Surgical Management of Severe Mandibular Actinomycosis: Segmental Mandibulectomy and Fibula Free Flap for Optimal Outcomes.

Actinomycosis is a chronic, suppurative, granulomatous bacterial infection primarily associated with Actinomyces israelii. The condition can be categorized into three distinct clinical types based on the affected anatomical region: cervicofacial, pulmonary, or abdominopelvic actinomycosis. The standard treatment for actinomycosis involves antibiotic therapy, with an empiric penicillin regimen as the first-line approach. Surgical interventions comprise curettage of the affected bone, resection of necrotic tissues, excision of existing sinus tracts, and drainage of abscesses. These procedures are considered a last resort for cases of actinomycosis unresponsive to antibiotic therapy. In this context, we present a case of severely unresponsive actinomycosis that necessitated aggressive surgical resection of the infected mandibular bone, followed by immediate reconstruction using a fibula-free flap. The outcome yielded both favorable functional and aesthetic results.

Heterotopic ossification - A rare donor site complication after iliac crest free flap.

Iliac crest free flap is still essential as a source of vascularized bone tissue, having a definite role in osseous reconstruction of the face and other small bone defects. Some of its drawbacks include laborious dissection and donor site morbidity. We report a case of a patient that presented to our follow-up consultation ten years after iliac crest free flap harvest with new complaints of pain, gait disturbance and swelling in the right hip. Imaging exams revealed a heterotopic bone formation and helped with the diagnosis of heterotopic ossification (HO) of the right iliacus bone. Surgical intervention was needed for debridement of the heterotopic bone, with resolution of the symptoms. To our knowledge, this is the first report of HO after iliac crest free flap harvest. This rare condition adds to an already well-known number of donor zone complications of this flap. Plastic surgeons should be aware of this complication, as it can cause disability many years after the original surgery.

A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol.

Introduction: Depression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver). Methods: This is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver. Discussion: MCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group. Clinical trial registration: ClinicalTrials.gov, NCT05640492.

Stylomandibular False Ankylosis: An Unusual Complication After Vascularized Iliac Crest Flap for Mandibular Reconstruction.

Stylomandibular fusion is a poorly documented and rare complication of maxillofacial surgical procedures. This case report describes a patient presenting with stylomandibular false ankylosis following mandibular reconstruction. A 59-year-old female patient underwent segmental mandibular resection and reconstruction for a defect resulting from ameloblastoma surgery using an iliac crest free flap. A styloid fracture was detected postoperatively, and the patient was managed conservatively. In the third postoperative year, the patient presented with marked limitation of oral gape. A diagnosis of stylomandibular false ankylosis was made, and the patient underwent an ostectomy of the aberrant bone, with improved mouth opening. The abnormal union between the styloid process and the mandible is a previously unreported complication in the use of iliac crest free flaps. This case report emphasizes the importance of being vigilant for stylomandibular false ankylosis, especially when there is a restriction of oral aperture postoperatively following reconstructive procedures involving bone flaps.

Long-term care units: a Portuguese study about the functional profile.

Aim: In this study, we analyze the relationship between the functional profile of older people admitted to long-term care units in Portugal and some demographic variables such as education level, sex, and age as well as the emotional state of mind. Methods: A sample of 59,516 older people from the National Network of Integrated Continuous Care of Portugal were analyzed in this longitudinal study. All the retrospective data of the older people were collected during the period of hospitalization at the long-term care units. The database records of these units were analyzed, and a functional profile spanning the period of hospitalization was calculated. Results: Activities of daily living and cognitive states improved, in the first 90 days of hospitalization, while mobility and instrumental activities of daily living worsened for the same period of 90 days. Generally, there was a decline in all domains after 450 days of hospitalization. The older women that did not attend school, those over 85 years old, and those who suffered from anxiety were pre-dominantly placed in the group of those with greater dependence (severe/complete dependence). Conclusion: The participants hospitalized between 90 and 360 days presented the best results in the long-term care units of the National Network of Integrated Continuous Care of Portugal. With this study, we highlight the importance of evaluating the functional status of persons in long-term hospitalizations and the influence exerted by the level of education on the recovery and rehabilitation of dependence.

Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver).

Background: Metacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver's effects on depression. Materials and methods: We conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment). Results: Mediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome. Conclusion: The current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.

Depression in older adults during the COVID-19 pandemic: A systematic review.

BACKGROUND: Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID-19 pandemic. METHODS: Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID-19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria. RESULTS: Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress-related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID-19 through the media); factors directly related to COVID-19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID-19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS-SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness. CONCLUSIONS: Improved understanding of pandemic-associated risk factors for depression can inform person-cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID-19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity.

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Functional Profile of Older Adults Hospitalized in Rehabilitation Units of the National Network of Integrated Continuous Care of Portugal: A Longitudinal Study.

BACKGROUND: The success of healthy aging depends on the ability of countries to study and act on frailty in the elderly, control chronic diseases, improve functional capacity and prevent cognitive decline and social interaction. AIM: (1) to evaluate the functional profile of older adults hospitalized in a Unit of the National Network of Integrated Continuous Care of Portugal; and (2) to assess the relationship between functional profile and age, gender, level of education and emotional state. METHODS: Longitudinal study with a population of 59,013 older adults (65 years or older) hospitalized in Medium-Term Care and Rehabilitation Units in Portugal. RESULTS: Older age (≥85 years), no school attendance, low body mass index and presence of sad or depressed mood were predictive factors for a deficit in functional capacity. We identified significant improvements in rehabilitation, but after 210 days of hospitalization, older people incurred a loss of functionality. Total compensation needs were typified by severe deficits in self-care and functional capacity: 47.1%. A moderate deficit was present in 43.1%, and a slight self-care and functional deficit occurred in 9.8% of the individuals. CONCLUSIONS: Knowing the determinants of functional capacity and self-care needs will make it possible to define priority intervention groups and implement quality and financing models based on gains in functionality.

Depression in older adults during the COVID-19 pandemic: a systematic review protocol.

INTRODUCTION: Depression is a common mental disorder and is a major cause of years lived with disability. The COVID-19 pandemic has caused an increase in the prevalence of depression worldwide. Our aim is to identify and synthesise the determinants of depression, the diagnostic assessment tools used to evaluate depression, and the interventions carried out since the beginning of the COVID-19 pandemic in the population aged 60 and older. METHODS AND ANALYSIS: A systematic review of the literature will be conducted. The following databases will be searched: CINAHL Plus with Full Text, MedicLatina, MEDLINE with Full Text, and Psychology and Behavioural Sciences Collection. The search strategy will include the following Medical Subject Headings or similar terms: "Depression", "Depressive Disorder", "Depressive Symptoms", "Older Adults", "Aging", "Elderly", Pandemic" and "COVID-19". Two independent reviewers will ascertain whether the resulting articles meet inclusion and exclusion criteria, and perform the analysis of data quality. Disagreements will be resolved by a third reviewer. All studies reported between December 2019 and March 2022 meeting the following criteria will be included: studies in adults aged 60 and over, and articles written in English, Portuguese, Spanish or German. Information on determinants of depression, assessment instruments used to assess depressive symptoms and/or interventions to decrease depression are reported. Studies will not be excluded based on geographical area study context (eg, community, culture or specific environment). All studies related to diagnostic assessment, care planning and/or intervention strategies specifically for older adults with depression will be included. ETHICS AND DISSEMINATION: As only secondary data will be analysed, no ethical approval is required for this study. This scientific article is a systematic review protocol for which data have not yet been extracted or analysed. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42022299775.

Protease technology for obtaining a soy pulp extract enriched in bioactive compounds: isoflavones and peptides.

This work presents a new bioprocess process for the extraction of bioactive components from soy pulp by-product (okara) using an enzymatic technology that was compared to a conventional water extraction. Okara is rich in fiber, fat, protein, and bioactive compounds such as isoflavones but its low solubility hampers the use in food and fertilizer industry. After the enzymatic attack with endoproteases half of the original insoluble proteins were converted into soluble peptides. Linked to this process occured the solubilization of isoflavones trapped in the insoluble protein matrix. We were able to extract up to 62.5% of the total isoflavones content, specially aglycones, the more bioactive isoflavone forms, whose values rose 9.12 times. This was probably due to the increased solubilization and interconversion from the original isoflavones. In conclusion, our process resulted in the formulation of a new functional product rich in aglycones and bioactive peptides with higher antioxidant potency than the original source. Therefore, we propose that the enzymatic extraction of okara bioactive compounds is an advantageous tool to replace conventional extraction.

Obtaining edaphic biostimulants/biofertilizers from sewage sludge using fermentative processes. Short-time effects on soil biochemical properties.

In this manuscript, we study the manufacture and effect on soils of different edaphic biostimulants/biofertilizers (BS) obtained from sewage sludge using Bacillus licheniformis as biological tool. These BS consist of different combinations of organic matter, bacteria and enzymes that were subjected to several treatments. These BS were applied in soil in order to observe their influence on the biochemical properties (enzymatic activities and ergosterol content). Dehydrogenase, urease, ß-glucosidase, phosphatase activities and ergosterol content were measured at different incubation days. Only dehydrogenase activity and ergosterol content were significantly stimulated after the application of BS1 and BS4. Rest of the extracellular activities were not stimulated probably because B. licheniformis practically has digested all organic substrates during fermentation process.

Caroli's Disease as a Cause of Chronic Epigastric Abdominal Pain: Two Case Reports and a Brief Review of the Literature.

Caroli's disease is a very rare congenital malformation, currently included in cystic diseases of the biliary tract, and is characterized by ectasia and dilatation of the intrahepatic bile ducts. Two clinical entities can be distinguished, Caroli's disease in which congenital hepatic impairment is limited to cystic dilatation and Caroli's syndrome in which congenital hepatic fibrosis coexists. We present two cases of atypical presentations of Caroli's disease. Case one was a 76-year-old man who was referred to our hospital for chronic non-remitting epigastric pain prior to diagnosis. Magnetic resonance cholangiopancreatography (MRCP) was performed, which revealed findings consistent with Caroli's disease. Laboratory investigation disclosed a raised α-fetoprotein. Left hepatectomy was performed due to suspected cholangiocarcinoma. Morphological findings were compatible with Caroli's disease and no evidence of malignancy was found. Case two was a 47-year-old man who presented with chronic epigastric pain and generalized abdominal discomfort. MRCP revealed findings compatible with Caroli's disease. The patient was discharged with ursodeoxycholic acid treatment and was later admitted twice due to inaugural episodes of cholangitis that were medically managed. Bisegmentectomies II and III were performed for suspected neoplasia after a gradual rise in α-fetoprotein and CA19-9 values were noted during follow-up. The surgical specimen confirmed Caroli's disease and there was no evidence of malignancy. Postoperative periods for both patients were favorable, and they remain asymptomatic and well to date.

Sanitary impact evaluation of drinking water in storage reservoirs in Moroccan rural area.

In Morocco, storage reservoirs are particular systems of water supply in rural areas. These reservoirs are fed with rainwater and/or directly from the river, which are very contaminated by several pathogenic bacteria. They are used without any treatment as a drinking water by the surrounding population. In this context, the aim of this study is to evaluate the impact of consuming contaminated water stored in reservoirs on health status for six rural communities located in Assif El Mal, Southern East of Marrakech. This was investigated using a classical methodology based on population survey and by molecular approach using PCR-DGGE technique to determine the intestinal bacterial diversity of consumers. The survey showed that, the residents of the studied area suffered from numerous health problems (diarrheal diseases, vomiting or hepatitis A) due to the lack of waste management infrastructures. The consumer's stool analysis by molecular approach revealed that numbers of Escherichia coli, Aeromonas hydrophila and Clostridia, were significantly higher in the diarrheal feces. In addition, PCR-DGGE study of the prevalence and distribution of bacteria causing human diseases, confirmed that, there is a relationship between water bacterial contaminations of storage reservoirs and microbial disease related health status. Therefore, water reservoir consumption is assumed to be the mean way of exposure for this population. It's clear that this approach gives a very helpful tool to confirm without any doubt the relationship between water bacterial contamination and health status.

Pre-fermentative addition of an enzymatic grape seed hydrolysate in warm climate winemaking. Effect on the differential colorimetry, copigmentation and polyphenolic profiles.

The effect of adding an enzymatic hydrolysate of grape seeds (EH-GS) during Syrah wine fermentation in a warm climate has been evaluated. We focused on the polyphenolic composition as well as the application of differential and tristimulus colorimetry to colour data. This is the first attempt at using this oenological alternative to avoid common colour losses of red wines elaborated in a warm climate. The addition of 250g (simple dose, SW) of EH-GS to 120kg of fermentation material promoted a significant (p<0.05) increase in the polyphenolic content of stored wines, especially in benzoic acid, hydroxycinnamic acid derivative, flavonol and anthocyanin levels. This increase could promote a higher copigmentation percentage and maximum colour stabilization (C(∗)ab) without significantly changing the wine tonality. Unexpectedly, the use of a double quantity (DW) of EH-GS resulted in significantly less chroma than for control wines (CW), demonstrating visually perceptible colour changes (ΔE(∗)ab>3 CIELAB units).

Extensive and ulcerated malignant proliferating trichilemmal (pilar) tumour, arising from multiple, large, degenerated trichilemmal (pilar) cysts.

We report a rare case of a 61-year-old homeless man with a 15-year history of multiple trichilemmal cysts that served as a forerunner for the emergence of a malignant proliferating pilar tumour. The patient presented multiple, large, purulent, ulcerated lesions ranging from 10 to 150 mm in diameter, covering most of the scalp, with large areas superimposed by extensive myiasis infestation. The patient presented with no other major clinical findings. A CT scan showed no detectable signs of local or distant metastatic invasion. Initial supportive treatment was implemented. Given the extent of the injury, further surgical excision was considered, which required transfer to a specialised surgical centre. This social case is of educational value, as it can raise clinician awareness about the ability of trichilemmal cysts to undergo malignant transformation. Additionally, it highlights the importance of adequate social assistance structures for patients in need.

Leukocytoclastic Vasculitis with Systemic Involvement Associated with Ciprofloxacin Therapy: Case Report and Review of the Literature.

A 71-year-old woman presented with constitutional signs and lower extremity palpable purpura after being prescribed a four-day course of 500 mg of ciprofloxacin two times daily for a gastrointestinal infection. She was admitted for inpatient treatment. During the third hospital day, she presented with an episode of abundant hematemesis while her skin lesions remained unchanged. Upper endoscopy revealed multiple lesions consistent with vasculitis and histological examination of the skin biopsy disclosed a leukocytoclastic vasculitis. The patient was successfully treated with prednisone following ciprofloxacin discontinuation. Complete resolution of the lesions on drug withdrawal strongly suggested drug toxicity, which was further supported by a score of 8 in the Naranjo Adverse Drug Reaction Probability Scale. Awareness that the development of skin and gastrointestinal lesions following administration of ciprofloxacin may be a manifestation of ciprofloxacin-induced vasculitis can help early detection, treatment, and lead to an overall good prognosis.

Severe Legionella Pneumophila Infection in an Immunocompetent Patient: A Success Story 300 Kilometers Away.

The most significant outbreak of Legionella pneumophila, or Legionnaires' Disease, ever registered in Portugal occurred in 2014, and was considered one of the largest in European history. This relatively rare infection has a dire prognosis if not timely identified and correctly treated, presenting with a high lethality rate. We describe a case of infection by Legionella pneumophila in a previously healthy individual during an outbreak that originated 300 kilometers away from our hospital. The patient presented to the Emergency Department and after an initial assessment, was admitted to the Intensive Care Unit (ICU). He underwent supportive treatment with invasive mechanical ventilation and antibiotic therapy, having been discharged with functional improvement 21 days after admission. During follow-up, the patient presented well without residual clinical or radiological findings. Prompt management following established guidelines allowed for the appropriate treatment and a favorable prognosis. This case serves as a reminder that early management is important, healthy individuals without known risk factors may present with severe infection, and there is the possibility for individual cases of Legionellosis to present far from the outbreak source.

Accelerated degradation of PAHs using edaphic biostimulants obtained from sewage sludge and chicken feathers.

We studied in the laboratory the bioremediation effects over a 100-day period of three edaphic biostimulants (BS) obtained from sewage sludge (SS) and from two different types of chicken feathers (CF1 and CF2), in a soil polluted with three polycyclic aromatic hydrocarbons (PAH) (phenanthrene, Phe; pyrene, Py; and benzo(a)pyrene, BaP), at a concentration of 100 mg kg(-1) soil. We determined their effects on enzymatic activities and on soil microbial community. Those BS with larger amounts of proteins and a higher proportion of peptides (<300 daltons), exerted a greater stimulation on the soil biochemical properties and microbial community, possibly because low molecular weight proteins can be easily assimilated by soil microorganisms. The soil dehydrogenase, urease, ß-glucosidase and phosphatase activities and microbial community decreased in PAH-polluted soil. This decrease was more pronounced in soils contaminated with BaP than with Py and Phe. The application of the BS to PAH-polluted soils decreased the inhibition of the soil biological properties, principally at 7 days into the experiment. This decrease was more pronounced in soils contaminated with BaP than with Py and Phe and was higher in polluted soils amended with CF2, followed by SS and CF1, respectively.

Obtaining edaphic biostimulants/biofertilizers from different sewage sludges. Effects on soil biological properties.

We studied the influence of six edaphic biostimulants/biofertilizers (BSs) manufactured by the pH-stat method from different sewage sludge (SS): SS1 (an anaerobic mature sludge, one year old), SS2 (an aerobic young sludge, without maturation) and SS3 (an aerobic mature sludge, four months old), not previously autoclaved (A) and autoclaved (B), by analysing their effects on soil biological properties. Soil enzymatic activities were measured at 1, 3, 5, 7, 15, 30 and 60 days of the incubation period, whereas the 16S rDNA-DGGE profiles were determined at 0, 5 and 60 days. The enzymatic activities were significantly stimulated. The highest stimulation was found in the B2 treatment followed by B3, A2, A3, B1 and A1 treatments. Increasing the number of lower molecular weight proteins in the BS enhances the stimulation of soil enzymatic activities. The application of BS caused at 5 days of the incubation period temporal variations in the soil bacterial community structure.