Early intervention for obsessive compulsive disorder : An expert consensus statement

© 2019 Elsevier B.V.and ECNP. All rights reserved.Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the ‘toxic’ effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.Peer reviewe

Scalp reconstruction with large dorsal muscle-free flap after dog bite scalping

Introduction: Scalping is characterized by trauma in the scalp region, which can be classified as partial or total. Scalping trauma is extremely mutilating and stigmatizing, especially when exposing the bone without periosteum, leading to chronic osteomyelitis and external table erosion. When there are extensive scalp lesions above 200cm2, and with periosteum, the lesion is required a large amount of tissue with microsurgical flap, which is not available in all centers. This work aims to report a case of a 69-year-old female patient who suffered trauma due to total avulsion of a big scalp of 550cm2 with exposure of a skull cap without periosteum and total unviability of the scalp after a dog bite. Due to the total unviability of the avulsed scalp, we opted to transplant a large dorsal muscle free flap with microvascular anastomosis of the thoracodorsal pedicle with the superficial temporal vessels. The flap evolved with good perfusion, and partial grafting was performed in the bloody area. Methods: Retrospective analysis of the medical records of the patient in question. This paper follows the Declaration of Helsinki's standards and the approval of the Ethics and Research Committee. Conclusion: The free flap of the large dorsal muscle proved effective in this case of reconstruction of the scalp's extensive lesion (550cm2) with partial periosteum lesion due to scalping. The flap recovered the shape of the skull and the protective function of the skull cap

The application of omics in ruminant production: a review in the tropical and sub-tropical animal production context

The demand for animal products (e.g. dairy and beef) in tropical regions is expected to increase in parallel with the public demand for sustainable practices, due to factors such as population growth and climate change. The necessity to increase animal production output must be achieved with better management and production technologies. For this to happen, novel research methodologies, animal selection and postgenomic tools play a pivotal role. Indeed, improving breeder selection programs, the quality of meat and dairy products as well as animal health will contribute to higher sustainability and productivity. This would surely benefit regions where resource quality and quantity are increasingly unstable, and research is still very incipient, which is the case of many regions in the tropics. The purpose of this review is to demonstrate how omics-based approaches play a major role in animal science, particularly concerning ruminant production systems and research associated to the tropics and developing countriesinfo:eu-repo/semantics/acceptedVersio

O ensino de ciências por investigação: uma proposta de sequência didática para auxiliar no desenvolvimento de conteúdos de química para alunos do sexto ano

This work’s proposal is to discuss the main difficulties in insertig the Chemistry in Middle School, from the application of a didactic sequence. The didactic sequence using the water theme was elaborated and applied in a group of 6th grade students of a Middle School. The qualitative analysis, of an interpretive nature, was used for a methodological approach. It will be presented the observations performed in the Science classes, the planning, application of a didactic program and the results. The results showed that the development of an investigative didactic sequence promoted a greater understanding and significance of chemical concepts.En este trabajo se utilizó una secuencia didáctica investigativa para contribuir con la significación de los contenidos y en la reflexión acerca de las dificultades de insertar conceptos de la Química en la enseñanza de las Ciencias. La secuencia se aplicó a las clases del 6° año de la escolarización con el tema "Agua". Se utilizó de la investigación cualitativa de carácter interpretativo para un enfoque metodológico. Se presentarán las observaciones, la planificación y los resultados de la aplicación de la secuencia. Las actividades realizadas han contribuído una mejor comprensión y significación de los conceptos trabajados.Neste trabalho foi utilizado uma sequência didática investigativa para contribuir na significação de conteúdos e na reflexão das dificuldades de inserção de conceitos de Química no ensino de Ciências. A sequência foi aplicada em turmas do 6o ano do Ensino Fundamental, abordando o tema “Água". A análise qualitativa, de natureza interpretativa, foi utilizada para abordagem metodológica. Serão apresentadas as observações, o planejamento e os resultados da aplicação da sequência. As atividades realizadas contribuíram para uma maior compreensão e significação dos conceitos trabalhados

There have been changes in the incidence and epidemiology of pelvic ring fractures in recent decades?

The pelvic ring fractures comprise 2 -8% of all skeletal injuries. As the incidence rises to 25% in polytrauma and represents a negative prognostic factor with regard to morbidity and mortality of patients, we sought with this work to establish the profile of these, compared to an alteration in the profile of patients with pelvic ring fractures in recent decades. To this end, we evaluated the epidemiological profile, mechanism of injury and types of fractures. By reviewing the literature indexed in the databases related to the theme, 20 papers were selected that contained the requirements for the study. For the period between January 1987 and December 1999 (first decade), and another period in January 2000 and December 2010 (second decade), data were analyzed by Mann -Whitney test. The ratings Tile, Young and Burgess AO were adequate to permit their categorization. The research in each decade was homogeneous. At first the lesions were more prevalent in men with 62.5% with a tendency to reverse this pattern given the increase of women in the second decade (p = 0.286). The average age in the first decade was 39.3 years, an increase in the second (p = 0.068). The most prevalent mechanisms of trauma were related to traffic in both periods as well as fractures classified as type A (p = 0.203 and p = 0.457, respectively), having mortality rates decreased (p = 0.396). We conclude that there was a tendency to increase in the average age of patients (p = 0.068); however the increasing involvement of women (p = 0.286) and decreased mortality (p = 0.396) were not significant

Alternative Treatment Modalities for Immature Intruded Permanent Incisors: Report of 2 Cases

Intrusion of permanent teeth is one of the most severe types of traumatic injuries. Different treatment strategies have been proposed, and the best approach for each case depends on the stage of root development, severity of the intrusive luxation, presence of alveolar fracture and number of intruded teeth. The purpose of this paper is to describe the treatment management of 2 cases of severely intruded immature permanent maxillary central incisors in 71/2- and 8-year-old children. In case 1, the traumatized tooth was treated by surgical repositioning, while in case 2 watchful waiting for spontaneous re-eruption was the treatment of choice. Treatment strategies were successful in both cases, as demonstrated by the continuation of root development, maintenance of pulp vitality, and absence of signs of per/apical pathosis during the follow-up period. Regardless of the treatment strategy, traumatically intruded teeth should undergo periodical clinical and radiographic surveillance on a long-term basis to allow early detection of possible complications. (Pediotr Dent 2009;31:340-5) Received March 11, 2008 vertical bar Last Revision June 25, 2008 vertical bar Revision Accepted July 16, 200

Macroecological links between the Linnean, Wallacean, and Darwinian shortfalls

Species are the currency of most biodiversity studies. However, many shortfalls and biases remain in our biodiversity estimates, preventing a comprehensive understanding of the eco-evolutionary processes that have shaped the biodiversity currently available on Earth. Biased biodiversity estimates also jeopardize the effective implementation of data-driven conservation strategies, ultimately leading to biodiversity loss. Here, we delve into the concept of the Latitudinal Taxonomy Gradient (LTG) and show how this new idea provides an interesting conceptual link between the Linnean (i.e., our ignorance of how many species there are on Earth), Darwinian (i.e., our ignorance of species evolutionary relationships), and Wallacean (i.e., our ignorance on species distribution) shortfalls. More specifically, we contribute to an improved understanding of LTGs and establish the basis for the development of new methods that allow us to: (i) better account for the integration between different shortfalls and, (ii) estimate how these interactions may affect our understanding about the evolutionary components of richness gradients at macroecological scales

Impact of the ventilator bundle on ventilator-associated pneumonia (VAP) rates in a pediatric intensive care unit in Londrina-PR

Healthcare-associated infections (HAI) are an important patient safety concern around the globe. Ventilator-associated pneumonia (VAP) is the leading cause of death among HAI, with attributable mortality ranging from 15 to 70% depending on the patient population. The Center for Disease Control and Prevention (CDC) has recommended that all ICUs implement a ventilator bundle to reduce the VAP rate. The purposes of the present study were to examine the effect of the bundle of infection control interventions, education, VAP rates in the Pediatric Intensive Care Unit (PICU) of the Hospital Universitário of Londrina-PR. This study was conducted between January and December 2013 and consisted of three periods: pre-intervention, intervention and post-intervention. An educational intervention was given to 86 healthcare workers (HCWs) about bundles to prevent VAP, and a questionnaire was also performed pre and post-intervention. Overall, 135 opportunities of patient care were evaluated. The compliance with hand hygiene and the use of gloves and gowns did not improve, but orotracheal intubation, maintenance of the patients in a 30-45º head of bed elevation, endotracheal cuff pressure and removal of condensate from ventilator circuts increased significantly when comparing pre- and post-intervention. The VAP rate was 49.6% during the pre-intervention period and 17.5% during the post-intervention period demonstrating a 64.8% reduction in VAP rate. Our results show that implementation of the bundle of infection control interventions was associated with a significant reduction in VAP rate

Conjugated linoleic acid and cardiac health: Oxidative stress and energetic metabolism in standard and sucrose-rich diets

Studies on conjugated linoleic acid ingestion and its effect on cardiac tissue are necessary for the safe utilization of this compound as supplement for weight loss. Male Wistar 24-rats were divided into four groups (n = 6):(C)given standard chow, water and 0.5 ml saline, twice a week by gavage; (C-CLA)receiving standard chow, water and 0.5 ml of conjugated linoleic acid, twice a week, by gavage; (S)given standard chow, saline by gavage, and 30% sucrose in its drinking water; (S-CLA)receiving standard chow, 30% sucrose in its drinking water and conjugated linoleic acid. After 42 days of treatment S rats had obesity with increased abdominal-circumference, dyslipidemia, oxidative stress and myocardial lower citrate synthase(CS) and higher lactate dehydrogenase(LDH) activities than C. Conjugated linoleic acid had no effects on morphometric parameters in C-CLA, as compared to C, but normalized morphometric parameters comparing S-CLA with S. There was a negative correlation between abdominal adiposity and resting metabolic rate. Conjugated linoleic acid effect, enhancing fasting-VO2/surface area, postprandial-carbohydrate oxidation and serum lipid hydroperoxide resembled to that of the S group. Conjugated linoleic acid induced cardiac oxidative stress in both fed conditions, and triacylglycerol accumulation in S-CLA rats. Conjugated linoleic acid depressed myocardial LDH comparing C-CLA with C, and beta-hydroxyacyl-coenzyme-A dehydrogenase/CS ratio, comparing S-CLA with S. In conclusion, dietary conjugated linoleic acid supplementation for weight loss can have long-term effects on cardiac health. Conjugated linoleic acid, isomers c9, t11 and t10, c12 presented undesirable pro-oxidant effect and induced metabolic changes in cardiac tissue. Nevertheless, despite its effect on abdominal adiposity in sucrose-rich diet condition, conjugated linoleic acid may be disadvantageous because it can lead to oxidative stress and dyslipidemic profile. (c) 2007 Elsevier B.V All rights reserved