Neuroleptic-induced Parkinsonism in Patient with Obsessive Compulsive Disorder: A Case Report

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by either obsessions (recurrent unwanted thoughts, images or impulses) or compulsions (repetitive behaviors often performed to relieve anxiety or distress). In some cases, it is considered antipsychotic enhancement. However, in high doses, it can exacerbate OCD symptoms and cause extrapyramidal effects such as neuroleptic-induced Parkinsonism.

Here, the authors present a clinic case of a single male patient with 50 years old, in which with the age of 42, started with a obsessive-compulsive framework about the developed task at the work place (production of fabric) followed by several verifications of the assembled pieces, which interfered with his work performance. This patient was admitted to the psychiatric hospital due to the deterioration of the symptoms with obsessive ideas of HIV contamination resulting in rigid cleaning rituals. He was medicated with several OCD medications including Clozapine 50 mg.

In the following years and complaining of insomnia, the clozapine dose was increased by the patient reaching the dose of 200 mg. In 2016 he started secondary Parkinsonism framework to antipsychotics, characterized by akinesia, facial hypomimia, stiff, coarse tremor and stooped posture. Therapeutic setting was made with a reduction of clozapine at doses of 50 mg occurring fading of extrapyramidal symptoms and decrease the symptoms of OCD.

The authors intend with this presented case to highlight the importance of surveillance of patients receiving antipsychotics for OCD to avoid worsening of symptoms and the development of extrapyramidal effects, which deeply contribute to the decrease of quality life of these patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ect Combined with Clomipramine and rTMS in an OCD Patient with Secondary Severe Depression

Introduction

Obsessive-compulsive disorder (OCD) has high rates of comorbidity with mood disorders, mainly major depressive disorder (MDD). Symptoms of depression are usually secondary to severe and disabling OCD. Electroconvulsive therapy (ECT) has been an effective and well tolerated therapeutic alternative in the management of refractory MDD. Other neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have well known efficacy in MDD and also have shown positive results, in clinical trials, treating other psychiatric disorders such as OCD.

Objectives/aims

To determine the efficacy of combining rTMS, ECT and clomipramine in the treatment of severe OCD with comorbid severe MDD.

Methods

The authors report a case of a 54-year-old male patient diagnosed with severe OCD for 23 years. He has been submitted to several drug treatments and intensive cognitive-behavioural therapy (CBT) always with poor response. The patient was admitted in the beginning of 2016 in our inpatient unit. Besides continuing drug treatment (clomipramine IV) and CBT, he was submitted to 12 ECT sessions during one month (3 sessions per week) and to daily sessions of rTMS during the following month.

Outcome measures were obtained using Y-BOCS for OCD and HAM-D for depression.

Results

Our patient responded to ECT with mood improvement after session 4 to full euthymic state at the final session. He also responded well to rTMS with Y-BOCS score reduction.

Conclusion

Combined ECT and rTMS treatment with clomipramine IV and CBT was effective in our patient with a severe form of both disorders (OCD and MDD).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

S, Daly F, Nasri R, Ben Lakhal S, Paramba F, Purayil N, Naushad V, Mohammad O, Negi V, Chandra P, Kleinsasser A, Witrz MR, Buchner-Doeven JF, Tuip-de Boer AM, Goslings JC, Juffermans NP, Van Hezel M, Straat M, Boing A, Van Bruggen R, Juffermans N, Markopoulou D, Venetsanou K, Kaldis V, Koutete D, Chroni D, Alamanos I, Koch L, Jancik J, Rhodes H, Walter E, Maekawa K, Hayakawa M, Kushimoto S, Shiraishi A, Kato H, Sasaki J, Ogura H, Matauoka T, Uejima T, Morimura N, Ishikura H, Hagiwara A, Takeda M, Tarabrin O, Shcherbakow S, Gavrychenko D, Mazurenko G, Ivanova V, Chystikov O, Plourde C, Lessard J, Chauny J, Daoust R, Shcherbakow S, Tarabrin O, Gavrychenko D, Mazurenko G, Chystikov O, Vakalos A, Avramidis V, Kropman L, In het Panhuis L, Konings J, Huskens D, Schurgers E, Roest M, De Laat B, Lance M, Durila M, Lukas P, Astraverkhava M, Jonas J, Budnik I, Shenkman B, Hayami H, Koide Y, Goto T, Iqbal R, Alhamdi Y, Venugopal N, Abrams S, Downey C, Toh CH, Welters ID, Bombay VB, Chauny JM, Daoust RD, Lessard JL, Marquis MM, Paquet JP, Siemens K, Sangaran D, Hunt BJ, Durward A, Nyman A, Murdoch IA, Tibby SM, Ampatzidou F, Moisidou D, Dalampini E, Nastou M, Vasilarou E, Kalaizi V, Chatzikostenoglou H, Drossos G, Spadaro S, Fogagnolo A, Fiore T, Schiavi A, Fontana V, Taccone F, Volta C, Chochliourou E, Volakli E, Violaki A, Samkinidou E, Evlavis G, Panagiotidou V, Sdougka M, Mothukuri R, Battle C, Guy K, Mills G, Evans P, Wijesuriya J, Keogh S, Docherty A, O’Donnell R, Brunskill S, Trivella M, Doree C, Holst L, Parker M, Gregersen M, Almeida J, Walsh T, Stanworth S, Moravcova S, Mansell J, Rogers A, Smith RA, Hamilton-Davies C, Omar A, Allam M, Bilala O, Kindawi A, Ewila H, Ampatzidou F, Moisidou D, Nastou M, Dalampini E, Malamas A, Vasilarou E, Drossos G, Ferreira G, Caldas J, Fukushima J, Osawa EA, Arita E, Camara L, Zeferino S, Jardim J, Gaioto F, Dallan L, Jatene FB, Kalil Filho R, Galas F, Hajjar LA, Mitaka C, Ohnuma T, Murayama T, Kunimoto F, Nagashima M, Takei T, Tomita M, Omar A, Mahmoud K, Hanoura S, Sudarsanan S, Sivadasan P, Othamn H, Shouman Y, Singh R, Al Khulaifi A, Mandel I, Mikheev S, Suhodolo I, Kiselev V, Svirko Y, Podoksenov Y, Jenkins SA, Griffin R, Tovar Doncel MS, Lima A, Aldecoa C, Ince C, Taha A, Shafie A, Mostafa M, Syed N, Hon H, Righetti F, Colombaroli E, Castellano G, Righetti F, Colombaroli E, Hravnak M, Chen LC, Dubrawski AD, Clermont GC, Pinsky MR, Gonzalez S, Macias D, Acosta J, Jimenez P, Loza A, Lesmes A, Lucena F, Leon C, Tovar Doncel MS, Ince C, Aldecoa C, Lima A, Bastide M, Richecoeur J, Frenoy E, Lemaire C, Sauneuf B, Tamion F, Nseir S, Du Cheyron D, Dupont H, Maizel J, Shaban M, Kolko R, Salahuddin N, Sharshir M, AbuRageila M, AlHussain A, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, Slama M, Wagner J, Körner A, Kubik M, Kluge S, Reuter D, Saugel B, Colombaroli E, Righetti F, Castellano G, Tran T, De Bels D, Cudia A, Strachinaru M, Ghottignies P, Devriendt J, Pierrakos C, Martínez González Ó, Blancas R, Luján J, Ballesteros D, Martínez Díaz C, Núñez A, Martín Parra C, López Matamala B, Alonso Fernández M, Chana M, Huber W, Eckmann M, Elkmann F, Gruber A, Klein I, Schmid RM, Lahmer T, Moller PW, Sondergaard S, Jakob SM, Takala J, Berger D, Bastoni D, Aya H, Toscani L, Pigozzi L, Rhodes A, Cecconi M, Ostrowska C, Aya H, Abbas A, Mellinghoff J, Ryan C, Dawson D, Rhodes A, Cecconi M, Cronhjort M, Wall O, Nyberg E, Zeng R, Svensen C, Mårtensson J, Joelsson-Alm E, Aguilar Arzapalo M, Barradas L, Lopez V, Cetina M, Parenti N, Palazzi C, Amidei LA, Borrelli FB, Campanale SC, Tagliazucchi FT, Sedoni GS, Lucchesi DL, Carella EC, Luciani AL, Mackovic M, Maric N, Bakula M, Aya H, Rhodes A, Grounds RM, Fletcher N, Cecconi M, Avard B, Zhang P, Mezidi M, Charbit J, Ould-Chikh M, Deras P, Maury C, Martinez O, Capdevila X, Hou P, Linde-Zwirble WZ, Douglas ID, Shapiro NS, Ben Souissi A, Mezghani I, Ben Aicha Y, Kamoun S, Laribi B, Jeribi B, Riahi A, Mebazaa MS, Pereira C, Marinho R, Antunes R, Marinho A, Crivits M, Raes M, Decruyenaere J, Hoste E, Bagin V, Rudnov V, Savitsky A, Astafyeva M, Korobko I, Vein V, Kampmeier T, Arnemann P, Hessler M, Wald A, Bockbreder K, Morelli A, Van Aken H, Rehberg S, Ertmer C, Arnemann P, Hessler M, Kampmeier T, Rehberg S, Van Aken H, Ince C, Ertmer C, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Psirides A, Young P, Reddy S, Bailey M, Beasley R, Bellomo R, Mackle D, Young P, Venkatesh H, Ramachandran S, Basu A, Nair H, Egan S, Bates J, Oliveira S, Rangel Neto NR, Reis FQ, Lee CP, Lin XL, Choong C, Eu KM, Sim WY, Tee KS, Pau J, Abisheganaden J, Maas K, De Geus H, Lafuente E, Marinho R, Moura J, Antunes R, Marinho A, Doris TE, Monkhouse D, Shipley T, Kardasz S, Gonzalez I, Stads S, Groeneveld AJ, Elsayed I, Ward N, Tridente A, Raithatha A, Steuber A, Pelletier C, Schroeder S, Michael E, Slowinski T, Kindgen-Milles D, Ghabina S, Turani F, Belli A, Busatti S, Barettin G, Candidi F, Gargano F, Barchetta R, Falco M, Demirkiran O, Kosuk M, Bozbay S, Weber V, Hartmann J, Harm S, Linsberger I, Eichhorn T, Valicek G, Miestinger G, Hoermann C, Faenza S, Ricci D, Mancini E, Gemelli C, Cuoghi A, Magnani S, Atti M, Laddomada T, Doronzio A, Balicco B, Gruda MC, O’Sullivan P, Dan VP, Guliashvili T, Scheirer A, Golobish TD, Capponi VJ, Chan PP, Kogelmann K, Drüner M, Jarczak D, Turani F, Belli AB, Martni SM, Cotticelli VC, Mounajergi F, Barchetta R, Morimoto S, Ishikura H, Hussain I, Salahuddin N, Nadeem A, Ghorab K, Maghrabi K, Kloesel SK, Goldfuss C, Stieglitz A, Stieglitz AS, Krstevska L, Albuszies G, Aguilar Arzapalo M, Barradas L, Lopez V, Escalante A, Jimmy G, Cetina M, Izawa J, Iwami T, Uchino S, Takinami M, Kitamura T, Kawamura T, Powell-Tuck JG, Crichton S, Raimundo M, Camporota L, Wyncoll D, Ostermann M, Hana A, De Geus HR, De Geus HR, Hana A, Aydogdu M, Boyaci N, Yuksel S, Gursel G, Cayci Sivri AB, Meza-Márquez J, Nava-López J, Carrillo-Esper R, Dardashti A, Grubb A, Maizel J, Wetzstein M, Titeca D, Kontar L, Brazier F, De Cagny B, Riviere A, Soupison T, Joris M, Slama M, Peters E, Njimi H, Pickkers P, Vincent JL, Waraich M, Doyle J, Samuels T, Forni L, Desai N, Baumber R, Gunning P, Sell A, Lin S, Torrence H, O’Dwyer M, Kirwan C, Prowle J, Kim T, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Hanoura S, Omar A, Othamn H, Sudarsanan S, Allam M, Maksoud M, Singh R, Al Khulaifi A, O’Connor ME, Hewson RW, Kirwan CJ, Pearse RM, Prowle J, Uzundere O, Memis D, Ýnal M, Gultekin A, Turan N, Aydin MA, Basar H, Sencan I, Kapuagasi A, Ozturk M, Uzundurukan Z, Gokmen D, Ozcan A, Kaymak C, Artemenko VA, Budnyuk A, Pugh R, Bhandari S, Mauri T, Turrini C, Langer T, Taccone P, Volta CA, Marenghi C, Gattinoni L, Pesenti A, Sweeney L, O’Sullivan A, Kelly P, Mukeria E, MacLoughlin R, Pfeffer M, Thomas JT, Bregman GB, Karp GK, Kishinevsky EK, Stavi DS, Adi NA, Poropat T, Knafelj R, Llopart E, Batlle M, De Haro C, Mesquida J, Artigas A, Pavlovic D, Lewerentz L, Spassov A, Schneider R, De Smet S, De Raedt S, Derom E, Depuydt P, Oeyen S, Benoit D, Decruyenaere J, Gobatto A, Besen B, Tierno P, Melro L, Mendes P, Cadamuro F, Park M, Malbouisson LM, Civantos BC, Lopez JL, Robles A, Figueira J, Yus S, Garcia A, Oglinda A, Ciobanu G, Oglinda C, Schirca L, Sertinean T, Lupu V, Kelly P, O’Sullivan A, Sweeney L, MacLoughlin R, O’Sullivan A, Kelly P, Sweeney L, Mukeria E, Wolny M, MacLoughlin R, Pagano A, Numis F, Visone G, Saldamarco L, Russo T, Porta G, Paladino F, Bell C, Liu J, Debacker J, Lee C, Tamberg E, Campbell V, Mehta S, Silva-Pinto A, Sarmento A, Santos L, Kara Ý, Yýldýrým F, Zerman A, Güllü Z, Boyacý N, Basarýk Aydogan B, Gaygýsýz Ü, Gönderen K, Arýk G, Turkoglu M, Aydogdu M, Aygencel G, Ülger Z, Gursel G, Boyacý N, Isýkdogan Z, Özdedeoglu Ö, Güllü Z, Badoglu M, Gaygýsýz U, Aydogdu M, Gursel G, Kongpolprom N, Sittipunt C, Eden A, Kokhanovsky Y, Bursztein – De Myttenaere S, Pizov R, Neilans L, MacIntyre N, Radosevich M, Wanta B, Weber V, Meyer T, Smischney N, Brown D, Diedrich D, Fuller A, McLindon P, Sim K, Shoaeir M, Noeam K, Mahrous A, Matsa R, Ali A, Dridi C, Koubaji S, Kamoun S, Haddad F, Ben Souissi A, Laribi B, Riahi A, Mebazaa MS, Pérez-Calatayud A, Carrillo-Esper R, Zepeda-Mendoza A, Diaz-Carrillo M, Arch-Tirado E, Carbognin S, Pelacani L, Zannoni F, Agnoli A, Gagliardi G, Cho R, Adams A, Lunos S, Ambur S, Shapiro R, Prekker M, Thijssen M, Janssen L, Foudraine N, Voscopoulos CJ, Freeman J, Voscopoulos CJ, Freeman J, George E, Voscopoulos CJ, Eversole D, Freeman J, George E, Muttini S, Bigi R, Villani G, Patroniti N, Williams G, Voscopoulos CJ, Freeman J, George E, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Waldmann A, Böhm S, Windisch W, Strassmann S, Karagiannidis C, Karagiannidis CK, Waldmann AW, Böhm SB, Strassmann S, Windisch WW, Persson P, Lundin S, Stenqvist O, Porta G, Numis F, Serra CS, Pagano AP, Masarone MM, Rinaldi LR, Amelia AA, Fascione MF, Adinolfi LA, Ruggiero ER, Asota F, O’Rourke K, Ranjan S, Morgan P, DeBacker JW, Tamberg E, O’Neill L, Munshi L, Burry L, Fan E, Mehta S, Poo S, Mahendran K, Fowles J, Gerrard C, Vuylsteke A, Loveridge R, Chaddock C, Patel S, Kakar V, Willars C, Hurst T, Park C, Best T, Vercueil A, Auzinger G, Borgman A, Proudfoot AG, Grins E, Emiley KE, Schuitema J, Fitch SJ, Marco G, Sturgill J, Dickinson MG, Strueber M, Khaghani A, Wilton P, Jovinge SM, Sampson C, Harris-Fox S, Cove ME, Vu LH, Sen A, Federspiel WJ, Kellum JA, Mazo Torre C, Riera J, Ramirez S, Borgatta B, Lagunes L, Rello J, Kuzovlev AK, Moroz V, Goloubev A, Polovnikov S, Nenchuk S, Karavana V, Glynos C, Asimakos A, Pappas K, Vrettou C, Magkou M, Ischaki E, Stathopoulos G, Zakynthinos S, Spadaro S, Kozhevnikova I, Dalla Corte F, Grasso S, Casolari P, Caramori G, Volta C, Andrianjafiarinoa T, Randriamandrato T, Rajaonera T, El-Dash S, Costa ELV, Tucci MR, Leleu F, Kontar L, De Cagny B, Brazier F, Titeca D, Bacari-Risal G, Maizel J, Amato M, Slama M, Mercado P, Maizel J, Kontar L, Titeca D, Brazier F, Riviere A, Joris M, Soupison T, De Cagny B, El Dash S, Slama M, Remmington, Fischer A, Squire S, Boichat M, Honzawa H, Yasuda H, Adati T, Suzaki S, Horibe M, Sasaki M, Sanui M, Marinho R, Daniel J, Miranda H, Marinho A, Milinis K, Cooper M, Williams GR, McCarron E, Simants S, Patanwala I, Welters I, Su Y, Fernández Villanueva J, Fernández Garda R, López Lago A, Rodríguez Ruíz E, Hernández Vaquero R, Tomé Martínez de Rituerto S, Varo Pérez E, Lefel N, Schaap F, Bergmans D, Olde Damink S, Van de Poll M, Tizard K, Lister C, Poole L, Ringaitiene D, Gineityte D, Vicka V, Norkiene I, Sipylaite J, O’Loughlin A, Maraj V, Dowling J, Velasco MB, Dalcomune DM, Dias EB, Fernandes SL, Oshima T, Graf S, Heidegger C, Genton L, Karsegard V, Dupertuis Y, Pichard C, Friedli N, Stanga Z, Mueller B, Schuetz P, Vandersteen L, Stessel B, Evers S, Van Assche A, Jamaer L, Dubois J, Marinho R, Castro H, Moura J, Valente J, Martins P, Casteloes P, Magalhaes C, Cabral S, Santos M, Oliveira B, Salgueiro A, Marinho A, Marinho R, Santos M, Lafuente E, Castro H, Cabral S, Moura J, Martins P, Oliveira B, Salgueiro A, Duarte S, Castro S, Melo M, Casteloes P, Marinho A, Gray S, Maipang K, Bhurayanontachai R, Grädel LG, Schütz P, Langlois P, Manzanares W, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Manzanares W, Langlois P, Lemieux M, Elke G, Bloos F, Reinhart K, Heyland D, Langlois P, Lemieux M, Aramendi I, Heyland D, Manzanares W, Su Y, Marinho R, Babo N, Marinho A, Hoshino M, Haraguchi Y, Kajiwara S, Mitsuhashi T, Tsubata T, Aida M, Rattanapraphat T, Bhurayanontachai R, Kongkamol C, Khwannimit B, Marinho R, Santos M, Castro H, Lafuente E, Salgueiro A, Cabral S, Martins P, Moura J, Oliveira B, Melo M, Xavier B, Valente J, Magalhaes C, Casteloes P, Marinho A, Moisidou D, Ampatzidou F, Koutsogiannidis C, Moschopoulou M, Drossos G, Taskin G, Çakir M, Güler AK, Taskin A, Öcal N, Özer S, Yamanel L, Wong JM, Fitton C, Anwar S, Stacey S, Aggou M, Fyntanidou B, Patsatzakis S, Oloktsidou E, Lolakos K, Papapostolou E, Grosomanidis V, Suda S, Ikeda T, Ono S, Ueno T, Izutani Y, Gaudry S, Desailly V, Pasquier P, Brun PB, Tesnieres AT, Ricard JD, Dreyfuss D, Mignon A, White JC, Molokhia A, Dean A, Stilwell A, Friedlaender G, Peters M, Stipulante S, Delfosse A, Donneau AF, Ghuysen A, Feldmann C, Freitag D, Dersch W, Irqsusi M, Eschbach D, Steinfeldt T, Wulf H, Wiesmann T, Kongpolprom N, Cholkraisuwat J, Beitland S, Nakstad E, Stær-Jensen H, Drægni T, Andersen G, Jacobsen D, Brunborg C, Waldum-Grevbo B, Sunde K, Hoyland K, Pandit D, Hayakawa K, Oloktsidou E, Kotzampassi K, Fyntanidou B, Patsatzakis S, Loukipoudi L, Doumaki E, Grosomanidis V, Yasuda H, Admiraal MM, Van Assen M, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Ragusa F, Marudi A, Baroni S, Gaspari A, Bertellini E, Taha A, Abdullah T, Abdel Monem S, Alcorn S, McNeill S, Russell S, Eertmans W, Genbrugge C, Meex I, Dens J, Jans F, De Deyne C, Cholkraisuwat J, Kongpolprom N, Avard B, Burns R, Patarchi A, Spina T, Tanaka H, Otani N, Ode S, Ishimatsu S, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Won MH, Dakova S, Ramsheva Z, Ramshev K, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Cho J, Moon JB, Park CW, Ohk TG, Shin MC, Marudi A, Baroni S, Gaspari A, Bertellini E, Orhun G, Senturk E, Ozcan PE, Sencer S, Ulusoy C, Tuzun E, Esen F, Tincu R, Cobilinschi C, Tomescu D, Ghiorghiu Z, Macovei R, Van Assen M, Admiraal MM, Van Putten MJ, Tjepkema-Cloostermans M, Van Rootselaar AF, Horn J, Fallenius M, Skrifvars MB, Reinikainen M, Bendel S, Raj R, Abu-Habsa M, Hymers C, Borowska A, Sivadhas H, Sahiba S, Perkins S, Rubio J, Rubio JA, Sierra R, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, English S, Chasse M, Turgeon A, Lauzier F, Griesdale D, Garland A, Fergusson D, Zarychanski R, Tinmouth A, Van Walraven C, Montroy K, Ziegler J, Dupont Chouinard R, Carignan R, Dhaliwal A, Lum C, Sinclair J, Pagliarello G, McIntyre L, Groza T, Moreau N, Castanares-Zapatero D, Hantson P, Carbonara M, Ortolano F, Zoerle T, Magnoni S, Pifferi S, Conte V, Stocchetti N, Carteron L, Suys T, Patet C, Quintard H, Oddo M, Rubio JA, Rubio J, Sierra R, Spatenkova V, Pokorna E, Suchomel P, Ebert N, Jancik J, Rhodes H, Bylinski T, Hawthorne C, Shaw M, Piper I, Kinsella J, Kink AK, Rätsep IR, Boutin A, Moore L, Chasse M, Zarychanski R, Lauzier F, English S, McIntyre L, Lacroix J, Griesdale D, Lessard-Bonaventure P, Turgeon AF, Boutin A, Moore L, Green R, Lessard-Bonaventure P, Erdogan M, Butler M, Lauzier F, Chasse M, English S, McIntyre L, Zarychanski R, Lacroix J, Griesdale D, Desjardins P, Fergusson DA, Turgeon AF, Goncalves B, Vidal B, Valdez C, Rodrigues AC, Miguez L, Moralez G, Hong T, Kutz A, Hausfater P, Amin D, Struja T, Haubitz S, Huber A, Mueller B, Schuetz P, Brown T, Collinson J, Pritchett C, Slade T, Le Guen M, Hellings S, Ramsaran R, Alsheikhly A, Abe T, Kanapeckaite L, Abu-Habsa M, Bahl R, Russell MQ, Real KJ, Abu-Habsa M, Lyon RM, Oveland NP, Penketh J, Mcdonald M, Kelly F, Alfafi M, Alsolamy S, Almutairi W, Alotaibi B, Van den Berg AE, Schriel Y, Dawson L, Meynaar IA, Talaie H, Silva D, Fernandes S, Gouveia J, Santos Silva J, Foley J, Kaskovagheorgescu A, Evoy D, Cronin J, Ryan J, Huck M, Hoffmann C, Renner J, Laitselart P, Donat N, Cirodde A, Schaal JV, Masson Y, Nau A, Leclerc T, Howarth O, Davenport K, Jeanrenaud P, Raftery S, MacTavish P, Devine H, McPeake J, Daniel M, Kinsella J, Quasim T, Alrabiee S, Alrashid A, Alsolamy S, Gundogan O, Bor C, Akýn Korhan E, Demirag K, Uyar M, Frame F, Ashton C, Bergstrom Niska L, Dilokpattanamongkol P, Suansanae T, Suthisisang C, Morakul S, Karnjanarachata C, Tangsujaritvijit V, Mahmood S, Al Thani H, Almenyar A, Vakalos A, Avramidis V, Sharvill R, Penketh J, Morton SE, Chiew YS, Pretty C, Chase JG, Shaw GM, Knafelj R, Kordis P, Patel S, Grover V, Kuchyn I, Bielka K, Aidoni Z, Grosomanidis V, Kotzampassi K, Stavrou G, Fyntanidou B, Patsatzakis S, Skourtis C, Lee SD, Williams K, Weltes ID, Berhane S, Arrowsmith C, Peters C, Robert S, Caldas J, Panerai RB, Robinson TG, Camara L, Ferreira G, Borg-Seng-Shu E, De Lima Oliveira M, Mian NC, Santos L, Nogueira R, Zeferino SP, Jacobsen Teixeira M, Galas F, Hajjar LA, Killeen P, McPhail M, Bernal W, Maggs J, Wendon J, Hughes T, Taniguchi LU, Siqueira EM, Vieira Jr JM, Azevedo LC, Ahmad AN, Abu-Habsa M, Bahl R, Helme E, Hadfield S, Loveridge R, Shak J, Senver C, Howard-Griffin R, Wacharasint P, Fuengfoo P, Sukcharoen N, Rangsin R, Sbiti-Rohr D, Schuetz P, Na H, Song S, Lee S, Jeong E, Lee K, Cooper M, Milinis K, Williams G, McCarron E, Simants S, Patanwala I, Welters ID, Zoumpelouli E, Volakli EA, Chrysohoidou V, Georgiou S, Charisopoulou K, Kotzapanagiotou E, Panagiotidou V, Manavidou K, Stathi Z, Sdougka M, Salahuddin N, AlGhamdi B, Marashly Q, Zaza K, Sharshir M, Khurshid M, Ali Z, Malgapo M, Jamil M, Shafquat A, Shoukri M, Hijazi M, Abe T, Uchino S, Takinami M, Rangel Neto NR, Oliveira S, Reis FQ, Rocha FA, Moralez G, Ebecken K, Rabello LS, Lima MF, Hatum R, De Marco FV, Alves A, Pinto JE, Godoy M, Brasil PE, Bozza FA, Salluh JI, Soares M, Krinsley J, Kang G, Perry J, Hines H, Wilkinson KM, Tordoff C, Sloan B, Bellamy MC, Moreira E, Verga F, Barbato M, Burghi G, Soares M, Silva UV, Azevedo LC, Torelly AP, Kahn JM, Angus DC, Knibel MF, Brasil PE, Bozza FA, Salluh JI, Velasco MB, Dalcomune DM, Marshall R, Gilpin T, Tridente A, Raithatha A, Mota D, Loureiro B, Dias J, Afonso O, Coelho F, Martins A, Faria F, Al-Dorzi H, Al Orainni H, AlEid F, Tlaygeh H, Itani A, Hejazi A, Arabi Y, Gaudry S, Messika J, Ricard JD, Guillo S, Pasquet B, Dubief E, Dreyfuss D, Tubach F, Battle C, James K, Temblett P, Davies L, Battle C, Lynch C, Pereira S, Cavaco S, Fernandes J, Moreira I, Almeida E, Seabra Pereira F, Malheiro M, Cardoso F, Aragão I, Cardoso T, Fister M, Knafelj R, Muraray Govind P, Brahmananda Reddy N, Pratheema R, Arul ED, Devachandran J, Velasco MB, Dalcomune DM, Knafelj R, Fister M, Chin-Yee N, D’Egidio G, Thavorn K, Heyland D, Kyeremanteng K, Murchison AG, Swalwell K, Mandeville J, Stott D, Guerreiro I, Devine H, MacTavish P, McPeake J, Quasim T, Kinsella J, Daniel M, Goossens C, Marques MB, Derde S, Vander Perre S, Dufour T, Thiessen SE, Güiza F, Janssens T, Hermans G, Vanhorebeek I, De Bock K, Van den Berghe G, Langouche L, Devine H, MacTavish P, Quasim T, Kinsella J, Daniel M, McPeake J, Miles B, Madden S, Devine H, Weiler M, Marques P, Rodrigues C, Boeira M, Brenner K, Leães C, Machado A, Townsend R, Andrade J, MacTavish P, McPeake J, Devine H, Kinsella J, Daniel M, Kishore R, Fenlon C, Quasim T, Fiks T, Ruijter A, Te Raa M, Spronk P, Chiew YS, Docherty P, Dickson J, Moltchanova E, Scarrot C, Pretty C, Shaw GM, Chase JG, Hall T, Ngu WC, Jack JM, Morgan P, Avard B, Pavli A, Gee X, Bor C, Akin Korhan E, Demirag K, Uyar M, Shirazy M, Fayed A, Gupta S, Kaushal A, Dewan S, Varma A, Ghosh E, Yang L, Eshelman L, Lord B, Carlson E, Helme E, Broderick R, Hadfield S, Loveridge R, Ramos J, Forte D, Yang F, Hou P, Dudziak J, Feeney J, Wilkinson K, Bauchmuller K, Shuker K, Faulds M, Raithatha A, Bryden D, England L, Bolton N, Tridente A, Bauchmuller K, Shuker K, Tridente A, Faulds M, Matheson A, Gaynor J, Bryden D, ᅟ SSYHRC, Ramos J, Peroni B, Daglius-Dias R, Miranda L, Cohen C, Carvalho C, Velasco I, Forte D, Kelly JM, Neill A, Rubenfeld G, Masson N, Min A, Boezeman E, Hofhuis J, Hovingh A, De Vries R, Spronk P, Cabral-Campello G, Aragão I, Cardoso T, Van Mol M, Nijkamp M, Kompanje E, Ostrowski P, Omar A, Kiss K, Köves B, Csernus V, Molnár Z, Hoydonckx Y, Vanwing S, Stessel B, Van Assche A, Jamaer L, Dubois J, Medo V, Galvez R, Miranda JP, Stone C, Wigmore T, Arunan Y, Wheeler A, Bauchmuller K, Bryden D, Wong Y, Poi C, Gu C, Molmy P, Van Grunderbeeck N, Nigeon O, Lemyze M, Thevenin D, Mallat J, Ramos J, Correa M, Carvalho RT, Forte D, Fernandez A, McBride C, Koonthalloor E, Walsh C, Webber A, Ashe M, Smith K, Jeanrenaud P, Marudi A, Baroni S, Ragusa F, Bertellini E, Volakli EA, Chochliourou E, Dimitriadou M, Violaki A, Mantzafleri P, Samkinidou E, Vrani O, Arbouti A, Varsami T, Sdougka M, Bollen JA, Van Smaalen TC, De Jongh WC, Ten Hoopen MM, Ysebaert D, Van Heurn LW, Van Mook WN, Sim K, Fuller A, Roze des Ordons A, Couillard P, Doig C, Van Keer RV, Deschepper RD, Francke AF, Huyghens LH, Bilsen JB, Nyamaizi B, Dalrymple C, Molokhia A, Dobru A, Marrinan E, Ankuli A, Molokhia A, McPeake J, Struthers R, Crawford R, Devine H, Mactavish P, Quasim T, Morelli P, Degiovanangelo M, Lemos F, MArtinez V, Verga F, Cabrera J, Burghi G, Rutten A, Van Ieperen S, De Geer S, Van Vugt M, Der Kinderen E, Giannini A, Miccinesi G, Marchesi T, Prandi E. Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Stillbirth: Genome-wide copy number variation profiling in archived placental umbilical cord samples with pathologic and clinical correlation

INTRODUCTION

Stillbirth remains a devastating health issue with 26,000 stillbirths occurring annually in the United States. Formalin-fixed, paraffin-embedded (FFPE) umbilical cord samples are available for many stillbirths. Our aim was to validate the use of these samples in identifying genetic variations in stillbirth through microarray analysis.

METHODS

This is a retrospective case-control study from a single institution of stillbirths ≥ 23 weeks gestational age and control liveborn infants. Fetal genomic DNA was extracted from FFPE umbilical cord samples of stillborn and control placentas, and genotyping was performed using the Illumina HumanOmniExpresss-12v1 Beadchip. Array results were verified with qPCR.

RESULTS

31 case-specific CNVs (17 deletions and 14 amplifications) with an average size of 294 kb for amplifications and 74 kb for deletions were identified among 94 FFPE samples (86 cases; 8 controls). In total 38 (44%) of the stillbirth samples had a CNV detected. Validation of a subset of microarray findings with qPCR confirmed deletions on 1p (2 cases), 11q (4 cases) and amplifications on 18 (1 case). Placental underperfusion changes were seen in stillborns with deletions on 1p, a region containing complement regulatory genes which have been shown to play a role in preeclampsia.

DISCUSSION

This study validated the use of archived FFPE umbilical cord samples for genome-wide copy number profiling in stillbirths, and demonstrates specific CNV deletions and amplifications. Microarray analysis in an expanded cohort of stillbirth FFPE samples has the potential to identify biomarkers involved in stillbirth pathogenesis.

Epigenomic profiling in visceral white adipose tissue of offspring of mice exposed to late gestational sleep fragmentation

BACKGROUND

Sleep fragmentation during late gestation (LG-SF) is one of the major perturbations associated with sleep apnea and other sleep disorders during pregnancy. We have previously shown that LG-SF induces metabolic dysfunction in offspring mice during adulthood.

OBJECTIVES

To investigate the effects of late LG-SF on metabolic homeostasis in offspring and to determine the effects of LG-SF on the epigenome of visceral white adipose tissue (VWAT) in the offspring.

METHODS

Time-pregnant mice were exposed to LG-SF or sleep control during LG (LG-SC) conditions during the last 6 days of gestation. At 24 weeks of age, lipid profiles and metabolic parameters were assessed in the offspring. We performed large-scale DNA methylation analyses using methylated DNA immunoprecipitation (MeDIP) coupled with microarrays (MeDIP-chip) in VWAT of 24-week-old LG-SF and LG-SC offspring (n=8 mice per group). Univariate multiple-testing adjusted statistical analyses were applied to identify differentially methylated regions (DMRs) between the groups. DMRs were mapped to their corresponding genes, and tested for potential overlaps with biological pathways and gene networks.

RESULTS

We detected significant increases in body weight (31.7 vs 28.8 g; P=0.001), visceral (642.1 vs 497.0 mg; P=0.002) and subcutaneous (293.1 vs 250.1 mg; P=0.001) fat mass, plasma cholesterol (110.6 vs 87.6 mg dl(-1); P=0.001), triglycerides (87.3 vs 84.1 mg dl(-1); P=0.003) and homeostatic model assessment-insulin resistance values (8.1 vs 6.1; P=0.007) in the LG-SF group. MeDIP analyses revealed that 2148 DMRs (LG-SF vs LG-SC; P<0.0001, model-based analysis of tilling-arrays algorithm). A large proportion of the DMR-associated genes have reported functions that are altered in obesity and metabolic syndrome, such as Cartpt, Akt2, Apoe, Insr1 and so on. Overrepresented pathways and gene networks were related to metabolic regulation and inflammatory response.

CONCLUSIONS

Our findings show a major role for epigenomic regulation of pathways associated with the metabolic processes and inflammatory responses in VWAT. LG-SF-induced epigenetic alterations may underlie increases in the susceptibility to obesity and metabolic syndrome in the offspring.

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

We present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19 600 anaesthetics (95% CI 1:16 700-23 450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030-9700), and without it was ~1:135 900 (1:78 600-299 000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380-1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out-of-hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project - the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent, and medicolegal issues

The 5th National Audit Project (NAP5) of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland into accidental awareness during general anaesthesia (AAGA) yielded data related to psychological aspects from the patient, and the anaesthetist, perspectives; patients' experiences ranged from isolated auditory or tactile sensations to complete awareness. A striking finding was that 75% of experiences were for <5 min, yet 51% of patients [95% confidence interval (CI) 43-60%] experienced distress and 41% (95% CI 33-50%) suffered longer term adverse effect. Distress and longer term harm occurred across the full range of experiences but were particularly likely when the patient experienced paralysis (with or without pain). The patient's interpretation of what is happening at the time of the awareness seemed central to later impact; explanation and reassurance during suspected AAGA or at the time of report seemed beneficial. Quality of care before the event was judged good in 26%, poor in 39%, and mixed in 31%. Three-quarters of cases of AAGA (75%) were judged preventable. In 12%, AAGA care was judged good and the episode not preventable. The contributory and human factors in the genesis of the majority of cases of AAGA included medication, patient, and education/training. The findings have implications for national guidance, institutional organization, and individual practice. The incidence of 'accidental awareness' during sedation (~1:15,000) was similar to that during general anaesthesia (~1:19,000). The project raises significant issues about information giving and consent for both sedation and anaesthesia. We propose a novel approach to describing sedation from the patient's perspective which could be used in communication and consent. Eight (6%) of the patients had resorted to legal action (12, 11%, to formal complaint) at the time of reporting. NAP5 methodology provides a standardized template that might usefully inform the investigation of claims or serious incidents related to AAGA.

WO3 nanorods created by self-assembly of highly crystalline nanowires under hydrothermal conditions

WO3 nanorods and wires were obtained via hydrothermal synthesis using sodium tungstate as a precursor and either oxalic acid, citric acid, or poly(methacrylic acid) as a stabilizing agent. Transmission electron microscopy images showed that the organic acids with different numbers of carboxylic groups per molecule influence the final sizes and stacking nanostructures of WO3 wires. Three-dimensional electron diffraction tomography of a single nanocrystal revealed a hexagonal WO3 structure with preferential growth along the c-axis, which was confirmed by high-resolution transmission electron microscopy. WO3 nanowires were also spin-coated onto an indium tin oxide/glass conducting substrate, resulting in the formation of a film that was characterized by scanning electron microscopy. Finally, cyclic voltammetry measurements performed on the WO3 thin film showed voltammograms typical for the WO3 redox process.

Guidelines for maintenance of adult patients with brain death and potential for multiple organ donations: the Task Force of the Brazilian Association of Intensive Medicine the Brazilian Association of Organs Transplantation, and the Transplantation Center of Santa Catarina

INTRODUCTION

The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor.

OBJECTIVE

This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death.

METHOD

These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence.

RESULTS

Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines?

CONCLUSIONS

This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.

Can healthy lifestyle modify risk factors for dementia? findings from a pilot population-based survey

Introduction

Aspects of lifestyle are a key component to successful ageing and reducing the risk of cognitive impairment. Many developing countries, including India, currently have a much lower rate of dementia in people of the same age in the UK (Alzheimer’s Disease International 2008), in contrast to the higher prevalence rates of cardiovascular risk factors (reviewed in Misra and Kurana, 2009).

Objectives

Compare lifestyle choices in a developed and a developing country, that show contrasting dementia prevalence rates.

Aims

Identify protective factors that may reduce dementia prevalence.

Methods

A total of 251 participants at public meetings (123 in Newcastle and 128 in Chennai) on ageing completed a questionnaire voluntarily regarding their lifestyle, health status, 4-item GDS, and their subjective perception of their mental and physical health. The two groups had similar sociodemographic characteristics.

Results

Diabetes was three times more prevalent in the Chennai group (p = 0.001) but a significantly higher proportion of the Chennai population reported receiving treatment for diabetes (p = 0.012). Vegeterian diet was more frequent in the Chennai cohort (p = 0.000), as well as curry consumption (p = 0.000). The Newcastle group consumed more alcohol (p = 0.000) and practiced exercise less often (p = 0.005). Not surprinsingly, 95% of the Indian is religious, in contrast to 59.7% of the English (p = 0.000).

Conclusions

Type of diet, curry and alcohol consumption, and religious or spiritual beliefs, were the most significantly different, and may therefore confer protective advantages for dementia. Other explanations could be a higher proportion of uncontrolled diabetes and inactive people in the Newcastle sample.

Surveillance of norovirus infections in the state of Rio De Janeiro, Brazil 2005-2008

A 4-year (2005-2008) norovirus (NoV) surveillance study was conducted in the state of Rio Janeiro, Brazil, to demonstrate the role of these viruses in outbreaks and sporadic cases of acute gastroenteritis. A cohort of 1,687 fecal samples was obtained from patients with gastroenteritis; 324 were rotavirus-positive. Of the remainder 1,363 rotavirus-negative samples, 1,087 samples were tested for NoV RNA in this study. The study enrolled 267 outpatients from Municipal Public Health Centers and 820 inpatients, whose samples were obtained by active surveillance in Public Hospitals. Fecal samples were tested by reverse transcription (RT) followed by polymerase chain reaction (PCR) using the MON 431-434 set of degenerate primers for NoV GI and GII detection, and there were 35.1% (381/1,087) positive samples for NoV, consisting of 30.2% (248/820) and 49.8% (133/267) from inpatient and outpatient, respectively. Children infected by NoV had significantly more frequent mucus in feces, vomiting and fever. No seasonal pattern in NoV infections was observed in patients admitted to hospital; however, two peaks of NoV infections were observed from ambulatory cases, suggesting that there was an occurrence of outbreaks in those time periods. Molecular characterization revealed GII to be the most prevalent genogroup, totaling 96.3% (104/108) of all sequences analyzed, and GII.4 was the genotype detected most frequently (80.7%), followed by GII.6, 3, 14, 7, and 8. Two GI strains, GI.2 and GI.3, were also observed. The number of outbreaks and sporadic cases described in this study highlights the need to implement diagnosis of NoV in surveillance laboratories.