Decompression sickness responsive to delayed treatment with hyperbaric oxygen: a case report of two divers.

With the increasing popularity of recreational scuba diving, rare complications are becoming more commonly encountered. Although diving is generally safe, novice divers may be unfamiliar with the potential hazards of scuba diving and the resulting sequelae. Dive-related injuries are commonly due to barotrauma or from breathing gas at increased pressures, resulting in decompression illness (DCI), a term that includes both decompression sickness (DCS) and arterial gas embolism (AGE). Symptoms can range from minor aches and pains to neurologic or cardiopulmonary complications resulting in death. Clinical symptoms and diagnosis may initially go unrecognized and can present in a delayed manner, often remote to the diving location. When DCI is suspected standard treatment with hyperbaric oxygen (HBO2) therapy should be considered immediately. Current literature questions the efficacy of delayed HBO2 therapy longer than 24-48 hours after symptom onset. Here we present a case of two divers who simultaneously experienced DCS and were both successfully treated after receiving delayed HBO2 therapy nearly eight days after initiation of symptoms.

Molecular and morphological phylogeny of Saccocirridae (Annelida) reveals two cosmopolitan clades with specific habitat preferences.

Saccocirrids are tiny, slender annelids inhabiting the interstices among coarse sand sediments in shallow waters. The 22 nominal species can be grouped into two morphological groups "papillocercus" and "krusadensis", based on the absence/presence of a pharyngeal bulbus muscle, absence/presence of ventral ciliary patterns, bilateral/unilateral gonad arrangement and chaetal differences. We present herein the first phylogenetic analyses of Saccocirridae based on four molecular markers and 34 morphological characters, employing maximum likelihood and Bayesian methods. All analyses confirmed the monophyly of each morphological group with high nodal support. As a consequence and based on several apomorphic characters, a new genus, Pharyngocirrus gen. nov., is erected for the "krusadensis" clade. Remarkably, the habitat preferences and trophic guilds are also shown to differ between the two genera, yet show strong consistency within each group. Geographic distribution analyses underscore the family preference for subtropical areas, but reject the previously proposed restriction of Pharyngocirrus gen. nov. to the Indo-Pacific. The finding of two morphologically diverging, cosmopolitan sister clades with different habitat preferences suggest an early ecological diversification of the family, conserved during the later evolution, speciation processes and dispersal of the family.

[The link between aggressive behavior and depression in adolescence. A cross-sectional study conducted in the psychiatric emergency unit at the Sainte-Anne hospital]. / Lien entre comportements agressifs et vécu dépressif chez l'adolescent. Une étude transversale menée au centre psychiatrique d'orientation et d'accueil de l'hôpital Sainte-Anne.

INTRODUCTION: The link between depression and aggressive behavior in adults has been found in many studies. In adolescents, this relationship is still controversial. Several studies point out that irritability is a key symptom in adolescent depressed. Few studies have analyzed precisely the kind of aggressive behavior. This study sets out to assess the relationship between aggressive behavior and depressive affects in adolescents. We also pay attention in this population to hopelessness feelings, anxiety, global functioning and the type of aggressive behavior. METHOD: This is a descriptive and observational cross-sectional study. Data was collected from 49 successive adolescents admitted for a 24-hour evaluation in the emergency department of the Sainte-Anne psychiatric hospital. The inclusion period was from February to April 2012, with age limits between 15 and 18. For each patient, the clinician completed with the parents or other caregivers the Modified Overt Aggressive Scale (MOAS) searching for existence of aggressive behavior in the week prior to the consultation. The population was divided into two groups: P- group when the MOAS score was < 3 and the P+ group when the MOAS score was ≥ 3. The Global Assessment of Functioning Scale and Adolescent Depression Rating Scale for clinicians (ADRSc) were also completed. Each patient completed the self-report Buss-Perry Aggression Questionnaire (QA), the Beck Hopelessness scale and the Adolescent Depression Rating Scale for patients (ADRSp). RESULTS: Forty-nine adolescents with a median age of 16 years and 4 months participated. The first reason for consultation was depressive symptoms, followed by disruptive behavior. The analysis was conducted on 39 questionnaires. The demographic profile of the two groups was similar. We did not find any significant difference between the groups P+ and P- on ADRSc scores and secondary criteria. However, we found higher scores in the QA in the more depressed patient, especially a higher hostility score in this sample. In the subgroup analysis: as expected self-aggressive behavior was associated with a higher depression score, more hospitalization and a poor global functioning score. Surprisingly, the patients who showed physical aggression against others had a better prognosis and lower depression scores. DISCUSSION: The study did not conclude on the link between aggressive behavior and depression in this population. The adolescent hostility appears more characteristic of depression compared to other dimensions of aggressivity (anger, verbal aggression, physical aggression) in adolescents. Physical aggression against others appeared not only less typical in depression but was also associated with a better global functioning. Clinicians should pay particular attention to the kind of aggressive behavior in clinical evaluations of adolescents in an emergency context.

[Decision of emergency involuntary hospitalization: categorical or dimensional approach?]. / La décision d'hospitalisation sans consentement aux urgences: approche dimensionnelle ou catégorielle?

BACKGROUND: In 2005, in its recommendations on the modalities of decision making for compulsory hospitalization, the French Health High Authority (HAS) had already stressed the need for rapid implementation of studies and epidemiological analyses on the subject to compensate the lack of adequate data in France. The new French law of July 5, 2011, on the rights and protection of persons under psychiatric care, establishes a judicial review of decisions for compulsory hospitalization. Therefore, healthcare professionals need to better define and characterize the criteria for such decisions, especially in their relation to psychopathology. The concept of capacity to consent to treatment includes the ability to understand (to receive information about the disease), the ability to appreciate (to weigh the risks and benefits of treatment), the ability to reason (determining the best choice rationally) and the ability to freely express a decision. However, assessment tools of capacity to consent to treatment seem to fail to predict the modality of hospitalization. OBJECTIVE: This study examined the impact of clinical and contextual characteristics on the decision in emergency services to admit patients to compulsory inpatient psychiatric units. METHOD: Data was collected from 442 successive patients admitted to hospital for care from five psychiatric emergency facilities in Paris and covered sociodemographic information, previous hospitalizations, recent course of care, clinical diagnosis, Global Assessment of Functioning scale (GAF) and Insight measured by the Q8 Bourgeois questionnaire. Patients were also assessed based on criteria established by the HAS for the severity of mental disorders and the necessity of emergency care. RESULTS: Multivariable logistic regression shows that diagnosis does not affect the decision of hospitalization. Agitation, aggressiveness toward others, being married as well as being referred by a doctor or family are all factors that increase the risk of involuntary hospitalization. Last, low Q8 and GAF scores are strong predictors for compulsory admission. CONCLUSION: Our study shows a dimensional rather than categorical assessment of patients by clinicians. Assessment of insight is the main operational criterion used by clinicians in our study. This supports using insight and GAF evaluation in clinical practice to clarify assessment and decision-making in an emergency setting regarding compulsory hospitalization.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS: NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS: In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION: There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Recurrent Strokes in Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulant Agents.

Recurrent ischemic strokes (IS) in patients treated with direct oral anticoagulant agents (DOACs) are rare. Knowledge regarding the type of recurrent IS and predisposing factors is insufficient. We analyzed a cohort of 1001 patients (77.6 ± 9.2 years; females: 57.1%) with non-valvular atrial fibrillation (AF) treated with DOACs as part of secondary prevention after initial IS or transient ischemic attack. Cardiovascular risk factors, stroke etiology, and Fazekas score based on computed tomography images at the time of the initial IS were assessed. Low Fazekas scores were defined as 0 or 1 and high scores were 2 or 3. Recurrent IS occurred in 46 patients (4.6%, annual rate 1.6%) during the observation period (2.8 ± 1.8 years). Stroke was cardioembolic in 20 patients (43.5%), lacunar in 19 patients (37.5%) and large artery stroke in 6 patients (19.2%). Non-cardioembolic stroke was more common (75.0 vs 26.7%; P = .002) in patients with high Fazekas scores. Arterial hypertension was more frequent (P = .027) in patients with high (93.3%) vs low (68.8%) Fazekas scores. Recurrent IS was predominantly non-cardioembolic with higher Fazekas score and arterial hypertension as predisposing factors. The reported hypothesis-generating results regarding the clinical relevance of the Fazekas score should be further evaluated.

Hierarchical Virtual Screening of Potential New Antibiotics from Polyoxygenated Dibenzofurans against Staphylococcus aureus Strains.

Staphylococcus aureus is a microorganism with high morbidity and mortality due to antibiotic-resistant strains, making the search for new therapeutic options urgent. In this context, computational drug design can facilitate the drug discovery process, optimizing time and resources. In this work, computational methods involving ligand- and structure-based virtual screening were employed to identify potential antibacterial agents against the S. aureus MRSA and VRSA strains. To achieve this goal, tetrahydroxybenzofuran, a promising antibacterial agent according to in vitro tests described in the literature, was adopted as the pivotal molecule and derivative molecules were considered to generate a pharmacophore model, which was used to perform virtual screening on the Pharmit platform. Through this result, twenty-four molecules were selected from the MolPort® database. Using the Tanimoto Index on the BindingDB web server, it was possible to select eighteen molecules with greater structural similarity in relation to commercial antibiotics (methicillin and oxacillin). Predictions of toxicological and pharmacokinetic properties (ADME/Tox) using the eighteen most similar molecules, showed that only three exhibited desired properties (LB255, LB320 and LB415). In the molecular docking study, the promising molecules LB255, LB320 and LB415 showed significant values in both molecular targets. LB320 presented better binding affinity to MRSA (-8.18 kcal/mol) and VRSA (-8.01 kcal/mol) targets. Through PASS web server, the three molecules, specially LB320, showed potential for antibacterial activity. Synthetic accessibility (SA) analysis performed on AMBIT and SwissADME web servers showed that LB255 and LB415 can be considered difficult to synthesize and LB320 is considered easy. In conclusion, the results suggest that these ligands, particularly LB320, may bind strongly to the studied targets and may have appropriate ADME/Tox properties in experimental studies.

Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review.

INTRODUCTION: Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. METHODS: We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decision-making power) or no engagement. RESULTS: We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowdsourcing) that were feasible in multiple settings and resulted in substantial engagement. CONCLUSIONS: We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings.

A systematic review of skills transfer after surgical simulation training.

OBJECTIVE: To determine whether skills acquired by simulation-based training transfer to the operative setting. SUMMARY BACKGROUND DATA: The fundamental assumption of simulation-based training is that skills acquired in simulated settings are directly transferable to the operating room, yet little evidence has focused on correlating simulated performance with actual surgical performance. METHODS: A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was determined using a predetermined protocol, independent assessment by 2 reviewers, and a final consensus decision. Only studies that reported on the use of simulation-based training for surgical skills training, and the transferability of these skills to the operative setting, were included. RESULTS: Ten randomized controlled trials and 1 nonrandomized comparative study were included in this review. In most cases, simulation-based training was in addition to normal training programs. Only 1 study compared simulation-based training with patient-based training. For laparoscopic cholecystectomy and colonoscopy/sigmoidoscopy, participants who received simulation-based training before undergoing patient-based assessment performed better than their counterparts who did not receive previous simulation training, but improvement was not demonstrated for all measured parameters. CONCLUSIONS: Skills acquired by simulation-based training seem to be transferable to the operative setting. The studies included in this review were of variable quality and did not use comparable simulation-based training methodologies, which limited the strength of the conclusions. More studies are required to strengthen the evidence base and to provide the evidence needed to determine the extent to which simulation should become a part of surgical training programs.

Assessment of the Bioaccessibility of Trace Elements in Cat's Claw Teas by In Vitro Simulated Gastrointestinal Digestion Using FAAS.

The aim of this study was to evaluate the bioaccessibility of Ca, Fe, Mg, Mn, and Zn in cat's claw plant teas through in vitro gastrointestinal digestion with gastric and intestinal juice solutions. The total concentrations and bioaccessible fractions of Ca, Fe, Mg, Mn, and Zn were measured by flame atomic absorption spectrometry (FAAS). The results obtained showed that Zn was the most bioaccessible element in the teas, contributing a mean of 57.9% by infusion and 62.5% by decoction. Among macroelements, the Ca was less bioaccessible with 17.4% recovery. The bioavailability assessment revealed that daily intake of 200 ml of cat's claw teas cover about 1.0% of manganese RDA.

Normal-weight obesity syndrome: diagnosis, prevalence, and clinical implications.

The growing concern about the impact of overweight on health has led to studies that shed light on types of obesity other than the classic model based on body mass index. Normal-weight obesity syndrome is characterized by excess body fat in individuals with adequate body mass index (18.5-24.9 kg/m(2)). This condition increases the risk of cardiovascular morbidity and mortality and other conditions associated with chronic diseases, such as insulin resistance, hypertension, and dyslipidemia. The aims of this review are to define the diagnostic criteria for normal-weight obesity syndrome and to examine the risks associated with this condition in order to promote preventive measures and early treatment for affected individuals.

Complex spatial and temporal variation of subtropical benthic macrofauna under sewage impact.

To better understand variation in sewage-impacted benthic macrofauna from subtropical tidal flats over time and space, we applied a five-factor linear model at a hierarchy of spatial (Condition - Contaminated or Non-Contaminated, Tidal Flat and Plot) and temporal scales (Season and Fortnight). The Contaminated site showed high levels of coprostanol and the presence of Paranais cf frici as markers or indicators of organic enrichment. Differences between Seasons were more pronounced for the faunal variation patterns than for the other parameters, with lower species richness and abundance in summer. There were significant interactions between Fortnight and Tidal Flat for most variables, reflecting marked heterogeneity within Tidal Flats. Benthic community has significantly changed over short periods of time. These rapid changes may lead to erroneous interpretations and mask the true sources of variation. Our results clearly demonstrate the need to better understand benthic temporal variability even at small scales.

The effect of urban sewage on benthic macrofauna: a multiple spatial scale approach.

We investigated the spatial scales of variation of macrofauna in intertidal flats subjected to different levels of contamination from urban effluents in two areas sampled in the Paranaguá Estuarine Complex. The scales considered were: Conditions; Tidal flats and Plots. Although the numerically dominant taxa showed the greatest variability at a scale of Tidal flats, the variability at the Condition scale was also significant. Tubificinae sp. 1, Laeonereis culveri and Heteromastus sp. were the most abundant organisms in the Contaminated area, while Heleobia australis was most abundant in the Non-contaminated area. Our results, contrary to those frequently observed in the literature, showed that the variability was significant at the scale of hundreds of metres (Tidal flats). At this scale, the intrinsic characteristics of each tidal flat are more important in determining macrofaunal distribution, while the effects of the urban sewage contamination represent the primary forces acting at a greater spatial scale.

A systematic review of dermal fillers for age-related lines and wrinkles.

BACKGROUND: Dermal fillers are gaining popularity for rapid aesthetic improvement. Long-term efficacy and safety have not been well documented. The aim of this systematic review was to assess the safety and efficacy of injectable dermal fillers compared with other facial augmentation techniques for the management of age-related lines and wrinkles. METHODS: Studies including patients receiving injectable semi-permanent or permanent dermal fillers for age-related lines and wrinkles were included in this review. Efficacy outcomes (including changes in skin thickness and patient satisfaction) and safety outcomes (including mortality, lumps and infections) were examined. RESULTS: Three randomized control trials and six case series were included. Permanent and semi-permanent dermal fillers improved subjective ratings of appearance and resulted in higher patient satisfaction than temporary fillers. Long-term efficacy appeared good in the few studies that reported it. Short-term safety appeared favourable. Lumps were reported in all but one study but received little follow-up. Long-term safety data were limited. CONCLUSIONS: The treatment of age-related lines and wrinkles with permanent and semi-permanent dermal fillers is more efficacious compared with temporary fillers in those studies that compared them. Case series evidence suggests that these fillers achieve their objective, which is to decrease the visible effects of age-related changes. These fillers appear at least as safe as temporary fillers in the short term in those studies that compared them. Long-term safety could not be determined.

A systematic review of permanent and semipermanent dermal fillers for HIV-associated facial lipoatrophy.

The objective of this study was to assess the safety and efficacy of injectable semipermanent and permanent dermal fillers, compared to other facial augmentation techniques, for the management of facial lipoatrophy as a result of highly active antiretroviral therapy (HAART) for HIV infection through a systematic review of the literature. A systematic search strategy was used to retrieve relevant studies. Inclusion of articles was by the application of a predetermined protocol, independent assessment by two reviewers, and a final consensus decision. One randomized controlled trial (RCT), one pseudo-RCT, two nonrandomized comparative studies, and seven case series were included for review. Injections with permanent and semipermanent dermal fillers improved subjective ratings of appearance and resulted in high patient satisfaction. Although short-term safety appeared favorable, of the seven studies that reported lumps, three studies reported these events in more than 40% of patients. Long-term safety data were lacking. Evidence suggests that permanent and semipermanent dermal fillers achieve their objective, which is to decrease the visible effects of HIV-associated facial lipoatrophy, with high patient satisfaction. Safety appears favorable in the short term, but further studies are required to determine long-term outcomes.

Detection of simulated multiple sclerosis lesions on T2-weighted and FLAIR images of the brain: observer performance.

PURPOSE: To determine observer performance in the detection of multiple sclerosis (MS) lesions on magnetic resonance (MR) images of the brain and to assess the dependence of observer performance on lesion size, parenchymal location, pulse sequence, and supratentorial versus infratentorial level. MATERIALS AND METHODS: This HIPAA-compliant protocol was approved by the institutional review board, and previously acquired MR data from a healthy volunteer and a patient with MS were used to derive parameter maps, with waiver of informed consent. Parameter maps and image simulator software were used to generate 320 phantom brain images with simulated supratentorial and infratentorial MS lesions. Images were displayed with T2-weighting or fluid-attenuated inversion recovery (FLAIR) contrast. Four readers independently evaluated the images, rating lesions on a five-point certainty scale. Observer performance was measured by using the area under the alternative free-response receiver operating characteristic curve (A(1)), and significance was determined with the z test. RESULTS: Pooled A(1) scores were significantly better for FLAIR imaging (0.96 +/- 0.01 [standard error]) than for T2-weighted MR imaging (0.89 +/- 0.04) supratentorially (P = .05) but were similar for FLAIR imaging (0.90 +/- 0.06) and T2-weighted MR imaging (0.88 +/- 0.05) infratentorially. A(1) scores for cortical, deep white matter, and periventricular lesions were 0.93 +/- 0.05, 0.97 +/- 0.02, and 0.89 +/- 0.04, respectively, for FLAIR imaging and 0.77 +/- 0.06, 0.99 +/- 0.01, and 0.89 +/- 0.05, respectively, for T2-weighted MR imaging. FLAIR scores were significantly higher than T2-weighted scores for cortical lesions. Linear correlation was found between A(1) and lesion size (r = 0.5). CONCLUSION: Supratentorially, performance was better with FLAIR imaging than with T2-weighted MR imaging. Infratentorially, performance was moderate with both modalities. Observers did better with FLAIR imaging in the detection of cortical lesions, and performance improved with increasing lesion size.

[An outbreak of trichinosis in Huerta del Marquesado (the Cañete-Cuenca basic health area). December 1992 to January 1993]. / Brote de triquinelosis en Huerta del Marquesado (ZBS Cañete-Cuenca). Diciembre-92 a enero-93.

BACKGROUND: A trichinellosis outbreak was investigated (December 1992-January 1993). It occurred in the village of Huerta del Marquesado among people who consumed sausages made with pork, meat. The aim of this study is to show the consequences of consuming meat without a sanitary control on human health. METHODS: A case-control study was carried out. Information was obtained using a standardized questionnaire for Foodbornes. A descriptive study was done and the relationship between the intake of sausages and disease was also investigated. RESULTS: 19 cases were reported, median frequency: 11 of January. The outbreak lasted 21 days. The mean incubation period was 26.47 days (SD 4.45 days). Most frequent symptoms were fever, myalgia, eyelid's edema. The age of the patients varied from 5 to 65 years old, being the mean 33 years old. Proportionally more women than men were diseased (58%). No cases died or were hospitalized. A significant statistic association was show between trichinellosis and intake of sausages (OR = 54; 95% Confidence interval 3.1- 2622.43; p < 0.0006). Trichinella spiralis larvae have been shown in samples of the pork meat which had been eaten. CONCLUSIONS: The disease did not last excessively and was not too severe, which suggest a low parasite density. After the laboratory confirmation the meat was confiscated and destroyed. The outbreak was controlled with the active collaboration of the public health veterinarians.