Omphalocele: clinical and epidemiological profile of patients born in a tertiary care center in Rio de Janeiro.

BACKGROUND: The objective of this paper is to describe the clinical and epidemiological profile and the early outcomes of patients with omphalocele born in a fetal medicine, pediatric surgery, and genetics reference hospital in Rio de Janeiro - Brazil. To determine its prevalence, describe the presence of genetic syndromes, and congenital malformations, emphasizing the characteristics of congenital heart diseases and their most common types. METHODS: Using Latin-American Collaborative Study of Congenital Malformations (ECLAMC) database and records review, a retrospective cross-sectional study was performed, including all patients born with omphalocele between January 1st, 2016, and December 31st, 2019. RESULTS: During the period of the study, our unity registered 4,260 births, 4,064 were live births and 196 stillbirths. There were 737 diagnoses of any congenital malformation, among them 38 cases of omphalocele, 27 were live born, but one was excluded for missing data. 62.2% were male, 62.2% of the women were multiparous and 51.3% of the babies were preterm. There was an associated malformation in 89.1% of the cases. Heart disease was the most common (45.9%) of which tetralogy of Fallot was the most frequent (23.5%). Mortality rate was 61.5%. CONCLUSIONS: Our data showed a good correspondence with the existing literature. Most patients with omphalocele had other malformations, especially congenital heart disease. No pregnancy was interrupted. The presence of concurrent defects showed a huge impact on prognosis, since, even if most survived birth, few remained alive and received hospital discharge. Based on these data, fetal medicine and neonatal teams must be able to adjust parents counseling about fetal and neonatal risks, especially when other congenital diseases are present.

Neuropsychological Assessment in the Distinction Between Biomarker Defined Frontal-Variant of Alzheimer's Disease and Behavioral-Variant of Frontotemporal Dementia.

BACKGROUND: Frontal-variant of Alzheimer's disease (fvAD) was purposed for patients with AD pathology that, despite the typical amnestic presentation, show early and progressive deterioration of behavior and executive functions, closely resembling the behavioral-variant of frontotemporal dementia (bvFTD). This leads to a challenging differential diagnosis where neuropsychological evaluation and in vivo pathological evidence are essential. OBJECTIVE: To evaluate the contribution of a comprehensive neuropsychological assessment (NP) battery in distinguishing between fvAD-dementia and bvFTD supported by cerebrospinal fluid (CSF) biomarkers. METHODS: We included 40 patients with a baseline NP profile with prominent early executive and/or behavioral dysfunction, who meet both diagnosis of bvFTD and fvAD-dementia, according to international criteria. All patients underwent comprehensive NP assessment and CSF-AD biomarker evaluation. Neuropsychological domains as well as clinical and sociodemographic features, and APOE genotype were compared between groups. RESULTS: 21 patients (52.5%) met the biological criteria for AD (decreased Aß42 together with increased T-tau or P-tau in CSF) and were therefore classified as fvAD (mean age was 64.57, with 47.6% female). There were no differences between groups regarding age/age-at-onset, gender, or educational level. Regarding neuropsychological profile, performances in language and memory functions were equivalent in both groups. Significant differences were found in visuo-constructional abilities (p = 0.004), Trail Making Test A (p < 0.001), and Raven's Colored Progressive Matrices (p = 0.019), with fvAD patients showing worst performances. CONCLUSION: In patients with an early prominent frontal profile, a higher impairment in attention and visuo-spatial functions, signaling additional right hemisphere fronto-parietal dysfunction, point towards a diagnosis of fvAD-dementia and may be useful in clinical practice.

Zincon-Modified CNTs Electrochemical Tool for Salivary and Urinary Zinc Detection.

Recently, the abnormal level of zinc emerged as a powerful indicator or risk factor for metabolic, endocrine, neurodegenerative and cardiovascular diseases, including cancer. Electrochemical detection has been explored to quantify zinc in a precise, rapid, and non-expensive way; however, most of the current electrochemical systems lack in specificity. In this work we studied a highly selective and sensitive electrochemical method to detect quickly and reliably free zinc ions (Zn2+). The surface of the working electrode was modified with zincon electropolymerized on carbon nanotube (CNT) to enable the binding of zinc in complex body fluids. After being physicochemically characterized, the performances of the zincon-CNT complex was electrochemically assessed. Square Wave Voltammetry (SWV) was used to determine the calibration curve and the linear range of zinc quantification in artificial saliva and urine. This zincon- CNT system could specifically quantify mobile Zn2+ in salivary and urinary matrices with a sensitivity of ~100 ng·mL-1 and a limit of detection (LOD) of ~20 ng·mL-1. Zincon-modified CNT presented as a desirable candidate for the detection and quantification of free zinc in easily body fluids that potentially can become a diagnostic non-invasive testing platform.

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Abstract Background: Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs. Objective: To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation. Methods: In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally participated in 6 meetings of an interdisciplinary group with a nutritionist and a psychologist. Anthropometric data and results from a food frequency questionnaire (FFQ), Lipp's Inventory of Stress Symptoms for Adults (ISSL), and the 12-Item Short Form Health Survey (SF-12) were analyzed. Student's t-tests, Generalized Estimation Equations (GEE), Mann-Whitney tests, and Bonferroni tests were used for statistical analyses, with a significance level of 5%. Results: The sample consisted of 76 patients: 31 in the IG (64±9.2 years old) and 45 in the CG (61.4±11.8 years old). There was a significant reduction (p<0.001) in weight, body mass index, and waist circumference, and an increase (p=0.010) in the consumption of healthy food only in the IG. The consumption of unhealthy food was reduced in both groups (p<0.001), the physical aspect of quality of life improved (p=0.018), and women presented better physical (p=0.011) and mental results (p=0.008). Conclusions: This group intervention was effective regarding the nutritional status of patients in cardiopulmonary rehabilitation. The physical aspect of quality of life showed improvements in both groups.

Alzheimer's Disease Diagnosis Based on the Amyloid, Tau, and Neurodegeneration Scheme (ATN) in a Real-Life Multicenter Cohort of General Neurological Centers.

BACKGROUND: The ATN scheme was proposed as an unbiased biological characterization of the Alzheimer's disease (AD) spectrum, grouping biomarkers into three categories: brain Amyloidosis-A, Tauopathy-T, Neurodegeneration-N. Although this scheme was mainly recommended for research, it is relevant for diagnosis. OBJECTIVE: To evaluate the ATN scheme performance in real-life cohorts reflecting the inflow of patients with cognitive complaints and different underlying disorders in general neurological centers. METHODS: We included patients (n = 1,128) from six centers with their core cerebrospinal fluid-AD biomarkers analyzed centrally. A was assessed through Aß42/Aß40, T through pTau-181, and N through tTau. Association between demographic features, clinical diagnosis at baseline/follow-up and ATN profiles was assessed. RESULTS: The prevalence of ATN categories was: A-T-N-: 28.3%; AD continuum (A + T-/+N-/+): 47.8%; non-AD (A- plus T or/and N+): 23.9%. ATN profiles prevalence was strongly influenced by age, showing differences according to gender, APOE genotype, and cognitive status. At baseline, 74.6% of patients classified as AD fell in the AD continuum, decreasing to 47.4% in mild cognitive impairment and 42.3% in other neurodegenerative conditions. At follow-up, 41% of patients changed diagnosis, and 92% of patients that changed to AD were classified within the AD continuum. A + was the best individual marker for predicting a final AD diagnosis, and the combinations A + T+ (irrespective of N) and A + T+N+ had the highest overall accuracy (83%). CONCLUSION: The ATN scheme is useful to guide AD diagnosis in real-life neurological centers settings. However, it shows a lack of accuracy for patients with other types of dementia. In such cases, the inclusion of other markers specific for non-AD proteinopathies could be an important aid to the differential diagnosis.

O efeito do ácido ascórbico tópico na cicatrização cutânea / The effect of topical ascorbic acid on cutaneous healing

Introdução: A ferida cirúrgica apresenta altos níveis de radicais livres em resposta ao dano cutâneo, o que gera a hipótese de um possível benefício do uso de antioxidantes no reparo destas feridas, tal como a aplicação tópica do ácido ascórbico. No entanto, pesquisas recentes obtiveram conclusões discrepantes para este tipo de tratamento. O objetivo é avaliar o efeito do ácido ascórbico tópico na cicatrização cutânea por meio de uma revisão de escopo. Métodos: A revisão de escopo foi realizada na base de dados Medline, Lilacs e Cochrane, com os descritores: ácido ascórbico, creme para a pele e cicatrização de feridas. Foram definidos como critérios de inclusão: ensaios clínicos randomizados, observacionais e revisões sistemáticas, em humanos, com data de publicação de até 5 anos, nas línguas inglesa, portuguesa ou espanhola. Foram excluídas: revisões narrativas, dissertações, teses, editoriais, estudos in vitro e em animais. Por fim, foi realizada a classificação dos estudos através da metodologia GRADE. Resultados: Foram encontrados 83 estudos e, após triagem, seis artigos foram selecionados. Destacou-se o uso do ácido ascórbico na concentração de 5 a 20% e de seus derivados (0,075% a 9,55%). Apresentaram a qualidade GRADE moderada os desfechos: aumento da firmeza cutânea e redução da vermelhidão, e alta qualidade: melhora na hidratação, elasticidade, colorometria das manchas e melhora do fechamento das feridas. Conclusão: O ácido ascórbico promove melhor elasticidade cutânea, diminuição do eritema e melhor fechamento das feridas. Apesar destes fortes indícios, ensaios clínicos randomizados com menor risco de viés de aferição e com maior casuística ainda se fazem necessários.

Introduction: The surgical wound has high levels of free radicals in response to skin damage, which raises the hypothesis of a possible benefit from using antioxidants in repairing these wounds, such as the topical application of ascorbic acid. However, recent research has found conflicting conclusions about this type of treatment. The objective is to evaluate the effect of topical ascorbic acid on skin healing through a scope review. Methods: The scope review was carried out in the Medline, Lilacs and Cochrane databases, with the descriptors: ascorbic acid, skin cream, and wound healing. Inclusion criteria were defined as randomized clinical trials, observational and systematic reviews, in humans, with a publication date of up to 5 years, in English, Portuguese or Spanish. The following were excluded: narrative reviews, dissertations, theses, editorials, in vitro and animal studies. Finally, the studies were classified using the GRADE methodology. Results: 83 studies were found, and six articles were selected after screening. The use of ascorbic acid in the concentration of 5 to 20% and its derivatives (0.075% to 9.55%) stood out. The outcomes presented a moderate GRADE quality: increased skin firmness and reduced redness, and high quality: improved hydration, elasticity, colorimetry of the stains and improved wound closure. Conclusion: Ascorbic acid promotes better skin elasticity, reduced erythema and better wound closure. Despite these strong indications, randomized clinical trials with a lower risk of measurement bias and greater casuistry are still necessary.

Cognitive impairment and markers of optical neurodegeneration in early multiple sclerosis.

INTRODUCTION: Cognitive impairment and retinal atrophy have been proposed as two potential markers of neurodegeneration in multiple sclerosis (MS). We aimed at assessing the relation between peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell layer (mGCL) atrophy and cognitive performance in early MS. METHODS: This is a multicenter cross-sectional study on patients with early MS (clinically isolated syndrome and relapsing-remitting MS), with an EDSS score ≤ 3.0. Patients with previous optic neuritis, other ocular diseases, psychiatric illness, or recent relapse were excluded. All patients underwent standardized optical coherence tomography (OCT) and neuropsychological evaluation with validated tests for MS patients. Cognitive impairment was defined as having two cognitive tasks below age- and education-adjusted norms. RESULTS: We recruited 52 patients with early MS, with an average age of 37 years (SD = 10.5), an average disease duration of 3.69 years (SD = 2.3), and a median EDSS of 1.0 (IQR = 0.5). In this sample, 15/52 patients presented cognitive impairment. Regarding OCT measurements, 7/52 patients had an average pRNFL below the 5th percentile and 2/52 had an average mGCL below the 5th percentile. The average pRNFL thickness was comparable in cognitively impaired and cognitively preserved patients (100.3 µm vs 103.1 µm, p = 0.52); the average mGCL thickness had also similar values between groups (50.5 µm vs 53 µm, p = 0.38). CONCLUSIONS: Cognitive impairment was frequent in our sample of early MS. However, no association with reduced pRNFL or mGCL thickness was found. When compared to OCT, cognitive assessment could provide an earlier marker of neurodegeneration in MS.

Engineering surgical stitches to prevent bacterial infection.

Surgical site infections (SSIs) account for a massive economic, physiological, and psychological burden on patients and health care providers. Sutures provide a surface to which bacteria can adhere, proliferate, and promote SSIs. Current methods for fighting SSIs involve the use of sutures coated with common antibiotics (triclosan). Unfortunately, these antibiotics have been rendered ineffective due to the increasing rate of antibiotic resistance. A promising new avenue involves the use of metallic nanoparticles (MNPs). MNPs exhibit low cytotoxicity and a strong propensity for killing bacteria while evading the typical antibiotic resistance mechanisms. In this work, we developed a novel MNPs dip-coating method for PDS-II sutures and explored the capabilities of a variety of MNPs in killing bacteria while retaining the cytocompatibility. Our findings indicated that our technique provided a homogeneous coating for PDS-II sutures, maintaining the strength, structural integrity, and degradability. The MNP coatings possess strong in vitro antibacterial properties against P aeruginosa and S. aureus-varying the %of dead bacteria from ~ 40% (for MgO NPs) to ~ 90% (for Fe2O3) compared to ~ 15% for uncoated PDS-II suture, after 7 days. All sutures demonstrated minimal cytotoxicity (cell viability > 70%) reinforcing the movement towards the use MNPs as a viable antibacterial technology.

Pediatric cerebral sinus venous thrombosis: clinical characterization of a Portuguese cohort.

INTRODUCTION: Pediatric cerebral sinus venous thrombosis (CSVT) is a rare entity. Risk factors differ from the adults, and treatment is not consensual. With this work, we aimed to characterize a pediatric cohort from two Portuguese tertiary centers. METHODS: All patients under 18 years old with confirmed CSVT admitted between 2006 and 2019 were retrospectively included. Demographics, clinical presentation, workup, and follow-up were evaluated. RESULTS: Fifty-three patients were included, 29 were male (54.7%). Median age was 5 years (IQR 11.08, range 0-17 years old). Headache, seizures and impairment of consciousness were the most frequent manifestations. A risk factor was identified in 90.6% (n = 48), mostly infections (43.8%; n = 21). CNS complications were comprised of hemorrhage, venous infarction, hydrocephalus and edema. Treatment included anticoagulation in 36 patients (67.9%), and there were no recurrences on follow-up. Prognosis was favorable, with most patients presenting no or only slight disability comparing to same age and sex children, on the follow-up. DISCUSSION: In this cohort, impairment of consciousness was the most frequent clinical presentation and infections were the most frequent risk factors. The outcome was mainly favorable, with most patients presenting none or mild disability and without recurrences on follow-up. Studies are needed to define the criteria for anticoagulation and its recommended duration in children.

Psychometric validity of the Portuguese version of SWAL-QOL for head and neck cancer / Validez psicométrica de la versión portuguesa de SWAL-QOL en el cáncer de cabeza y cuello

Introduction and aim: In Portugal there are no instruments that measure the impact of dysphagia on the quality of life. The aim of this study was the assessment of the psychometric properties of the Portuguese version of SWAL-QOL, in a head and neck cancer population. Materials and methods: It was a case–control study, with a consecutive sample of 300 subjects that was divided into 3 groups (2 controls and 1 case). We performed principal components analysis, assessed reliability and clinical validity. For concurrent validity of the Portuguese version of SWAL-QOL, the Functional Scale of Oral Intake (FOIS) and the Performance Status Scale (PSS) for patients with head and neck cancer were used. Results: The sample was predominantly male (66%) with a mean age of 57 years. Regarding the patients with head and neck cancer, 22% were in stage IIIA, and 43% had lesions on the larynx. As to the treatment provided, 33% underwent surgery and radiotherapy, and 80% of cases had oral feeding. The psychometric validity of SWAL-QOL was established, with good results for internal consistency (from .665 to .952), reproducibility (from .628 to .877) and construct validity. SWAL-QOL also showed good correlation with the clinical variable dysphagics vs. non-dysphagics. There were no statistical significant differences for the consistency of food and fluids, and oral vs. non-oral nutrition. Conclusions: The validation of SWAL-QOL for the Portuguese language revealed that this instrument is psychometrically valid and appropriate for use with dysphagic patients with head and neck cancer.(AU)

Introducción y objetivo: En Portugal no existen instrumentos que midan el impacto de la disfagia en la calidad de vida. El objetivo de este estudio fue evaluar las propiedades psicométricas de la versión portuguesa de SWAL-QOL, en una población de pacientes de cáncer de cabeza y cuello. Materiales y métodos: Estudio de control de casos, con una muestra consecutiva de 300 sujetos, que se dividió en 3 grupos (2 grupos control y un caso). Realizamos un análisis de los componentes principales, y evaluamos la fiabilidad y la validez clínica. Para la validez concurrente de la versión portuguesa de SWAL-QOL, utilizamos la Functional Scale of Oral Intake (FOIS) y la Performance Status Scale (PSS) para los pacientes de cáncer de cabeza y cuello. Resultados: La muestra se compuso fundamentalmente de varones (66%), con una edad media de 57 años. Con relación a los pacientes de cáncer de cabeza y cuello, el 22% estaba en estadio IIIA y el 43% tenía lesiones en la laringe. En cuanto a la terapia suministrada, el 33% recibió cirugía y radioterapia y el 80% de los casos recibió alimentación oral. Se estableció la validez psicométrica de SWAL-QOL, con buenos resultados para consistencia interna (de 0,665 a 0,592), reproducibilidad (de 0,628 a 0,877), y validez del constructo. SWAL-QOL reflejó también una buena correlación con la variable clínica disfágicos vs no disfágicos. No se produjeron diferencias estadísticamente significativas para la consistencia de alimentos y líquidos y nutrición oral vs no oral. Conclusiones: La validación de SWAL-QOL para el idioma portugués reveló que se trata de un instrumento psicométricamente válido para uso con pacientes disfágicos de cáncer de cabeza y cuello.(AU)

Neuropsychological features of progranulin-associated frontotemporal dementia: a nested case-control study.

The distinction between sporadic and genetic behavioural-variant frontotemporal dementia (bvFTD) regarding some neuropsychological (NP) features remains challenging. Specifically, progranulin (GRN)-associated bvFTD frequently presents with early episodic memory impairment and some degree of parietal dysfunction which are supporters of Alzheimer's disease (AD) diagnosis. In this context, we aimed to characterize the NP profile of GRN-bvFTD as compared to sporadic-bvFTD and AD in patients with mild dementia (Mini-Mental State Examination score ≥ 17 and Clinical Dementia Rating Scale score ≤ 1. We identified 21 patients at Centro Hospitalar e Universitário de Coimbra, Portugal with GRN mutations belonging to fifteen different families. As our focus was bvFTD variants, FTD-related aphasic forms (3 patients) were excluded. The remaining 18 GRN-bvFTD were further matched with 18 sporadic-bvFTD and 18 AD patients according to disease staging, age and education. All patients completed the Mini-Mental State Examination, Montreal Cognitive Assessment (MoCA) and a comprehensive NP assessment battery. Results were converted into z-scores. Differences between groups in individual NP measures and NP domains were assessed through non-parametric tests (Kruskal-Wallis test analysis) and eta squared (ŋ2) was calculated as a measure of effect size. Group comparisons show that GRN patients have worse performances on verbal retrieval processes (P = 0.039, ŋ2 = 0.110) and visuoconstructive abilities (P = 0.039, ŋ2 = 0.190) than sporadic bvFTD forms. When compared to AD, GRN patients present a higher impairment in frontal (P = 0.001, ŋ2 = 0.211) and parietal (P = 0.041, ŋ2 = 0.129) measures and a better performance in memory tasks (P = 0.020, ŋ2 = 0.120). Sporadic-bvFTD forms are worse than AD in frontal measures (P = 0.032, ŋ2 = 0.200), being better in both memory (P = 0.010, ŋ2 = 0.131) and visuospatial skills (P = 0.023, ŋ2 = 0.231). Considering these results, we conclude that GRN-bvFTD patients present a NP profile that associates the typical patterns of FTD and AD deficits. This is particularly expressive in visuoconstructive abilities, which was the more discriminative feature between groups, followed by episodic verbal memory. This study was approved by the Institutional Ethics Committee of Centro Hospitalar e Universitário de Coimbra, Portugal (CE-029/2019) on June 24, 2019.

Microelectrochemical Smart Needle for Real Time Minimally Invasive Oximetry.

A variety of brain disorders such as neural injury, brain dysfunction, vascular malformation, and neurodegenerative diseases are associated with abnormal levels of oxygen. Current methods to directly monitor tissue oxygenation in the brain are expensive and invasive, suffering from a lack of accuracy. Electrochemical detection has been used as an invasiveness and cost-effectiveness method, minimizing pain, discomfort, and injury to the patient. In this work, we developed a minimally invasive needle-sensor with a high surface area to monitor O2 levels in the brain using acupuncture needles. The approach was to directly etch the iron from stainless steel acupuncture needles via a controlled pitting corrosion process, obtaining a high microporous surface area. In order to increase the conductivity and selectivity, we designed and applied for the first time a low-cost coating process using non-toxic chemicals to deposit high surface area carbon nanoparticle, catalytically active laccase, and biocompatible polypyrrole. The physicochemical properties of the materials were characterized as well as their efficacy and viability as probes for the electrochemical detection of PO2. Our modified needles exhibited efficient electrocatalysis and high selectivity toward O2, with excellent repeatability. We well engineered a small diagnostic tool to monitor PO2, minimally invasive, able to monitor real-time O2 in vivo complex environments.

APOEɛ4-TOMM40L Haplotype Increases the Risk of Mild Cognitive Impairment Conversion to Alzheimer's Disease.

BACKGROUND: Mild cognitive impairment (MCI) has been considered as a pre-dementia stage, although the factors leading to Alzheimer's disease (AD) conversion remain controversial. OBJECTIVE: Evaluate whether TOMM40 poly-T (TOMM40' 523) polymorphism is associated with the risk and conversion time from MCI to AD and secondly with AD cerebrospinal fluid (CSF) biomarkers, disentangling the APOE genotype. METHODS: 147 AD patients, 102 MCI patients, and 105 cognitively normal controls were genotyped for poly-T polymorphism. MCI patients were subdivided into two groups, the group of patients that converted to AD (MCI-AD) and the group of those that remained stable (MCI-S). RESULTS: TOMM40' 523 L allele was significantly more frequent in the MCI-AD group and having at least one L allele significantly increased the risk of conversion from MCI to AD (OR = 8.346, p < 0.001, 95% CI: 2.830 to 24.617). However, when adjusted for the presence of APOEɛ4 allele, both the L allele and ɛ4 allele lost significance in the model (p > 0.05). We then analyzed the APOEɛ4-TOMM40' 523 L haplotype and observed that patients carrying this haplotype had significantly higher risk (OR = 5.83; 95% CI = 2.30-14.83) and mean lower times of conversion to AD (p = 0.003). This haplotype was also significantly associated with a biomarker profile compatible with AD (p = 0.007). CONCLUSION: This study shows that the APOEɛ4-TOMM40' 523 L haplotype is associated with a higher risk and shorter times of conversion from MCI to AD, possibly driven by CSF biomarkers and mitochondrial dysfunction.

Psicanálise Solidária: projeto da Diretoria de Comunidade e Cultura da Febrapsi (2020) / Solidarity Psychoanalysis: project from Febrapsi Community and Culture Board (2020) / Psicoanálisis Solidario: proyecto de la Dirección de la Comunidad y Cultura de la Febrapsi (2020) / Psychanalyse Solidaire: projet de la Direction de Communauté et Culture de la Febrapsi (2020)

RESUMO A Febrapsi apoiou as federadas, Sociedades e Grupos de Estudos, a promover projetos que utilizem o dispositivo psicanalítico para a interação com a comunidade e com ações solidárias de suporte àqueles que estavam em sofrimento agudo. Entendemos que é nosso compromisso ético com o outro oferecer a psicanálise como importante instrumento de escuta, disponibilizando-nos na travessia do período crítico da pandemia. Também era, e ainda é, uma preocupação constante as graves consequências sociais e econômicas que repercutem nas vidas de uma grande parcela da população, já em situação de vulnerabilidade, como desempregados, trabalhadores informais e moradores de rua.

ABSTRACT Febrapsi has supported the federal Society and Study Groups, to promote projects that use the psychoanalytical mechanism for the interaction with the community and also with solidarity actions to help those suffering greatly. We understand that it is our ethical commitment to others to offer psychoanalysis as an essential listening tool, making ourselves available during this critical time of the pandemic. Social and economic serious outcomes have also been of great concern, as they influence great part of the people who are already vulnerable, as the unemployed and the self-employed people, besides the ones living on the streets.

RESUMEN Febrapsi apoyó a las federadas, Sociedades y Grupos de Estudio para pro-mover proyectos que utilizasen el dispositivo psicoanalítico para la interacción con la comunidad y con acciones solidarias de soporte a aquellos que estaban relatando su-frimiento agudo. Entendemos que es nuestro compromiso ético con el prójimo ofrecer el psicoanálisis como importante instrumento de atención, disponibilizándonos en la travesía del periodo crítico de la pandemia. También eran y todavía son una preocupación constante las graves consecuencias sociales y económicas que repercuten en la vida de una gran parcela de la población, ya en situación de vulnerabilidad, tales como desempleados, trabajadores informales y personas que viven en la calle.

RÉSUMÉ La Febrapsi a soutenu ses fédérées, Sociétés et Groupes d'étude, à pro-mouvoir des projets qui utilisent le dispositif psychanalytique pour établir une interaction avec la communauté et les actions solidaires d'appui à ceux qui étaient en souffrance aiguë. Nous comprenons que c'est notre engagement éthique par rapport à l'autre d'offrir la psychanalyse comme un important instrument d'écoute, nous rendant disponibles pendant la traversée de la période critique de la pandémie. Les graves conséquences sociales et économiques qui répercutent dans les vies d'une grande partie de la population, déjà en situation de vulnérabilité, tels que les chômeurs, les travailleurs informels et les sans-abri, c'était aussi, et c'est encore, une préoccupation constante.

Electroceutical Silk-Silver Gel to Eradicate Bacterial Infection.

With more than 50% of bacteria resistant to standard antibiotics, new strategies to treat bacterial infection and colonization are needed. Based on the concept of targeting the bacteria synergistically on various fronts, it is hypothesized that an electrical insult associated with antibacterial materials may be a highly effective means of killing bacteria. In this work, an injectable conductive gel based on silk fibroin (SF) and silver nanoparticles (Ag-NPs) is synthesized, capable of coating a zone of injury, allowing the application of a low electrical current to decrease bacterial contamination. With a high conductivity of 1.5 S cm-1 , SF/Ag-NPs gels killed 80% of Escherichia coli in 1 min, no toxicity toward Chinese hamster ovary cells is observed. The mechanism of an electrical composite gel combined with electrical wound therapy is associated with silver ion (Ag+ ) release, and reactive oxygen species (ROS) production. The findings in the present study show a similar Ag+ release for treatment with gels and the combined effect, whereas ROS generation is 50% higher when a small electrical current is applied leading to a broad bactericidal effect.

Adult-onset methylenetetrahydrofolate reductase deficiency.

Severe hyperhomocysteinemia (>100 µmol/L) is often associated with inborn errors of homocysteine metabolism. It manifests typically in neonatal period with developmental delay, hypotonia, feeding problems or failure to thrive. Adult-onset forms are rare and include less severe manifestations. Early diagnosis is crucial because effective treatment is available. A 23-year-old man presented with a 3-week history of speech and gait impairment, and numbness in lower limbs. Neurological examination revealed dysarthria, decreased vibratory sensation in both legs and appendicular and gait ataxia. Brain MRI revealed T2-hyperintense symmetric white matter lesions and cortical atrophy. He had folate and vitamin B12 deficiency, a markedly elevated serum homocysteine and low methionine. Despite vitamin supplementation homocysteine levels remained elevated. Molecular studies of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene revealed a new pathogenic mutation (c.1003C>T (p.Arg335Cys)) and a polymorphism (C677T (p.Ala222Val)) associated with hyperhomocysteinemia, both in homozygosity. The patient started betaine with clinical and biochemical improvement.

Lower CSF Amyloid-Beta1-42 Predicts a Higher Mortality Rate in Frontotemporal Dementia.

Frontotemporal lobar degeneration, the neuropathological substrate of frontotemporal dementia (FTD), is characterized by the deposition of protein aggregates, including tau. Evidence has shown concomitant amyloid pathology in some of these patients, which seems to contribute to a more aggressive disease. Our aim was to evaluate cerebrospinal fluid (CSF) amyloid-beta as a predictor of the mortality of FTD patients. We included 99 patients diagnosed with FTD-both behavioral and language variants-with no associated motor neuron disease, from whom a CSF sample was collected. These patients were followed prospectively in our center, and demographic and clinical data were obtained. The survival analysis was carried through a Cox regression model. Patients who died during follow up had a significantly lower CSF amyloid-beta1-42 than those who did not. The survival analysis demonstrated that an increased death rate was associated with a lower CSF amyloid-beta1-42 (HR = 0.999, 95% CI = [0.997, 1.000], p = 0.049). Neither demographic nor clinical variables, nor CSF total tau or p-tau were significantly associated with this endpoint. These results suggest that amyloid deposition in FTD patients may be associated with a higher mortality.

Endovascular treatment of bilateral isolated aneurysm of the internal iliac artery.

Isolated aneurysms of the iliac arteries comprise less than 2% of abdominal aneurysms. The internal iliac artery is involved in 10-30% of cases. In most cases patients are asymptomatic, unless rupture occurs. They can be diagnosed by Doppler ultrasonography, magnetic resonance imaging or, preferably, angiotomography. Significant expansion, diameter of 3 cm or greater, and symptomatic cases are indications for surgery. We present the case of a patient with an incidental ultrasonographic finding of bilateral aneurysm of the internal iliac arteries, both with indications for surgery. The patient was successfully treated with endovascular techniques, first repairing the right internal iliac with a branched iliac stent graft, preserving patency, then embolizing the left internal iliac artery. Knowledge of the various different techniques and devices and their limitations is fundamental to adequate planning of endovascular treatment, even in rare cases.

Metabolic Syndrome Features: Is There a Modulation Role by Mineral Water Consumption? A Review.

Metabolic syndrome (MetSyn) promotes, among others, the development of atherosclerotic cardiovascular disease and diabetes. Its prevalence increases with age, highlighting the relevance of promoting precocious MetSyn primary prevention and treatment with easy-to-implement lifestyle interventions. MetSyn features modulation through mineral water consumption was reviewed on Pubmed, Scopus and Google Scholar databases, using the following keywords: metabolic syndrome, hypertension, blood pressure (BP), cholesterol, triglycerides, apolipoprotein, chylomicron, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein (HDL), glucose, insulin, body weight, body mass index, waist circumference (WC), obesity and mineral(-rich) water. Twenty studies were selected: 12 evaluated BP, 13 assessed total-triglycerides and/or HDL-cholesterol, 10 analysed glucose and/or 3 measured WC. Mineral waters were tested in diverse protocols regarding type and composition of water, amount consumed, diet and type and duration of the study. Human and animal studies were performed in populations with different sizes and characteristics. Distinct sets of five studies showed beneficial effects upon BP, total-triglycerides, HDL-cholesterol and glucose. WC modulation was not reported. Minerals/elements and active ions/molecules present in mineral waters (and their pH) are crucial to counterbalance their inadequate intake and body status as well as metabolic dysfunction and increased diet-induced acid-load observed in MetSyn. Study characteristics and molecular/physiologic mechanisms that could explain the different effects observed are discussed. Further studies are warranted for determining the mechanisms involved in the putative protective action of mineral water consumption against MetSyn features.