Liver steatosis in patients with rheumatoid arthritis treated with methotrexate is associated with body mass index.

BACKGROUND: Methotrexate (MTX) is the usual first-line treatment for rheumatoid arthritis (RA). Long-term use of MTX has been associated with liver steatosis (LS) and liver fibrosis (LF). AIM: To determine if LS in patients treated with MTX for RA is associated with MTX cumulative dose (MTX-CD), metabolic syndrome (MtS), body mass index (BMI), the male sex, or LF. METHODS: A single-center, prospective study of patients receiving MTX for RA was performed from February 2019 to February 2020. The inclusion criteria were patients aged 18 years or older diagnosed with RA by a rheumatologist and being treated with MTX (without limitation on the duration of treatment). The exclusion criteria were previous diagnosis of liver disease (hepatitis B or C virus infection, known nonalcoholic fatty liver disease), alcohol consumption greater than 60 g/d in males or 40 g/d in females, human immunodeficiency virus infection on antiretroviral therapy, diabetes mellitus, chronic renal failure, congestive heart failure, or BMI greater than 30 kg/m². Patients receiving leflunomide in the 3 years prior to the study were also excluded. Transient elastography (FibroScan, Echosens®, Paris, France) was used for fibrosis determination (LF > 7 KpA) and computer attenuation parameter (CAP) for LS (CAP > 248 dB/m). Demographic variables, laboratory data, MTX-CD (> 4000 mg), MtS criteria, BMI (> 25), transient elastography, and CAP scores were collected from all patients. RESULTS: Fifty-nine patients were included. Forty-three were female (72.88%), and the mean age was 61.52 years (standard deviation: 11.73). When we compared MTX-CD ≤ 4000 mg (26 patients; 14 with LS and 12 without) with > 4000 mg (33 patients; 12 with LS and 21 without), no statistical differences were found (P = 0.179). We compared CAP scores stratified by MtS, BMI, sex, and LF. There were no significant differences in CAP scores based on the presence of MtS [CAP/MtS: 50 no MtS (84.75%); 9 MtS (15.25%); P = 0.138], the male sex (CAP/sex: 8 male/18 female LS; 8 male/25 female no LS; P = 0.576), or LF [CAP/fibrosis: 53 no LF (89.83%); 6 LF (10.17%); P = 0.239]. LS determined by CAP was significantly associated with BMI > 25 (CAP/BMI: 22 BMI ≤ 25 (37.29%); 37 BMI > 25 (62.71%); P = 0.002]. CONCLUSION: LS in patients with RA treated with MTX was not associated with MTX-CD, LF, the male sex, or MtS. However, BMI was significantly related to LS in these patients.

Evidence of successful modulation of brain activation and subjective experience during reappraisal of negative emotion in unmedicated depression.

Functional magnetic resonance imaging (fMRI) was used to examine cognitive regulation of negative emotion in 12 unmedicated patients with major depressive disorder (MDD) and 24 controls. The participants used reappraisal to increase (real condition) and reduce (photo condition) the personal relevance of negative and neutral pictures during fMRI as valence ratings were collected; passive viewing (look condition) served as a baseline. Reappraisal was not strongly affected by MDD. Ratings indicated that both groups successfully reappraised negative emotional experience. Both groups also showed better memory for negative vs. neutral pictures 2 weeks later. Across groups, increased brain activation was observed on negative/real vs. negative/look and negative/photo trials in left dorsolateral prefrontal cortex (DLPFC), rostral anterior cingulate, left parietal cortex, caudate, and right amygdala. Depressive severity was inversely correlated with activation modulation in the left DLPFC, right amygdala, and right cerebellum during negative reappraisal. The lack of group differences suggests that depressed adults can modulate the brain activation and subjective experience elicited by negative pictures when given clear instructions. However, the negative relationship between depression severity and effects of reappraisal on brain activation indicates that group differences may be detectable in larger samples of more severely depressed participants.

[Perception of mistreatment during medical residency training]. / Percepción de maltrato durante la capacitación de médicos residentes.

Because previous investigations show that mistreatment during residency is frequent we undertook this research to assess the prevalence of psychological abuse, physical violence and sexual harassment in residency training programs and the professional status of perpetrators. Through a literature review and a previous qualitative study we developed a self-administered questionnaire. Thirteen events that could be experienced by residents and ten possible perpetrators were described in the questionnaire. Residents were asked to record whether they had experienced these events, at least once, and who was responsible. This survey was distribuided among the residents from three hospitals of Buenos Aires city. A total of 322 residents answered the questionnaire (55% women) 72% of whom worked in clinical programs, 22% in surgical programs, and 6% in diagnostic programs. Mistreatment was reported by 89% of the residents. On average each resident recorded 8 different episodes of mistreatment, such as being criticized for not completing administrative work (75%), being shouted at (64%), being humiliated in public (57%), sexual harassment (10%), being exposed to pornographic material without permission (7%), being hit or pushed (15%), suffering racial or religious discrimination (10%). The most common perpetrators were senior residents (26%), chief resident (19%), attending physicians (14%), and nurses (8%). Mistreatment and abuse are commonly experienced by residents in training programs. A multidisciplinary approach is needed to address this problem in the training environment.

Percepción de maltrato durante la capacitación de médicos residentes. / [Perception of mistreatment during medical residency training]

Because previous investigations show that mistreatment during residency is frequent we undertook this research to assess the prevalence of psychological abuse, physical violence and sexual harassment in residency training programs and the professional status of perpetrators. Through a literature review and a previous qualitative study we developed a self-administered questionnaire. Thirteen events that could be experienced by residents and ten possible perpetrators were described in the questionnaire. Residents were asked to record whether they had experienced these events, at least once, and who was responsible. This survey was distribuided among the residents from three hospitals of Buenos Aires city. A total of 322 residents answered the questionnaire (55

women) 72

of whom worked in clinical programs, 22

in surgical programs, and 6

in diagnostic programs. Mistreatment was reported by 89

of the residents. On average each resident recorded 8 different episodes of mistreatment, such as being criticized for not completing administrative work (75

), being shouted at (64

), being humiliated in public (57

), sexual harassment (10

), being exposed to pornographic material without permission (7

), being hit or pushed (15

), suffering racial or religious discrimination (10

). The most common perpetrators were senior residents (26

), chief resident (19

), attending physicians (14

), and nurses (8

). Mistreatment and abuse are commonly experienced by residents in training programs. A multidisciplinary approach is needed to address this problem in the training environment.