Aging microplastics enhances the adsorption of pharmaceuticals in freshwater.

Plastic pollution is an increasing environmental concern. Pollutants such as microplastics (< 5 mm) and pharmaceuticals often co-exist in the aquatic environment. The current study aimed to elucidate the interaction of pharmaceuticals with microplastics and ascertain how the process of photo-oxidation of microplastics affected the adsorption of the pharmaceuticals. To this end, a mixture containing ibuprofen, carbamazepine, fluoxetine, venlafaxine and ofloxacin (16 µmol L-1 each) was placed in contact with one of six either virgin or aged microplastic types. The virgin microplastics were acquired commercially and artificially aged in the laboratory. Polypropylene, polyethylene, polyethylene terephthalate, polyamide, polystyrene, and polyvinyl chloride microparticles at two sizes described as small (D50 < 35 µm) and large (D50 95-157 µm) were evaluated. Results demonstrated that the study of virgin particles may underestimate the adsorption of micropollutants onto microplastics. For virgin particles, only small microparticles of polypropylene, polyethylene, polyvinyl chloride, and both sizes of polyamide adsorbed pharmaceuticals. Aging the microplastics increased significantly the adsorption of pharmaceuticals by microplastics. Fluoxetine adsorbed onto all aged microplastics, from 18 % (large polyethylene terephthalate) to 99 % (small polypropylene). The current investigation highlights the potential of microplastics to act as a vector for pharmaceuticals in freshwater, especially after aging.

Psychological burden in Portuguese university students during the COVID-19 pandemic.

Background: University students are a risk population for mental health problems. This study aims to evaluate the psychological burden of the COVID-19 pandemic in Portuguese university students and to uncover factors associated with worse psychological indicators. Methods: We used an online survey to perform a cross-sectional study that evaluated students' perceptions, lifestyle, and psychological well-being during the pandemic. Depression symptoms and risk were measured by the Patient Health Questionnaire-9, and resilience levels were quantified by the 9-item Resilience Evaluation Scale. Self-perceived levels of anxiety and current mental health status were evaluated. Results: From a population of around 30,000 students invited to participate, 1751 responses were obtained and 1447 were included. Most students were female (72.3%) and were taking a master's degree (58.4%). The course with more responses was engineering (25.5%), followed by medicine (13.2%). The prevalence rates for higher anxiety levels, depression risk, and low resilience levels were 66.7%, 37.3%, and 24.9%, respectively. The factors associated with better psychological outcomes were being male, spending more time studying, having a job, performing extracurricular activities, physical exercise, and relaxing activities. By contrast, spending more time watching news, difficulty accessing online lectures, and absence of contact with family or friends were associated with worse psychological indicators. Although all courses presented substantial levels of depressive symptoms, architectures/arts, sciences, and humanities scored significantly more in the depression scale. Medicine students had significantly higher resilience levels compared with other courses. Conclusions: Our findings identify factors associated with worse psychological outcomes and can be used to create protective measures for the mental health of university students during current and future pandemics.

Characterisation of microplastics is key for reliable data interpretation.

Microplastic research has gained attention due to the increased detection of microplastics (<5 mm size) in the aquatic environment. Most laboratory-based research of microplastics is performed using microparticles from specific suppliers with either superficial or no characterisation performed to confirm the physico-chemical information detailed by the supplier. The current study has selected 21 published adsorption studies to evaluate how the microplastics were characterised by the authors prior experimentation. Additionally, six microplastic types described as 'small' (10-25 µm) and 'large' (100 µm) were commercially acquired from a single supplier. A detailed characterisation was performed using Fourier transform infrared spectroscopy (FT-IR), x-ray diffraction, differential scanning calorimetry, scanning electron microscopy, particle size analysis, and N2-Brunauer, Emmett and Teller adsorption-desorption surface area analysis. The size and the polymer composition of some of the material provided by the supplier was inconsistent with the analytical data obtained. FT-IR spectra of small polypropylene particles indicated either oxidation of the particles or the presence of a grafting agent which was absent in the large particles. A wide range of sizes for the small particles was observed: polyethylene (0.2-549 µm), polyethylene terephthalate (7-91 µm) and polystyrene (1-79 µm). Small polyamide (D50 75 µm) showed a greater median particle size and similar size distribution when compared to large polyamide (D50 65 µm). Moreover, small polyamide was found to be semi-crystalline, while the large polyamide displayed an amorphous form. The type of microplastic and the size of the particles are a key factor in determining the adsorption of pollutants and subsequent ingestion by aquatic organisms. Acquiring uniform particle sizes is challenging, however based on this study, characterisation of any materials used in microplastic-related experiments is critical to ensure reliable interpretation of results, thereby providing a better understanding of the potential environmental consequences of the presence of microplastics in aquatic ecosystems.

Lung and physical function in post COVID-19 and clinical and functional associations: a cross-sectional study in Brazil.

OBJECTIVE: The purpose of this study was to assess exercise capacity, lung and physical function in COVID-19 survivors, and the association of lesion-level characteristics assessed by chest computed tomography, probable sarcopenia, and percentage of diffusing capacity of the lung for carbon monoxide with clinical and functional variables. METHODS: This study was conducted in Salvador, Bahia, Brazil. All patients had a laboratory-confirmed SARS-CoV-2 infection. The sociodemographic characteristics, COVID-19 exposure history, pulmonary function, computed tomography, and functionality of the participants between 1 and 3 months of diagnosis of the disease were collected. RESULTS: A total of 135 patients after COVID-19 recovery were included in this study. Probable sarcopenia, reduction in percentage of diffusing capacity of the lung for carbon monoxide, and a lower 6-min walk distance were observed after COVID-19 infection. Computed tomography>50% was associated with a longer length of stay and a lower percentage of diffusing capacity of the lung for carbon monoxide. Probable sarcopenia diagnosis was associated with a worse percentage of the predicted 6-min walk distance in relation to the predicted, absolute 6-min walk distance (m), percentage of diffusing capacity of the lung for carbon monoxide, and percentage of total lung capacity. CONCLUSION: Muscle disability and lung dysfunction are common in COVID-19 survivors. Hospitalization was associated with the worst muscle force and diffusing capacity of the lung for carbon monoxide. Computed tomography characteristics could be a marker of prolonged hospital stay after the acute phase of COVID-19. Additionally, the probable diagnosis of sarcopenia could be a marker of impact on walking distance. These results highlight the need for long-term follow-up of those patients and rehabilitation programs.

Lung and physical function in post COVID-19 and clinical and functional associations: a cross-sectional study in Brazil

SUMMARY OBJECTIVE: The purpose of this study was to assess exercise capacity, lung and physical function in COVID-19 survivors, and the association of lesion-level characteristics assessed by chest computed tomography, probable sarcopenia, and percentage of diffusing capacity of the lung for carbon monoxide with clinical and functional variables. METHODS: This study was conducted in Salvador, Bahia, Brazil. All patients had a laboratory-confirmed SARS-CoV-2 infection. The sociodemographic characteristics, COVID-19 exposure history, pulmonary function, computed tomography, and functionality of the participants between 1 and 3 months of diagnosis of the disease were collected. RESULTS: A total of 135 patients after COVID-19 recovery were included in this study. Probable sarcopenia, reduction in percentage of diffusing capacity of the lung for carbon monoxide, and a lower 6-min walk distance were observed after COVID-19 infection. Computed tomography>50% was associated with a longer length of stay and a lower percentage of diffusing capacity of the lung for carbon monoxide. Probable sarcopenia diagnosis was associated with a worse percentage of the predicted 6-min walk distance in relation to the predicted, absolute 6-min walk distance (m), percentage of diffusing capacity of the lung for carbon monoxide, and percentage of total lung capacity. CONCLUSION: Muscle disability and lung dysfunction are common in COVID-19 survivors. Hospitalization was associated with the worst muscle force and diffusing capacity of the lung for carbon monoxide. Computed tomography characteristics could be a marker of prolonged hospital stay after the acute phase of COVID-19. Additionally, the probable diagnosis of sarcopenia could be a marker of impact on walking distance. These results highlight the need for long-term follow-up of those patients and rehabilitation programs.

Adsorption of cyanotoxins on polypropylene and polyethylene terephthalate: Microplastics as vector of eight microcystin analogues.

Plastics are utilised globally but are of environmental concern due to their persistence. The global presence of microplastics (particles <5 mm in all dimensions) in freshwater environments is increasingly reported, as has the presence of cyanobacterial toxins, including the microcystins. We elucidated the potential role of microplastics as a vector for eight microcystin analogues. Two sizes of polypropylene (PP) and polyethylene terephthalate (PET) microparticles were evaluated. The median particle size distribution (D50) was 8-28 µm for small particles, and 81-124 µm for large particles. Additionally, microcystin-LR and -LF were evaluated individually using small PP and PET to elucidate the adsorption behaviour in the absence of competition. Microcystin hydrophobicity, polymer material, and particle size were key factors influencing adsorption to the plastic microparticles. The small size PP microparticles demonstrated a high affinity for the 8 microcystin analogues. The proportion of microcystin adsorbed onto the small particles of PP after 48 h contact was between 83 and 100%, depending on the analogue. Of all analogues investigated, only microcystin-LW and -LF adsorbed onto the larger sized PP and PET microparticles. Individually, greater amounts of MC-LF adsorbed onto the small PET (19%) compared to when it was present in the mixture of microcystins (11%). While MC-LR did not adsorb onto small PET microparticles in the mixture, 5% adsorption was observed when individually in contact with small PET microparticles. The results demonstrated that microplastics can adsorb eight different microcystin analogues and that more hydrophobic analogues are more likely to adsorb than less hydrophobic analogues.

Immunoglobulin G4-related constrictive pericarditis and the importance of a thorough workup: a case report.

BACKGROUND: Constrictive pericarditis remains a problematic diagnosis and a thorough investigation is critical. Among possible aetiologies, immunoglobulin-G4 (IgG4)-related pericardial disease is an unusual cause of pericardial constriction. We report a challenging diagnostic case of pericardial constriction due to IgG4-related disease. CASE PRESENTATION: A 68-year old male with a history of inferior myocardial infarction with right ventricle (RV) involvement was thrice-hospitalized due to marked ascites and peripheral oedema. Systemic congestion was initially attributed to RV dysfunction due to previous infarction. Yet, at the final admission, a re-assessment echocardiogram followed by cardiac computed tomography, magnetic resonance and right heart catheterization raised a possible diagnosis of constrictive pericarditis with a finding of abnormal pulmonary venous return. Patient therefore underwent pericardiectomy and surgical correction of pulmonary venous return. Pericardium histology revealed an IgG4-related pericardial constriction. Patient was later discharged on corticosteroids with marked symptomatic improvement. CONCLUSION: IgG4-related disease remains a rare cause of pericardium constriction while also presenting a challenging diagnosis in everyday clinical practice. This case exemplifies the difficulties faced by clinicians when reviewing a possible case of constrictive pericarditis, while highlighting the importance of a multimodality assessment.

Communication skills preparedness for practice: Is there a key ingredient in undergraduate curricula design?

OBJECTIVE: To characterize medical interns' experience regarding communication skills education and to explore potential associations with preparedness for practice. METHODS: Two hundred sixty-six medical interns answered an original questionnaire specifically developed to explore how well they feel their undergraduate training had prepared them in key aspects of medical communication. Instrument's psychometric properties were tested. Medical schools' curricula were considered and associations explored using non-parametric tests. RESULTS: The questionnaire reliability was high, with Cronbach's alphas ranging from 0.89 to 0.94 on all the factors. Core communication skills were highly rated. Perceived preparedness was lower in aspects concerning dealing with emotion, breaking bad news and communicating with speech impaired patients. Better preparedness was associated with a longitudinal integration of communication skills throughout the curriculum, simulation with standardized patients and real patient interviewing with feedback on communication skills. CONCLUSIONS: Integrated programs, standing on a strong experimental component, particularly combining patient-simulation strategies with continuous supervision and learner centred feedback, were associated with higher preparedness. These results support the expansion of an educational model based on simulation strategies and structured longitudinally throughout the undergraduate medical curriculum. PRACTICE IMPLICATIONS: This study intends to inform educational background and to support further development of communication skills curricula.

Metabolic parameters as possible diagnostic predictors in first-episode psychosis: An exploratory retrospective cohort study.

AIM: Patients in early phases of schizophrenia or mood disorders with psychotic symptoms have a wide array of metabolic abnormalities. We analysed the potential predictive value of uric acid (UA) levels and other metabolic parameters in first-episode psychosis patients to differentiate between non-affective and affective psychosis. METHODS: Retrospective chart review of all patients referenced to a first-episode psychosis unit (n = 149), between 2012 and 2017, with available UA levels. Patients included (n = 37) were compared according to the follow-up diagnosis of schizophrenia or mood disorder. RESULTS: Mood disorder patients presented higher UA levels (p = .030) and lower fasting blood glucose levels (p = .020) compared with schizophrenia patients. The remaining variables did not show significant intergroup differences. CONCLUSIONS: Findings in this first-episode psychosis cohort support previous evidence suggesting higher UA levels as a predictor of affective psychosis and glucose dysfunction as predictive of schizophrenia. Further studies are needed to explore metabolic parameters as possible diagnostic predictors in first-episode psychosis.

Potentially Poisonous Plastic Particles: Microplastics as a Vector for Cyanobacterial Toxins Microcystin-LR and Microcystin-LF.

The potential of microplastics to act as a vector for micropollutants of natural or anthropogenic origin is of rising concern. Cyanobacterial toxins, including microcystins, are harmful to humans and wildlife. In this study, we demonstrate for the first time the potential of microplastics to act as vectors for two different microcystin analogues. A concentration of up to 28 times from water to plastic was observed for the combination of polystyrene and microcystin-LF achieving toxin concentrations on the plastic of 142 ± 7 µg g-1. Based on the experimental results, and assuming a worst-case scenario, potential toxin doses for daphnids are calculated based on published microplastic ingestion data. Progressing up through trophic levels, theoretically, the concentration of microcystins in organisms is discussed. The experimental results indicate that adsorption of microcystins onto microplastics is a multifactorial process, depending on the particle size, the variable amino acid composition of the microcystins, the type of plastic, and pH. Furthermore, the results of the current study stressed the limitations of exclusively investigating microcystin-LR (the most commonly studied microcystin congener) as a model compound representing a group of around 250 reported microcystin congeners.

Modeling phosphorus exchange between bottom sediment and water in tropical semiarid reservoirs.

This study investigated phosphorus (P) dynamics in the sediment-water interface of three distinct reservoirs located in a tropical semiarid region. Sequential chemical fractioning of the P content in the sediment and controlled experiments of the sediment-water interface were performed to understand and model the effect of the different P fractions on the exchange dynamics under anoxic and oxic scenarios. The results revealed that the older the reservoir, the higher the amount of iron and aluminum-bound P in the sediment, and that this fraction was responsible for a 10-fold increase in P concentration in the water during anoxic conditions. After aeration, P in water decreased but did not return to its initial concentration. The most recently constructed reservoir showed the lowest P concentration in the sediment and dominance of the unavailable P fraction, resulting in no potential impact on water quality. Phosphorus release and precipitation rates were well described by zero- and first-order models, respectively. Reservoirs with high P availability in the sediment, not only released more phosphorus but also presented a lower precipitation rate, resulting in higher potential damage to water quality and making some in-lake treatment techniques potentially ineffective.

Ruptura esplênica secundária à infeção por Plasmodium falciparum / Splenic rupture secondary to Plasmodium falciparum infection

A ruptura esplênica é uma complicação possível da malária. É importante pela dificuldade diagnóstica, pois um elevado índice de suspeição é necessário para um diagnóstico atempado. Pode condicionar uma hemorragia intraperitoneal e deve ser considerada no diagnóstico diferencial de quadros de dor abdominal, hipotensão e diminuição do hematócrito. Os autores descrevem o caso de um homem de 59 anos, com ruptura esplênica secundária à malária por Plasmodium falciparum, tendo realizado esplenectomia urgente. Com a apresentação do caso, os autores pretendem chamar a atenção para a necessidade de incluir esta afecção no diagnóstico diferencial dos doentes com malária e hipotensão refractária.

Splenic rupture is a possible complication of malaria. Due to its difficult diagnosis, it is important, because a high level of suspicion is needed for a timely diagnosis. It results in intraperitoneal bleeding and should be considered in the differential diagnosis of abdominal pain, hypotension and low hematocrit. The authors report the case of a 59-year old man with splenic rupture secondary to malarial infection by Plasmodium Falciparum, who was treated with urgent splenectomy. This case is presented to remind the clinicians of include this entity in the differential diagnosis of patients with malaria and refractory hypotension.

Oxytocin and depression in the perinatal period-a systematic review.

Postpartum depression (PPD) is the most common postnatal psychiatric disorder, and it represents a considerable problem to the health and well-being of women and their families. Several pathogenic mechanisms have been identified in PPD, and recently, oxytocin (OT), known to be involved in childbirth and lactation, has drawn attention as a possible diagnostic and therapeutic tool in this disorder. The aim of this review was to assess and summarize the current literature on the relationship between OT as a potential depressive biomarker and depression in the perinatal period. We conducted a literature search on four electronic databases (Pubmed, PsycINFO, Web of Science, and Science Direct) by applying the following search terms: oxytocin AND (postpartum OR postnatal OR perinatal OR peripartum) AND (depression OR depressive). Six studies were included and a total of 620 pregnant women were recruited and completed the follow-up. Depressive symptoms were evaluated using self-report scales, and in three studies, the diagnosis of major depression was additionally confirmed using semi-structured interviews. Peripheral OT levels and depression were assessed during pregnancy and/or after delivery. Higher OT levels were associated with lower depressive symptoms, even if this association lacked statistical significance in two studies. Although some studies are beginning to shed light upon the complex nature of OT's effect in depression, its role as a diagnostic and therapeutic tool in PPD is still unclear. Future research is needed to clarify the neuroendocrinological and psychosocial particularities of mothers with PPD and to define a specific profile associated with OT dysfunction.

An atypical spondylodiscitis: case report / Uma espondilodiscite atípica: relato de caso

Spondylodiscitis is a rare pathology, however its incidence has been rising in recent years. Its signs and symptoms are nonspecific therefore the diagnosis may be delayed from 2 to 6 months. The main symptom is back or neck pain but some patients may experience no pain. The authors report the case of an 82 year old man with a presentation of initial cough, followed by monoarthritis, then polyarthritis and finally paraparesis, accompanied by fever and elevation of infection markers. The insidious evolution delayed the diagnosis of spondylodiscitis as well as its treatment. The identified pathogen was Streptococcus pneumoniae, a very rare cause of spondylodiscitis. After 6 weeks of antibiotics the patient was discharged. Spondylodiscitis diagnosis requires a high level of suspicion due to its wide range of clinical presentations and must be ruled out when we are faced with a fever of unknown origin or an inappropriate response to treatment.

A espondilodiscite é uma patologia rara, porém sua incidência tem vindo a aumentar nos últimos anos. Os seus sinais e sintomas não são específicos e, como tal, o diagnóstico pode ser atrasado de 2 a 6 meses. O principal sintoma é a dor nas costas ou no pescoço, mas alguns doentes podem não apresentar dor. Os autores relatam o caso de um homem de 82 anos, com uma apresentação inicial de tosse, seguida de monoartrite, depois poliartrite, e finalmente paraparésia, acompanhado de elevação dos parâmetros de infecção. A evolução insidiosa atrasou o diagnóstico de espondilodiscite, assim como o seu tratamento. O patogénio identificado foi Streptococcus pneumoniae, uma causa bastante rara de espondilodiscite. Após 6 semanas de anti-bioterapia o doente teve alta. A espondilodiscite é um diagnóstico que requer um alto nível de suspeição dada a ampla variedade de apresentações clínicas e deve ser excluída quando estamos perante um caso de febre de origem indeterminada ou uma resposta inadequada ao tratamento.