Management of Emotional Dysregulation in Adult ADHD

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by impairing symptoms of inattention and/or hyperactivity/impulsivity. Although Emotional Dysregulation (ED) is not current criteria for ADHD, several clinical, imaging and genetic studies have been suggesting its inclusion. ED seems to impair social and occupational capacities, leading to poor quality life. In this regard, managing this situation is fundamental.

Objectives

ED in ADHD review and its management, including pharmacological and nonpharmacological approaches.

Methods

Non-systematic review through literature using databases as Pubmed and UpToDate. Keywords used: Attention-Deficit/Hyperactivity Disorder, Emotional Dysregulation, management, pharmacotherapy.

Results

Literature refers to ADHD drugs, such as psychostimulants and atomoxetine, as the first line managing ED. However, some studies demonstrated that ADHD drugs have lower efficacy while treating emotional symptoms, when compared to attention or hyperactivity/impulsivity symptom control. Other medications, such as antidepressants or mood stabilizers, are not considered due to low efficacy and side effects (such as irritability or suicidality behaviour worsening). Regarding non pharmacological approaches, there have been results with cognitive behavioral treatment, and management techniques for anger, frustration and communication skills.

Conclusions

Although the majority of studies demonstrate psychostimulants and atomoxetine role, there is an important lack of information regarding management of ADHD emotional dysregulation. It is a multifactorial condition, and, as such, non pharmacological and pharmacological management are needed to address this issue. More research is necessary, in order to improve patients’ quality of life.

Disclosure

No significant relationships.

Capgras and Fregoli delusions - a case report

Introduction

Capgras and Fregoli delusions are psychotic complex conditions that integrate a larger group of Delusional Misidentification Syndromes (DMS), where the patient misidentifies people, places or objects.

Objectives

Review of the literature and exposure of a case report of a first psychotic episode with DMS.

Methods

Case report and a nonsystematic review through databases. With the keywords: Capgras; Fregoli; DMS.

Results

This case presents a caucasian male, 34-year-old, with no personal or family history of psychiatric pathology. He was taken to the emergency service, due to behavior disorder with verbal aggressiveness to his mother. During the psychiatric emergency he was restless, with accelerated speech and presented Capgras and Fregoli delusion. He believed that his mother had been replaced by an imposter and that the doctor was actually his childhood friend disguised, all with the intention of harming him. The patient was hospitalized, analytical and brain scan show no abnormally. Improvement in symptoms was been seen when a long-term injectable antipsychotic was started. The diagnosis was Bipolar type I disorder.

Conclusions

DSM are more frequent than previously considered, they often occur in association with psychiatric or neurological disorders. Case reports like this one helps to clarify the association between DMS and psychiatric disorders. Given the high incidence of DMS, it is essential to recognize them, carry out an early treatment and be alert to other psychopathological or neurological symptoms that may coexist.

Disclosure

No significant relationships.

Gender Dysphoria and Mental Health

Introduction

Gender dysphoria is characterized by a mismatch between the biological sex and gender identity of a person, frequently associated to distress or discomfort. Many transgender people will seek professional help to obtain a congruence between the gender identity and the body.

Objectives

Brief review of the literature in the field of mental health and gender dysphoria.

Methods

Review of the literature, through research in the PubMed database, using the following keywords: “gender dysphoria”, “mental health”, “psychiatric disorders”.

Results

Although the true prevalence of gender dysphoria (GD) is unknown, several studies indicated that the prevalence of psychiatric disorders in this population is elevated. In comparison with the general population, persons with GD have higher rates of depressive symptoms (64.5%), suicidality (42.9%), substance use disorders (40.2%), general distress (33.8%), anxiety (25.9%), discrimination, and stigma, that contribute to mental health problems. Even though, we cannot reach firm conclusions due to the lack of controlled studies exploring psychiatric disorders on GD people versus controls. An interdisciplinary approach to the health and well-being of this population is highly recommended. Social support, community connectedness, and effective coping strategies appear beneficial.

Conclusions

Individuals with GD have higher rates of psychiatric disorders and social stressors. Healthcare professionals should have a basic understanding on GD. Management should be individualized and may involve a multidisciplinary team. It would be important to have access to more controlled studies in order to achieve a better characterization of the prevalence of mental health disorders in this population.

Disclosure

No significant relationships.

Prenatal Exposure to SARS-Cov-2 and Schizophrenia Development: What to Expect?

Introduction

Schizophrenia is a complex and multifactorial psychiatric condition characterized by thought, speech, perception and behaviour disorders, and social and occupational impairment. It has been related that viral prenatal infection may contribute to schizophrenia development. As such, there are some hypotheses regarding SARS-Cov-2 prenatal infection and its potential relation with “future” offspring schizophrenia.

Objectives

Literature review of schizophrenia development and relation with viral infections, and data research of COVID-19 neurotropic effects.

Methods

Non-systematic review through literature using databases as Pubmed and UpToDate. Keywords used: schizophrenia, prenatal, viral infection, COVID-19, SARS-Cov-2.

Results

Several studies had shown a relationship between prenatal viral infections, such as Influenza, and development of schizophrenia in the offspring. It relates with viral neurotropism mechanisms and inflammatory processes in the fetal neurology system. Regarding SARS-Cov-2, it is early to assume a relation between prenatal COVID-19 and offspring schizophrenia development. However, literature describes psychiatric manifestations post COVID, such as psychotic and manic episodes. As such, a SARS-Cov-2 neurotropic effect is demonstrated.

Conclusions

Schizophrenia has a multifactorial etiology. Since prenatal viral infections may interfere and contribute to schizophrenia development, it is logical to assume prenatal SARS-Cov-2 infection may also contribute. It may be relevant to investigate whether these offspring will manifest schizophrenia symptoms.

Disclosure

No significant relationships.

How particle-particle and liquid-particle interactions govern the fate of evaporating liquid marbles

Liquid marbles refer to droplets that are covered with a layer of non-wetting particles. They are observed in nature and have practical significance. These squishy objects bounce, coalesce, break, inflate, and deflate while the liquid does not touch the substrate underneath. Despite the considerable cross-disciplinary interest and value of the research on liquid marbles, a unified framework for describing the mechanics of deflating liquid marbles-as the liquid evaporates-is unavailable. For instance, analytical approaches for modeling the evaporation of liquid marbles exploit empirical parameters that are not based on liquid-particle and particle-particle interactions. Here, we have combined complementary experiments and theory to fill this gap. To unentangle the contributions of particle size, roughness, friction, and chemical make-up, we investigated the evaporation of liquid marbles formed with particles of sizes varying over 7 nm-300 μm and chemical compositions ranging from hydrophilic to superhydrophobic. We demonstrate that the potential final states of evaporating liquid marbles are characterized by one of the following: (I) constant surface area, (II) particle ejection, or (III) multilayering. Based on these insights, we developed an evaporation model for liquid marbles that takes into account their time-dependent shape evolution. The model fits are in excellent agreement with our experimental results. Furthermore, this model and the general framework can provide mechanistic insights into extant literature on the evaporation of liquid marbles. Altogether, these findings advance our fundamental understanding of liquid marbles and should contribute to the rational development of technologies.

Cervical cancer screening information flow in Northern regional administrative service in Portugal

Management of a population-based screening program circuit depends on characteristics and technical barriers of its application and implementation. The aim is to clarify the information flow, to understand and build a vision of cervical screening information flows in Northern Regional Health Administration Portuguese Public System and to identify the constraints among them. A total of 5 cluster meetings were presented and two expert interviews were conducted allowing to present an informational flow and its constraints. Aims addressed in each interview where based on the expertise of the interviewed. Cervical cancer screening program depends on the use of SiiMA application. This is an information system for the management of population-based screening program which involves mainly 3 entities and allows a longitudinal data collection and study. Three main constraints were reported. The time for updating data for the list of eligible women was bigger than accorded reaching up to 3 months delay. A duplicate of records and discharges in hospital care since the discharge was done both in the hospital system and the SiiMA platform manually in order to the woman re-enter the screening program. Pendencies were seen due to other screening programs running in parallel which had to be sorted out manually in the regional level or by the entity involved. The existence of a screening application is vital for the implementation purposes of a screening program. The lack of integration of the systems increases bureaucratic work, costs and causes time delay. To improve the efficiency of digital transformation ensuring the quality of the process it is necessary to adapt the design of the health informatic systems to the daily practice and its wants and needs. The strategies of forcing an ever-increasing number of frameworks have demonstrated not to be so effective. Therefore, it is a cornerstone to understand these flows in order to improve its structure, intervention and optimization.

Key messages

The existence of a screening digital application is vital but its expanding use arises constraints. Due to the complexity of such programs, a digital strategy is crucial for management and monitoring of the screening at this scale.

Garden and food waste co-fermentation for biohydrogen and biomethane production in a two-step hyperthermophilic-mesophilic process

Co-fermentation of garden waste (GW) and food waste (FW) was assessed in a two-stage process coupling hyperthermophilic dark-fermentation and mesophilic anaerobic digestion (AD). In the first stage, biohydrogen production from individual substrates was tested at different volatile solids (VS) concentrations, using a pure culture of Caldicellulosiruptor saccharolyticus as inoculum. FW concentrations (in VS) above 2.9 g L^-1 caused a lag phase of 5 days on biohydrogen production. No lag phase was observed for GW concentrations up to 25.6 g L^-1. In the co-fermentation experiments, the highest hydrogen yield (46 ± 1 L kg^-1) was achieved for GW:FW 90:10% (w/w). In the second stage, a biomethane yield of 682 ± 14 L kg^-1 was obtained using the end-products of GW:FW 90:10% co-fermentation. The energy generation predictable from co-fermentation and AD of GW:FW 90:10% is 0.5 MJ kg^-1 and 24.4 MJ kg^-1, respectively, which represents an interesting alternative for valorisation of wastes produced locally in communities.

Cardioprotective effects of physical exercise on redox biology in mice exposed to hand-rolled cornhusk cigarette smoke

The present study sought to evaluate the effects of physical training on histological parameters and oxidative stress in the myocardium of mice chronically exposed to hand-rolled cornhusk cigarette (HRCC) smoke. Male Swiss mice (60 days old, 30-35 g) were either exposed to ambient air or passively exposed to the smoke of 12 cigarettes daily over 3 sessions (4 cigarettes per session) for 60 consecutive days with or without physical training for 8 weeks. Forty-eight hours after the last training session, the heart was surgically removed for histological analysis and measurement of oxidative stress parameters. Histological imaging revealed cell disruption, with poorly defined nuclei, in the mice exposed to HRCC smoke, but not in the control group. However, mice exposed to HRCC smoke with physical training displayed signs of tissue repair and improved tissue integrity. Biochemical analysis revealed decreased production of superoxide, 2',7'-dichlorofluorescein (DCF), and nitrite, as well as decreased protein carbonylation, in the physical training groups, likely due to the exercise-induced increase in glutathione peroxidase (GPX) activity and glutathione (GSH) content. Taken together, our results suggest that physical exercise exerts cardioprotective effects by modulating the redox responses in animals exposed to HRCC smoke.

Safety of AS03-adjuvanted split-virion H1N1 (2009) pandemic influenza vaccine: a prospective cohort study

OBJECTIVES

To assess the safety of an AS03-adjuvanted split virion H1N1 (2009) vaccine (Pandemrix) in persons vaccinated during the national pandemic influenza vaccination campaign in the UK.

DESIGN

Prospective, cohort, observational, postauthorisation safety study.

SETTING

87 general practices forming part of the Medical Research Council General Practice Research Framework and widely distributed throughout England.

PARTICIPANTS

A cohort of 9143 individuals aged 7 months to 97 years who received at least one dose of the AS03-adjuvanted H1N1 pandemic vaccine during the national pandemic influenza vaccination campaign in the UK was enrolled. 94% completed the 6-month follow-up. Exclusion criteria were previous vaccination with other H1N1 pandemic vaccine and any child in care.

PRIMARY AND SECONDARY OUTCOME MEASURES

Medically attended adverse events (MAEs) occurring within 31 days after any dose, serious adverse events (SAEs) and adverse events of special interest (AESIs) following vaccination were collected for all participants. Solicited adverse events (AEs) were assessed in a subset of participants.

RESULTS

MAEs were reported in 1219 participants and SAEs in 113 participants during the 31-day postvaccination period. The most frequently reported MAEs and SAEs were consistent with events expected to be reported during the winter season in this population: lower respiratory tract infections, asthma and pneumonia. The most commonly reported solicited AEs were irritability in young children aged <5 years (61.8%), muscle aches in children aged 5-17 years (61.9%) and adults (46.9%). 18 AESIs, experienced by 14 patients, met the criteria to be considered for the observed-to-expected analyses. AESIs above the expected number were neuritis (1 case within 31 days) and convulsions (8 cases within 181 days). There were 41 deaths during the 181-day period after vaccination, fewer than expected.

CONCLUSIONS

Results indicate that the AS03-adjuvanted H1N1 pandemic vaccine showed a clinically acceptable reactogenicity and safety profile in all age and risk groups studied.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT00996853.

Meta-analysis of pregnancy outcomes in pooled randomized trials on a prophylactic adjuvanted glycoprotein D subunit herpes simplex virus vaccine

The primary objective of this investigation was to assess whether the AS04-adjuvanted herpes simplex virus (HSV) glycoprotein D candidate prophylactic vaccine against genital herpes disease increases the risk of spontaneous abortion associated with pregnancy conceived within the vaccination exposure window (vaccine dose received within the period starting 60 days before and ending 20 weeks post-conception day). We performed a meta-analysis of studies designed as part of the clinical development program for this vaccine, to examine the relative risk of abortion (spontaneous or elective) associated with unintended vaccination exposure during pregnancy. Nineteen studies, completed before September 2010, were eligible; 5 matched the inclusion criteria for this analysis (presence of a control arm and at least one adverse pregnancy outcome reported). All vaccinated women (N=19,727) were included, of whom 660 reported a pregnancy during the study period. Overall, 13.3% of pregnancies in the HSV vaccine group and 11.0% in the control group resulted in spontaneous abortion; 24.2% and 20.0% resulted in elective abortion. Among 180 women with a first pregnancy conceived in the vaccination exposure window, 16.7% (HSV vaccine) and 9.5% (control) had a spontaneous abortion and 38.5% and 33.3%, elective abortion. The relative risk for spontaneous abortion associated with vaccine exposure during the risk period for abortion in the course of pregnancy was 1.7 (95% CI: 0.7-4.6). For all women receiving HSV vaccine, this relative risk was 1.3 (95% CI: 0.8-2.1). The corresponding relative risks for elective abortion were 1.2 (95% CI: 0.7-2.0) and 1.3 (95% CI: 0.9-1.8). There was no apparent relationship to dosing and no difference between groups in gestational age at the time of spontaneous or elective abortion. In conclusion there is no statistical evidence that the investigational HSV vaccine increased the risk of spontaneous or elective abortion.

Safety of AS03-adjuvanted split-virion H1N1 (2009) pandemic influenza vaccine: a prospective cohort study

OBJECTIVES

To assess the safety of an AS03-adjuvanted split virion H1N1 (2009) vaccine (Pandemrix) in persons vaccinated during the national pandemic influenza vaccination campaign in the UK.

DESIGN

Prospective, cohort, observational, postauthorisation safety study.

SETTING

87 general practices forming part of the Medical Research Council General Practice Research Framework and widely distributed throughout England.

PARTICIPANTS

A cohort of 9143 individuals aged 7 months to 97 years who received at least one dose of the AS03-adjuvanted H1N1 pandemic vaccine during the national pandemic influenza vaccination campaign in the UK was enrolled. 94% completed the 6-month follow-up. Exclusion criteria were previous vaccination with other H1N1 pandemic vaccine and any child in care.

PRIMARY AND SECONDARY OUTCOME MEASURES

Medically attended adverse events (MAEs) occurring within 31 days after any dose, serious adverse events (SAEs) and adverse events of special interest (AESIs) following vaccination were collected for all participants. Solicited adverse events (AEs) were assessed in a subset of participants.

RESULTS

MAEs were reported in 1219 participants and SAEs in 113 participants during the 31-day postvaccination period. The most frequently reported MAEs and SAEs were consistent with events expected to be reported during the winter season in this population: lower respiratory tract infections, asthma and pneumonia. The most commonly reported solicited AEs were irritability in young children aged <5 years (61.8%), muscle aches in children aged 5-17 years (61.9%) and adults (46.9%). 18 AESIs, experienced by 14 patients, met the criteria to be considered for the observed-to-expected analyses. AESIs above the expected number were neuritis (1 case within 31 days) and convulsions (8 cases within 181 days). There were 41 deaths during the 181-day period after vaccination, fewer than expected.

CONCLUSIONS

Results indicate that the AS03-adjuvanted H1N1 pandemic vaccine showed a clinically acceptable reactogenicity and safety profile in all age and risk groups studied.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT00996853.

Pregnancy and safety outcomes in women vaccinated with an AS03-adjuvanted split virion H1N1 (2009) pandemic influenza vaccine during pregnancy: a prospective cohort study

Infection with influenza virus during pregnancy poses a significant risk of complications for both mother and fetus. During the H1N1 2009 pandemic, pregnant women constituted one of the priority groups for vaccination in many countries, creating a need for close monitoring of the safety of the vaccine in pregnant women. We present findings from an analysis of a cohort of pregnant women (N=267) from a prospective, observational, post-authorization safety study of the AS03-adjuvanted split virion H1N1 (2009) pandemic vaccine. There were 265 known pregnancy outcomes with 261 live births, four spontaneous abortions with no congenital anomalies, and no stillbirths. There were six live births with congenital anomalies, of which one was diagnosed before vaccination. A total of 247 women (94.6%), of whom four had twin pregnancies, delivered at term, and 14 women (5.4%), of whom two had twin pregnancies, delivered preterm (between Weeks 24 and 36 of gestation), with three of them (1.1%) occurring before 32 weeks (very preterm). Twenty-one neonates (8.1%) had a low birth weight (<2.5 kg), of whom nine (3.5%) were term neonates. The prevalence of all outcomes was in line with the expected rates. The adverse events reported were consistent with the events anticipated to be reported by this study population. No adverse events of special interest were reported. The results of this analysis suggest that exposure to the AS03 adjuvanted H1N1 (2009) vaccine during pregnancy does not increase the risk of adverse pregnancy outcomes including spontaneous abortion, congenital anomalies, preterm delivery, low birth weight neonates, or maternal complications. Although limited in size, the fully prospective nature of the safety follow-up of these women vaccinated during pregnancy is unique and offers an important degree of reassurance for the use of the AS03 adjuvanted H1N1 (2009) vaccine in this high risk group for H1N1 infection.

Automatic analysis of macroarrays images

The analysis of dot blot (macroarray) images is currently based on the human identification of positive/negative dots, which is a subjective and time consuming process. This paper presents a system for the automatic analysis of dot blot images, using a pre-defined grid of markers, including a number of ON and OFF controls. The geometric deformations of the input image are corrected, and the individual markers detected, both tasks fully automatically. Based on a previous training stage, the probability for each marker to be ON is established. This information is provided together with quality parameters for training, noise and classification, allowing for a fully automatic evaluation of a dot blot image.

Automatic detection of molecular markers in digital images

Labeled molecular markers are an important tool in molecular biology. This work presents a method for the automatic identification of molecular markers in dot blot images. The method detects the location of markers in the image and their size. An experiment was made with 6 test images, which were used to produce an additional set of 222 images with various rotation, translation, contrast and noise levels. Over 7500 markers were identified automatically and compared with reference values obtained manually. The RMS error for the marker positioning in the original test images were between 1.1 and 3.8 pixels, which is about 1/10 of the typical radius (26 pixels). The method proposed was found to be almost insensitive to grid rotation and translation, and reasonably robust to image contrast changes and presence of noise.

A novel approach for the identification of bacterial taxa-specific molecular markers

AIMS

To develop and establish a methodology for an oriented and fast identification of species taxa-specific molecular markers useful for the identification of micro-organisms.

METHODS AND RESULTS

From the complete microbial genomes available in Pfam database, taxa-specific protein domains were identified which lead to the selection of taxa-specific loci. This strategy was used to identify six genetic markers: four specific for Pseudomonas syringae pv. tomato, one specific for P. syringae pv. syringae and one specific for P. putida. The discriminatory potential of these loci was evaluated by Southern hybridization using several pseudomonad species and pathovars, by dot-blot hybridization and by multiplex PCR optimized for the simultaneous detection of P. putida, P. syringae pv. syringae and P. syringae pv. tomato. Sensitivity assays indicated a detection limit of approximately 10 pg of chromosomal DNA template needed for each bacterium.

CONCLUSIONS

The proposed methodology was efficient on the selection of six Pseudomonas-specific markers able to discriminate Pseudomonas at the species and pathovar level.

SIGNIFICANCE AND IMPACT OF THE STUDY

The oriented search of taxa-specific molecular probes described in this work, which can be easily extended to other groups of bacteria, will improve the accuracy and expedite the identification of micro-organisms by DNA-based molecular methods.

Involvement of central airways in vibroacoustic disease patients

INTRODUCTION

Vibroacoustic disease (VAD) is the whole-body pathology caused by excessive exposure to LFN. For the past 25 years, it has been know that low frequency noise (LFN, < 500 Hz, including infrasound) targets the respiratory system. In LFN-exposed rodents, the morphological changes of respiratory tract tissue partially explained some respiratory symptoms reported by VAD patients. However, many questions remain unanswered. Recently, some volunteer VAD patients underwent bronchoscopy in order to ascertain possible damage that could be associated with their respiratory complaints.

METHODS

Fourteen fully-informed and volunteer VAD patients were submitted to bronchoscopy, and biopsies were removed for analysis.

RESULTS

All patients exhibited small submucosal vascular-like lesions near the spurs, consisting of increased collagen and elastin fibres. Histology disclosed cilliary abnormalities, basal membrane hyperplasia, and thickening of vessel walls. In five patients, collagen bundles appeared degenerative and disrupted. No inflammatory process was ever identified, and no differences were seen between smokers and non-smokers.

DISCUSSION

Data is in accordance with what was observed in LFN-exposed animal models and also in 8 VAD patients who developed lung tumours. Collagen disruption and degeneration was also observed in electron microscopy images of the respiratory tract of LFN-exposed rodents. Thickened blood and lymphatic vessel walls have been consistently seen in images of VAD patients and of LFN-exposed rodents. During bronchoscopy performed by other reasons, this sort of structural aspects is not frequently seen. Taken together, it is strongly suggested that these findings could be VAD-specific.

DNase-resistant DNA in the extracellular and cell wall-associated fractions of Frankia strains R43 and CcI3

DNases were shown to be present in the extracellular fraction of Frankia strains R43 and CcI3. In spite of this, DNA was found in both the extracellular and cell wall fractions of these strains, and it was shown that extracellular DNA was resistant to the DNases secreted into the culture medium of both Frankia strains. Furthermore, Southern blot analysis under high stringency conditions revealed the chromosomal origin of the cell wall-adsorbed DNA (CW-DNA). Mobility gel band shift assays suggested that the extracellular DNA and the CW-DNA are engaged in complexes with other molecules, most likely proteins, which are probably responsible for the enzymatic resistance observed against extracellular DNase activities. In addition, it was shown that lysis of a small proportion of the cells in the exponential growth phase may account for the DNA being released into the supernatant and adsorbed to the cell wall.

Osteoporotic fractures of proximal femur: clinical and epidemiological features in a population of the city of São Paulo

CONTEXT

It is believed that about 25% of menopausal women in the USA will exhibit some kind of fracture as a consequence of osteoporosis. Fractures of the proximal femur are associated with a greater number of deaths and disabilities and higher medical expenses than all the other osteoporotic fractures together.

OBJECTIVE

To study the clinical and epidemiological features of patients with proximal femur fracture in hospitals in São Paulo.

DESIGN

Transversal and retrospective study. LOCAL: Hospital São Paulo and Hospital Servidor Público Estadual "Francisco Morato Oliveira".

PARTICIPANTS

Patients aged sixty-five years or more hospitalized because of proximal femur fracture, from March to November 1996 (N = 73). This group was compared to patients of the same age without fracture of the proximal femur.

INTERVENTION

Evaluation of weight, height, body mass index; lifestyle habits (physical activity at home, ingestion of dairy calcium, drinking of coffee, smoking habit), gynecological history (ages at menarche and menopause, number of pregnancies and lactations), previous morbidity, use of medications, history of previous fractures, family history of osteoporosis.

MEASUREMENT

The comparison of the different data regarding lifestyle habits between the two groups was made using the chi-squared test. Other data were analyzed using the Mann--Whitney test. P pound 0.05 was considered significant.

RESULTS

We noted a predominance of proximal femur fracture among females in relation to males (a female/male ratio of 3.3:1) with a progressive increase in the frequency of proximal femur fracture with age in both sexes. The group with proximal femur fracture, in comparison with the control group, showed a lower body mass index, less physical activity, and a greater number of pregnancies and lactations. Other data were not different.

CONCLUSION

In accordance with the literature, we found a predomination of proximal femur fracture in women in relation to men, and a favorable effect of higher body mass index and physical activity for decreasing the frequency of proximal femur fracture. We also discuss the role of pregnancies and lactation on the frequency of proximal femur fracture.

A simple, rapid and non-destructive procedure to extract cell wall-associated proteins from Frankia

A simple cell fractionation procedure was developed to extract cell wall-associated proteins from the nitrogen-fixing actinomycete Frankia. The method was based on washing Frankia mycelia in 62.5 mM Tris-HCl (pH 6.8) buffer supplemented with 0.1% Triton X-100 as solubilizing agent. Cell wall-associated proteins were efficiently extracted in less than 10 min, recovering approximately 94.5+/-7.44 microg protein per extraction procedure from exponentially growing cells corresponding to 50 ml of culture. The amount of cell lysis occurring during the cell wall extraction was estimated to be 1.50+/-0.51%. Three peptidoglycan hydrolases with apparent molecular masses of 4.7, 12.1, and 17.8 kDa were detected by zymography in the cell wall-associated protein fraction. On the contrary, no cell wall lytic enzyme was detected in the cytoplasmic protein fraction. These results indicate that the present method enables a specific extraction of cell wall-associated proteins. Moreover, fluorescein isothiocyanate (FITC) labelling of the cell surface proteins showed an efficient removal of cell wall-associated proteins. Growth of the treated Frankia cells (i.e. cells from which the cell wall-associated proteins were removed) in semi-solid media suggested that these cells were still viable. This technique is of importance for functionality studies of cell wall-associated proteins, particularly for bacteria where traditional cell fractionation methods are difficult to be applied.

The human pericardium in vibroacoustic disease

INTRODUCTION

One of the main features of vibroacoustic disease (VAD) is the proliferation of the extra-cellular matrix which induces cardiovascular morphological and dynamic changes, and has been evaluated through echo-Doppler. While all subjects exposed to large pressure amplitude (> or =90 dB SPL) and low frequency (< or =500 Hz) (LPALF) for at least 15 yr have thickening of some cardiac structure, most frequently the pericardium, no significant diastolic changes accompany these observations. Echocardiography has become the diagnostic method of choice for the VAD. However, there have been no studies relating the echo-images of pericardial thickening to gross anatomy.

METHODS

We present the histology and ultrastructure of the pericardia of four patients who underwent cardiac surgery.

RESULTS

The most important findings concern the real thickening of the pericardium (values: 1.11, 1.35, 2.19, and 2.33 mm vs. norm: < or = 0.5 mm), the dynamic arrangements of mesothelial cells in the serosa layer, and the plasticity of the cells found among the multifascicular waveform collagen fibers. We found that the fibrosa of VAD patients has three layers: sandwiched between two thickened layers of normal fibrosa there is a loose tissue layer with vascular, nervous, and adipose structures.

CONCLUSION

These features may partially explain why no important diastolic changes are observed in VAD patients in spite of the pericardium thickening.

[A seroconversion study of the measles component of the MMR vaccine in adolescents of the town of Sabrosa]

The Portuguese national programme of vaccination has instituted a two-dose MMR vaccine schedule. The second dose of MMR (measles-mumps-rubella combined vaccine) is given at 11-13 years of age, for both sexes. This study was conducted to evaluate the duration of immunity of the monovalent measles vaccine, and the efficacy of a second dose given as MMR. MMR (Triviraten Berna with the strain Edmonston-Zagreb) was given to the 38 participants. Blood samples were collected before and after vaccination. Thirty-six participants had been vaccinated with measles monovalent vaccine during childhood. To measure anti-measles IgG (mIgG), an enzyme immunoassay was used. Participants were classified as "susceptible" or "immune", using 200 mIU/ml (milli international units per millilitre) as the threshold for "immune". Geometric mean concentration (GMC) of mIgG was 1401 mIU/ml in prevaccination sera (n = 38). Thirty-five (92%) of the adolescents were "immune". Only the two unvaccinated had a positive measles history. GMC in the sera of the 36 vaccinated participants was 1301 mIU/ml. Neither the time since measles vaccination nor age at vaccination were correlated with the levels of mIgG. After receiving MMR, all adolescents became "immune". GMC of mIgG was 2879 mIU/ml in postvaccination sera (n = 38). In 28 (74%) participants, mIgG levels increased after receiving MMR. Mean concentration increase was 1082 mIU/ml. For measles, results support the use of a two-dose MMR vaccine schedule in Portugal.

[The diagnostic and prognostic value of the 12-lead electrocardiogram in assessing the severity of coronary disease in the acute phase of an acute myocardial infarct]

The conventional twelve-lead electrocardiogram (ECG) still is the cheapest, most used and absolutely essential diagnostic method for the acute phase of myocardial infarction (MI) allowing risk stratification and coronary prognostic evaluation in this phase mainly by the localization of the ST segment depression and/or T wave inversion (ST/T changes) not related to the infarct area in Q-Wave MI or at any localization in case of non-Q wave MI. The etiology and pathophysiology of these ST/T changes in the setting of MI has been controversial. With the objective of determining ECG prognostic and diagnostic value, 70 patients (Pts) (59 men and 11 women, mean age 58 + 13) admitted in the acute phase of MI were studied with revision of acute phase ECG ST/T changes. All patients underwent coronary angiography and ventriculography at the moment of hospital discharge. Patients were divided into two classifications: A) MI localization: A1--Q-wave MI (anterior--20 pts, inferior--29 pts, lateral--1 pt); A2--non-Q wave--20 pts. B) Evidence of ST/T changes outside the infarct area in Q wave MI or at any localization in non-Q wave MI (group B1--with ST/T changes, group B2--without ST/T changes). We correlated the angiographically documented coronary artery disease in groups with ST/T changes and their localization.

RESULTS

A1) Anterior MI group: in the 6 pts (30%) with "opposite" (inferior) ST/T changes, right coronary artery (RCA) disease was documented in 5 and in the other 14 patients the RCA did not show significant lesions. Inferior MI group: in the 24 Pts (83%) with "opposite" (precordial) ST/T changes. 23 of them had angiographic correlation (left anterior descending (LAD) and/or circumflex (CX) artery disease). Lateral MI group: one Pt with anterior wall ST/T changes and LAD and CX disease. A2) Non-Q wave group: in 13 pts (87%) the diseased vessels were correlated with the site of ST/T changes. B1) Q-Wave AMI: left main and 3-vessel disease in 2 pts, 3-vessel disease in 17 pts, 2-vessel disease in 9 pts, 1-vessel disease in 2 pts and non-significant disease in one pt. Non-Q wave MI: left main and 3-vessel disease in 1 pt, 3-vessel disease in 7 patients, 2-vessel disease in 3 pts and 1-vessel disease in 4 pts. B2) non-Q Wave MI: 3-vessel disease in 5 pts, 2-vessel disease in 7 pts, 1-vessel disease in 6 pts and non-significant disease in 1 pt. Non-Q wave MI: 2-vessel disease in 2 pts and non-significant disease in 1 pt.

IN CONCLUSION

When pts were divided according to MI localization, a correlation was found between the ST/T changes outside the infarct area with CAD in 91% of Pts in the Q-Wave infarction group, with more significance in inferior and lateral MI. In the non-Q wave group, we found correlation between the a coronary lesions and the localization of ST/T changes in 87% of the pts. The pt group with ST/T changes presented, when compared with the pt group without these changes, evidence of more severe coronary artery disease (CAD): 3 vessels or left main with 3 vessel disease. However, only in the Q-Wave infarction group was a statistically significant difference found between the group with ST/T changes compared to the group without these changes, concerning to the existence of more severe coronary disease.

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF) are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD) is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR) and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 +/- 7.2 years) hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 +/- 5.2 years) without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 +/- 6.6 years (mean +/- SD). Analysis of VDR gene polymorphism by restriction fragment length polymorphism (RFLP) was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5% BB, 42.5% Bb and 37% bb and did not differ significantly from the values obtained for group II (16% BB, 36% Bb and 48% bb) or for group III (10.2% BB, 47.6% Bb and 41.8% bb). No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurrence of osteoporotic fractures with advancing age.

DNase Activities of the Extracellular, Cell Wall-Associated, and Cytoplasmic Protein Fractions of Frankia Strain R43

DNase activities in different protein fractions of Frankia strain R43 were studied. The extracellular and the cell wall-associated fractions revealed the presence of exo- and endonucleolytic enzymes, but none was detected in the cytoplasmic fraction. The strongest DNase hydrolysis was found in the extracellular fraction, in which six DNases were detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

[Cor pulmonale caused by neoplasm cell embolism]

The authors describe a case of Cor Pulmonale due to Tumor Cell Embolization in a 42-year-old woman with no history of antecedent malignant disease. The primary tumor was a Choriocarcinoma which could not be found in postmortem examination. The pathophysiology, clinical manifestations and diagnostic evaluation of this entity are briefly discussed.

[Phlebectasis of the external jugular vein]

Phlebactasia of the external jugular vein is a rare nosological entity. Few reports appeared in the world literature. Clinically it presents as a cervical mass enlarging with a Valsalva maneuver. The Authors present one clinical case, emphasizing the possibilities of Computed Tomography (CT) in a precise diagnosis, etiological and topographical, without using other invasive modalities.