Phenomenology of Somatization in Immigrants: An Idealtypical Approach.

INTRODUCTION: Somatization in immigrants is frequent but standard studies do not differentiate between various forms of somatization. In this qualitative study, we used an idealtypical approach with the aim of phenomenologically differentiating between different forms of somatization in immigrants. METHODS: The clinical description of the ideal types was based on seven levels: medical examination; description of somatization symptoms; the patients' own interpretation of their somatic experience; concomitant psychopathological phenomena; genetic understanding; clinician's interpretation; and course and treatment. RESULTS: Five different ideal typologies of patients emerged: anxious hypochondriasis, somatization with cultural features playing a pathogenetic role, culturally shaped somatization (through pathoplastic effects), somatization as part of adjustment reactions due to migratory living difficulties, and somatization as post-traumatic reaction. CONCLUSION: These differences are useful to highlight the complex interrelationship between socioeconomic, migratory, cultural, and value factors in the construction of somatization among immigrants. Implications for research methodology, nosology, clinical management, and organization of medical facilities are also discussed.

Effects of Chronic Hypertension on the Energy Metabolism of Cerebral Cortex Mitochondria in Normotensive and in Spontaneously Hypertensive Rats During Aging.

In this study the subcellular modifications undergone by cerebral cortex mitochondrial metabolism in chronic hypertension during aging were evaluated. The catalytic properties of regulatory energy-linked enzymes of Tricarboxylic Acid Cycle (TCA), Electron Transport Chain (ETC) and glutamate metabolism were assayed on non-synaptic mitochondria (FM, located in post-synaptic compartment) and on intra-synaptic mitochondria of pre-synaptic compartment, furtherly divided in "light" (LM) and "heavy" (HM) mitochondria, purified form cerebral cortex of normotensive Wistar Kyoto Rats (WKY) versus Spontaneously Hypertensive Rats (SHR) at 6, 12 and 18 months. During physiological aging, the metabolic machinery was differently expressed in pre- and post-synaptic compartments: LM and above all HM were more affected by aging, displaying lower ETC activities. In SHR at 6 months, FM and LM showed an uncoupling between TCA and ETC, likely as initial adaptive response to hypertension. During pathological aging, HM were particularly affected at 12 months in SHR, as if the adaptive modifications in FM and LM at 6 months granted a mitochondrial functional balance, while at 18 months all the neuronal mitochondria displayed decreased metabolic fluxes versus WKY. This study describes the effects of chronic hypertension on cerebral mitochondrial energy metabolism during aging through functional proteomics of enzymes at subcellular levels, i.e. in neuronal soma and synapses. In addition, this represents the starting point to envisage an experimental physiopathological model which could be useful also for pharmacological studies, to assess drug actions during the development of age-related pathologies that could coexist and/or are provoked by chronic hypertension.

In vitro pharmacological characterization of growth hormone secretagogue receptor ligands using the dynamic mass redistribution and calcium mobilization assays.

Ghrelin modulates several biological functions via selective activation of the growth hormone secretagogue receptor (GHSR). GHSR agonists may be useful for the treatment of anorexia and cachexia, while antagonists and inverse agonists may represent new drugs for the treatment of metabolic and substance use disorders. Thus, the identification and pharmacodynamic characterization of new GHSR ligands is of high interest. In the present work the label-free dynamic mass redistribution (DMR) assay has been used to evaluate the pharmacological activity of a panel of GHSR ligands. This includes the endogenous peptides ghrelin, desacyl-ghrelin and LEAP2(1-14). Among synthetic compounds, the agonists anamorelin and HM01, the antagonists HM04 and YIL-781, and the inverse agonist PF-05190457 have been tested, together with HM03, R011, and H1498 from patent literature. The DMR results have been compared to those obtained in parallel experiments with the calcium mobilization assay. Ghrelin, anamorelin, HM01, and HM03 behaved as potent full GHSR agonists. YIL-781 behaved as a partial GHSR agonist and R011 as antagonist in both the assays. LEAP2(1-14) resulted a GHSR inverse agonist in DMR but not in calcium mobilization assay. PF-05190457, HM04, and H1498 behaved as GHSR inverse agonists in DMR experiments, while they acted as antagonists in calcium mobilization studies. In conclusion, this study provided a systematic pharmacodynamic characterization of several GHSR ligands in two different pharmacological assays. It demonstrated that the DMR assay can be successfully used particularly to discriminate between antagonists and inverse agonists. This study may be useful for the selection of the most appropriate compounds to be used in future studies.

Atypical Ductal Hyperplasia and Lobular In Situ Neoplasm: High-Risk Lesions Challenging Breast Cancer Prevention.

This retrospective study investigates the histopathological outcomes, upgrade rates, and disease-free survival (DFS) of high-risk breast lesions, including atypical ductal hyperplasia (ADH or DIN1b) and lobular in situ neoplasms (LIN), following Vacuum-Assisted Breast Biopsy (VABB) and surgical excision. The study addresses the challenge posed by these lesions due to their association with synchronous or adjacent Breast Cancer (BC) and increased future BC risk. The research, comprising 320 patients who underwent stereotactic VABB, focuses on 246 individuals with a diagnosis of ADH (120) or LIN (126) observed at follow-up. Pathological assessments, categorized by the UK B-coding system, were conducted, and biopsy samples were compared with corresponding excision specimens to determine upgrade rates for in situ or invasive carcinoma. Surgical excision was consistently performed for diagnosed ADH or LIN. Finally, patient follow-ups were assessed and compared between LIN and ADH groups to identify recurrence signs, defined as histologically confirmed breast lesions on either the same or opposite side. The results reveal that 176 (71.5%) patients showed no upgrade post-surgery, with ADH exhibiting a higher upgrade rate to in situ pathology than LIN1 (Atypical Lobular Hyperplasia, ALH)/LIN2 (Low-Grade Lobular in situ Carcinoma, LCIS) (38% vs. 20%, respectively, p-value = 0.002). Considering only patients without upgrade, DFS at 10 years was 77%, 64%, and 72% for ADH, LIN1, and LIN2 patients, respectively (p-value = 0.92). The study underscores the importance of a multidisciplinary approach, recognizing the evolving role of VABB. It emphasizes the need for careful follow-up, particularly for lobular lesions, offering valuable insights for clinicians navigating the complex landscape of high-risk breast lesions. The findings advocate for heightened awareness and vigilance in managing these lesions, contributing to the ongoing refinement of clinical strategies in BC care.

The role of stroke-induced immunosuppression as a predictor of functional outcome in the neurorehabilitation setting.

Stroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: - 2.1 ± 2.3 vs. IC: - 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.

Síndrome hemolítico urémico secundario a Streptococcus pneumoniae. Reporte de un caso clínico / Streptococcus pneumoniae associated hemolytic uremic syndrome. Case report

El síndrome hemolítico urémico secundario a Streptococcus pneumoniae (SHU-Sp) es una complicación poco frecuente de las enfermedades invasoras por S. pneumoniae. Presenta una alta morbimortalidad, con requerimiento de transfusiones de glóbulos rojos y plaquetas, terapia de sustitución de la función renal de inicio precoz y más prolongada, así como mayores complicaciones a largo plazo, comparado con las formas secundarias a infección entérica por Escherichia coli productora de toxina Shiga. Presentamos el caso clínico de una preescolar de dos años, previamente sana, vacunada con tres dosis de PCV13, que desarrolló una insuficiencia renal aguda, anemia hemolítica y plaquetopenia, en el contexto de una neumonía con empiema y bacteriemia por S. pneumoniae.

Streptococcus pneumoniae associated hemolytic uremic syndrome (Sp-HUS) is an uncommon complication of invasive pneumococcal infections. Patients with Sp-HUS have a higher mortality and long term morbidity than those due to HUS from Shiga toxin-producing Escherichia coli infections (STEC-HUS). They often require more red blood cells and platelet transfusions, and early initiation of renal substitution therapy, presenting a higher rate of arterial hypertension and chronic renal disease in the long term, compared to STEC-HUS. We report a healthy 2 year-old infant, vaccinated with three doses PCV13, that developed acute renal failure, hemolytic anemia and thrombocytopenia in the course of a complicated pneumococcal pneumonia with empyema and bacteremia.

Síndrome multisistémico post COVID-19 y dificultad en su diagnóstico etiológico: a propósito de un caso clínico / Multisystem post COVID-19 syndrome and its difficult etiological diagnosis: a clinical case / Síndrome multissistêmica pós COVID-19 e a dificuldade no seu diagnóstico etiologico: relato de caso clínico

El SARS-CoV-2 afecta a un reducido número de pacientes pediátricos, que en su mayoría son asintomáticos o presentan compromiso respiratorio leve y evolución favorable. Sin embargo, en niños previamente sanos puede aparecer el síndrome inflamatorio multisistémico (SIM-C) o similar a Kawasaki (Kawasaki-like) asociado a la enfermedad por COVID-19, que evolucionan al shock y requiere internación en la unidad de cuidados intensivo. Presentamos el caso de un adolescente con antecedentes ambientales de SARS-CoV-2 37 días antes de su ingreso, que no se testeó en ese momento. Recibe la primera dosis de vacuna Pfizer 15 días antes de la presentación de un cuadro de sintomatología digestiva con dolor abdominal y fiebre, con test de antígenos COVID-19 y PCR viral negativos. Luego de una laparoscopia exploratoria, al sexto día de fiebre y dolor instaló conjuntivitis bilateral no supurada y exantema en tórax, odinofagia, astenia y lengua saburral con fenotipo Kawasaki. La serológica IgG anti spike fue positiva y la IgM negativa, con parámetros inflamatorios elevados, por lo que se planteó un síndrome multisistémico post COVID-19. Recibió tratamiento con inmunoglobulina intravenosa, ácido acetilsalicílico y metilprednisolona. Dada la necesidad de descartar la posibilidad de un evento atribuible a vacunación o inmunización (ESAVI), se realizó la búsqueda serológica para SARS-CoV-2, en un estudio cualitativo, buscando anticuerpos que no se generan con la vacuna Pfizer, que fueron positivos. De esta forma confirmamos la etiología post COVID-19 y descartamos la etiología por ESAVI, realizándose además el estudio cuantitativo de los anticuerpos anti spike con disminución de estos al mes del debut.

Summary: SARS-CoV-2 affects a low number of pediatric patients, most asymptomatic or with mild respiratory compromise and favorable evolution. However, in previously healthy children, Multisystem Inflammatory Syndrome (SIM-C) or Kawasaki-like Syndrome(Kawasaki-like) may appear linked to the COVID-19 disease, progressing to shock and requiring admission to the intensive care unit. We present the case of an adolescent with an environmental history of SARS-CoV-2 37 days prior to her admission, who was not tested at that time. She had received the first dose of Pfizer vaccine 15 days before the presentation of digestive symptoms with abdominal pain and fever. She had a negative Covid-19 antigen test and viral PCR. After an exploratory laparoscopy, on the sixth day of fever and pain, she developed bilateral non-suppurative conjunctivitis and a rash on the chest, odynophagia, asthenia, and coated tongue with the Kawasaki phenotype. The anti-spike IgG serology was positive and the IgM negative, with elevated inflammatory parameters, so a post-COVID-19 multisystem syndrome was suggested. She received treatment with intravenous immunoglobulin, ASA and methylprednisolone. In order to rule out the possibility of an event allegedly caused by vaccination or immunization (ESAVI), the serological search for SARS-CoV-2 was carried out through a qualitative study, looking for antibodies that are not generated with the Pfizer vaccine. The result was positive. Therefore, we confirmed the post-Covid etiology and ruled out the ESAVI etiology, and also performed the quantitative study of the anti-spike antibodies, which showed a decrease one month after the debut.

O SARS-CoV-2 afeta um número reduzido de pacientes pediátricos, em sua maioria, assintomáticos ou apresentando comprometimento do nível respiratório e evolução favorável. Porém, em crianças previamente sãs, pode aparecer a Síndrome Inflamatória Multissistêmica (SIM-C) ou similar a Kawasaki (Kawasaki-like) associada à doença por COVID-19, que pode evoluir a choque e requer a internação na UTI. Apresentamos o caso de um adolescente com antecedentes ambientais de SARS-CoV-2 37 dias antes do seu ingresso, que não se testou nesse momento. Recebendo a dose da primeira vacina Pfizer 15 dias antes da apresentação de sintomatologia digestiva com dor abdominal e febre. Teve um teste de antígenos COVID-19 viral negativo. Depois de una laparoscopia exploratória, ao sexto dia de febre e dor, teve conjuntivite bilateral não supurada e exantema en tórax, odinofagia, astenia e língua saburral com fenótipo Kawasaki. A sorologia IgG anti-spike foi positiva e a gM negativa, com parâmetros inflamatórios superiores, indicando uma síndrome multissistêmica pós Covid 19. O tratamento recebido foi imunoglobulina intravenosa, AAS e Metilprednisolona. Com o fim de descartar a possibilidade de um evento supostamente atribuível à vacinação ou vacinação positiva (ESAVI), realizou-se uma busca sorológica para SARS COV2, através de um estúdio qualitativo, procurando anticorpos não gerados pela vacina Pfizer, os quais foram confirmados. Nesta forma, confirmamos a etiologia pós-Covid e descartamos a etiologia por ESAVI. Aliás, realizamos um estudo quantitativo dos anticorpos anti-spike e comprovamos a sua diminuição a um mês de ter acontecido o debut.