Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors.

Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.

Communication, Forgiveness and Morbidity in Young Adults Involved in a Romantic Relationship

This study examined the direct and indirect effects of communication patterns and forgiveness on physical and psychological morbidity, among young adults involved in a romantic relationship. Participants were 298 students, currently involved in a heterosexual romantic relationship, from a large university in the United States, who completed the Tendency to Forgive Scale, the Communication Patterns Questionnaire, and the Rotterdam Symptom Checklist. Physical morbidity was directly predicted by mutuality communication. Destructive communication had an indirect effect on physical and psychological morbidity, via forgiveness. However, the indirect connection between destructive communication and psychological morbidity was only significant for female partners. Teaching constructive communication skills may be a key factor for interventions addressed to young adults in romantic relationships, in order to promote forgiveness, due to its potential positive influence in physical and psychological well-being (AU)

Referees’ Emotions and Performance Perception: The Importance of Stress and Cognitive Appraisal / Emociones y Percepción de Rendimiento en Árbitros: Importancia del Estrés y la Evaluación Cognitiva / Emoções e Perceção de Rendimento em Árbitros: A Importância do Stresse da Avaliação Cognitiva

The tasks referees must perform are both complex and very important, and are usually associated with high levels of stress. In this study, we aimed to understand the role of stress and cognitive appraisal on referees’ emotions and sports performance perception before the realization of a game. We adopted a critical incident methodology to understand how referees adapt to the stress related to their next game. The study included 708 football referees (646 males), aged between 18 and 53 (M = 26.81; SD =7.32). We evaluated sources of stress, cognitive appraisal, emotions, and perception of individual performance. Regression analyses pointed out that stress was a main predictor of negative emotions, cognitive appraisal was a predictor of both negative and positive emotions, and that cognitive appraisal also contributed to comprehend the perception of individual performance. In sum, stress and appraisal are important factors to understand the stress experience of referees. (AU)

La tarea de un árbitro se asocia con un alto estrés. En este estudio buscamos comprender el papel del estrés y evaluación cognitiva en las emociones y percepción del rendimiento deportivo de los árbitros antes de un partido. Adoptamos una metodología de incidentes críticos para analizar se adaptan alestrés relacionado con su próximo juego. El estudio incluyó a 708 árbitros de fútbol (646 hombres), de entre 18-53 años (M= 26,81; DE= 7,32). Evaluamos las fuentes de estrés, evaluación cognitiva, emociones y percepción del desempeño individual. El análisis de regresión mostró que el estrés fue el principal predictor de las emociones negativas, la evaluación cognitiva fue un predictor de las emociones negativas y positivas y que la evaluación cognitiva también contribuyó a comprender la percepción del desempeño individual. En resumen, el estrés y la evaluación son factores importantes para comprender la experiencia de estrés de los árbitros. (AU)

A tarefa dosárbitrosestágeralmente associada a elevado stress. Neste estudo, procuramos compreender o papel do stresse da avaliação cognitiva nas emoções e percepçãodo desempenho desportivo dos árbitros antes da realização de um jogo. Adotámos uma metodologia de incidente crítico para analisar o modo como os árbitros se adaptam ao stressrelativoao seu próximo jogo. O estudo incluiu 708 árbitros de futebol (646 homens), com idades entre 18-53 (M= 26,81; DP= 7,32). Avaliámos as fontes de stress, avaliação cognitiva, emoções e perceção do rendimento individual. A análise de regressão mostrou que o stressfoi o principal preditor de emoções negativas, a avaliação cognitiva foi um preditor de emoções negativas e positivas e que a avaliação cognitiva também contribuiu para compreender a percepção do rendimento individual. Em suma, o stresse a avaliação são fatores importantes para entender a experiência de stressdos árbitros. (AU)

Esophageal motility patterns are altered in older adult patients. / Los patrones de motilidad esofágica están alterados en pacientes adultos mayores.

INTRODUCTION AND AIMS: Since the 1960s, several studies have shown the effect of aging on esophageal motility, with inconsistent results. The aim of the present study was to evaluate the manometric results in older adult patients (=60 years of age) with an esophageal disorder and compare them with adults under 60 years of age. MATERIALS AND METHODS: A cross-sectional, retrospective study was conducted that included a sample of 1,175 patients (936 older adults and 239 non-older adults). The patients were evaluated and compared with respect to (i) sex, (ii) main complaint for which esophageal manometry was indicated, (iii) comorbidities, (iv) current medications, (v) smoking, and (vi) manometry results. RESULTS: Patient age ranged from 19 to 92 years (women made up 76.5% of the older adults and 72.8% of the non-older adults). Normal lower esophageal sphincter relaxation and normal peristalsis were more frequent in the non-older patient group (91.1% vs. 84.8% and 87.4% vs. 76%, respectively). The manometry results for the non-older adults vs. the older adults, respectively, were: achalasia (2.9% vs. 5.9%); hypercontractile disorder (9.2% vs. 10.4%); hypocontractile disorder (38.5% vs. 47.6%); and normal values (49.4% vs. 36.1%). After excluding the variables that could change esophageal motility, the results revealed significant differences between the two study groups. CONCLUSIONS: Esophageal manometry demonstrated statistically significant differences between the older adult and non-older adult study population evaluated.

Species Identification in the Thrips Genus-Group in Brazil.

The Thrips genus-group is a monophyletic taxon composed of 17 genera, whose representatives exhibit three main synapomorphies: absence of ocellar setae I, presence of ctenidia on tergites V-VIII, and ctenidia on tergite VIII positioned posteromesad to the spiracles. The group is native to and more diverse in the Old World, especially in Southeast Asia, but several species are widely distributed, including some pests of cultivated plants. Here, we provide an identification key to the species of the Thrips genus-group currently recorded in Brazil, including three new records of Bolacothrips striatopennatus (Schmutz), Thrips florum Schmutz, and Thrips orientalis (Bagnall), and present notes on their morphology and biology. Stenchaetothrips biformis Bagnall is excluded from the list of thrips recorded in Brazil.

Effect of Menstrual Cycle on Acute Intermittent Porphyria.

A 16-year-old female who was attended as an outpatient reported localized, acute abdominal pain with vomiting, symmetrical motor weakness, and burning sensation in both arms and legs. Her medical history showed irrational behavior, repeated admissions at the emergency units of many other reference hospitals, where she had been investigated for celiac disease and treated with analgesics for pain events. Her clinical condition remained unchanged despite the use of many oral analgesics. In those admissions, she showed dysautonomia, vomiting, and abdominal pain. Diagnosis investigation disclosed a notable serum hyponatremia (133.7 mEq/L). She was referred for endoscopy and the histopathological lesion of the antrum in the stomach did not show neoplastic lesions. Colonoscopy, pelvic magnetic resonance imaging (MRI), total abdominal computed tomography, and video laparoscopy were without significant abnormalities. Suspicion of acute intermittent porphyria was confirmed by quantitative urine porphobilinogen-level tests and genetic analysis. Patient was successfully treated with intravenous infusion of glucose and hemin therapy.

Estudio comparativo de los niveles plasmáticos de homocisteína, vitamina B12 y ácido fólico en pacientes epilépticos frente a controles / Comparative case-control study of homocysteine, vitamin B12, and folic acid levels in patients with epilepsy

Introducción: El aumento de homocisteína en sangre constituye un conocido factor de riesgo cardiovascular. Los pacientes epilépticos en tratamiento crónico con fármacos antiepilépticos pueden presentar niveles más elevados de homocisteína y, en consecuencia, un potencial aumento del riesgo cardiovascular. Material y métodos: Estudio observacional de casos y controles para la comparación de los niveles plasmáticos de homocisteína, ácido fólico y vitamina B12. Resultados: Se reclutó a un total de 88 sujetos, 52 de ellos epilépticos y 36 controles. Se observó una tendencia a niveles de homocisteína más elevados (p=0,084) en los pacientes epilépticos y unos valores de ácido fólico más bajos (p<0,05). Conclusiones: Por su potencial efecto como factor de riesgo cardiovascular, es importante prestar atención a los niveles de homocisteína en los pacientes epilépticos en tratamiento crónico con fármacos antiepilépticos y en caso de encontrar niveles elevados sugerimos la instauración de tratamiento específico (AU)

Introduction: Increased blood homocysteine levels are a known cardiovascular risk factor. Epileptic patients on long-term treatment with antiepileptic drugs may present higher homocysteine levels and, consequently, a potential increase in cardiovascular risk. Material and methods: We conducted an observational case-control study to compare plasma levels of homocysteine, folic acid, and vitamin B12. Results: Our study included a total of 88 subjects: 52 patients with epilepsy and 36 controls. Epileptic patients showed higher homocysteine levels (P=.084) and lower levels of folic acid (P<.05). Conclusion: Homocysteine levels should be monitored in epileptic patients on long-term treatment with antiepileptic drugs. We suggest starting specific treatment in patients with high homocysteine levels (AU)

Modificaciones epigenéticas en neurología: alteraciones en la metilación del ADN en la esclerosis múltiple / Epigenetic changes in neurology: DNA methylation in multiple sclerosis

Introducción: La epigenética se define como el estudio de los mecanismos que regulan la expresión génica sin modificar la secuencia de ADN, siendo entre ellos el más conocido la metilación del ADN. La esclerosis múltiple (EM) es una enfermedad de etiología no del todo conocida, en la que se plantea que la participación de factores ambientales sobre individuos con una determinada predisposición genética, pueden resultar claves para el desarrollo de la enfermedad. Es en esta intersección entre la predisposición genética y los factores ambientales donde la metilación del ADN puede desempeñar un papel patogénico. Desarrollo: Realizamos una revisión bibliográfica de los efectos que los factores de riesgo ambiental para el desarrollo de EM pueden ejercer sobre los distintos mecanismos epigenéticos, así como la implicación que presentan dichas modificaciones en el desarrollo de la enfermedad. Conclusión: El conocimiento de las modificaciones epigenéticas involucradas en la patogenia de la EM abre una nueva vía de investigación para la identificación de potenciales biomarcadores, así como para la búsqueda de nuevas dianas terapéuticas (AU)

Introduction: Epigenetics is defined as the study of the mechanisms that regulate gene expression without altering the underlying DNA sequence. The best known is DNA methylation. Multiple Sclerosis (MS) is a disease with no entirely known etiology, in which it is stated that the involvement of environmental factors on people with a genetic predisposition, may be key to the development of the disease. It is at this intersection between genetic predisposition and environmental factors where DNA methylation may play a pathogenic role. Development: A literature review of the effects of environmental risk factors for the development of MS can have on the different epigenetic mechanisms as well as the implication that such changes have on the development of the disease. Conclusion: Knowledge of epigenetic modifications involved in the pathogenesis of MS, opens a new avenue of research for identification of potential biomarkers, as well as finding new therapeutic targets (AU)

PET/TC en sarcoidosis asociada a enfermedad oncológica / PET/TC en sarcoidosis asociada a enfermedad oncológica

Objetivos: Considerar el diagnóstico de sarcoidosis y reacción sarcoid-like en pacientes oncológicos controlados por tomografía computada por emisión de positrones (PET/TC), que presentan adenopatías hiliomediastinales hipercaptantes, para evitar errores diagnósticos. Materiales y métodos: Se analizaron retrospectivamente 18 estudios PET/TC realizados durante 3 anos a pacientes con tumores sólidos y linfoma, que presentaron adenopatías hiliomediastinales hipermetabólicas. El patrón morfológico, la distribución y, en algunos casos, la asociación con nódulos pulmonares permitieron plantear como diagnóstico diferencial la sarcoidosis. Resultados: Las enfermedades oncológicas correspondieron a mama (n = 4), próstata (n = 3), ovario (n = 2) y otros (n = 9). En 9 pacientes se obtuvo la confirmación histopatológica. En 7 de los 18 pacientes, las adenopatías fueron catalogadas como benignas por confirmación histológica de sarcoidosis, antracosis o reacción sarcoid-like. En 5 el comportamiento evolutivo fue compatible con benignidad, en 2 la biopsia mostró secundarismo y en los 4 restantes la evolución demostró malignidad. El total de lesiones benignas fue de 12 (66%). Discusión: El hallazgo de adenopatías hiliomediastinales hipermetabólicas con patrón morfológico y de distribución que orientan a sarcoidosis lleva a plantear esta entidad. En pacientes oncológicos, se requiere biopsia para descartar recaída. El uso de nuevos marcadores PET/TC para un diagnóstico diferencial representa un desafío. Los trazadores de síntesis de aminoácidos, como la 18F-fluorotimidina (FLT) y 18F-fluorometiltirosina (FMT), han demostrado ser útiles en la diferenciación entre malignidad y enfermedades granulomatosas. Conclusión: En estudios PET/TC de pacientes oncológicos, la presencia de adenopatías hiliomediastinales bilaterales y simétricas debe plantear sarcoidosis como diagnóstico diferencial.

Purposes: To describe the radiological findings of sarcoidosis or sarcoid-like reactions in cancer patients being monitored by positron emission computed tomography (PET/CT). Materials and methods: A retrospective analysis was performed on 18 PET/CT studies performed over 3 years in patients with lymphomas and solid tumours who presented with hypermetabolic hiliar-mediastinal adenopathies. The morphological pattern of these adenopathies, the distribution, and in some cases the association with pulmonary nodules, might suggest sarcoidosis as a differential diagnosis. Results: Oncological diseases corresponded to breast (4), prostate (3), ovary (2), and others (9). The adenopathies were classified in 7 of the 18 patients as benign after histological confirmation of sarcoidosis, anthracosis or sarcoid-like reaction. The evolutionary behaviour in 5 patients was compatible with benign lesions. The biopsy of 2 patients indicated secondary lesions and malignancy was confirmed by the evolution of the 4 remaining cases. There was a total of 12 (66%) benign lesions. Discussion: Sarcoidosis must be suspected in the presence of hypermetabolic hiliar-mediastinal adenopathies with a characteristic morphological pattern and pulmonary changes. However, biopsy is required to rule out oncological recurrence. The use of new PET/CT markers for differential diagnosis represents a challenge. Aminoacid synthesis tracers such as 18F-fluorothymidine (FLT) and 18F-fluoromethyltyrosine (FMT) are useful in the differentiation between malignancy and granulomatous diseases in oncologic patients. Conclusion: The differential diagnosis of sarcoidosis should be considered in the presence of bilateral symmetric mediastinal hilum lymphadenopathies.

Epigenetic changes in neurology: DNA methylation in multiple sclerosis. / Modificaciones epigenéticas en neurología: alteraciones en la metilación del ADN en la esclerosis múltiple.

INTRODUCTION: Epigenetics is defined as the study of the mechanisms that regulate gene expression without altering the underlying DNA sequence. The best known is DNA methylation. Multiple Sclerosis (MS) is a disease with no entirely known etiology, in which it is stated that the involvement of environmental factors on people with a genetic predisposition, may be key to the development of the disease. It is at this intersection between genetic predisposition and environmental factors where DNA methylation may play a pathogenic role. DEVELOPMENT: A literature review of the effects of environmental risk factors for the development of MS can have on the different epigenetic mechanisms as well as the implication that such changes have on the development of the disease. CONCLUSION: Knowledge of epigenetic modifications involved in the pathogenesis of MS, opens a new avenue of research for identification of potential biomarkers, as well as finding new therapeutic targets.

Comparative case-control study of homocysteine, vitamin B12, and folic acid levels in patients with epilepsy. / Estudio comparativo de los niveles plasmáticos de homocisteína, vitamina B12 y ácido fólico en pacientes epilépticos frente a controles.

INTRODUCTION: Increased blood homocysteine levels are a known cardiovascular risk factor. Epileptic patients on long-term treatment with antiepileptic drugs may present higher homocysteine levels and, consequently, a potential increase in cardiovascular risk. MATERIAL AND METHODS: We conducted an observational case-control study to compare plasma levels of homocysteine, folic acid, and vitamin B12. RESULTS: Our study included a total of 88 subjects: 52 patients with epilepsy and 36 controls. Epileptic patients showed higher homocysteine levels (P=.084) and lower levels of folic acid (P<.05). CONCLUSION: Homocysteine levels should be monitored in epileptic patients on long-term treatment with antiepileptic drugs. We suggest starting specific treatment in patients with high homocysteine levels.

Cefalea tipo SUNCT ( Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing) asociada a lesión hipofisaria / SUNCT (Short-lasting unilateral neuralgiform headache attack with conjunctival injection and tearing) associated with pituitary lesion

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Epigenética y epilepsia / Epigenetics and epilepsy

Introducción: La epigenética es el estudio de los cambios heredables en el ADN sin afectar a las secuencia de nucleótidos. Entre los mecanismos de regulación epigenética, los más estudiados y conocidos hasta la fecha son la metilación del ADN, la modificación de las histonas y los ARN no codificantes. Mediante estos mecanismos se regula la expresividad génica y la alteración de los mismos puede llevar al desarrollo de patologías. Desarrollo: Describimos los principales mecanismos de regulación epigenética y realizamos una revisión de la bibliografía reciente sobre los mecanismos de regulación epigenética y su implicación en distintos síndromes epilépticos. Conclusión: La identificación de los mecanismos epigenéticos implicados en la epilepsia constituye una prometedora vía de investigación para profundizar en el conocimiento de la fisiopatología y terapéutica de esta enfermedad

Introduction: Epigenetics is the study of heritable modifications in gene expression that do not change the DNA nucleotide sequence. Some of the most thoroughly studied epigenetic mechanisms at present are DNA methylation, post-transcriptional modifications of histones, and the effect of non-coding RNA molecules. Gene expression is regulated by means of these mechanisms and disruption of these molecular pathways may elicit development of diseases. Development: We describe the main epigenetic regulatory mechanisms and review the most recent literature about epigenetic mechanisms and how those mechanisms are involved in different epileptic syndromes. Conclusion: Identifying the epigenetic mechanisms involved in epilepsy is a promising line of research that will deliver more in-depth knowledge of epilepsy pathophysiology and treatments