Anxiety-Related Disorders

Anxiety is a common experience, a physiologic mechanism that lets us cope with a stressor, but if it occurs without a stimulus or it is exaggerated and general functioning is impaired, it becomes pathological. Treating anxiety disorders requires pharmacotherapy to lower anxiety levels and psychological therapies to learn to cope with stressors adaptively. Obsessive-compulsive disorder (OCD) has been considered as part of the Anxiety Disorders chapter up to the fourth edition of the DSM (DSM IV-TR), while from the fifth edition (DSM-5) it is placed in a separate chapter. The nosographic autonomy of this disorder depends on the fact that the anxious manifestations, even if present, would be secondary and dependent on the obsessive contents. A group of conditions related to OCD from a clinical, epidemiological, and sometimes aetiopathological perspective is included in the DSM chapter about “obsessive-compulsive and related disorders”. After a traumatic experience, one person physiologically develops a limited-in-time reaction. In some cases, more pronounced depressive, anxious, intrusive, and/or dissociative symptoms occur. The biological basis for trauma-related disorders is not fully understood, but insights so far have let us choose pharmacological treatments alongside with psychotherapy in order to control symptoms and elaborate the traumatic experience

Febre Q: uma zoonose de distribuição mundial.

A febre Q é uma zoonose de distribuição mundial causada pelo patógeno Coxiella burnetii, uma bactéria que, além de apresentar resistência e estabilidade ambiental, é um dos agentes mais infecciosos ao ser humano. Sua principal forma de transmissão à população humana ocorre através da inalação de aerossóis contaminados com produtos de animais infectados, principalmente bovinos, caprinos e ovinos. A infecção em humanos apresenta um amplo espectro de manifestações, desde casos assintomáticos até complicações graves e fatais

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

<p>Abstract</p> <p>Background</p> <p>Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure.</p> <p>The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region.</p> <p>Methods</p> <p>Population-based (n=206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4months and when patients withdrew more than 80% of the packs required.</p> <p>Results</p> <p>5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives=3months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42).</p> <p>Conclusions</p> <p>In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.</p

Q fever: characteristics and reports ofanimportant neglected zoonosisin Brazil.

ABSTRACT - The Q fever is a zoonotic disease neglected in many countries all over the world. This zoonosis is caused by the bacteria Coxiella burnetii, a pathogen that presents stability and environmental resistance with high capacity to cause human infection, which could be fatal. This literature review study aims to describe the general aspects of Q fever, presenting the main cases occurred in Brazil and discussing ways to avoid this zoonosis negligence and underreporting in Brazil. The Q fever is still a disease unknown by the larger part of healthcare professionals in Brazil. In addition, the disease in humans presents a clinical picture similar to that of other acute feverish diseases. Therefore, cases of Q fever cannot be diagnosed and their treatment can be erroneous, which can increase the chances of chronic Q fever occurrence. The inclusion of Q fever as a disease of mandatory notification in humans and the utilization of the "One Health" approach are essential for the confrontation of the disease. Moreover, measures for the control, investigation, and prevention of Q fever will contribribute to avoid the occurrence of outbreaks and possible worsening resulting from this zoonosis. RESUMO - A febre Q é uma doença zoonótica negligenciada em muitos países do mundo. Essa zoonose é causada pela bactéria Coxiella burnetii, um patógeno que apresenta estabilidade e resistência ambiental com alta capacidade de causar infecção em humanos, podendo ser fatal. Este estudo de revisão da literatura tem como objetivo descrever os aspectos gerais da febre Q, apresentar os principais casos ocorridos no Brasil e discutir formas para que essa zoonose deixe de ser negligenciada e subnotificada no Brasil. A febre Q ainda é uma doença desconhecida por grande parte dos profissionais de saúde no Brasil. Aliado a isso, a doença em humanos apresenta um quadro clínico similar ao de outras doenças febris agudas. Dessa forma, casos de febre Q podem não estar sendo diagnosticados e sendo tratados de forma equivocada, o que pode aumentar as chances de ocorrência da febre Q crônica. A inclusão da febre Q como uma doença de notificação compulsória em humanos e a utilização da abordagem "One Health" são fundamentais para o enfrentamento da doença. Ademais, medidas de controle, de investigação e de prevenção da febre Q contribuirão para evitar a ocorrência de surtos e possíveis agravamentos decorrentes dessa zoonose

The PTPN22 C1858T gene variant is associated with proinsulin in new-onset type 1 diabetes

<p>Abstract</p> <p>Background</p> <p>The protein tyrosine phosphatase nonreceptor type 2 (<it>PTPN22</it>) has been established as a type 1 diabetes susceptibility gene. A recent study found the C1858T variant of this gene to be associated with lower residual fasting C-peptide levels and poorer glycemic control in patients with type 1 diabetes. We investigated the association of the C1858T variant with residual beta-cell function (as assessed by stimulated C-peptide, proinsulin and insulin dose-adjusted HbA_1c), glycemic control, daily insulin requirements, diabetic ketoacidosis (DKA) and diabetes-related autoantibodies (IA-2A, GADA, ICA, ZnT8Ab) in children during the first year after diagnosis of type 1 diabetes.</p> <p>Methods</p> <p>The C1858T variant was genotyped in an international cohort of children (n = 257 patients) with newly diagnosed type 1 diabetes during 12 months after onset. We investigated the association of this variant with liquid-meal stimulated beta-cell function (proinsulin and C-peptide) and antibody status 1, 6 and 12 months after onset. In addition HbA_1cand daily insulin requirements were determined 1, 3, 6, 9 and 12 months after diagnosis. DKA was defined at disease onset.</p> <p>Results</p> <p>A repeated measurement model of all time points showed the stimulated proinsulin level is significantly higher (22%, p = 0.03) for the T allele carriers the first year after onset. We also found a significant positive association between proinsulin and IA levels (est.: 1.12, p = 0.002), which did not influence the association between <it>PTPN22 </it>and proinsulin (est.: 1.28, p = 0.03).</p> <p>Conclusions</p> <p>The T allele of the C1858T variant is positively associated with proinsulin levels during the first 12 months in newly diagnosed type 1 diabetes children.</p

The challenges of transferring chronic illness patients to adult care: reflections from pediatric and adult rheumatology at a US academic center

<p>Abstract</p> <p>Background</p> <p>Little is known about the transfer of care process from pediatric to adult rheumatology for patients with chronic rheumatic disease. The purpose of this study is to examine changes in disease status, treatment and health care utilization among adolescents transferring to adult care at the University of California San Francisco (UCSF).</p> <p>Methods</p> <p>We identified 31 eligible subjects who transferred from pediatric to adult rheumatology care at UCSF between 1995–2005. Subject demographics, disease characteristics, disease activity and health care utilization were compared between the year prior to and the year following transfer of care.</p> <p>Results</p> <p>The mean age at the last pediatric rheumatology visit was 19.5 years (17.4–22.0). Subject diagnoses included systemic lupus erythematosus (52%), mixed connective tissue disease (16%), juvenile idiopathic arthritis (16%), antiphospholipid antibody syndrome (13%) and vasculitis (3%). Nearly 30% of subjects were hospitalized for disease treatment or management of flares in the year prior to transfer, and 58% had active disease at the time of transfer. In the post-transfer period, almost 30% of subjects had an increase in disease activity. One patient died in the post-transfer period. The median transfer time between the last pediatric and first adult rheumatology visit was 7.1 months (range 0.7–33.6 months). Missed appointments were common in the both the pre and post transfer period.</p> <p>Conclusion</p> <p>A significant percentage of patients who transfer from pediatric to adult rheumatology care at our center are likely to have active disease at the time of transfer, and disease flares are common during the transfer period. These findings highlight the importance of a seamless transfer of care between rheumatology providers.</p

The other side of recovery: validation of the Portuguese version of the subjective experiences of psychosis scale.

BACKGROUND: The aim of this study was to develop and validate a Portuguese version of The Subjective Experiences of Psychosis Scale (SEPS) for use in Portuguese-speaking populations in order to provide a self-report instrument to assess and monitor dimensions of psychotic experiences, translating patient's perspective and experience in terms of recovery from psychosis. METHODS: The sample consisted of 30 participants with psychotic disorders who had recently experienced delusions or hallucinations. The SEPS was completed along with other observer-based assessments and self-report questionnaires, such as the Brief Psychiatric Rating Scale, the Insight and Treatment Attitudes Questionnaire and the Function Assessment Short Test. RESULTS: Two main factors representing the positive and negative components of each subscale were identified. We obtained good internal consistency and test-retest reliability for the positive and negative components of all subscales. The subscales of SEPS correlated with observer-based assessments and self-report questionnaires. CONCLUSIONS: The Portuguese version of the SEPS is a useful tool in the assessment and monitoring of psychotic symptoms

Solitary median maxillary central incisor (SMMCI) syndrome

Solitary median maxillary central incisor syndrome (SMMCI) is a complex disorder consisting of multiple, mainly midline defects of development resulting from unknown factor(s) operating in utero about the 35th–38th day(s) from conception. It is estimated to occur in 1:50,000 live births. Aetiology is uncertain. Missense mutation in the SHH gene (I111F) at 7q36 may be associated with SMMCI. The SMMCI tooth differs from the normal central incisor, in that the crown form is symmetric; it develops and erupts precisely in the midline of the maxillary dental arch in both primary and permanent dentitions. Congenital nasal malformation (choanal atresia, midnasal stenosis or congenital pyriform aperture stenosis) is positively associated with SMMCI. The presence of an SMMCI tooth can predict associated anomalies and in particular the serious anomaly holoprosencephaly. Common congenital anomalies associated with SMMCI are: severe to mild intellectual disability, congenital heart disease, cleft lip and/or palate and less frequently, microcephaly, hypopituitarism, hypotelorism, convergent strabismus, oesophageal and duodenal atresia, cervical hemivertebrae, cervical dermoid, hypothyroidism, scoliosis, absent kidney, micropenis and ambiguous genitalia. Short stature is present in half the children. Diagnosis should be made by eight months of age, but can be made at birth and even prenatally at 18–22 weeks from the routine mid-trimester ultrasound scan. Management depends upon the individual anomalies present. Choanal stenosis requires emergency surgical treatment. Short stature may require growth hormone therapy. SMMCI tooth itself is mainly an aesthetic problem, which is ideally managed by combined orthodontic, prosthodontic and oral surgical treatment; alternatively, it can be left untreated

Definitions and pathophysiology of vasoplegic shock.

Vasoplegia is the syndrome of pathological low systemic vascular resistance, the dominant clinical feature of which is reduced blood pressure in the presence of a normal or raised cardiac output. The vasoplegic syndrome is encountered in many clinical scenarios, including septic shock, post-cardiac bypass and after surgery, burns and trauma, but despite this, uniform clinical definitions are lacking, which renders translational research in this area challenging. We discuss the role of vasoplegia in these contexts and the criteria that are used to describe it are discussed. Intrinsic processes which may drive vasoplegia, such as nitric oxide, prostanoids, endothelin-1, hydrogen sulphide and reactive oxygen species production, are reviewed and potential for therapeutic intervention explored. Extrinsic drivers, including those mediated by glucocorticoid, catecholamine and vasopressin responsiveness of the blood vessels, are also discussed. The optimum balance between maintaining adequate systemic vascular resistance against the potentially deleterious effects of treatment with catecholamines is as yet unclear, but development of novel vasoactive agents may facilitate greater understanding of the role of the differing pathways in the development of vasoplegia. In turn, this may provide insights into the best way to care for patients with this common, multifactorial condition