Vitamin D Status in Obesity: Relation with Expression of Vitamin D Receptor and Vitamin D Hydroxylation Enzymes in Subcutaneous and Visceral Adipose Tissue

Currently and worldwide, a high prevalence of obesity, obesity-associated metabolic dysfunction, and vitamin D (VD) deficiency occurs. Besides participating in bone mineralization and calcium homeostasis, VD has other major functional roles. The vitamin D receptor (VDR) signaling pathway is crucial for the proper functioning of adipose tissue (AT). AT is a reservoir for VD and can activate/inactivate VD by hydroxylation. Subcutaneous and visceral AT (SAT, VAT) have different and prime roles in metabolic regulation/dysfunction. A search was done on PubMed/Medline, Web of Science, and Scopus databases using the following keywords: vitamin D, vitamin D receptor, hydroxylases, subcutaneous adipose tissue, visceral adipose tissue, obesity, and metabolic dysfunction. Our chapter focuses on human studies on VD status and expression of VDR and VD activation/inactivation enzymes in SAT and VAT in an obese environment

Saliency-driven system models for cell analysis with deep learning.

Background and objectivesSaliency refers to the visual perception quality that makes objects in a scene to stand out from others and attract attention. While computational saliency models can simulate the expert's visual attention, there is little evidence about how these models perform when used to predict the cytopathologist's eye fixations. Saliency models may be the key to instrumenting fast object detection on large Pap smear slides under real noisy conditions, artifacts, and cell occlusions. This paper describes how our computational schemes retrieve regions of interest (ROI) of clinical relevance using visual attention models. We also compare the performance of different computed saliency models as part of cell screening tasks, aiming to design a computer-aided diagnosis systems that supports cytopathologists.MethodWe record eye fixation maps from cytopathologists at work, and compare with 13 different saliency prediction algorithms, including deep learning. We develop cell-specific convolutional neural networks (CNN) to investigate the impact of bottom-up and top-down factors on saliency prediction from real routine exams. By combining the eye tracking data from pathologists with computed saliency models, we assess algorithms reliability in identifying clinically relevant cells.ResultsThe proposed cell-specific CNN model outperforms all other saliency prediction methods, particularly regarding the number of false positives. Our algorithm also detects the most clinically relevant cells, which are among the three top salient regions, with accuracy above 98% for all diseases, except carcinoma (87%). Bottom-up methods performed satisfactorily, with saliency maps that enabled ROI detection above 75% for carcinoma and 86% for other pathologies.ConclusionsROIs extraction using our saliency prediction methods enabled ranking the most relevant clinical areas within the image, a viable data reduction strategy to guide automatic analyses of Pap smear slides. Top-down factors for saliency prediction on cell images increases the accuracy of the estimated maps while bottom-up algorithms proved to be useful for predicting the cytopathologist's eye fixations depending on parameters, such as the number of false positive and negative. Our contributions are: comparison among 13 state-of-the-art saliency models to cytopathologists' visual attention and deliver a method that the associate the most conspicuous regions to clinically relevant cells

Predicting dye biodegradation from redox potentials

Two biological approaches for decolorization of azo sulfonated dyes have been compared: reductive decolorization with the ascomycete yeast Issatchenkia occidentalis and nzymatic oxidative decolorization with Trametes villosa laccase alone or in the presence of the mediator 1-hydroxybenzotriazole. The redox potential difference between the biological cofactor involved in the reductive activity of growing cells and the azo dye is a reliable indication for the decolorization ability of the biocatalyst. A linear relationship exists between the redox potential of the azo dyes and the decolorization efficiency of enzyme, enzyme/mediator, and yeast. The less positive the anodic peak of the dye, the more easily it is degraded oxidatevely with laccase. The more positive the cathodic peak of the dye, the more rapidly the dye molecule is reduced with yeast

Serum Antioxidant Associations with Metabolic Characteristics in Metabolically Healthy and Unhealthy Adolescents with Severe Obesity: An Observational Study

Considering the inadequacy of some antioxidant nutrients in severely obese adolescents, this study aimed to assess the relationship between antioxidant micronutrients status and metabolic syndrome components in metabolically healthy obesity (MHO) and unhealthy obesity (MUO). We performed an observational study in severely obese adolescents (body mass index > 99th percentile) and they were classified into MHO or MUO, according to the criteria adapted for adolescents. Anthropometric, biochemical, and clinical variables were analyzed to characterize the sample of adolescents. The serum antioxidant nutrients assessed were retinol, beta-carotene, Vitamin E, Vitamin C, zinc and selenium. A total of 60 adolescents aged 17.31 +/- 1.34 years were enrolled. MHO was identified in 23.3% of adolescents. The MHO group showed lower frequency of non-alcoholic fatty liver disease (14.3% vs. 78.3%, p < 0.001) when compared to MUO. A correlation was found between retinol and beta-carotene concentrations with glycemia (r = -0.372p = 0.011 and r = -0.314p = 0.034, respectively) and between Vitamin E with waist circumference (r = -0.306p = 0.038) in the MUO group. The current study shows that some antioxidant nutrients status, specifically retinol, beta-carotene, and Vitamin E, are negatively associated with metabolic alterations in MUO. Further studies are necessary to determine the existing differences in the serum antioxidant profile of metabolically healthy and unhealthy obese adolescents.Fundacao Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ) (Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro)Fed Univ Rio de Janeiro UFRJ, Sch Med, BR-21941902 Rio De Janeiro, BrazilUniv Fed Rio de Janeiro, Ctr Res Micronutrients NPqM, Inst Nutr Josue de Castro, BR-21941902 Rio de Janeiro, BrazilMultidisciplinary Ctr Bariatr & Metab Surg, BR-22280020 Rio De Janeiro, BrazilUniv Fed Rio de Janeiro, Dept Social & Appl Nutr, Inst Nutr, BR-21941902 Rio de Janeiro, BrazilFed Univ Sao Paulo UNIFESP, Escola Paulista Med, BR-04021001 Sao Paulo, BrazilFed Univ Sao Paulo UNIFESP, Escola Paulista Med, BR-04021001 Sao Paulo, BrazilWeb of Scienc

Prescribers\u27 approval rate of pharmacist-initiated interventions to optimise patients\u27 clinical status of hypertension in the ambulatory care setting

This perspective, pre- and post-intervention study with a one-year follow-up primarily aimed to ascertain prescribers\u27 approval rate of pharmacists\u27 interventions and clinical status of hypertension following comprehensive medication management (CMM) intervention in the ambulatory care clinic. Between January 2018 and January 2022 overall 100 patients with hypertension and other comorbidities were referred to the CMM services at the Health Centre Zagreb – Centar (HCZC). Out of 275 interventions directed to prescribers, 73.1 % of interventions were approved, 12.4 % were rejected and 14.5 % were not reviewed. The percentage of patients with a blood pressure goal increased from 45 % at the initial consultation to 82.5 % at the patients’ latest encounter (p < 0.001). The average number of drug therapy problems (DTPs) per patient totaled 3.53 ± 1.80, where 98 % of patients had one or more DTPs, 48 % had 4 or more DTPs, whereas 26 % had 5 or more DTPs. Subtherapeutic dosage (32.6 %) and the need for additional drug therapy (30.9 %) were the two most commonly identified DTPs. These results reinforce the need to integrate pharmacy-led services in the primary care setting with the aim of improving patients\u27 health outcomes

Undergraduate psychiatric education: current situation and way forward

Undergraduate psychiatric education is essential for the training of medical students and for their recruitment into psychiatry. A significant shortage of graduates choosing a career in psychiatry has been recently documented, and this trend might have many causes. When medical students have positive experiences of teaching, elective placements and exposure to psychiatric patients, their attitudes towards psychiatry are significantly better. Therefore, there is a need to improve the quality of undergraduate training courses in psychiatry. Innovative teaching strategies are suggested, including the use of movies, virtual reality, simulated patients and multiprofessional training wards

A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency

Severe Combined Immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency (PID). Complications of BCG vaccination, especially disseminated infection and its most severe forms, are known to occur in immunodeficient patients, particularly in SCID. A carefully taken family history before BCG injection as well as delaying vaccination if PID is suspected could be a simple and effective method to avoid inappropriate vaccination of an immunodeficient child in some cases until the prospect of newborn screening for SCID has been fully developed. We describe a patient with a very early diagnosis of SCID, which was suspected on the basis of the previous death of two siblings younger than one year due to severe complications secondary to the BCG vaccine. We suggest that a family history of severe or fatal reactions to BCG should be included as a warning sign for an early diagnosis of SCID

Sveobuhvatna usluga upravljanja farmakoterapijom kao rješenje za propuste u propisivanju lijekova: europska perspektiva

Due to an increase in the prevalence of chronic diseases, medication use and their cost is rising rapidly. This scenario render chronic patients at an increased risk of experiencing drug therapy problems, subsequently leading to unfavourable clinical and economic outcomes. Thus, to ensure patients’ optimal medication use and improve their clinical outcomes, a comprehensive and systematic management of medications is deemed crucial. Hence, Comprehensive Medication Management (CMM) services offered by trained pharmacists can fill this gap by decreasing the unnecessary and often harmful use of medicines and consequent resulting complications. Collaborative practice between pharmacists and gen- eral practitioners, together with patients’ active participation in the definition of treatment regimens, plays an important role in the effectiveness of CMM services. CMM services is defined as the standard of care that ensures each patient’s medications (prescription, non-prescription, alternative, traditional, vitamins, or nutritional supplements) are individ- ually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications taken, and that the patient is able to take them as intended. It includes an individualized care plan that achieves the intended goals of therapy with appropriate follow-up to determine actual patient outcomes. Apart from the USA, several countries (e.g. Australia, Canada and Brazil) have managed to integrate CMM services into their existing health care system at the primary care level. However, in Europe, in spite of the widespread recog- nition of the need for medication management services, initiation and implementation of CMM services are lagging behind. Hence, for CMM services to become a reality in Europe and elsewhere, numerous prerequisites need to be accomplished, including policies and legal regulations supporting the provision of CMM services on a much larger scale, clearly defined and standardized professional practice and common language shared among the pharmacists, and well trained and experienced practitioners providing full-time, direct patient care.Zbog porasta prevalencije kroničnih bolesti, potrošnja lijekova ubrzano raste. Uslijed toga, kronični bolesnici su izloženi povećanom riziku pojave terapijskih problema što dovodi do nepovoljnih kliničkih i ekonomskih ishoda liječenja. Stoga se smatra da je sveobuhvatno i sustavno upravljanje farmakoterapijom ključno za osiguranje optimalne uporabe lijekova kao i za poboljšanje kliničkih ishoda liječenja. Sveobuhvatna usluga upravljanja farmakoterapijom (engl. Comprehensive Med- ication Management Services, CMM services) koju provode posebno educirani ljekarnici može ponuditi rješenje za ovaj problem, smanjujući nepotrebnu, a često i štetnu primjenu lijekova te njene posljedične komplikacije. Kolaborativna prak- sa ljekarnika i liječnika obiteljske medicine, koja uključuje i aktivno sudjelovanje pacijenata u kreiranju terapijskih režima, važan je čimbenik koji doprinosi učinkovitosti CMM usluge. CMM usluga se definira kao standard skrbi koji osigurava da se svakom pacijentu pojedinačno procjenjuju svi lijekovi (u receptnom ili bezreceptnom režimu, biljni, tradicionalni), vitamini ili dodaci prehrani koje uzima, kako bi se za svaki od njih utvrdilo je li prikladan za pacijenta, je li učinkovit za pacijentovo zdravstveno stanje, je li siguran s obzirom na komorbiditete i druge lijekove koje pacijent uzima, te je li pacijent sposoban i u mogućnosti uzimati lijekove kako treba. Usluga sadrži individualizirani plan skrbi kojim se postižu predviđeni ciljevi terapije kao i odgovarajuće praćenje (follow-up) kako bi se utvrdili stvarni ishodi liječenja. Pored SAD-a, nekoliko je drugih zemalja (Australija, Kanada i Brazil) uspjelo integrirati CMM uslugu u svoje postojeće sustave primarne zdravstvene zaštite. Međutim, u Europi, unatoč raširenosti spoznaje o potrebi za upravljanjem farmakoterapijom, razvoj i implementacija CMM usluge zaostaje. Kako bi se CMM usluge realizirale u Europi i ostalim zemljama, potrebno je ispuniti brojne preduvjete, uključujući donošenje politika i zakonskih propisa koji podržavaju pružanje CMM usluga u mnogo većem obimu, ostvarivanje jasno definirane i standardizirane profesionalne prakse i zajedničkog jezika ljekarnika, te stvaranje dobro educiranih i iskusnih ljekarnika koji u punom radnom vremenu pružaju izravnu skrb pacijentima

Cortical morphology changes in women with borderline personality disorder: a multimodal approach

Objective: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUniversidade Federal do ABC Center of Mathematics, Computation and CognitionUniversidade Federal de São Paulo (UNIFESP) Department of Diagnostic RadiologyUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Outpatient Clinic for Personality Disorders (AMBORDER)UNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUNIFESP, Department of Diagnostic RadiologyUNIFESP, Department of Psychiatry Outpatient Clinic for Personality Disorders (AMBORDER)SciEL