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Acanthamoeba spp. are widely distributed in the environment and cause serious infections in humans. Treatment of Acanthamoeba infections is very challenging and not always effective which requires the development of more efficient drugs against Acanthamoeba spp. The purpose of the present study was to test medicinal plants that may be useful in the treatment of Acanthamoeba spp. Here we evaluated the trophozoital and cysticidal activity of 13 flavonoid glycosides isolated from Delphinium gracile, D. staphisagria, Consolida oliveriana and from Aconitum napellus subsp. Lusitanicum against the amoeba Acanthamoeba castellanii. AlamarBlue Assay Reagent® was used to determine the activity against trophozoites of A. castellanii, and cytotoxic using Vero cells. Cysticidal activity was assessed on treated cysts by light microscopy using a Neubauer chamber to quantify cysts and trophozoites. Flavonoids 1, 2, 3 and 4 showed higher trophozoital activity and selectivity indexes than the reference drug chlorhexidine digluconate. In addition, flavonoid 2 showed 100% cysticidal activity at a concentration of 50 μm, lower than those of the reference drug and flavonoid 3 (100 μm). These results suggest that flavonoids 2 and 3 might be used for the development of novel therapeutic approaches against Acanthamoeba infections after satisfactory in vivo evaluations.
The novel coronavirus, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is the causative agent of the 2020 worldwide coronavirus pandemic. Antibody testing is useful for diagnosing historic infections of a disease in a population. These tests are also a helpful epidemiological tool for predicting how the virus spreads in a community, relating antibody levels to immunity and for assessing herd immunity. In the present study, SARS-CoV-2 viral proteins were recombinantly produced and used to analyse serum from individuals previously exposed, or not, to SARS-CoV-2. The nucleocapsid (Npro) and spike subunit 2 (S2Frag) proteins were identified as highly immunogenic, although responses to the former were generally greater. These two proteins were used to develop two quantitative enzyme-linked immunosorbent assays (ELISAs) that when used in combination resulted in a highly reliable diagnostic test. Npro and S2Frag-ELISAs could detect at least 10% more true positive coronavirus disease-2019 (COVID-19) cases than the commercially available ARCHITECT test (Abbott). Moreover, our quantitative ELISAs also show that specific antibodies to SARS-CoV-2 proteins tend to wane rapidly even in patients who had developed severe disease. As antibody tests complement COVID-19 diagnosis and determine population-level surveillance during this pandemic, the alternative diagnostic we present in this study could play a role in controlling the spread of the virus.
Assistive strategies for occupational back-support exoskeletons have focused, mostly, on lifting tasks. However, in occupational scenarios, it is important to account not only for lifting but also for other activities. This can be done exploiting human activity recognition algorithms that can identify which task the user is performing and trigger the appropriate assistive strategy. We refer to this ability as exoskeleton versatility. To evaluate versatility, we propose to focus both on the ability of the device to reduce muscle activation (efficacy) and on its interaction with the user (dynamic fit). To this end, we performed an experimental study involving $ 10 $ healthy subjects replicating the working activities of a manufacturing plant. To compare versatile and non-versatile exoskeletons, our device, XoTrunk, was controlled with two different strategies. Correspondingly, we collected muscle activity, kinematic variables and users’ subjective feedbacks. Also, we evaluated the task recognition performance of the device. The results show that XoTrunk is capable of reducing muscle activation by up to $ 40\% $ in lifting and $ 30\% $ in carrying. However, the non-versatile control strategy hindered the users’ natural gait (e.g., $ -24\% $ reduction of hip flexion), which could potentially lower the exoskeleton acceptance. Detecting carrying activities and adapting the control strategy, resulted in a more natural gait (e.g., $ +9\% $ increase of hip flexion). The classifier analyzed in this work, showed promising performance (online accuracy > 91%). Finally, we conducted 9 hours of field testing, involving four users. Initial subjective feedbacks on the exoskeleton versatility, are presented at the end of this work.
Mucositis is an inflammation of the gastrointestinal mucosa resulting from high doses of radio/chemotherapy treatment and may lead to interruption of antineoplasic therapy. Soluble fibres, like pectin, increase SCFA production, which play a role in gut homoeostasis and inflammation suppression. Due to the properties of pectin, the aim of the present study was to evaluate the effect of a high-fibre (HF) diet on chemotherapy-induced mucositis in a murine model. C57/BL6 mice received control (AIN93M), HF, low/zero fibre (LF) diets for 10 d prior to mucositis challenging with irinotecan (75 mg/kg), or they were treated with acetate added to drinking water 5 d prior to and during the mucositis induction. Mice that received the HF diet showed decreased immune cells influx and improved histopathological parameters in the intestine, compared with mice that received the normal diet. Furthermore, the HF diet decreased intestinal permeability induced in the mucositis model when compared with the control group. This effect was not observed for acetate alone, which did not improve gut permeability. For instance, mice that received the LF diet had worsened gut permeability, compared with mice that received the normal diet and mucositis. The effects of the HF and LF diets were shown to modulate the intestinal microbiota, in which the LF diet increased the levels of Enterobacteriaceae, a group associated with gut inflammation, whereas the HF diet decreased this group and increased Lactobacillus and Bifidobacterium (SCFA producers) levels. In conclusion, the results demonstrated the importance of dietary fibre intake in the modulation of gut microbiota composition and homoeostasis maintenance during mucositis in this model.
We study the stability of the differential process of Rochberg and Weiss associated with an analytic family of Banach spaces obtained using the complex interpolation method for families. In the context of Köthe function spaces, we complete earlier results of Kalton (who showed that there is global bounded stability for pairs of Köthe spaces) by showing that there is global (bounded) stability for families of up to three Köthe spaces distributed in arcs on the unit circle while there is no (bounded) stability for families of four or more Köthe spaces. In the context of arbitrary pairs of Banach spaces, we present some local stability results and some global isometric stability results.
We evaluated the effects of fermentation time and acid casein content on the microbial rennet obtained by solid-state fermentation using wheat bran as the carbon source. The experiments used two fermentation times (72 and 96 h), while acid casein content was 1.5, 2.0, 2.5, and 3.0 g. Rennet strength from eight enzymatic extracts was measured using pasteurized whole milk. Rennet strength of samples from 72 h of fermentation showed an increase when acid casein content increased. The rennet strength increased at 96 h of fermentation with increasing amount of casein (up to 2.5 g), and then decreased with the largest addition (3.0 g) of casein. Coagulation time for the sample with highest rennet strength was 420 s.
Mexico has been one of the most affected countries in the world by the COVID-19 pandemic. The true impact of the pandemic has probably been underestimated, and President López Obrador, as well as the Ministry of Health, has struggled to lead the country since the beginning. While cases and deaths continue to rise, stronger leadership and unity are needed to limit the impact of COVID-19 on the health of millions of Mexicans.
S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.
Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).
At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.
At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.
FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.
The authors intend to analyse through a historical and philosophical perspective, the relationship between nihilistic delusions content and ideas expressed in remarkable literary works addressing the Nihilism theme.
Report of two clinical cases of patients with nihilistic delusions. Review of relevant literature collected from PubMed and other medical internet databases under key-words “nihilistic delusions”, “nihilism”, “Cotard syndrome” and “psychotic depression”. Review of relevant historical and philosophical literature.
First descriptions of nihilistic delusions were made by Jules Cotard, who described a syndrome with his name in middle nineteenth century. First references to the Nihilistic philosophy are contemporary to that, initially by Jacobi and later on by other philosophers, including Nietzsche, who was its main propeller. Some literature propose that Nietzsche suffered from migraine and mental illness, namely bipolar disorder.
Cotard's Syndrome refers to the delusional belief held by patients that they are dead, do not exist, are putrefying or have lost their blood or internal organs. Nihilistic philosophy posed great influence to world's thinking of XIX and XX centuries. Analysis of Nihilistic philosophy works show ideas that resemble the ones reported by patients with nihilistic delusions.
Cardinal ideas expressed by Nietzsche in some of his works, relating to the nihilistic thematic, may have been influenced by an altered mental state, with manifestations compatible with Cotard syndrome which can be associated with bipolar disorder, migraine or organic cerebral pathologies.
The authors intend to characterize the population of foreign patients admitted to Department L of Centro Hospitalar Psiquiátrico de Lisboa, Portuguese biggest Psychiatric hospital, and compare it with published data on the subject.
The authors identified all foreigner patients hospitalized in the Inpatient Clinic from 01/01/2010 to 30/06/2011. Clinical information was obtained from the case notes and statistically treated. Relevant literature collected from PubMed was reviewed.
A great heterogeneity of nationalities was found including 21 countries, the majority of which are a part of CPLP (Community of Portuguese Language Countries). Nearly all of the patients (91%) were in Portugal as immigrants, most being single and unemployed. Housing conditions are unstable. Psychiatric diagnoses show that schizophrenia is the pathology with more expression (27%), followed by major depression (16%) and bipolar disorder (15%). A significant number of patients have disorders due to psychoactive substance use (19%). After discharged from the hospital 77% where referred to outpatient services, but only half of those are still being followed-up.
Social and familial stability is an important factor influencing mental health. Most patients covered by this study experience familiar, professional and housing instability, making them a risk group. Schizophrenia and affective disorders are the most prevalent pathologies, which agrees with the prevailing idea that social distress is a risk factor to them.
Further studies should be held in order to characterise foreigner populations admitted to psychiatric clinics so that better therapeutic and follow-up measures can be carried out.
N-acetylcystein (NAC), a precursor to the amino acid cysteine, has been emerging as an interesting add-on treatment in several psychiatric conditions and especially in Obsessive Compulsive Disorder (OCD). These results may be linked to its metabolic profile: antioxidant properties through glutathione production; anti-inflammatory properties; and modulation of the glutamatergic and dopaminergic systems of neurotransmission.
Review the potential therapeutic effects of NAC in psychiatry, with main focus on syndromes of the obsessive-impulsive spectrum with report of a clinical case.
Case report of a patient with OCD and Hoarding disorder, with complete clinical remission after treatment with NAC; bibliographic search using PubMed/MedLine database with the following keywords: n-acetylcysteine; OCD; hoarding.
We report and discuss the case of a 44-year-old man with a diagnosis of Obsessive Compulsive Disorder with orderliness and contamination themes, coupled with Hoarding disorder. The patient experienced gradual though slight improvement with Paroxetine (60 mg/day) to which was subsequently added Risperidone (2 mg/day) with further slight improvement. In combination with the previously given pharmacological agents, NAC (1800 mg/day) was introduced with subsequent complete remission of all symptoms.
Studies suggest that NAC may be useful in the treatment of several psychiatric conditions. Our case report suggests direct relation between treatment with NAC and remission of obsessive and hoarding symptoms. Although encouraging, additional controlled research will be required to ascertain NAC clinical usefulness.
Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic.
Aim This study aims at analyzing psychopathology sex differences in asthmatics.
The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered.
The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex.
The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.
The Olfactory Reference Syndrome (ORS) is a clinical condition in which patients are convinced that they exude an unpleasant odor that is noticed by others. It was described for the first time in 1891, but became relevant in the nosology with Phillips in 1971. Since then discussion remains about diagnostic framework of this clinical entity.
About a clinical case series, the authors intend to review clinical features, nosological framework and response to treatment of the ORS.
Review of literature collected from online medical databases. Report of a case series of five patients with ORS.
The literature on the ORS consists mainly of case reports, and there are few controlled studies and systematic reviews. It was found that in most cases the complaints relate to a typical body odor, more often fecal, genital or halitosis. These beliefs range from overvalued ideas to delusions with strong conviction and they are usually accompanied by ideas of self-reference. Patients do not always smell the odor that they believe to emanate. The disturbance has high social, family and work impact. The response to treatment is variable and it was observed at different rates when antipsychotics, antidepressants and psychotherapy are used.
Although it was proposed for integration in DSM-5 as an independent entity, the ORS was not so defined, remaining as a disorder whose characteristics overlap other diagnoses, including delusional disorder, in which is usually included, but also disorders from the obsessive-compulsive spectrum and social anxiety, given the variability of morbid consciousness. We also discuss the possible relationship of the ORS with symptoms of olfactory expression in other psychiatric disorders. The ORS deserves the attention of psychiatrists since it brings great suffering for the patient, as well as high demand for non-psychiatric care and the consequent delay in diagnosis and treatment.
First psychotic break represents a challenging differential diagnosis for psychiatrists as the clinical outcome depends on an aetiology-directed approach. There is growing focus on detection of treatable causes of psychosis because treatment can alter the natural history of disease. Anti-NMDA-receptor encephalitis is a recently described treatable neuropsychiatric disease presenting with psychiatric symptoms.
Review of epidemiology, clinical presentation, diagnostic tests and differential diagnosis, treatment and prognosis of anti-NMDAr encephalitis.
Case report of a patient diagnosed with anti-NMDAr encephalitis. Review of relevant literature collected from medical internet databases.
Male 15 year-old patient with a previous episode of involuntary movements of the limbs and loss of conscience, presented with distonic contact, behaviour disturbances, sexual stereotypies, agitation and disturbed speech, that evolved with generalized tonic-clonic seizures, global aphasia and sinking of consciousness. A diagnose of anti-NMDAr encephalitis was made and partial recovery was obtained after treatment.
Anti-NMDAr encephalitis is an auto-immune process against synaptic receptors, paraneoplasic or not, detectable by anti-body mesurement in CSF. Most patients develop a multistage illness initially presenting with psychiatric manifestations, progressing to seizures, language disintegration and catatonic states associated with abnormal movements. As patients are frequently treated with antipsychotics, motor abnormalities and catatonia are often interpreted as extrapyramidal effects or neuroleptic malignant syndrome, confounding the diagnosis.
Early recognition and treatment of anti-NMDAr encephalitis improve the outcome. Psychiatrists working in emergency departments and first psychotic break units should be aware of this severe disorder in order to start adequate treatment and prevent negative outcomes
About half of the patientsundergoing surgery is chronically medicated and a significant percentage of them is treated with psychotropicdrugs. Therefore, it is importantto focus on psychiatricmedication during the perioperative period in order to decrease the risk ofintra- and postoperative complications.
Objectives and Aims
This review aims to develop updated guidelines on perioperative managementof psychotropic drugs in patientsundergoing elective surgery.
Review of literature collected from online medical databases under the issue.
The literature collected revealed mostlynon-systematic reviews, uncontrolledtrials and case reports. Considering factors related to duration/extent of surgical intervention, physical status of the patient receiving the intervention, type of anesthesia/drug interaction and routeof administration of medicines, the authors issuerecommendations on the management ofthe following drugclasses: mood stabilizers; antidepressants;antipsychotics; drugs used in the treatment of anxietydisorders; psychostimulant drugsand drugs used inthe treatment of opioid dependence.
Knowledge of about the management of psychotropic drugs around the surgery is ofgreat importance for psychiatrists working in liaison services as well as forall medical doctors leading with surgical patients, namely surgeons and anesthetists. Following the recommendations yielded by thisreview will allow professionals to take preventive actions andthus decreasing risks regarding psychiatric patientsundergoing surgery.
N-acetylcystein (NAC) is a precursor to the amino acid cysteine, which participates in antioxidant mechanisms through glutathione production and plays a role as a modulator of the glutamatergic system of neurotransmission. Thus, NAC may exert therapeutic effect in psychiatric disorders.
Review the potential therapeutic effects of NAC in psychiatry, with main focus on syndromes of the obsessiveimpulsive spectrum, namely skin-picking disorder (SPD), with report of a case series.
Review of literature collected under key-words “n-acetylcysteine; psychiatric”, “skin-picking disorder”. Report of a series of three cases of patients with SPD treated with NAC.
The three patients were being treated for different multi-impulse control disorders, all of them suffering from SPD. In combination with previously given pharmacological agents, they were administered NAC in dosages from 1200 to 1800 mg/day. All patients had great improvement of skin picking behaviours resistant to other treatments. It was also observed that worsening of symptoms occurred after stopping the NAC and restarting the drug led to new remission of symptoms.
Studies suggest that modulation of glutamatergic neurotransmission may decrease compulsive behaviors such as skin-picking, by influencing the reward reinforcement pathway. NAC may be used to achieve this modulation. The fact that in the case series stopping/re-starting the NAC corresponded respectively to worsening/improvement of symptoms, suggests direct relation between treatment with NAC and remission of SPD.
SPD is a prevalent and insufficiently studied condition and randomized controlled studies are needed to ascertain the potential benefits of NAC for patients with the disorder.
Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported.
We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described.
Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication.
Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective.
Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses.
Psychiatric comorbidities are well described in literature. about 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.
The authors intend to review clinical features, epidemiology and management of bipolar disorder in elderly patients, and discuss the possibility of a sub-classification as late-onset bipolar disorder, concerning a clinical case.
Relevant literature was collected from PubMed database under keywords “bipolar disorder”, “late-onset”; “old age” and “age of onset”; the authors reviewed selected articles, publishing dates ranging from 1994 to 2011. Report of a clinical case of a 72 y.o. female patient without previous psychiatric history, admitted for the first time on psychiatric wards, for affective symptoms.
The clinical presentation initially led to the diagnosis of psychotic depression. After treated with antidepressant and atypical antipsychotic, the patient developed mania symptoms and is currently on mood stabilizer.
Although peak incidence of bipolar disorder is around 30 y.o., several studies have suggested a second peak of elderly-presenting cases. Data shows that the later have a greater proportion of medical comorbidities, especially neurological, and of cases with no familial history, which may suggest that these patients belong to a different aetiological sub-group.
Patients with bipolar disorder with onset at older age differ clinically from younger patients, probably due to different aetiological factors. When an elderly patient without previous history of psychiatric disease is admitted for first episode, late-onset bipolar disorder diagnosis must be considered, concerning therapeutic and prognostic implications.