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[Introduction]: Health-care Workers (HCW) are facing a critical situation caused by Coronavirus Disease 2019 (COVID-19) which could impact on their mental health status. In addition, HCW women have been identified as a group at high-risk of developing psychological distress, although no previous longitudinal studies have explored this issue in a sample of HCW., [Aims]: The main aim of the study was to observe the temporal pattern of the stress reactions among HCW as well as to explore its potential predictors of poor outcome. Moreover, we analyzed possible gender differences in stress reaction responses., [Methods]: One thousand for hundred and thirty-two HCW responded an online survey including sociodemographic, clinical, and psychometric tests in May 2020 while 251 HCW answered in November 2020. Bivariate and multivariate analyses as well as repeated measures analyses were used to achieve the aims of the study., [Results]: The proportion of HCW who fulfilled Acute Stress Disorder criteria did not change over the follow-up period, although we observed a significant improvement in stress reactions responses among HCW. Proximal factors were the most salient predictors of traumatic reactions. Repeated analyses revealed significant gender differences in acute stress reactions. In addition, women showed significantly greater improvement than men in re-experiencing the traumatic event and hyperarousal dimensions., [Conclusions]: Monitoring of working conditions as well as emotional reactions in HCW facing major disasters should be carried out to prevent the development of peritraumatic stress reactions. In addition, HCW women are characterized by a different pattern of progression in stress responses.

The seal heartworm Acanthocheilonema spirocauda (Nematoda: Onchocercidae) parasitizes the heart and pulmonary arteries of various phocid seals of the Northern Hemisphere. Over many decades, potential vectors of this parasite have been discussed, and to this date, the life cycle is not fully known. The seal louse Echinophthirius horridus (Anoplura: Echinophthiriidae) is an obligatory, permanent and haematophagous ectoparasite of phocids that has been hypothesized to function as obligate intermediate host for A. spirocauda. We examined 11 adult E. horridus specimens collected from stranded harbour seals (Phoca vitulina) in rehabilitation at the Sealcentre Pieterburen by X-ray microCT imaging, aiming to illustrate larval A. spirocauda infection sites in situ. In three of these specimens, thread-like larvae were detected in insect organs. Detailed imaging of the most infected louse revealed a total of 54 A. spirocauda larvae located either in fat bodies or the haemocoel. Histological analysis of the same specimen illustrated nematode cross-sections, confirming X-ray microCT data. The current data strongly suggest that E. horridus is a natural intermediate host for A. spirocauda. Moreover, we demonstrate the potential of X-ray microCT-based imaging as a non-destructive method to analyze host-parasite interactions, especially in the neglected field of marine mammal parasitology.

[Background] Few investigations have been carried out on metabolic syndrome in antipsychotic- naïve patients with schizophrenia., [Methods] Our primary objective was to compare the prevalence of Metabolic Syndrome (MetS), as defined by the National Cholesterol Education Program, Adult Treatment Panel III in 2001 (NCEP-ATP III), between a Spanish cohort of 303 drug-naïve patients with a first episode of psychosis (FEP) without any previous cardiovascular condition, and 153 healthy individuals., [Results] Participants included 303 patients with FEP (M:F 53:46) and 153 control subjects (M:F 56:43). The mean and standard deviation ages were 31(9.38) and 29 (7.57) years in the study and control groups respectively (F = 4.09; p = 0.93). We found that the prevalence of MetS in drug-naïve patients with FEP (5.6 %) was similar to the prevalence of MetS in age-sex matched controls (5.12 %). However, 60.7 % of patients with FEP met at least one of the five MetS components, while among the control subjects only 36.5 % met at least one component. Additionally, we found that other factors not included among the operational definition of MetS, but still important in cardiovascular risk, were also altered., [Conclusion] FEP patients have a greater risk of presenting at least one altered MetS component than healthy controls which could indicate the need of development of screening methods detecting cardiovascular risk. Likewise, gender differences in metabolic components such as waist circumference, which is a predictor of cardiovascular events have been found. Similarly, research should focus on metabolic risk predictors that include not only MetS, but also specific parameters for the early psychosis population.

[Introduction] The SARS-CoV-2 pandemic with psychiatric comorbidities leads to a scenario in which the use of psychotropic drugs may be required. This requires the support of evidence-based medicine to take into account possible interactions between antidepressants, mood stabilizers, benzodiazepines, and coronavirus infection treatments., [Methods] Three databases were consulted: (a) Lexicomp Drug Interactions, (b) Micromedex Solutions Drugs Interactions, (c)Liverpool Drug Interaction Group for COVID-19 therapies. The CredibleMeds QTDrugs List was also queried. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, remdesivir, favipiravir, tocilizumab, baricitinib, anakinra, and dexamethasone – drugs used for SARS-CoV-2 – were analyzed, and consensus recommendations are made., [Results] The potential interactions of agomelatine, desvenlafaxine, duloxetine, milnacipran, and vortioxetine with COVID-19 treatments shall be considered less risky. Antidepressant interactions with hydroxychloroquine, chloroquine, and azithromycin enhance the risk of QT prolongation, and ECG monitoring is advised for most antidepressants. Antidepressants with lopinavir/ritonavir involve multiple CYP enzyme interactions (except with milnacipran). Gabapentin, oxcarbazepine, pregabalin, topiramate, and zonisamide are safe treatment options that have no significant interactions with COVID-19 treatments. Lithium is contraindicated with hydroxychloroquine, chloroquine, and azithromycin. Precaution should be taken in using valproic acid with lopinavir-ritonavir. The use of benzodiazepines does not present a risk of drug interaction with COVID-19 treatments, except lopinavir/ritonavir., [Conclusions] Clinicians prescribing antidepressants, mood stabilizers/anticonvulsants, and benzodiazepines, should be aware of the probable risk of drug-drug interaction with COVID-19 medications and may benefit from heeding these recommendations for use to ensure patient safety.

RelevanceManagement of symptoms like anxiety, delirium and agitation cannot be neglected in COVID-19 patients. Antipsychotics are usually used for the pharmacological management of delirium, and confusion and behavioral disturbances. The selection of concomitant COVID-19 medications and antipsychotics should be evidence-based and closely monitoredObjectiveTo systematically review evidence-based available on drug-drug interactions between COVID-19 treatments and antipsychotics.Evidence ReviewThree databases were consulted: (a) Lexicomp® Drug Interactions, (b) Micromedex® Solutions Drugs Interactions, (c) Liverpool © Drug Interaction Group for COVID-19 therapies. To acquire more information on QT prolongation and TdP, the CredibleMeds® QTDrugs List was searched. Based on the information collected, the authors made a recommendation agreed to by consensus. In addition, a systematic review was conducted to find the clinical outcomes of drug-drug interactions between COVID-19 treatments and antipsychoticsResultsThe main interaction between COVID-19 drugs and antipsychotics are the risk of QT prolongation and TdP, and CYP interactions. Remdesivir, favipiravir, baricinitib, and anakinra can be used concomitantly with antipsychotics with no risk of drug-drug interaction (except for hematological risk with clozapine and baricinitib). Tocilizumab is rather safe to use in combination with antipsychotics, although it can restore the activity of CYP3A4 and therefore its substrate metabolism may increase. The most demanding COVID-19 treatments for co-administration with antipsychotics are chloroquine, hydroxychloroquine, azithromycin (all prolong QT interval) and lopinavir / ritonavir (CYP interaction and risk of QT prolongation).ConclusionsWe urge to development of evidence-based guidelines that can help clinicians decide the safest treatment combination and monitoring necessary for each particular patient. The selection of concomitant COVID-19 medications and antipsychotics should be evidence-based and closely monitored.

Background Nature relatedness can be associated with health-related outcomes. This study aims to evaluate the associations of nature relatedness with physical activity and sedentary behavior. Methods A cross-sectional study involving 9–12 year old children living in Cuenca, Ecuador, was conducted between October 2018 and March 2019. Questionnaires were used to evaluate physical activity (PAQ-C), out-of-school sedentary behavior, nature relatedness and wellbeing. Associations of nature relatedness with physical activity, and sedentary behavior were evaluated using linear regression models or tobit regressions adjusted by age, sex, school type, wellbeing, and body mass index z-score. Results A total of 1028 children were surveyed (average age:10.4±1.22 years, 52% female.). Nature relatedness was positively associated with physical activity (β = 0.07; CI 95%: 0.05–0.09; p < 0.001) and non-screen-related sedentary leisure (β = 3.77 minutes; CI 95%: 0.76–6.68; p < 0.05); it was negatively associated with screen time (β = -5.59 minutes; CI 95%: -10.53–0.65; p < 0.05). Conclusions Findings suggest that nature relatedness is associated with physical activity and some sedentary behaviors among Ecuadorian school-age children. The promotion of nature relatedness has the potential to improve health.

Background: Belonging to the anopluran family Echinophthiriidae, Echinophthirius horridus, the seal louse, has been reported to parasitize a broad range of representatives of phocid seals. So far, only few studies focused on vector function of echinophthiriid lice and knowledge on their role in pathogen transmission is still scarce. The current study aims to investigate the possible vector role of E. horridus parasitizing seals in the Dutch Wadden Sea.Methods: More than 1200 E. horridus seal lice were collected from 54 harbour seals (Phoca vitulina) and one grey seal (Halichoerus grypus) during their rehabilitation period in the Sealcentre Pieterburen, the Netherlands. DNA was extracted from pooled seal lice of individual seals for molecular detection of the seal heartworm Acanthocheilonema spirocauda, the rickettsial intracellular bacterium Anaplasma phagocytophilum, and Mycoplasma spp. using PCR assays.Results: Seal lice from 35% of the harbour seals (19/54) and from the grey seal proved positive for A. spirocauda. The seal heartworm was molecularly characterised and phylogenetically analysed for the first time (rDNA, cox1). A nested PCR was developed for the cox1 gene to detect A. spirocauda stages in seal lice. A. phagocytophilum and a Mycoplasma species previously identified from a patient with disseminated ‘seal finger’ mycoplasmosis were detected the first time in seal lice. Conclusions: Our findings support the potential vector role of seal lice in transmission of A. spirocauda, and reveal new insights into the spectrum of pathogens occurring in seal lice. As these pathogens might have detrimental effects on the health of seal populations further epidemiological investigations on infections due to these pathogens in seals should be conducted.

Background: Belonging to the anopluran family Echinophthiriidae, Echinophthirius horridus, the seal louse, has been reported to parasitize a broad range of representatives of phocid seals. So far, only few studies focused on vector function of echinophthiriid lice and knowledge on their role in pathogen transmission is still scarce. The current study aims to investigate the role of E. horridus in vector-borne diseases of seals in the Dutch Wadden Sea and to attribute to its morphological features of environmental adaptation.Methods: More than 1200 E. horridus seal lice were collected from 54 harbour seals (Phoca vitulina) and one grey seal (Halichoerus grypus) during their rehabilitation period in the Sealcentre Pieterburen, the Netherlands. DNA was extracted from pooled seal lice of individual seals for molecular detection of the seal heartworm Acanthocheilonema spirocauda, the rickettsial intracellular bacterium Anaplasma phagocytophilum, and Mycoplasma spp. using PCR assays. In addition E. horridus-adult and -eggs were analysed by scanning electron microscopy (SEM).Results: Seal lice from 35% of the harbour seals (19/54) and from the grey seal proved positive for A. spirocauda. The seal heartworm was molecularly characterised and phylogenetically analysed for the first time (rDNA, cox1). A nested PCR was developed for the cox1 gene to detect A. spirocauda stages in seal lice. A. phagocytophilum and a Mycoplasma species previously identified from a patient with disseminated ‘seal finger’ mycoplasmosis were detected the first time in seal lice. SEM analyses of E. horridus-adults and -eggs brought out more clearly unique morphological features, such as ‘lock-like’ claws, setae-covered cuticle as well as vaulted nit lids carrying micropyles for respiration, which all demonstrate the adaption of this ectoparasite to its semiaquatic host and the marine environment.Conclusions: Our findings support the vector role of seal lice in transmission of A. spirocauda, Mycoplasma spp. and A. phagocytophilum and presented more detailed images of their morphological adaptations to the semiaquatic lifestyle of their hosts. As the vector-borne pathogens might have detrimental effects on the health of seal populations further epidemiological investigations on infections due to these pathogens in seals should be conducted.

INTRODUCCIÓN Y DESCRIPCIÓN DEL CASO Presentamos el caso de un varón de 43 años que acude al servicio de Urgencias del Hospital General por presentar ideación autolítica en contexto de síntomas ansioso-depresivos tras crisis vital (ha dejado el sacerdocio por motivación sentimental y ha comenzado de prácticas de “chemsex” con uso de mefedrona como medio inicial de socialización). Estas ideas aparecen en marco de una lucha interna con modelo previo moral e insatisfacción vital. Como antedecentes de SM, una consulta una semana antes donde acude para deshabituación y manejo de ansiedad en relación al craving. No alergias, enfermedades somáticas o antecedentes de intervenciones quirúrgicas. EXPLORACIÓN PSICOPATOLÓGICA: Consciente, orientado, colaborador y abordable. Lenguaje coherente y organizado. Ánimo bajo con disminución de las capacidades hedónicas e intenso craving. Ideas autolíticas en este contexto sin plan estructurado, pero riesgo de paso al acto con poca contención familiar. No fenómenos de orden psicótico. No alteraciones groseras en sueño o alimentación. Juicio de realidad y capacidades volitivas conservadas. Test de tóxicos positivo a BZD y AD tricíclicos. TRATAMIENTO: Se decide ingreso breve en Unidad de Hospitalización para contención.Se inicia AD, ansiolíticos y oxcarbazepina para manejo de impulsos. EVOLUCIÓN Durante su estancia en la planta (de tres días de duración) se mitigan estas ideas y se trabaja en relación a la autosuficiencia y autodeterminaciones vitales y la confrontación de vida autodestructiva como evasión. Permeable a ello y consciente de necesidad de manejo alternativo. Solicita ayuda específica para deshabituación y restablecimiento de rutina ajustada. JUICIO CLÍNICO: -Ideación autolítica, ya resuelta. -Trastorno adaptativo. -Consumo perjudicial de tóxicos (mefedrona). PLAN TERAPÉUTICO: Se deriva a centro privado de deshabituación y seguimiento posterior en Salud Mental.

INTRODUCCIÓN Y DESCRIPCIÓN DEL CASO: Presentamos el caso de una mujer de 20 años que acude al servicio de Urgencias por intento autolítico por precipitación en contexto de episodio psicótico. Es valorado durante el ingreso en la UCI por Salud Mental de enlace. Este intento se produce tras días previos de intensa angustia en contexto de fenómenos sensoperceptivos y consumo de tóxicos (THC, setas) como medio evasivo pasando al acto por intolerancia a dicha situación de manera impulsiva. Valorada cuando tenía 14 años en SM con OD de TDAH. Un ingreso en 2017 en USHM con OD de episodio psicótico exotóxico. Desde entonces seguimiento irregular. Mantiene consumo de cocaína y THC. EXPLORACIÓN Y PRUEBAS COMPLEMENTARIAS: Al ingreso consciente, orientada y parcialmente colaboradora. Juicio de realidad estrechado. Discurso vago e inconexo. Afecto inapropiado. Minimización de síntomas psicóticos con alucinaciones auditivas e ideas de perjuicio. Rasgos anómalos de personalidad. No franca ideación autolítica. TRATAMIENTO: Se mantiene seguimiento estrecho por nuestra parte y se pauta APS oral que se van ajustando según clínica sustituyendo por tratamiento depot (Aripiprazol) previo alta. EVOLUCIÓN Y DIAGNÓSTICO DIFERENCIAL: Durante su ingreso al comienzo predomina la minimización de clínica, pero con el paso del tiempo, presencia de paranoidismo en primer plano hacia familia y personal sanitario que aminoran progresivamente. Percibimos dinámica familiar disfuncional y dificultad en el manejo emocional. Se alcanza la estabilidad psicopatológica finalmente. Aunque los síntomas siempre han estado presentes en relación al consumo lo cierto es que han persistido de manera incesante durante meses siendo necesaria la evolución longitudinal para filiación de origen de los mismos (psicosis primaria vs secundaria a tóxicos). ORIENTACIÓN FINAL Se enjuicia como Psicosis tóxica (F19.5 según CIE-10) y Trastorno de inestabilidad emocional de la personalidad (F60.3). Se deriva a Hospital de Día para seguimiento intensivo, adherencia y prevención de recaídas.

Pinnipeds are a diverse Glade of semi-aquatic mammals, which act as key indicators of ecosystem health. Their transition from land to marine environments provides a complex microbial milieu, making them vulnerable to both aquatic and terrestrial pathogens, thereby contributing to pinniped population decline. Indeed, viral pathogens such as influenza A virus and phocine distemper virus (PDV) have been identified as the cause of several of these mass mortality events. Furthermore, bacterial infection with mammalian Brucella sp. and methicillin-resistant Staphylococcus aureus strains have also been observed in marine mammals, posing further risk to both co-habiting endangered species and public health. During these disease outbreaks, mortality rates have varied amongst different pinniped species. Analyses of innate immune receptors at the host pathogen interface have previously identified variants which may drive these species-specific responses. Through a combination of both sequence- and structure-based methods, this study characterises members of the Toll-like receptor (TLR) 1 superfamily from both harbour and elephant seals, identifying variations which will help us to understand these species-specific innate immune responses, potentially aiding the development of specific vaccine-adjuvants for these species. (C) 2015 Elsevier B.V. All rights reserved.

In 2012, 543 harbor seals (Phoca vitulina) and 124 grey seals (Halichoerus grypus) were admitted to the Seal Rehabilitation and Research Centre in Pieterburen, The Netherlands. In 19 seals (3%), signs of infection in a hind flipper were observed. Initial treatment consisting of antibiotics and anti-inflammatory drugs resolved the symptoms in 15 animals. In four harbor seals, estimated to be 3 to 4 mo old, a necrotizing infection developed that resulted in osteoarthritis of the tarsus or tibiotarsal joint or both. Bacterial culture revealed the presence of polymicrobial infection in three of the four animals. Treatment consisted of amputation of the hind flipper under general anesthesia combined with tumescent anesthesia in the operation field. Amputations were done at the diaphysis of the tibia and fibula. After resecting these bones, the flipper was discarded, leaving a good muscle-skin cuff to cover the edges of the bones and close the skin without tension. The estimated blood loss varied between

Extracellular traps (ETs) are composed of nuclear DNA as backbone adorned with histones, cytoplasmic antimicrobial peptides/proteins which are released from a range of vertebrate and invertebrate host immune cells in response to several invading pathogens. Until now this ancient novel innate defence mechanism has not been demonstrated in any marine mammal. Interactions of harbour seal (Phoca vitulina)-PMN and -monocytes with viable tachyzoites of Toxoplasma gondii were investigated in this respect in vitro. For the demonstration and quantification of harbour seal PMN- and monocyte-derived ETs, extracellular DNA was stained with Sytox Orange. Fluorescence assays as well as scanning electron microscopy (SEM) analyses demonstrated PMN- and monocyte-promoted ET formation rapidly being induced upon contact with T. gondii-tachyzoites. The co-localisation of extracellular DNA decorated with histones (H3), neutrophil elastase (NE) and myeloperoxidase (MPO) in parasite entrapping structures confirmed the classical characteristics of PMN- and monocyte-promoted ETs. Exposure of harbour seal PMN and monocytes to viable tachyzoites resulted in a significant induction of ETs when compared to negative controls. Harbour seal-ETs were efficiently abolished by DNase I treatment and were reduced after PMN and monocytes pre-incubation with the NADPH oxidase inhibitor diphenilane iodondium. Tachyzoites of T. gondii were firmly entrapped and immobilised within harbour seal-ET structures. To our best knowledge, we here report for the first time on T. gondii-induced ET formation in harbour seal-PMN and -monocytes. Our results strongly indicate that PMN- and monocyte-triggered ETs represent a relevant and ancient conserved effector mechanism of the pinniped innate immune system as reaction against the pathogenic protozoon T. gondii and probably against other foreign pathogens occurring in the ocean environment.