Toxic stress,inflammation and symptomatology of chronic complications in diabetes

Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035.The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009.The effects of toxic stress,the culmination of biological and environmental interactions,on the development of diabetes complications is gaining attention.Stress impacts the hypothalamus-pituitaryadrenal axis and contributes to inflammation,a keybiological contributor to the pathogenesis of diabetes and its associated complications.This review provides an overview of common diabetic complications such as neuropathy,cognitive decline,depression,nephropathy and cardiovascular disease.The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes,associated symptomatology and importance of early identification of symptoms of depression,fatigue,exercise intolerance and pain.

Language, executive functioning and symptomatology—Is fluency a transversal tool in schizophrenia?

Despite a large number of studies on fluency disorders in schizophrenia, it is still not clear whether executive functioning and fluency tasks are empirically linked and how symptomatology could specifically get involved on these influences. We carried out analyses of performances in several verbal fluency tasks, a non-verbal fluency task and an executive test (FAB) in 25 schizophrenics and 25 healthy subjects matched in terms demographic data. Patients also completed the Positive and Negative Symptoms Scale in order to control for their clinical profile. Our results suggest that schizophrenic patients show both category and letter fluency deficits with a greater impairment for letter fluency. They also display poorer performances for the non-verbal fluency task. In patients, all the verbal and non-verbal fluencies are significantly correlated with the FAB total score. By contrast, in controls, only letter fluency correlates with the FAB total score, which is congruent with previous literature on the healthy mechanisms of verbal fluency. Besides, factorial analyses show that symptomatology is specifically related to particular indexes of fluency tasks. Taken together, these data lead to support the hypothesis of retrieval rather than semantic difficulties and alargest involvement of executive functioning in schizophrenics during tasks that require a certain degree of efficiency, with performance being influenced by the clinical profile. Yet, the relation between fluency scores and executive functioning has to be more intensively explored and further studies should include semantic memory measures that fit with pathology’s constraints and characteristics.

Symptomatology of irritable bowel syndrome and inflammatory bowel disease during the menstrual cycle

Gender-related physiological variations in gastrointestinal(GI)symptomatology have been observed in women of reproductive age.Many women experience cyclical changes in GI symptomatology during their menstrual cycle,particularly alteration in their bowel habits.Physiological studies of healthy women during the menstrual cycle showed a prolonged GI transit time during the luteal phase,either in the oro-cecumroute or in the colon.Worsened GI symptoms,such as abdominal pain,bloating or diarrhea are observed in patients with irritable bowel syndrome(IBS)during menses.This may be due to elevated prostaglandin levels during menses,with an enhanced perception of viscera-somatic stimuli resulting in nausea,abdominal distension and pain.Also patients with IBS or IBD demonstrate a cyclical pattern more closely related to their bowel habits than healthy controls.Women with inflammatory bowel disease(IBD)also have exacerbated symptoms during menses;however,it is unclear whether this relates to physiological variation or disease exacerbation in IBS or IBD.Studies examining the association of the menstrual cycle and GI symptomatology in patients with IBS or IBD,have not yet clarified the underlying mechanisms.Moreover medications—such as non-steroidal anti-inflammatory drugs and oral contraceptive pills used for dysmenorrhea and menstrual migraine in those patients have not well been controlled for in the previous studies,which can contribute to further bias.Understanding changes in GI symptomatology during the menstrual cycle may help to determine the true extent of disease exacerbation and proper management strategy.

Factors affecting meibomian gland area loss in symptomatic adults

AIM:To characterize the distribution of meibomian gland(MG)area loss(MGL)and its relationship with demographic characteristics,mites,and symptoms.METHODS:This retrospective observational study included patients who visited the Dry Eye Clinic of Shenzhen Eye Hospital between June 2020 and August 2021.General patient characteristics,ocular symptoms,Demodex test results of the eyelid edges,and the results of a comprehensive ocular surface analysis were collected.MGL was analyzed using Image J software.RESULTS:This study enrolled 1204 outpatients aged 20-80(40.70±13.44)y,including 357 males(29.65%)and 847 females(70.35%).The patients were classified into mild(n=155;12.87%),moderate(n=795;66.03%),severe(n=206;17.11%),and extremely severe(n=48;3.99%)MGL groups.MGL was significantly larger in female than in male(P=0.006).The degree of MGL also significantly differed in age(P<0.001)and the more numbers of mites with severity(P<0.001).Multivariate disordered multinomial logistic regression analysis identified that female sex,older age,secretory symptoms,and a large number of mites were risk factors for MGL(P<0.05).CONCLUSION:Patients with MGL are more likely to be older,female,more numbers of mites,and increased secretion.

Study of negatives symptoms in first episode schizophrenia

Background: Prevalence of negative symptoms in the early phase of schizophrenia remains uncertain. Negative symptoms are the primary cause of long term disability and poor functional outcome. The purpose of this study is to examine the presence of negative symptoms in patients with fist episode psychosis in schizophrenia who were hospitalized. Methods: Negative symptoms were measured in 72 patients presenting with FEP using the scale for assessment of negative symptoms (SANS) and ascertained diagnosis using DSM-IV. Prevalence of SANS items and subscales were examined for both schizophrenia and bipolar disorder. Results: This study shows that a significant number of patients with first episode schizophrenia had negative symptoms 66 (87.5%). All five subtypes of negative symptoms were present in 47% of patients suggesting primary negative symptoms, and about 40% have secondary negative symptoms. Independently, each subtype of negative symptoms was seen in 48% - 76% of patients. The most prevalent negative symptom in first-episode schizophrenia was found to be blunting (72%). 46% of patients had significant level of depression, overall psychopathology was severe and level of functioning was poor. We found that 45.8% patients were prescribed anticholinergic medications which indicated that at least 45% subjects had extra-pyramidal symptoms (EPS). Conclusion: Primary negative symptoms are prevalent in about half of First episode Psychosis (FEP) schizophrenia patients. These findings have implications for identification, early treatment, and reduced treatment resistance for negative symptoms in order to increase social and clinical outcome of schizophrenia. Further research is required in this area.

Mental health and polygamy: The Syrian case

AIM: To examine the psychological, self-esteem(SE), family function, marital satisfaction, life satisfaction and degree of agreement with the practice of polygamy among polygamous women with a control group from monogamous women in Syria. METHODS: Convenience sample of 136 women, 64 of whom were wives in polygamous marriages and 72 were wives in monogamous marriages participated in this study. A snowball method of sampling was used, conducted by undergraduate local female students trained to collect data according to culturally competent methods. The following research instruments were deployed: the symptoms checklist-90, the Rosenberg SE, the Life Satisfaction, family function and marital satisfaction. RESULTS: Findings revealed that women in polygamous marriages experienced lower SE, less life satisfaction, less marital satisfaction and more mental health symptomatology than women in monogamous marriages. Many of the mental health symptoms were different; noteworthy were elevated somatization, depression, hostility and psychoticism and their general severity index was higher. Furthermore, "first wife syndrome" was examined in polygamous families, comparing first with second and third wives in polygamous marriages. Findings indicated that first wives reported on more family problems, less SE, more anxiety, moreparanoid ideation, and more psychoticism than second and third wives. CONCLUSION: These results are best understood through consideration of the socio-cultural and economic realities facing these women. Implications for mental health practice, policy and further research are discussed.

Pseudotumoral Chronic Subdural Hematomas on Two Cases

Introduction: Calcified forms with pseudo-tumor symptomatology of chronic subdural hematomas are rare. They are the result of slow bleeding over several years. The main etiology is related to the complications of the ventriculo-peritoneal shunt (VP). The purpose of this study was to recall the peculiarities and physiopathology of its pseudotumoral hematomas through 2 observations. Observation: Case 1: 8-year-old patient with a history of ventriculoperitoneal shunt at 3 months of age for congenital hydrocephalus, was admitted for functional impotence of the left-side of the body of insidious onset spreading over 9 months in a chronic headache, blurred vision and generalized seizure. CT scan showed a heterogeneous subdural hematoma of the right frontoparietal with calcifications. The patient underwent an excision by morcellation of a yellowish, friable partly calcific mass. The postoperative history was marked by a total recovery of the neurological deficit. There was no recurrence at 6 months postoperatively. Case 2: 11-year-old adolescent, treated with VP shunt at 6 months of age for post-meningitic hydrocephalus, was admitted for helmet headache, dizziness, lightheadedness and apathy progressing for 3 years. CT scan showed hypodensity of right peri-hemisphere with calcified linings, exerting a mass effect on the medial structures. The patient was given a block excision of a calcific mass with blood content. The evolution was marked by the complete resolution of seizures and hemiparesis. There was no recurrence at 6 months postoperatively. Conclusion: Calcified subdural hematomas are rare and consecutive to the complications of VPS. The clinical signs are those of a benign brain tumor. Treatment is dominated by the difficulties of cerebral reexpression.

Current concepts in sport concussion management:A multifaceted approach

Sport-related concussion is a common neurological injury that occurs in all levels of athletic participation.Concussions may actually go undiagnosed,as they do not always display outward signs and athletes may fail to report symptoms of concussion,either because they do not know the symptoms,or for fear of removal from play.Inappropriate management of concussion can lead to increased risk of subsequent injury.This article outlines various aspects of sport-related concussion management,including preparation/planning,education,evaluation,management,return to play decisions,and long term effects of concussion.Preparation and education are the first steps that must be taken to minimize the potentially negative consequences of concussion.If a concussion is suspected,it must be stressed that the evaluation should include a multifaceted approach,with a physical examination and assessment of signs and symptoms,neurocognition and balance.The management of concussion should include both physical and cognitive rest and factors such as transportation,sleep,work,and academics should be taken into consideration.Return to play following concussion should follow a graduated return to play protocol,with careful monitoring of symptoms.Sports medicine clinicians should stay up to date with information regarding concussion management and take a conservative approach,because there are recent reports of various cumulative effects of multiple concussions.

Origins and Mechanisms in the Development of Major Mental Disorders: A Clinical Approach

This paper considers the following collective significance of the shared, clinical characteristics of the major mental disorders (MMDs), their co-morbidities, overlaps and pharmacological responses with the following conclusions: 1) These disorders have a common, initial, neurodevelopmental origin. 2) They can occur probabilistically on susceptible individuals, on account of pre-existing, extreme, temperamental variances-signifying underlying structural variance. 3) Each of these syndromes can be considered the expression of disturbances in the overall, common, operating mode of brain function which normally ensures the synchrony, coordination, elegance and subtlety in the expression of all the brain’s higher faculties. 4) Lastly, this function is a complex, emergent phenomenon based on the individual’s temperamental/structural underlying makeup, switching intermittently from a normal phase to a pathologically, ordered one-the latter phase expressing itself with symptoms made up of expressing either/or, antithetical substitutes for each of the MMDs-similar to the fluctuations found in patient’s with Parkinson’s disease.

Management of Secondary Leyll Syndrome Due to Anti-Covid Vaccine in a Case, at the Renaissance University Teaching Hospital, Ndjamena (CHAD)

Introduction: Lyell’s syndrome (SL), called Toxic Epidermal Necrolysis is one of the most serious forms of medication accidents. It is an acute, rare pathology, its incidence is estimated at 1 to 2 cases out of one million inhabitants per year and its evolution can be fatal. Materials and Methods: We report the observation of a 60-year-old patient, with no significant pathological history, admitted to our intensive care unit at the Renaissance University Teaching Hospital in N’Djamena for the treatment of Toxic Epidermal Necrolysis. In whom the onset of symptoms dates back to few hours after vaccination against COVID-19 with Ag Johnson and Johnson. Results: An ophthalmology opinion was requested and the patient was put on Fucithalmic. In our case, in addition to the advanced age of the patient (60 years old), her SCORTEN was ≥5. Conclusion: The late management as well as the absence of a specific department for severe burns, which condition the presence of a technical plate was fatal to her despite multidisciplinary care: Resuscitators, Traumato-Orthopedist and ophthalmologist.

Limbic Encephalitis and Autoimmune Encephalitides: Pathophysiology, Classification, Clinical Presentation, and Treatment

Limbic encephalitis represents a cluster of autoimmune disorders, with inflammation in the medial temporal lobe characterised by the subacute onset of neuropsychiatric symptoms such as anxiety, affective symptoms, psychosis, short-term memory impairment, as well as faciobrachial and grand mal seizures. The limbic system is a complex anatomical structure which this paper seeks to explain in terms of its anatomy and physiology, before exploring what happens when it is impaired as is the case of autoimmune and limbic encephalitis. We will discuss the pathophysiology, clinical symptomatology and diagnosis of autoimmune encephalitis, a cluster of symptoms which can be easily overlooked or misdiagnosed within psychiatric settings. Characteristic indicators of autoimmune encephalitis include neurologic symptoms such as facial twitching, seizures, confusion, and cognitive decline;however, our experience realises that autoimmune encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology rather than these neurological symptoms. Furthermore, immunological and laboratory testing take a long time to diagnose the condition. Importantly, few psychiatrists consider the autoimmune nature of the neuropsychiatric presentation. It is hence vital to consider autoimmune encephalitis in all patients with atypical presentations.

Evaluation of the toxic effect of insecticide chlorantraniliprole on the silkworm Bombyx mori(Lepidoptera:Bombycidae)

The silkworm Bombyx mori feeds exclusively on mulberry leaves and is highly sensitive to pesticides in general. Although mulberry plantations are free of agrochemicals, pesticide drift can occur. Chlorantraniliprole, a novel insecticide of the anthranilic diamides class, has been used to control pests in field crops. In this study, we investigated the biological effects of different concentrations of chlorantraniliprole on B. mori silkworm commercial Brazilian hybrids. To evaluate the toxicity of chlorantraniliprole, bioassays were carried out and data on the lethal concentrations, symptomatology, morphology and variables of silk production were collected. Results indicated that B. mori is extremely sensitive to chlorantraniliprole, even in low concentrations. The highest silkworm mortality rates were observed in the two highest chlorantraniliprole concentrations, 0.2 and 0.1 ppm. Although lower chlorantraniliprole concentrations did not cause death of all the silkworm larvae, various symptoms of toxicity were observed: feeding cessation, regurgitation, late development and incomplete ecdysis. Such symptoms reflect the morphological changes we observed in the midgut epithelium, which affected nutrient uptake and metabolism, and even the production of cocoons. Exposed larvae also produced?thin-shelled cocoons, which constitutes a serious economic problem because this type of cocoon is not useful for the silk industry. The results provided herein confirm the toxicity of chlorantraniliprole in silkworm larvae. Therefore, we strongly suggest that, competent authorities of the National Health Surveillance Agency, in pesticide management should take measures to reduce or eliminate the use of chlorantraniliprole in areas nearest to silkworm cultivation.

Myocarditis–A silent killer in athletes:Comparative analysis on the evidence before and after COVID-19 pandemic

Myocarditis is a rare cardiomyocyte inflammatory process,typically caused by viruses,with potentially devastating cardiac sequalae in both competitive athletes and in the general population.Investigation into myocarditis prevalence in the Coronavirus disease 2019(COVID-19)era suggests that infection with Severe acute respiratory syndrome coronavirus(SARS-CoV-2)is an independent risk factor for myocarditis,which is confirmed mainly through cardiovascular magnetic resonance imaging.Recent studies indicated that athletes have a decreased risk of myocarditis after recent COVID-19 infection compared to the general population.However,given the unique nature of competitive athletics with their frequent participation in high-intensity exercise,athletes possess distinct factors of susceptibility for the development of myocarditis and its subsequent severe cardiac complications(e.g.,sudden cardiac death,fulminant heart failure,etc.).Under this context,this review focuses on comparing myocarditis in athletes versus non-athletes,owing special attention to the distinct clinical presentations and outcomes of myocarditis caused by different viral pathogens such as cytomegalovirus,Epstein-Barr virus,human herpesvirus-6,human immunodeficiency virus,and Parvovirus B19,both before and after the COVID-19 pandemic,as compared with SARS-CoV-2.By illustrating distinct clinical presentations and outcomes of myocarditis in athletes versus non-athletes,we also highlight the critical importance of early detection,vigilant monitoring,and effective management of viral and non-viral myocarditis in athletes and the necessity for further optimization of the return-to-play guidelines for athletes in the COVID-19 era,in order to minimize the risks for the rare but devastating cardiac fatality.

Association between gastro-intestinal symptoms and menstruation in patients with ileal pouches

Background and aims:Gastro-intestinal(GI)symptoms are often experienced by healthy women during menstruation.An increased frequency of GI symptoms during menses has also been reported in women with irritable bowel syndrome or inflammatory bowel disease(IBD);however,IBD patients with restorative proctocolectomy and ileal pouch-anal anastomoses(IPAA)have not been studied.We aimed to examine the association between GI symptoms before and during menses in patients with IPAA,and to assess factors for exacerbation of GI symptoms in those patients.Methods:Adult women recorded in the Pouchitis Registry were invited to participate in a mailed survey.Participants reported on GI symptoms 1–5 days prior to-(pre-menses)and during the days of their menses in recent months.Demographic and clinical variables were obtained through the survey and chart review.Results:One hundred and twenty-eight(21.3%)out of 600 women with IPAA responded to the survey questionnaire.Fortythree(33.5%)were excluded for reasons including post-menopausal(n=25),hysterectomy(n=14)and use of contraceptives(n=4).Abdominal pain(P=0.001),diarrhea(P=0.021),and urgency(P=0.031)were more commonly reported during menses than pre-menses by the participants.Only a history of painful menses was significantly associated with increased GI symptoms during menses for patients with ileal pouch(odds ratio=5.67;95%confidence interval:1.41–22.88;P=0.015).Conclusion:GI symptoms such as abdominal pain,diarrhea,and urgency are commonly associated with menses in patients with ileo-anal pouch.Painful menses may be associated with worsening of GI symptoms.