing and externalizing symptoms

BACKGROUND

Mother-child discrepancies frequently occur in reports of child physical abuse. Such report discrepancies raise important challenges for interpreting and integrating data from multiple informants in forensic and clinical settings.

OBJECTIVES

The main goal of this study was to identify patterns of mother-child discrepancies in reporting CPA using latent profile analysis. We then tested differences between profiles on mothers' mental health problems and children's internalizing and externalizing symptoms.

PARTICIPANTS AND SETTING

Participants were 159 mother-child dyads with police-documented exposure to intimate partner violence.

METHOD

Participants were recruited from Child Protective Services and shelter residences from all regions of Portugal. After obtaining informed consent, assessment protocols were administered separately to mothers and children.

RESULTS

We identified two convergent profiles (mother-child agreement on reports of both high and low exposure to CPA) and one divergent profile (the child reported significantly higher exposure to CPA than the mother). Mothers from the divergent profile reported more depressive and post-traumatic stress symptoms than mothers from the convergent profiles. Children of the divergent profile and one of the convergent profiles (mother-child agreement on high exposure to CPA) showed the highest internalizing and externalizing symptoms.

CONCLUSIONS

These results illustrate how examining informant discrepancies in the assessment of abusive parenting practices increases our understanding of children's psychological adjustment in high-risk contexts.

Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society

INTRODUCTION

Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking.

OBJECTIVE

To establish recommendations for CTD-ILD screening based on the current evidence.

METHOD

Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD.

RESULTS

The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous.

CONCLUSIONS

Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.

Influenza vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Society of Diabetology, the Portuguese Society of Cardiology, the Portuguese Society of Geriatrics and Gerontology, the Study Group of Geriatrics of the Portuguese Society of Internal Medicine, and the Portuguese Society of Infectious Diseases and Clinical Microbiology

Influenza affects millions of people worldwide each year and can lead to severe complications, hospitalizations, and even death, especially among vulnerable populations such as older adults and those with chronic medical conditions. Annual vaccination is considered the most effective measure for preventing influenza and its complications. Despite the widespread availability of influenza vaccines, however, vaccination coverage rates remain suboptimal in several countries. Based on the latest scientific evidence and expert opinions on influenza vaccination in older people and patients with chronic disease, the Portuguese Society of Pulmonology (SPP), the Portuguese Society of Diabetology (SPD), the Portuguese Society of Cardiology (SPC), the Portuguese Society of Geriatrics and Gerontology (SPGG), the Study Group of Geriatrics of the Portuguese Society of Internal Medicine (NEGERMI-SPMI), and the Portuguese Society of Infectious Diseases and Clinical Microbiology (SPDIMC) discussed best practices for promoting vaccination uptake and coverage and drew up several recommendations to mitigate the impact of influenza. These recommendations focus on the efficacy and safety of available vaccines; the impact of influenza vaccination on older adults; patients with chronic medical conditions, namely cardiac and respiratory conditions, diabetes, and immunosuppressive diseases; and health care professionals, optimal vaccination timing, and strategies to increase vaccination uptake and coverage. The resulting position paper highlights the critical role that vaccinations play in promoting public health, raising awareness, and encouraging more people to get vaccinated.

Distinct TNF-alpha and HLA polymorphisms associate with fibrotic and non-fibrotic subtypes of hypersensitivity pneumonitis

INTRODUCTION

Since Hypersensitivity Pneumonitis (HP) categorization in fibrotic and nonfibrotic/inflammatory types seems to be more consistent with the distinctive clinical course and outcomes, recent international guidelines recommended the use of this classification. Moreover, fibrotic subtype may share immunogenetic and pathophysiological mechanisms with other fibrotic lung diseases.

AIM

To investigate HLA -A, -B, -DRB1 and TNF-α -308 gene polymorphisms among fibrotic and nonfibrotic HP patients due to avian exposure, also in comparison with asymptomatic exposed controls.

METHODS

We prospectively enrolled 40 HP patients, classified as fibrotic or nonfibrotic/inflammatory, and 70 exposed controls. HLA and TNF-α polymorphisms were determined by polymerase chain reaction-sequence specific primer amplification.

RESULTS

While HLA alleles were not associated to HP susceptibility, fibrotic HP patients showed increased frequencies of HLA A*02 (46.7% vs 25.7%; OR=2.53, p = 0.02) and HLA DRB1*14 (10.0% vs 0.7%; OR=15.44, p=0.02) alleles when compared with exposed controls, although not statistically significant after correction for multiple comparisons. TNF-α G/G genotype (associated with low TNF-α production) frequencies were significantly increased among the non-fibrotic/inflammatory HP patients comparatively to fibrotic presentations (88% vs 60%; RR=0.44; p=0.04) and controls (88% vs 63%, OR 4.33, p=0.037). Also, these patients had a significantly increased frequency of the G allele (94.0% vs 73.3%, RR=0.44, p=0.01), while fibrotic HP patients predominantly presented the A allele (26.7% vs 6.0%, RR=2.28, p=0.01).

CONCLUSIONS

Our results support the hypothesis that fibrotic and non-fibrotic HP subtypes exhibit a distinct profile of TNF-α and HLA polymorphisms, which may be relevant to predict disease course and better define treatment strategies.

The effect of parenting behaviours on adolescents' rumination: a systematic review of longitudinal studies

Rumination is an emotional regulation mechanism strongly associated with the development and maintenance of internalising psychopathology in adolescence and adulthood. Parenting behaviours (PBs) play a pivotal role in the development of rumination in children and adolescents. Nonetheless, the specific PBs that can either protect against or increase the risk of rumination development remain poorly understood. This systematic review aimed to explore the (1) temporal associations between PBs and adolescents' rumination and (2) potential moderators influencing these associations. We conducted a comprehensive search across Web of Science, Scopus, PubMed, Academic Search Complete and Eric databases, adhering to PRISMA reporting guidelines. Out of 1,868 abstracts screened, 182 articles underwent full-text examination, with nine meeting the inclusion criteria for the systematic review. Overall, the studies indicated that PBs characterised by criticism, rejection and control were positively associated with the development of rumination in adolescents, whilst PBs marked by authoritative practises exhibited a negative association with rumination. Gender, temperament, environmental sensitivity and pubertal timing emerged as significant moderators in the effects of PBs on rumination. However, conclusions were limited due to the studies' methodological heterogeneity. Future studies on PBs and rumination should address various dimensions of PBs and different moderators to identify factors that can modify the development of rumination across adolescence. Findings may inform family-based prevention programmes to promote emotion regulation in adolescents as a protective factor against internalising psychopathology across adulthood.

The influence of maternal reflective functioning and parenting behavior on infant development in the context of perinatal intimate partner violence: a study protocol

BACKGROUND

Intimate partner violence (IPV) affects 25% of children under the age of five worldwide, yet the impact of perinatal IPV and its underlying mechanisms on infant development remains poorly understood. IPV indirectly affects infant development through the mother's parenting behavior, but research on maternal neuro and cognitive processes, such as parental reflective functioning (PRF), is scarce, despite its potential as an unfolding mechanism. The objective of our study, Peri_IPV, is to examine the direct and indirect pathways linking perinatal IPV and infant development. We will analyze the direct impact of perinatal IPV on mothers' neuro and cognitive parental reflective functioning (PRF) and parenting behavior during the postpartum period, the direct impact of perinatal IPV on infant development, and whether maternal PRF mediates the link between perinatal IPV and parenting behavior. We will also explore the mediation role of parenting behavior in the association between perinatal IPV and infant development and whether the impact of perinatal IPV on infant development occurs through the links between maternal PRF and parenting behavior. Finally, we will examine the moderation role of mother's adult attachment in the impact of perinatal IPV on maternal neuro and cognitive PRF and parenting behavior during the postpartum period, as well as on infant development.

METHODS

Our study will use a multi-method, prospective design to capture different levels of PRF, parenting behavior, and infant development. Three-hundred and forty pregnant women will participate in a 4-wave longitudinal study from the 3rd trimester of pregnancy to 12 months postpartum. In the 3rd trimester and 2 months postpartum, women will report on their sociodemographic and obstetric characteristics. In all assessment waves, mothers will complete self-reported measures of IPV, cognitive PRF, and adult attachment. At 2 months postpartum, women's neuro PRF will be monitored, and at 5 months postpartum, their parenting behavior will be assessed. The infant-mother attachment will be assessed at 12 months postpartum.

DISCUSSION

Our study's innovative focus on maternal neuro and cognitive processes and their impact on infant development will inform evidence-based early intervention and clinical practices for vulnerable infants exposed to IPV.

Childbirth-related post-traumatic stress disorder symptoms and mother-infant neurophysiological and behavioral co-regulation during dyadic interaction: study protocol

BACKGROUND

Mother's childbirth-related posttraumatic stress disorder (PTSD) symptoms have a negative impact on mother and infant's behaviors during dyadic interactions which may increase mother-infant neurophysiological and behavioral co-regulation difficulties, leading to dysregulated mother-infant interactions. This study was specifically designed to analyze: (1) the sociodemographic and obstetric factors associated with mother's childbirth-related PTSD symptoms; (2) mother-infant neurophysiological functioning and behavioral co-regulation during dyadic interaction; (3) the impact of mother's childbirth-related PTSD symptoms on neurophysiological and behavioral mother-infant co-regulation during dyadic interaction; (4) the moderator role of previous trauma on the impact of mother's childbirth-related PTSD symptoms on neurophysiological and behavioral mother-infant co-regulation during dyadic interaction; and (5) the moderator role of comorbid symptoms of anxiety and depression on the impact of mother's childbirth-related PTSD symptoms on neurophysiological and behavioral mother-infant co-regulation during dyadic interaction.

METHODS

At least 250 mothers will be contacted in order to account for refusals and dropouts and guarantee at least 100 participating mother-infant dyads with all the assessment waves completed. The study has a longitudinal design with three assessment waves: (1) 1-3 days postpartum, (2) 8 weeks postpartum, and (3) 22 weeks postpartum. Between 1 and 3 days postpartum, mothers will report on-site on their sociodemographic and obstetric characteristics. At 8 weeks postpartum, mothers will complete online self-reported measures of birth trauma, previous trauma, childbirth-related PTSD, anxiety, and depressive symptoms. At 22 weeks postpartum, mothers will complete online self-reported measures of childbirth-related PTSD, anxiety, and depressive symptoms. Mothers and infants will then be home-visited to observe and record their neurophysiological, neuroimaging and behavioral data during dyadic interactions using the Still-face Paradigm. Activation patterns in the prefrontal cortices of mother and infant will be recorded simultaneously using hyperscanning acquisition devices. Unadjusted and adjusted multilevel linear regression models will be performed to analyze objectives 1 to 3. Moderation models will be performed to analyze objectives 4 and 5.

DISCUSSION

Data from this study will inform psychological interventions targeting mother-infant interaction, co-regulation, and infant development. Moreover, these results can contribute to designing effective screenings to identify mothers at risk of perinatal mental health problems and those who may need specialized perinatal mental health care.

Urea cycle disorders and indications for liver transplantation

Urea cycle disorders (UCD) are inborn errors of metabolism caused by deficiency of enzymes required to convert nitrogen from ammonia into urea. Current paradigms of treatment focus on dietary manipulations, ammonia scavenger drugs, and liver transplantation. The aim of this study was to describe the characteristics and indication of liver transplantation in UCD in a tertiary hospital. We performed a retrospective study of children with UCD seen in the period 2000-2021. Data was collected on clinical onset, hyperammonemia severity, evolution and liver transplantation. There were 33 patients in the study period, whose diagnosis were: ornithine transcarbamylase (OTC, n = 20, 10 females), argininosuccinate synthetase (ASS, n = 6), carbamylphosphate synthetase 1 (CPS1, n = 4), argininosuccinate lyase (ASL, n = 2) and N-acetylglutamate synthetase (NAGS, n = 1) deficiency. Thirty one were detected because of clinical symptoms (45% with neonatal onset). The other 2 were diagnosed being presymptomatic, by neonatal/family screening. Neonatal forms (n = 14) were more severe, all of them presented during the first week of life as severe hyperammonemia (mean peak 1,152 µmol/L). Seven patients died (6 at debut) and all survivors received transplantation. There was no mortality among the late forms. Of the 27 patients who did not die in the neonatal period, 16 (59%) received liver transplantationwith 100% survival, normal protein tolerance and usual need of citrulline supplementation. The transplant's metabolic success was accompanied by neurologic sequelae in 69%, but there was no progression of brain damage. Decision of continuous medical treatment in 11 patients appeared to be related with preserved neurodevelopment and fewer metabolic crises.

Phase Angle as a Predictor for Physical Function in Institutionalized Independent Older Adults

The aim of this study was to investigate the relationship between phase angle (PhA) and physical function in institutionalized, independent older adults. Physical function was evaluated using the Senior Fitness Test Battery. PhA was measured by electrical bioimpedance at 50 khz, and body composition parameters were also registered. Results showed that PhA significantly correlated with all physical fitness tests, except for arm curls. Regarding the results of the multivariate analysis, three models were created: Model 1, formed by a dependent variable "PhA" and two predictor variables "8 ft up-and-go" and "6 min walk"; Model 2, formed by a dependent variable "PhA" and three predictor variables "8 ft up-and-go", "6 min walk" and "30-s chair stand"; and Model 3, formed by a dependent variable "PhA" and four predictor variables "8 ft up-and-go", "6 min walk", "30-s chair stand" and "arm curl". Results showed that predictor variables had a significant influence on the PhA for all three models (Model 1: p = 0.001, 12.5%; Model 2: p = 0.002, 12.9%; and Model 3: p = 0.005, 13.1%). For women, Model 1 showed a significant influence of predictor variables on the PhA (p = 0.030, 9.3%). The results for men in Models 1, 2 and 3 showed significant influences on the PhA (p = 0.002, 31.2%; p = 0.006, 31.6%; and p = 0.016, 31.6%; respectively). This study confirmed previous studies regarding to the relationship between PhA and physical function. It also indicates that PhA could be an excellent predictor of physical function.

Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study

INTRODUCTION AND OBJECTIVES

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

MATERIALS AND METHODS

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

RESULTS

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

CONCLUSIONS

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

Low Platinum-Content Electrocatalysts for Highly Sensitive Detection of Endogenously Released H2O2

The commercial viability of electrochemical sensors requires high catalytic efficiency electrode materials. A sluggish reaction of the sensor’s primary target species will require a high overpotential and, consequently, an excessive load of catalyst material to be used. Therefore, it is essential to understand nanocatalysts’ fundamental structures and typical catalytic properties to choose the most efficient material according to the biosensor target species. Catalytic activities of Pt-based catalysts have been significantly improved over the decades. Thus, electrodes using platinum nanocatalysts have demonstrated high power densities, with Pt loading considerably reduced on the electrodes. The high surface-to-volume ratio, higher electron transfer rate, and the simple functionalisation process are the main reasons that transition metal NPs have gained much attention in constructing high-sensitivity sensors. This study has designed to describe and highlight the performances of the different Pt-based bimetallic nanoparticles and alloys as an enzyme-free catalytic material for the sensitive electrochemical detection of H₂O₂. The current analysis may provide a promising platform for the prospective construction of Pt-based electrodes and their affinity matrix.

Are Crohn's Disease Patients Limited in Sport Practise? An UltraEndurance Case-Control Study Response

The aim of this study was to analyze the psychophysiological response of a Crohn's Disease patient in an ultra-endurance event. The psychophysiological responses of a Crohn's Disease and non-Crohn's Disease participant were analysed before during and after an 8 h ultra-endurance running event. Results showed how Crohn's patient presented a similar psychophysiological response than non-Crohn's participant in the ultra-endurance event, except for a higher pre- and post-event sympathetic modulation, lower event sympathetic tone, and lower event body temperature. This study could contribute to improving physical activity recommendations for persons with Crohn's Disease and open a new research line for an improved understanding of psychophysiological modifications of Crohn's Disease patients during exercise.

Paliperidone palmitate-induced enuresis: a case report

Introduction

Schizophrenia is a severe mental illness that requires long-term treatment with antipsychotics and the intramuscular (IM) long-acting injectable (LAI) formulations may enhance treatment adherence. Some antipsychotics have been associated with enuresis, including atypical antipsychotics such as risperidone(6.2%), quetiapine(6.7%), olanzapine (9.6% ) and clozapine (20.7%) [1]. Although oral paliperidone has been related to urinary incontinence, there is only 1 report of urinary incontinence linked to monthly paliperidone palmitate [2]. [1] Harrison-Woolrych, M., Skegg, K., Ashton, J., Herbison, P., Skegg, D.C., 2011. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. British Journal of Psychiatry 199, 140–144. doi:10.1192/bjp.bp.110.087478 [2] Karslıoǧlu, E.H., Özalp, E., Çayköylü, A., 2016. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report. Clinical Psychopharmacology and Neuroscience 14, 96–100. doi:10.9758/cpn.2016.14.1.96

Objectives

To establish an association between paliperidone palmitate and enuresis.

Methods

Case report and a narrative review of the literature.

Results

The patient was a 25-year-old healthy man when he was diagnosed with schizophrenia. Doctors prescribed paliperidone palmitate (LAI) 200mg monthly and he started to complain of enuresis. He was clearly suffering with this unpleasant and embarrassing adverse effect so the LAI was reduced to 150mg. Enuresis remained, so it was prescribed oxybutynin 20 mg/day and the patient improved.

Conclusions

We reported a case in which enuresis is likely to be associated with high-dose paliperidone LAI (with no clinical evidence of an organic cause). To treat it, the most effective strategy was oxybutynin 20 mg/day. This case is also important to show the impact of this symptom, which is not actively investigated.

Disclosure

No significant relationships.

Impact of muscle mass on the prognosis of liver transplantation for infants with biliary atresia

BACKGROUND

Sarcopenia in adult cirrhotic patients is associated with increased morbidity and mortality whereas in children it is still being studied. Anthropometric variables in cirrhotic children are not reliable for assessing muscle mass as they may be altered by ascites, edema, and organomegaly. Measuring the area of the psoas showed good correlation with muscle mass in adults. We aimed to study in cirrhotic infants undergoing liver transplantation the association of the psoas area with liver transplant prognosis as well as with several analytical and anthropometric parameters used to evaluate nutritional status.

METHODS

Retrospective cohort of 29 infants with cirrhosis due to biliary atresia who underwent abdominal CT scan as a pre-transplant study. We measured the psoas muscle index (PMI) at L4-L5 since it best correlates with muscle mass in pediatric patients. As there are no validated cut-off points to define sarcopenia in children under one year of age, PMI was recorded as a continuous variable and correlated with different prognostic, clinical, and analytical variables. The SPSS 17.0 package was used for statistical analysis and a P < 0.05 was considered significant.

RESULTS

29 infants (10 boys, 19 girls) were studied. 62% were Caucasian and the rest were South American. The mean age at CT scan was 8.5 months (range 3-15 months). There was a negative correlation between PMI and days of admission prior to liver transplant, previous infections, and bone fractures. Among the analytical parameters, cholinesterase, albumin, and prealbumin correlated positively with PMI (P < 0.05). No relationship was observed with anthropometric parameters: weight, height, BMI, brachial perimeter, or bioimpedance. During surgery, patients with lower PMI had a greater need for plasma transfusion, and in the immediate postoperative period, there was a longer stay in intensive care, more days of mechanical ventilation, and more days of hospital admission (P < 0.05). On the contrary, no relationship was found with other complications: bleeding, re-interventions, biliary leaks, rejection, thrombosis, re-transplantation, or infections.

CONCLUSIONS

The decrease in muscle mass is associated with increased morbidity in infants with biliary atresia undergoing liver transplantation. Muscle mass in these patients cannot be adequately assessed with anthropometric measurements commonly used in the clinic.

The immune response to SARS-CoV-2 and COVID-19 immunopathology - Current perspectives

SARS-CoV-2 is a new beta coronavirus, similar to SARS-CoV-1, that emerged at the end of 2019 in the Hubei province of China. It is responsible for coronavirus disease 2019 (COVID-19), which was declared a pandemic by the World Health Organization on March 11, 2020. The ability to gain quick control of the pandemic has been hampered by a lack of detailed knowledge about SARS-CoV-2-host interactions, mainly in relation to viral biology and host immune response. The rapid clinical course seen in COVID-19 indicates that infection control in asymptomatic patients or patients with mild disease is probably due to the innate immune response, as, considering that SARS-CoV-2 is new to humans, an effective adaptive response would not be expected to occur until approximately 2–3 weeks after contact with the virus. Antiviral innate immunity has humoral components (complement and coagulation-fibrinolysis systems, soluble proteins that recognize glycans on cell surface, interferons, chemokines, and naturally occurring antibodies) and cellular components (natural killer cells and other innate lymphocytes). Failure of this system would pave the way for uncontrolled viral replication in the airways and the mounting of an adaptive immune response, potentially amplified by an inflammatory cascade. Severe COVID-19 appears to be due not only to viral infection but also to a dysregulated immune and inflammatory response. In this paper, the authors review the most recent publications on the immunobiology of SARS-CoV-2, virus interactions with target cells, and host immune responses, and highlight possible associations between deficient innate and acquired immune responses and disease progression and mortality. Immunotherapeutic strategies targeting both the virus and dysfunctional immune responses are also addressed.

Synthetic skull bone defects for automatic patient-specific craniofacial implant design

Patient-specific craniofacial implants are used to repair skull bone defects after trauma or surgery. Currently, cranial implants are designed and produced by third-party suppliers, which is usually time-consuming and expensive. Recent advances in additive manufacturing made the in-hospital or in-operation-room fabrication of personalized implants feasible. However, the implants are still manufactured by external companies. To facilitate an optimized workflow, fast and automatic implant manufacturing is highly desirable. Data-driven approaches, such as deep learning, show currently great potential towards automatic implant design. However, a considerable amount of data is needed to train such algorithms, which is, especially in the medical domain, often a bottleneck. Therefore, we present CT-imaging data of the craniofacial complex from 24 patients, in which we injected various artificial cranial defects, resulting in 240 data pairs and 240 corresponding implants. Based on this work, automatic implant design and manufacturing processes can be trained. Additionally, the data of this work build a solid base for researchers to work on automatic cranial implant designs.

Measurement(s)	Image Acquisition Matrix Size • Image Slice Thickness • craniofacial region
Technology Type(s)	imaging technique • computed tomography
Sample Characteristic - Organism	Homo sapiens

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13265225

Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings

BACKGROUND

This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3).

METHODS

Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity.

RESULTS

The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established.

LIMITATIONS

Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties.

CONCLUSIONS

Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.

Translating Idiopathic pulmonary fibrosis guidelines into clinical practice

INTRODUCTION AND OBJECTIVES

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease of unknown cause, which predominantly manifests in older males. IPF diagnosis is a complex, multi-step process and delay in diagnosis cause a negative impact on patient survival. Additionally, a multidisciplinary team of pulmonologists, radiologists and pathologists is necessary for an accurate IPF diagnosis. The present study aims to assess how diagnosis and treatment of IPF are followed in Portugal, as well as the knowledge and implementation of therapeutic guidelines adopted by the Portuguese Society of Pulmonology.

MATERIALS AND METHODS

Seventy-eight practicing pulmonologists were enrolled (May-August 2019) in a survey developed by IPF expert pulmonologists comprised of one round of 31 questions structured in three parts. The first part was related to participant professional profile, the second part assessed participant level of knowledge and practice agreement with national consensus and international guidelines for IPF as well as their access to radiology and pathology for IPF diagnosis, and the third part was a self-evaluation of the guidelines adherence for diagnosis and treatment in their daily practice.

RESULTS

Participants represented a wide spectrum of pulmonologists from 14 districts of Portugal and autonomous regions of Azores and Madeira. The majority were female (65%), with 5-19 years of experience (71%) and working in a public clinical center (83%). Importantly, the majority of pulmonologists follow their IPF patients (n=45) themselves, while 26% referred IPF patients to ILD experts in the same hospital and 22% to another center. Almost all pulmonologists (98%) agreed or absolutely agreed that multidisciplinary discussion is recommended to accurately diagnose IPF. No pulmonologists considered pulmonary biopsy as absolutely required to establish an IPF diagnosis. However, 87% agreed or absolutely agree with considering biopsy in a possible/probable UIP context. If a biopsy is necessary, 96% of pulmonologists absolutely agree or agree with considering criobiopsy as an option for IPF diagnosis. Regarding IPF treatment, 98% absolutely agreed or agreed that antifibrotic therapy should be started once the IPF diagnosis is established. Finally, 76% stated that 6 months is the recommended time for follow-up visit in IPF patients.

CONCLUSIONS

Portuguese pulmonologists understand and agree with national consensus and international guidelines for IPF treatment but their implementation in Portugal is heterogeneous.

Post-transplantation Outcomes in Patients with PA or MMA: A Review of the Literature

Introduction

Liver transplantation is recognised as a treatment option for patients with propionic acidemia (PA) and those with methylmalonic acidemia (MMA) without renal impairment. In patients with MMA and moderate-to-severe renal impairment, combined liver–kidney transplantation is indicated. However, clinical experience of these transplantation options in patients with PA and MMA remains limited and fragmented. We undertook an overview of post-transplantation outcomes in patients with PA and MMA using the current available evidence.

Methods

A literature search identified publications on the use of transplantation in patients with PA and MMA. Publications were considered if they presented adequate demographic and outcome data from patients with PA or MMA. Publications that did not report any specific outcomes for patients or provided insufficient data were excluded.

Results

Seventy publications were identified of which 38 were full papers. A total of 373 patients underwent liver/kidney/combined liver–kidney transplantation for PA or MMA. The most typical reason for transplantation was recurrent metabolic decompensation. A total of 27 post-transplant deaths were reported in patients with PA [14.0% (27/194)]. For patients with MMA, 18 post-transplant deaths were reported [11% (18/167)]. A total of 62 complications were reported in 115 patients with PA (54%) with cardiomyopathy (n = 12), hepatic arterial thrombosis (HAT; n = 14) and viral infections (n = 12) being the most commonly reported. A total of 52 complications were reported in 106 patients with MMA (49%) with viral infections (n = 14) and renal failure/impairment (n = 10) being the most commonly reported.

Conclusions

Liver transplantation and combined liver–kidney transplantation appears to benefit some patients with PA or MMA, respectively, but this approach does not provide complete correction of the metabolic defect and some patients remain at risk from disease-related and transplantation-related complications, including death. Thus, all treatment avenues should be exhausted before consideration of organ transplantation and the benefits of this approach must be weighed against the risk of perioperative complications on an individual basis.

Pathogenic variants of DNAJC12 and evaluation of the encoded cochaperone as a genetic modifier of hyperphenylalaninemia

Biallelic variants of the gene DNAJC12, which encodes a cochaperone, were recently described in patients with hyperphenylalaninemia (HPA). This paper reports the retrospective genetic analysis of a cohort of unsolved cases of HPA. Biallelic variants of DNAJC12 were identified in 20 patients (generally neurologically asymptomatic) previously diagnosed with phenylalanine hydroxylase (PAH) deficiency (phenylketonuria [PKU]). Further, mutations of DNAJC12 were identified in four carriers of a pathogenic variant of PAH. The genetic spectrum of DNAJC12 in the present patients included four new variants, two intronic changes c.298-2A>C and c.502+1G>C, presumably affecting the splicing process, and two exonic changes c.309G>T (p.Trp103Cys) and c.524G>A (p.Trp175Ter), classified as variants of unknown clinical significance (VUS). The variant p.Trp175Ter was detected in 83% of the mutant alleles, with 14 cases homozygous, and was present in 0.3% of a Spanish control population. Functional analysis indicated a significant reduction in PAH and its activity, reduced tyrosine hydroxylase stability, but no effect on tryptophan hydroxylase 2 stability, classifying the two VUS as pathogenic variants. Additionally, the effect of the overexpression of DNAJC12 on some destabilizing PAH mutations was examined and a mutation-specific effect on stabilization was detected suggesting that the proteostasis network could be a genetic modifier of PAH deficiency and a potential target for developing mutation-specific treatments for PKU.

Coparenting and Relationship Satisfaction in Mothers: The Moderating Role of Sociosexuality

This study explored the moderating effect of sociosexual orientation on the association between coparenting alliance/coparenting conflict and relationship satisfaction in mothers in a romantic relationship. Sociosexuality is defined as a personality trait that reflects the individual difference in willingness to engage in uncommitted sexual relations. The study examined a community sample of 635 Portuguese mothers with a monogamous heterosexual relationship. Data on coparenting, relationship satisfaction, and sociosexual orientation were collected. The results revealed the moderating effect of sociosexuality on the significant associations between both coparenting alliance and coparenting conflict predicting relationship satisfaction. For the association between coparenting alliance and relationship satisfaction, mothers with a more restricted sociosexual orientation reported the highest levels of satisfaction when their coparenting alliance was high, but the lowest levels of satisfaction when coparenting alliance was low. For the association between coparenting conflict and relationship satisfaction, mothers with a more restricted sociosexual orientation reported the highest levels of satisfaction when their coparenting conflict was low, but the lowest levels when coparenting conflict was high. Together, the results suggest that especially for women with a more restricted sociosexual orientation, coparenting quality explains significant interindividual variability in relationship satisfaction.

Assessing Motor and Cognitive Areas in Older People: Confirmatory Factor Analysis of Portuguese Version of Éxamen Géronto-Psychomoteur

Aging involves changes in psychomotor performance. Few studies are focused on psychomotor skills among older people due, in part, to the inexistence of valid instruments in the field. The purpose of this article is to analyze the factor structure model of the Portuguese version of Exámen Géronto-Psychomoteur. The confirmatory factor analysis was completed in a sample of 497 older persons, aged between 60 and 99 years, with and without dementia (74.4% female; M = 78.0; standard deviation = 8.6). A baseline one-factor model was compared against 2 three-factor models (first and second order) that were developed based on the previous exploratory factor analysis. Fit indices for the one-factor model were slightly higher when compared with other models; however, the second-order model seems to be more representative of human behavior. The results of this study provide evidence to support a three-factor model: cognition, motor function, and physical aspects.

The role of interventional bronchoscopy in the management of post-intubation tracheal stenosis: A 20-year experience

PURPOSE

Benign tracheal stenosis management is still controversial, and there is no international consensus on the best treatment option. Thus, we aimed to look into the history of PITS and the different strategies used in its treatment. The importance of bronchoscopic treatment was also defined, and its effectiveness and safety were assessed.

METHODS

Retrospective study of patients diagnosed with PITS, who were referred to the Bronchology Department between January 1996 and December 2016.

RESULTS

Of 115 patients enrolled (mean age 48.5±17.6 years, 53% males), 66.1% had complex stenosis. The most common causes of intubation were respiratory (29.9%), neurological (26.8%) and surgical (19.6%). Complex stenosis was caused by longer intubation, and was more frequent among previously tracheostomized patients. The most common location was the upper third of trachea (60.9%). Most cases were initially treated by interventional bronchoscopy, and although serial dilations were effective in some complex PITS, a higher proportion of simple stenosis was successfully managed with this treatment option. Long-term recurrence after serial dilation was observed in 25.0% of cases. Stent placement was required (19.1%) only for complex PITS. Stent-related complications were frequent (61.9%) and linked to the stenting time (p<0.001). Overall, there were no procedure-related complications. Surgical intervention was also performed (30.0%), always with complex PITS. Post-surgical recurrences were observed in 24.2% of cases.

CONCLUSIONS

Interventional bronchoscopy is an efficient and safe modality in PITS management. Further studies are needed for better classification and improved knowledge of PITS pathogenesis, and to achieve international consensus of definition to guide clinicians in their practice.

Are measures of marital satisfaction valid for women with depressive symptoms? The examination of factor structure and measurement invariance of the Couple Satisfaction Index-4 across depression levels in Portuguese women

Marital satisfaction (MS) is a key indicator of mental and physical health. Factor structure of MS measures in individuals with clinical levels of depression as well as their measurement invariance across groups with different levels of depressive symptoms were not yet explored. The lack of evidence of measurement invariance might compromise valid comparisons between individuals with elevated and minimal depressive symptoms in MS. This study examined the factor structure of the Couple Satisfaction Index-4 (CSI-4) among women with clinical levels of depression, tested the CSI-4 measurement invariance across depression levels groups, and investigated CSI-4 convergent and divergent validity. Participants were 891 heterosexual married/cohabiting women who were assigned into one of two groups based on assessment of their levels of depressive symptoms. Participants completed the CSI-4 and self-reported measures used to examine convergent and divergent validity. Support was found for the factor structure of the CSI-4 for the total sample and both elevated depressive symptoms and minimal depressive symptoms groups. Subsequent multigroup confirmatory factor analyses supported the measurement invariance of the CSI-4 across depression levels groups. The CSI-4 revealed excellent values of internal consistency and convergent and divergent validity. Our findings suggest that CSI-4 produces comparable response patterns across depression groups and thus meaningful comparisons between groups can be performed.

An Ex Vivo Evaluation of Tomographic 3-D Ultrasound, B-Mode Ultrasound, CT And MR Imaging to Measure Artery Diameter, Length and Wall Volume

Precise measurement of luminal diameter in arteries is important when planning interventional vascular procedures in patients. Measuring wall volume may be important in detecting early artery disease and in the assessment of treatments to prevent atherosclerosis. An ex vivo phantom using porcine arteries was used to evaluate the accuracy with which (i) B-mode ultrasound, (ii) 3-D tomographic ultrasound (tUS), (iii) computed tomography (CT) and (iv) magnetic resonance imaging (MRI) measured length, diameters and volume. The mean error in inner-to-inner diameter measurements by B mode, tUS, CT and MRI were 0.08 ± 0.26, -0.73 ± 0.96 mm, 0.09 ± 0.55 and 0.60 ± 1.01 mm, respectively. The mean error in outer-to-outer diameter measurements by B mode, tUS, CT and MRI were -1.33 ± 0.61, -1.03 ± 0.35, 0.02 ± 1.00 and -0.47 ± 1.32 mm, respectively. The mean error in volume measurements by B mode, tUS, CT and MRI were -0.54 ± 0.62, -0.06 ± 0.09, 0.01 ± 0.18 and -0.20 ± 0.32 cm³, respectively. Errors in length and diameters remain within clinically acceptable thresholds where MRI was the least accurate. tUS was the most accurate method of volume measurement.

Expanding the genetic and phenotypic spectrum of branched-chain amino acid transferase 2 deficiency

The first step in branched-chain amino acid (BCAA) catabolism is catalyzed by the two BCAA transferase isoenzymes, cytoplasmic branched-chain amino acid transferase (BCAT) 1, and mitochondrial BCAT2. Defects in the second step of BCAA catabolism cause maple syrup urine disease (MSUD), a condition which has been far more extensively investigated. Here, we studied the consequences of BCAT2 deficiency, an ultra-rare condition in humans. We present genetic, clinical, and functional data in five individuals from four different families with homozygous or compound heterozygous BCAT2 mutations which were all detected following abnormal biochemical profile results or familial mutation segregation studies. We demonstrate that BCAT2 deficiency has a recognizable biochemical profile with raised plasma BCAAs and, in contrast with MSUD, low-normal branched-chain keto acids (BCKAs) with undetectable l-allo-isoleucine. Interestingly, unlike in MSUD, none of the individuals with BCAT2 deficiency developed acute encephalopathy even with exceptionally high BCAA levels. We observed wide-ranging clinical phenotypes in individuals with BCAT2 deficiency. While one adult was apparently asymptomatic, three individuals had presented with developmental delay and autistic features. We show that the biochemical characteristics of BCAT2 deficiency may be amenable to protein-restricted diet and that early treatment may improve outcome in affected individuals. BCAT2 deficiency is an inborn error of BCAA catabolism. At present, it is unclear whether developmental delay and autism are parts of the variable phenotypic spectrum of this condition or coincidental. Further studies will be required to explore this.

Heterozygous TERT gene mutation associated with familial idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown cause that occurs sporadically, but it can also occur in families and so named as Familial Pulmonary Fibrosis (FPF). Some forms of FPF overlaps IPF features, namely the radiological and histological pattern of usual interstitial pneumonia (UIP). Genetic and environmental factors commonly play an important role in the pathogenesis of FPF and the most commonly identified mutations involve the telomerase complex. Here, we report a rare case of FPF in a male at the age of 44, in whom genetic testing showed heterozygous variants for the telomerase reverse transcriptase gene (TERT). Our report highlights the importance of compiling a thorough family history in younger patients identified with UIP serving as a resource for identifying the current and future genetic links to disease. Families with UIP hold a great promise in defining UIP pathogenesis, potentially suggesting targets for the development of future therapies.

Validação psicométrica da Escala da Relação Coparental em mães portuguesas

El presente estudio tuvo como objetivo la adaptación y la validación de la Escala de Relación Coparental —erc— en madres portuguesas. La versión original de la medida evalúa las cuatro dimensiones de la coparentalidad del modelo ecológico de la coparentalidad, a través de 7 subescalas. El estudio estuvo compuesto por una muestra de 548 madres en una relación íntima heterosexual y por lo menos un hijo con el actual compañero conyugal, con una edad inferior a 18 años. Probada a través de análisis factorial confirmatorio, la solución factorial final investigada  presentó un ajuste satisfactorio, lo que sugiere la validez de constructo de la erc, χ2 (372) = 828.5, ns, cfi = 0.95, nfi = 0.91 y rmsea = 0.04 (90 % ic = 0.04-0.05). La escala también presentó coeficientes de consistencia interna entre lo satisfactorio y lo elevado en todas las subescalas (α de Cronbach entre 0.70 e 0.94) y valores muy satisfactorios de validez convergente y divergente, obtenidos a través de análisis correlacionales de la erc con otros constructos teóricamente seleccionados. Los resultados dan soporte inicial a la calidad psicométrica de la versión portuguesa de la erc.Palabras clave: coparentalidad, madres, validación, evaluación.

Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.

Improving the diagnosis of cobalamin and related defects by genomic analysis, plus functional and structural assessment of novel variants

Background

Cellular cobalamin defects are a locus and allelic heterogeneous disorder. The gold standard for coming to genetic diagnoses of cobalamin defects has for some time been gene-by-gene Sanger sequencing of individual DNA fragments. Enzymatic and cellular methods are employed before such sequencing to help in the selection of the gene defects to be sought, but this is time-consuming and laborious. Furthermore some cases remain undiagnosed because no biochemical methods have been available to test for cobalamin absorption and transport defects.

Results

This paper reports the use of massive parallel sequencing of DNA (exome analysis) for the accurate and rapid genetic diagnosis of cobalamin-related defects in a cohort of affected patients. The method was first validated in an initial cohort with different cobalamin defects. Mendelian segregation, the frequency of mutations, and the comprehensive structural and functional analysis of gene variants, identified disease-causing mutations in 12 genes involved in the absorption and synthesis of active cofactors of vitamin B₁₂ (22 cases), and in the non-cobalamin metabolism-related genes ACSF3 (in four biochemically misdiagnosed patients) and SUCLA2 (in one patient with an unusual presentation). We have identified thirteen new variants all classified as pathogenic according to the ACGM recommendation but four were classified as variant likely pathogenic in MUT and SUCLA2. Functional and structural analysis provided evidences to classify them as pathogenic variants.

Conclusions

The present findings suggest that the technology used is sufficiently sensitive and specific, and the results it provides sufficiently reproducible, to recommend its use as a second-tier test after the biochemical detection of cobalamin disorder markers in the first days of life. However, for accurate diagnoses to be made, biochemical and functional tests that allow comprehensive clinical phenotyping are also needed.

Electronic supplementary material

The online version of this article (10.1186/s13023-018-0862-y) contains supplementary material, which is available to authorized users.

Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients

Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).

Effectiveness of a Referral Program for rheumatoid arthritis and axial spondyloarthritis Diagnosis at Primary Care Centers in Portugal - SIARA STUDY

OBJECTIVES

Early diagnosis and treatment of Rheumatoid Arthritis (RA) and axial Spondylarthritis (axial SpA) can limit the impact of disease outcomes. This study evaluated the effectiveness of a referral program on the identification of patients with RA and axial SpA.

METHODS

This was an observational, prospective, randomized (by clusters) study conducted in Portugal to evaluate the impact of the implementation of a set of referral support actions (RSA). The study was divided in two sub-studies, the RA sub-study and the axial SpA sub-study. 28 participating primary care units were randomly (by clusters) assigned to RSA or control group (with no intervention). Both RSA and control groups identified and referred patients with suspected RA or axial SpA to the rheumatology unit of the reference hospital. The primary objective was to evaluate the correct diagnosis of RA or axial SpA cases confirmed by the rheumatologist of the reference hospital.

RESULTS

RA-Substudy: A total of 340 patients were recruited (144 in the RSA-exposed group; 196 in the control). RA diagnosis confirmation was 7.3% (95%CI, 2.1-12.5%) in RSA group versus 2.7% (95%CI, 0.0-5.7%) in control group RSA effect was positive but moderate (4.6%) and not statistically significant (95% CI, 0.0%-11.8%; p=0.222, adjusted for clustering effect). Rate of confirmed arthritis of any type was 16.9% (n=14/83) in the RSA group and 6.0% (n=5/83) in the control group. This difference was statistically significant and favorable to RSA group (OR=3.2; 95% CI 1.1-9.2; p=0.028). Axial SpA-Substudy: A total of 231 patients were recruited (108 in the RSA-exposed group; 123 in the control). Axial SpA diagnosis confirmation was 8.7% (95% CI, 2.1-15.4%) in RSA group versus 5.6% (95% CI, 0.0-11.73%) in control group. RSA effect was positive (3.1%) but not statistically significant (95% CI, -7.5- 12.9%; p=0.568, adjusted for clustering effect).

CONCLUSIONS

This study showed a positive tendency for the RSA program, most relevantly on the diagnosis of patients with any type of arthritis in the RA sub-study. It is possible that a referral program more comprehensive than the one herein tested might improve early diagnosis of RA and SpA.

Learning curve for transbronchial lung cryobiopsy in diffuse lung disease

INTRODUCTION

Transbronchial lung cryobiopsy (TBLC) is increasingly used in the diagnosis of diffuse lung disease (DLD), but no data have yet been published on the learning curve associated with this technique.

AIM

To evaluate diagnostic yield, lung tissue sample length and area, and procedure-related complications in a cohort of TBLC procedures to define the learning curve and threshold for proficiency.

METHODS

Retrospective analysis of the first 100 TBLCs performed in different segments of the same lobe in patients with suspected DLD. We compared diagnostic yield, sample length and area, and complications between consecutive groups of patients.

RESULTS

The overall diagnostic yield for TBLC was 82%. Median sample length was 5.4mm (IQR, 5-6) and median area was 19.5mm2 (IQR, 13.3-25). Pneumothorax was the most common complication (18%). On comparing the two groups of 50 consecutive patients, a significant difference was found for diagnostic yield (74% vs 90%; p=0.04), sample length (5.0mm [2.5-16] vs 6.0mm [4-12;] p<0.01) and area (17.5mm2 [6-42] vs 21.5mm2 [10-49]; p<0.01). Logarithm regression was applied to median diagnostic yield and sample length and area for groups of 10 consecutive patients to define the learning curve, which plateaued after approximately 70 procedures.

CONCLUSIONS

Our findings suggest that proficiency in TBLC is achieved at approximately the 70th procedure; however they need to be validated in more series and cohorts.

Cognitive-affective depression and somatic symptoms clusters are differentially associated with maternal parenting and coparenting

BACKGROUND

Both depressive and somatic symptoms are significant predictors of parenting and coparenting problems. However, despite clear evidence of their co-occurrence, no study to date has examined the association between depressive-somatic symptoms clusters and parenting and coparenting. The current research sought to identify and cross-validate clusters of cognitive-affective depressive symptoms and nonspecific somatic symptoms, as well as to test whether clusters would differ on parenting and coparenting problems across three independent samples of mothers.

METHOD

Participants in Studies 1 and 3 consisted of 409 and 652 community mothers, respectively. Participants in Study 2 consisted of 162 mothers exposed to intimate partner violence. All participants prospectively completed self-report measures of depressive and nonspecific somatic symptoms and parenting (Studies 1 and 2) or coparenting (Study 3).

RESULTS

Across studies, three depression-somatic symptoms clusters were identified: no symptoms, high depression and low nonspecific somatic symptoms, and high depression and nonspecific somatic symptoms. The high depression-somatic symptoms cluster was associated with the highest levels of child physical maltreatment risk (Study 1) and overt-conflict coparenting (Study 3). No differences in perceived maternal competence (Study 2) and cooperative and undermining coparenting (Study 3) were found between the high depression and low somatic symptoms cluster and the high depression-somatic symptoms cluster.

CONCLUSIONS

The results provide novel evidence for the strong associations between clusters of depression and nonspecific somatic symptoms and specific parenting and coparenting problems. Cluster stability across three independent samples suggest that they may be generalizable. The results inform preventive approaches and evidence-based psychotherapeutic treatments.

Four Years' Experience in the Diagnosis of Very Long-Chain Acyl-CoA Dehydrogenase Deficiency in Infants Detected in Three Spanish Newborn Screening Centers

Identification of very long-chain acyl-CoA dehydrogenase deficiency is possible in the expanded newborn screening (NBS) due to the increase in tetradecenoylcarnitine (C14:1) and in the C14:1/C2, C14:1/C16, C14:1/C12:1 ratios detected in dried blood spots. Nevertheless, different confirmatory tests must be performed to confirm the final diagnosis. We have revised the NBS results and the results of the confirmatory tests (plasma acylcarnitine profiles, molecular findings, and lymphocytes VLCAD activity) for 36 cases detected in three Spanish NBS centers during 4 years, correlating these with the clinical outcome and treatment. Our aim was to distinguish unambiguously true cases from disease carriers in order to obtain useful diagnostic information for clinicians that can be applied in the follow-up of neonates identified by NBS.Increases in C14:1 and of the different ratios, the presence of two pathogenic mutations, and deficient enzyme activity in lymphocytes (<12% of the intra-assay control) identified 12 true-positive cases. These cases were given nutritional therapy and all of them are asymptomatic, except one. Seventeen individuals were considered disease carriers based on the mild increase in plasma C14:1, in conjunction with the presence of only one mutation and/or intermediate residual activity (18-57%). In addition, seven cases were classified as false positives, with normal biochemical parameters and no mutations in the exonic region of ACADVL. All these carriers and the false positive cases remained asymptomatic. The combined evaluation of the acylcarnitine profiles, genetic results, and residual enzyme activities have proven useful to definitively classify individuals with suspected VLCAD deficiency into true-positive cases and carriers, and to decide which cases need treatment.

Psychomotor, Functional, and Cognitive Profiles in Older People with and without Dementia:What Connections?

BACKGROUND

In typical aging, it is possible to observe a decline in psychomotor domains, such as balance or global and fine motor skills as well as a cognitive and functional decline. Although, it is not clear which psychomotor domains are mostly affected in elderly with dementia and the association with the cognitive and functional level.

OBJECTIVE

To identify the correlation between psychomotor, cognitive, and functional skills, and seeking whether there are differences among persons with and without dementia.

DESIGN AND METHODS

A total of 120 persons with dementia (ages between 61 and 99 years old; mean age 80.6 ± 7.4) and 377 persons without dementia (ages between 60 and 99 years old; mean age 77.2 ± 8.7) were recruited from nursing homes, day-care centers, and home care. Consenting participants were assessed in psychomotor, cognitive, and functional domains using the Mini Mental State Examination (MMSE) to assess cognitive impairment, the Barthel Index (BI), and Lawton Index (LI) to identify basic and instrumental activities of daily living and a Portuguese Version of Éxamen Geronto-Psychomoteur (P-EGP) to evaluate psychomotor skills.

RESULTS

People with dementia showed a higher percentage of cognitive deficit and higher level of dependency in basic and instrumental activities of daily living. Further, findings also showed significant differences in psychomotor domains and total of P-EGP, with exception of Joint Mobilizations of Upper and Lower Limbs. There were moderate to strong correlations between the totals of the scales, and between the totals and domains.

CONCLUSIONS

The population with dementia has higher percentage of cognitive deficit, higher dependency on the performance of basic and instrumental activities of daily living and poorer psychomotor performance, except in joint mobilizations. It was also possible to find strong correlations between the total of P-EGP and the total of cognitive and functional scales. Implications for future research and practice are discussed.