Search

RESUMEN Los acontecimientos estresantes y traumáticos mantienen una estrecha relación con los síntomas del trastorno obsesivo-compulsivo (TOC), constituyendo una barrera en el tratamiento convencional de dicho trastorno, en especial cuando se trata de experiencias tempranas y recurrentes que han comprometido las necesidades básicas de seguridad y bienestar. Se expone el caso de una paciente con diagnóstico de TOC que presenta sintomatología comórbida de estrés postraumático. En el abordaje terapéutico se consideran relevantes tanto los eventos que actuaron como factores precipitantes como los sucesos relacionados con primeras experiencias en la infancia. La intervención psicológica contempla un abordaje integrado que incluye técnicas de la terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) y de la terapia de esquemas de Young. Los resultados muestran una reducción de las conductas problema.

IntroductionThe COVID-19 pandemic has forced changes in patient care in Mental Health Day Hospitals (MHDHs).ObjectivesTo study the interventions performed in MHDHs during the pandemic in comparison with those performed in other facilities and to analyze the new hospital admissions in both groups.MethodA retrospective multicenter cohort study comparing the interventions received by a group of 161 patients admitted in MHDHs during the lockdown period in Spain with the interventions of another group of 109 patients who were treated at other facilities during lockdown.ResultsMHDHs reduced their face-to-face interventions during lockdown just as much as other facilities but implemented telematic intervention methods to a greater extent. Patients attached to MHDHs during lockdown were admitted significantly less and presented fewer urgent consultations in the following 6 months.ConclusionThe use of telepsychiatry made it feasible to adapt MHDHs to periods of lockdown, being useful to improve the continuity of care during the pandemic. In addition, it was possible to maintain a reduction in hospital admissions in patients treated at MHDHs.

BackgroundTo date, there's no evidence of an increased risk of SARS-CoV-2 infection or more severe COVID-19 in patients with inflammatory bowel disease (IBD). However, whether COVID-19 alters the clinical course of IBD or whether IBD treatment affects the immunological response to SARS-CoV-2 is still under investigation, especially in children.AimTo assess the serological response to SARS-CoV-2 in children with IBD, and to evaluate the impact of COVID-19 on the clinical course of IBD.Material and MethodsThis prospective study enrolled children (0–18 years) followed-up at the University Hospital of Padova for IBD, who acquired a confirmed SARS-CoV-2 infection between 02.2020 and 02.2021. The anti-SARS-CoV-2 S-RBD IgG titer was evaluated at 3 months after infection and compared to that of a control group of healthy children matched for age, sex, and COVID-19 severity.ResultsTwelve children with IBD (M = 5; median age 14 years) contracted COVID-19 during the study period. 11/12 patients were under immunomodulatory treatment (4/12 steroids; 6/12 azathioprine; 3/12 anti-TNFs; 2 vedolizumab; 1 ustekinumab). SARS-CoV-2 infection remained asymptomatic in 4/12 children and caused mild COVID-19 in the remaining 8. Mean anti-SARS-CoV-2 IgG S-RBD titer was similar between IBD patients and controls (27.3 ± 43.8 vs. 36.8 ± 35.3 kAU/L, p = ns). No children experienced IBD flares nor required gastroenterological support during the infection period.DiscussionChildren with IBD can mount a protective humoral response against SARS-CoV-2, which is comparable to that of their healthy peers regardless of ongoing immunomodulatory treatment. This study also supports the favorable course of PIBD during COVID-19 and vice-versa.

Introduction: The diet provided in hospital environments should promote good eating habits by offering healthy food. However, it is known that processed foods are served in hospital diets. Objective: To evaluate the presence and the frequency of ultra-processed foods in the pediatric diets of a university hospital. Methods: The sample consisted of 25 pediatric diets prescribed for children older than two years. Data collection occurred from January to August 2020. The menus were analyzed according to the level of food processing, following the NOVA classification. The data was analyzed in Microsoft Excel, and the results obtained were described by absolute and relative frequency. Results: Natural or minimally processed foods represent 54.3% (n=10,851). The culinary ingredients accounted for 28.9% (n=5,768); processed foods, 2.7% (n=551); and ultra-processed, 13.9% (n=2,789). A total of 29 ultra-processed foods were identified, of which the three most frequent were chocolate milk powder (23.5%, n=658), margarine (18.5%, n=518) and sliced bread (11%, n=308). The biggest offer occurs in breakfast (31%, n=854), in the afternoon snack (30%, n=844) and on supper (24%, n=661), representing 85% (n=2,359) of the total offer. Conclusions: The findings of this study include the presence of ultra-processed foods in virtually all hospital pediatric diets analyzed. However, natural or minimally processed foods represent more than half of the composition of the menus.

The use of residues from the black pepper bean drying process as fertilizer for agricultural crops implies the need to know the dynamics of their decomposition and release of the nutrients to guide it’s management, especially regarding the best time of its application in the soil. This study aimed to evaluate the dynamics of organic carbon and nitrogen during the mineralization process of this residue. The experiment was conducted in a completely randomized design with ten treatments related to different post-disposal periods to the soil (0, 7, 13, 20, 27, 34, 48, 69, 98, 147 days). Samples were collected to quantify easily oxidized organic carbon (OCeo), organic nitrogen (ON) and the determinations of their respective mineralized fractions. The evaluation of OCeo mineralization, being more stable and less susceptible to climatic variations, was the most appropriate for estimating the mineralized fraction of the residue. The application of the residue in dystrophic Yellow Red Latosol soil during the month of August provides, after 140 days, OCeo and ON mineralized fractions around 99 and 60%, respectively, in the climatic conditions of Espirito Santo state, Brazil.

With the recognition and expansion of agroecology, studies on experiences towards the agroecological transition become relevant. This article analyzes social and technical aspects in a process aimed at the organic coffee production in eastern Minas Gerais. Based on the agroecological transition approach and the actor-oriented perspective, the implemented actions, their results, limitations and advancements were analyzed. The study identified an approach focused more on organic conversion, to the detriment of an agroecological transition process, and evidenced a sharp drop in coffee productivity, with the removal of chemical fertilization without adequate substitution, in addition to difficulties in making commercialization possible, with consequent loss of income and discouragement of farmers. On the other hand, it revealed an increase in sustainable practices and socio-economic organization initiatives in family farming. In strategic terms, learning on the construction of changes was identified, integrating production, organization and market, from local social actors.

Nodular lymphoid hyperplasia (NLH) is a lymphoproliferative disease caused by non-clonal expansion of lymphoid cells in the gut mucosa. Little is known about the pathogenesis of NLH, which is often disregarded as an insignificant or para-physiologic phenomenon. We present the case of a girl with isolated diffuse NLH (extending from the stomach to the rectum) caused by activated PI3Kδ syndrome (APDS) due to the novel p.Glu525Gly variant in PIK3CD. The gain-of-function effect of the variant was confirmed by demonstration of over activation of the Akt/mTOR pathway in the patient's cells. APDS diagnosis led to treatment with sirolimus, which resulted in the complete remission of NLH and in the prevention of extra intestinal complications. In conclusion, we identify APDS as a novel cause of isolated NLH and suggest that patients with severe pan-enteric NLH should be screened for this disorder that may not be apparent on first-line immunological testing.

Introduction: Limited data are available on the course of Coronavirus disease 2019 (COVID-19) in people with Multiple Sclerosis (MS). More real-world data are needed to help the MS community to manage MS treatment properly. In particular, it is important to understand the impact of immunosuppressive therapies used to treat MS on the outcome of COVID-19.Methods: We retrospectively collected data on all confirmed cases of COVID-19 in MS patients treated with ocrelizumab, followed in two MS Centers based in University Hospitals in Northern Italy from February 2020 to June 2021.Results: We identified 15 MS patients treated with ocrelizumab with confirmed COVID-19 (mean age, 50.47 ± 9.1 years; median EDSS, 3.0; range 1.0–7.0). Of these, 14 were confirmed by nasal swab and 1 was confirmed by a serological test. COVID-19 severity was mild to moderate in the majority of patients (n = 11, 73.3%; mean age, 49.73; median EDSS 3.0). Four patients (26.7%; mean age, 52.5 years; median EDSS, 6) had severe disease and were hospitalized; one of them died (age 50, EDSS 6.0, no other comorbidities). None of them had underlying respiratory comorbidities.Conclusion: This case series highlights the large variability of the course of COVID-19 in ocrelizumab-treated MS patients. The challenges encountered by the healthcare system in the early phase of the COVID-19 pandemic might have contributed to the case fatality ratio observed in this series. Higher MS-related disability was associated with a more severe COVID-19 course.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment. Methods: The ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients. Results: Our population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p

Simple and low-cost observational-tools to detect symptoms of Autism Spectrum Disorder (ASD) are still necessary. The OERA is a new assessment tool to screen children eliciting observable behaviors with no substantial knowledge on ASD required. The sample was 99 children aged 3-10: 76 with ASD and 23 without ASD (11/23 had intellectual disability). The 13 remained items exhibited high interrater agreement and high reliability loaded onto a single latent trait. Such model showed excellent fit indices evaluated via confirmatory factor analysis and no item showed differential function in terms of age/sex/IQ. A cutoff of five points or higher resulted in the highest sensitivity (92.75) and specificity (90.91) percentages. OERA is a brief, stable, low-cost standardized observational-screening to identify ASD children.

Abstract Some children with Autism Spectrum Disorder (ASD) experience the loss of previously acquired abilities, especially that of using words, a phenomenon that is still poorly understood. This study aimed to investigate parents’ perceptions of the age of word acquisition and word loss in individuals with ASD as compared to children with Down Syndrome (DS) and those with typical development (CG). Parents of 77 individuals with ASD, 33 with DS, and 63 from CG completed an inventory on the loss of words and developmental abilities. The median age of acquisition of the first words was 14 months for the ASD group, approximately 4 months after those in CG, and 23 months for the SD group. Word loss occurred only in the ASD group (36.4%). The median age of loss was 18 months. Parents’ perception of word loss can contribute to the understanding of this phenomenon as a potential early ASD indicator.

Abstract: We verified the prevalence of adequacy in prenatal care considering nutritional assistance and associated factors. It is a cross-sectional study, part of Maternar Cohort Study, conducted between 2018-2019 in Southern Brazil. Women were interviewed during hospitalization in the immediate postpartum period and data were collected from the prenatal chart. Prenatal adequacy and nutritional care were assessed according to criteria from the Brazilian Ministry of Health. Two outcome models were constructed. Outcome 1 consisted of minimal coverage (early prenatal start and minimum number of visits) and exams, and Outcome 2 comprised minimal coverage, exams, and nutritional assistance. Poisson regression was used to estimate prevalence ratios. A total of 802 women were analyzed, and we identified 57% of adequacy of Outcome 1. Unplanned pregnancy (PR = 0.76; 95%CI: 0.68-0.86), parity (PR = 0.88; 95%CI: 0.83-0.94) and prenatal care outside Porto Alegre, Rio Grande do Sul State (PR = 0.80; 95%CI: 0.69-0.92), were associated with lower prenatal adequacy frequencies. Outcome 2 was considered adequate for 10.2% of women. Follow-up by different professionals during prenatal care was associated with lower adequacy (PR = 0.49; 95%CI: 0.28-0.86). Women with high-risk pregnancies had a higher frequency of adequacy in Outcome 1 (PR = 1.21; 95%CI: 1.07-1.37) and in Outcome 2 (PR = 1.75; 95%CI: 1.16-2.64). General adequacy was considered low in both outcomes. There was a lack of nutritional assistance during prenatal care. Characteristics such as pregnancy planning, lower parity, prenatal care in Porto Alegre, follow-up by the same professional and high-risk pregnancy were predictors for the adequacy of prenatal care.

Patients with multiple sclerosis (MS) have a lower quality of life (QoL) than the general population. Rehabilitation is an essential part of the comprehensive treatment of MS patients. The aim was to determine the influence of complex physical therapy on the QoL of MS patients and the association of functional status with certain domains of health-related QoL. We followed 58 MS patients. The complex kinesitherapy used the Bobath concept and occupational therapy with the use of robot-assisted rehabilitation for the upper extremities. Before the start of rehabilitation and at the end, functional status was assessed by the Expanded Disability Status Scale (EDSS) and Berg Balance Scale (BBS). QoL was assessed through the standardized SF36 test and summarized into two scores: physical health component score and mental health component score. The average age of patients was 49.38 years. There was a significant improvement in all patients after the therapy, both in functional status and in QoL. There were no significant correlations between the EDSS and BBS with QoL parameters (individual SF36 categories and two summary scores). Duration of the disease correlated with the EDSS and BBS, but not with QoL. The age of patients did not correlate with functional status or with QoL. Physical therapy improves both functional status and QoL, but improvements do not correlate. There is a need to incorporate QoL assessment into assessments of disease severity, progression, and treatment success to obtain the most relevant results in creating the right treatment strategy. [ABSTRACT FROM AUTHOR]