Delusional parasitosis or Ekbom's syndrome

INTRODUCTION: Ekbom's syndrome or delusional parasitosis is a disorder in which the patient believes that he/she is infected by a parasite. Epidemiologic, nosologic, psychopathologic and therapeutic data can barely be interpreted, as delusional parasitosis has mostly been described in either isolated cases or small cohorts. An extensive literature review is recommended to better understand common features associated with this syndrome. EXEGESIS: Ekbom's syndrome is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy, and cooperation between dermatologists and psychiatrists. CONCLUSION: Pimozide is currently the most effective treatment. It requires careful monitoring, as it has several adverse effects. For patients with concomitant depressive symptoms, the use of antidepressants is recommended.     

Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients

Elderly people with mental health problems receive much worse outpatient care than younger people. Although the health-promoting factors are known, there are hardly any studies on effective biopsychosocial care models. A 1-year longitudinal study examined the effectiveness of the GHT presented below. For this purpose, 12 depressive and delusional patients discharged from inpatient gerontopsychiatric care received mental and social treatment and care at home for 1 year. Functionality was surveyed by means of the Global Assessment of Functioning Scale (GAF) and psychiatric symptoms by means of the Brief Psychiatric Rating Scale (BPRS). Subjective quality of life (QoL) was surveyed by means of the WHOQOL-BREF self-report questionnaire. The main findings were as follows: (1) no patient had to receive inpatient psychiatric care or be admitted to a nursing home during the study period; (2) mental QoL had improved significantly after 1 year; (3) functionality remained stable; (4) the BPRS scores did not deteriorate. We see this as confirmation that GHT is an effective instrument for extramural care of elderly people with psychiatric disorders. The limitations of the pilot study necessitate further studies to back up the findings.     

When a sperm meets an egg: block to polyspermy

Embryonic development is initiated after the fertilizing spermatozoon enters the egg and triggers a series of events known as egg activation. Activation results in an increase in intracellular calcium concentration, cortical granule exocytosis (CGE), cell cycle resumption and recruitment of maternal mRNA. CGE is an evolutionary developed mechanism that causes modification of the zona pellucida to prevent penetration of additional spermatozoa, ensuring successful egg activation and embryo development. The egg CGE is a unique and convenient mammalian model for studying the different proteins participating at the membrane fusion cascade, which, unlike other secretory cells, occurs only once in the egg's lifespan. This article highlights a number of proteins, ascribed to participate in CGE and thus the block to polyspermy. CGE can be triggered either by a calcium dependent pathway, or via protein kinase C (PKC) activation that requires a very low calcium concentration. In a recent study, we suggested that the filamentous actin (F-actin) at the egg's cortex is a dynamic network. It can be maneuvered towards allowing CGE by activated actin associated proteins and/or by activated PKC and its down stream proteins, such as myristoylated alanine-rich C kinase substrate (MARCKS). MARCKS, a protein known to cross-link F-actin in other cell types, was found to be expressed and colocalized with actin in non-activated MII eggs. We further demonstrated MARCKS dissociation from actin after activation by ionomycin, a process that can lead to the breakdown of the actin network, thus allowing CGE. The more we know of the intricate process of CGE and of the proteins participating in it, the more the assisted reproductive procedures might benefit from that knowledge.     

When saliva meets acid: chemical warfare at the oesophagogastric junction

In the Western world at least, most upper gastrointestinal cancers now arise from the mucosa near to the oesophagogastric junction. Research into the mechanism of the development of adenocarcinoma at the oesophagogastric junction has mainly focused on the noxious effects of acid and bile. There is however an alternative concept for explaining the location of adenocarcinomas: the cancers are occurring at the anatomical site where saliva encounters acidic gastric juice and their interaction generates reactive nitrogen species which are potentially mutagenic and carcinogenic. At present, it is unclear whether the active nitrite chemistry is exerting detrimental effects on the surrounding tissue but it is important to investigate this possibility as it could reveal new ways of preventing and treating the high prevalence of disease occurring at this anatomical site.     

When APS (Hughes syndrome) met the autoimmune/inflammatory syndrome induced by adjuvants (ASIA)

Vaccination of healthy individuals is the most effective approach to protect the public from infections and prevent the spread of many infectious diseases all over the globe. Licensed vaccines are mostly safe, but in rare cases they may be associated with humoral response to self-antigens due to molecular mimicry, epitope spread, bystander activation or polyclonal triggering. Moreover, the clinical picture of autoimmune conditions following post-vaccination is rarer. Nevertheless, anecdotal case reports on the flare of autoimmune response with clinical manifestations were reported. Herein, we discuss this topic in relation to post-vaccination-induced antiphospholipid antibodies following tetanus toxoid vaccine, HBV and influenza associated in rare cases with antiphospholipid syndrome clinical manifestations. We will discuss the possible mechanisms which pertain to ASIA (Shoenfeld syndrome).     

When pancreas solid mass meets liver cystic lesion: A case report

Pancreatic neuroendocrine tumors are in low incidence compared with other pancreatic tumors, and they present as various pathological forms, including solid, cy...     

When planning meets reality: COVID-19 interpandemic survey of Michigan Nursing Homes

BackgroundNursing home (NH) populations have borne the brunt of morbidity and mortality of COVID-19. We surveyed Michigan NHs to evaluate preparedness, staffing, testing, and adaptations to these challenges.MethodsInterpandemic survey responses were collected May 1-12, 2020. We used Pearson's Chi-squared test, Fisher's exact test, and logistic regression to evaluate relationships.ResultsOf 452 Michigan NHs contacted via e-mail, 145 (32.1%) opened the survey and of these, 143 (98.6%) responded. Sixty-eight percent of respondents indicated their response plan addressed most issues. NHs reported receiving rapidly changing guidance from many sources. Two-thirds reported shortages of personal protective equipment and other supplies. Half (50%) lacked sufficient testing resources with only 36% able to test residents and staff with suspected COVID-19. A majority (55%) experienced staffing shortages. Sixty-three percent experienced resignations, with front-line clinical staff more likely to resign, particularly in facilities caring for COVID-19 patients (P < .001). Facilities adapted quickly, creating COVID-19 units (78%) to care for patients on site. To reduce isolation, NHs facilitated communication via phone calls (98%), videoconferencing (96%), and window visits (81%). A majority continued to provide requisite therapies (90%).ConclusionsNHs experienced shortages of resources, testing supplies, and staffing challenges. COVID-19 in the facility was a key predictor of staff resignations. Facilities relied on rapidly changing, often conflicting advice from multiple sources, suggesting high-yield areas of improvement.     

Broken-heart syndrome (Takotsubo syndrome)

We report on the rare case of partial anomalous return of four pulmonary veins in the right atrium and superior vena cava with intact interatrial septum in a five-year-old child. There were few symptoms in contrast with the left ventricular output dependent on the flow of the left upper lobe vein and from the lingula. Reduced compliance to the left led to a severe picture of pulmonary venocapillary hypertension in the immediate postoperative period, mitigated by an 8-mm interatrial septal defect. The patient progressed well after the intervention.