Therapeutic assessment as a brief and intensive intervention for avoidant restrictive food intake disorder, belching, and histrionic personality disorder: A case report

A 26-year-old female was hospitalized with complaints of repeated vomiting and weight loss (18 kg in 8 months); and incessant belching and nausea/regurgitation for 30 days subsequent to her COVID-19 treatment. After all the normal medical radiological reports, appropriate psychological and psychiatric evaluations were done. Incessant belching warranted a simple and flexible cognitive psychotherapy for histrionic personality with a therapeutic assessment technique. A total of 6 h of psychotherapy was delivered in three sessions. The belching and vomiting came down by 75% after the first extensive session, and almost 100% after the second session. However, mild belching reappeared, and after the termination-cum-booster session belching subsided till discharge and the first follow-up after 2 weeks

The Urine Microbiome of Healthy Men and Women Differs by Urine Collection Method / 대한배뇨장애요실금학회지

Purpose@#Compared to the microbiome of other body sites, the urinary microbiome remains poorly understood. Although noninvasive voided urine specimens are convenient, contamination by urethral microbiota may confound understanding of the bladder microbiome. Herein we compared the voiding- versus catheterization-associated urine microbiome of healthy men and women. @*Methods@#An asymptomatic, healthy cohort of 6 women and 14 men underwent midstream urine collection, followed by sterile catheterization of the bladder after bladder refilling. Urine samples underwent urine dipstick testing and conventional microscopy and urine cultures. Samples also underwent Illumina MiSeq-based 16S ribosomal RNA gene amplification and sequencing. @*Results@#All organisms identified by urine culture were also identified by 16S amplification; however, next-generation sequencing (NGS) also detected bacteria not identified by cultivation. Lactobacillus and Streptococcus were the most abundant species. Abundances of the 9 predominant bacterial genera differed between the urethra and bladder. Voided and catheterized microbiomes share all dominant (>1%) genera and Operational Taxonomic Units but in similar or different proportions. Hence, urethra and bladder microbiomes do not differ in taxonomic composition, but rather in taxonomic structure. Women had higher abundance of Lactobacillus and Prevotella than men. @*Conclusions@#Our findings lend credence to the hypothesis that Lactobacilli are important members of the healthy urine microbiome. Our data also suggest that the microbiomes of the urethra and bladder differ from one another. In conclusion, urine collection method results in different 16S-based NGS data, likely due to the sensitivity of NGS methods enabling detection of urethral bacteria present in voided but not catheterized urine specimens.

A qualidade de vida de jovens portadores de espinha bífida do Children's National Medical Center – Washington DC / The quality of life of adolescents with spina bifida at the Children's National Medical Center - Washington DC

O presente artigo tem como objetivo explorar a qualidade de vida de jovens portadores de espinha bífida atendidos no Children's National Medical Center em Washington DC. A pesquisa baseia-se em uma perspectiva qualitativa que utiliza como referencial teórico central a "Teoria do estigma" e as discussões conceituais sobre as dimensões de qualidade de vida. Foram entrevistados 15 jovens do serviço acima citado, sendo que 8 deles participaram de um grupo focal construído através das questões levantadas durante entrevistas. Os discursos dos jovens em questão refletem a necessidade de categorias mais englobantes que não remetam a uma pulverização da experiência de vida. Evidenciou-se uma estrutura de desigualdade nas interações entre saudáveis e deficientes, e reproduzida pelos próprios jovens. Os resultados demonstram que o estigma se encontra presente em todas as dimensões da vida dos sujeitos, interferindo na inserção social, construção subjetiva do jovem e sua auto-estima, reforçando o papel do portador de deficiência como uma "não-pessoa". Embora a categoria sexualidade não seja priorizada em outros instrumentos para esta população, o tema se faz presente e central na discussão da experiência da vida dos mesmos.

The present article explores the quality of life of adolescents with spina bifida at the Children's National Medical Center in Washington DC. The research is based on a qualitative perspective that utilizes the "Theory of stigma" as the central theoretical framework, in addition to the discussions of the concept of quality of life and its dimensions. Fifteen adolescents were interviewed at the above institution, eight of which then participated in a focal group structured through issues that emerged during this previous phase. The discourses reflected the need for more encompassing categories for quality of life that do not pulverize the life experience. The adolescent's discourses demonstrate an inequality structure in interactions between the healthy and the disabled. The results demonstrated that stigma permeates all life dimensions of these subjects, interfering in their social inclusion, as well as in their subjective construction and self-esteem, asserting the role of the disabled as a "non-person". Finaly, we found that even though sexuality was not prioritized in other instruments that contemplate this population, the theme emerges as central to the discussion of their life experiences.

The Circadian Timing system: Making Sense of day/night gene expression

The circadian time-keeping system ensures predictive adaptation of individuals to the reproducible 24-h day/night alternations of our planet by generating the 24-h (circadian) rhythms found in hormone release and cardiovascular, biophysical and behavioral functions, and others. In mammals, the master clock resides in the suprachiasmatic nucleus (SCN) of the hypothalamus. The molecular events determining the functional oscillation of the SCN neurons with a period of 24-h involve recurrent expression of several clock proteins that interact in complex transcription/translation feedback loops. In mammals, a glutamatergic monosynaptic pathway originating from the retina regulaltes the clock gene expression pattern in the SCN neurons, synchronizing them to the light:dark cycle. The emerging concept is that neural/humoral output signals from the SCN impinge upon peripheral clocks located in other areas of the brain, heart, lung, gastrointestinal tract, liver, kidney, fibroblasts, and most of the cell phenotypes, resulting in overt circadian rhythms in integrated physiological functions. Here we review the impact of day/night alternation on integrated physiology; the molecular mechanisms and input/output signaling pathways involved in SCN circadian function; the current concept of peripheral clocks; and the potential role of melatonin as a circadian neuroendocrine transducer.

Routine monitoring of arterial pressure in a brain AVM during embolisation: a diagnostic tool

Identification of normal cerebral arteries in the vicinity of a cerebral arteriovenous malformation [AVM] is essential in order to minimize the risk of morbidity and mortality related to the procedure. The identification of these arteries depends on the skill and experience of the Interventionist. When the angio-architecture is complex or unclear, routine monitoring of cerebral arterial pressure may be a useful tool to assist the Interventionist, especially the less experienced one. In a patient with a remnant high flow brain AVM, a pressure recording in a distal artery immediately before an intended deposit of glue revealed an unexpectedly high pressure of 61 mmHg compared to previously recorded pressures of 29 mmHg in a distal feeder and 21 mmHg in the nidus, indicating that the vessel may not only be feeding the AVM but also supplying brain parenchyma making it unsuitable for embolisation

Actualización por temas. Moon cycle effects on humans: myth or reality?

Durante siglos se ha mantenido la creencia popular de que el ciclo lunar influye en los factores fisiológicos y conductuales de los seres humanos. Esta idea podría explicarse por la cronobiología, pues esta perspectiva sugiere que los patrones conductuales de los organismos son el resultado de la interacción entre el programa temporal endógeno, que genera los ritmos biológicos, y las modificaciones causadas por los estímulos externos, como los ambientales y los sociales. Sin embargo tales interacciones pueden ser enmascaradas por efectos no naturales, como la luz eléctrica y los ruidos de la ciudad, entre otros. Diversas investigaciones han buscado la relación causal entre el ciclo lunar y los factores fisiológicos: las admisiones a los hospitales psiquiátricos, los traumas mentales, la conducta anormal, la actividad criminal, los intentos de homicidio y el suicidio, etc. No obstante los estudios han tenido un carácter epidemiológico, con extensas muestras poblacionales, y han obtenido resultados contradictorios debido, principalmente, a la manipulación estadística de los datos. Las relaciones entre el ciclo lunar y el periodo de sueño-vigilia de los seres humanos ha sido poco estudiado y no ofrece resultados convincentes. Por otro lado, los estudios sistematicos en los que se han usado métodos robustos, en los animales han proporcionado fuertes evidencias acerca de la alteración de los ritmos de reposo-actividad, en relación con las fases del ciclo lunar. Proponemos que se hagan estudios comparados en los seres humanos, con métodos confiables de registro y de observación sistemática que aporten datos más objetivos, capaces de distinguir los factores que probablemente estén enmascarando los efectos del ciclo lunar en la vida humana.

Elevacion del seno maxilar controlada endoscopicamente / Sinus augmentation controled by endoscopy

La elevacion del seno ha sido recomendada por ser una tecnica quirurgica con unos resultados predecibles en cirugia periimplantaria. La cirugia endoscopica del seno maxilar hasta la fecha se ha utilizado como procedimiento de diagnostico. En este trabajo, el uso de la endoscopia se describe como una tecnica de ayuda poco evasiva en la elevacion del piso del seno. Tras la preparacion de la mucosa del seno, se colocan injertos oseos bajo control endoscopico entre el piso del seno y la mucosa. La elevacion de la mucosa y la colocacion del injerto se hacen posibles mediante un abordaje laterobasal a traves de una pequeña osteotomia y un abordaje transalveolar. Se han informado los primeros resultados clinicos. La elevacion endoscopica del seno puede contribuir a la reduccion de la morbilidad perioperativa, a una reduccion de las fistulas oroantrales y al control de la posicion del injerto. Una tecnica menos invasiva puede permitir la extension de las indicaciones para elevacion del seno

La cirugía en la pancreatitis aguda

El aspecto diagnóstico más importante en el manejo de la pancreatitis aguda es la diferenciación entre la pancreatitis intersticial-edematosa y la pancreatitis necrotizante. Determinaciones químicas de proteína C reactiva, deshidrogenosa láctica y antiproteasas, y la tomografía computadorizada con contraste, constituyen métodos de elevada sensibilidad. La desición sobre intervención quirúrgica debe fundamentarse en aspectos clínicos, información bacteriológica o imágenes por tomografía computadorizada con contraste. Complicaciones orgánicas persistentes o progresivas sistémicas o locales, a pesar del tratamiento intensivo de no menos de tres días de evolución, constituyen indicación para intervención quirúrgica en la pancreatitis necrotizante. Pacientes con síndrome séptico, con shok cardiovascular, con síndrome de falla orgánica multisistémica o con abdomen quirúrgico agudo deben ser intervenidos precozmente. Debe evitarse la resección pancreática mayor. El mejor método de tratamiento quirúrgico ha probado ser la necrosectomía cuidadosa, o sea el desbrindamiento del tejido necrótico, combinada con lavado continuo postoperatorio para lograr la evacuación de tejido necrótico residual, bacterias y sustancias biológicamente activas. La necrosectomía con lavado local continuo es un procedimiento seguro, eficaz y atraumático. Su aplicación resulta en una mortalidad inferior a 10 por ciento de los pacientes con pancreatitis necrotizante.

La cirugía en la pancreatitis aguda

El aspecto diagnóstico más importante en el manejo de la pancreatitis aguda es la diferenciación entre la pancreatitis intersticial-edematosa y la pancreatitis necrotizante. Determinaciones químicas de proteína C reactiva, deshidrogenasa láctica y antiproteasas, y la tomografía computadorizada con contraste, constituyen métodos de elevada sensibilidad. La desición sobre intervención quirúrgica debe fundamentarse en aspectos clínicos, información bacteriológica o imágenes por tomografía computadorizada con contraste. Complicaciones orgánicas persistentes o progresivas sistémicas o locales, a pesar del tratamiento intensivo de no menos de tres días de evolución, constituyen indicación para intervención quirúrgica en la pancreatitis necrotizante. Pacientes con síndrome séptico, con shock cardiovascular, con síndrome de falla orgánica multisistémica o con abdomen quirúrgico agudo deben ser intervenidos precozmente. Debe evitarse la resección pancreática mayor. El mejor método de tratamiento quirúrgico ha probado ser la necrosectomía cuidadosa, o sea el desbrindamiento del tejido necrótico, combinada con lavado continuo postooperatorio para lograr la evacuación del tejido necrótico residual, bacterias y sustancias biológicamente activas. La necrosectomía con lavado local continuo es un procedimiento seguro, eficaz y atraumático. Su aplicación resulta en una mortalidad inferior a 10 de los pacientes con pancreatitis necrotizante.