A Case Report of Whipple's Disease: A Challenging Diagnosis.

Whipple's disease is caused by a ubiquitous Gram-positive bacillus, Tropheryma whipplei. The disease is extremely rare, with only 1,000 cases reported worldwide. Classic Whipple's disease is characterized by a multisystemic involvement with joint (arthralgias) and gastrointestinal (abdominal pain, diarrhea, and weight loss) symptoms.  We present a case of a 48-year-old male who had a constitutional syndrome associated with an exuberant bilateral pleural effusion. The small bowel biopsy identified a rod-shaped bacterial cologne in the macrophage cytoplasm, positive for periodic acid-Schiff (PAS) staining, and the polymerase chain reaction (PCR) exam identified the DNA of Tropheryma whipplei. The patient was medicated with two weeks of endovenous antibiotherapy with ceftriaxone 2 g per day, followed by one year of oral trimethoprim 160 mg and sulfamethoxazole 800 mg twice daily. He presented good evolution with total resolution of symptoms.

Circular RNAs: Promising Targets in Osteoporosis.

PURPOSE OF REVIEW: Circular RNAs (circRNAs) are RNA transcripts derived from fragments of pre-messenger RNAs through a back-splicing process. An advantage that rises from their circular covalently closed conformation is their high stability, when compared with their linear counterparts. The current review focuses on the emerging roles of circRNAs in osteoporosis, including in osteogenic differentiation and osteoclastogenesis. Their potential as osteoporosis biomarkers will also be discussed. RECENT FINDINGS: Although firstly described as non-coding, some of these single-stranded RNAs were recently reported to possess protein-coding capacity. On the other hand, the circRNAs exhibit cell and tissue-specific patterns at the transcriptome level in eukaryotes and are regulated throughout the development or disease progression. Even though thousands of these circular transcripts are listed and annotated, only a limited number of studies describe their biological role in bone processes. Recent evidence indicates inhibitory activator roles in both osteoblasts and osteoclasts differentiation and function. Latest screenings in the blood, plasma, or serum of osteoporosis patients support the potential for circRNA signature to be used as biomarkers in osteoporosis, but further validation is required. While intense research into circRNAs has been detailing their biological roles, there remains a need for standardization and further research to fulfil the future potential of this emerging and highly promising class of regulatory molecules.

Comorbidity of psychiatric and dermatologic disorders with skin picking disorder and validation of the Skin Picking Scale Revised for Brazilian Portuguese

Objective: Skin picking disorder (SPD) affects up to 5.4% of the population. Less than half of patients are correctly diagnosed and treated. Developing tools to recognize SPD can help professionals and patients alike. This trial aimed to validate the Skin Picking Scale-Revised (SPS-R) for the Brazilian population and assess the psychiatric and dermatological comorbidities of patients with SPD. Methods: Brazilians with a primary diagnosis of SPD, 18 years or older, were recruited from a community sample by media advertising and evaluated by a dermatologist and a psychiatrist. Self-report instruments were used: SPS-R, Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed to evaluate the SPS-R, and Pearson correlation (r) was used to assess the relationship between instruments. Results: Overall, 124 patients were included. The SPS-R demonstrated good internal consistency (Cronbach's coefficient = 0.84). CFA found a good fit to the model according to all indices (χ2 = 29.67; degrees of freedom [df] = 19; p = 0.056; root mean square error of approximation [RMSEA] = 0.067; comparative fit index [CFI] = 0.969; non-normed fit index [NNFI] = 0.954). SPS-R correlated with DLQI (r = 0.73), GAD-7 (r = 0.51), and PHQ-9 (r = 0.43). The sample had a high prevalence of psychiatric disorders, mainly generalized anxiety disorder (62.1%) and current (32.3%) and past (37.1%) depressive episodes. Conclusion: The Brazilian version of the SPS-R presents good psychometric properties. The severity of SPD is related to severity of depression, anxiety, and impairment in quality of life. Clinical trial registration: ClinicalTrials.gov, NCT04731389

Eagle's Syndrome Presenting as Peripheral Facial Palsy.

Eagle's syndrome (ES) is the elongation of the ossified styloid process that causes symptoms such as foreign body sensation, neck pain, and odynophagia. A styloid process greater than 25 mm in length should be considered abnormal. Facial palsy is a condition that affects the facial nerve and results in weakness or total paralysis of the facial muscles that control expression. Here, we describe a rare presentation of ES presenting as facial palsy. We present the case of a 62-year-old female who was admitted to the emergency department with right peripheral facial palsy. A computed tomography (CT) scan of the neck confirmed the diagnosis. The patient underwent conservative management and physical therapy, which resulted in good evolution with an improvement of symptoms. She was referred to the otorhinolaryngologist for surgical evaluation.

Comorbidity of psychiatric and dermatologic disorders with skin picking disorder and validation of the Skin Picking Scale Revised for Brazilian Portuguese.

OBJECTIVE: Skin picking disorder (SPD) affects up to 5.4% of the population. Less than half of patients are correctly diagnosed and treated. Developing tools to recognize SPD can help professionals and patients alike. This trial aimed to validate the Skin Picking Scale-Revised (SPS-R) for the Brazilian population and assess the psychiatric and dermatological comorbidities of patients with SPD. METHODS: Brazilians with a primary diagnosis of SPD, 18 years or older, were recruited from a community sample by media advertising and evaluated by a dermatologist and a psychiatrist. Self-report instruments were used: SPS-R, Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Confirmatory factor analysis (CFA) was performed to evaluate the SPS-R, and Pearson correlation (r) was used to assess the relationship between instruments. RESULTS: Overall, 124 patients were included. The SPS-R demonstrated good internal consistency (Cronbach's coefficient = 0.84). CFA found a good fit to the model according to all indices (?2 = 29.67; degrees of freedom [df] = 19; p = 0.056; root mean square error of approximation [RMSEA] = 0.067; comparative fit index [CFI] = 0.969; non-normed fit index [NNFI] = 0.954). SPS-R correlated with DLQI (r = 0.73), GAD-7 (r = 0.51), and PHQ-9 (r = 0.43). The sample had a high prevalence of psychiatric disorders, mainly generalized anxiety disorder (62.1%) and current (32.3%) and past (37.1%) depressive episodes. CONCLUSION: The Brazilian version of the SPS-R presents good psychometric properties. The severity of SPD is related to severity of depression, anxiety, and impairment in quality of life.

Reflexos da (in)capacidade de estar só em tempos de isolamento social na pandemia COVID-19 / Reflections of the (in)ability to be alone in times of social isolation in pandemia COVID-19

As medidas adotadas em diversos países, necessárias como tentativa de contenção da pandemia causada pelo novo coronavírus (COVID-19), desencadearam mudanças radicais no dia a dia dos indivíduos, ocasionando sentimentos de incerteza, angústia, ansiedade e depressão na população em geral. O aumento do sentimento de solidão levou muitos indivíduos a utilizarem recursos internos e pôs à prova a capacidade de estar só. Alguns conceitos psicanalíticos evidenciam que o indivíduo que atinge um ego integrado, através de cuidados maternos suficientemente bons nos momentos primitivos, como bebê, adquire a capacidade de estar só. Isso ressalta a importância das primeiras relações objetais para a construção de um mundo interno satisfatório. Em contrapartida, a interrupção desse amadurecimento emocional pode despertar no sujeito adulto a utilização de mecanismos de ordem externa, como diversos tipos de adições, exposição a comportamentos de risco e, provavelmente, no caso da pandemia, desrespeito às medidas de distanciamento social. Diante disso, observa-se quão importante é o desenvolvimento saudável das primeiras relações objetais para que o indivíduo seja capaz de lidar com a solidão, e adote estratégias saudáveis ao longo da vida, inclusive em situações críticas. Assim, esse artigo se propõe a revisar alguns aspectos da teoria psicanalítica sobre a capacidade de estar só dentro do desenvolvimento emocional e compreender as consequências psíquicas resultantes das falhas nessa etapa da vida psíquica dos indivíduos.(AU)

The measures adopted in several countries, necessary as an attempt to contain the pandemic caused by the new coronavirus (COVID 19), triggered radical changes in the daily lives of individuals, causing feelings of uncertainty, anguish, anxiety and depression in the general population. The increased feeling of loneliness has led many individuals to use internal resources and test their ability to be alone. Some psychoanalytic concepts show that the individual who reaches an integrated ego, through maternal care good enough in primitive moments, as a baby, acquires the ability to be alone. This underscores the importance of early object relations for building a satisfying inner world. On the other hand, the interruption of this emotional maturation can awaken in the adult the use of external mechanisms, such as various types of addictions, exposure to risky behaviors and probably, in the case of the pandemic, disrespect to the measures of social distancing. Therefore, it is observed how important the healthy development of the first object relations is for the individual to be able to deal with loneliness, and to adopt healthy strategies throughout life, including in critical situations. Thus, this article set out to review some aspects of psychoanalytic theory about the ability to be alone within emotional development and to understand the psychic consequences resulting from failures in this stage of the psychic life of individuals.(AU)

Las medidas adoptadas en varios países, necesarias como intento de contener la pandemia por el nuevo coronavirus (COVID 19), desencadenaron cambios radicales en la vida cotidiana de las personas, causando sentimientos de incertidumbre, angustia, ansiedad y depresión en la población en general. El aumento de la sensación de soledad ha llevado a muchas personas a utilizar recursos internos y ha puesto a prueba la capacidad de estar solos. Algunos conceptos psicoanalíticos muestran que el individuo que alcanza un ego integrado, a través del cuidado materno suficientemente bueno en momentos primitivos, como un bebé, adquiere la capacidad de estar solo. Esto resalta la importancia de las primeras relaciones de objeto para la construcción de un mundo interno satisfactorio. Por otro lado, la interrupción de esta maduración emocional puede despertar en el sujeto adulto el uso de mecanismos externos, como varios tipos de adicciones, la exposición a conductas de riesgo y probablemente, en el caso de la pandemia, la falta de respeto a las medidas de distanciamiento social. Por lo tanto, se observa cuán importante es el sano desarrollo de las primeras relaciones de objeto para que el individuo sea capaz de afrontar la soledad y adoptar estrategias saludables a lo largo de la vida, incluso en situaciones críticas. Así, este artículo se propuso revisar algunos aspectos de la teoría psicoanalítica sobre la capacidad de estar solo dentro del desarrollo emocional y comprender las consecuencias psíquicas derivadas de los fracasos en esta etapa de la vida psíquica de los individuos.(AU)

Antibiotics and antidepressants occurrence in surface waters and sediments collected in the north of Portugal.

To our knowledge, this is the first study in Portugal for the analysis of both antibiotics and psychiatric drugs in river waters from Douro and Leça rivers and its sediments. Samples were extracted using solid phase extraction and QuEChERS procedures and the analysis was performed using liquid chromatography with tandem mass spectrometry. Higher number of pharmaceuticals and higher concentrations were found in the Leça river for the two matrices under study. The highest detection frequency for the twenty-seven pharmaceuticals was observed for fluoxetine with 83.3% in both matrices. None of the studied antibiotics were detected in water collected in the Douro river however six antibiotics (azithromycin, ciprofloxacin, clarithromycin, moxifloxacin, ofloxacin, and trimethoprim) were found in the Leça river. Further, the analysis of sediments exhibits the occurrence of sulfamethoxypyridazine in the Douro river and azithromycin in the Leça river. The highest concentration was observed in Leça river for azithromycin in the river water (2,819 ng/L) and sediments (43.2 ng/g). Carbamazepine, citalopram, fluoxetine, sertraline, trazodone, and venlafaxine were the psychiatric drugs detected in river waters and sediments with more diazepam as water river contamination. Concentrations ranged from

Evaluation of the adsorption potential of biochars prepared from forest and agri-food wastes for the removal of fluoxetine.

Twelve biochars from forest and agri-food wastes (pruning of Quercus ilex, Eucalyptus grandis, Pinus pinaster, Quercus suber, Malus pumila, Prunus spinosa, Cydonia oblonga, Eriobotrya japonica, Juglans regia, Actinidia deliciosa, Citrus sinensis and Vitis vinifera) were investigated as potential low-cost and renewable adsorbents for removal of a commonly used pharmaceutical, fluoxetine. Preliminary adsorption experiments allowed to select the most promising adsorbents, Quercus ilex, Cydonia oblonga, Eucalyptus, Juglans regia and Vitis vinifera pruning material. They were characterized by proximate, elemental and mineral analysis, thermogravimetric analysis, Fourier transform infrared spectroscopy, determination of specific surface area and pH at the point of zero charge. Batch and equilibrium studies were performed, and the influence of pH was evaluated. The equilibrium was reached in less than 15 min in all systems. The maximum adsorption capacity obtained was 6.41 mg/g for the Eucalyptus biochar, which also demonstrated a good behavior in continuous mode (packed column).

Assessment of 83 pharmaceuticals in WWTP influent and effluent samples by UHPLC-MS/MS: Hourly variation.

The removal efficiency of pharmaceuticals in wastewater treatment plants (WWTPs) is variable and some of these compounds pass these plants almost intact and others presenting a removal efficiency close to 100%. Their incomplete removal results in a continuous discharge of pharmaceuticals into the environment. To assess the profile of contamination of influents and effluents over a day, a set of 83 pharmaceuticals were evaluated hourly in a WWTP in Leiria, Portugal. The composite samples of the influent and effluent were also collected. Concentrations varied from 1 in WWTP influents, and carbamazepine, fluoxetine, sertraline the pharmaceuticals with an RQ > 1 in WWTP effluents.

Nutritional supplements usage by Portuguese athletes.

In this study, we determined the prevalence of nutritional supplements (NS) usage, the type of supplements used, the reasons for usage, and the source of nutritional advice among Portuguese athletes. Two hundred ninety-two athletes (68 % male, 12 - 37 years old) from 13 national sports federations completed a questionnaire that sought information on socio-demographics, sports data, and NS usage. Most athletes (66 %) consumed NS, with a median consumption of 4 supplements per athlete. The most popular supplements included multivitamins/minerals (67 %), sport drinks (62 %), and magnesium (53 %). Significant differences for the type of NS consumed were found between gender and age groups and the number of weekly training hours. Most athletes used NS to accelerate recovery (63 %), improve sports performance (62 %), and have more energy/reduce fatigue (60 %). Athletes sought advice on supplementation mainly from physicians (56 %) and coaches (46 %). Age and gender were found to influence reasons for use and the source of information. Reasons for NS usage were supported scientifically in some cases (e. g., muscle gain upon protein supplementation), but others did not have a scientific basis (e. g., use of glutamine and magnesium). Given the high percentage of NS users, there is an urgent need to provide athletes with education and access to scientific and unbiased information, so that athletes can make assertive and rational choices about the utilization of these products.