General Practitioners' Own Traumatic Experiences and Their Skills in Addressing Patients' Past History of Adversities: A Cross-Sectional Study in Portugal.

Addressing trauma has been found to be important for primary care patients, as it can improve their health-related outcomes. We aimed to assess how Portuguese general practitioners' (GPs) past history of traumatic events (TEs) and adverse childhood experiences (ACEs) influence their clinical communication skills when addressing their patients' past history of adversities. An online survey was circulated by email to GPs' associations and through GPs' social media groups. A sample of 143 GPs participated in this study. GPs' exposure to ACEs and TEs was assessed using the Childhood Trauma Questionnaire-Short Form and the Life Events Checklist for the DSM-5. To evaluate clinical communication skills, we adapted the Self-confidence Scale and used the Jefferson Scale of Physician Empathy. GPs identified barriers to addressing trauma routinely, including a lack of time (86.7%) and a fear of causing further patient suffering (56.6%). GPs' exposure to TEs and ACEs was positively correlated with scores in some dimensions of self-confidence and empathy (r values varying from 0.170 to 0.247). GPs exposed to traumatic experiences felt more confident when addressing their patients' adversities and were more empathic when conducting therapeutic relationships. This study shows that GPs with a history of traumatic experiences are able to address their patients' adversities; however, they lack proper training and better patient care conditions, such as more time and more resources available for patient guidance.

Caracterização e avaliação do paciente anticoagulado com varfarina em relação à complexidade da farmacoterapia / Characterization and evaluation of patients anticoagulated with warfarin in relation to the complexity of pharmacotherapy

A realização de diagnóstico e tratamento das arritmias sustentadas fazem parte da rotina clínica, sendo uma das arritmias mais frequentes a Fibrilação Atrial (FA). Para prevenção de eventos tromboembólicos em pacientes com FA, recomendase a anticoagulação oral, destacando-se a varfarina. Apesar da importância, esse medicamento possui estreita margem terapêutica, o que faz com que pequenas mudanças no tratamento gerem risco de eventos trombóticos ou hemorrágicos. Dentre essas mudanças, destaca-se a adesão aos demais medicamentos em uso, alteração do uso desses medicamentos por prescritores e automedicação. Várias são as interações entre varfarina e demais medicamentos de uso contínuo, acreditando-se que a complexidade da prescrição pode interferir nos desfechos clínicos da terapia anticoagulante. O objetivo do estudo foi caracterizar pacientes acompanhados em um ambulatório de anticoagulação em relação ao Índice de Complexidade da Farmacoterapia. Para identificação da complexidade da farmacoterapia, considerou-se as prescrições dos demais medicamentos em uso, prescritas por médicos da atenção primária em saúde. Utilizouse o instrumento Medication Regimen Complexity Index (MRCI). A complexidade, compreendida como a forma de administração, posologia e forma farmacêutica, fatores que interferem na adesão à terapia anticoagulante, foi subdividida em três níveis: baixa complexidade, moderada e alta, conforme indicado pela literatura. A análise da complexidade foi realizada por dois pesquisadores de forma independente, sendo considerados os critérios conforme orientação do MRCI. Trata-se de um estudo descritivo realizado em duas clínicas de anticoagulação, localizadas em Minas Gerais. Durante a pesquisa, pacientes foram acompanhados em dois ambulatórios de anticoagulação do Brasil, em uso de varfarina, foram convidados a participarem de um ensaio clínico entre dezembro de 2018 e fevereiro de 2019, sendo que posteriormente foi realizado um recorte para o presente estudo. Um total de 93 pacientes foram incluídos no estudo, sendo a média de idade de 63 anos e a maioria do sexo feminino (68,8%). A fibrilação atrial foi a indicação da ACO mais predominante (92,5%). A média do número de medicamentos utilizados foi de 7,0. A maioria dos pacientes com farmacoterapia classificada como alta (38, 6,5%) e média complexidade (24, 80,7%) apresentou TTR inadequado. O presente estudo permitiu identificar que há um predomínio de pacientes com alta complexidade da farmacoterapia, o que pode indicar necessidades de cuidados adicionais em relação ao tratamento anticoagulante. Para tanto, em casos de pacientes com controle inadequado da anticoagulação oral, recomenda-se que aspectos da complexidade da farmacoterapia sejam incorporados na abordagem educacional.

Diagnosis and treatment of sustained arrhythmias are part of the clinical routine, with one of the most frequent arrhythmias being Atrial Fibrillation (AF). To prevent thromboembolic events in patients with AF, oral anticoagulation is recommended, particularly warfarin. Despite its importance, this medication has a narrow therapeutic range, which means that small changes in treatment generate a risk of thrombotic or hemorrhagic events. Among these changes, adherence to other medications in use, changes in the use of these medications by prescribers and self-medication stand out. There are several interactions between warfarin and other medications for continuous use, with the belief that the complexity of the prescription may interfere with the clinical outcomes of anticoagulant therapy. The objective of the study was to characterize patients followed in an anticoagulation outpatient clinic in relation to the Pharmacotherapy Complexity Index. To identify the complexity of pharmacotherapy, prescriptions for other medications in use, prescribed by primary health care doctors, were considered. The Medication Regimen Complexity Index (MRCI) instrument was used. Complexity, understood as the form of administration, dosage and pharmaceutical form, factors that interfere with adherence to anticoagulant therapy, was subdivided into three complexity levels: low, moderate and high, as indicated in the literature. The complexity analysis was carried out by two researchers independently, considering the criteria as per MRCI guidance. This is a descriptive study carried out in two anticoagulation clinics, located in Minas Gerais. During the research, patients were monitored in two anticoagulation clinics in Brazil, using warfarin, and were invited to participate in a clinical trial between December 2018 and February 2019, and a selection was subsequently made for the present study. A total of 93 patients were included in the study, the average age was 63 years and the majority were female (68.8%). Atrial fibrillation was the most predominant OAC indication (92.5%). The average number of medications used was 7.0. The majority of patients with pharmacotherapy classified as high (38, 6.5%) and medium complexity (24, 80.7%) presented inadequate TTR. The present study identified that there is a predominance of patients with high complexity of pharmacotherapy, which may indicate the need for additional care in relation to anticoagulant treatment. Therefore, in cases of patients with inadequate control of oral anticoagulation, it is recommended that aspects of the complexity of pharmacotherapy be incorporated into the educational approach.

Biogeographic history of a large clade of ectomycorrhizal fungi, the Russulaceae, in the Neotropics and adjacent regions.

The biogeography of neotropical fungi remains poorly understood. Here, we reconstruct the origins and diversification of neotropical lineages in one of the largest clades of ectomycorrhizal fungi in the globally widespread family Russulaceae. We inferred a supertree of 3285 operational taxonomic units, representing worldwide internal transcribed spacer sequences. We reconstructed biogeographic history and diversification and identified lineages in the Neotropics and adjacent Patagonia. The ectomycorrhizal Russulaceae have a tropical African origin. The oldest lineages in tropical South America, most with African sister groups, date to the mid-Eocene, possibly coinciding with a boreotropical migration corridor. There were several transatlantic dispersal events from Africa more recently. Andean and Central American lineages mostly have north-temperate origins and are associated with North Andean uplift and the general north-south biotic interchange across the Panama isthmus, respectively. Patagonian lineages have Australasian affinities. Diversification rates in tropical South America and other tropical areas are lower than in temperate areas. Neotropical Russulaceae have multiple biogeographic origins since the mid-Eocene involving dispersal and co-migration. Discontinuous distributions of host plants may explain low diversification rates of tropical lowland ectomycorrhizal fungi. Deeply diverging neotropical fungal lineages need to be better documented.

Tracking pollutants in a municipal sewage network impairing the operation of a wastewater treatment plant.

This work provides a screening of organic contaminants and characterization of the dissolved organic matter in the sewer network until the municipal wastewater treatment plant (WWTP), identifying the network areas with a higher degree of contamination and their impact on the WWTP performance, particularly in the activated sludge reactor. Three monitoring campaigns were carried out at six selected locations of the sewage system (PVZ-1, PVZ-2, PS-F, PS-VC, CP-VC, and PS-T), influent (WWTPINF) and effluent (WWTPEFF) of the WWTP. Advanced analytical techniques were employed, namely excitation/emission matrix fluorescence-parallel factor analysis (EEM-PARAFAC), size exclusion chromatography with organic carbon detector (SEC-OCD), and liquid chromatography with high-resolution-mass spectrometric detection (LC-HRMS). EEM-PARAFAC showed higher fluorescence intensity for the protein-like component (C2), particularly at CP-VC (near seafood industries) associated with the presence of surfactants (~50 mg/L). SEC-OCD highlighted the WWTP efficiency in removing low molecular weight acids and neutrals. LC-HRMS tentatively identified 108 compounds of emerging concern (CEC) and similar detection patterns were obtained for all wastewater samples, except for PVZ-2 (lower detection), many of which occurred in the effluent. Eight CECs included on relevant Watch-Lists were detected in all WWTPEFF samples. Furthermore, 111 surfactants were detected, the classes more frequently found being alcohol ethoxylates (AEOs), nonylphenol polyethoxylates (NPEOs) and linear alkylbenzene sulphonates (LAS). The continuous presence of LAS and NPEOs allied to surfactants concentrations in the WWTPINF of 15-20 mg/L, with CP-VC location (linked with food industries) as an important contributor, explain the morphological changes in the activated sludge and high LAS content in the dewatered sludge, which may have impacted WWTP performance.

Vaso-occlusive crisis in a sickle cell patient after transfusion-transmitted dengue infection.

CASE REPORT: A 26-year-old woman with sickle cell disease (SCD) on chronic transfusion therapy complained of severe arthralgia, myalgia, abdominal pain, headache, and fever 24 hours after transfusion of a red blood cells (RBCs). Dengue virus (DENV) infection was suspected and the patient was hospitalized for clinical support and RBC transfusion, to lower the hemoglobin S to less than 30%. The patient's clinical condition improved approximately 8 days after the onset of symptoms. RESULTS: DENV type 2 (DENV-2) TaqMan real-time polymerase chain reaction was negative in the patient's pretransfusion sample while the posttransfusion sample was positive (Ct, 27.8), suggesting a high viral load and an acute infection. To investigate DENV transfusion transmission (TT-DENV) the stored donor serum was tested and was also positive (Ct, 25.8). Molecular typing confirmed the presence of DENV-2. The phylogenetic analysis of the DENV-2 strains obtained from both donor and patient samples were classified as the Southeast Asia-American genotype (Genotype III) and demonstrated 100% genomic identity, indicating TT-DENV. CONCLUSION: This is the first description of TT-DENV in a SCD patient. A presumed high viral load in the transfused RBC unit probably determined the early clinical manifestation. In endemic regions dengue fever should be considered as differential diagnosis in SCD patients with fever and acute pain crisis, mainly during DENV outbreaks.

Comparação entre as técnicas de estimulação sensorial em diferentes texturas e banho de contraste na melhora da sensibilidade plantar em indivíduos portadores de diabetes mellitus tipo 2 / Comparison between sensory stimulation techniques at different textures and contrast bath on improving plantar sensitivity in patients with diabetes type 2

Introdução: O Diabetes Mellitus tipo 2 (DM2) é considerado um dos principais problemas da saúde pública. Assim, uma das complicações a longo prazo está relacionada as alterações de sensibilidade principalmente na região podal. Objetivo: Comparar os efeitos entre as técnicas de estimulação sensorial em diferentes texturas e o banho de contraste para melhora da sensibilidade plantar de indivíduos diabéticos tipo 2. Métodos: Trata-se de um ensaio clínico randomizado, no qual os indivíduos foram inclusos por ordem de adesão através de sorteio, sendo 6 participantes do circuito com estações em diferentes texturas (GDT) e 6 participantes do revezamento em banho de contraste (GBC) com idade média de 63 ± 12 e 56 ± 11 anos. A avaliação sensitiva foi realizada em 9 pontos dos pés, antes e após 24 intervenções fisioterapêuticas, sendo aplicadas 5 dias por semana. Resultados: Tanto a técnica GDT quanto a GBC apresentaram melhora significativa, com o valor de p < 0,0001 comparando o antes e depois. A variável entre os grupos obteve o resultado de 0,0258. Conclusão: Foi possível identificar que as duas técnicas promoveram a melhora da sensibilidade plantar de forma significativa, evidenciando que a técnica do banho de contraste mostrou-se mais eficaz comparada a variável do protocolo de diferentes texturas. (AU)

Introduction: Diabetes Mellitus type 2 (DM2) is considered one of the major public health problems. Thus, one of the long-term complications is related to changes in sensitivity, especially in the foot region. Objective: To compare the effects between sensory stimulation techniques in different textures and the contrast bath to improve plantar sensitivity of type 2 diabetic individuals. Methods: This is a randomized clinical trial, in which the individuals were included by order of adherence by lottery, being 6 participants in the circuit with stations in different textures (GDT) and 6 participants in the contrast bath relay (GBC) with mean age of 63 ± 12 and 56 ± 11 years. The sensory evaluation was performed in 9 points of the feet before and after 24 physiotherapeutic interventions, being applied 5 days a week. Results: Both the GDT and GBC techniques showed significant improvement, with the value of p < 0.0001 comparing the before and after. The variable between the groups obtained the result of p < 0.0258. Conclusion: It was possible to identify that both techniques promoted the return of plantar sensitivity significantly, showing that the contrast bath technique was more effective compared to the protocol variable of different textures. (AU)

VRK1 variants in two Portuguese unrelated patients with childhood-onset motor neuron disease.

VRK1 encodes a serine/protein kinase possibly involved in pathways related to amyotrophic lateral sclerosis (ALS) pathogenesis. Pathogenic variants in VRK1 have been related to different phenotypes. We describe the clinical phenotype of two unrelated Portuguese patients with different VRK1 variants. Both patients presented a bilateral distal weakness in lower limbs beginning in childhood slowly progressing to upper limbs, associated with pyramidal signs, without bulbar, respiratory or cognitive involvement, according to probable ALS. Imaging and nerve conduction studies were unremarkable in both patients. Genetic testing in patient 1 identified two VRK1 variants in heterozygosity: c.265C > T, p.(Arg89*) and c.769G > A, p.(Gly257Ser), classified as pathogenic and variant of uncertain significance, respectively. In patient 2, two probably pathogenic variants in VRK1 were identified in heterozygosity: c.710-14T > C in intron 8 and c.721C > T, p.(Arg241Cys) in exon 9. We report two unrelated patients with different variants in VRK1 displaying a similar childhood-onset motor neuron disease/ALS, further expanding the phenotypic spectrum associated to VRK1 variants.

Validación y reproducibilidad de la prueba Glittre de actividades de la vida diaria en personas con enfermedad de Parkinson / Validation and reproducibility of the Glittre activities of daily living test for individuals with Parkinsons disease

Objetivo: Investigar la validez y la reproducibilidad de la prueba Glittre de actividades de la vida diaria (AVD-Glittre) para personas con enfermedad de Parkinson. Sujetos y métodos: Se evaluó a 30 pacientes con enfermedad de Parkinson y 19 sujetos sanos (grupo de control). El grupo con enfermedad de Parkinson fue evaluado con la Unified Parkinson’s Disease Rating Scale (UPDRS) y sometido a la prueba AVD-Glittre, la prueba de marcha de seis minutos (6 MWT) y la prueba de marcha de 10 metros (10mWT). El grupo de control realizó la prueba AVD-Glittre. Para el análisis intraobservador se realizaron dos pruebas AVD-Glittre, y para el análisis interobservador, la prueba se repitió otro día con un segundo examinador. Resultados: La prueba AVD-Glittre se correlacionó significativamente con la sección II, la sección III y la puntuación total de la UPDRS. Se correlacionó inversamente con la 6MWT y positivamente con la 10mWT. El tiempo requerido para realizar la prueba AVD-Glittre fue más corto en la nueva prueba en el análisis intraobservador y en el análisis interobservador. La diferencia de medias entre la primera y la segunda pruebas, el error estándar de medición y el cambio mínimo detectable en minutos fueron 0,40, 0,08 y 0,24, respectivamente, para el análisis intraobservador, y 0,40, 0,22 y 0,62, respectivamente, para el análisis interobservador. Conclusión: La prueba AVD-Glittre es válida y reproducible para evaluar la capacidad funcional en personas con enfermedad de Parkinson

Aim: To investigate the validity and reproducibility of the Glittre Activities of Daily Living (Glittre-ADL) test for individuals with Parkinsons disease. Subjects and methods: Thirty individuals with Parkinson’s disease and 19 healthy individuals (control group) were evaluated. Parkinson’s disease group was evaluated by the Unified Parkinson’s Disease Rating Scale (UPDRS) and underwent the Glittre-ADL test, six-minute walk test (6MWT) and ten-meter walk test (10mWT). Control group performed the Glittre-ADL test. For the intraobserver analysis, two Glittre-ADL tests were performed. For the interobserver analysis, the Glittre-ADL test was repeated on a different day by a second examiner. Results: The Glittre-ADL test was significantly correlated with UPDRS Section II, Section III, and total score. The Glittre-ADL test was inversely correlated with the 6MWT and positively correlated with the 10mWT. The time required to perform the Glittre-ADL test was shorter on the retest in the intraobserver analysis and in the interobserver analysis. The mean difference between the first and second tests, the standard error of measurement and minimum detectable change in minutes were 0.40, 0.08 and 0.24, respectively, for intraobserver, and 0.40, 0.22 and 0.62, for interobserver. Conclusion: The Glittre-ADL test is valid and reproducible to evaluate functional capacity in individuals with Parkinsons disease

Fluxes of CO2, CH4, and N2O in tundra-covered and Nothofagus forest soils in the Argentinian Patagonia.

While most soils in periglacial environments present high fluxes of CO2 (FCO2), CH4 (FCH4), and N2O (FN2O), few of them have a tendency to drain greenhouse gases from the atmosphere. This study aimed to assess greenhouse gas fluxes at different sub-Antarctic sites and time periods (at the beginning of thaw and height of summer). To investigate the time of year effect on greenhouse gas emissions, FCO2, FCH4, and FN2O were measured at two sites tundra-covered (Ti and Th) and Nothofagus forest soil (Nf) on Monte Martial, at the southernmost tip of South America, Tierra del Fuego, Argentina. FCO2 ranged from 96.33 to 225.72 µg CO2 m-2 s-1 across all sites and periods, showing a positive correlation with soil temperature (Ts) (4.1 and 8.2 °C, respectively) (r2 > 0.7; p < 0.05). The highest values of FCO2 were found at Ti and Th (728.2 and 662.64 µg CO2 m-2 s-1, respectively), which were related to higher temperatures (8.2 and 8.6 °C, respectively) when compared to those of Nf. For FCH4, the capture (drain) occurred during both periods at Nf (-26 and -79 µg C-CH4 m-2 h-1) as well as Ti and Th (-21 and 12 µg C-CH4 m-2 h-1, respectively). FN2O also presented low values during both periods and showed a tendency to drain N2O from the atmosphere, especially at Nf (-2 µg N-N2O m-2 h-1). In addition, FN2O was slightly positive for Ti and Th (0.3 and 0.55 µg N-N2O m-2 h-1, respectively). Soil moisture did not show a correlation (p > 0.05) with the measured greenhouse gas fluxes. A scenario of increased temperatures might result in changes in the balance between the emissions and drains of these gases from soils, leading to higher emission values of CH4 and N2O, especially for tundra covered soils (Ti and Th), where the highest average fluxes and thermohydric variations were observed over the year.

Corrente Russa associada ao ultrassom ou a fonoforese reduz o fibro edema gelóide / Russian Current associated with ultrasound or phonophoresis reduces cellulite

Introdução: O fibro edema gelóide (FEG) ocasiona deformações locais no tecido subcutâneo. Correntes excito motoras, como a corrente russa (CR), e métodos que associam efeitos mecânicos e térmicos no tecido, como o ultrassom (US), são usados para tratar a FEG. O US pode ainda ser aplicado com a fonoforese (FN) para aumentar a absorção percutânea de princípios ativos. Objetivo: Verificar o efeito da CR associada ao US ou à FN no tratamento da FEG em glúteos e coxas de mulheres jovens. Métodos: Participaram mulheres com FEG que realizaram 10 sessões de CR com US ou com FN. As voluntárias foram avaliadas antes e após os tratamentos. Resultados: Obteve-se diminuição da espessura das dobras cutâneas, redução do grau de FEG, redução da distorção da imagem corporal e índice de satisfação elevado das voluntárias com os resultados de ambos tratamentos, porém a FN associada à CR apresentou efeito mais evidente. Conclusão: Os tratamentos utilizados fornecem resultados rápidos e satisfatórios na redução do FEG.

Introduction: Geloid fibroedema (GF) or Cellulitis causes local deformations in the subcutaneous tissue. Electric Stimulation Therapy, such as the Russian Current (RC), and methods associating mechanical and thermal effects on tissue, such as Ultrasound (US), are used to treat GF. US can still be applied with Phonophoresis (Ph) to increase percutaneous absorption of active principles. Objective: To verify the effect of RC associated with US or Ph in the treatment of GF in glutes and thighs of young women. Methods: GF women who performed 10 sessions of RC with US or with Ph participated. The volunteers were evaluated before and after the treatments. Results: There was a reduction in the thickness of the skin folds, reduction of the GF degree, reduction of the body image distortion and high index of satisfaction of the volunteers with the results of both treatments, but the Ph associated to the CR showed a more evident effect. Conclusion: The treatments used provide fast and satisfactory results in the reduction of GF.

Análise do desenvolvimento motor e da atenção de crianças submetidas a um programa de intervenção psicomotora / Analysis of motor development and attention of children submitted to a motor intervention program

Introdução: As crianças com atrasos no desenvolvimento motor devem receber ações específicas, visto que os problemas relacionados com o controle do movimento poderão perdurar até a fase adulta. Objetivo: Analisar a influência de uma intervenção psicomotora sobre o desenvolvimento motor e os níveis de atenção em crianças com atrasos motores. Métodos: Foram avaliados 28 escolares de ambos os sexos, de 7 à 10 anos, com atrasos motores. Antes e após a intervenção, as crianças foram submetidas à avaliação motora, dos níveis de atenção, e das dificuldades na escrita. As crianças participaram de 20 sessões de um protocolo incluindo exercícios psicomotores. Para análise dos dados foi utilizado o teste t pareado e correlação de Pearson. Resultados: Houve melhora nas habilidades motoras avaliadas (<0,001), e nos níveis de atenção pós-intervenção (<0,001). Conclusão: O protocolo proposto contribuiu para o desenvolvimento das habilidades motoras e dos níveis de atenção das crianças.

Introduction: Children with motor development delays should be given specific actions, as problems related to movement control may persist into adulthood. Objective: To analyze the influence of a motor intervention on motor development and attention levels in children with motor delas. Methods: 28 Students of both sexes, aged 7 to 10 years, with motor delas were evaluated. Before and after the intervention, the children were submitted to motor evaluation, levels of attention, and difficulties in writing. The children participated in 20 sessions of a protocol including psychomotor exercises. The paired t-test and Pearson's correlation were used for data analysis. Results: There was improvement in motor skills assessed (<0.001), and at post-intervention attention levels (<0.001). Conclusion: The proposed protocol contributed to the development of motor skills and attention levels of children.

Determination of water quality, toxicity and estrogenic activity in a nearshore marine environment in Rio de Janeiro, Southeastern Brazil.

Endocrine disrupting compounds (EDCs) can be found in domestic sewage, wastewater treatment plant effluents, natural water, rivers, lakes and in the marine environment. Jurujuba Sound, located in the state of Rio de Janeiro, Southeastern Brazil, receives untreated sewage into its waters, one the main sources of aquatic contamination in this area. In this context, the aim of the present study was to evaluate the estrogenic potential of water sampled from different depths and from areas with differential contamination levels throughout Jurujuba Sound. Water quality was evaluated and acute toxicity assays using Allviibrio fischeri were conducted, while estrogenic activity of the water samples was determined by a Yeast Estrogen Screening assay (YES). Water quality was mostly within the limits established for marine waters by the Brazilian legislation, with only DOC and ammoniacal nitrogen levels above the maximum permissible limits. No acute toxicity effects were observed in the Allivibrio fisheri assay. The YES assay detected moderate estrogenic activity in bottom water samples from 3 sampling stations, ranging from 0.5 to 3.2ngL-1, as well as in one surface water sample. Estrogenic activity was most frequently observed in samples from the bottom of the water column, indicating adsorption of estrogenic compounds to the sediment.

Sleep and circadian alterations in people at risk for bipolar disorder: A systematic review.

BACKGROUND: Sleep and circadian abnormalities have been mostly demonstrated in bipolar patients. However, it is not clear whether these alterations are present in population at high risk for bipolar disorder (BD), indicating a possible risk factor for this condition. OBJECTIVE: This systematic review aims to define current evidence about sleep and rhythm alterations in people at risk for BD and to evaluate sleep and circadian disorders as risk factor for BD. METHODS: The systematic review included all articles about the topic until February 2016. Two researchers performed an electronic search of PubMed and Cochrane Library. Keywords used were 'sleep' or 'rhythm' or 'circadian' AND 'bipolar disorder' or 'mania' or 'bipolar depression' AND 'high-risk' or 'risk'. RESULTS: Thirty articles were analyzed (7451 participants at risk for BD). Sleep disturbances are frequent in studies using both subjective measures and actigraphy. High-risk individuals reported irregularity of sleep/wake times, poor sleep and circadian rhythm disruption. Poor sleep quality, nighttime awakenings, and inadequate sleep are possible predictive factors for BD. A unique study suggested that irregular rhythms increase risk of conversion. People at risk for BD showed high cortisol levels in different times of day. Studies about anatomopathology, melatonin levels, inflammatory cytokines and oxidative stress were not identified. The most important limitations were differences in sleep and rhythm measures, heterogeneity of study designs, and lack of consistency in the definition of population at risk. CONCLUSION: Sleep and circadian disturbances are common in people at risk for BD. However, the pathophysiology of these alterations and the impact on BD onset are still unclear.

Macrodactyly in tuberous sclerosis complex: Case report and review of the literature.

Macrodactyly in the context of tuberous sclerosis complex (TSC) is a known but rare manifestation. We report the case of a boy diagnosed with TSC at 2 years and 4 months of age, presenting with bilateral macrodactyly of the first three fingers of both hands, with underlying radiographic changes, in whom molecular analysis identified a frameshift mutation on the TSC1 gene (encoding hamartin), leading to a premature stop codon. We reviewed the literature for reported cases of TSC patients with the same manifestation. In four of 14 patients, including ours, macrodactyly caused some type of joint limitation or flexion deformity, thus contradicting the established idea that this is a finding without clinical significance. Our patient is, to our knowledge, the first reported to have clear bilateral involvement. We briefly discuss the underlying mechanism for this phenomenon, which has yet to be fully elucidated, although somatic mosaicism for loss of heterozygosity at TSC loci is a plausible explanation. © 2016 Wiley Periodicals, Inc.

Study of the transformation of two salicylates used in personal care products in chlorinated water.

Disinfection of swimming pool water is essential to inactivate pathogenic microorganisms. However chlorine based disinfectants, the most commonly used, are known to lead to the formation of disinfection by-products (DBPs), some of which have been associated with adverse health effects. Precursors of DBPs include the organic matter present in the water used to fill the swimming pool, human body fluids and personal care products (PCPs) used by swimmers and bathers. The increased use, in the last years, of PCPs lead to an increased concern about the fate of PCPs in swimming pool waters and potential health risks of formed DBPs. In this study, the chemical transformations of two salicylates, benzyl salicylate (BzS) and phenyl salicylate (PS), incorporated in several PCPs, in chlorinated water were investigated. High-performance liquid chromatography (HPLC) with UV-diode-array detection (HPLC-UV-DAD) was used to follow the reaction kinetics and HPLC with mass spectrometry (HPLC-MS) was used to tentatively identify the major transformation by-products. Under the experimental conditions used in this work both salicylates reacted with chlorine following pseudo-first order kinetics: rate constant k = (0.0038 ± 0.0002) min(-1) and half-life t1/2 = (182 ± 10) min for BzS and rate constant k = (0.0088 ± 0.0005) min(-1) and half-life t1/2 = (79 ± 4) min for PS (mean ± standard deviation). The reactions of the two salicylates in chlorinated water led to the formation of DBPs that were tentatively identified as mono- and dichloro- substituted compounds. Most probably they result from an electrophilic substitution of one or two hydrogen atoms in the phenolic ring of both salicylates by one or two chlorine atoms.

Percepção da sobrecarga familiar nos cuidados ao paciente psiquiátrico crônico

Objetivos: avaliar o impacto da sobrecarga familiar nos cuidados ao paciente psiquiátrico crônico. Metodologia: pesquisa bibliográfica por meio de referências publicadas em documentos, livros, revistas, artigos científicos, internet, ou seja, aborda tudo o que foi publicado sobre o tema proposto. Resultados: a convivência com a pessoa acometida por uma doença mental é desgastante para o familiar e, muitas vezes, há dificuldade de compreensão dos sintomas apresentados pelo doente. Conclusão: há a necessidade de desenvolver programas de informação, orientação e apoio aos familiares dos pacientes psiquiátricos...

Aims: to assess the impact of family burden in caring for chronic psychiatric patients. Methodology: literature search by means of references in published papers, books, magazines, papers, and internet, that is, it approaches all publishings on the theme. Results: living with the person affected by mental illness is stressful for the family and sometimes there is difficulty in understanding the symptoms presented by the patient. Conclusion: there is a need to develop information, guidance and support to families of psychiatric patients...

Objectivos: Evaluar el impacto de la carga familiar en el cuidado de pacientes psiquiátricos crónicos. Metodología: la literatura a través de referencias de artículos publicados, libros, revistas, periódicos, internet, o las direcciones de lo que se ha publicado sobre el tema. Resultados: la convivencia con la persona afectada por una enfermedad mental es muy estresante para la familia y con frecuencia hay dificultad en la comprensión de los síntomas que presenta el paciente. Conclusión: Hay una necesidad de desarrollar programas de información, orientación y apoyo a las familias de los pacientes psiquiátricos...