Obstetric Phenotypes in the Heterogeneity of Schizophrenia.

Schizophrenia is a complex mental disorder with genetic and environmental components. Obstetric complications (OCs) are one of the most common environmental risk factors described. However, despite being different in timing and outcome, OCs are usually described as a homogeneous entity. In the present study, we evaluate the presence of different patterns of OCs evaluated with the Lewis-Murray Scale in chronic schizophrenia patients (n = 101) and their association with a crude marker of the intrauterine environment such as weight at birth.OCs related with abnormal fetal growth (p < 0.001) and OCs during gestation (p = 0.003) were associated with lower birth weight. However, difficulties in delivery, complications in pregnancy, and OCs all together (as a set) were not associated with weight at birth.Our results infer that OCs cannot be taken as a homogeneous group. Different patterns of OCs result in different birth weights, which is associated with specific metabolic, cognitive, and brain structure outcomes.This work was supported by the Government of Catalonia, Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement (2014SGR441), with the grants FI-DGR-2013 Contract of the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) (2015 FI_B2 00100) and from Fundació Bosch Gimpera (FBG) within the RETOS COLABORACIÓN 2015, funded by the Spanish Ministry of Economic Affairs and Competitiveness (RTC-2015-3440-1) to G. Mezquida. Dr. Bernardo has been supported by research funding from the Spanish Ministry of Health, the Spanish Ministry of Science and Education, the Spanish Ministry of Economic Affairs and Competitiveness, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), by Secretaria d'Universitat i Recerca del Departament d'Economia I Coneixement (2014SGR441), Foundation European Group for Research In Schizophrenia (EGRIS), and the 7th Framework Program of the European Union. Dr. Garcia-Rizo is supported by the PI14/00753 project, integrated into the State Plan of Scientific and Technical Research and Innovation 2013–2016 and co-financed by the ISCIII-General Evaluation Branch and the European Regional Development Fund (ERDF). Dr. Bobes is supported by the Spanish Ministry of Health, the Spanish Ministry of Science and Education, the Spanish Ministry of Economic Affairs and Competitiveness and CIBERSAM. Dr. Paz-Portilla has been also supported by the European Commission, ISCIII-General Evaluation Branch and CIBERSAM. Dr. Savulich is funded by a grant from Eton College and theWallitt Foundation. Dr. Fernanez-Egea is supported, in part, by the NIRH-Biomedical Research Center, Cambridge

The effect of early life events on glucose levels in first-episode psychosis

First episode of psychosis (FEP) patients display a wide variety of metabolic disturbances at onset, which might underlie these patients’ increased morbidity and early mortality. Glycemic abnormalities have been previously related to pharmacological agents; however, recent research highlights the impact of early life events. Birth weight (BW), an indirect marker of the fetal environment, has been related to glucose abnormalities in the general population over time. We aim to evaluate if BW correlates with glucose values in a sample of FEP patients treated with different antipsychotics. Two hundred and thirty-six patients were included and evaluated for clinical and metabolic variables at baseline and at 2, 6, 12, and 24 months of follow-up. Pearson correlations and linear mixed model analysis were conducted to analyze the data. Antipsychotic treatment was grouped due to its metabolic risk profile. In our sample of FEP patients, BW was negatively correlated with glucose values at 24 months of follow-up [r=-0.167, p=0.037]. BW showed a trend towards significance in the association with glucose values over the 24-month period (F=3.22; p=0.073) despite other confounders such as age, time, sex, body mass index, antipsychotic type, and chlorpromazine dosage. This finding suggests that BW is involved in the evolution of glucose values over time in a cohort of patients with an FEP, independently of the type of pharmacological agent used in treatment. Our results highlight the importance of early life events in the later metabolic outcome of patients

Cross-cultural Validation of the 5-Factor Structure of Negative Symptoms in Schizophrenia.

Objective: Negative symptoms are currently viewed as having a 2-dimensional structure, with factors reflecting diminished expression (EXP) and motivation and pleasure (MAP). However, several factor-analytic studies suggest that the consensus around a 2-dimensional model is premature. The current study investigated and cross-culturally validated the factorial structure of BNSS-rated negative symptoms across a range of cultures and languages. Method: Participants included individuals diagnosed with a psychotic disorder who had been rated on the Brief Negative Symptom Scale (BNSS) from 5 cross-cultural samples, with a total N = 1691. First, exploratory factor analysis was used to extract up to 6 factors from the data. Next, confirmatory factor analysis evaluated the fit of 5 models: (1) a 1-factor model, 2) a 2-factor model with factors of MAP and EXP, 3) a 3-factor model with inner world, external, and alogia factors; 4) a 5-factor model with separate factors for blunted affect, alogia, anhedonia, avolition, and asociality, and 5) a hierarchical model with 2 second-order factors reflecting EXP and MAP, as well as 5 first-order factors reflecting the 5 aforementioned domains. Results: Models with 4 factors or less were mediocre fits to the data. The 5-factor, 6-factor, and the hierarchical second-order 5-factor models provided excellent fit with an edge to the 5-factor model. The 5-factor structure demonstrated invariance across study samples. Conclusions: Findings support the validity of the 5-factor structure of BNSS-rated negative symptoms across diverse cultures and languages. These findings have important implications for the diagnosis, assessment, and treatment of negative symptoms

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluación del efecto del proceso de extrusión en harina de quinua (chenopodium quinoa willd) normal y germinada

Quinoa (Chenopodium quinua Willd) germinated seeds shows nutritional value and body assimilation differences respect to normal seeds, therefore, sought to identify the extrusion process effect over flour from normal and germinated quinoa. Proximal analysis, pasting curves, Water Absorption Index (WAI) and Water Solubility Index (WSI). After extrusion process, proximal analysis, WAI and WSI performed to flours. Changes in germinated flour was found respect to normal flour like protein increase (15,06 g/100 g sample to 15,74 g/100 g sample), gelation properties, WAI and WSI variations. Significant differences was found on germinated flour due to extrusion process applied, over WSI and WAI (2,5274 g gel/g D.M. in normal quinoa flour increased to 5,8761 g gel/g D.M. in extruded quinoa flour. Thus, 2,5829 g gel/g D.M. for no extruded germinated quinoa flour, increased to 5,4197 g gel/g D.M. for extruded germinated quinoa flour).Las semillas germinadas de quinua (Chenopodium quinoa Willd) presentan diferencias en su valor nutricional y asimilación en el organismo respecto a las semillas normales, por esto, se buscó identificar el efecto del proceso de extrusión sobre harina de quinua normal y germinada. Para ello se les realizó análisis proximal, curvas de empastamiento, índice de solubilidad de agua (ISA) e índice de absorción de agua (IAA). Posteriormente las harinas fueron extruidas y se les realizó análisis proximal, ISA e IAA. Se identificó que la germinación generó cambios en el contenido de proteína (15,06 g/100 g de muestra a 15,74 g/100 g de muestra), en las propiedades de gelificación, en el ISA e IAA. Se identificaron diferencias significativas en la composición de las harinas debidas al proceso de extrusión aplicado, siendo más notable en la harina germinada, así como en el IAA e ISA (2,5274 g gel/g M.S. en harina de quinua normal e incrementó a 5,8761 g gel/g M. S. en la harina de quinua extruida. Así mismo, en harina de quinua germinada sin extruir fue de 2,5829 g gel/g M.S., aumentó a 5,4197 g gel/g M.S. en harina de quinua germinada extruida)

Role of Procalcitonin in the Timely Detection of Ischemia and Necrosis in Children With Intestinal Obstruction

Abstract Introduction: Procalcitonin (PCT) has been studied for early identification of ischemia and/or necrosis (I/N) in children with intestinal obstruction (IO) secondary to adhesive small bowel obstruction (ASBO). However, the causes of IO in children are numerous. Purpose: To correlate the level of PCT with the presence of I/N.Results: Fifty-seven patients were analyzed. The incidence of I/N was 36%. PCT median was statistically higher in patients with I/N compared to those patients with normal intestine: 4.13 (13.9) vs 0.11 (0.28) ng/ml, p = &lt;0.001. A PCT threshold &gt;1.17 ng/ml for predicting I/N yielded a sensitivity of 90%, a specificity of 97%, a positive predictive value (PPV) of 95%, a negative predictive value (NPV) of 94%, p = &lt;0.001, relative risk (RR) 17.57 (95%CI, 4.54 – 67.90). Similarly, a PCT threshold &gt;1.41 ng/ml for predicting intestinal necrosis yielded a sensitivity of 92%, a specificity of 88%, a PPV of 72%, a NPV of 97%, p = &lt;0.001, RR 28.16 (95%CI, 3.98 – 119.12).Conclusions: This study corroborates the association of PCT with IN in children with IO and expands the evidence of its use in this field. Similarly, suggests a PCT threshold &gt;1.17 ng/ml and &gt;1.41 for predicting IN and intestinal necrosis respectively.</jats:p