Stress, anxiety, and depression trajectories during the "first wave" of the COVID-19 pandemic: what drives resilient, adaptive and maladaptive responses in the Portuguese population?

Introduction: The COVID-19 outbreak and the community mitigation strategies implemented to reduce new SARS-CoV-2 infections can be regarded as powerful stressors with negative consequences on people's mental health. Although it has been shown that negative emotional symptoms subside during lockdown, it is likely the existence of inter-individual differences in stress, anxiety and depression trajectories throughout lockdown. Objectives: We aimed to cluster participants' according to their trajectories of stress, anxiety and depression scores throughout lockdown, and identify the sociodemographic, clinical, and lifestyle factors that may distinguish the subjects included in the different clusters. Methods: From March 23, 2020, to May 31, 2020, participants completed weekly online questionnaires on sociodemographic information (age, sex, education level, and employment status), psychological functioning (DASS-21, NEO-FFI-20), and clinical data (psychiatric disorders, psychiatric medication, physical disorders). Data regarding smoking status, alcohol consumption, physical activity, and time spent daily looking for COVID-19-related information were also collected. Stress, anxiety and depression trajectories were determined using latent class mixed models. Results: A total of 2040 participants answered the survey at baseline and 603 participants answered all surveys. Three groups ("Resilient," "Recovered," and "Maladaptive") with distinct mental health trajectories were identified. Younger participants, women, participants with lower education level, not working, studying, diagnosed with a mental disorder, taking psychiatric medication, smokers, those who spent more time consuming COVID-19-related information and those with higher neuroticism tended to cluster in the "Maladaptive" group, placing them at higher risk of persistent negative emotional symptoms during compulsory confinement. Conclusion: Accordingly, a tailored approach to emotional suffering for vulnerable subjects during the COVID-19 and future pandemics must be devised.

Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disease that is characterized by its clinical heterogeneity and complex pathophysiology. This complexity comes from the diversity of pathophysiological factors that have been proposed to be involved in the natural history of the disorder. Many theories on OCD pathology support inflammation as a pathophysiological factor, although studies are not consistent on the presence of a pro-inflammatory state among OCD patients. However, some pre-clinical animal studies suggest lipocalin-2 (LCN2), an analogous form of the acute-phase pro-inflammatory protein neutrophil gelatinase-associated lipocalin (NGAL), may be involved in in the regulation of the stress response, which is thought to be disrupted in OCD. METHODS: Twenty-one OCD patients and 19 healthy subjects participated in this exploratory study. Levels of NGAL were assessed in the peripherous blood of all participants. Severity of disease was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS: OCD patients exhibited significantly higher levels of NGAL when compared to healthy control subjects. No correlation was found between elevated levels of NGAL and severity of symptoms. CONCLUSIONS: This is the first study to report elevated levels of NGAL among OCD patients, adding evidence for a possible role of immune dysregulation in the pathophysiology of OCD.

Breast cancer surgery with augmented reality.

INTRODUCTION: Innovations in 3D spatial technology and augmented reality imaging driven by digital high-tech industrial science have accelerated experimental advances in breast cancer imaging and the development of medical procedures aimed to reduce invasiveness. PRESENTATION OF CASE: A 57-year-old post-menopausal woman presented with screen-detected left-sided breast cancer. After undergoing all staging and pre-operative studies the patient was proposed for conservative breast surgery with tumor localization. During surgery, an experimental digital and non-invasive intra-operative localization method with augmented reality was compared with the standard pre-operative localization with carbon tattooing (institutional protocol). The breast surgeon wearing an augmented reality headset (Hololens) was able to visualize the tumor location projection inside the patient's left breast in the usual supine position. DISCUSSION: This work describes, to our knowledge, the first experimental test with a digital non-invasive method for intra-operative breast cancer localization using augmented reality to guide breast conservative surgery. In this case, a successful overlap of the previous standard pre-operative marks with carbon tattooing and tumor visualization inside the patient's breast with augmented reality was obtained. CONCLUSION: Breast cancer conservative guided surgery with augmented reality can pave the way for a digital non-invasive method for intra-operative tumor localization.

Sorption/Diffusion Contributions to the Gas Permeation Properties of Bi-Soft Segment Polyurethane/Polycaprolactone Membranes for Membrane Blood Oxygenators.

Due to their high hemocompatibility and gas permeation capacity, bi-soft segment polyurethane/polycaprolactone (PU/PCL) polymers are promising materials for use in membrane blood oxygenators. In this work, both nonporous symmetric and integral asymmetric PU/PCL membranes were synthesized, and the permeation properties of the atmospheric gases N2, O2, and CO2 through these membranes were experimentally determined using a new custom-built gas permeation apparatus. Permeate pressure vs. time curves were obtained at 37.0 °C and gas feed pressures up to 5 bar. Fluxes, permeances, and permeability coefficients were determined from the steady-state part of the curves, and the diffusion and sorption coefficients were estimated from the analysis of the transient state using the time-lag method. Independent measurements of the sorption coefficients of the three gases were performed, under equilibrium conditions, in order to validate the new setup and procedure. This work shows that the gas sorption in the PU/PCL polymers is the dominant factor for the permeation properties of the atmospheric gases in these membranes.

Treatments used for obsessive-compulsive disorder-An international perspective.

OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.

Síndrome de koro associado a transtorno obsessivo-compulsivo: caso clínico e breve revisão / Koro syndrome associated with obsessive-compulsive disorder: clinical case and brief review

RESUMO A síndrome de koro é uma síndrome psiquiátrica ligada à cultura, que se caracteriza por um episódio de ansiedade súbito e intenso relacionado com a crença de que o pênis (nas mulheres, mamilos e grandes lábios) estar a retrair-se para o interior do organismo, podendo conduzir à impotência, esterilidade e, eventualmente, morte. É mais frequente nos países do Sudoeste Asiático e no sexo masculino. No Ocidente é rara, embora existam descrições de koro-like secundárias a perturbações neurológicas, psiquiátricas ou orgânicas. No Diagnostic and Statistical Manual of Mental Disorders-5 é classificada como um "Transtorno Obsessivo-Compulsivo e transtornos relacionados com outra especificação". Este artigo descreve um caso raro de um doente com síndrome de koro secundária a um transtorno obsessivo-compulsivo. Neste artigo, apresenta-se a descrição de um caso clínico e revisão bibliográfica, com base na pesquisa de artigos publicados, desde 2000, no PubMed, com as palavras-chave: "koro syndrome", "obsessive-compulsive disorder" e "koro-like symptoms". Analisaram-se alguns artigos anteriores ao ano 2000 para contextualização histórica. Doente com síndrome de koro secundária a transtorno obsessivo-compulsivo, com boa resposta à terapia farmacológica associada à terapia cognitivo-comportamental. O conhecimento desse diagnóstico e da sua gestão clínica é importante para identificar as condições subjacentes e otimizar o tratamento.

ABSTRACT Koro's syndrome is a psychiatric culture-bound syndrome characterized by an episode of sudden and intense anxiety related to the belief that the penis (in women, nipples and labia majora) is retracting into the body, leading to erectile dysfunction, sterility and, eventually, death. It is more common in Southeast Asia and in males. In the West it is rare, although there are descriptions of koro-like secondary to neurological, psychiatric or organic disorders. In the Diagnostic and Statistical Manual of Mental Disorders-5 it is classified as an "Obsessive-Compulsive Disorder and disorders related to another specification". This article describes a rare case of a patient with koro's syndrome secondary to obsessive-compulsive disorder. In this article we present the description of a case report and review of the literature by searching articles published in PubMed since 2000, with the keywords: "koro syndrome", "obsessive-compulsive disorder" and "koro-like symptoms". Articles prior to 2000 were also analyzed for historical considerations. A patient with koro's syndrome secondary to obsessive-compulsive disorder with good response to pharmaceutical and cognitive behavioral therapy combination. Being aware of this diagnosis and its clinical management is essential to identify the underlying conditions and optimize treatment.

Three-Dimensional Planning Tool for Breast Conserving Surgery: A Technological Review.

Breast cancer is one of the most common malignancies affecting women worldwide. However, despite its incidence trends have increased, the mortality rate has significantly decreased. The primary concern in any cancer treatment is the oncological outcome but, in the case of breast cancer, the surgery aesthetic result has become an important quality indicator for breast cancer patients. In this sense, an adequate surgical planning and prediction tool would empower the patient regarding the treatment decision process, enabling a better communication between the surgeon and the patient and a better understanding of the impact of each surgical option. To develop such tool, it is necessary to create complete 3D model of the breast, integrating both inner and outer breast data. In this review, we thoroughly explore and review the major existing works that address, directly or not, the technical challenges involved in the development of a 3D software planning tool in the field of breast conserving surgery.

Depressão em pacientes HIV positivos: a realidade de um hospital português / Depression in HIV-positive patients: the reality of a Portuguese hospital

Objetivos: A depressão constitui a mais frequente perturbação psiquiátrica entre indivíduos infectados pelo HIV. Este trabalho pretende caracterizar a população de doentes HIV positivos da clínica de infectologia do Hospital de Joaquim Urbano do Porto quanto ao perfil de sintomas depressivos e verificar se estes se correlacionam com os parâmetros analíticos mais frequentemente avaliados no contexto da infecção por este vírus: carga viral do HIV, contagem e percentagem de linfócitos CD4+. Métodos: Foi realizado um estudo observacional descritivo e analítico. Os níveis de sintomas depressivos dos participantes foram avaliados com o Inventário Depressivo de Beck. Os antecedentes patológicos, psiquiátricos e os valores analíticos da carga viral, contagem e percentagem de CD4+ foram obtidos através de consulta aos respectivos processos clínicos. Resultados: Foi encontrada uma prevalência de 65,5% de sintomas depressivos, com uma percentagem considerável (32,7%) dos indivíduos apresentando sintomas graves. Não se verificaram associações entre os níveis de sintomas depressivos e a contagem de CD4+, percentagem de CD4+ ou carga viral. Foram, no entanto, demonstradas associações entre sintomas depressivos, toxicodependência e grau de escolaridade. Conclusões: A elevada prevalência de sintomas depressivos encontrada neste estudo reforça a importância da vigilância desse tipo de sintomatologia em indivíduos HIV positivos. O fato de não se terem verificado associações entre sintomas depressivos e os parâmetros analíticos avaliados está em conformidade com estudos anteriores.

Aims: Depression is the most common psychiatric disorder among people infected with HIV. This study aims to characterize the Hospital of Joaquim Urbano population of HIV-infected patients' profile regarding depressive symptoms and whether they correlate with the analytical parameters most frequently evaluated in the context of infection by this virus ­ HIV viral load, CD4+ count and CD4+ percentage. Methods: We conducted an observational descriptive and analytical study. The participants' level of depressive symptoms was assessed with the Beck Depression Inventory. The medical and psychiatric history and the analytical values of viral load, CD4+ count and CD4+ percentage were obtained by consulting the participants' clinical processes. Results: A prevalence of 65.5% in HIV-infected patients' depressive symptoms was found, with a considerable high percentage of subjects presenting with severe symptoms (32.7%). No associations between the depressive symptoms' levels and CD4+ count, CD4+ percentage or viral load were found. However, depressive symptoms were associated with substance abuse and education level. Conclusions: The high prevalence of depressive symptoms found in this study reinforces the importance of monitoring this type of symptoms in HIV-infected subjects. The fact that there have been no associations between depressive symptoms and the analytical parameters evaluated is in line with previous studies.

Type II Toxoplasma gondii induction of CD40 on infected macrophages enhances interleukin-12 responses.

Toxoplasma gondii is an obligate intracellular parasite that can cause severe neurological disease in infected humans. CD40 is a receptor on macrophages that plays a critical role in controlling T. gondii infection. We examined the regulation of CD40 on the surface of T. gondii-infected bone marrow-derived macrophages (BMdMs). T. gondii induced CD40 expression both at the transcript level and on the cell surface, and interestingly, the effect was parasite strain specific: CD40 levels were dramatically increased in type II T. gondii-infected BMdMs compared to type I- or type III-infected cells. Type II induction of CD40 was specific to cells harboring intracellular parasites and detectable as early as 6 h postinfection (hpi) at the transcript level. CD40 protein expression peaked at 18 hpi. Using forward genetics with progeny from a type II × type III cross, we found that CD40 induction mapped to a region of chromosome X that included the gene encoding the dense granule protein 15 (GRA15). Using type I parasites stably expressing the type II allele of GRA15 (GRA15II), we found that type I GRA15II parasites induced the expression of CD40 on infected cells in an NF-κB-dependent manner. In addition, stable expression of hemagglutinin-tagged GRA15II in THP-1 cells resulted in CD40 upregulation in the absence of infection. Since CD40 signaling contributes to interleukin-12 (IL-12) production, we examined IL-12 from infected macrophages and found that CD40L engagement of CD40 amplified the IL-12 response in type II-infected cells. These data indicate that GRA15II induction of CD40 promotes parasite immunity through the production of IL-12.

Complement protein C1q directs macrophage polarization and limits inflammasome activity during the uptake of apoptotic cells.

Deficiency in C1q, the recognition component of the classical complement cascade and a pattern recognition receptor involved in apoptotic cell clearance, leads to lupus-like autoimmune diseases characterized by auto-antibodies to self proteins and aberrant innate immune cell activation likely due to impaired clearance of apoptotic cells. In this study, we developed an autologous system using primary human lymphocytes and human monocyte-derived macrophages (HMDMs) to characterize the effect of C1q on macrophage gene expression profiles during the uptake of apoptotic cells. C1q bound to autologous apoptotic lymphocytes modulated expression of genes associated with JAK/STAT signaling, chemotaxis, immunoregulation, and NLRP3 inflammasome activation in LPS-stimulated HMDMs. Specifically, C1q sequentially induced type I IFNs, IL-27, and IL-10 in LPS-stimulated HMDMs and IL-27 in HMDMs when incubated with apoptotic lymphocyte conditioned media. Coincubation with C1q tails prevented the induction of type I IFNs and IL-27 in a dose-dependent manner, and neutralization of type I IFNs partially prevented IL-27 induction by C1q. Finally, C1q decreased procaspase-1 cleavage and caspase-1-dependent cleavage of IL-1ß suggesting a potent inhibitory effect of C1q on inflammasome activation. These results identify specific molecular pathways induced by C1q to suppress macrophage inflammation and provide potential therapeutic targets to control macrophage polarization and thus inflammation and autoimmunity.

Toxoplasma gondii induces B7-2 expression through activation of JNK signal transduction.

Toxoplasma gondii is a globally distributed parasite pathogen that infects virtually all warm-blooded animals. A hallmark of immunity to acute infection is the production of gamma interferon (IFN-γ) and interleukin-12 (IL-12), followed by a protective T cell response that is critical for parasite control. Naïve T cell activation requires both T-cell receptor (TCR) stimulation and the engagement of costimulatory receptors. Because of their important function in activating T cells, the expression of costimulatory ligands is believed to be under tight control. The molecular mechanisms governing their induction during microbial stimulation, however, are not well understood. We found that all three strains of T. gondii (types I, II, and III) upregulated the expression of B7-2, but not B7-1, on the surface of mouse bone marrow-derived macrophages. Additionally, intraperitoneal infection of mice with green fluorescent protein (GFP)-expressing parasites resulted in enhanced B7-2 levels specifically on infected, GFP(+) CD11b(+) cells. B7-2 induction occurred at the transcript level, required active parasite invasion, and was not dependent on MyD88 or TRIF. Functional assays demonstrated that T. gondii-infected macrophages stimulated naïve T cell proliferation in a B7-2-dependent manner. Genome-wide transcriptional analysis comparing infected and uninfected macrophages revealed the activation of mitogen-activated protein kinase (MAPK) signaling in infected cells. Using specific inhibitors against MAPKs, we determined that parasite-induced B7-2 is dependent on Jun N-terminal protein kinase (JNK) but not extracellular signal-regulated kinase (ERK) or p38 signaling. We also observed that T. gondii-induced B7-2 expression on human peripheral blood monocytes is dependent on JNK signaling, indicating that a common mechanism of B7-2 regulation by T. gondii may exist in both humans and mice.

Predicting the phase behavior of nitrogen + n-alkanes for enhanced oil recovery from the SAFT-VR approach: examining the effect of the quadrupole moment.

The phase behavior of nitrogen + n-alkanes is studied within the framework of the statistical associating fluid theory for potentials of variable range (SAFT-VR). The effect of the quadrupole moment of nitrogen on the phase behavior is considered through an extension of the SAFT-VR equation that includes an additional contribution to the Helmholtz free energy due to quadrupolar interactions. A significant improvement in the description of the phase diagram of the binary mixtures of nitrogen with different n-alkanes is obtained with the new approach when compared to predictions from the original SAFT-VR EOS (i.e., without the quadrupolar term). The experimental value for the quadrupole moment of nitrogen is used in the new equation; thus, no additional parameters are employed. Given the nonideal nature of the binary mixtures, a binary interaction parameter is needed to describe the full-phase diagram and high-pressure critical lines of these systems; however, this can be fitted to a single system and successfully used to predict the phase behavior of other binary mixtures without additional fitting. Furthermore, only a single, transferable, cross-energy parameter is required when the quadrupolar term is considered, whereas a cross-range parameter is also needed with the original SAFT-VR approach. The inclusion of the quadrupolar term in the equation of state therefore reduces the need to use effective parameters by explicitly including at the molecular level interactions due to the quadrupole moment.

Cirugía ambulatoria en coloproctología / Ambulatory surgery in cotoproctology

Se presenta un estudio de 89 pacientes operados por problemas anorectales en el Centro Médico de Caracas y el Servicio de Cirugía 2 del Hospital "Carlos J. Bello" en forma ambulatoria, entre octubre de 1993 y octubre de 1994. Más de la mitad de los pacientes fue intervenida bajo anestesia local, recibiendo un anestésico de larga duración y una droga antiinflamatoria no esteroidea para controlar el dolor que sigue al despertar anestésico y el "normal" dolor postoperatorio. Aun cuando los autores están de acuerdo en que cualquier paciente puede ser operado en forma ambulatoria, cambiando el hospital por su casa, se hace hincapié en la selección de los pacientes a quienes se les puede ofrecer esta alternativa, dependiendo, al final, de los resultados inmediatos de la cirugía para su regreso o no a la casa. Las intervenciones practicadas fueron 43 hemorroidectomías, 19 fisurectomías y esfinterotomías, 12 fistulotomías o fistulectomías perianales, 9 ligaduras de hemorroides con bandas elásticas, 4 cistectomías pilonidales y 2 esfinteroplastias. Adicionalmente, en 25 pacientes a quienes se practicó hemorroidectomía o fisurectomía, se añadió una o más ligaduras con bandas elásticas. Ningún paciente fue readmitido al hospital por complicaciones. No hubo accidentes anestésicos ni de otro tipo durante las intervenciones. Ningún paciente necesitó la administración de morfina o sucedáneos. Dos pacientes presentaron epigastralgia que ameritó la suspensión de la droga antinflamatoria no esteroidea. Un paciente presentó sangrado postoperatorio, que no requirió transfusión. Tres pacientes consideraron que sus molestias eran lo suficientemente importantes como para llamar telefónicamente a su médico tratante. Los gastos hospitalarios, incluyeron honorarios por anestesiología representaron el 40 por ciento del total de los mismos gastos si el paciente hubiese estado por lo menos un día hospitalizado. Se concluye que la cirugía ambulatoria es efectiva, segura y económica

¿Es necesaria la morfina en el control del dolor en cirugía anorectal? / Is necessary the morphine in the pain in anorectal surgery?

Tradicionalmente la morfina a sus sucedáneos han sido utilizados en el alivio del dolor postoperatorio en cirugía anorectal. Los efectos secundarios de la morfina y los problemas derivados de su manejo dentro del entorno hospitalario o familiar, han orientado a la búsqueda de otros fármacos que, dando el mismo resultado, ocasionen menos problemas. Este trabajo evalúa el uso de una droga antiinflamatoria no esteroidea en el control del dolor postoperatorio en cirugía anorectal, llevado a cabo en forma prospectiva entre octubre de 1993 y octubre de 1994. Ciento seis pacientes fueron ingresados al protocolo, siendo 80 de ellos como ambulatorios. El estudio evaluó la administración de una ampolla de ketoprofen al finalizar el efecto de la anestesia empleada y continuar luego utilizando la misma droga por vía oral, en forma de comprimidos entéricos, durante un mínimo de tres días y máximo de cinco, recurriendo a la vía inyectable si la oral no era suficiente para mantener el dolor en límites tolerables. En 67 pacientes la cirugía fue cerrada; en 51 la anestesia empleada fue peridural simple; en 34, local; en 13, general; en 4 peridural continua y en 4 no se utilizó anestesia. En 50 pacientes que recibieron anestesia general o peridural, se hizo una infiltración local de 10 ml de bupivacaína al 0,25 por ciento, alrededor de la o las heridas al terminar la intervención. Dos pacientes mostraron intolerancia a la droga utilizada; en 2 fue necesario abortar la peridural continua por razones de enfermería y en 3 pacientes hubo retención urinaria postoperatoria. Ningún paciente ameritó la administración de morfina o sus sucedáneos

La técnica del doble engrapado en cirugía colorectal: ¿vale la pena? / The double stapled technique in colorectal surgery: to be worth while?

La resección del recto, con anastomosis extra-peritoneal colorectal o ileorectal, fue hecha en 74 pacientes. En 39, la anastomosis se realizó empleando la técnica del doble engrapado, con el instrumento EEA-Premium, la pinza de sutura en bolsa de tabaco y el instrumento de autosutura TA-55 regular y/o rotatorio. En 35 pacientes la anastomosis fue construida manualmente, suturándose en dos capas con poliglactin 910, 3-0. Ambos grupos fueron comparables en relación a edad, sexo, preparación de colon y patología local. En cuatro pacientes se escogió la técnica de doble engrapado debido a que la anastomosis debía ser construida profundamente en la pelvis y se consideró que la anastomosis manual aunque posible, resultaba muy difícil de ser realizada. Del estudio fueron excluidos los pacientes portadores de una peritonitis local generalizada. Se admisnitraron 3 g de cefotaxime y 1,5 g de metronidazole durante el acto operatorio solamente. En el grupo tratado mediante anastomosis mecánica, dos pacientes (5,1 por ciento) presentaron una complicación importante relacionada con la técnica: una fístula colovaginal y un absceso pélvico. No hubo muertes en este grupo. en el grupo de las anastomosis manuales, hubo tres complicaciones importantes (8,4 por ciento): dos abscesos pélvicos y un absceso de pared. Uno de estos pacientes falleció por sepsis (3 por ciento). El tiempo corriente para construir la anastomosis con doble engrapado fue de 15 minutos y la anastomosis manual de 30 minutos. En nuestra experiencia, el doble engrapado es seguro, confiable y permite conservar el esfínter en aquellos pacientes donde hay necesidad de construir anastomosis colorectales o ileorectales bajas