Prognostic factors for schizophrenia during first psychotic episode

Objetivo Revisar la literatura disponible sobre el pronóstico del primer episodio psicótico para el desarrollo de esquizofrenia. Método Una revisión sistemática de los estudios que han evaluado los determinantes pronósticos para el primer episodio psicótico y su relación con esquizofrenia. Resultados Se revisaron 161 artículos que cumplían con los criterios de búsqueda y que se ajustaban con el propósito del estudio. Conclusiones El tiempo de psicosis no tratada (DUP), el nivel del funcionamiento premórbido, la presencia o predominio de síntomas negativos, el consumo comórbido de sustancias psicoactivas y el estado psicosocial fueron las características mas influyentes para el desarrollo de la esquizofrenia, en los pacientes que presentaban un primer episodio psicótico.Objective Reviewing the available literature regarding prognosis for first psychotic episode for developing schizophrenia. Method A systematic review of studies which have evaluated prognostic determinants for the first psychotic episode and its relationship to schizophrenia was made. Results 161 articles were reviewed which fulfilled the search criteria and which were adjusted to the purpose of the study. Conclusions Duration of untreated psychosis (DUP), pre-morbid functioning level, the presence or predominance of negative symptoms, co-morbid consumption of psychoactive substances and psychosocial state were the most influential characteristics for developing schizophrenia in patients presenting a first psychotic episode

Immunomodulatory Effects of Bone Marrow-Derived Mesenchymal Stem Cells in a Swine Hemi-Facial Allotransplantation Model

BACKGROUND: In this study, we investigated whether the infusion of bone marrow-derived mesenchymal stem cells (MSCs), combined with transient immunosuppressant treatment, could suppress allograft rejection and modulate T-cell regulation in a swine orthotopic hemi-facial composite tissue allotransplantation (CTA) model. METHODOLOGY/PRINCIPAL FINDINGS: Outbred miniature swine underwent hemi-facial allotransplantation (day 0). Group-I (n = 5) consisted of untreated control animals. Group-II (n = 3) animals received MSCs alone (given on days -1, +1, +3, +7, +14, and +21). Group-III (n = 3) animals received CsA (days 0 to +28). Group-IV (n = 5) animals received CsA (days 0 to +28) and MSCs (days -1, +1, +3, +7, +14, and +21). The transplanted face tissue was observed daily for signs of rejection. Biopsies of donor tissues and recipient blood sample were obtained at specified predetermined times (per 2 weeks post-transplant) or at the time of clinically evident rejection. Our results indicated that the MSC-CsA group had significantly prolonged allograft survival compared to the other groups (P<0.001). Histological examination of the MSC-CsA group displayed the lowest degree of rejection in alloskin and lymphoid gland tissues. TNF-α expression in circulating blood revealed significant suppression in the MSC and MSC-CsA treatment groups, as compared to that in controls. IHC staining showed CD45 and IL-6 expression were significantly decreased in MSC-CsA treatment groups compared to controls. The number of CD4+/CD25+ regulatory T-cells and IL-10 expressions in the circulating blood significantly increased in the MSC-CsA group compared to the other groups. IHC staining of alloskin tissue biopsies revealed a significant increase in the numbers of foxp3(+)T-cells and TGF-β1 positive cells in the MSC-CsA group compared to the other groups. CONCLUSIONS: These results demonstrate that MSCs significantly prolong hemifacial CTA survival. Our data indicate the MSCs did not only suppress inflammation and acute rejection of CTA, but also modulate T-cell regulation and related cytokines expression

Insights from computational modeling in inflammation and acute rejection in limb transplantation

Acute skin rejection in vascularized composite allotransplantation (VCA) is the major obstacle for wider adoption in clinical practice. This study utilized computational modeling to identify biomarkers for diagnosis and targets for treatment of skin rejection. Protein levels of 14 inflammatory mediators in skin and muscle biopsies from syngeneic grafts [n = 10], allogeneic transplants without immunosuppression [n = 10] and allografts treated with tacrolimus [n = 10] were assessed by multiplexed analysis technology. Hierarchical Clustering Analysis, Principal Component Analysis, Random Forest Classification and Multinomial Logistic Regression models were used to segregate experimental groups. Based on Random Forest Classification, Multinomial Logistic Regression and Hierarchical Clustering Analysis models, IL-4, TNF-α and IL-12p70 were the best predictors of skin rejection and identified rejection well in advance of histopathological alterations. TNF-α and IL-12p70 were the best predictors of muscle rejection and also preceded histopathological alterations. Principal Component Analysis identified IL-1α, IL-18, IL-1β, and IL-4 as principal drivers of transplant rejection. Thus, inflammatory patterns associated with rejection are specific for the individual tissue and may be superior for early detection and targeted treatment of rejection. © 2014 Wolfram et al

Hand disease in scleroderma: a clinical correlate for chronic hand transplant rejection

Chronic rejection remains a potential long-term consequence of hand composite tissue allotransplantation (CTA). Scleroderma has already been proposed as a model for chronic facial allograft rejection based on potential parallels of observed progression of disease and pathophysiology course. This study proposes a similar model for how chronic rejection may manifest itself in the context of hand CTA through the functional and psychological assessment of patients with scleroderma, should it occur

Utilisation of health care services and patient quality oflife following nocturnal and daytime non-severe hypogycaemic events in people with diabetes in Colombia

258-258Objectives: To study the effect of nocturnal and daytime non-severe hypoglycaemic events on the utilisation of health care services and health-related quality of life in people with diabetes in Colombia. Methods: People with diabetes from five different countries who had experienced a non-severe hypoglycaemic event in the past 4 weeks were asked to take part in a nocturnal (N) and/or daytime (D) hypoglycaemia survey. In the Colombian subgroup, 83 people responded (50 respondents for the nocturnal survey; 50 for the daytime survey). Both surveys were conducted face-toface. All information, including hypoglycaemic events, was self-reported. Results: In the Colombian cohort, respondents’ mean age was 58 years/54 years (N/D), mean weight was 64.3 kg/65.5 kg (N/D), 36%/38% (N/D) were male, 76%/76% (N/D) had type 2 diabetes, and all received treatment with insulin (100%/100% [N/D]). Although 78%/82% (N/D) of respondents considered themselves in good health, almost half had diabetes-related complications (48%/54% [N/D]). Non-severe hypoglycaemic episodes were experienced at least once weekly by 16%/20% (N/D) and at least once a month by 70%/70% (N/D). After a hypoglycaemic event, 0%/24% (N/D) decreased their insulin dose, 32%/40% contacted a health care professional, and, in the following week, they used on average 5/6 (N/D) extra blood glucose strips. The majority of respondents reported a high level of fear of nocturnal hypoglycaemic events (60%/36% [N/D]). One third (32%) reported that a nocturnal event had a high impact on quality of sleep, and one in five (22%) reported that an event highly impacted their social life. Hypoglycaemic events did not severely effect paid work (n=16/15), with 19%/7% (N/D) of respondents reporting arriving at work late or leaving early, and 13%/7% (N/D) missing ≥1 full working day. Conclusions: Nocturnal and daytime non-severe hypoglycaemic events have an impact upon patients’ health-related quality of life and diabetes management in Colombia

Percepciones de los trabajadores del sector salud frente a internet y las tecnologías móviles en Colombia

In July 2007 in Medellín, Colombia, 1 200 health care professionals were asked to complete a questionnaire: of the 493 who participated, the mean age was 31.2 years; 58.8% were physicians; and 97.6% had Internet access, 60.5% on a daily basis and 27.7%, weekly. The preferred place to access the Internet was from home (58%) or from the work place (12.5%); 98% reported having a cell phone, and of those, 80% were interested in using health education tools via cell phone. These are the first data published regarding Internet and cellular phone penetration among health care workers in Colombia. Acceptance of the Internet and mobile systems as health information tools is gaining, and as such, creating a new opportunity for training and harnessing of these new technologies

Percepciones de los trabajadores del sector salud frente a internet y las tecnologías móviles en Colombia

In July 2007 in Medellín, Colombia, 1 200 health care professionals were asked to complete a questionnaire: of the 493 who participated, the mean age was 31.2 years; 58.8% were physicians; and 97.6% had Internet access, 60.5% on a daily basis and 27.7%, weekly. The preferred place to access the Internet was from home (58%) or from the work place (12.5%); 98% reported having a cell phone, and of those, 80% were interested in using health education tools via cell phone. These are the first data published regarding Internet and cellular phone penetration among health care workers in Colombia. Acceptance of the Internet and mobile systems as health information tools is gaining, and as such, creating a new opportunity for training and harnessing of these new technologies