Problematic patient narratives emerging in the process of treatment have been identified as important factors in the maintenance of psychopathology, and their change is associated with desired ...treatment outcomes. This increased focus in psychotherapy research has triggered the investigation of innovative moments (IMs) as novelties in patient narratives in therapy. This exploratory study aims to investigate the development of IMs throughout treatment in bulimia nervosa (BN) in a sample of good and poor outcome cases, and examine their longitudinal associations with binge and purge frequency change. IMs were coded in sixty sessions across five good outcome and five poor outcome cases in different stages of treatment. Generalized estimating equation analyses indicated that IMs evolved significantly over time, with different trajectories between good and poor outcome groups. High-level IMs showed higher proportion in the good outcome group at the end of treatment indicating that the ability to elaborate on how and why change might occur (as measured by high-level IMs) plays a role in the process of change in BN. Additionally, both low- and high-level IMs predicted symptom decrease in the following session. The study provides a preliminary understanding of important patient narrative processes in psychotherapy for BN and their association with treatment change.
Introduction/objectives
Infections are a major cause of morbidity and death in systemic lupus erythematosus (SLE). Perfecting the understanding of contributors to infection burden in SLE is pivotal ...to improve management and outcomes. This study aims to identify clinical predictors of infection in SLE.
Method
We conducted a prospective cohort study at a referral SLE clinic. Infections were identified at each visit and categorized as (a) any type, (b) serious, (c) non-serious, and (d) bacterial. Survival analysis followed by multivariate Cox regression with an estimation of hazard ratios (HR) with 95% confidence intervals (95%CI) was performed.
Results
We included 259 patients during a mean follow-up of 23.3 ± 5.7 months. The incidence rate of infection of any type was 59.3 cases per 100 patient-years. Multivariate Cox models showed that (a) prednisolone ≥ 7.5 mg/day (HR = 1.95, 95%CI 1.26–3.03) and female gender (HR = 2.08, 95%CI 1.12–3.86) were associated with higher risk of infection of any type; (b) prednisolone ≥ 10 mg/day was associated with higher (HR = 4.32, 95%CI 1.39–13.40), and antimalarials with lower risk (HR = 0.18, 95%CI 0.06–0.51) of serious infection; (c) female gender (HR = 1.92, 95%CI 1.04–3.57) and prednisolone ≥ 7.5 mg/day (HR = 1.89, 95%CI 1.21–2.96) were associated with higher risk of non-serious infection; (d) antimalarials were associated with lower (HR = 0.49, 95%CI 0.26–0.93) and female gender (HR = 5.12; 95%CI 1.62–16.18) with higher risk of bacterial infection.
Conclusions
The risk of infection was higher in females in this young, well-controlled, low-comorbidity SLE cohort. Antimalarials were associated with lower and prednisolone ≥ 7.5 mg with higher risk of infection.
Key Points
• Lupus patients treated with prednisolone
≥
7.5 mg/day were 89% more likely to present infections
.
• Lupus patients receiving prednisolone
≥
10 mg/day were four times more likely to present serious infections
.
• Lupus patients receiving antimalarials were 82% less likely to present serious infections
.
Cerebrovascular reactivity (CVR) reflects the capacity of blood vessels to adjust their caliber in order to maintain a steady supply of brain perfusion, and it may provide a sensitive disease ...biomarker. Measurement of the blood oxygen level dependent (BOLD) response to a hypercapnia-inducing breath-hold (BH) task has been frequently used to map CVR noninvasively using functional magnetic resonance imaging (fMRI). However, the best modeling approach for the accurate quantification of CVR maps remains an open issue. Here, we compare and optimize Fourier models of the BOLD response to a BH task with a preparatory inspiration, and assess the test–retest reproducibility of the associated CVR measurements, in a group of 10 healthy volunteers studied over two fMRI sessions. Linear combinations of sine–cosine pairs at the BH task frequency and its successive harmonics were added sequentially in a nested models approach, and were compared in terms of the adjusted coefficient of determination and corresponding variance explained (VE) of the BOLD signal, as well as the number of voxels exhibiting significant BOLD responses, the estimated CVR values, and their test–retest reproducibility. The brain average VE increased significantly with the Fourier model order, up to the 3rd order. However, the number of responsive voxels increased significantly only up to the 2nd order, and started to decrease from the 3rd order onwards. Moreover, no significant relative underestimation of CVR values was observed beyond the 2nd order. Hence, the 2nd order model was concluded to be the optimal choice for the studied paradigm. This model also yielded the best test–retest reproducibility results, with intra-subject coefficients of variation of 12 and 16% and an intra-class correlation coefficient of 0.74. In conclusion, our results indicate that a Fourier series set consisting of a sine–cosine pair at the BH task frequency and its two harmonics is a suitable model for BOLD-fMRI CVR measurements based on a BH task with preparatory inspiration, yielding robust estimates of this important physiological parameter.
•BOLD-fMRI of breath-hold tasks is used to study cerebrovascular reactivity (CVR).•Fourier models were compared for the BOLD response to breath-hold with inspiration.•The 2nd order model predicted the BOLD response better than lower-order models.•The 2nd order model yielded the best test–retest reproducibility results for CVR.
Tiroide Lingual: Apresentação de Caso Clínico Lopes, Patrícia; Bacelar, Cristina; Sousa, Inês ...
Gazeta médica (Carnaxide. Em linha),
06/2024, Letnik:
1, Številka:
1
Journal Article
Recenzirano
Odprti dostop
A patologia tiroideia, designadamente o hipotiroidismo, é uma situação comum e habitualmente gerida em cuidados de saúde primários. No seu estudo inicial é importante considerar a hipótese de tiroide ...lingual, ainda que se trate de anomalia rara.Utente do sexo feminino, 48 anos de idade, transferida recentemente de outra unidade de saúde, apresenta-se na sua primeira consulta programada. Refere que no início da sua adolescência, após realização de ecografia à tiroide, terá sido informada de que “nasceu sem tiroide” (sic), pelo que se encontra medicada com levotiroxina 0,175 mg uma vez por dia. Como antecedentes familiares de relevo menciona que a mãe e a sobrinha apresentam patologia tiroideia. Ao exame objetivo não se verificaram outras alterações para além de, à palpação cervical, não apresentar tecido tiroideu na sua normal localização pré-traqueal.A ecografia da tiroide realizada revelou ausência de tiroide na sua topografia habitual. O estudo analítico da função tiroideia não revelou alterações. Foi então solicitada cintigrafia da tiroide que demonstrou um foco de captação do radiofármaco na topografia do pavimento da boca sobre a linha média, compatível com tecido tiroideu funcionante em localização ectópica. A utente foi referenciada a consulta de cirurgia geral e proposta para cirurgia de ressecção da tiroide ectópica, a qual decorreu sem intercorrências.O médico de família tem uma posição privilegiada no estudo e orientação dos seus utentes, tendo sido, neste caso, fulcral a investigação desencadeada pela suspeição de uma entidade rara, mesmo anos após o diagnóstico inicial de hipotiroidismo.
In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a ...problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression.
When dealing with several years of daily data, such as the number of daily admissions to a hospital’s emergency department (ED), how complex does it get to forecast into the future? With that in ...mind, this study has two main goals: to explore the differences between several methodologies, considering both single and multiple-seasonal patterns; and to select the most suitable model for the administration of a Portuguese hospital to use while managing their ED. To that end, we first considered the data as a time series with a single weekly seasonal pattern. We then modelled the data using time series regression, linear regression with autoregressive integrated moving average (ARIMA) errors, seasonal ARIMA and exponential smoothing techniques. Second, the data was set to be a time series with weekly and annual seasonal patterns. Then, using Fourier terms, we applied time series regression, linear regression with ARIMA errors and trigonometric exponential smoothing state space models with Box–Cox transformation, ARMA errors, Trend and Seasonal components (TBATS) for the analysis. After selecting the best-fitting models using the Akaike Information Criteria (AIC) values, we forecasted into the future and compared the results using both training and test datasets’ root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) values. The time series regression model based on seasonal variables and a weekly seasonal pattern gives the best results. However, we decided to use linear regression with ARIMA errors, seasonal variables, and both weekly and annual seasonal patterns. This produces similar results but allows for the annual seasonality to be considered, which is useful when more data is added.
•Daily emergency department admissions data is challenging to forecast due to the presence of complex seasonal patterns.•We compare several forecasting methods and select the most suitable one for a Portuguese hospital.•We consider two scenarios: the time series with a weekly seasonal pattern and with both weekly and annual seasonal patterns.•The non-regression-based techniques reveal the worst performances.•Time series regression with seasonal covariates and a weekly seasonal pattern produces the most accurate forecasts.
Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution ...to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments.
We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance.
The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups.
Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice.
ClinicalTrials.gov (identifier: NCT04587895).
Obesity entails metabolic alterations across multiple organs, highlighting the role of inter-organ communication in its pathogenesis. Extracellular vesicles (EVs) are communication agents in ...physiological and pathological conditions, and although they have been associated with obesity comorbidities, their protein cargo in this context remains largely unknown. To decipher the messages encapsulated in EVs, we isolated plasma-derived EVs from a diet-induced obese murine model. Obese plasma EVs exhibited a decline in protein diversity while control EVs revealed significant enrichment in protein-folding functions, highlighting the importance of proper folding in maintaining metabolic homeostasis. Previously, we revealed that gut-derived EVs' proteome holds particular significance in obesity. Here, we compared plasma and gut EVs and identified four proteins exclusively present in the control state of both EVs, revealing the potential for a non-invasive assessment of gut health by analyzing blood-derived EVs. Given the relevance of post-translational modifications (PTMs), we observed a shift in chromatin-related proteins from glycation to acetylation in obese gut EVs, suggesting a regulatory mechanism targeting DNA transcription during obesity. This study provides valuable insights into novel roles of EVs and protein PTMs in the intricate mechanisms underlying obesity, shedding light on potential biomarkers and pathways for future research.
(1) Background: Patients with systemic lupus erythematous (SLE) experience profound effects on health-related quality of life (HRQoL) that cannot be explained by objective indicators of mortality and ...morbidity. This study aimed to adapt the SLE Quality of Life (SLEQoL) questionnaire to the European Portuguese population and to assess its reliability and validity for patients with SLE. (2) Methods: Two independent translators translated the original version of the SLEQoL questionnaire into Portuguese. A back-translated version was produced. The Portuguese version of the questionnaire was reviewed and tested for validity and reliability. Cronbach's alpha and the internal validity index were calculated to verify the internal reliability and validity of the content. Rheumatologists filled out the SLE Disease Activity Score (SLE-DAS) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index SLICC/ACR-DI questionnaires. (3) Results: This study involved 180 patients, of which 93.8% were females. The results indicated very high internal consistency reliability (α = 0.949), low correlations between the SLEQoL and the SLE-DAS, a correlation between all SLEQoL dimensions and all SF-36 dimensions (except for "response to treatment" and "self-image"), and good correlation scores with both the EQ-5D-5L index and VAS. (4) Conclusion: The Portuguese version of the SLEQoL questionnaire is valid and reliable for the measurement of HRQoL in SLE patients.
Transfer RNAs (tRNAs) are widely known for their roles in the decoding of the linear mRNA information into amino acid sequences of proteins. They are also multifunctional platforms in the translation ...process and have other roles beyond translation, including sensing amino acid abundance, interacting with the general stress response machinery, and modulating cellular adaptation, survival, and death. In this mini-review, we focus on the emerging role of tRNA genes in the organization and modification of the genomic architecture of yeast and the role of tRNA misexpression and decoding infidelity in genome stability, evolution, and adaption. We discuss published work showing how quickly tRNA genes can mutate to meet novel translational demands, how tRNAs speed up genome evolution, and how tRNA genes can be sites of genomic instability. We highlight recent works showing that loss of tRNA decoding fidelity and small alterations in tRNA expression have unexpected and profound impacts on genome stability. By dissecting these recent evidence, we hope to lay the groundwork that prompts future investigations on the mechanistic interplay between tRNAs and genome modification that likely triggers genome evolution.
PDF