Inflammatory gene expression in adipose tissue according to diagnosis of anxiety and mood disorders in obese and non-obese subjects

Psychiatric disorders have been widely reported to be associated with systemic inflammation upregulation and adiposity. However, there are no data that link adipose tissue inflammation to these mental disorders. The analysis of adipokines and inflammation-related markers in adipose tissue could help to elucidate the potential association between obesity and mental health. An observational study was conducted in samples of patients consisting of non-obese and obese subjects, who were diagnosed with anxiety or mood disorders. Gene expression of adiponectin (ADIPOQ), leptin (LEP) and inflammatory markers (IL6, IL1B, TNF, CCL2, CSF3, ITGAM, and PLAUR) were determined in visceral (VAT) and subcutaneous (SAT) adipose tissues. Our results showed that the gene expression of adipokines and inflammation-related markers was higher in the VAT and SAT of obese subjects compared with non-obese subjects. Regarding mental disorders, all the inflammatory genes in the VAT were significantly higher in non-obese subjects with anxiety or mood disorders than in subjects without mental disorders, except for TNF and ITGAM. Additionally, IL6 expression was significantly lower in SAT. In contrast, obese patients diagnosed with anxiety or mood disorders only showed significantly lower expression levels of IL1B in VAT and ADIPOQ in SAT when compared with obese subjects without mental disorders. These data suggest the potential involvement of VAT inflammation in anxiety and mood disorders, involving complex mechanisms which are strongly affected by obesity.

Age-specific excess mortality patterns and transmissibility during the 1889-1890 influenza pandemic in Madrid, Spain

PURPOSE

Although the 1889-1890 influenza pandemic was one of the most important epidemic events of the 19th century, little is known about the mortality impact of this pandemic based on detailed respiratory mortality data sets.

METHODS

We estimated excess mortality rates for the 1889-1890 pandemic in Madrid from high-resolution respiratory and all-cause individual-level mortality data retrieved from the Gazeta de Madrid, the Official Bulletin of the Spanish government. We also generated estimates of the reproduction number from the early growth phase of the pandemic.

RESULTS

The main pandemic wave in Madrid was evident from respiratory and all-cause mortality rates during the winter of 1889-1890. Our estimates of excess mortality for this pandemic were 58.3 per 10,000 for all-cause mortality and 44.5 per 10,000 for respiratory mortality. Age-specific excess mortality rates displayed a J-shape pattern, with school children aged 5-14 years experiencing the lowest respiratory excess death rates (8.8 excess respiratory deaths per 10,000), whereas older populations aged greater than or equal to 70 years had the highest rates (367.9 per 10,000). Although seniors experienced the highest absolute excess death rates, the standardized mortality ratio was highest among young adults aged 15-24 years. The early growth phase of the pandemic displayed dynamics consistent with an exponentially growing transmission process. Using the generalized-growth method, we estimated the reproduction number in the range of 1.2-1.3 assuming a 3-day mean generation interval and of 1.3-1.5 assuming a 4-day mean generation interval.

CONCLUSIONS

Our study adds to our understanding of the mortality impact and transmissibility of the 1889-1890 influenza pandemic using detailed individual-level mortality data sets. More quantitative studies are needed to quantify the variability of the mortality impact of this understudied pandemic at regional and global scales.

Emotional processing in obsessive-compulsive disorder

The aim of the present study was to investigate whether there are differences in emotional processing among people with obsessive-compulsive disorder, using Lang's dimensional model of emotions. A total of 22 individuals with obsessive-compulsive disorder participated in the study and were compared to a control group (n=25). All participants assessed a set of photographs with emotional content (pleasant, neutral, unpleasant, and with obsessive-compulsive content) using the Self-Assessment Manikin pictorial scales for rating emotional valence (pleasant/unpleasant), arousal (calm/aroused) and dominance (controlling/controlled). The results show significant differences in the processing of emotional images among individuals with obsessive-compulsive disorder and the high predictive value of dominance for diagnosis.

[Factor structure and reliability of the Spanish adaptation of the Children's Yale-Brown Obsessive-Compulsive Scale--Self Report (CY-BOCS-SR)]

The aim of this study was the adaptation to Spanish of the «Children's Yale-Brown Obsessive-Compulsive Scale--Self Report» (CY-BOCS-SR), one of the most frequently utilized scales in the assessment of obsessive-compulsive behaviors. After its translation to Spanish, its factor invariance in boys and girls, reliability, and relationship with the children's age were examined. Lastly, normative data for this Spanish version are presented. The sample comprised 1,706 children and adolescents from the general population. Results show that the factor composition of the CY-BOCS-SR does not present a very good fit to the usual scoring of three scales were observed: Obsession Severity, Compulsion Severity, and total score. Results also show that the factor validity and reliability of the CY-BOCS-SR improve remarkably if items related to Resistance to Obsessions and Compulsions are considered a different factor from Severity. It is concluded that the Spanish version of the CY-BOCS-SR has similar psychometric characteristics as the original English version.

[Bacterial meningitis in emergency medicine. Factors associated with delay of antimicrobial therapy]

BACKGROUND

Bacterial meningitis is a severe infection. Outcome might be improved if diagnosis and therapy are achieved promptly. We studied the time elapsed until antimicrobial therapy and analyzed factors associated to delay.

METHODS

We performed a retrospective study of bacterial meningitis diagnosed in a hospital emergency medicine department in two consecutive years. Dependent variable was time since admission to antimicrobial therapy; delay was defined as time to administration longer than 2 h. The relationship between clinical variables and delay was studied with bivariate analysis. Significative variables were included in a multivariate analysis using multiple logistic regression.

RESULTS

We studied 40 cases of bacterial meningitis (67.5% female, mean age 25.2 years). The mean time to antibiotic therapy was 127 min; in 16 patients (40%; 95% confidence interval: 25-56%) delay was 2 h or more. In bivariate analysis differences were observed for age (15.5 +/- 24.2 vs 39.7 +/- 28.7 years; p < 0.01), temperature (38.7 +/- 1 vs 38 +/- 1.1 degrees C; p < 0.05), mean blood pressure (77 +/- 14 vs 91 +/- 20 mmHg; p < 0.05), headache (29% vs 75%; p < 0.01), meningeal signs (63% vs 19%; p < 0.01), skin lesions (60% vs 13%; p < 0.01), "sick" presentation (67% vs 19%; p < 0.01), performance of CT scan (8% vs 38%; p < 0.05) and appropriateness of management (96% vs 44%; p < 0.001). In multivariate analysis only absence of skin lesions and inappropriate management remained significative. Mortality was higher when there was a delay of more than 2 h in antimicrobial therapy (25% vs 0%; p < 0.05).

CONCLUSIONS

Factors associated with delay of antimicrobial therapy were the absence of skin lesions and inappropriate management.

[Pleural effusion associated with primary lymphedema: a rare combination. Apropos of a case]

A case of exclusive association of pleural effusions and primary lymphedema, without ungual dystrophy is described. This isolated combination is an uncommon clinical condition with only 11 cases reported in the literature. The pathogenesis is characterized by aplasia-hypoplasia of the lymphatic vessels with consequent defective lymphatic drainage. We present a pleural effusion associated with a left lower extremity cellulitis, we argue about the differential diagnosis and treat the patient with thoracocentesis and aspiration with a favourable evolution without recidive.