Pulmonary biological glue embolism after endoscopic repair of gastric varices - A case report

Cyanoacrylate injection is widely used to treat hemorrhagic gastric varices. A pulmonary glue embolism is an unusual but potentially fatal complication. We present a case of a 51-year-old man with a history of alcoholic hepatic cirrhosis Child-Pugh B, who had an acute pulmonary embolism with sudden cardiorespiratory collapse due to biological glue injection used for the emergent repair of bleeding gastric varices. After the restoration of respiratory and hemodynamic parameters, he was admitted to the intensive care unit and the pulmonary biological glue emboli were documented with computed tomography scan. A high index of suspicion for this entity is essential in patients submitted to endoscopic sclerotherapy. Some might be asymptomatic or mildly symptomatic, while others might present with cardiorespiratory collapse.

Self-criticism and self-compassion role in the occurrence of insomnia on college students

Introduction

To our knowledge there are no research about the influence of self-criticism and self-compassion in the occurrence of insomnia.

Objectives

To study the association between self-criticism, self-compassion and insomnia on university students; to explore differences in these associations on two moments of student's lives–examination and no examination period.

Aims

We anticipate that the stress and pressure of the examination period have an impact on student's sleep and there are, also, differences by age and gender.

Method

Self-Criticism and Self-Reassurance Scale, Self-Compassion Scale, Pre-Activation Sleep Scale, Insomnia Assessment Scale and Anxiety and Depression and Stress Scales were answered by 160 college students (M = 26.45, SD = 7.98; range = 19–54 years) during an examination period and by 108 college students during a no examination period (M = 26.34; SD = 0.43; range = 19–54 years).

Results

In both periods (examination and no examination period) older students (30–54 years) tended to be more self-compassionate and tolerant, such as less self-critical and punitive. During the examination period, younger students (19–29 years) showed higher levels of self-criticism, cognitive, and somatic activation before falling asleep. There was also a higher proportion of younger students in the insomniac and insomnia symptomatic groups. Moreover, significant correlations were found between cognitive and somatic activation and depression, anxiety, and stress in both moments.

Conclusions

In the examination period, the youngest students are more critical and less compassionate, what might lead to greater cognitive and somatic activation before sleep and, consequently, to insomnia symptoms and insomnia itself.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The cytosolic sensor STING is required for intestinal homeostasis and control of inflammation

STING (stimulator of interferon genes) is a cytosolic sensor for cyclic dinucleotides and also an adaptor molecule for intracellular DNA receptors. Although STING has important functions in the host defense against pathogens and in autoimmune diseases, its physiological relevance in intestinal homeostasis is largely unknown. In this study, we show that STING^-/- mice presented defective protective mechanisms of intestinal mucosa, including decreased number of goblet cells, diminished mucus production, and lower levels of secretory IgA, when compared with wild-type (WT) mice. Fecal content and microbiota DNA could activate STING, indicating a role of this molecule in gut. Microbiota composition was altered in STING^-/- mice toward a more inflammatory profile, evidencing a reduction in the Allobacolum and Bifidobacterium groups along with increase in Disulfovibrio bacteria. Absence of STING lead to decrease in induced intraepithelial lymphocytes (IEL) and to increase in group 1 innate lymphoid cell (ILC1) as well as ILC3 frequencies and decrease in ILC2 in the colon. Development and function of Foxp3+ and LAP+ regulatory T cells were also compromised in STING^-/- mice. Moreover, these mice were highly susceptible to dextran sodium sulfate-induced colitis, T-cell-induced colitis, and enteric Salmonella typhimurium infection when compared with WT animals. Therefore, our results identify an important role of STING in maintaining gut homeostasis and also a protective effect in controlling gut inflammation.

The temporal evolution of life satisfaction in institutionalized elderly: A longitudinal study

Introduction

Research shows that variables, such as depression, less functionality and health, less contact with family and others, may have a negative impact on life satisfaction.

Objectives

To verify which variables correlate with satisfaction with life (SWL) and analyse which of them predict the evolution of SWL.

Aims

To examine correlates and predictors of SWL in institutionalized elderly.

Methods

This study involved a subsidiary longitudinal analysis of cross-sectional data gathered at Phase I (2010–2012; n = 493 elderly) and after 36 months at Phase II (2013–2014; n = 85) of Aging Trajectories Project from Miguel Torga University College.

Results

At Phase I, higher scores in SWL scale correlated with having visits (r = 0.17; P < 0.01), specially from family (r = 0.20; P < 0.01), less depressive (r = –0.42; P < 0.001) and anxiety symptoms (r = –0.25; P < 0.001), less loneliness feelings (r = –0.37; P < 0.001), less functionality (r = 0.15; P < 0.01), and better general physical health (r = 0.25; P < 0.001). Age, sex, civil status, cognitive, and executive status did not correlate with SWL. SWL, depressive and anxiety symptoms, and loneliness feelings were stable through time, between assessment stages (P < 0.01). The worsening of depression and loneliness through time predicted the negative evolution of SWL (respectively, β = 1.16; P < 0.01; β = –0.69; P < 0.05).

Conclusions

These findings highlight the relevance of early detecting depressed mood and loneliness feelings in institutionalized elderly, and the importance of the treatment and the development of preventive interventions for this vulnerable population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mindfulness, self-compassion and spiritual well-being in chronic depression

Introduction

Depression is one of the main causes of incapacity worldwide. Research has shown that mindfulness practice, self-compassion promotion, and spiritual well-being are beneficial for depressed individuals.

Objective

Analyze the associations between compassion, mindfulness, and spiritual well-being, during and after a therapeutic intervention (concluded less than a year ago).

Aims

To determine if mindfulness, self-compassion, and spiritual well-being are predictors of depression.

Method

Patients diagnosed with chronic depression were treated in a residential therapeutic community for a period of six to eight months. The 63 participants (M = 32.84, SD = 10.24, range = 15–50 years old; 32 during treatment; 31 after treatment) were assessed with the Beck Depression Inventory, the Questionnaire of the Five Facets of Mindfulness, the Self-Compassion Scale, and the Spiritual Well-Being Questionnaire.

Results

There were differences in mindfulness, self-compassion, spiritual well-being and depression by sex, existence of previous psychiatric treatment, moment of the study (during versus after intervention), and depression levels. After intervention the group had higher levels of mindfulness and self-compassion (common humanity) and lower levels of over-identification, compared with group during treatment. The predictors of depression were the self-judgment dimension of the self-compassion scale and, negatively, the mindfulness dimensions of non-reactivity and non-judging, and the spiritual well-being dimension of personal well-being.

Conclusion

Results confirm the relationship between the study variables and depression. This reinforces the importance of intervention based on positive psychology enhancing positive areas of human experience, rather than focusing on psychological pain, weaknesses, and disabilities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Mental Health, Self-Compassion, Organizational Virtuosity and Commitment in Workers From Local Administration

Introduction

Positive and organizational psychology can offer an important contribution to strengthen human virtues that protects intra- and interpersonal functioning, which, in turn, might enhance worker's well-being and the success of organizations.

Objective

To study the associations between a psychological construct, self-compassion, and some organizational constructs, organizational commitment and organizational virtuosity and to explore differences in each construct by gender, age, working time (in the organization), type of employment bond and professional group.

Aims

Positive actions inside organizations promote positive emotional states.

Method

One hundred and thirty workers from local administration (men, n = 78; 60%; age, M = 44,22; SD = 8,67; range = 19-63 years old) filled in the Self-Compassion Scale, the Organizational Commitment Questionnaire, the Organizational Virtuosity Questionnaire and the Depression, Anxiety and Stress Scales.

Results

There was a positive association between organizational commitment and organizational virtuosity. Optimism and integrity (organizational virtuosity dimensions) positively correlated with the self-criticism dimension and with self-compassion total score. Some dimensions of mental health (depression and stress) were negatively associated with organizational virtuosity. Employees with less education, belonging to a professional group less qualified or with an unfavourable employment bond perceived the organization as less virtuous, and were less committed.

Conclusion

Promoting positive actions inside organizations seem to encourage positive emotional states in individuals. The development of a compassionate capacity, by self-compassion and mindfulness, humanize both individuals and organizations. These workers, with their leaders, can promote affective and normatively committed workforces, presenting positive perceptions about organizational virtues.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Morbidity among nursing personnel and its association with working conditions and work organization

INTRODUCTION

Work organization patterns and working conditions experienced by nursing personnel in the hospital settings may be associated to increased morbidity among these health workers.

AIM

To estimate the prevalence and factors associated with self-reported diseases among nursing personnel at the emergency hospital in Rio Branco/State of Acre, Brazil.

METHODS

A cross-sectional study was conducted involving 272 participants who answered a questionnaire including sociodemographic characteristics, working conditions, lifestyles, work ability, and a fatigue perception scale. The self-reported diseases in the 12 months prior to data collection were considered the dependent variable.

RESULTS

A total of 85.7% of the participants reported one or more diseases in the past 12 months. Most prevalent diseases were: musculoskeletal diseases (37.1%), digestive diseases (28.7%), mental disorders (28.3%), work injuries (27.9%), and respiratory diseases (26.8%). The following significant variables remained in the final model: high work demands (OR 2.69), reported fatigue (OR 3.59), night work (OR 6.55) and being a technician or nursing assistant (OR 4.23).

CONCLUSIONS

Variables related to working conditions and work organization were associated with the occurrence of reported diseases among nursing professionals. Health promotion measures at work require a comprehensive approach including the working conditions and the work organization.

Sorption of pentachlorophenol on pine bark

The minimization of pentachlorophenol (PCP) transport in the environment driven by industrial wastewater discharges can be accomplished by sorption in natural, available and low cost by-products like pine bark. Taking into account that PCP is a chemical which behaviour is highly dominated by the surrounding features, this work intended to evaluate the sorption kinetics and equilibrium parameters according to the pH and temperature as well as the pine bark particle size. The PCP uptake by pine bark showed to be faster in the initial phase followed by a slower process, being 24 h the suitably time to reach the sorption equilibrium in the range of pH studied. The neutral PCP species showed to have higher binding capacity to pine bark than the anionic PCP, which was reflected in a decrease in the distribution coefficient (Kd) of the linear sorption isotherm with the increase of solution pH from 2 to 7. On the other hand, between 10 degrees C and 35 degrees C, the temperature does not seem to play a significant role in the PCP sorption by pine bark, while the sorbent size is a key parameter to enhance the overall process.

Nodular sarcoid myositis of skeletal muscle diagnosed by fine needle aspiration biopsy. A case report

BACKGROUND

Symptomatic striated muscle involvement in sarcoidosis is rare. Muscle biopsy is usually required for the diagnosis. Fine needle aspiration biopsy (FNAB) has been successfully used in diagnosing soft tissue lesions. To the best of our knowledge, FNAB of sarcoid myositis has not been reported.

CASE

A 31-year-old, black female with a history of sarcoidosis presented with an enlarging, painful, left calf mass. Infected thrombi were suspected. FNAB showed numerous loosely arranged epithelioid histiocytes, multinucleated giant cells and skeletal muscle cells. The overall cytologic picture was that of granulomatous myositis. The cytologic features coupled with the patient's history and magnetic resonance imaging findings suggested sarcoid myositis. Subsequent muscle biopsy showing noncaseating granulomata and negative stains for organisms confirmed the diagnosis of nodular sarcoid myositis.

CONCLUSION

Nodular sarcoid myositis can be suggested by FNAB cytology in a patient with a past history of sarcoidosis.

Cellular responses to various levels of sustained delivery of testosterone in the ventral prostate

The objective of this study was to evaluate the effect of various dosages of testosterone (T) delivered in a sustained manner by means of tricalcium phosphate-lysine (TCPL) delivery system on morphological changes of prostatic tissue using adult male rats as a model. In this experiment, adult male rats (250-300 g BW) were randomly divided into five equal groups (n = 8). Rats in group I, II, and III were castrated and implanted subcutaneously with TCPL loaded with three different dosages (10, 100 and 200 mg T, respectively) of T. Rats in group IV were castrated and implanted with sharm TCPL capsules, and rats in group V served as intact unimplanted controls. Surgical aseptic techniques were performed according to standard laboratory procedures. At the end of 4 and 12 weeks post implantation, four animals from each group were sacrificed and the prostate tissues were collected, weighted, and embedded for histo-pathological evaluations. Data collected from this study have shown that exogenous intake of T delivered in a sustained manner for twelve weeks induced several pathophysiological conditions in ventral prostatic tissue in comparison to the control and sham operated groups. This phenomenon was found to be directly proportional to the dose or the level of sustained delivery. The results demonstrated that the use of 10 mg filled TCPL implants decreased the total mass weight of ventral prostate. Light microscopic evaluation of this group (Group I) revealed a cellular adaptation through an atrophy in the epithelium component. Cytopathological observations such as low cuboidal and thin glands, pleomorphism, and occasional presence of connective tissue stroma were detected. In contrast, ventral prostate collected from animals implanted with TCPL filled with 200 mg T (Group III) showed a significant increase in weights of the wet prostatic tissues in comparison to all groups. Histopathological evaluations demonstrated the following. (i) prostatic hypertrophy alone, or in conjunction with hyperplasia of the epithelial cells, (ii) less connective tissue stroma in comparison to the control group, (iii) occasional involvement of mitotic figures, and (iv) increased angiogenesis. No significant change was observed in those animals implanted with TCPL capsules containing 100 mg T compared to the intact control animals.

[Health care delivered to Portuguese children. The past, present and new challenges]

The socio-economic development of a country as well as the state of its health, its communications network, cultural level and health care organisation together affect what is known as the health indicators. Portugal belongs to the group of UNICEF countries with the best indicators in what concerns infant mortality and death below the age of five. It is still, however, 25th and 28th respectively at world level. The authors review some of the factors which have most contributed towards the progress of the indicators over the last twenty years, namely, the role played by general practitioners, the creation of health centers, the development of a maternal-infant assistance programme and the activity of Central and District Hospitals. They analyse the recent maternal-infant programme and discuss the main short and mid-term problems in the perinatal and paediatric age groups. The socio-economic changes seen in Portuguese society, together with sociological changes and those observed in the field of pathology, call for a new approach in the organisation of care which includes the need for a new dialogue between the different health structures of a society, namely, through maintaining the functional coordinating maternal-infant units, the creation of the same units for paediatrics, new efforts by the general paediatrician, the community paediatrician and the sub-specialised paediatrician together with the general practitioners within a specific action programme of a Health Unit.

[The aspects of humanizing in hospitals for adults. We learn from pediatric experience!]

Since the late seventies, the Portuguese pediatric health services have gradually been accepting and desiring the presence of a family member during a child's hospital stay, due to the affective and psychological benefits thereof. This attitude was extended to include the emergency room, wards and intensive care units. In the majority of cases there is a perfect understanding between the health care team and the family member. It would be of the utmost importance for the humanization of the respective Services that the health care professionals of the adult hospitals, which are still very conservative with respect to this issue, should be encouraged to follow the Pediatric experience.

The effect of TCPL devices on tissue-implant interface analysis using adult sheep as a model

Inflammatory response and the subsequent fibrous capsule formation are often used as a screening method to determine biocompatibility of an implanted material. In this study, porous implants of tricalcium phosphate-lysine (TCPL) delivery devices were implanted subcutaneously in adult rams. The fibrous capsule surrounding the implant was studied histochemically to determine the resorbability rate of the device. Fibrous capsular tissues were carefully dissected away from the capsule noting the tissue closest to the implanted material. Evaluation of the sections (5um, H&E) collected from various areas of the implants (n = 127) revealed that: vascularity, macrophages, multinucleated giant cells and plasma cells at the TCPL implant-interface were evident after the first month. Persistence of these cell types and progressive angiogenesis in subsequent months was apparent in all tissues collected from experimental animals. The formation of distinct cell layers was remarkable at the six and twelve month phases. After the first month, macrophages were the predominant cell type at the interface and as the tissue progressed away from the implant the presence of fibroblast and plasma cells were observed. The layer of tissue furthest from the implant mostly consisted of structured collagen fibers with minimal number of microvasculature. The presence of inflammatory cells at the interface sites in all phases was further evidenced by immunohistochemical analysis (IL-1 and IL-6). The inflammatory cells seen at the interface along with the formation of a structured fibrous tissue resembles a normal repair process and supports our previous observations regarding the biocompatibility and biodegradability of TCPL delivery device.

Hypercalcemia associated with epidermoid carcinoma in ovarian cystic teratoma

A case of metastatic epidermoid carcinoma arising in benign cystic teratoma of the ovary is reported. The clinical course was complicated by severe hypercalcemia and respiratory distress due to associated diffuse calcification of the lungs. Presumptive evidence is presented to show that prostaglandin E found in the tumor was the cause of the hypercalcemia.