Feasibility and acceptability of a hospital-at-home program for adolescents with eating disorders: Making progress in community/family-based treatments.

OBJECTIVE: To explore the feasibility and acceptability of a novel hospital-at-home (HaH) program for adolescent patients with a severe eating disorder (ED). METHOD: Retrospective description of the program during its first year of activity. The feasibility construct is based on accessibility, recruitment, rate of retention, avoidance of hospital stays, and management of crisis situations. Caregivers completed a satisfaction questionnaire on discharge, including an item on perceived safety. All patients referred to the program were included. RESULTS: Fifty-nine female patients with a mean age of 14.69 years (SD = 1.67) were admitted. The mean stay was 39.14 days (SD = 14.47). On admission, 32.2% of patients presented nonsuicidal self-harm behavior and 47.5% had comorbid mental disorders. All patients were screened in the first 48 h after referral, and the program retention rate was 91.52%. As for use of health services, 2016.03 hospital stays were avoided, and only 16.12% of the 31 calls received for urgent care required emergency department visits. Families gave the program an overall satisfaction score of 4.95/5, and all described it as "very safe." DISCUSSION: The HaH program described is a feasible and acceptable care model in adolescents with severe EDs and comorbidities. Effectiveness studies should be performed. PUBLIC SIGNIFICANCE: Eating disorders are a major concern for public health. The adolescent HaH program presented marks an advance in intensive community treatments for patients with severe EDs and comorbidities.

Novel carbon skeletons activate human NicotinAMide Phosphoribosyl Transferase (NAMPT) enzyme in biochemical assay.

Nicotinamide adenine dinucleotide (NAD) is a central molecule in cellular metabolism that has been implicated in human health, the aging process, and an array of human diseases. NAD is well known as an electron storage molecule, cycling between NAD and the reduced NADH. In addition, NAD is cleaved into nicotinamide and Adenine diphosphate ribose by NAD-consuming enzymes such as sirtuins, PARPs and CD38. There are numerous pathways for the biosynthesis of NAD to maintain a baseline concentration and thus avoid cellular death. The NAD salvage pathway, a two-step process to regenerate NAD after cleavage, is the predominant pathway for humans. Nicotinamide PhosphribosylTransferase (NAMPT) is the rate-limiting enzyme within the salvage path. Exposure to pharmacological modulators of NAMPT has been reported to either deplete or increase NAD levels. This study used a curated set of virtual compounds coupled with biochemical assays to identify novel activators of NAMPT. Autodock Vina generated a ranking of the National Cancer Institute's Diversity Set III molecular library. The library contains a set of organic molecules with diverse functional groups and carbon skeletons that can be used to identify lead compounds. The target NAMPT surface encompassed a novel binding location that included the NAMPT dimerization plane, the openings to the two active site channels, and a portion of the known binding location for NAMPT substrate and product. Ranked molecules were evaluated in a biochemical assay using purified recombinant NAMPT enzyme. Two novel carbon skeletons were confirmed to stimulate NAMPT activity. Compound 20 (NSC9037) is a polyphenolic xanthene derivative in the fluorescein family, while compound 2 (NSC19803) is the polyphenolic myricitrin nature product. Micromolar quantities of compound 20 or compound 2 can double NAMPT's product formation. In addition, natural products that contain high concentrations of polyphenolic flavonoids, similar to myricitrin, also stimulate NAMPT activity. Confirmation of a novel binding site for these compounds will further our understanding of the cellular mechanism leading to NAD homeostasis and better human health outcomes.

Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients.

BACKGROUND: The safety and efficacy data of the different types of available vaccines is still needed. The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients. METHODS: Participants were included from February to September 2021. No prioritized vaccination roll call applied for OLT patients. Controls were otherwise healthy people. Blood samples were drawn after 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer's instructions using the Liaison XL platform from DiaSorin (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (Abbott Diagnostics, IL, USA). RESULTS: A total of 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity. The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p = 0.001). A positive humoral response was found in 133 OLT individuals: 89.2% with BNT162b2 (Pfizer-BioNTech), 60% ChAdOx1 nCOV-19 (Oxford-AstraZeneca), 76.9% with CoronaVac (Sinovac, Life Sciences, China), 55.6% Ad5-nCov (Cansino, Biologics), 68.2% Gam-COVID-Vac (Sputnik V) and 100% with mRNA-1273. In controls the serological response was 100%, except for Cansino (75%). In a multivariable model, personal history of COVID-19 and BNT162b2 inoculation were associated with the serologic response, while the use of prednisone (vs. other immunosuppressants) reduced this response. CONCLUSION: The serologic response to COVID-19 vaccines in OLT patients is lower than in healthy controls. The BNT162b2 vaccine was associated with a higher serologic response.

Direct-Acting Antivirals in the Treatment of Hepatitis C Virus Recurrence after Liver Transplantation: Real-life Experience in a Mexican Cohort.

BACKGROUND: Hepatitis C virus (HCV) infection is one of the most frequent causes of liver transplantation (LT) worldwide. Patients with HCV viremia at the time of LT universally develop recurrent HCV in the allograft, leading to accelerated fibrosis and graft loss. Treatment with direct-acting antivirals (DAA) is highly effective and safe in this population. AIM OF THE STUDY: To describe the efficacy and safety of DAA in treating post LT HCV recurrence in a Mexican cohort. METHODS: We designed a retrospective cohort study that included all LT patients from 2000-2019 with HCV recurrence after LT who received DAA. Clinical and biochemical characteristics were collected from clinical records. Patients who received treatment before LT and those who received interferon-based therapies after LT achieving sustained viral response at 12 weeks were excluded; patients who didn´t complete DAA therapy were eliminated. The primary outcome was SVR-12. RESULTS: Fifty-six patients received DAA after the LT with 98% SVR-12. The most frequent genotypes were 1b (54%) and 1a (34%). The most common antiviral scheme used was sofosbuvir/ledipasvir for 12 weeks in 59% of the patients. No severe adverse effects were observed. Ribavirin was used in 82% of the patients, of which 23.9% had adverse effects, mostly mild. The median follow-up after LT was 55 months (IQR 43-51), with a global and graft survival at one and three years of 100%. CONCLUSION: In a Mexican cohort, DAA therapy in LT patients with recurrence of HCV infection showed high efficacy and an acceptable safety profile.

Educación emocional en la educación para la salud: cuestión de Salud Pública / Emotional education in health education: a matter of Public Health

El modelo holístico de salud exige incluir las emociones en las estrategias de prevención y promoción. Para comprobar la extensión de su consideración en la educación para la salud, se realizó una revisión sistemática en las bases de datos Medline, PsycInfo y ERIC. Se aceptaron 66 de los 648 artículos revisados, hallándose gran diversidad temática, teórica y terminológica respecto a la salud emocional. Por tanto, la representación en la literatura científica de las estrategias de educación para la salud que incluyen las emociones es todavía pequeña. Asimismo, aquellas que sí las incluyen presentan una gran variedad terminológica y teórica que dificulta la difusión del conocimiento y la generalización de resultados. Se pone de manifiesto la necesidad de implementación de un modelo de formación para la salud en el que se incluya la educación emocional como componente fundamental de la misma, en sintonía con los recientes avances científicos

The holistic model of health requires the inclusion of emotions in prevention and promotion policies. A systematic review was carried out in databases Medline, PsychInfo, and ERIC to check the extent to which emotions are covered in health education. Sixty-six of the 648 papers reviewed were accepted, presenting a wide range of topics, theories, and terms regarding emotional health. Therefore, health education strategies that take emotions into consideration are still underrepresented in scie.jpgic literature. Moreover, a great terminological and theorical diversity is found among the ones that incorporate emotional health, hindering knowledge dissemination and generalization of results. The need for an implementation of a health education model where emotional education is included as an essential part of it, according to recent scie.jpgic advances is clearly shown

Children and adolescents with eating disorders during COVID-19 confinement: Difficulties and future challenges.

OBJECTIVE: To present the adaptations to treatment protocols made in a child and adolescent eating disorders (ED) unit during the eight-week confinement period mandated in response to the COVID-19 pandemic and examine clinical and treatment variables in the outpatient, day hospital, and inpatient care programs. METHOD: Description of the implementation of a combined teletherapy program for outpatient and day-hospital patients and the adaptations made to the inpatient protocol. Retrospective review of medical records and analysis of general and specific variables related to the pandemic and confinement. RESULTS: We held 1,329 (73.10%) telehealth consultations and 489 (26.9%) face-to-face outpatient visits with 365 patients undergoing treatment in the outpatient clinic or day hospital. Twenty-eight (7.67%) were initial evaluations. Twenty-two patients were newly admitted and 68 ED-related emergencies were attended. Almost half of the children and adolescents studied experienced reactivation of ED symptoms despite treatment, and severe patients (25%) presented self-harm and suicide risk. CONCLUSIONS: The implementation of a combined teletherapy program has enabled continuity of care during confinement for children and adolescents with ED. Delivery of treatment to adolescents in the day hospital program posed the biggest challenge due to their greater degrees of severity and higher hospitalization rates. An adapted inpatient program should be maintained throughout confinement, as the need for hospitalization of children and adolescents with ED does not decrease with lockdown.

Organization of cholinergic systems in the brain of different fish groups: a comparative analysis.

Using choline acetyltransferase immunocytochemistry, we compared the cholinergic systems of the brains of four groups of fishes (lampreys, elasmobranchs, chondrosteans, and teleosts). Cholinergic nuclei were classified in four groups according to their distribution in vertebrates. The cranial motor nuclei and the habenulo-interpeduncular system were cholinergic in all vertebrates. The cholinergic nuclei of the isthmus of fishes showed many similarities with those of tetrapods. The magnocellular preoptic neurosecretory cells were cholinergic in most fishes, whereas in neurosecretory nuclei of tetrapods, cholinergic cells were only observed adjacent to the magnocellular cells. In the subpallium, cholinergic cells were observed in all fishes, with the exception of elasmobranchs, which suggests that they might be secondarily lost. In the pallium of fishes, cholinergic neurons were only observed in elasmobranchs. Because pallial cholinergic cells were only observed in lizard and mammals, they could have appeared several times during evolution. The same is suggested for the presence of cholinergic cells in the optic tectum of only a few vertebrate groups, including teleosts. This preliminary analysis enlarges our knowledge of the cholinergic systems of fishes, although more species and groups need to be studied to provide a more complete scenario of their evolution.