Eosinophilic colitis with favorable response to vedolizumab.

Eosinophilic gastroenteritis is a rare, chronic inflammatory disease with eosinophil infiltration in the digestive tract. Treatment typically involves corticosteroids, but new therapies, including vedolizumab, are under evaluation. Vedolizumab inhibits lymphocyte migration to intestinal tissue, impacting eosinophil activity. We report a 34-year-old male with eosinophilic colitis, dependent on corticosteroids, who showed clinical improvement with vedolizumab. Despite a mild flare-up, intensifying vedolizumab resulted in prolonged stability and reduced steroid use over seventeen months. Although corticosteroids are the primary treatment, vedolizumab shows promise in some cases, warranting further investigation to confirm its effectiveness.

"Cap polyposis", refractory to drug treatment, including infliximab.

Cap polyposis is a rare disease characterized by the presence of inflammatory polyps with an adherent fibrin sheath ("cap"), in variable number and size, in the rectum and sigmoid. It presents with tenesmus, mucous stools and rectorrhagia. There is currently no standardized treatment, having been treated empirically with aminosalicylates, oral or rectal steroids, metronidazole, H. pylori eradication therapy and infliximab with variable results. In refractory cases, endoscopic resection of polyps may be used and surgery may even be necessary. We present the case of a 36-year-old patient diagnosed in our center with cap polyposis, refractory to both pharmacological and endoscopic treatment, and therefore treatment with infliximab was decided out of indication. The case we present is the fourth case of cap polyposis treated with infliximab available in the current literature and highlights the difficulty of achieving a clinical response with pharmacological treatment, including biologic drugs such as infliximab.

Peristomal cutaneous Crohn's disease by contiguity.

Peristomal ulcer is a frequent complication that, in most cases, is mild and responds to topical treatment. In much less frequent cases, it is associated with other pathologies, such as Crohn's disease, requiring in these cases systemic treatment, including surgery. The differential diagnosis between Cutaneous Inflammatory Bowel Disease and Pyoderma Gangrenosum is interesting, although both are managed in a similar way.

Genomic Characterization of Bacillus safensis Isolated from Mine Tailings in Peru and Evaluation of Its Cyanide-Degrading Enzyme CynD.

Understanding the biochemistry and metabolic pathways of cyanide degradation is necessary to improve the efficacy of cyanide bioremediation processes and industrial requirements. We have isolated and sequenced the genome of a cyanide-degrading Bacillus strain from water in contact with mine tailings from Lima, Peru. This strain was classified as Bacillus safensis based on 16S rRNA gene sequencing and core genome analyses and named B. safensis PER-URP-08. We searched for possible cyanide-degradation enzymes in the genome of this strain and identified a putative cyanide dihydratase (CynD) gene similar to a previously characterized CynD from Bacillus pumilus C1. Sequence analysis of CynD from B. safensis and B. pumilus allow us to identify C-terminal residues that differentiate both CynDs. We then cloned, expressed in Escherichia coli, and purified recombinant CynD from B. safensis PER-URP-08 (CynDPER-URP-08) and showed that in contrast to CynD from B. pumilus C1, this recombinant CynD remains active at up to pH 9. We also showed that oligomerization of CynDPER-URP-08 decreases as a function of increased pH. Finally, we demonstrated that transcripts of CynDPER-URP-08 in B. safensis PER-URP-08 are strongly induced in the presence of cyanide. Our results suggest that the use of B. safensis PER-URP-08 and CynDPER-URP-08 as potential tool for cyanide bioremediation warrants further investigation. IMPORTANCE Despite being of environmental concern around the world due to its toxicity, cyanide continues to be used in many important industrial processes. Thus, searching for cyanide bioremediation methods is a matter of societal concern and must be present on the political agenda of all governments. Here, we report the isolation, genome sequencing and characterization of cyanide degradation capacity of a bacterial strain isolated from an industrial mining site in Peru. We characterize a cyanide dehydratase (CynD) homolog from one of these bacteria, Bacillus safensis PER-URP-08.

Individual exposure to air pollutants in a Portuguese urban industrialized area.

Industrial development from the second half of the 20th century coupled with population growth and concentration in urban areas has accentuated the concern for potential effects and impacts from air pollutant emissions on environmental and human health. This study examined the Estarreja region, an urban area that has one of the largest chemical complexes in Portugal, a complex that was recently under expansion. In the scope of the INSPIRAR project, individual daily exposure of a group of individuals to particulate matter of 10 µm aerodynamic diameter (PM10) and nitrogen dioxide (NO2) in two phases was determined using a microenvironmental approach. In this context, personal daily activity profiles of individuals were established for their normal routine by personal interviews. These profiles enabled determination of where each individual was at each moment of the day. Utilizing this information with hourly air quality maps simulated with URBAIR air quality model and indoor/outdoor relationships, it was possible to calculate personal daily exposure of each individual to air pollutants. Results from the analysis of daily activity profiles showed a high level of sedentariness of this population and long durations spent indoors. The studied individuals displayed high personal PM10 and NO2 exposure variability. Data demonstrated possible error when a single concentration measurement was assumed as a proxy of exposure. In general, no significant differences were found between the two population groups, indicating that workers of the chemical complex were not exposed to a greater extent to PM10 and NO2 than the general population working in the same area.

Initial construction and validation of the Pathological Narcissism Inventory.

The construct of narcissism is inconsistently defined across clinical theory, social-personality psychology, and psychiatric diagnosis. Two problems were identified that impede integration of research and clinical findings regarding narcissistic personality pathology: (a) ambiguity regarding the assessment of pathological narcissism vs. normal narcissism and (b) insufficient scope of existing narcissism measures. Four studies are presented documenting the initial derivation and validation of the Pathological Narcissism Inventory (PNI). The PNI is a 52-item self-report measure assessing 7 dimensions of pathological narcissism spanning problems with narcissistic grandiosity (Entitlement Rage, Exploitativeness, Grandiose Fantasy, Self-sacrificing Self-enhancement) and narcissistic vulnerability (Contingent Self-esteem, Hiding the Self, Devaluing). The PNI structure was validated via confirmatory factor analysis. The PNI correlated negatively with self-esteem and empathy, and positively with shame, interpersonal distress, aggression, and borderline personality organization. Grandiose PNI scales were associated with vindictive, domineering, intrusive, and overly-nurturant interpersonal problems, and vulnerable PNI scales were associated with cold, socially avoidant, and exploitable interpersonal problems. In a small clinical sample, PNI scales exhibited significant associations with parasuicidal behavior, suicide attempts, homicidal ideation, and several aspects of psychotherapy utilization.

Transferência e desfecho terapêutico em psicoterapia psicodinâmica breve / Transfer and therapeutic endpoints psychodynamic in brief / La transferencia y finalización terapéutica en psicoterapia breve

A pesquisa teve como objetivo geral verificar a relação entre desfecho terapêutico e momentos transferenciais que tenham ocorrido ao longo dos processos de psicoterapia breve analisados. Para embasar teoricamente o conceito de transferência, foram utilizados textos de Sigmund Freud e Melanie Klein. Trata-se de uma pesquisa exploratória e documental de caráter qualitativo. Analisaram-se 17 prontuários de pacientes, entre 20 e 40 anos, que foram atendidos em um serviço-escola de 2002 até 2006. Foi realizado o processo de análise temática que precedeu a categorização. Com base na leitura de 262 sessões de psicoterapia, selecionaram-se momentos transferenciais relevantes de cada caso analisado e criaram-se categorias de transferências. O manejo da transferência realizado pelos estagiários parece ter tido relação direta com o desfecho terapêutico dos atendimentos. Em 13 dos 17 prontuários, mesmo tendo havido obtenção do foco proposto, os pacientes foram encaminhados para processos de psicoterapia longa.

This research aims to verify if there is relationship between the therapeutic outcome and the transference moments that have occurred over the processes of psychotherapy shortly analyzed. To a theoretically support of foundation of the concept of transfer, were used texts of Sigmund Freud and Melanie Klein. This is an exploratory research and a documentary qualitative in nature. Were analyzed records of 17 patients who were treated in a clinic-school in 2002 until 2006, individuals between 20 and 40 years. Was realized the review process thematic what preceding the classification. From the reading of 262 sessions of psychotherapy, were selected the most important moments of transference of each case analyzed and then, created categories of transfer. The handling of the transfer, done by trainees, seems to have had direct relationship with the therapeutic outcome of the cases examined. In 13 of 17 cases, patients were sent for the long psychotherapy process, even with successful treatment.

La investigación busca verificar la relación entre el resultado terapéutico y los momentos transferenciales que hayan sucedido a lo largo de los procesos de psicoterapia breve analizados. Para fundamentar teóricamente el concepto de transferencia, se utilizaron textos de Sigmund Freud y Melanie Klein. Se trata de una investigación exploratoria y documental de carácter cualitativo. Se analizaron 17 historias clínicas de pacientes entre 20 y 40 años, atendidos en una clínica-escuela desde el año 2002 al 2006. Fue realizado el proceso de análisis temático que precedió a la categorización. A partir de la lectura de 262 sesiones de psicoterapia, se seleccionaron momentos transferenciales relevantes de cada caso analizado y se crearon tipos de transferencia. El manejo de transferencias realizado por el personal en prácticas, parece haber tenido relación directa con el resultado terapéutico de los casos analizados y, en 13 de los 17 casos, incluso con la obtención del objetivo propuesto, los pacientes fueron encaminados hacia procesos de psicoterapia larga.

Psychiatric and medical co-morbidity in mitral valve prolapse.

OBJECTIVE: Significant controversy continues to exist in the empirical literature regarding the diagnosis and treatment of mitral valve prolapse (MVP). In addition, there is also inconsistency in the correlation of anxiety disorders as co-existing with MVP, as well as cause and effect issues in terms of the role of the autonomic nervous system, MVP and panic attacks. Recent studies suggest that the co-morbidity of an anxiety disorder and clinical depression appears to increase the likelihood of MVP in predisposed patients. The objective of this review was to examine, clarify, and further define the medical and psychiatric aspects of MVP. METHODS: A literature review was conducted on empirical studies and reviews examining MVP. RESULTS: It was found that although MVP is highly correlated with psychiatric disorders, the lack of adequate control groups and clear criteria for a diagnosis of MVP in most empirical studies examining these associations make it difficult to determine the relationship between MVP and psychiatric disorders. CONCLUSIONS: Suggestions for further research in the areas of depression and personality characteristics are offered. It is also suggested that the use of control groups from populations with cardiac disorders and a better definition of MVP will clarify many of the problems in empirical studies aiming to determine the relationship between MVP and psychiatric disorders.