Parenthood of people with anxiety disorders - Problems faced by parents and children

Roditeljstvo kod osoba s anksioznim poremećajima donosi dodatne rizike za razvoj anksioznih poremećaja kod njihove djece te otežava mogućnost uspješnog obavljanja roditeljskih uloga. Istraživanjima koja su usmjerena na otkrivanje i razumijevanje mehanizama transgeneracijskog prijenosa anksioznosti na djecu oblikuju se teorije prijenosa i daje se prilika razvijanju efikasnih ciljanih psihoterapijskih intervencija. Dokazane teorije se mogu podijeliti na bihevioralne i biološke. Od bihevioralnih teorija opisane su; učenje po modelu anksioznog ponašanja, pretjerano zaštitnički i kritični stilovi roditeljstva, roditeljski odgovor osoba s anksioznim poremećajem na simptome anksioznosti kod djeteta i poremećaji privrženosti, a od bioloških; aspekti prenatalnog okoliša pod utjecajem majčine anksioznosti, funkcioniranje oksitocinergičkog sustava te genetski i epigenetski prijenos anksioznosti. One potvrđuju da terapija anksioznih poremećaja ne smije obuhvatiti samo pacijente, već cijelu obitelj u cilju olakšanja roditeljskih uloga i smanjenja ili uklanjanja rizičnih čimbenika koji pridonose razvoju anksioznih simptoma kod djece. Terapijske intervencije koje su usmjerene na roditelje s anksioznim poremećajima i imaju potvrđene pozitivne rezultate su: kognitivna terapija zasnovana na usredotočenoj svjesnosti (eng. Mindfulness-Based Cognitive Therapy – MBCT), Psihoterapija roditelj-dojenče (eng. „Parent-infant psychopherapy“ (PIP)) i Partneri u roditeljstvu (eng. „Partners in Parenting“ (PiP)).Parenting in people with anxiety disorders brings additional risks for the development of anxiety disorders in their children and makes it difficult to successfully perform parental roles. Research aimed at discovering and understanding the mechanisms of cross-generational transmission of anxiety to children shapes transmission theories and provides an opportunity to develop effective targeted psychotherapeutic interventions. Proven theories can be divided into behavioral and biological. Of the behavioral theories are described; learning by model of anxiety behavior, overly protective and critical parenting styles, parental response of people with anxiety disorder to anxiety symptoms in children and attachment disorders, and from biological; aspects of the prenatal environment influenced by maternal anxiety, the functioning of the oxytocinergic system, and genetic and epigenetic transmission of anxiety. They confirm that the treatment of anxiety disorders should not only involve patients, but the whole family in order to facilitate parental roles and reduce or eliminate risk factors that contribute to the development of anxiety symptoms in children. Therapeutic interventions that are aimed at parents with anxiety disorders and have confirmed positive results are: Mindfulness-Based Cognitive Therapy (MBCT), Parent-infant psychopherapy (PIP)) and Partners in Parenting (PiP)

Parenthood of people with anxiety disorders - Problems faced by parents and children

Roditeljstvo kod osoba s anksioznim poremećajima donosi dodatne rizike za razvoj anksioznih poremećaja kod njihove djece te otežava mogućnost uspješnog obavljanja roditeljskih uloga. Istraživanjima koja su usmjerena na otkrivanje i razumijevanje mehanizama transgeneracijskog prijenosa anksioznosti na djecu oblikuju se teorije prijenosa i daje se prilika razvijanju efikasnih ciljanih psihoterapijskih intervencija. Dokazane teorije se mogu podijeliti na bihevioralne i biološke. Od bihevioralnih teorija opisane su; učenje po modelu anksioznog ponašanja, pretjerano zaštitnički i kritični stilovi roditeljstva, roditeljski odgovor osoba s anksioznim poremećajem na simptome anksioznosti kod djeteta i poremećaji privrženosti, a od bioloških; aspekti prenatalnog okoliša pod utjecajem majčine anksioznosti, funkcioniranje oksitocinergičkog sustava te genetski i epigenetski prijenos anksioznosti. One potvrđuju da terapija anksioznih poremećaja ne smije obuhvatiti samo pacijente, već cijelu obitelj u cilju olakšanja roditeljskih uloga i smanjenja ili uklanjanja rizičnih čimbenika koji pridonose razvoju anksioznih simptoma kod djece. Terapijske intervencije koje su usmjerene na roditelje s anksioznim poremećajima i imaju potvrđene pozitivne rezultate su: kognitivna terapija zasnovana na usredotočenoj svjesnosti (eng. Mindfulness-Based Cognitive Therapy – MBCT), Psihoterapija roditelj-dojenče (eng. „Parent-infant psychopherapy“ (PIP)) i Partneri u roditeljstvu (eng. „Partners in Parenting“ (PiP)).Parenting in people with anxiety disorders brings additional risks for the development of anxiety disorders in their children and makes it difficult to successfully perform parental roles. Research aimed at discovering and understanding the mechanisms of cross-generational transmission of anxiety to children shapes transmission theories and provides an opportunity to develop effective targeted psychotherapeutic interventions. Proven theories can be divided into behavioral and biological. Of the behavioral theories are described; learning by model of anxiety behavior, overly protective and critical parenting styles, parental response of people with anxiety disorder to anxiety symptoms in children and attachment disorders, and from biological; aspects of the prenatal environment influenced by maternal anxiety, the functioning of the oxytocinergic system, and genetic and epigenetic transmission of anxiety. They confirm that the treatment of anxiety disorders should not only involve patients, but the whole family in order to facilitate parental roles and reduce or eliminate risk factors that contribute to the development of anxiety symptoms in children. Therapeutic interventions that are aimed at parents with anxiety disorders and have confirmed positive results are: Mindfulness-Based Cognitive Therapy (MBCT), Parent-infant psychopherapy (PIP)) and Partners in Parenting (PiP)

Severe Lipoatrophy in a Patient With Type 2 Diabetes in Response to Human Insulin Analogs Glargine and Degludec: Possible Involvement of CD4 T Cell–Mediated Tissue Remodeling

CASE SUMMARY A female patient age 69 years with .10-year history of type 2 diabetes (T2D), on a therapy of premixed aspart insulin, presented with poor glycemic control (HbA1c 8.7%). Change of therapy to three injections of short- acting aspart and once-daily glargine improved glycemic control but resulted in severe lipoatrophy at all sites of injection, a rare complication of insulin therapy almost exclusively associated with type 1 diabetes (T1D). The patient had C-peptide levels within normal range and lacked autoantibodies against GAD, islet antigen 2 (IA-2), and tissue transglutaminase (tTg), excluding T1D. Glargine injection was replaced by degludec, but this did not prevent formation of new indentures. Histological analysis of tissue biopsies revealed strong tissue remodeling at affected sites including fibrosis, reduction of adipocyte size, and increased vascularization. Immunohistochemical staining showed a strong influx of CD4 T cells in affected sites but no apparent signs of T cell–mediated cell death. Flow cytometry of peripheral blood leukocytes did not show an overt effector cell profile of CD4 T cells, indicating that the response was mediated locally. Our findings indicate that insulin-induced lipoatrophy in the context of T2D is distinct from that seen in T1D and appears to depend on CD4 T cell–mediated tissue remodeling

Extreme anaerobic exercise causes reduced cytotoxicity and increased cytokine production by peripheral blood lymphocytes

Exercise has many beneficial effects for our body, but can become detrimental at high intensity, especially for our immune system. Little is known about the underlying mechanism of impaired immune functionality under conditions of intense physical strain. Freedivers, people who dive to high depths on a single breath, perform extreme exercise under anaerobic conditions. In this study, we investigated the impact of freediving on the cytotoxic arm of the immune system. At rest, elite freedivers did not display changes in their immunological profile compared to non-diving controls. In contrast, after a freedive, granzyme B and IL-2 production were reduced, whereas IFNγ and TNF secretion were increased by cytotoxic immune cells. Using in vitro models mimicking freedive conditions, we could show that hypoxia in combination with stress hyperglycemia had a negative impact on Granzyme B secretion, whereas IL-2 production was inhibited by stress hormones. Our findings suggest that in response to extreme exercise, cytotoxic immune cells transiently change their functional profile to limit tissue damage

NKG2D-mediated detection of metabolically stressed hepatocytes by innate-like T cells is essential for initiation of NASH and fibrosis

Metabolic-associated fatty liver disease (MAFLD) is a spectrum of clinical manifestations ranging from benign steatosis to cirrhosis. A key event in the pathophysiology of MAFLD is the development of nonalcoholic steatohepatitis (NASH), which can potentially lead to fibrosis and hepatocellular carcinoma, but the triggers of MAFLD-associated inflammation are not well understood. We have observed that lipid accumulation in hepatocytes induces expression of ligands specific to the activating immune receptor NKG2D. Tissue-resident innate-like T cells, most notably γδ T cells, are activated through NKG2D and secrete IL-17A. IL-17A licenses hepatocytes to produce chemokines that recruit proinflammatory cells into the liver, which causes NASH and fibrosis. NKG2D-deficient mice did not develop fibrosis in dietary models of NASH and had a decreased incidence of hepatic tumors. The frequency of IL-17A$^{+}$ γδ T cells in the blood of patients with MAFLD correlated directly with liver pathology. Our findings identify a key molecular mechanism through which stressed hepatocytes trigger inflammation in the context of MAFLD

NKG2D-mediated detection of metabolically stressed hepatocytes by innate-like T cells is essential for initiation of NASH and fibrosis.

Metabolic-associated fatty liver disease (MAFLD) is a spectrum of clinical manifestations ranging from benign steatosis to cirrhosis. A key event in the pathophysiology of MAFLD is the development of nonalcoholic steatohepatitis (NASH), which can potentially lead to fibrosis and hepatocellular carcinoma, but the triggers of MAFLDassociated inflammation are not well understood. We have observed that lipid accumulation in hepatocytes induces expression of ligands specific to the activating immune receptor NKG2D. Tissue-resident innate-like T cells, most notably γδ T cells, are activated through NKG2D and secrete IL-17A. IL-17A licenses hepatocytes to produce chemokines that recruit proinflammatory cells into the liver, which causes NASH and fibrosis. NKG2D-deficient mice did not develop fibrosis in dietary models of NASH and had a decreased incidence of hepatic tumors. The frequency of IL-17A+ γδ T cells in the blood of patients with MAFLD correlated directly with liver pathology. Our findings identify a key molecular mechanism through which stressed hepatocytes trigger inflammation in the context of MAFLD

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić

Slagalica nasljeđa : priručnik za opismenjavanje iz medicinske genetike

"Slagalica nasljeđa" - priručnik za opismenjavanje iz medicinske genetike ima tri namjene. Prije svega, on je edukativna slikovnica za studente, liječnike i pacijente, ali i druge zainteresirane pojedince jer su u njoj kroz ilustracije objašnjene osnove genetike čovjeka, kao i osnove medicinske genetike. Od toga kako prepoznati osobu s genetičkim poremećajem, kako nastaju i koje vrste genetičkih poremećaja postoje pa sve do toga na koji ih način možemo dijagnosticirati. Nadalje, nakon svake ilustracije na pojedinoj stranici nalaze se definicije 79 pojmova iz medicinske genetike koje čine tezaurus za studente, liječnike i pacijente koji se na bilo koji način susreću s genetičkim poremećajima. Naposljetku, ova knjiga sadrži i primjere rečenica u koje su ubačeni stručni pojmovi iz medicinske genetike, a koji su namijenjeni studentima prilikom savladavanja komunikacijskih vještina na kolegiju Medicinska genetika, ali i liječnicima prilikom informiranja svojih pacijenata o (mogućem) genetičkom poremećaju. Uz kreatoricu ideje i urednicu izdanja, doc. dr. sc. Ninu Perezu, autori izdanja su studenti šeste godine Integriranog preddiplomskog i diplomskog sveučilišnog studija Medicina i prof. dr. sc. Saša Ostojić