Polygenic risk score and peer victimisation independently predict depressive symptoms in adolescence: results from the Quebec Longitudinal Study of Children Development

BACKGROUND

Peer victimisation has been associated with depressive symptoms during adolescence, however not all peer victimised adolescents will exhibit such symptoms. This study tested whether having a genetic predisposition to developing depression increased the risk of experiencing depressive symptoms in peer victimised youth. To date, no study has explored such gene-environment interaction using a polygenic risk score for depression (PRS-depression) in the context of peer victimisation and depressive symptoms in adolescence.

METHODS

The sample included 748 participants born in 1997/98 from the Quebec Longitudinal Study of Child Development with genotype data and prospectively collected information on peer victimisation (12-13 years) obtained from both self- and teacher-reports, as well as self-reported depressive symptoms (15-17 years). The PRS-depression was based on the genome-wide association meta-analysis of broad depression by Howard et al. (2019).

RESULTS

Self- and teacher-reported peer victimisation in early adolescence were both associated with depressive symptoms in adolescence (β = 0.34, p < .001; β = 0.14, p = .001 respectively), and this association remained significant when accounting for PRS-depression (β = 0.33, p < .001; β = 0.13, p = .002 respectively). PRS-depression was independently associated with depressive symptoms, but there was no significant PRS-depression by peer victimisation interaction (self-reported and teacher-reported). PRS-depression was correlated with self-reported, but not teacher-reported, peer victimisation.

CONCLUSIONS

Our findings suggested that a partial measure of an individual's genetic predisposition to depression, as measured by PRS-depression, and being exposed to peer victimisation (self- and teacher-reported) were independently associated with depressive symptoms in adolescence. Furthermore, PRS-depression did not exacerbate the risk of depressive symptoms among adolescents who had been peer victimised. Lastly, we found evidence of a gene-environment correlation between PRS-depression and self-reported peer victimisation. Future studies are needed to replicate this finding and to further understand the role of genetic predispositions in experiencing depressive symptoms following peer victimisation.

468 - Mode d'admission en milieu de réadaptation gériatrique et risque de COVID-19

Contexte

En temps de pandémie, l'admission aux soins post-aigus et de réadaptation gériatrique a été faite en adoptant des mesures de confinement à la chambre, dans des unités transitoires désignées zones tampons. Dans notre établissement, gestionnaires et cliniciens se sont interrogés sur le mode d'admission optimal de tels patients en provenance des hôpitaux. Un essai pragmatique de non-infériorité a évalué l'incidence de COVID-19 dans ces zones tampons ainsi que les délais d'accès aux soins de réadaptation selon le mode d'admission par disponibilité de lits comparativement à l'admission par cohorte.

Méthodes

L’étude a porté sur 312 patients admis en zone tampon dans trois centres. Les nouveaux cas de COVID-19, les délais de prise en charge et les caractéristiques des patients ont été colligés dans les dossiers médicaux alors que les quotas de personnel soignant et les résultats d'un audit de lavage des mains ont été relevés dans les dossiers administratifs.

Résultats

Le nombre d'infections à la COVID-19 s'est révélé plus élevé dans le mode d'admission par disponibilité de lits. Le délai total d'accès aux soins de réadaptation a toutefois été plus court dans le mode par disponibilité de lits (-23,5 %).

Discussion/Conclusion

Les mesures générales de prévention et de contrôle des infections constituaient l'unique barrière de protection contre la COVID-19 au moment de l’étude. En matière de modalité d'admission, la variable à surveiller semble être la situation épidémiologique communautaire. Quand elle se montre basse, il pourrait être avantageux de recourir au mode d'admission par disponibilité de lits pour prévenir le déconditionnement, celui-ci permettant une réduction des délais pour l'accès au programme de soins de réadaptation. Quand la contamination communautaire s'avère au contraire élevée, il serait plus sécuritaire d'utiliser le mode d'admission par cohorte pour assurer une réduction de contamination entre les patients.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Safety and Adverse Events Among Long-term Care Residents Receiving a Third COVID-19 mRNA Vaccine Booster Dose in Quebec

This cohort study examines the safety and adverse events associated with receipt of various 3-dose combinations of COVID-19 mRNA vaccines with among long-term care residents in Quebec, Canada.

Comparison of saliva with oral and nasopharyngeal swabs for SARS-CoV-2 detection on various commercial and laboratory-developed assays

The accurate laboratory detection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a crucial element in the fight against coronavirus disease 2019 (COVID-19). Reverse transcription-polymerase chain reaction testing on combined oral and nasopharyngeal swab (ONPS) suffers from several limitations, including the need for qualified personnel, the discomfort caused by invasive nasopharyngeal sample collection, and the possibility of swab and transport media shortage. Testing on saliva would represent an advancement. The aim of this study was to compare the concordance between saliva samples and ONPS for the detection of SARS-CoV-2 on various commercial and laboratory-developed tests (LDT). Individuals were recruited from eight institutions in Quebec, Canada, if they had SARS-CoV-2 RNA detected on a recently collected ONPS, and accepted to provide another ONPS, paired with saliva. Assays available in the different laboratories (Abbott RealTime SARS-CoV-2, Cobas® SARS-CoV-2, Simplexa™ COVID-19 Direct, Allplex™ 2019-nCoV, RIDA®GENE SARS-CoV-2, and an LDT preceded by three different extraction methods) were used to determine the concordance between saliva and ONPS results. Overall, 320 tests were run from a total of 125 saliva and ONPS sample pairs. All assays yielded similar sensitivity when saliva was compared to ONPS, with the exception of one LDT (67% vs. 93%). The mean difference in cycle threshold (∆C t ) was generally (but not significantly) in favor of the ONPS for all nucleic acid amplification tests. The maximum mean ∆​​​​​C t was 2.0, while individual ∆C t varied importantly from -17.5 to 12.4. Saliva seems to be associated with sensitivity similar to ONPS for the detection of SARS-CoV-2 by various assays.

Comprehensive analysis of the specificity of transcription activator-like effector nucleases

A key issue when designing and using DNA-targeting nucleases is specificity. Ideally, an optimal DNA-targeting tool has only one recognition site within a genomic sequence. In practice, however, almost all designer nucleases available today can accommodate one to several mutations within their target site. The ability to predict the specificity of targeting is thus highly desirable. Here, we describe the first comprehensive experimental study focused on the specificity of the four commonly used repeat variable diresidues (RVDs; NI:A, HD:C, NN:G and NG:T) incorporated in transcription activator-like effector nucleases (TALEN). The analysis of >15 500 unique TALEN/DNA cleavage profiles allowed us to monitor the specificity gradient of the RVDs along a TALEN/DNA binding array and to present a specificity scoring matrix for RVD/nucleotide association. Furthermore, we report that TALEN can only accommodate a relatively small number of position-dependent mismatches while maintaining a detectable activity at endogenous loci in vivo, demonstrating the high specificity of these molecular tools. We thus envision that the results we provide will allow for more deliberate choices of DNA binding arrays and/or DNA targets, extending our engineering capabilities.

Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis

The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of <500 cells/μl, and viremia, as defined by an HIV-1 RNA count of ≥50 copies/ml, were associated with NS in multivariate analysis (P = <0.001 for each factor). Blood serum rapid plasma reagin (RPR) titers were not associated with early NS (P = 0.575). For the diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of <500 cells/μl were predictors of NS in HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.

Pulmonary recruitment protocol for organ donors: a new strategy to improve the rate of lung utilization

Because lung transplantation is the only effective therapy for terminal respiratory failure, the demand for donor lungs has increased steadily. However, the number of donors has remained fairly constant over the years, which results in an increasing duration of waiting for lung transplantation. To overcome the lack of organs, various strategies have been developed by transplant centers including use of marginal donors. To increase the lung utilization rate in multiorgan donors, we implemented a simple lung recruitment protocol involving a brief period of controlled sustained inflation. In 2005, the lung utilization rate in the transplant program at our institution was only 20% in multiorgan donors. With the lung recruitment protocol, the rate of lung utilization for transplantation increased to 33%, in 2006, 24% in 2007, and 24% in 2008. Following the lung recruitment protocol, the arterial oxygen tension/fraction of inspired oxygen ratio increased to greater than 15% in more than 40% of donors. We were able to improve gas exchange sufficiently that as many as two-thirds of the lungs were suitable for transplantation. During the protocol, no complications were reported, and no patient became hemodynamically unstable, precluding organ procurement. We believe that optimization of multiorgan donor management with simple interventions may improve oxygenation, reducing the number of inadequate donor lungs and increasing the overall donor pool and organ availability.

Enquête sur la mise en place d’une consultation pharmaceutique pour les patients sous antirétroviraux

OBJECTIVE

Highly active anti-retroviral therapies (HAART) in HIV treatment can result in complex treatment regimens. We surveyed HIV patients followed in the infectious disease department of Saint-Germain-en-Laye Hospital to assess the interest of offering patients a consultation with a pharmacist.

METHODS

The 3-part questionnaire enabled us to assess the medical and pharmaceutical information given to the patient, adherence, and risk factors for poor observance. The questionnaire was distributed to all patients, regardless of whether they were receiving treatment. A simple adherence score was computed as well as a score for the risk of poor adherence.

RESULTS

Ninety patients returned analyzable questionnaires: 65 (72.2%) thought a pharmaceutical consultation would be useful. They felt it should cover in priority the following subjects: drug interactions (51%), secondary effects (49%), and what to do after forgetting a dose (44%). Treatment was perceived as positive by 82 patients (91%) and tolerated well by 57 (65%). Sixty patients (66.3%) reported that they occasionally forgot a dose, 37 (41.3%) that they regularly did. The results showed good adherence by 61.3% and poor adherence by 38.5%. Risk of non-adherence was significantly associated with three factors: the number of pills to take, the number of daily doses, and the length of the treatment.

CONCLUSION

Our survey shows the interest of consultations with pharmacists as a clinical service. By reinforcing the patient's understanding, these can complete and supplement the physician's explanation and instructions on pharmaceutical topics, especially those that could not be addressed during the clinical visit. The main aim of this process is to improve adherence, which is a key element in treatment efficacy.

[Chronic lymphoid leukemia complicated with ascites]

Ascites are common in malignancies of the gastrointestinal tract but are rarely associated with chronic lymphoid leukemia. An unusual progression of chronic lymphoid leukemia, rapidly complicated with ascites, is presented, followed by a discussion of the causes and types of ascites found in solid and blood malignancies.

Alfentanil causes less postoperative nausea and vomiting than equipotent doses of fentanyl or sufentanil in outpatients

BACKGROUND

The relative potencies of alfentanil, fentanyl, and sufentanil as a risk factor for postoperative nausea and vomiting have not been determined. They were compared in a randomized study designed to obtain equipotent plasma concentrations of these three opioids at the beginning of the recovery period.

METHODS

The study included 274 patients treated on an outpatient basis. The steady state opioid plasma concentration providing a predicted 50% reduction of the minimum alveolar concentration of isoflurane was used to determine the relative potency of the opioids. The opioids were prepared in equal volumes at concentrations of alfentanil 150 microg/ml, fentanyl 50 microg/ml, and sufentanil 5 microg/ml and were administered in vol/kg. Anesthesia was induced in a blinded fashion with a bolus of the study opioid (0.05 ml/kg) and 4-6 mg/kg thiopental and was maintained with isoflurane (0.6-1%) in a nitrous oxide-oxygen mixture with a continuous infusion of the study opioid (0.06 ml x kg(-1) x h(-1)). If necessary, up to five additional boluses of opioid (0.02 ml/kg) could be given. This opioid administration protocol was tested by pharmacokinetic simulations.

RESULTS

The incidence of postoperative nausea and vomiting was not different in the postanesthesia care unit, but in the ambulatory surgery unit it was significantly lower for alfentanil compared with fentanyl and sufentanil (12, 34, and 35%, respectively P < 0.005). Pharmacokinetic modeling showed that the end-anesthesia opioid plasma concentrations were approximately equipotent in the three groups. However, modeling does not support that the difference between groups in the postoperative period can be explained by a more rapid disappearance of alfentanil from the plasma.

CONCLUSIONS

Alfentanil, compared with approximately equipotent doses of fentanyl and sufentanil, is associated with a lower incidence of postoperative nausea and vomiting in outpatients.

Does diet affect values obtained during prolonged ambulatory pressure monitoring

With the development of a portable high-capacity data-recording device and fully automated computer analysis, it is now possible to monitor esophageal motility in an ambulatory outpatient setting and over a complete circadian cycle. However, limited data are available on the characteristics and pattern of esophageal motility in healthy subjects, particularly the effects of meals. We studied the effect of food types (liquid vs solid) and standardized vs nonstandardized diet on 17 healthy volunteers with a probe combining three miniature pressure transducers 5 cm apart. All subjects followed the same diet regimen: a standardized breakfast, strict liquid lunch, and no restriction for composition and quantity of dinner. The characteristics of contraction events (amplitude, duration, velocity, slope, area under curve) and their propagation types (peristaltic, simultaneous, segmental, retrograde) were analyzed and compared to supine and interprandial periods. The contraction characteristics and the propagation pattern were identical for the three types of meals. In comparison with the interprandial and supine periods, the three types of meals showed higher percent peristaltic contractions and smaller percent simultaneous contractions. The individual contraction characteristics were, however, not significantly different. Higher percentages of simultaneous, retrograde, and segmental contractions were found during the supine period than either the perprandial or interprandial periods. This study indicates that characteristics of esophageal contractions and propagation pattern are similar for meals of different composition and quantity. In comparison with interprandial and supine periods, the meals are always characterized predominantly by peristaltic contractions. Thus, standardization of meals during prolonged ambulatory pressure monitoring is not required.

Idiopathic ulcerative proctitis may be the initial manifestation of Crohn's disease

Of 213 patients with proctitis of all etiologies seen between 1977 and 1987, we studied an original cohort of 96 patients with idiopathic ulcerative proctitis (mean follow-up of 62 months). The diagnosis was made according to strict inclusion criteria, and all cases with any initial feature suggestive of Crohn's disease were excluded. Follow-up showed that 13 patients (13.6%) eventually progressed to Crohn's disease, usually within the first 3 years of the initial diagnosis of idiopathic ulcerative proctitis. Their clinical, endoscopic and histological features at initial presentation were indistinguishable from those in whom the diagnosis remained that of idiopathic ulcerative proctitis. In nine of 13 of these patients (70.0%), the clinical course was characterized by a more protracted course and a poorer response to standard treatment. Such features were not found in those in whom the diagnosis of idiopathic ulcerative proctitis was maintained. Clinicians should be aware that Crohn's disease may present initially as apparent idiopathic ulcerative proctitis.

Esophageal motility disorders and chest pain

Motility abnormalities have long been recognized as a possible esophageal cause of chest pain; however, their exact role and prevalence remain largely unknown. Baseline manometry and the various provocative tests may suggest an esophageal origin, but their yield is low. The recent advent of prolonged ambulatory monitoring of intraesophageal pressure and the assessment of psychological factors are contributing to a clearer understanding of this complex problem.

Destructive spondyloarthropathy in short term chronic ambulatory peritoneal dialysis and hemodialysis

Of the many rheumatic manifestations of kidney failure treated by longterm dialysis, a destructive spondyloarthropathy has recently been recognized. We performed a survey of our small, relatively short term (3-year average) dialysis population of 45 patients to establish a prevalence figure and establish a data base to assess risk factors. Destructive spondyloarthropathy was seen in 4 of 34 patients receiving hemodialysis and in 2 patients receiving chronic ambulatory peritoneal dialysis (CAPD). Age of the patient (p less than 0.09) and duration of dialysis (p less than 0.05) seem to be associated risk factors. Although it may be coincidental, radiological and biochemical hyperparathyroidism can be clearly dissociated from destructive spondyloarthropathy. The very peculiar quasiconstant, asymptomatic and early cervical localization of destructive spondyloarthropathy suggests a local mechanical factor accentuated by crystal and/or amyloid deposition disease which may become overwhelming as survival is prolonged.

Reduced association between the Ii blood group and congenital cataracts in white patients

The authors have identified a white patient with the red blood cell phenotype i, who also has congenital cataracts. However, in comparison with the strong association in Japanese patients between congenital cataracts and the i phenotype, the overall incidence of cataracts in white people with the i phenotype (three of ten people have congenital cataracts) is much lower. In addition, the authors studied the blood of 31 white patients with congenital cataracts and found no patients with the i phenotype. Thus, a close link between genes for these traits does not appear in most white patients with i red blood cell phenotypes.