ABSTRACT
Introduction: Childhood trauma is a risk factor for the development of psychosis. Furthermore, a number of theories propose specific mechanisms by which childhood trauma may contribute to more severe positive and negative psychotic symptoms, some of which are supported empirically. The robustness of this empirical evidence is unclear due to mixed results and methodological limitations of individual studies. A systematic review and meta-analysis of the evidence for associations between childhood trauma and severity of hallucinations, delusions, and negative psychotic symptoms in clinical populations with a diagnosed psychotic disorder is needed. Method: A systematic search was conducted. Reference lists of relevant review articles were hand-searched, and authors contacted for data and additional unpublished studies. Study reporting bias and quality was assessed. Results: In total, 6667 studies were identified and of these 41 studies met inclusion criteria. Of these, 29 studies (4680 participants) were meta-analyzed. Among individuals with psychosis, childhood trauma was significantly correlated with severity of hallucinations (r = .199, P < .001) and delusions (r = .172, P < .001) but contrary to our hypothesis, not correlated with severity of negative symptoms (r = .049, P = .095). Severity of childhood neglect was correlated with negative symptoms (r = .142, P = .005). Conclusion: The results lend support for cognitive and biological theories that traumas in childhood may lead to hallucinations and delusions within psychotic disorders and have important implications for clinical practice.
Subject(s)
Adult Survivors of Child Adverse Events , Delusions , Hallucinations , Psychological Trauma/complications , Psychotic Disorders , Schizophrenia , Severity of Illness Index , Delusions/etiology , Delusions/physiopathology , Hallucinations/etiology , Hallucinations/physiopathology , Humans , Psychotic Disorders/etiology , Psychotic Disorders/physiopathology , Schizophrenia/etiology , Schizophrenia/physiopathologyABSTRACT
Thiolases catalyze the condensation of acyl-CoA thioesters through the Claisen condensation reaction. The best described enzymes usually yield linear condensation products. Using a combined computational/experimental approach, and guided by structural information, we have studied the potential of thiolases to synthesize branched compounds. We have identified a bulky residue located at the active site that blocks proper accommodation of substrates longer than acetyl-CoA. Amino acid replacements at such a position exert effects on the activity and product selectivity of the enzymes that are highly dependent on a protein scaffold. Among the set of five thiolases studied, Erg10 thiolase from Saccharomyces cerevisiae showed no acetyl-CoA/butyryl-CoA branched condensation activity, but variants at position F293 resulted the most active and selective biocatalysts for this reaction. This is the first time that a thiolase has been engineered to synthesize branched compounds. These novel enzymes enrich the toolbox of combinatorial (bio)chemistry, paving the way for manufacturing a variety of α-substituted synthons. As a proof of concept, we have engineered Clostridium's 1-butanol pathway to obtain 2-ethyl-1-butanol, an alcohol that is interesting as a branched model compound.
Subject(s)
Acetyl-CoA C-Acetyltransferase/metabolism , Acyl Coenzyme A/metabolism , Hexanols/metabolism , Saccharomyces cerevisiae Proteins/metabolism , Saccharomyces cerevisiae/metabolism , Acetyl-CoA C-Acetyltransferase/chemistry , Acetyl-CoA C-Acetyltransferase/genetics , Catalytic Domain , Metabolic Networks and Pathways , Models, Molecular , Protein Engineering/methods , Saccharomyces cerevisiae/chemistry , Saccharomyces cerevisiae/genetics , Saccharomyces cerevisiae Proteins/chemistry , Saccharomyces cerevisiae Proteins/geneticsABSTRACT
Objetivo: determinar el impacto de una intervención multifactorial dirigida a la prevención de úlceras por presión (UPP) en unidades de medicina interna y de cuidados intensivos. Material y método: estudio de intervención antes-después realizado en tres unidades de medicina interna y una de cuidados intensivos del Hospital Universitario Virgen Macarena de Sevilla, sobre 81 pacientes en la fase preintervención y 81 en la fase postintervención. Variables: intervención multifactorial (variable independiente principal): a) sensibilización y formación a los profesionales sobre prevención y tratamiento de las UPP; b) implementación de un nuevo registro de curas, monitorización del proceso preventivo y de la incidencia de UPP; c) difusión de la Unidad Integral de Telecuidados de UPP y Heridas Crónicas. Variable resultado: incidencia de UPP. Variables de control: edad, sexo, días de estancia y nivel de riesgo para presentar UPP según Escala EMINA. Se realizó un análisis descriptivo de las variables estudiadas y se calcularon las incidencias pre y postintervención, comparándose mediante el test Chi-cuadrado. Resultados: se estudiaron 162 pacientes, 52,2% y una edad media de 72,11 años. El 48,14% tenían riesgo medio de UPP y el 51,85% riesgo alto. Respecto al impacto de la intervención multifactorial, hubo una mayor incidencia en la fase preintervención (9,9% frente a 2,5%; p = 0,049). En la fase postintervención aumentó significativamente el uso de protecciones (de 46,9% a 75,3%; p = 0,000). En cuidados intensivos se utilizan más las superficies de aire alternantes (82,2% frente a 14,4%; p = 0,000) y los ácidos grasos hiperoxigenados (87,5% frente 69,2%; p = 0,005) y menos los cambios posturales (32,8% frente a 72,1%; p = 0,000). Conclusiones: la intervención multifactorial se ha mostrado eficaz para prevenir la aparición de UPP. La sensibilización de los profesionales de Enfermería hacia este problema es el primer paso para conseguirlo (AU)
Objective: to determine the impact of a multifactorial intervention aimed at the prevention of pressure ulcers in internal medicine and intensive care units. Material and method: before and after intervention study performed in three internal medicine units and one intensive care unit of the Virgen Macarena University Hospital of Sevilla, on 81 patients in pre-intervention phase and 81 in post-intervention phase. Variables: multifactorial intervention (primary independent variable): a) awareness raising and training of professionals on prevention and treatment of pressure ulcers; b) implementation of a new wound care registry, monitoring of the preventive process and incidence of pressure ulcers; c) dissemination of the Integral Unit of Telecare of Pressure Ulcers and Chronic Wounds. Outcome variable: pressure ulcer incidence. Control variables: age, sex, stay duration in days and degree of risk of presenting pressure ulcers according to the EMINA scale. A descriptive analysis of the studied variables was performed and the pre- and post-intervention incidences were calculated and compared using the Chi square test. Results: 162 patients were studied, 52,2% and mean age 72,11 years.48,14% had a moderate risk of pressure ulcers and 51,85% had a high risk. With regard to the impact of a multifactorial intervention, there was a higher incidence in the pre-intervention phase (9,9% versus 2,5%; p =0,049). In the post-intervention phase the use of protections increased significantly (from 46,9% to 75.3%; p = 0,000). In Intensive Care alternating air surfaces (82,2% versus 14,4%; p = 0,000) and hyperoxygenated fattyacids (87,5% versus 69,2%; p = 0,005) are used more frequently and postural changes less (32,8% versus 72,1% p = 0,000). Conclusions: a multifactorial intervention has been proven to be effective in the prevention of pressure ulcers. The awareness of nursing professionals regarding this issue is the first step to address it (AU)
Subject(s)
Humans , Critical Care/methods , Pressure Ulcer/prevention & control , Nursing Process/organization & administration , Evaluation of Results of Preventive Actions , Risk FactorsABSTRACT
El trastorno de ideas delirantes inducidas se caracteriza por síntomas psicóticos similares, comúnmente ideas delirantes, en 2 o más individuos que mantienen una relación cercana. Este trabajo describe y analiza un caso de delirio compartido de persecución entre 3 personas; la paciente, su hija y su yerno. El delirio compartido entre madre e hija se inicia tras la separación matrimonial de la paciente hace 6 años, a lo que se añade el tercer implicado, el yerno, unos días antes del ingreso de nuestra paciente en la unidad de hospitalización breve de psiquiatría de nuestro hospital. Realizamos una breve revisión bibliográfica sobre los aspectos psicopatológicos y terapéuticos de esta entidad (AU)
Shared psychotic disorder is characterized by the presence of similar psychotic symptoms, usually delusional ideas, in 2 or more individuals maintaining a close relationship. In this report, we aim to describe and analyze a case of induced delusional disorder affecting three people: the patient, her daughter andher son-in law. Shared delusional disorder between mother and daughter had started 6 years previously, following the patients divorce. The son-in law became involved as a third component a few days before the patient was admitted to the short-stay psychiatric unit of our hospital. We provide a brief literature review of the psychopathologic and therapeutic aspects of this entity (AU)
