Metabolomic insights in advanced cardiomyopathy of chronic chagasic and idiopathic patients that underwent heart transplant.

Heart failure (HF) studies typically focus on ischemic and idiopathic heart diseases. Chronic chagasic cardiomyopathy (CCC) is a progressive degenerative inflammatory condition highly prevalent in Latin America that leads to a disturbance of cardiac conduction system. Despite its clinical and epidemiological importance, CCC molecular pathogenesis is poorly understood. Here we characterize and discriminate the plasma metabolomic profile of 15 patients with advanced HF referred for heart transplantation - 8 patients with CCC and 7 with idiopathic dilated cardiomyopathy (IDC) - using gas chromatography/quadrupole time-of-flight mass spectrometry. Compared to the 12 heart donor individuals, also included to represent the control (CTRL) scenario, patients with advanced HF exhibited a metabolic imbalance with 21 discriminating metabolites, mostly indicative of accumulation of fatty acids, amino acids and important components of the tricarboxylic acid (TCA) cycle. CCC vs. IDC analyses revealed a metabolic disparity between conditions, with 12 CCC distinctive metabolites vs. 11 IDC representative metabolites. Disturbances were mainly related to amino acid metabolism profile. Although mitochondrial dysfunction and loss of metabolic flexibility may be a central mechanistic event in advanced HF, metabolic imbalance differs between CCC and IDC populations, possibly explaining the dissimilar clinical course of Chagas' patients.

Experiencia de grupo terapéutico durante el confinamiento por COVID-19 en una unidad de agudos de psiquiatría / Therapeutic group experience during confinement by COVID-19 in an acute psychiatry unit

El presente trabajo consiste en la descripciónde las sesiones grupales que se efectuarondurante el confinamiento por COVID-19en la Unidad de Agudos 1 de Psiquiatría generaldel Hospital Sagrat Cor de Martorell,en Barcelona.Se planteó un grupo abierto con aquellospacientes ingresados que voluntariamenteaccedieran a participar, como una propuestaa la alta respuesta emocional del momento.Se efectuó una sesión grupal semanal de unahora de duración a lo largo de seis semanas.El equipo terapéutico quedó constituidotanto por profesionales de la unidad comode los provenientes de recursos ambulatoriostomando un carácter interdisciplinar. Participaronun total de 41 pacientes con unaheterogeneidad diagnóstica; trastornos dela personalidad (26,83%), trastorno bipolar(19.51%), esquizofrenia y otros trastornospsicóticos (19,51%) y trastornos depresivos(14,61%). El porcentaje restante (19,54%)corresponde a otros diagnósticos. El 46,34%del total de los pacientes ha presentadoconsumo de sustancias en comorbilidad. Seaprecian como temas principales: La aceptacióndel ingreso, la compresión de lasnormativas por COVID-19, el manejo de laangustia por el ingreso bajo las condicionesde confinamiento y el desarrollo de capacidadesde diálogo, responsabilidad y cuidadode los participantes. Se describieron en las terapeutas intervenciones más directivas alinicio de las sesiones a intervenciones deacompañamiento y facilitación a medida quese desarrollaba el grupo.ConclusionesLa actividad grupal permitió un espacio decontención emocional, seguridad, información,reflexión, educación e integración paralos participantes. (AU)

The present work consists of the descriptionof the group sessions that were carriedout during the confinement becauseof COVID-19 in the Acute Unit 1 of GeneralPsychiatry of the Hospital Sagrat Cor de Martorell,in Barcelona.An open group was proposed with thoseadmitted patients who voluntarily agreed toparticipate, as a proposal to the high emotionalresponse of the moment. A weeklyone-hour group session was held over sixweeks. The therapeutic team was constitutedby both professionals from the unit andthose from outpatient resources, adoptingan interdisciplinary character. The outstandingthemes extracted from the summariesof each session were described. A total of 41patients with diagnostic heterogeneity participated;personality disorders (26.83%), bipolar disorder (19.51%), schizophreniaand other psychotic disorders (19.51%) anddepressive disorders (14.61%). The remainingpercentage (19.54%) corresponds toother diagnoses. 46.34% of the total of patientshave presented substance use in comorbidity.The main themes are the management ofanxiety due to admission under confinementconditions; compression of regulations becauseof COVID-19; and the development ofa dialogue capacity, responsibility and careof the participants. More directive interventionswere described in the therapists at thebeginning of the sessions towards accompanimentinterventions as the group develops.ConclusionsThe group activity allowed a space foremotional containment, security, information,reflection, education and integrationfor the participants. (AU)

Innovative Approaches to Assess Intermediate Cardiovascular Risk Subjects: A Review From Clinical to Metabolomics Strategies.

Current risk stratification strategies for coronary artery disease (CAD) have low predictive value in asymptomatic subjects classified as intermediate cardiovascular risk. This is relevant because not all coronary events occur in individuals with traditional multiple risk factors. Most importantly, the first manifestation of the disease may be either sudden cardiac death or acute coronary syndrome, after rupture and thrombosis of an unstable non-obstructive atherosclerotic plaque, which was previously silent. The inaccurate stratification using the current models may ultimately subject the individual to excessive or insufficient preventive therapies. A breakthrough in the comprehension of the molecular mechanisms governing the atherosclerosis pathology has driven many researches toward the necessity for a better risk stratification. In this Review, we discuss how metabolomics screening integrated with traditional risk assessments becomes a powerful approach to improve non-invasive CAD subclinical diagnostics. In addition, this Review highlights the findings of metabolomics studies performed by two relevant analytical platforms in current use-mass spectrometry (MS) hyphenated to separation techniques and nuclear magnetic resonance spectroscopy (NMR) -and evaluates critically the challenges for further clinical implementation of metabolomics data. We also discuss the modern understanding of the pathophysiology of atherosclerosis and the limitations of traditional analytical methods. Our aim is to show how discriminant metabolites originated from metabolomics approaches may become promising candidate molecules to aid intermediate risk patient stratification for cardiovascular events and how these tools could successfully meet the demands to translate cardiovascular metabolic biomarkers into clinical settings.

Sialoadenite esclerosante crônica em glândula salivar menor / Chronic sclerosing sialoadenitis in small salivary gland

A sialoadenite esclerosante crônica, também conhecida como tumor de Kutner, é uma condição, que acomete, predominantemente, glândulas salivares maiores. Clinicamente, apresenta-se como um nódulo, móvel, assintomático e de consistência endurecida. Seu diagnóstico definitivo só é conseguido através da análise histopatológica onde estão presentes: intenso infiltrado inflamatório linfocítico, atrofia acinar, fibrose do parênquima glandular e graus variáveis de esclerose. Neste artigo, é relatado um caso clínico raro de sialoadenite esclerosante crônica, localizada em glândula salivar menor... (AU)

Chronic sclerosing sialoadenitis, also known as Kutner's tumor, is a condition that predominantly affects major salivary glands. Clinically it presents as a nodule, mobile, asymptomatic, and of hardened consistency. Its definitive diagnosis is only achieved through the histopathological analysis where they are present: intense lymphocytic inflammatory infiltrate, acinar atrophy, fibrosis of the glandular parenchyma and variable degrees of sclerosis. In this article we report a rare clinical case of chronic sclerosing sialoadenitis located in the minor salivary gland... (AU)

Dietary calcium, phosphorus, and phytase effects on bird performance, intestinal morphology, mineral digestibility, and bone ash during a natural necrotic enteritis episode.

The objective of this study was to evaluate the effects of dietary Ca, P, and phytase on performance, intestinal morphology, bone ash, and Ca and P digestibility during a necrotic enteritis (NE) outbreak. The 35-d trial was designed as a 2 × 2 × 2 factorial, which included 2 Ca levels (0.6 and 0.9%), 2 P levels (0.3 and 0.45%), and 2 levels of phytase [0 and 1,000 phytase units (FTU)/kg]. Birds were placed on litter from a previous flock that exhibited clinical signs of NE. Birds and feed were weighed on d 12, 19, and 35, and BW gain, feed intake, and feed conversion were calculated. Mortality was recorded daily, and gastrointestinal pH was measured. Tibias and ileal digesta were also collected. Birds began exhibiting clinical signs of NE on d 9, and NE-associated mortality persisted until d 26. Dietary Ca supplemented at 0.9% or inclusion of 1,000 FTU/kg of phytase significantly increased mortality compared with 0.6% Ca or 0 FTU/kg of phytase, respectively. From d 0 to 12, birds fed 0.9% Ca and 0.45% available P with phytase had greater BW gain compared with birds fed 0.6% Ca, 0.45% available P, and phytase. From d 0 to 19, birds fed diets with 0.9% Ca and 0.3% available P had decreased feed intake and improved feed conversion compared with birds fed 0.9% Ca and 0.45% available P. Calcium at 0.9% increased gizzard (d 19) and jejunum (d 12) pH. Phytase supplementation significantly increased Ca digestibility regardless of Ca and P levels of the diets. In addition, diets containing 0.6% Ca and 1,000 FTU/kg of phytase resulted in a significant increase in P digestibility. The results suggest that dietary Ca level may influence NE-associated mortality. In addition, bird performance was affected by interactions of Ca, P, and phytase during the exposure to Clostridium perfringens and the subsequent NE outbreak. Results showed improvements in bird performance when birds were fed 0.6% Ca and 0.3% P in diets supplemented with phytase, which was likely consequent to the influence of Ca in NE pathogenesis.