Possible impact of COVID-19 pandemic and lockdown on suicide behavior among patients in Southeast Serbia

Individuals with serious mental illness are more affected by emotional reactions, including suicidal behavior due to COVID‐19 and psychosocial consequences of pandemic. The current cross-sectional study aimed to explore the possible association of COVID-19 and suicidal behavior (suicide ideation and attempt) before and during pandemic-associated lockdown in Serbia. We retrospectively reviewed the clinical records of 104 adult psychiatric inpatients admitted at Psychiatric Clinic, University Clinic Center Niš, Serbia, after ending lockdown and compared the obtained results with 181 adult psychiatric inpatients admitted during the same period in 2019 and 2018. Suicide ideation were more frequent in 2020 comparing with 2019 and 2018 (25 vs 12.5%, vs 9.41%; p < 0.05). Around 28% of patients with suicide attempts were exposed daily to the information related to COVID-19 coming from social media, while this frequency was significantly lower, only 7.55% (p < 0.1), among patients with no suicide ideation or attempts. Adjustment disorder was more frequent among patients with suicide attempts in comparison to the patients with suicide ideation (32 vs 11%), especially in patients without suicide ideation and attempts (32 vs 0%, p < 0.001). Of all studied patients with suicide attempts during 2020, 60% were not in the previous psychiatric treatment before admission.

The risk of metabolic syndrome in patients with arterial hypertension in relation to psychological and biological risk factors

Background/Aim. A type of personality and negative emotional reactions could be important for clustering biological risk factors for a cardiovascular disease in patients with arterial hypertension (AH). This study investigated if the patients with AH and psychological characteristics of the Distressed Type of personality with elevated anxiety/depression/aggression, have a higher risk of metabolic syndrome (MS) and explored value of the assessed parameters for MS occurrence. Methods. A total of 85 patients with AH were included in the cross-sectional observational study. Type D Scale-14 (DS-14) was used to detect Type D (Distressed) personality. The Hospital Anxiety and Depression Scale (HADS) assessed the levels of anxiety and depression and the Buss Perry Aggression Questionnaire (BPAQ) was used for the assessment of aggression. The explored biological parameters included: blood pressure, lipid status, body mass index (BMI), the occurrence of diabetes mellitus (DM) and MS. Results. Type D patients were frequently more anxious, aggressive and had more frequent MS compared to non-type D. Type D females were younger, more anxious and had a greater prevalence of DM than those with non-type D personality. A multivariate analysis revealed that in type D personality patients with AH, depression had predictive value for MS. Conclusion. The occurrence of both MS and AH was in correlation with the type D personality, anxiety and depression. Early detection/treatment of depression in patients with AH and Type D personality could decrease a risk of metabolic syndrome.

Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?

OBJECTIVE

Many studies have reported insufficient support from surgical services, resulting in nephrologists creating arteriovenous fistulas in many centers. The aim of this study was to compare risk factors of arteriovenous fistula dysfunction in patients whose fistulas were created by nephrologists versus vascular surgeons.

METHODS

This was a retrospective, analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. Out of a total of 1,048 fistulas, 764 (72.9%) were created by nephrologists patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. Laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed.

RESULTS

Patients whose arteriovenous fistula was formed by nephrologists differed significantly from those created by vascular surgeons in relation to the preventive character of the arteriovenous fistula (p = 0.011), lumen of the vein (p < 0.001) and systolic blood pressure (p = 0.047). Multivariate logistic regression of arteriovenous fistula dysfunction showed that risk factors were female gender (odds ratio [OR] = 1.56, 95% CI 1.16-2.07), whether the fistulae were created by vascular surgeons or nephrologists (OR = 1.38; 95% CI 1.01-1.89) and the site of the arteriovenous fistula (OR = 0.64; 95% CI 0.48-0.85).

CONCLUSIONS

Arteriovenous fistulae created by vascular surgeons, female gender, and the location are risk factors of dysfunction.

Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study

OBJECTIVE

To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes.

METHODS

This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first-trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age.

RESULTS

Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes.

CONCLUSIONS

Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early-pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Interactions of metronidazole with other medicines: a brief review

Metronidazole, a medicine discovered in the late 1950 s is mainly an antibiotic active against anaerobes and protozoa. There are numerous side effects of metronidazole. Some interactions with other medicines enhance its activity, and some cause the decrease in activity and plasma concentration. A short review of its side effects, mechanisms of action and interactions with other medicines is provided. As resistance towards metronidazole occurred, these mechanisms are described as well. The data presented in the review were selected on the basis of relevancy, citation and age of the used references.

Effect of commercial or depurinized milk on rat liver growth-regulatory kinases, nuclear factor-kappa B, and endonuclease in experimental hyperuricemia: comparison with allopurinol therapy

Hyperuricemia is a biochemical hallmark of gout, renal urate lithiasis, and inherited purine disorders, and may be a result of enormous ATP breakdown or purine release as a result of cardiovascular disease, hypertension, kidney disease, eclampsia, obesity, metabolic syndrome, psoriasis, tumor lysis syndrome, or intense physical training. The beneficial role of dairy products on hyperuricemia management and prevention is well documented in the literature. The primary aim of our experimental study was to examine the effect of milk dietary regimen (commercial 1.5% fat UHT milk or patented depurinized milk) compared with allopurinol therapy on experimental hyperuricemia induced by oxonic acid in rats. Principal component analysis was applied on a data set consisting of 11 variables for 8 different experimental groups. Among the 11 parameters measured (plasma uric acid and the liver parameters NFκB-p65, Akt kinase/phospho-Akt kinase, ERK kinase/phospho-ERK kinase, IRAK kinase/phospho IRAK kinase, p38/phospho-p38, and DNase), Akt/phospho Akt and ERK/phospho-ERK signaling were extracted as the most discriminating. We also compared the content of various potentially toxic compounds (sulfur compounds, ketones, aldehydes, alcohols, esters, carboxylic acids, and phthalates) in untreated commercial milk and depurinized milk. Of all the compounds investigated in this study that were observed in commercial milk (24 volatile organic compounds and 4 phthalates), 6 volatile organic compounds were not detected in depurinized milk. For almost all of the other compounds, significant decreases in concentration were observed in depurinized milk compared with commercial milk. In conclusion, a depurinized milk diet may be recommended in nutritional treatment of primary and secondary hyperuricemia to avoid uric acid and other volatile, potentially toxic compounds that may slow down liver regeneration and may induce chronic liver diseases.

Constructed wetlands as an alternative restoration measure for shallow lakes

This paper deals with the consequences of cultural eutrophication and unconventional solutions for shallow lake restoration. Cultural eutrophication is the primary problem that affects especially shallow lakes, due to their physical characteristics (e.g. shallow depth, lack of stratification). Palic Lake, a very shallow Pannonian lake, received treated municipal wastewaters coming from the lagoons of a wastewater treatment plant. The sewage discharge mainly increased the nutrient load to the lake in the last decades. The lake sustainability is affected by inappropriate quality of water that flows into the lake, and abundance of deposited sediment. The technology that can provide both improvement of water quality and resolution of the sediment problem is a constructed wetland, which is designed to utilise the natural processes involving wetland vegetation, soil and their associated microbial assemblages to assist in additional water treatment. The technical solution is based on three key aspects: quality and quantity of deposited sediment, enriched by nutrients; effluent quality; desired lake water quality. A designed constructed wetland can accomplish the desired water quality and gradually remediate deposited sediment.

The effect of depurinized milk draught diet on rat serum uric acid, lipid status and haematological parameters

Hyperuricaemia and gout are closely related, but hyperuricaemia is an independent risk factor for endothelial damage, autoinflammation and haemodynamic abnormalities. Milk, generally known as a 'purine-free diet', is an essential protein source for patients suffering from hyperuricaemia and gout. As milk still contains different purine ribonucleotides, the new product, depurinized milk, almost free of purine nucleotides and uric acid, was produced. The potential effect of depurinized milk diet on serum uric acid (SUA) level, lipid parameters and blood haematological parameters was explored in rats after 72 h and 15 days, in relation to standard laboratory chow or the untreated milk diet. The beneficial effect on SUA was achieved when depurinized milk draught was given instead of standard chow for 72 h [28.39 ± 4.76 μm; p < 0.001 vs. standard diet (STD) 47.6 ± 6.12, vs. untreated milk diet 31.55 ± 8.50; p < 0.05] or as a supplement for STD for 15 days experiment (35.38 ± 6.40 μm; p < 0.05 vs. STD only 48.05 ± 4.32; vs. untreated milk + STD 46.02 ± 9.48). Depurinized milk diet significantly decreased the low density lipoproteins/high density lipoproteins (LDL/HDL) ratio (p < 0.001), triglycerides (p < 0.05) and leucocyte count (p < 0.001), while both milk draughts enhanced haemoglobin concentration (p < 0.01). In conclusion, considering the detrimental effect of persisting hyperuricaemia, the depurinized milk draught may meet the demand of healthy dairy product for population under hyperuricaemic risk.

A therapist's communications and interventions in group psychotherapy of paranoid patients

Group psychotherapy of paranoid patients implies gradualism in achieving therapeutic goals. Establishing reality is the first therapeutic goal, and acquiring insight and understanding of the current conflicts in the situation here-and-now connected with conflicts from the past in the situation there-and-then is the second one. Five Small psychotherapeutic groups of paranoid patients were included in our study. We measured the participation of the therapist's communications in group communication structure and the structure of the therapist's interventions. The therapist's communications in the group were determined using Bales’ category system. The therapist's interventions were determined according to the Scale of therapist's interventions. We made two measurements: at the beginning and after a period of two months. The total score of the therapists’ communications in the first measuring (38.2%) was significantly higher than in the second measuring (25.79%) (p < 0.01). In the structure of the therapists’ communications, a high level of the emotionally positive communications was maintained in the first (55.45%), as well as in the second measuring (41.17%). Explanations, clarifications and alternative solutions could be found in the beginning of the group therapist's interventions. The most frequent therapist's interventions in the second measurement were interpretations and confrontations. In the therapeutic process, members of the group were taught to observe communication and to search for its meaning together. The group responded to the reality of its world and defined reality for every single member. Communications brought new meanings to old experiences and enabled the acquisition of new experiences with meaning.

Risk health behavior and psychological reactions after cardiac event

Introduction

Risk health behavior can influence coronary syndromes outcome, especially associated with undesirable psychological reactions. Anxiety and depressive syndromes could be associated with higher frequency of smoking, alcohol consumption and lack of physical activity.

Objectives

Assesment of differences in psychological and behavior parameters between acute coronary and healthy controls and influence on 6 months re- hospitalization rate.

Method

Comparation between K group = 33 of first myocardial infarction patients and E group = 30 healthy persons at baseline and after 6 months. Instruments applied:

Semistructured psychiatric interview, M.I.N.I., Beck Anxiety Inventory (BAI) for anxiety level, Beck Depression Inventory (BDI) for depression level, KON-6 sigma Aggression Scale and Holms-Rahe (H-R) Stress Life Events Scale and Questioner for risk health behavior. Parameters differences were assessed by t-test chi square test, for p< 0,05. Regression analysis for 6 months re-hospitalization.

Results

Anxiety-depressive and Anxiety syndromes were present at 23% of K group and 10% of E group. Anxiety level of K group was higher than E: (BAI = 8,15 ± 4,37:4,83 ± 2,60; t = −3,62), for p < 0.01, depression level was also higher (BDI = 8,67 ± 3,94: 4.63 ± 2.04; t = −5,02). Lack of physical exercise, was more present at K group. After 6 months there were 11 rehospitalization in K group. Family history of coronary disease and alcohol consumption had significant influence on 6 months re-hospitaization of infarct patients.

Conclusion

Anxiety and depression levels are mild in K group. Risk health behavior has been present at bouth groups but alcohol consumption and family disposition are important for re-hospitalization

Hyperglycemia, oxidative and nitrosative stress affect antiviral, inflammatory and apoptotic signaling of cultured thymocytes

A high prevalence of various infectious diseases is reported in diabetic patients, which may suggest impaired innate immunity against different pathogen-associated molecular patterns. This study investigated the effects of hyperglycemia, oxidative stress (H(2)O(2)), nitric oxide (NO) and peroxynitrite (ONOO(-)) on the modulation of antiviral (MDA-5, IRF-3 and phospho-IRF-3), inflammatory (NF-kappaB) and pro/anti-apoptotic molecules (Bax and Bcl-2) in BALB/c mice thymocytes. Each of the experimental conditions, except the weakest NO concentration, resulted in down-regulation of MDA-5, IRF-3 and phospho-IRF-3. In contrast, each of the experimental conditions elicited up-regulation of NF-kappaB, Bcl-2 and Bax. These results suggest that hyperglycemia, oxidative and nitrosative stress may contribute to the reduced immunity of the host by altering the MDA-5/IRF-3/phosphoIRF-3 axis, as well as contributing to the mechanisms of inflammatory reaction via increased NF-kappaB, and to augmented turnover rate of thymocyte cells via Bcl2/Bax up-regulation.

Circulating nucleic acids in type 1 diabetes may modulate the thymocyte turnover rate

The autoimmunity of type 1 diabetes is associated with T-cell hyperactivity. Current study was designed to examine the effect of circulating ribonucleic acids (RNAs), isolated from type 1 diabetic patients on proliferative, apoptotic and inflammatory potential of rat thymocytes. Rat thymocytes were assayed for proliferating nuclear cell antigen (PCNA), Bcl-2, Bax and NF-κB level, using the flow cytometric and fluorometric assays. Cells were allocated into groups, treated with RNAs purified from plasma of juvenile diabetics, adult type 1 diabetic patients, control healthy children, healthy adult persons, nucleic acids and polynucleotide standards (RNA, polyC, PolyA, PolyIC, and CpG). The upregulation of PCNA and Bcl-2 protein and downregulation of Bax protein and NF-κB was shown when the thymocytes where incubated with RNA purified from plasma of juvenile type 1 diabetic patients. The dysregulation of inflammatory cascade and central tolerance may be a defect in autoimmune diseases related to innate immunity leading to corresponding alteration in adaptive immune response.

Irritable bowel syndrome, anxiety, depression and personality characteristics

BACKGROUND

Numerous studies have suggested that 54%-100% of patients with IBS may have associated psychiatric illness and personality pathology. This transversal controlled study was realized in order to evaluate anxiety and depression levels, as well as the personality characteristics of patients with IBS and to compare the results obtained with patients with episodes of depression and healthy individuals.

SUBJECTS AND METHODS

The experimental group consisted of 30 IBS patients, while two control groups consisted of the same number of inpatients with episodes of depression and healthy individuals from the general population. There were equal number of men and women in the study sample and all subjects were aged between 25 to 65 years. Standard psychometric instruments employed included Hamilton anxiety scale, Zung depression scale, Hamilton depression scale, Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Perosonality Inventory (EPI).

RESULTS

The average Hamilton and Zung depression scores were significantly higher in patients with depressive episodes compared with the IBS patients, while the mentioned scores among them were also significantly higher compared with the healthy controls. There were no significant differences between IBS and the group with depressive episodes in the average Hamilton anxiety levels, EPI neuroticism and extraversion levels and MMPI neurotic scales levels (Hs, D, and Hy). The significant differences were observed comparing the IBS patients to healthy individuals.

CONCLUSION

The patients suffering from irritable bowel syndrome who asked for medical help (consulters) because of their intestinal symptoms, presented emotional problems such as depression and anxiety and expressed neurotic personality characteristics.

Gastrojejunocolic fistula as a complication of Billroth II gastrectomy: a case report

Gastrojejunocolic fistula is a late, severe complication of a stomal ulcer, which develops as a result of inadequate resection of the stomach or incomplete vagotomy. It is uncommon and in our century is reported only sporadically in medical literature The authors report a case of benign gastrojejunocolic fistula, diagnosed by barium based contrast radiography, which demonstrated reflux of contrast from the transverse colon to the stomach and jejunum via a fistulous tract. Therapy of the gastrojejunal fistula is always radical and comprises en bloc resection of the fistula and revision of gastrectomy, partial resection of the jejunum and the colon, which is involved in the fistula, and restoration of continuity of the digestive tract by gastrojejunostomy, jejunojejunostomy and colocolostomy. If trunkal vagotomy has not previously been completed, it is advisable to perform it nonetheless.

Altered degradation of circulating nucleic acids and oligonucleotides in diabetic patients

Foreign, infection-associated or endogenously generated circulating nucleotide motifs may represent the critical determinants for the activation of the Toll-like receptors (TLRs), leading to immune stimulation and cytokine secretion. The importance of circulating nucleases is to destroy nucleic acids and oligonucleotides in the blood stream and during cell entry. Patients with juvenile insulin-dependent diabetes, adult patients with insulin-dependent diabetes and adult patients with type 2 diabetes were allocated to the study, together with the age-matched control subjects. Plasma RNase and nuclease activity were examined, in relation to different substrates-TLRs response modifiers, and circulating RNA and oligonucleotides were isolated. The fall in enzyme activity in plasma was obtained for rRNA, poly(C), poly(U), poly(I:C), poly(A:U) and CpG, especially in juvenile diabetics. In order to test the non-enzymatic glycation, commercial RNase (E.C.3.1.27.5) and control plasma samples were incubated with increasing glucose concentrations (5, 10, 20 and 50 mmol/l). The fall of enzyme activity was expressed more significantly in control plasma samples than for the commercial enzyme. Total amount of purified plasma RNA and oligonucleotides was significantly higher in diabetic patients, especially in juvenile diabetics. The increase in the concentration of nucleotides corresponded to the peak absorbance at 270 nm, similar to polyC. The electrophoretic bands shared similar characteristics between controls and each type of diabetic patients, except that the bands were more expressed in diabetic patients. Decreased RNase activity and related increase of circulating oligonucleotides may favor the increase of nucleic acid "danger motifs", leading to TLRs activation.

Synthesis of some new antianemics I. Iron pullulan complexes of pharmaceutical interest

First experiments were performed in order to obtain a polynuclear iron(III) complex with pullulan, which could be applied in therapy of sideropenic anemia. Complete synthesis of the complex can be realized with oligomers of depolymerized pullulan at an average molar mass 8000-10,000 g.mol-1. Maximum iron contents of 51.4 mg.cm-3 is effected by pullulan depolymerizates (Mw approximately 9000 g.mol-1, [eta] = 0.085 dl.g-1) at 130 degrees C for 240 min, at pH = 10.5 and at an initial mass ratio Fe/ligand of 1:3. The effected concentrations and complex stability respond to requirements of pharmacological application of parenteral antianemic preparations.

Protein sgp 120 as a marker of an acquired angioedema

BACKGROUND

Angioedema is not an event peculiar to an acute-phase response. We registered the appearance of angioedema in four nonatopic patients suffering from diverse inflammatory stimuli.

MATERIALS AND METHODS

Serum concentrations of C-reactive protein (CRP), haptoglobin, alpha1-antitrypsin, alpha2-macroglobulin, C3, C4, C1INH and protein sgp 120 (classified as a regulatory protein of the complement system) were assessed over 7 consecutive days, beginning with the onset of angioedema in these four patients.

RESULTS

Instead of returning to the normal level, CRP peaked again on the 4th day (A-test, P<0.05) and declined significantly by the 7th day (A-test, P<0.05). Serum levels of sgp 120, C3c and C1INH increased gradually up to the 5th day but only sgp 120 was significantly raised in relation to the initial value (P< 0.05).

CONCLUSION

In our patients, we registered four diverse profiles of the acute-phase proteins (Kruskal-Wallis test, P<0.05) probably due to the diverse nature of the pre-existing inflammatory stimuli. According to these results, the unexpected appearance of angioedema implies the contribution of sgp 120 as the main source of fragments with kinin-like properties.

Hydroxychloroquine overdose: toxicokinetics and management

BACKGROUND

The management and toxicokinetics of hydroxychloroquine overdose are poorly described.

CASE REPORT

We report a case of an 18-year-old girl who ingested 20 g of hydroxychloroquine. She developed marked hypokalemia, hypotension, and ventricular tachyarrhythmias but survived with treatment including intubation, adrenaline infusion, high-dose diazepam, and aggressive potassium replacement. Plasma hydroxychloroquine level was 29.40 mumol/L (9.87 mg/L) 2 hours after ingestion and the elimination half-life of hydroxychloroquine was 22 hours.

CONCLUSIONS

The clinical manifestations of this hydroxychloroquine overdose were similar to those reported for chloroquine overdose and the management principles recommended for chloroquine overdose appeared to be efficacious in this case.

Lack of cross-reactivity between casein and gliadin in sera from coeliac disease patients

BACKGROUND

While searching for antigliadin and anticasein antibodies in sera from coeliac patients we investigated more than 20 persons suffering from this enteropathy. In some of sera, we registered antibodies against gliadin and in parallel the appearance of anticasein antibodies. A high percentage of glutamic acid has been proven by amino acid analysis in both these proteins. Therefore we try to demonstrate the existence of cross-reactivity between them in sera from coeliac patients.

METHODS

We analyzed sera from 5 adult patients by using Western blot (SDS-PAGE and immunoblot assay). All of them had previously proven serum antibodies against casein and gliadin. In the procedure, antigliadin-antibodies were removed from sera by adsorption with gliadin. Adsorbed antibodies were then eluted from the adsorbent.

RESULTS

Adsorbed samples retained anticasein activity. Eluates had a strong reactivity to gliadin but not to casein.

CONCLUSION

No cross-reactivity restricted to any of the immunoglobulin isotypes (IgG, IgM, IgA) had been proven between these two proteins. Before the final conclusion, we believe the study has to be completed by using partly of totally disassembled proteins by intestinal enzymes. It might be that enzymatic digestion could open some epitopes shared by both these proteins.