Hyperglycemia-induced hemichorea-hemiballismus syndrome - a systematic review

ABSTRACT Nonketotic hyperglycemia may occur as a cause of chorea in patients with chronic decompensated diabetes. Because it is rare and consequently poorly studied, diagnosis and treatment can be delayed. Therefore, our objective was to summarize clinical and radiological features, as well as treatments performed, from previously reported cases to facilitate adequate management in clinical practice. We searched MEDLINE/PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Scopus, and LILACS databases for studies published before April 23, 2021. We included case reports and case series of adults (aged ≥ 18 years) that described hyperglycemic chorea with measurement of glycated hemoglobin (HbA1c) and cranial magnetic resonance imaging (MRI). Studies were excluded if participants were pregnant women, aged < 18 years, and had no description of chorea and/or physical examination. We found 121 studies that met the inclusion criteria, for a total of 214 cases. The majority of the included studies were published in Asia (67.3%). Most patients were women (65.3%) aged > 65 years (67.3%). Almost all patients had decompensated diabetes upon arrival at the emergency department (97.2%). The most common MRI finding was abnormalities of the basal ganglia (89.2%). There was no difference in patient recovery between treatment with insulin alone and in combination with other medications. Although rare, hyperglycemic chorea is a reversible cause of this syndrome; therefore, hyperglycemia should always be considered in these cases.

Benefits of water intake on kidney function in older adults: protocol for a randomized controlled trial / Benefícios da ingestão de água na função renal de idosos: protocolo para um estudo clínico randomizado controlado

Objective: The goal of this study is to evaluate the benefits of an increase in water intake guided by a mathematical formula (per kg of body weight) on kidney function in older adults. Methods: Older adults (≥ 65 years old) cared for at the Internal Medicine Unit of a tertiary hospital will be randomized to receive or not guidance on water intake (30 mL/kg per day) after initial assessment of kidney function. After 14 days, participants will be reevaluated through clinical and laboratory examinations. Patients with uncompensated disease will be excluded. The main outcomes will be glomerular filtration rate and laboratory measures such as serum and urinary osmolality, sodium, urea, 24-h urine volume and serum creatinine, uric acid, and copeptin. The Mini Nutritional Assessment (MNA) questionnaire will be applied to participants at each visit. Categorical variables will be described as numbers of cases (%) and compared using the χ2 test whereas continuous variables will be analyzed with Student's t-test in relation to baseline measures. The Generalized Estimating Equations (GEE) method will be performed to assess differences over time and between groups. This study was approved by the Institution's Research Ethics Committee (grant number 16-0153) and is in accordance with the Declaration of Helsinki. Expected Results:By increasing water intake (ml/Kg) we expect to provide an improvement in kidney function in older population assessed by serum creatinine and cystatin-c applied to eGFR formulas. Relevance:Many conditions, both organic and behavioral, can contribute to chronic dehydration states in older adults. To mention, decreased ability to concentrate urine, reduced kidney mass, blood flow, and glomerular filtration rate (GFR) along with changes in sensitivity to hormones such as renin, vasopressin and natriuretic peptide can generate water imbalance, leading to dehydration. For being simple and inexpensive, this strategy may be broadly used and bring several health benefits to older adults.

Objetivo: O objetivo deste estudo é avaliar os benefícios de um aumento da ingestão de água guiado por uma fórmula matemática (por kg de massa corporal) na função renal de idosos. Metodologia:Idosos (≥ 65 anos) atendidos pelo Serviço de Clínica Médica de um hospital terciário foram randomizados para receber ou não orientação sobre o consumo de água (30 mL/kg por dia) após uma avaliação inicial da função renal. Após 14 dias, os participantes serão reavaliados através de exames clínicos e laboratoriais. Pacientes com doença descompensada serão excluídos. Os desfechos principais são a taxa de filtração glomerular e medidas laboratoriais como osmolaridade, sódio e ureia séricos e urinários, volume de urina de 24 horas e creatinina, ácido úrico e copeptina séricos. A Mini Avaliação Nutricional (MNA) será aplicada aos participantes a cada consulta. Variáveis categóricas serão descritas como números de casos (%) e comparadas usando o teste χ2 , enquanto variáveis contínuas serão analisadas com o teste t de Student em relação às medidas iniciais. O método de Equações de Estimativas Generalizadas (GEE) será usado para avaliar diferenças ao longo do tempo e entre grupos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da nossa Instituição (processo número 16-0153) e está de acordo com a Declaração de Helsinki. Resultados esperados:Ao aumentar a ingestão de água (ml/Kg) esperamos proporcionar uma melhora na função renal na população idosa avaliada pela creatinina sérica e cistatina-c aplicada às fórmulas de eGFR. Relevância:Muitas condições, tanto orgânicas quanto comportamentais, podem contribuir para estados de desidratação crônica em idosos. Vale mencionar que a diminuição da capacidade de concentração da urina, redução da massa renal, fluxo sanguíneo e taxa de filtração glomerular (TFG) juntamente com alterações na sensibilidade a hormônios como renina, vasopressina e peptídeo natriurético podem gerar desequilíbrio hídrico, levando à desidratação. Por ser simples e de baixo custo, essa estratégia pode ser amplamente utilizada e trazer diversos benefícios à saúde dos idosos.

Impact of the COVID-19 pandemic on mental health of pregnant women with diabetes mellitus and hypertension

SUMMARY OBJECTIVE: Psychological effects of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women with diabetes and hypertension are not yet studied. Besides the pregnancy, these women have additional risk factors for severe acute respiratory syndrome due to COVID-19 and are considered a particularly vulnerable, unique population. We aimed to assess their mental health during this pandemic. METHODS: This is a cross-sectional study carried out at a Brazilian tertiary hospital. Women with pregnancies complicated by hypertension and/or diabetes were evaluated. The primary outcome was anxiety, and depressive symptoms evaluated with the State-Trait Anxiety Inventory and Patient Health Questionnaire. Perception of changing habits during quarantine was evaluated as a secondary outcome. RESULTS: Seventy-nine patients were included. The prevalence of State-Trait Anxiety Inventory ≥40 was 79.7% and that of Patient Health Questionnaire ≥10 was 59.2%. Lower social support was correlated with higher scores on both scales. Time spent with electronic devices was perceived as greater by 62% of the women. CONCLUSIONS: Pregnant women with diabetes and hypertension presented high levels of anxiety and depressive symptoms during the COVID-19 pandemic. Considering that these symptoms can affect both the mother's and offspring's health, it is necessary to implement tools to improve their mental health.

Choosing statins: a review to guide clinical practice

ABSTRACT Statins are among the most widely prescribed medicines in the world and have proved their value in reducing cardiovascular events and mortality. Many patients report adverse effects that lead to interruption of treatment. This review aims to individualize statin treatment, considering efficacy for reducing cardiovascular risk and safety, in the setting of specific diseases, to minimize the side effects and improve compliance. We gathered evidence that may help clinicians to choose specific statins in different clinical situations, such as the risk of new diabetes, chronic kidney disease, liver disease, human immunodeficiency virus infection, organ transplant, heart failure and elderly people. Efficacy of statins is well established in a large number of clinical conditions. Therefore, main objective is to revise statin in specific clinical settings, based on pharmacokinetics, safety, drug metabolism and interactions to provide the best choice in different clinical scenarios.

Reunion overseas: introduced wild boars and cultivated orange trees interact in the Brazilian Atlantic Forest

Introduction: Little is known concerning novel interactions between species that typically interact in their native range but, as a consequence of human activity, are also interacting out of their original distribution under new ecological conditions. Objective: We investigate the interaction between the orange tree and wild boar, both of which share Asian origins and have been introduced to the Americas (i.e. the overseas). Methods: Specifically, we assessed whether i) wild boars consume orange (Citrus sinensis) fruits and seeds in orchards adjacent to a remnant of the Atlantic Forest of Brazil, ii) the orange seeds are viable after passing through boar's digestive tract and iii) whether the orange tree may naturalise in the forest remnant assisted by wild boars. Results: Our camera surveys indicated that wild boar was by far the most frequent consumer of orange fruits (40.5 % of camera trap-days). A considerable proportion of sown orange seeds extracted from fresh boar feces emerged seedlings (27.8 %, N = 386) under controlled greenhouse conditions. Further, 37.6 % of sown seeds (N = 500) in the forest remnant emerged seedlings in July 2015; however, after ~4 years (March 2019) only 9 seedlings survived (i.e. 4.8 %, N = 188). Finally, 52 sweet orange seedlings were found during surveys within the forest remnant which is intensively used by wild boars. This study indicates a high potential of boars to act as effective seed dispersers of the sweet orange. However, harsh competition with native vegetation and the incidence of lethal diseases, which quickly kill sweet orange trees under non-agricultural conditions, could seriously limit orange tree establishment in the forest. Conclusions: Our results have important implications not only because the wild boar could be a vector of potential invasive species, but also because they disperse seeds of some native species (e.g. the queen palm, Syagrus romanzofiana) in defaunated forests, where large native seed dispersers are missing; thus, wild boars could exert critical ecological functions lost due to human activity.

Introducción: Se conoce relativamente poco sobre las llamadas 'interacciones noveles' entre especies que típicamente interactúan en su área de distribución nativa pero que, como consecuencia de la actividad humana, también interactúan fuera de su distribución original bajo nuevas condiciones ecológicas. Objetivo: Investigamos la interacción entre el naranjo y el jabalí, ambos con origen asiático e introducidos en las Américas (es decir, del extranjero). Métodos: Específicamente, evaluamos si i) los jabalíes consumen frutas y semillas del naranjo (Citrus sinensis) en naranjales adyacentes a un parche remanente del bosque atlántico de Brasil, ii) las semillas de naranja son viables tras pasar por el tracto digestivo del jabalí, y iii) si el naranjo puede llegar a naturalizarse en el parche de bosque gracias a los jabalíes. Resultados: Los resultados de nuestro fototrampeo indicaron que el jabalí fue, con mucho, el consumidor más frecuente de las naranjas (40.5 % cámaras trampa-días). Una proporción considerable de semillas de naranjo extraídas de heces de jabalí frescas y sembradas emergieron plántulas bajo condiciones de invernadero controladas (27.8 %, N = 386). Además, del 37.6 % de las semillas sembradas (N = 500) en el parche remanente de bosque emergieron plántulas en julio 2015; sin embargo, después de ~ 4 años (marzo 2019) solo sobrevivieron 9 plántulas (es decir, 4.8 %, N = 188). Finalmente, se encontraron 52 plántulas de naranja dulce durante varias prospecciones dentro del parche de bosque que es utilizado intensivamente por los jabalíes. Este estudio indica un alto potencial de los jabalíes para actuar como dispersores de semillas eficaces del naranjo dulce. Sin embargo, la severa competencia con la abundante vegetación nativa y la incidencia de enfermedades letales, que matan rápidamente los naranjos dulces en condiciones no agrícolas, podrían limitar seriamente el establecimiento de naranjos en el bosque. Conclusiones: Nuestros resultados tienen implicaciones importantes no solo porque el jabalí podría ser un vector de posibles especies de plantas invasoras, sino también porque dispersan semillas de algunas especies nativas (p.e., la palmera reina, Syagrus romanzofiana) en estos bosques defaunados, donde faltan dispersores nativos de semillas de gran tamaño. Por ello, los jabalíes podrían ejercer funciones ecológicas críticas que se han perdido debido a la actividad humana.

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Objective: To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients. Methods: A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/retardation, and agitation). Results: The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension. Conclusion: Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.