How inflammation influences psychiatric disease.

Recent studies highlight the strong correlation between infectious diseases and the development of neuropsychiatric disorders. In this editorial, we comment on the article "Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients" by Zhang et al, published in the recent issue of the World Journal of Psychiatry 2023; 13 (11): 903-911. Our discussion highlighted the potential consequences of anxiety, depression, and psychosis, which are all linked to bacterial, fungal, and viral infections, which are relevant to the impact of inflammation on the sequelae in mental health as those we are observing after the coronavirus disease 2019 pandemic. We focus specifically on the immune mechanisms triggered by inflammation, the primary contributor to psychiatric complications. Importantly, pathophysiological mechanisms such as organ damage, post-injury inflammation, and infection-induced endocrine alterations, including hypocortisolism or autoantibody formation, significantly contribute to the development of chronic low-grade inflammation, promoting the emergence or development of psychiatric alterations in susceptible individuals. As inflammation can have long-term effects on patients, a multidisciplinary treatment plan can avoid complications and debilitating health issues, and it is crucial to recognize and address the mental health implications.

Role of Angiotensin II in Non-Alcoholic Steatosis Development.

Fatty liver is a multifactorial disease characterized by excessive accumulation of lipids in hepatocytes (steatosis), insulin resistance, oxidative stress, and inflammation. This disease has a major public health impact because it is the first stage of a chronic and degenerative process in the liver that can lead to steatohepatitis, cirrhosis, and liver cancer. Although this disease is mainly diagnosed in patients with obesity, type 2 diabetes mellitus, and dyslipidemia, recent evidence indicates that vasoactive hormones such as angiotensin II (ANGII) not only promote endothelial dysfunction (ED) and hypertension, but also cause fatty liver, increase adipose tissue, and develop a pro-steatotic environment characterized by a low-grade systemic pro-inflammatory and pro-oxidant state, with elevated blood lipid levels. The role of ANGII in lipid accumulation has been little studied, so this review aims to summarize existing reports on the possible mechanism of action of ANGII in inducing lipid accumulation in hepatocytes.

Metabolic Recovery with the Persistence of Proinflammatory Leucocyte Dysfunction After Bariatric Intervention for Obesity.

PURPOSE: A suitable option for severe obesity treatment is a surgical approach. After surgery, metabolic markers and weight frequently return to adequate values; however, concerning systemic inflammatory mediators, the results are inconsistent. Furthermore, it has been suggested that leucocyte function may be affected even after weight normalization. This study aimed to determine if the surgical treatment of obesity influences the production of cytokines by LPS-stimulated as a function of leucocytes. MATERIALS AND METHODS: We performed a cross-sectional study that investigated the production of cytokines in response to lipopolysaccharide (LPS) along a kinetic of simulation by leucocytes recovered from individuals with normal weight (NW, n = 8), persons living with obesity (Ob, n = 7), persons living with obesity and diabetes mellitus (Ob-DM, n = 17), and persons that used to live with obesity who underwent bypass surgery (fOb + bypass, n = 8) and recover normal weigh. RESULTS: IL-6 levels were significantly higher in the Ob and fOb + bypass groups than in NW (p = 0.043). IL-10 secretion without LPS was significantly higher in the NW group than in the other groups explored (p < 0.05). When exposed to LPS, the IL-10 levels increased in all groups except the NW group. As also observed for IL-18 and IL-33, the secretion curve of the fOb + bypass group was more similar to the Ob group, even when they had reached normal weight, as opposed to the NW group. CONCLUSION: Our results show that in patients with fOb + bypass, inflammatory and anti-inflammatory cytokine production dynamics remain disrupted even with improved metabolic control and normal weight recovery.

Newcastle disease virus vector-based SARS-CoV-2 vaccine candidate AVX/COVID-12 activates T cells and is recognized by antibodies from COVID-19 patients and vaccinated individuals.

Introduction: Several effective vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed and implemented in the population. However, the current production capacity falls short of meeting global demand. Therefore, it is crucial to further develop novel vaccine platforms that can bridge the distribution gap. AVX/COVID-12 is a vector-based vaccine that utilizes the Newcastle Disease virus (NDV) to present the SARS-CoV-2 spike protein to the immune system. Methods: This study aims to analyze the antigenicity of the vaccine candidate by examining antibody binding and T-cell activation in individuals infected with SARS-CoV-2 or variants of concern (VOCs), as well as in healthy volunteers who received coronavirus disease 2019 (COVID-19) vaccinations. Results: Our findings indicate that the vaccine effectively binds antibodies and activates T-cells in individuals who received 2 or 3 doses of BNT162b2 or AZ/ChAdOx-1-S vaccines. Furthermore, the stimulation of T-cells from patients and vaccine recipients with AVX/COVID-12 resulted in their proliferation and secretion of interferon-gamma (IFN-γ) in both CD4+ and CD8+ T-cells. Discussion: The AVX/COVID-12 vectored vaccine candidate demonstrates the ability to stimulate robust cellular responses and is recognized by antibodies primed by the spike protein present in SARS-CoV-2 viruses that infected patients, as well as in the mRNA BNT162b2 and AZ/ChAdOx-1-S vaccines. These results support the inclusion of the AVX/COVID-12 vaccine as a booster in vaccination programs aimed at addressing COVID-19 caused by SARS-CoV-2 and its VOCs.

Sociodemographic, clinical and pharmacological characteristics of older adults with fractures, in three reference centers, Colombia / Características sociodemográficas, clínicas y farmacológicas de adultos mayores con fracturas, en tres centros de referencia, Colombia

Abstract Introduction: Falls and bone fractures are important causes of morbidity and mortality in the elderly. Its etiology is multicausal, including inadequate prescriptions and osteoporosis. The aim was to identify the clinical and pharmacological characteristics of a group of older adults diagnosed with fractures in Colombia. Methods: Cross-sectional study that analyzed the prescriptions made one month before the fracture, during hospitalization and discharge. Patients aged 60 years and over were selected, assisted in three reference centers in Colombia. The quality of the prescriptions was analyzed using the STOPP criteria. Results: 220 pa- tients with fractures were included, with a mean age of 75.3±10.3 years and 68.2 % were women. Hip fracture was the most frequent (37.7 %) and in-hospital mortality was 2.3 %. Prescription of calcium/vitamin D supplements and antiabsortive therapy at discharge was 23.7 % and 12.1 %, respectively. Prescriptions potentially inappropriate to discharge were identified in 11.6 % of patients and having five or more comorbidities was associated with greater probability of having them (OR:9.44, 95 % CI: 2.16-41.20). Conclusions: Medical staff generally do not formulate antiosteporotic medications as secondary prevention or improve the quality of prescriptions for fractured patients once they are hospitalized and discharged, so it is necessary to develop pharmacological strategies to help prevent new episodes of falls and fractures.

Resumen Introducción: las caídas y fracturas óseas son causas importantes de morbilidad y mortalidad en ancianos. Su etiología es multicausal comprendiendo, entre otros, prescripciones inadecuadas y osteoporosis. El objetivo fue identificar las características clínicas y farmacológicas de un grupo de adultos mayores con fracturas. Materiales y métodos: estudio de corte transversal que analizó las prescripciones realizadas un mes antes de la fractura, durante la hospitalización y al egreso de 220 pacientes de 60 o más años atendidos en tres centros de referencia de Colombia. Se analizó la calidad de las prescripciones mediante los criterios STOPP. Resultados: la edad media fue de 75,3±10,3 años y 68,2 % eran mujeres. La fractura de cadera fue la más frecuente (37,7 %) y se presentó una mortalidad intrahospitalaria del 2,3 %. La prescripción de suplementos de calcio/vitamina D y terapia antiabsortiva al egreso fue de 23,7 % y 12,1 %, respectivamente. Las prescripciones potencialmente inapropiadas al egreso se identificaron en 11,6 % de pacientes y tener cinco o más comorbilidades se asoció con mayor probabilidad de tenerlas (OR:9,44, IC95 %: 2,16-41,20). Conclusiones: generalmente, el personal médico no formula medicamentos antiosteporóticos como prevención secundaria, ni mejoran la calidad de las prescripciones de los pacientes con fracturas una vez que son dados de alta, por lo que se hace necesario el desarrollo de estrategias farmacológicas para ayudar a prevenir nuevos episodios de caídas y fracturas.

Prevalence and trends of mental disorders requiring inpatient care in the city of Porto Alegre: a citywide study including all inpatient admissions due to mental disorders in the public system from 2013-2017 / Prevalência e tendências temporais de transtornos mentais necessitando de tratamento de internação na cidade de Porto Alegre: um estudo de toda a cidade incluindo todas as internações por motivo de saúde mental no sistema público de 2013-2017

Abstract Objectives To investigate the 5-year prevalence of patients admitted to public inpatient care units due to a mental disorder, stratifying them by age group and diagnosis, and to assess trends of admissions over this time period in Porto Alegre. Methods All admissions to the public mental health care system regulated by the city-owned electronic system Administração Geral dos Hospitais (AGHOS) were included in the analysis. The total population size was obtained by estimations of Fundação de Economia e Estatística (FEE). General information about 5-year prevalence of inpatient admissions, time-series trends e prevalence by age groups and diagnosis were presented. Results There were 32,608 admissions over the 5-year period analyzed. The overall prevalence of patients was 1.62% among the total population, 0.01% among children, 1.12% among adolescents, 2.28% among adults and 0.93% among the elderly. The most common diagnosis was drug-related, followed by mood, alcohol-related and psychotic disorders. There was a linear trend showing an increase in the number of admissions from 2013 to the midst of 2014, which dropped in 2015. Conclusions Admissions due to mental disorders are relatively common, mainly among adults and related to drug use and mood disorders. Time trends varied slightly over the 5 years. Prevalence rates in real-world settings might be useful for policymakers interested in planning the public mental health system in large Brazilian cities.

Resumo Objetivos Investigar a prevalência de 5 anos de pacientes internados no sistema público de saúde por motivo de saúde mental, estratificando-os por grupo etário e diagnóstico, e avaliar tendências temporais nas admissões nesse período em Porto Alegre. Métodos Todas as admissões no sistema público de saúde mental reguladas pelo sistema eletrônico da cidade, denominado Administração Geral dos Hospitais (AGHOS), foram incluídos na análise. A população total foi obtida a partir de estimativas da Fundação de Economia e Estatística (FEE). Informações gerais sobre a prevalência de 5 anos de admissões, tendências das séries temporais e prevalência por grupo etário e por diagnóstico foram apresentadas. Resultados Ocorreram 32.608 admissões no período de 5 anos analisado. A prevalência global de pacientes foi de 1,62% na população total, 0,01% em crianças, 1,12% em adolescentes, 2,28% em adultos e 0,93% em idosos. Os diagnósticos mais comuns foram relacionados ao uso de drogas, seguidos de transtornos de humor, relacionados ao álcool e transtornos psicóticos. Houve uma tendência linear mostrando um aumento no número de admissões de 2013 a meados de 2014, que caíram em 2015. Conclusões Admissões por transtornos mentais são relativamente comuns, principalmente entre adultos e relacionados ao uso de drogas e transtornos de humor. Tendências lineares variaram levemente nos últimos 5 anos. Estimativas de prevalência no mundo real podem ser úteis para formuladores de políticas interessados em planejar o sistema público de saúde mental em grandes cidades brasileiras.

Feto con trisomía 18 asociado a mola parcial / Fetus with trisomy 18 associated to partial molar

We present a 38 years old women G2P1A1 who was detected hydramnios; fetal growth restriction, altered Doppler and multiple vesicular forms in the placental structure; at 24 weeks of gestation. A genetic study in amniotic fluid was performed and we determinate a 18 trisomy. The labour begun spontaneously at her´s 32 weeks of gestation, showing us a masculine fetus who had, fenotipically, a small heel malformation. In the macroscopic exam of the placenta, we saw a multicystic form in approximately 15 percent of its structure. The histology demostrated partial molar degeneration and trophoblastic hyperplasia.

Se presenta el caso de una paciente de 38 años, G2P1A1, quien a las 24 semanas de gestación le fue pesquisado un polihidroamnios, asociado a restricción de crecimiento intrauterino, Doppler materno alterado y múltiples imágenes vesiculares en relación a la placenta. Se realizó estudio genético en líquido amniótico que determinó la presencia de una trisomía 18. El trabajo de parto se inicio espontáneamente a las 32 semanas y se obtuvo un producto masculino de 950 gramos, fenotípicamente sólo presentaba leve malformación del talón (talón enpiolet). Al examen macroscópico la placenta presentaba múltiples zonas con vesículas grandes y pequeñas en +/- 15 por ciento de su estructura. El estudio histológico demostró degeneración molar parcial con hiperplasia trofoblástica.

Características clínicas y evolución de pacientes con SIDA y dolor abdominal agudo / Clinical characteristics and follow-up of patients with AIDS and acute abdominal pain

Los síntomas abdominales son frecuentes en el SIDA y el dolor abdominal es un reto diagnóstico que puede requerir cirugía electiva o urgente aunque la información acerca de esta última es pobre. En este estudio analizamos los hallazgos clínicos y evolución de pacientes con SIDA y dolor abdominal agudo. En un periodo de dos años, recolectamos variables demográficas y de laboratorio, síntomas clínicos, diagnóstico inicial, hallazgos quirúrgicos, diagnóstico postquirúrgico, hallazgos histopatológicos y complicaciones postoperatorias de pacientes con SIDA y dolor abdominal agudo. De 232 pacientes hospitalizados, 34 tuvieron dolor abdominal agudo: 32 hombres y 2 mujeres (mediana de edad = 32 años; intervalos 26 a 58). Veintidós pacientes requirieron manejo quirúrgico. Ocho pacientes presentaron complicaciones postquirúrgicas; cinco requirieron seis segundas intervenciones. Ocurrieron tres muertes en los 30 días luego de la cirugía inicial. La supervivencia para los pacientes tratados médicamente fue 4 meses (1 a 17), contra 6.5 meses (1 a 20) del grupo quirúrgico. El médico debe estar alerta acerca de las posibilidades diagnósticas del enfermo con SIDA y dolor abdominal agudo. Demorar la cirugía puede ser letal. La cirugía tiene un papel importante en el tratamiento integral del paciente con SIDA.

Abdominal symptoms frequently affect patients with AIDS. Acute abdominal pain is a diagnostic challenge that may require elective or urgent surgical treatment, although information about the latter is scarce. In this study we analyzed the clinical findings and follow up of acute abdominal pain complicating patients with AIDS. In a two-year period, we collected several variables from patients with AIDS and acute abdominal pain: demographic, laboratory, clinical symptoms, initial diagnosis, surgical findings, post surgical and histopathological diagnosis and post surgical complications. From 232 hospitalized patients, 34 had acute abdominal pain: 32 male and 2 women (median age = 32 years; range 26 to 58 years). Twenty-two patients required surgical treatment. Eight patients had a post surgical complication; in five of them, six surgical re interventions were performed. Three deaths occurred in the 30 day period after surgery. Survival for patients conservatively treated was 4 months (1 to 17 months), vs. 6.5 months (1 to 20 months) in the surgically treated group. Physicians should be aware about the several diagnostic possibilities of acute abdominal pain complicating patients with AIDS. Delay of surgery in these patients may be lethal. Surgery has an important role in the integral treatment of patients with AIDS.

Aplicación del ultrasonido power Doppler 3D para la visualización de estructuras del endometrio / Usefulness of 3D-power Doppler ultrasound for endometrial thickening

This study provides evidence on the extent to which color power Doppler imaging technique may improve accuracy in endometrial thickening etiologic diagnosis, which in connection with clinical records may prove to be of significant usefulness for patients. Features of the technique and an imaging gallery for proper interpretation of its use are provided as well. This is a preliminary report of a more comprehensive case report that will include statistical findings.

El presente estudio muestra cómo el uso del power Doppler color puede ayudar en el diagnóstico etiológico del engrosamiento endometrial, lo que apoyado por la clínica puede ser de mucha utilidad para el paciente. Además, se definen las condiciones de la técnica y se presenta una galería de imágenes para su interpretación. Este es un informe preliminar de una casuística mayor, que contará con un estudio estadístico.

Mama aberrante axilar / Aberrant axillary breast

Se estudia prospectivamente 19 pacientes portadoras de mama aberrante axilar que consultaron en la Unidad de Mastología del Servicio de Obstetrícia y Ginecología del Hospital del Salvador, precisando aspectos ginecológicos, somáticos y motivación de las afectadas que fueron sometidas a intervención quirúrgica. El resultado histológico permitió precisar la presencia de tejido mamario atrófico, displásico y cáncer de las piezas obtenidas. Se insiste en la indicación quirúrgica como una solución eficaz de esta anomalía

Hamartoma de la vía biliar. Reporte de un caso / Bile duct hamartoma. Report of a case

Antecedentes: las obstrucciones de la vía biliar en general son provocadas por cálculos y neoplasias. Existen otras alteraciones mucho menos frecuentes que pueden provocar obstrucción, entre ellas se encuentran los hamartomas de la vía biliar. Se presenta el caso de una paciente de 34 años diabética, que inicia su padecimiento con dolor abdominal e ictericia. El estudio inicia con ultrasonido de vesícula y vías biliares, que reporta colelitiasis y dilatación de vías biliares. Se realiza CPRE y se descubre una lesión ocupativa del árbol biliar. Se somete a colecistectomía y exploración de la vía biliar. La evolución de la paciente fue satisfactoria. La revisión de patología reporta un hamartoma de la vía biliar extrahepática. Los hamartomas de la vía biliar son neoplasias benignas poco frecuentes, sin embargo, debemos de tenerlas en mente como parte del diagnóstico diferencial.

Tratamento das fraturas cominutivas do fêmur pelo método de placa em ponte / Treatment of several comminuted femoral shaft fractures treated by bridging osteosynthesis

Os autores analisam os resultados de dez casos de fraturas cominutivas graves do fêmur que foram operadas entre março de 1990 e junho de 1993 no HUCFF-UFRJ. O método de estabilizaçäo cirúrgica foi a "osteossíntese por placa em ponte" sem abertura do foco de fratura. A consolidaçäo ocorreu num tempo médio de 20 semanas. Nao é necessário nenhum instrumento ou equipamento especializado. Os resultados foram considerados excelentes em 80 por cento dos casos e a taxa de complicaçöes foi relativamente baixa, quando comparada aos outros meios de osteossíntese. No tratamento cirúrgico das fraturas cominutivas graves do fêmur, consideramos esta técnica vantajosa e acessível à maioria dos serviços de nosso país.

Cistouretropexia combinada en la correción de la incontinencia urinaria de esfuerzo (I.U.E.) / Combined cystourethropexia in the treatment of stress urinary incontinence

Se estudia prospectivamente un grupo de 32 pacientes portadoras de colpocistocele e I.U.E. de 2§ y 3§ grado, que fueron sometidas a cistouretropexia combinada en el Servicio de Ginecología y Obstetricia del Hospital del Salvador durante el período desde marzo de 1980 hasta agosto de 1985. En la intervención se usó un instrumento guía diseñado específicamente para esta experiencia. Se concluye que la técnica empleada resultó de fácil práctica y sin complicaciones de importancia atribuíbles al nuevo instrumento. El porcentaje de curación general en esta casuística fue de 84,3%

Cáncer de ovario: comunicación preliminar / Ovarian cancer: preliminary communication

Se analizan los antecedentes clínicos de 51 pacientes con cáncer de ovario, estudiadas y tratadas en el Servicio de Obstetricia y Ginecología del Hospital del Salvador, entre diciembre de 1980 y diciembre de 1986. El diagnóstico se efectuó en etapas avanzadas en 68,2% de los casos, siendo los tumores de origen epitelial la variedad predominante, en el 78,3%. Se desarrolló un protocolo operatorio preestablecido en forma completa en el 82,3%, y se analizan las principales complicaciones postoperatorias. La terapia complementaria predominante fue quimioterapia, que se efectuó en 23 de 27 casos. La tasa de mortalidad en el tiempo de seguimiento alcanza al 8,3% en etapa I; 25% en etapa II; 35% en etapa III, y 70% en etapa IV. En 12 pacientes se ha efectuado revisión de "segundo vistazo", evidenciándose ausencia de enfermedad en sólo la mitad de los casos