Impact of inequalities in health care on the mortality risk of individuals with severe mental illnesses

Univ Fed Sao Paulo, UNIFESP, Dept Psiquiatria, Res Grp Mol & Behav Neurosci Bipolar Disorder, Sao Paulo, BrazilUniv Hlth Network, Mood Disorders Psychopharmacol Unit, Toronto, ON, CanadaBrain & Cognit Res Fdn, Toronto, ON, CanadaUniv Fed Sao Paulo, UNIFESP, Dept Psiquiatria, Res Grp Mol & Behav Neurosci Bipolar Disorder, Sao Paulo, BrazilWeb of Scienc

Intervenção precoce em psicose: um mapa das iniciativas clínicas e de pesquisa na América Latina

OBJECTIVE: This article aims to review Latin America's early intervention services in psychosis and to shed light into their challenges and particularities. METHOD: An internet-based search comprising medical societies' websites, published articles, and major universities' websites was conducted and the results were critically discussed. RESULTS: Latin American countries are profoundly deficient in specialized early intervention services. Our search found seven target services, four of which are based in urban areas of Brazil, inside tertiary hospitals or universities. Among the initiatives advanced by these centers, there are partnerships with the public educational system and other community-based efforts toward knowledge transfer. On the other hand, several challenges remain to be overcome, especially in relation to their expansion, which is necessary to match the existing demand.OBJETIVO: Este artigo tem o objetivo de revisar os serviços de intervenção precoce em psicose na América Latina e lançar luz sobre seus desafios e particularidades. MÉTODO: Foi realizada uma busca na internet compreendendo os websites de sociedades médicas e das principais universidades e artigos publicados por autores latino-americanos e os resultados foram discutidos criticamente. RESULTADOS: Os países latino-americanos são profundamente deficientes no que diz respeito a serviços especializados de intervenção precoce em psicose. Nossa busca encontrou sete serviços principais, quatro dos quais baseados em áreas urbanas do Brasil, dentro de hospitais terciários ou universidades. Dentre as iniciativas promovidas por esses centros, há parcerias com o sistema público de educação e outros esforços baseados na comunidade para transferência de conhecimento. Não obstante, vários desafios ainda devem ser superados, relacionados sobretudo à expansão de tais serviços, necessária para abarcar a demanda existente.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Program for Recognition and Intervention in Individuals in At-Risk Mental StateUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Program of SchizophreniaUNIFESP, Department of Psychiatry Program for Recognition and Intervention in Individuals in At-Risk Mental StateUNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUNIFESP, Department of Psychiatry Program of SchizophreniaSciEL

Impacto de estresse na infância na psicopatologia

OBJECTIVE: Advances in our knowledge of mental disorder (MD) genetics have contributed to a better understanding of their pathophysiology. Nonetheless, several questions and doubts persist. Recent studies have focused on environmental influences in the development of MDs, and the advent of neuroscientific methodologies has provided new perspectives. Early life events, such as childhood stress, may affect neurodevelopment through mechanisms such as gene-environment interactions and epigenetic regulation, thus leading to diseases in adulthood. The aim of this paper is to review the evidence regarding the role of the environment, particularly childhood stress, in the pathophysiology of MD. METHODOLOGY: We reviewed articles that evaluated environmental influences, with a particular focus on childhood trauma, brain morphology, cognitive functions, and the development of psychopathology and MD. RESULTS AND CONCLUSION: MRI studies have shown that exposure to trauma at an early age can result in several neurostructural changes, such as the reduction of the hippocampus and corpus callosum. Cognitive performance and functioning are also altered in this population. Finally, childhood stress is related to an increased risk of developing MD such as depression, bipolar disorder, schizophrenia and substance abuse. We conclude that there is robust evidence of the role of the environment, specifically adverse childhood experiences, in various aspects of MD.OBJETIVO: Avanços no conhecimento da genética dos transtornos mentais (TM) contribuíram para um melhor entendimento de suas bases fisiopatológicas. No entanto, dúvidas e questões ainda persistem. Estudos recentes têm se concentrado nas influências do ambiente no desenvolvimento de TM, e o advento de metodologias neurocientíficas oferece novas perspectivas. Eventos precoces de vida, como estresse na infância, podem ser capazes de alterar o neurodesenvolvimento através de mecanismos como interação gene-ambiente e regulação epigenética, resultando em patologias na idade adulta. O objetivo deste artigo é revisar as evidências referentes ao papel do ambiente, em especial o estresse na infância, na fisiopatologia de TM. METODOLOGIA: Revisamos artigos que avaliam as influências ambientais, com um foco especial no trauma na infância, na morfologia cerebral, nas funções cognitivas e no desenvolvimento de psicopatologias e TM. RESULTADOS E CONCLUSÃO: Estudos com ressonância magnética demonstram que a exposição a traumas em uma idade precoce pode levar a diversas alterações neuroestruturais, como a diminuição do hipocampo e do corpo caloso. O desempenho e o funcionamento cognitivo também são alterados nessa população. Por fim, o estresse na infância está ligado a um maior risco de desenvolver TM como depressão, transtorno bipolar, esquizofrenia e abuso de substâncias. Concluímos que existem evidências sólidas quanto à importância do ambiente, especificamente das experiências adversas na infância, em diversos aspectos dos TM.Universidade Federal de São Paulo (UNIFESP) Department of Psychiatry Recognition and Intervention in Individuals in at-Risk Mental StatesUniversidade Federal de São Paulo (UNIFESP) Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesUniversidade Federal do Rio Grande do Sul Laboratory of Molecular PsychiatryPontifícia Universidade Católica do Rio Grande do Sul Nucleus of Studies and Research in Trauma and StressUNIFESP, Department of Psychiatry Recognition and Intervention in Individuals in at-Risk Mental StatesUNIFESP, Department of Psychiatry Interdisciplinary Laboratory of Clinical NeurosciencesSciEL

von Willebrand Factor unfolding mediates platelet deposition in a model of high-shear thrombosis

Thrombosis under high-shear conditions is mediated by the mechanosensitive blood glycoprotein von Willebrand Factor (vWF). vWF unfolds in response to strong flow gradients and facilitates rapid recruitment of platelets in flowing blood. While the thrombogenic effect of vWF is well recognized, its conformational response in complex flows has largely been omitted from numerical models of thrombosis. We recently presented a continuum model for the unfolding of vWF, where we represented vWF transport and its flow-induced conformational change using convection-diffusion-reaction equations. Here, we incorporate the vWF component into our multi-constituent model of thrombosis, where the local concentration of stretched vWF amplifies the deposition rate of free-flowing platelets and reduces the shear cleaning of deposited platelets. We validate the model using three benchmarks: in vitro model of atherothrombosis, a stagnation point flow, and the PFA-100, a clinical blood test commonly used for screening for von Willebrand Disease (vWD). The simulations reproduced the key aspects of vWF-mediated thrombosis observed in these experiments, such as the thrombus location, thrombus growth dynamics, and the effect of blocking platelet-vWF interactions. The PFA-100 simulations closely matched the reported occlusion times for normal blood and several hemostatic deficiencies, namely, thrombocytopenia, vWD Type 1, and vWD Type 3. Overall, the multi-constituent model of thrombosis presented in this work enables macro-scale 3-D simulations of thrombus formation in complex geometries over a wide range of shear rates and accounts for qualitative and quantitative hemostatic deficiencies in patient blood. The results also demonstrate the utility of the continuum model of vWF unfolding that could be adapted to other numerical models of thrombosis

Continuing lack of evidence for the psychotic subtyping of PTSD

Universidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, São Paulo, BrazilWeb of Scienc

Progressive dyspnea and a right atrial mass in an 80-year-old man

Hepatocellular carcinoma (HCC) is among the five most frequent causes of cancer death worldwide, according to the WHO. The disease is related to alcohol abuse, viral infections, and other causes of cirrhosis, and unfortunately, in some developed countries, the incidence shows an increasing trend. Although the diagnosis of the HCC often relies upon the context of a chronic hepatopathy, some cases may present a silent course, and the initial symptoms ensue when the disease is in an advanced stage with no chance for any therapeutic attempt. The clinical picture of the HCC is varied, and unexpected forms may surprise the clinician. One of the unusual presentations of the HCC is shock by the blockage of the venous return to the right atrium by the inferior vena cava infiltration. Herein we present a case of an old patient who sought medical care complaining of dyspnea. The clinical workup disclosed a right thorax pleural effusion and imaging exams depicted a mass in the right hepatic lobe, invasion of the inferior vena cava (IVC) and the right atrium (RA). During the attempts of clinical investigation, the patient passed away. The autopsy disclosed an HCC involving the right hepatic lobe, with the invasion of the IVC and the RA. The authors highlight the importance of recognizing the bizarre presentation of not so rare diseases

Uma Aplicação de Geometria Diferencial à Indústria: molde para empacotamento automático

Neste trabalho, fazemos uma descrição matemática para a obtenção do molde de uma máquina de empacotar e apresentamos passo a passo a construção de um caso particular quando a parametrização da curva que determina a forma do molde é gráfico de uma função. A fim de ilustrarmos o molde obtido, utilizamos o \textit{software} GeoGebra. Para construir o molde, usamos conceitos clássicos de Geometria Diferencial. O principal conceito de Geometria Diferencial envolvido é um caso particular de superfícies regradas, que são conhecidas como superfícies desenvolvíveis. Tais superfícies apresentam uma série de propriedades que as tornam eficazes para aplicações em diferentes áreas e acreditamos que este modelo se assemelha a muitos que existem no mercado. Nosso objetivo principal é apresentar uma aplicação de Geometria Diferencial à indústria, contribuindo para justificar a importância da presença de um matemático colaborando na projeção e execução de equipamentos mais eficazes e produtivos

Uma Aplicação de Geometria Diferencial à Indústria: molde para empacotamento automático

Neste trabalho, fazemos uma descrição matemática para a obtenção do molde de uma máquina de empacotar e apresentamos passo a passo a construção de um caso particular quando a parametrização da curva que determina a forma do molde é gráfico de uma função. A fim de ilustrarmos o molde obtido, utilizamos o \textit{software} GeoGebra. Para construir o molde, usamos conceitos clássicos de Geometria Diferencial. O principal conceito de Geometria Diferencial envolvido é um caso particular de superfícies regradas, que são conhecidas como superfícies desenvolvíveis. Tais superfícies apresentam uma série de propriedades que as tornam eficazes para aplicações em diferentes áreas e acreditamos que este modelo se assemelha a muitos que existem no mercado. Nosso objetivo principal é apresentar uma aplicação de Geometria Diferencial à indústria, contribuindo para justificar a importância da presença de um matemático colaborando na projeção e execução de equipamentos mais eficazes e produtivos

Peripheral interleukin-2 level is associated with negative symptoms and cognitive performance in schizophrenia

Although several studies have pointed to a possible role of interleukin 2 (IL-2) in schizophrenia (SZ), association between IL-2 and the different groups of symptoms has not been explored. the objective of this study was to investigate a possible correlation of peripheral IL-2 levels with symptoms and cognitive performance in patients with SZ. in addition, we compared the plasma levels of IL-2 between patients with SZ and healthy controls. Twenty-nine chronically medicated outpatients with SZ according to DSM-IV were compared with twenty-six healthy controls. the patients were evaluated with the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF). All the participants had blood collected into EDTA tubes by venipuncture between 9:00 and 10:00 AM. Plasma concentrations of IL-2 were determined by cytometric bead array. A computerized neuropsychological battery assessed verbal learning, verbal fluency, working memory, set shifting, executive function, inhibition and intelligence. Patients with SZ had lower levels of IL-2 than healthy controls (p < 0.001). in the SZ group, IL-2 levels were positively correlated with scores in the digit span test (rho = 0.416, P = 0.025) and intelligence (rho = 0.464, P = 0.011). We also found a negative correlation between IL-2 and total score in the negative subscale of PANSS (rho = -0.447, p = 0.015). Our findings suggest that IL-2 may be involved in the mechanisms related to cognitive deterioration and negative symptomatology in schizophrenia. (C) 2014 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, Schizophrenia Program PROESQ, BR-04044000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, BR-04039032 São Paulo, BrazilUniv Fed Minas Gerais, Translat Psychoneuroimmunol Grp, BR-31270901 Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Schizophrenia Program PROESQ, BR-04044000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LINC, BR-04039032 São Paulo, BrazilWeb of Scienc