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Gemici Karaaslan HB, Turkkan E, Goksoy Topal E, Karaaslan F, Dag H, Arica V. Association of depression and social anxiety symptom scores with disease characteristics in pediatric patients with chronic immune thrombocytopenia: a cross-sectional study. Int J Hematol 2024:10.1007/s12185-024-03826-9. [PMID: 39090520 DOI: 10.1007/s12185-024-03826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 07/11/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
Patients with ITP have been reported to experience higher levels of depression and anxiety than their healthy counterparts. The limited research conducted on this subject in the pediatric age group has demonstrated that patients have psychosocial difficulties, and their quality of life is adversely affected. The correlation of depressive symptoms with disease characteristics of cITP has never been investigated. This was a cross-sectional study in patients being treated for cITP. Communication with participants was done during routine outpatient visits or by telephone or e-mail, and a survey about demographics and the Children's Depression Inventory (CDI) and the Social Anxiety Scale for Children-Revised (SAS-CR) was administered prospectively. A total of 56 children with cITP were recruited. The mean CDI score was 17 (SD: ± 9.44). Approximately half of the patients had higher CDI scores than healthy Turkish children. Older age, time since diagnosis, a number of hospitalizations (both total and within the last year) were positively correlated with CDI scores. There was no significant correlation between SAS-CR scores and disease characteristics. Depressive symptom scores were higher in children with cITP compared with healthy children in this study. Psychological needs may be overlooked in the medical management of children with cITP.
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Affiliation(s)
- Hatice Betul Gemici Karaaslan
- Department of Pediatrics, University of Health Sciences, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
| | - Emine Turkkan
- Department of Pediatrics, Division of Pediatric Hematology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Evrim Goksoy Topal
- Department of Pediatrics, University of Health Sciences, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Fatih Karaaslan
- Department of Pediatrics, Istanbul Yeni Yuzyil University, Medical Faculty, Istanbul, Turkey
| | - Huseyin Dag
- Department of Pediatrics, University of Health Sciences, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Vefik Arica
- Department of Pediatrics, University of Health Sciences, Istanbul Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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2
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Brito-Santana L, Medinas RL, Neves A, Gago J. Steroid-induced psychosis: a spectrum of neuropsychiatric glucocorticoid side effects. BMJ Case Rep 2024; 17:e259134. [PMID: 39038870 DOI: 10.1136/bcr-2023-259134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Glucocorticoid-induced neuropsychiatric side effects have been known since their initial usage and frequently manifest in clinical settings. Despite this, they remain unpredictable, variable and complex to manage, impacting patient outcomes and the healthcare system.We report a case of glucocorticoid-induced psychosis after the administration of dexamethasone post-neurosurgical intervention and its evolution with the initiation of chemotherapy. Although initially manic symptoms were prominent, with the beginning of chemotherapy psychotic symptoms dominated the clinical presentation, followed by depressive symptoms. Despite challenges in diagnosis and management, including adverse reactions to antipsychotic treatment, this case provides critical insights into the variable and dynamic nature of neuropsychiatric side effects induced by glucocorticoids.
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Affiliation(s)
- Leonor Brito-Santana
- Psychiatry and Mental Health Department, Unidade Local de Saúde de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Raquel Luís Medinas
- Psychiatry and Mental Health Department, Unidade Local de Saúde de Lisboa Ocidental EPE, Lisboa, Portugal
- NOVA Medical School - Faculdade de Ciências Médicas, Lisboa, Portugal
| | - António Neves
- Psychiatry and Mental Health Department, Unidade Local de Saúde de Lisboa Ocidental EPE, Lisboa, Portugal
- NOVA Medical School - Faculdade de Ciências Médicas, Lisboa, Portugal
| | - Joaquim Gago
- Psychiatry and Mental Health Department, Unidade Local de Saúde de Lisboa Ocidental EPE, Lisboa, Portugal
- NOVA Medical School - Faculdade de Ciências Médicas, Lisboa, Portugal
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3
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Lockett J, Inder WJ, Clifton VL. The Glucocorticoid Receptor: Isoforms, Functions, and Contribution to Glucocorticoid Sensitivity. Endocr Rev 2024; 45:593-624. [PMID: 38551091 PMCID: PMC11244253 DOI: 10.1210/endrev/bnae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Indexed: 07/13/2024]
Abstract
Glucocorticoids exert pleiotropic effects on all tissues to regulate cellular and metabolic homeostasis. Synthetic forms are used therapeutically in a wide range of conditions for their anti-inflammatory benefits, at the cost of dose and duration-dependent side effects. Significant variability occurs between tissues, disease states, and individuals with regard to both the beneficial and deleterious effects. The glucocorticoid receptor (GR) is the site of action for these hormones and a vast body of work has been conducted understanding its function. Traditionally, it was thought that the anti-inflammatory benefits of glucocorticoids were mediated by transrepression of pro-inflammatory transcription factors, while the adverse metabolic effects resulted from direct transactivation. This canonical understanding of the GR function has been brought into question over the past 2 decades with advances in the resolution of scientific techniques, and the discovery of multiple isoforms of the receptor present in most tissues. Here we review the structure and function of the GR, the nature of the receptor isoforms, and the contribution of the receptor to glucocorticoid sensitivity, or resistance in health and disease.
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Affiliation(s)
- Jack Lockett
- Mater Research Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD 4101, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD 4102, Australia
| | - Warrick J Inder
- Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD 4102, Australia
| | - Vicki L Clifton
- Mater Research Institute, The University of Queensland, Translational Research Institute, Woolloongabba, QLD 4101, Australia
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Meca-García JM, Perní-Lasala MT, Parrón-Carreño T, Lozano-Paniagua D, Castro-Luna G, Nievas-Soriano BJ. Neuropsychiatric symptoms of patients two years after experiencing severe COVID-19: A mixed observational study. Med Clin (Barc) 2024:S0025-7753(24)00360-9. [PMID: 38964970 DOI: 10.1016/j.medcli.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The impact of SARS-CoV-2 infection (COVID-19) on mental health has not been extensively studied in the medium and long term. This study assessed how clinical, biological, and social factors affect mental health in patients who recovered from severe COVID-19. The evaluation was done 90 days after hospital discharge and followed up at 12 and 24 months. METHODS A retrospective-prospective cohort mixed observational study was conducted on patients over 18 years of age who required hospitalization in Internal Medicine or ICU for severe COVID-19 pneumonia during 2020 and 2021. Demographic information, clinical variables, and data for the scales were obtained from electronic medical records and telephone interviews. For comparisons of the different variables in each clinical variable (insomnia, depression, anxiety), the Student's t-test for independent samples has been used (normal distribution); otherwise, the Mann-Whitney test will be used. All tests and intervals will be performed with a confidence level of 95. Fisher's exact or Pearson's Chi-square test has been used as appropriate for qualitative variables. RESULTS 201 patients were recruited. 37.3% presented insomnia, 22.4% anxiety, and 21.4% depressive symptoms. A direct association was established between female sex and depressive symptoms. Psychotropic history, fatigue, and C-reactive protein levels (CRP) were correlated with depression. Anosmia and ageusia, CRP, cognitive symptoms, and dyspnea predicted insomnia. Sex, orotracheal intubation (OTI), pain, fatigue, mental health history, and academic level were independent predictors of anxiety. High percentages of depressive, anxiety, and insomnia symptoms were detected in the second month after discharge and persisted at 12 and 24 months. The fatigue variable maintained a significant relationship with depressive symptoms at 2, 12 and 24 months. A possible limitation could be recall bias in retrospective data collection. CONCLUSIONS This is a novel study to follow up on mental health for two years in patients with severe COVID-19. Clinical, biological, and psychosocial variables could be predictors of depressive symptoms, anxiety, and insomnia. The psychiatric symptoms persisted throughout the 2-year follow-up. These findings are critical for the follow-up of these patients and open the possibility of further studies in the medium and long term.
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Affiliation(s)
| | | | - Tesifón Parrón-Carreño
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
| | - David Lozano-Paniagua
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain.
| | - Gracia Castro-Luna
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
| | - Bruno José Nievas-Soriano
- Department of Nursing, Physiotherapy, and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
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Chatterjee A, Jayaprakasan M, Chakrabarty AK, Lakkaniga NR, Bhatt BN, Banerjee D, Narwaria A, Katiyar CK, Dubey SK. Comprehensive insights into rheumatoid arthritis: Pathophysiology, current therapies and herbal alternatives for effective disease management. Phytother Res 2024; 38:2764-2799. [PMID: 38522945 DOI: 10.1002/ptr.8187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024]
Abstract
Rheumatoid arthritis is a chronic autoimmune inflammatory disease characterized by immune response overexpression, causing pain and swelling in the synovial joints. This condition is caused by auto-reactive antibodies that attack self-antigens due to their incapacity to distinguish between self and foreign molecules. Dysregulated activity within numerous signalling and immunological pathways supports the disease's development and progression, elevating its complexity. While current treatments provide some alleviation, their effectiveness is accompanied by a variety of adverse effects that are inherent in conventional medications. As a result, there is a deep-rooted necessity to investigate alternate therapeutic strategies capable of neutralizing these disadvantages. Medicinal herbs display a variety of potent bioactive phytochemicals that are effective in the complementary management of disease, thus generating an enormous potency for the researchers to delve deep into the development of novel phytomedicine against autoimmune diseases, although additional evidence and understanding are required in terms of their efficacy and pharmacodynamic mechanisms. This literature-based review highlights the dysregulation of immune tolerance in rheumatoid arthritis, analyses the pathophysiology, elucidates relevant signalling pathways involved, evaluates present and future therapy options and underscores the therapeutic attributes of a diverse array of medicinal herbs in addressing this severe disease.
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Affiliation(s)
- Amrita Chatterjee
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | - Monisha Jayaprakasan
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
| | | | - Naga Rajiv Lakkaniga
- Department of Chemistry and Chemical Biology, Indian Institute of Technology (Indian School of Mines), Dhanbad, India
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Weisse CS, Melekis K, Cheng A, Konda AK, Major A. Mixed-Methods Study of End-of-Life Experiences of Patients With Hematologic Malignancies in Social Hospice Residential Home Care Settings. JCO Oncol Pract 2024; 20:779-786. [PMID: 38306585 DOI: 10.1200/op.23.00534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/28/2023] [Accepted: 12/21/2023] [Indexed: 02/04/2024] Open
Abstract
PURPOSE Hospice is underutilized by patients with hematologic malignancies (HM), and when patients are referred, they are typically more ill, hospitalized, and with shorter length of stay (LOS) than patients with solid tumors (ST), limiting research about home hospice care experiences of patients with HM. In this mixed-methods study, we examined the hospice experiences of patients with HM who died at residential care homes (RCHs), home-based settings in which volunteer caregivers and hospice staff provide end-of-life (EOL) care under the social hospice model. METHODS We queried a registry of 535 hospice patients who died at RCHs between 2005 and 2020 that included quantitative medication administration data as well as qualitative data from hospice intake forms and written volunteer caregiver narratives. Qualitative data were analyzed by collective case study methodology. Quantitative comparisons of LOS and liquid morphine use were performed with matched patients with ST. RESULTS The registry yielded 29 patients with HM, of whom qualitative data were available for 18 patients. Patients with HM exhibited common EOL symptoms (pain, dyspnea, and agitation). Instances of bleeding were low (22%), and notable HM-specific care concerns were described regarding bone fractures, skin integrity, and delirium. Most (78%) experienced good symptom management and peaceful or comfortable deaths. In only one case were symptoms described as severe and poorly managed. Patients with HM had comparable LOS on hospice and at the RCHs to patients with ST, with no group differences in liquid morphine use. CONCLUSION In this registry cohort, most patients with HM achieved good symptom management in home care settings with volunteer caregivers and hospice support. Caregivers may require additional counseling and palliative medications for HM-specific EOL symptoms.
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Affiliation(s)
- Carol S Weisse
- Department of Psychology, Union College, Schenectady, NY
| | - Kelly Melekis
- College of Education and Social Services, University of Vermont, Burlington, VT
| | | | | | - Ajay Major
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Karagiannis TC, Ververis K, Liang JJ, Pitsillou E, Liu S, Bresnehan SM, Xu V, Wijoyo SJ, Duan X, Ng K, Hung A, Goebel E, El-Osta A. Identification and Evaluation of Olive Phenolics in the Context of Amine Oxidase Enzyme Inhibition and Depression: In Silico Modelling and In Vitro Validation. Molecules 2024; 29:2446. [PMID: 38893322 PMCID: PMC11173677 DOI: 10.3390/molecules29112446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
The Mediterranean diet well known for its beneficial health effects, including mood enhancement, is characterised by the relatively high consumption of extra virgin olive oil (EVOO), which is rich in bioactive phenolic compounds. Over 200 phenolic compounds have been associated with Olea europaea, and of these, only a relatively small fraction have been characterised. Utilising the OliveNetTM library, phenolic compounds were investigated as potential inhibitors of the epigenetic modifier lysine-specific demethylase 1 (LSD1). Furthermore, the compounds were screened for inhibition of the structurally similar monoamine oxidases (MAOs) which are directly implicated in the pathophysiology of depression. Molecular docking highlighted that olive phenolics interact with the active site of LSD1 and MAOs. Protein-peptide docking was also performed to evaluate the interaction of the histone H3 peptide with LSD1, in the presence of ligands bound to the substrate-binding cavity. To validate the in silico studies, the inhibitory activity of phenolic compounds was compared to the clinically approved inhibitor tranylcypromine. Our findings indicate that olive phenolics inhibit LSD1 and the MAOs in vitro. Using a cell culture model system with corticosteroid-stimulated human BJ fibroblast cells, the results demonstrate the attenuation of dexamethasone- and hydrocortisone-induced MAO activity by phenolic compounds. The findings were further corroborated using human embryonic stem cell (hESC)-derived neurons stimulated with all-trans retinoic acid. Overall, the results indicate the inhibition of flavin adenine dinucleotide (FAD)-dependent amine oxidases by olive phenolics. More generally, our findings further support at least a partial mechanism accounting for the antidepressant effects associated with EVOO and the Mediterranean diet.
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Affiliation(s)
- Tom C. Karagiannis
- Epigenetics in Human Health and Disease Program, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3004, Australia
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC 3010, Australia
- Department of Microbiology and Immunology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Katherine Ververis
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Julia J. Liang
- Epigenetics in Human Health and Disease Program, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3004, Australia
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
- School of Science, STEM College, RMIT University, Melbourne, VIC 3001, Australia
| | - Eleni Pitsillou
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
- School of Science, STEM College, RMIT University, Melbourne, VIC 3001, Australia
| | - Siyao Liu
- School of Agriculture, Food and Ecosystem Sciences, Faculty of Science, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Sarah M. Bresnehan
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
| | - Vivian Xu
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
| | - Stevano J. Wijoyo
- Epigenomic Medicine Laboratory at prospED Polytechnic, Carlton, VIC 3053, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Xiaofei Duan
- Melbourne TrACEES Platform, School of Chemistry, Faculty of Science, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ken Ng
- School of Agriculture, Food and Ecosystem Sciences, Faculty of Science, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Andrew Hung
- School of Science, STEM College, RMIT University, Melbourne, VIC 3001, Australia
| | - Erik Goebel
- Occhem Labs, LLC, 3510 Hopkins Place North, Oakdale, MN 55128, USA
| | - Assam El-Osta
- Epigenetics in Human Health and Disease Program, Baker Heart and Diabetes Institute, 75 Commercial Road, Prahran, VIC 3004, Australia
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, 3/F Lui Che Woo Clinical Sciences Building, 30-32 Ngan Shing Street, Sha Tin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
- Biomedical Laboratory Science, Department of Technology, Faculty of Health, University College Copenhagen, 1799 Copenhagen V, Denmark
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8
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Huang H, Zhang Z, Xing M, Jin Z, Hu Y, Zhou M, Wei H, Liang Y, Lv Z. Angiostrongylus cantonensis induces energy imbalance and dyskinesia in mice by reducing the expression of melanin-concentrating hormone. Parasit Vectors 2024; 17:192. [PMID: 38654385 PMCID: PMC11036757 DOI: 10.1186/s13071-024-06267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Infection with Angiostrongylus cantonensis (AC) in humans or mice can lead to severe eosinophilic meningitis or encephalitis, resulting in various neurological impairments. Developing effective neuroprotective drugs to improve the quality of life in affected individuals is critical. METHODS We conducted a Gene Ontology enrichment analysis on microarray gene expression (GSE159486) in the brains of AC-infected mice. The expression levels of melanin-concentrating hormone (MCH) were confirmed through real-time quantitative PCR (RT-qPCR) and immunofluorescence. Metabolic parameters were assessed using indirect calorimetry, and mice's energy metabolism was evaluated via pathological hematoxylin and eosin (H&E) staining, serum biochemical assays, and immunohistochemistry. Behavioral tests assessed cognitive and motor functions. Western blotting was used to measure the expression of synapse-related proteins. Mice were supplemented with MCH via nasal administration. RESULTS Postinfection, a marked decrease in Pmch expression and the encoded MCH was observed. Infected mice exhibited significant weight loss, extensive consumption of sugar and white fat tissue, reduced movement distance, and decreased speed, compared with the control group. Notably, nasal administration of MCH countered the energy imbalance and dyskinesia caused by AC infection, enhancing survival rates. MCH treatment also increased the expression level of postsynaptic density protein 95 (PSD95) and microtubule-associated protein-2 (MAP2), as well as upregulated transcription level of B cell leukemia/lymphoma 2 (Bcl2) in the cortex. CONCLUSIONS Our findings suggest that MCH improves dyskinesia by reducing loss of synaptic proteins, indicating its potential as a therapeutic agent for AC infection.
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Affiliation(s)
- Hui Huang
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Zhongyuan Zhang
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Mengdan Xing
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Zihan Jin
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Yue Hu
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Minyu Zhou
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Hang Wei
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Yiwen Liang
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China
| | - Zhiyue Lv
- Key Laboratory of Tropical Disease Control, Ministry of Education, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China.
- Department of Pathogen Biology and Biosafety, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong Province, 510030, People's Republic of China.
- Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, Hainan Province, 570311, People's Republic of China.
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King JD, Elliott T, Pitman A. Steroid-induced mania in a patient with previously well-controlled organic bipolar 1-like affective disorder secondary to acquired brain injury: case report and literature review. DISCOVER MENTAL HEALTH 2024; 4:8. [PMID: 38453827 PMCID: PMC10920485 DOI: 10.1007/s44192-024-00061-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Steroid-induced neuropsychiatric sequelae are common, and pose significant risks to people usually receiving glucocorticoids in the context of physical illness. Steroid-induced mania and hypomania are the most common of the acute complications, yet despite great progress in understandings in neurophysiology there are no recent studies which review the factors which might predict who will experience this severe complication, nor are there consensus guidelines on management. We report the unusual case of a woman in her 50s admitted to a psychiatric unit with steroid-induced mania despite compliance with two mood stabilisers, several days after the administration of a Dexamethasone and Docetaxel chemotherapy regime adjunctive to lumpectomy for breast cancer. She had previously been diagnosed with an organic affective disorder (with classical bipolar 1 pattern) following severe ventriculitis related to ventricular drain insertion for obstructive hydrocephalus secondary to a colloid cyst. She had no psychiatric illness before this brain injury, but has a maternal history of idiopathic bipolar 1 affective disorder. Her episode of steroid-induced mania resolved following use of sedative medications, continuation of her existing mood stabilisers, and reductions of the steroid dosing in collaboration with her oncology team, which also protected her from further manic relapses during continued chemotherapy. Established mental illness, a family history, and acquired brain injury may reflect risk factors for steroid-induced mania through currently unclear pathways. Future epidemiological studies could better confirm these observations, and basic neuroscience may look to further explore the role of extrinsic glucocorticoids in the pathophysiology of affective disorders.
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Affiliation(s)
- Jacob D King
- Division of Psychiatry, Imperial College London, London, UK.
- Central and North West London NHS Foundation Trust, London, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| | - Thomas Elliott
- Camden and Islington NHS Foundation Trust, London, UK
- East London Foundation Trust, London, UK
| | - Alexandra Pitman
- Camden and Islington NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
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10
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Montastruc F, Taillefer de Laportaliere T. Drug-induced psychiatric disorders: A pharmacovigilance update. Therapie 2024; 79:173-179. [PMID: 37957053 DOI: 10.1016/j.therap.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 11/15/2023]
Abstract
The psychiatric risks associated with drugs are sometimes one of the few restrictions on the use of certain drug classes, such as corticosteroids in patients with a history of severe psychotic episodes associated with this drug class. In this non-exhaustive review, we propose to deal with the most recent issues concerning psychiatric disorders induced by drugs and encountered in doctors' clinical practice. Firstly, we look at depressive disorders and suicide risks, secondly at psychotic and manic disorders and thirdly at anxiety and sleep disorders. While lot of drugs are associated with psychiatric disorders, the confounding by indication represents an important methodological gap since information on the psychiatric profile of patients is not always available. This is particularly the case for serotonin reuptake inhibitors and esketamine used as antidepressants. Recent pharmacovigilance concerns of psychiatric disorders emerged with montelukast, orexin receptor antagonists or cystic fibrosis transmembrane regulator (CFTR) modulators.
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Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Faculty of Medicine, 31000 Toulouse, France; CIC 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, 31000 Toulouse, France.
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11
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Hato H, Kaneko A, Maeda C, Sakata KI, Ono Y, Mizukami Y, Kono T, Kitagawa Y. Comparison between hangeshashinto and dexamethasone for IL-1α and β-defensin 1 production by human oral keratinocytes. J Oral Biosci 2024; 66:188-195. [PMID: 38278301 DOI: 10.1016/j.job.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Human β-defensin 1 (hBD-1) is a antimicrobial peptide that is constantly secreted by oral tissues. Hangeshashinto (HST), a traditional Japanese medicine, has been reported to be effective against stomatitis. This study aimed to clarify the profile of HST by comparing the system of production of interleukin-1α (IL-1α) and hBD-1 in human oral mucosal epithelial cells with dexamethasone (DEX), a steroid used for the treatment of stomatitis. METHODS Human oral keratinocytes (HOK) were treated with HST, DEX, or HST components (baicalein, baicalin, berberine, and glycyrrhizin) for 24 h, and subsequently cultured for 24 h with or without Pam3CSK4 or lipopolysaccharide (LPS). The cell supernatants, total RNA, and intracellular proteins were collected, and changes in IL-1α and hBD-1 protein production and gene expression were evaluated using ELISA and RT-PCR. The phosphorylation of NF-kB and the cell proliferative ability of HOK were evaluated by western blotting and XTT assay, respectively. RESULTS DEX (0.01-10 μM) significantly suppressed IL-1α and hBD-1 production induced by either Pam3CSK4 or LPS, and also decreased cell growth. In contrast, HST inhibited Pam3CSK4- and LPS-induced IL-1α production at a concentration range of 12.5-100 μg/mL without affecting the cell proliferative capacity and hBD-1 production of HOK. Baicalein and baicalin, which are flavonoid ingredients of HST, showed anti-IL-1α production. CONCLUSION HST may be useful as a therapeutic agent for stomatitis and other inflammatory diseases of the oral cavity.
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Affiliation(s)
- Hiroyuki Hato
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, 060-0813, Japan.
| | - Atsushi Kaneko
- Tsumura Kampo Research Laboratories, Tsumura & CO., 3586 Yoshiwara, Ami-machi, Ibaraki, 300-1192, Japan
| | - Chiho Maeda
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, 065-0033, Japan
| | - Ken-Ichiro Sakata
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, 060-0813, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, 065-0033, Japan; Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, 078-8510, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, 065-0033, Japan; Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, 078-8510, Japan
| | - Toru Kono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, 065-0033, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, 060-0813, Japan
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Hahn C, Budhram A, Alikhani K, AlOhaly N, Beecher G, Blevins G, Brooks J, Carruthers R, Comtois J, Cowan J, de Robles P, Hébert J, Kapadia RK, Lapointe S, Mackie A, Mason W, McLane B, Muccilli A, Poliakov I, Smyth P, Williams KG, Uy C, McCombe JA. Canadian Consensus Guidelines for the Diagnosis and Treatment of Autoimmune Encephalitis in Adults. Can J Neurol Sci 2024:1-21. [PMID: 38312020 DOI: 10.1017/cjn.2024.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Autoimmune encephalitis is increasingly recognized as a neurologic cause of acute mental status changes with similar prevalence to infectious encephalitis. Despite rising awareness, approaches to diagnosis remain inconsistent and evidence for optimal treatment is limited. The following Canadian guidelines represent a consensus and evidence (where available) based approach to both the diagnosis and treatment of adult patients with autoimmune encephalitis. The guidelines were developed using a modified RAND process and included input from specialists in autoimmune neurology, neuropsychiatry and infectious diseases. These guidelines are targeted at front line clinicians and were created to provide a pragmatic and practical approach to managing such patients in the acute setting.
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Affiliation(s)
- Christopher Hahn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Adrian Budhram
- Clinical Neurological Sciences, London Health Sciences Centre, London, ON, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada
| | - Katayoun Alikhani
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nasser AlOhaly
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Grayson Beecher
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - Gregg Blevins
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | - John Brooks
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Robert Carruthers
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jacynthe Comtois
- Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | - Juthaporn Cowan
- Division of Infectious Diseases, Department of Medicine Ottawa Hospital, Ottawa, ON, Canada
| | - Paula de Robles
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Julien Hébert
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Ronak K Kapadia
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sarah Lapointe
- Neurosciences, Universite de Montreal Faculte de Medecine, Montreal, QC, Canada
| | - Aaron Mackie
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Warren Mason
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brienne McLane
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Ilia Poliakov
- Division of Neurology, University of Saskatchewan College of Medicine, Saskatoon, SK, Canada
| | - Penelope Smyth
- Division of Neurology, University of Alberta, Edmonton, AB, Canada
| | | | - Christopher Uy
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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13
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Lyne SA, Yip K, Vasiliou VS, Katz DA, Richards P, Tieu J, Black RJ, Bridgewater S, Palmowski A, Beaton D, Maxwell LJ, Robson JC, Mackie SL, Goodman SM, Hill CL. Consensus of the definitions of the OMERACT glucocorticoid impact core domain set for people with rheumatic and musculoskeletal diseases. Semin Arthritis Rheum 2024; 64:152338. [PMID: 38134623 DOI: 10.1016/j.semarthrit.2023.152338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The Outcome Measures in Rheumatology (OMERACT) Glucocorticoid (GC) Impact Working Group has been working to develop a core domain set to measure the impact of GCs on patients living with rheumatic and musculoskeletal diseases. The mandatory domains previously identified for inclusion in all clinical trials measuring the GC effects include infection, bone fragility, mood disturbance, hypertension, diabetes, weight, fatigue, and mortality. Before progressing to instrument selection, the Working Group sought to establish precise definitions of all mandatory domains within the core domain set. METHODS OMERACT methodology was applied with the use of evidence and consensus-based decision making of all stakeholder groups (patient research partners, health care professionals, clinician researchers, industry members and methodologists) to develop detailed definitions for the broad domain, target domain and domain components, taking into consideration sources of variability that could affect measurement of the domain. The working group synthesized prior qualitative studies, quantitative work, and results from Delphi rounds, to develop a rich definition of 'what' is to be measured. RESULTS Between 2021 and 2023, the OMERACT Working Group on GC Impact conducted virtual meetings to establish domain definitions. First, we mapped each domain onto an OMERACT Core Area. All domains were primarily represented within the Pathophysiological Manifestations Core Area, except from Fatigue which was primarily Life Impact and Weight which spanned both Core Areas. Sources of variability included cultural factors, age, gender, education level, socioeconomic status, personal experiences, emotional state, and language barriers. The domain definitions will form the foundation for instrument selection and the initial step of domain / concept match and content validity in the OMERACT pillar of 'truth' before moving on to feasibility and discrimination. CONCLUSION The OMERACT GC Impact Working Group has developed and agreed upon detailed domain definitions for core domains. Future steps of the working group are to select instruments and develop the core outcome measurement set for clinical trials measuring the impact of GC on patients with rheumatic and musculoskeletal diseases.
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Affiliation(s)
- Suellen A Lyne
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Kevin Yip
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Joanna Tieu
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Rachel J Black
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Susan Bridgewater
- Rheumatology Research, Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Andriko Palmowski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Germany; Section for Biostatistics and Evidence-based Research, the Parker Institute, Frederiksberg and Bispebjerg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Dorcas Beaton
- Institute for Work & Health, University of Toronto, Canada
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Joanna C Robson
- Rheumatology Research, Centre for Health and Clinical Research, University of the West of England, Bristol, UK; Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan M Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
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14
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Do Y, Lee E, Chee CG, Lee JW. [Lumbar Facet Joint Injection: A Review of Efficacy and Safety]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:54-76. [PMID: 38362388 PMCID: PMC10864157 DOI: 10.3348/jksr.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Facet joint arthrosis is a progressive degenerative disease that is frequently associated with other spinal degenerative disorders such as degenerative disc disease or spinal stenosis. Lumbar facet joint arthrosis can induce pain in the proximal lower extremities. However, symptoms and imaging findings of "facet joint syndrome" are not specific as they mimic the pain from herniated discs or nerve root compression. Currently, evidence for therapeutic intra-articular lumbar facet joint injections is still considered low, with a weak recommendation strength. Nevertheless, some studies have reported therapeutic effectiveness of facet joint injections. Moreover, the use of therapeutic facet joint injections in clinical practice has increased. This review article includes opinions based on the authors' experience with facet joint injections. This review primarily aimed to investigate the efficacy of lumbar facet joint injections and consider their associated safety aspects.
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15
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Oklar M, Zorlutuna Kaymak N, Tanyildiz B, Tezcan ME, Şimşek Ş. Treatment Adherence Effect on the Visual Acuity of Behçet's Uveitis Patients. Ocul Immunol Inflamm 2023:1-9. [PMID: 38127797 DOI: 10.1080/09273948.2023.2288905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This study aimed to explore the relationship between treatment adherence, visual acuity, quality of life (QoL), depression, and anxiety levels in individuals with Behçet's uveitis (BU). METHODS A total of 55 BU patients and 55 healthy controls completed sociodemographic questionnaires, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF), Self-reported Questionnaire About Treatment Compliance, and the Morisky Medication Adherence Scale (MMAS). The scores obtained from these scales were analyzed to assess the relationship between treatment adherence, visual acuity, QoL, depression, and anxiety levels. RESULTS The results revealed that 36 (65.4%) of the 55 BU patients exhibited depressive symptoms, while 45 (81.8%) of them experienced symptoms of anxiety. Patients with BU demonstrated significantly higher BAI and BDI scores compared to the healthy control group (p < 0.001). Furthermore, the patient group reported lower mean scores across multiple domains of the WHOQOL-BREF questionnaire, including general health, psychological health, social relationships, and environment (p < 0.05). Moreover, a significant association was observed between low treatment adherence and lower values of best-corrected visual acuity (BCVA) (p < 0.05), as well as a higher frequency of uveitis attacks (p = 0.005). CONCLUSION Poor treatment adherence in BU patients has a negative effect on final visual acuity outcomes. Moreover, BU patients experience lower QoL and higher rates of depression and anxiety compared to the healthy control group. These findings highlight the importance of addressing treatment adherence and psychological well-being in the management of BU.
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Affiliation(s)
- Murat Oklar
- Department of Ophthalmology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Nilüfer Zorlutuna Kaymak
- Department of Ophthalmology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Burak Tanyildiz
- Department of Ophthalmology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Mehmet Engin Tezcan
- Department of Rheumatology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| | - Şaban Şimşek
- Department of Ophthalmology, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
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16
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Kato T, Okawa G, Tanaka KF, Mitsukura Y. Dexamethasone induces sleep disturbance in a dose-dependent manner in mice. PLoS One 2023; 18:e0296028. [PMID: 38117835 PMCID: PMC10732373 DOI: 10.1371/journal.pone.0296028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023] Open
Abstract
Synthetic corticosteroids, the most well-known anti-inflammatory drugs globally, are effective against inflammatory diseases despite their adverse effects that decrease a patient's quality of life (QOL). One of these effects is sleep disturbance, which causes other health issues and further diminishes the QOL. However, the acute effects of steroid drugs on sleep-wake issues are not fully understood and must be clarified in detail using experimental animals. Therefore, this study examines the dose-dependent effect of dexamethasone (DXM), one of the strongest steroid drugs, on the sleep-wake architecture of mice. We conducted acute DXM administration at multiple doses and 24-hour EEG/EMG recordings. Our results revealed that DXM increased the time spent in arousal and decreased that of NREM sleep, even at very low doses. These results imply that steroid-induced sleep disturbance must be addressed at any dosage.
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Affiliation(s)
- Tomonobu Kato
- Faculty of Science and Technology of Keio University, Yokohama, Kanagawa, Japan
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Gento Okawa
- Faculty of Science and Technology of Keio University, Yokohama, Kanagawa, Japan
| | - Kenji F. Tanaka
- Division of Brain Sciences, Institute for Advanced Medical Research, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasue Mitsukura
- Faculty of Science and Technology of Keio University, Yokohama, Kanagawa, Japan
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17
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Chen SJ, Morin CM, Ivers H, Wing YK, Partinen M, Merikanto I, Holzinger B, Espie CA, De Gennaro L, Dauvilliers Y, Chung F, Yordanova J, Vidović D, Reis C, Plazzi G, Penzel T, Nadorff MR, Matsui K, Mota-Rolim S, Leger D, Landtblom AM, Korman M, Inoue Y, Hrubos-Strøm H, Chan NY, Bjelajac AK, Benedict C, Bjorvatn B. The association of insomnia with long COVID: An international collaborative study (ICOSS-II). Sleep Med 2023; 112:216-222. [PMID: 37922783 DOI: 10.1016/j.sleep.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection. METHODS Data were collected cross-sectionally (May-Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18-99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety. RESULTS COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07-1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50-2.66). CONCLUSIONS The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.
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Affiliation(s)
- Si-Jing Chen
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada; Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Charles M Morin
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada.
| | - Hans Ivers
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Markku Partinen
- Department of Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland; Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland
| | - Ilona Merikanto
- Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, Medical University of Vienna, Wien, Postgraduate Sleep Coaching, Vienna, Austria
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy; IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, Montpellier, France
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Juliana Yordanova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Domagoj Vidović
- University Psychiatric Hospital Vrapče, Bolnička Cesta 32, 10000, Zagreb, Croatia
| | - Catia Reis
- Universidade Católica Portuguesa, Católica Research Centre for Psychological-Family and Social Wellbeing, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi State, MS, USA
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Sergio Mota-Rolim
- Brain Institute, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Damien Leger
- APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France; Université Paris Cité, VIFASOM (EA 7331 Vigilance Fatigue Sommeil et Santé Publique), Paris, France
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | - Harald Hrubos-Strøm
- Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Christian Benedict
- Department of Pharmaceutical Biosciences, Molecular Neuropharmacology, Uppsala University, Uppsala, Sweden
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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18
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Gu SL, Maier T, Moy AP, Dusza S, Faleck DM, Shah NJ, Lacouture ME. IL12/23 Blockade with Ustekinumab as a Treatment for Immune-Related Cutaneous Adverse Events. Pharmaceuticals (Basel) 2023; 16:1548. [PMID: 38004414 PMCID: PMC10674871 DOI: 10.3390/ph16111548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Immune-related cutaneous adverse events (ircAEs) are frequent and may reduce quality of life and consistent dosing. IL12/23 has been implicated in psoriasis, which is reminiscent of the psoriasiform/lichenoid ircAE phenotype. We report the use of ustekinumab as a therapeutic option. Methods: Patients at Memorial Sloan Kettering Cancer Center, New York, who received immune checkpoint inhibitors and were treated with ustekinumab or had the keywords "ustekinumab" or "Stelara" in their clinical notes between 1 March 2017 and 1 December 2022 were retrospectively identified via a database query. Documentation from initial and follow-up visits was manually reviewed, and response to ustekinumab was categorized into complete cutaneous response (CcR, decrease to CTCAE grade 0), partial cutaneous response (PcR, any decrease in CTCAE grade exclusive of decrease to grade 0), and no cutaneous response (NcR, no change in CTCAE grade or worsening). Labs including complete blood count (CBC), cytokine panels, and IgE were obtained in a subset of patients as standard of care. Skin biopsies were reviewed by a dermatopathologist. Results: Fourteen patients with psoriasiform (85.7%), maculopapular (7.1%), and pyoderma gangrenosum (7.1%) ircAEs were identified. Ten (71.4%) receiving ustekinumab had a positive response to treatment. Among these 10 responders, 4 (40%) demonstrated partial cutaneous response and 6 (60%) demonstrated complete cutaneous resolution. Six patients (42.9%) experienced interruptions to their checkpoint inhibitor treatment as a result of intolerable ircAEs, and following ircAE management with ustekinumab, two (33.3%) were successfully rechallenged with their checkpoint inhibitors. On histopathology, patients primarily had findings of interface or psoriasiform dermatitis. No patients reported an adverse event related to ustekinumab. Conclusions: Ustekinumab showed a benefit in a subset of patients with psoriasiform/lichenoid ircAEs. No safety signals were identified. However, further prospective randomized controlled trials are needed to confirm our findings.
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Affiliation(s)
- Stephanie L. Gu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (S.L.G.)
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10021, USA
| | - Tara Maier
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (S.L.G.)
| | - Andrea P. Moy
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (S.L.G.)
| | - David M. Faleck
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | - Neil J. Shah
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (S.L.G.)
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10021, USA
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McDermott R. Trump's COVID-19 diagnosis and presidential illness. Politics Life Sci 2023; 42:319-321. [PMID: 37987576 DOI: 10.1017/pls.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
President Donald Trump's COVID-19 illness, and the treatments he received, raise serious concerns about the adequacy of the Twenty-Fifth Amendment to handle cases of transient presidential incapacity. This is particularly challenging when the president refuses to acknowledge any impairment and resists any attempt to constrain his powers, even temporarily.
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Van Steenhoven RW, de Vries JM, Bruijstens AL, Paunovic M, Nagtzaam MM, Franken SC, Bastiaansen AE, De Bruijn MA, Van Sonderen A, Schreurs MWJ, Gardeniers M, Verdijk RM, Balvers RK, Sillevis Smitt PA, Neuteboom RF, Titulaer MJ. Mimics of Autoimmune Encephalitis: Validation of the 2016 Clinical Autoimmune Encephalitis Criteria. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200148. [PMID: 37582614 PMCID: PMC10427145 DOI: 10.1212/nxi.0000000000200148] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND OBJECTIVES The clinical criteria for autoimmune encephalitis (AE) were proposed by Graus et al. in 2016. In this study, the AE criteria were validated in the real world, and common AE mimics were described. In addition, criteria for probable anti-LGI1 encephalitis were proposed and validated. METHODS In this retrospective cohort study, patients referred to our national referral center with suspicion of AE and specific neuroinflammatory disorders with similar clinical presentations were included from July 2016 to December 2019. Exclusion criteria were pure cerebellar or peripheral nerve system disorders. All patients were evaluated according to the AE criteria. RESULTS In total, 239 patients were included (56% female; median age 42 years, range 1-85). AE was diagnosed in 104 patients (44%) and AE mimics in 109 patients (46%). The most common AE mimics and misdiagnoses were neuroinflammatory CNS disorders (26%), psychiatric disorders (19%), epilepsy with a noninflammatory cause (13%), CNS infections (7%), neurodegenerative diseases (7%), and CNS neoplasms (6%). Common confounding factors were mesiotemporal lesions on brain MRI (17%) and false-positive antibodies in serum (12%). Additional mesiotemporal features (involvement extralimbic structures, enhancement, diffusion restriction) were observed more frequently in AE mimics compared with AE (61% vs 24%; p = 0.005). AE criteria showed the following sensitivity and specificity: possible AE, 83% (95% CI 74-89) and 27% (95% CI 20-36); definite autoimmune limbic encephalitis (LE), 10% (95% CI 5-17) and 98% (95% CI 94-100); and probable anti-NMDAR encephalitis, 50% (95% CI 26-74) and 96% (95% CI 92-98), respectively. Specificity of the criteria for probable seronegative AE was 99% (95% CI 96-100). The newly proposed criteria for probable anti-LGI1 encephalitis showed a sensitivity of 66% (95% CI 47-81) and specificity of 96% (95% CI 93-98). DISCUSSION AE mimics occur frequently. Common pitfalls in AE misdiagnosis are mesiotemporal lesions (predominantly with atypical features) and false-positive serum antibodies. As expected, the specificity of the criteria for possible AE is low because these criteria represent the minimal requirements for entry in the diagnostic algorithm for AE. Criteria for probable AE (-LGI1, -NMDAR, seronegative) and definite autoimmune LE are applicable for decisions on immunotherapy in early disease stage, as specificity is high.
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Affiliation(s)
- Robin W Van Steenhoven
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juna M de Vries
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Arlette L Bruijstens
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuela Paunovic
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mariska M Nagtzaam
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Suzanne C Franken
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anna E Bastiaansen
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke A De Bruijn
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Agnes Van Sonderen
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mayke Gardeniers
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert M Verdijk
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rutger K Balvers
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter A Sillevis Smitt
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rinze F Neuteboom
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Schiffmann N, Liang Y, Nemcovsky CE, Almogy M, Halperin-Sternfeld M, Gianneschi NC, Adler-Abramovich L, Rosen E. Enzyme-Responsive Nanoparticles for Dexamethasone Targeted Delivery to Treat Inflammation in Diabetes. Adv Healthc Mater 2023; 12:e2301053. [PMID: 37498238 DOI: 10.1002/adhm.202301053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/25/2023] [Indexed: 07/28/2023]
Abstract
Diabetes is a global epidemic accompanied by impaired wound healing and increased risk of persistent infections and resistance to standard treatments. Therefore, there is an immense need to develop novel methods to specifically target therapeutics to affected tissues and improve treatment efficacy. This study aims to use enzyme-responsive nanoparticles for the targeted delivery of an anti-inflammatory drug, dexamethasone, to treat inflammation in diabetes. These nanoparticles are assembled from fluorescently-labeled, dexamethasone-loaded peptide-polymer amphiphiles. The nanoparticles are injected in vivo, adjacent to labeled collagen membranes sub-periosteally implanted on the calvaria of diabetic rats. Following their implantation, collagen membrane resorption is linked to inflammation, especially in hyperglycemic individuals. The nanoparticles show strong and prolonged accumulation in inflamed tissue after undergoing a morphological switch into microscale aggregates. Significantly higher remaining collagen membrane area and less inflammatory cell infiltration are observed in responsive nanoparticles-treated rats, compared to control groups injected with free dexamethasone and non-responsive nanoparticles. These factors indicate improved therapeutic efficacy in inflammation reduction. These results demonstrate the potential use of enzyme-responsive nanoparticles as targeted delivery vehicles for the treatment of diabetic and other inflammatory wounds.
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Affiliation(s)
- Nathan Schiffmann
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Yifei Liang
- Department of Chemistry, International Institute for Nanotechnology, Simpson-Querrey Institute, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
| | - Carlos E Nemcovsky
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Michal Almogy
- Department of Periodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Michal Halperin-Sternfeld
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Nathan C Gianneschi
- Department of Chemistry, International Institute for Nanotechnology, Simpson-Querrey Institute, Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
- Department of Materials Science & Engineering, Department of Biomedical Engineering, Department of Pharmacology, Northwestern University, Evanston, IL, 60208, USA
| | - Lihi Adler-Abramovich
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, and The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Eyal Rosen
- Department of Endodontology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel
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22
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Cao Y, Song Y, Ding Y, Ni J, Zhu B, Shen J, Miao L. The role of hormones in the pathogenesis and treatment mechanisms of delirium in ICU: The past, the present, and the future. J Steroid Biochem Mol Biol 2023; 233:106356. [PMID: 37385414 DOI: 10.1016/j.jsbmb.2023.106356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
Delirium is an acute brain dysfunction. As one of the common psychiatric disorders in ICU, it can seriously affect the prognosis of patients. Hormones are important messenger substances found in the human body that help to regulate and maintain the function and metabolism of various tissues and organs. They are also one of the most commonly used drugs in clinical practice. Recent evidences suggest that aberrant swings in cortisol and non-cortisol hormones might induce severe cognitive impairment, eventually leading to delirium. However, the role of hormones in the pathogenesis of delirium still remains controversial. This article reviews the recent research on risk factors of delirium and the association between several types of hormones and cognitive dysfunction. These mechanisms are expected to offer novel ideas and clinical relevance for the treatment and prevention of delirium.
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Affiliation(s)
- Yuchun Cao
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuwei Song
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuan Ding
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Jiayuan Ni
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Bin Zhu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Jianqin Shen
- Department of Blood Purification Center, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China.
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China.
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23
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Elavia Z, Patra SS, Kumar S, Inban P, Yousuf MA, Thassu I, Chaudhry HA. Acute Psychosis and Mania: An Uncommon Complication of Dengue Fever. Cureus 2023; 15:e47425. [PMID: 38022096 PMCID: PMC10658754 DOI: 10.7759/cureus.47425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Dengue fever is primarily known as a mosquito-borne viral infection that causes a range of physical symptoms, ranging from myalgia to bleeding tendencies. However, there is growing recognition of its potential to trigger psychiatric manifestations, although such cases remain relatively rare. We report a case of acute dengue fever in a 25-year-old male who developed mania and psychotic symptoms after one week of infection. A comprehensive diagnostic workup, including laboratory tests, including cerebrospinal fluid analysis, and neuroimaging, confirmed the absence of organic causes for his psychiatric symptoms, except for his prior exposure to the dengue virus. The patient was initiated on mood stabilizers and antipsychotic medications, leading to a gradual improvement in his mental health.
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Affiliation(s)
- Zenia Elavia
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | | | - Sumit Kumar
- Medicine, Armed Forces Medical College, Pune, IND
| | - Pugazhendi Inban
- General Medicine, Government Medical College, Omandurar, Chennai, IND
| | | | - Ishaan Thassu
- Internal Medicine, Calcutta National Medical College, Kolkata, IND
| | - Hassan A Chaudhry
- Biological Sciences, Temple University, Philadelphia, USA
- Medicine, Medical University of Lublin, Lublin, POL
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Msalbi D, Jellali F, Elloumi-Mseddi J, Hakim B, Sahli E, Aifa S. Toxicity evaluation of synthetic glucocorticoids against breast cancer cell lines MDA-MB-231, MCF-7 and human embryonic kidney HEK293. Med Oncol 2023; 40:309. [PMID: 37773302 DOI: 10.1007/s12032-023-02189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/07/2023] [Indexed: 10/01/2023]
Abstract
In this study, we conducted a comprehensive assessment of the cytotoxicity of three glucocorticoids, namely Hydrocortisone, Dexamethasone, and Methylprednisolone, using three different human cell lines: MDA-MB-231, MCF-7 (both adenocarcinoma cell lines), and HEK293 (kidney epithelial cell line). At lower concentrations exceeding 50 µM, we did not observe any significant toxic effects of these glucocorticoids. However, when exposed to higher concentrations, Hydrocortisone exhibited dose-dependent cytotoxic effects on all three cell lines, with calculated IC50 values of 12 ± 0.6 mM for HEK293, 2.11 ± 0.05 mM for MDA-MB-231, and 2.73 ± 0.128 mM for MCF-7 cells after 48 h of exposure. Notably, Hydrocortisone, at its respective IC50 concentrations, demonstrated an inhibitory effect on the proliferation of the cancer cell lines, as evidenced by a substantial reduction in BrdU absorbance in a dose-dependent manner, coupled with a markedly reduced rate of colony formation in treated cells. Furthermore, Hydrocortisone exhibited remarkable anti-migratory properties in MDA-MB-231 and MCF-7 cells, and it induced cell cycle arrest in the SubG1 phase in MDA-MB-231 cells. In addition to these effects, Hydrocortisone triggered apoptosis in both cancer cell types, leading to observable morphological changes. This apoptotic response was characterized by a significant increase in the activity of caspase-3, which was time-dependent. Additionally, Hydrocortisone downregulated the expression of anti-apoptotic Bcl-2 proteins. In summary, our findings underscore the safety of clinical doses in terms of cell toxicity meanwhile increased concentration were showing an anti-proliferative potential of Hydrocortisone, particularly against adenocarcinoma breast cancer cell lines.
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Affiliation(s)
- Dhouha Msalbi
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia.
| | - Fatma Jellali
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia
| | - Jihene Elloumi-Mseddi
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia
| | - Bochra Hakim
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia
| | - Emna Sahli
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia
| | - Sami Aifa
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour Road Km 6, BP 1177, 3018, Sfax, Tunisia
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Mota Freitas RFD, Guerra APBM. Behçet Disease and Bipolar Disorder: A Case Report and Review. J Psychiatr Pract 2023; 29:421-425. [PMID: 37624756 DOI: 10.1097/pra.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Behçet disease (BD) is a rare, multifactorial condition with multiple manifestations affecting various systems. Bipolar disorder has been reported as more frequent in individuals with BD than in the general population. We report a case of BD and bipolar disorder and summarize previous findings in the literature concerning this topic. Our case illustrates the relevance of managing comorbid BD and bipolar disorder. It is crucial to manage both conditions to maximize the patient's quality of life. Clinicians should be aware of the risk of bipolar disorder in patients with BD and vice versa and an integrated model of care could be useful. The exact biological and psychological aspects mediating the association between the 2 diagnoses remain unclear. Further, larger, prospective studies could help better clarify this relationship, leading to new advances in diagnosis and treatment.
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26
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Bahsoun A, Fakih Y, Zareef R, Bitar F, Arabi M. Corticosteroids in COVID-19: pros and cons. Front Med (Lausanne) 2023; 10:1202504. [PMID: 37644981 PMCID: PMC10461317 DOI: 10.3389/fmed.2023.1202504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
The wide and rapid spread of the COVID-19 pandemic has placed an unanticipated burden on the global healthcare sector. This necessitated a swift response from the international community to reach a solution. Efforts were made in parallel to develop preventative and therapeutic modalities. Since then, drug repurposing has blossomed as a potentially rapid resolution and has included various agents with anti-viral and anti-inflammatory properties. Corticosteroids, being potent anti-inflammatory agents, have been placed under extensive investigation. Various trials have recorded the beneficial outcome of corticosteroids in decreasing the mortality and morbidity of COVID-19. With the high pace of escalating events, the quality and study design of clinical trials are varied. Therefore, this study aims to explore the role of corticosteroids in COVID-19 disease. It inspects the molecular, pharmacologic, and clinical proof behind this theory.
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Affiliation(s)
- Aymen Bahsoun
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yeva Fakih
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Tamene S, Dalhoff K, Schwarz P, Backer V, Aanaes K. Systemic corticosteroids in treatment of chronic rhinosinusitis-A systematic review. Eur Clin Respir J 2023; 10:2240511. [PMID: 37554567 PMCID: PMC10405757 DOI: 10.1080/20018525.2023.2240511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
Purpose When first-line chronic rhinosinusitis (CRS) treatment fails, patients can either be treated with oral or injected systemic corticosteroids. Although the EPOS and international guidelines for CRS do not mention injected corticosteroids, it is commonly used by ear, nose, and throat specialists. While the risks of systemic corticosteroids, in general, are known, the pros and cons of injected and oral corticosteroids (OCS) in CRS treatment are unclear. Methods A systematic review of studies that report the effects and/or side effects of injected and oral corticosteroids in the treatment of CRS was made according to the PRISMA guidelines. Results Altogether, 48 studies were included, only five studies reported on injected corticosteroids, and five attended with side effects. Three studies found beneficial effects of OCS perioperatively on sinus surgery, while four articles found no effect. Nineteen articles reported that OCS resulted in an improvement in symptoms. Two articles presented a longer-lasting effect of injected corticosteroids than OCS. Three studies reported adverse side effects of systemic corticosteroids, while two studies showed no adverse side effects. One study showed less adrenal suppression after injected corticosteroids compared to OCS. The evidence is not strong but shows a positive effect of systemic corticosteroids that lasts longer with injections. Conclusion Although systemic corticosteroids are widely used to treat CRS, there is a lack of studies comparing the OCS and injected corticosteroids. The evidence is sparse, however, injected steroids show longer effects with fewer side effects. An RCT study is needed to compare OCS and injected corticosteroids.
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Affiliation(s)
- Sarah Tamene
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Rigshospitalet and Faculty of Health Sciences, University of Copenhagen, Denmark, Copenhagen
| | - Vibeke Backer
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center of Physical Activity Research (CFAS), Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Kasper Aanaes
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Madrigal M, Fernández PL, Lleonart R, Carreño L, Villalobos Gorday KA, Rodríguez E, de Cupeiro K, Restrepo CM, Rao KSJ, Riordan NH. Comparison of Cost and Potency of Human Mesenchymal Stromal Cell Conditioned Medium Derived from 2- and 3-Dimensional Cultures. Bioengineering (Basel) 2023; 10:930. [PMID: 37627815 PMCID: PMC10451979 DOI: 10.3390/bioengineering10080930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Mesenchymal stromal cell (MSC)-derived products, such as trophic factors (MTFs), have anti-inflammatory properties that make them attractive for cell-free treatment. Three-dimensional (3D) culture can enhance these properties, and large-scale expansion using a bioreactor can reduce manufacturing costs. Three lots of MTFs were obtained from umbilical cord MSCs produced by either monolayer culture (Monol MTF) or using a 3D microcarrier in a spinner flask dynamic system (Bioreactor MTF). The resulting MTFs were tested and compared using anti-inflammatory potency assays in two different systems: (1) a phytohemagglutinin-activated peripheral blood mononuclear cell (PBMNC) system and (2) a lipopolysaccharide (LPS)-activated macrophage system. Cytokine expression by macrophages was measured via RT-PCR. The production costs of hypothetical units of anti-inflammatory effects were calculated using the percentage of TNF-α inhibition by MTF exposure. Bioreactor MTFs had a higher inhibitory effect on TNF (p < 0.01) than monolayer MTFs (p < 0.05). The anti-inflammatory effect of Bioreactor MTFs on IL-1β, TNF-α, IL-8, IL-6, and MIP-1 was significantly higher than that of monolayer MTFs. The production cost of 1% inhibition of TNF-α was 11-40% higher using monolayer culture compared to bioreactor-derived MTFs. A 3D dynamic culture was, therefore, able to produce high-quality MTFs, with robust anti-inflammatory properties, more efficiently than monolayer static systems.
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Affiliation(s)
- Marialaura Madrigal
- MediStem Panama Inc., Panama City 7144, Panama
- Department of Biotechnology, Acharya Nagarjuna University, Guntur 522510, India
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City 7144, Panama
| | - Patricia L. Fernández
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City 7144, Panama
| | - Ricardo Lleonart
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City 7144, Panama
| | | | | | | | | | - Carlos M. Restrepo
- Centro de Biología Celular y Molecular de Enfermedades, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), Panama City 7144, Panama
| | - K. S. Jagannatha Rao
- Department of Biotechnology, Konenru Lakshmaiah Education Foundation (KLEF) deemed to be University, Vaddeswaram 522302, India
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Fernando A, Tokell M, Ishak Y, Love J, Klammer M, Koh M. Mental health needs in cancer - a call for change. Future Healthc J 2023; 10:112-116. [PMID: 37786642 PMCID: PMC10540791 DOI: 10.7861/fhj.2023-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
There is continued under-recognition and underinvestment in the psychological and mental health aspects of care for cancer patients, despite the fact that increased patient survival rates in cancer mean that patients are living longer after diagnosis. In this article, we advocate for better integration and joint working between clinicians across all areas, including education and research, impacting positively on the outcomes and care of cancer patients.
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Affiliation(s)
- Asanga Fernando
- St George's University Hospitals NHS Foundation Trust, London, UK, and honorary senior lecturer, St George's, University of London, London, UK
| | | | - Yostina Ishak
- St George's University Hospitals NHS Foundation Trust, London, UK, and clinical pharmacology tutor, St George's, University of London, London, UK
| | - Jenna Love
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Matthias Klammer
- St George's University Hospitals NHS Foundation Trust, London, UK and honorary senior lecturer, St George's, University of London, London, UK
| | - Mickey Koh
- St George's University Hospitals NHS Foundation Trust, London, UK, and St George's, University of London, London, UK
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Dudley MB. Aerospace Medicine Clinic. Aerosp Med Hum Perform 2023; 94:561-564. [PMID: 37349920 DOI: 10.3357/amhp.6182.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
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Aranas DR, Tangalin JA. Steroid-induced psychosis related to pituitary adenoma status post trans-sphenoid excision and a history of psychiatric illness: A case report. World J Neurol 2023; 9:28-36. [DOI: 10.5316/wjn.v9.i3.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Steroid-induced psychosis is a common adverse effect of steroid exposure. Reported cases were mostly related to rheumatologic disease. Despite its high incidence, there is only one case reported related to perioperative steroid replacement for pituitary adenoma surgery. This manuscript presents the second case of such and compared the two with the latest literature review of steroid-induced psychosis.
CASE SUMMARY This is a case of an adult male with a chief complaint of auditory hallucinations and was referred by Neurosurgery to Psychiatry Out-patient department. He was diagnosed with pituitary adenoma who underwent trans-sphenoid excision of the mass from which steroid exposure led to steroid-induced psychosis. Also, patient had a history of psychiatric illness of severe depressive episode. At the out-patient department, patient was started on antipsychotic, Risperidone, which led to eventual improvement of his symptoms.
CONCLUSION The two cases of pituitary adenoma surgery with steroid-induced psychosis had almost similar clinical profile with the latest literature review of steroid-induced psychosis. However, the present case highlights the association of psychiatric illness in predisposing an individual in developing it. Also, this manuscript emphasizes that early recognition of steroid-induced psychosis leads to better prognosis. Multispecialty treatment is vital in the holistic management of the patient with timely referral and close coordination.
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Affiliation(s)
- Denmarc Romero Aranas
- Department of Psychiatry, Baguio General Hospital - Medical Center, Baguio 2600, Benguet, Philippines
| | - Jovy Anne Tangalin
- Department of Psychiatry, Baguio General Hospital - Medical Center, Baguio 2600, Benguet, Philippines
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Regli LKP, Huijs SMH, Pasmans RCOS, Leue C, Dijkstra JB, Eekers DBP, Hovinga KE, Anten MHME, Hoeben A, Broen MPG. Incidence of clinically relevant psychiatric symptoms during glioblastoma treatment: an exploratory study. J Neurooncol 2023; 163:185-194. [PMID: 37162667 PMCID: PMC10232638 DOI: 10.1007/s11060-023-04326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE In addition to neurological symptoms glioblastoma (GBM) patients can experience psychiatric complaints, which are often hard to recognize and difficult to treat. Research on psychiatric symptoms during glioblastoma treatment is limited, but can have significant impact on quality of life, treatment processes and even survival. The aim of this study is to explore the incidence of clinically relevant psychiatric symptoms, during glioblastoma treatment and active surveillance. METHODS Medical records of 302 GBM patients were reviewed from diagnostic surgery until discontinuation of treatment or active surveillance. Clinical relevance was defined as psychiatric symptoms that interfered with the oncological treatment and required referral to a psychiatrist. "Referred" versus "non-referred" GBM patients were compared using the Pearson Chi-Square test, Fisher's Exact Test or Mann Whitney-U test. RESULTS Psychiatric symptoms occurred in 11.5% of patients during glioblastoma treatment or active surveillance, most often mood or behavioral symptoms, followed by psychotic symptoms. Referral occurred mainly during concomitant chemoradiation or adjuvant chemotherapy (64.3%). In 28.6% of patients psychiatric symptoms were thought to be attributive to medication. Treatment was discontinued in 17.9% of patients and temporarily interrupted in 3.6%. Possible risk factors included male gender, history of psychiatric disorder, postoperative delirium, non-frontal tumor location, anti-epileptic drug use at baseline and corticosteroid initiation during treatment. CONCLUSION The found incidence of 11.5% and the high number of patients discontinuing treatment due to psychiatric symptoms justify more research in this, to date, understudied topic in scientific literature. Further prospective studies are needed to identify risk factors and unravel possible effects on survival.
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Affiliation(s)
- L K P Regli
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - S M H Huijs
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - R C O S Pasmans
- Department of Neurology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - C Leue
- Department Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNS, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - J B Dijkstra
- Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D B P Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - K E Hovinga
- Department of Neurosurgery, Maastricht UMC+, Maastricht, The Netherlands
| | - M H M E Anten
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - A Hoeben
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Medical Oncology, Maastricht UMC+, Maastricht, The Netherlands
| | - M P G Broen
- Department of Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
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Bisgaard TH, Poulsen G, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Longitudinal trajectories of anxiety, depression, and bipolar disorder in inflammatory bowel disease: a population-based cohort study. EClinicalMedicine 2023; 59:101986. [PMID: 37197708 PMCID: PMC10184046 DOI: 10.1016/j.eclinm.2023.101986] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/19/2023] Open
Abstract
Background Inflammatory bowel disease (IBD) is associated with psychiatric diseases, but it is unclear to what degree patients with IBD are affected over their lifetime. We aimed to longitudinally investigate the risk of anxiety, depression, and bipolar disorder before and after IBD diagnosis to understand the full burden of these diseases in patients with IBD. Methods In this population based cohort study, we identified 22,103 patients diagnosed with IBD between January 1, 2003 and December 31, 2013 in the Danish National registers and 110,515 matched reference individuals from the general population. We calculated yearly prevalence of hospital contacts for anxiety, depression, and bipolar disorder and dispensed prescriptions for antidepressants from five years before to ten years after IBD diagnosis. We used logistic regression to calculate prevalence odds ratios (OR) for each outcome prior to IBD diagnosis, and Cox regression to calculate hazard ratios (HR) of new outcomes after IBD diagnosis. Findings During >150,000 person years follow-up, patients with IBD had higher risk of anxiety (OR 1.4; 95% confidence interval (CI) 1.2-1.7) and depression (OR 1.4; 95% CI 1.3-1.6) starting at least five years before and continuing until at least ten years after IBD diagnosis (HR 1.3; 95% CI 1.1-1.5 for anxiety and HR 1.5; 95% CI 1.4-1.7 for depression). The risk was particularly high around IBD diagnosis and in patients diagnosed with IBD after the age of 40 years. We found no association between IBD and bipolar disorder. Interpretation This population-based study suggests that anxiety and depression are clinically significant comorbidities of IBD both before and after IBD diagnosis, which warrant thorough evaluation and management, particularly around the time of IBD diagnosis. Funding The Danish National Research Foundation [DNRF148], the Lundbeck Foundation [R313-2019-857], and Aage og Johanne Louis-Hansens Fond [9688-3374 TJS].
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Affiliation(s)
- Tania H. Bisgaard
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
- Corresponding author. Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, A.C. Meyers Vaenge 15, DK-2450, Copenhagen, SV, Denmark.
| | - Gry Poulsen
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Kristine H. Allin
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Laurie Keefer
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tine Jess
- Center for Molecular Prediction of Inflammatory Bowel Disease, PREDICT, Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
- Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
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Grammatikopoulou MG, Syrmou V, Lioliopoulou ML, Gkiouras K, Simopoulou T, Katsiari CG, Vassilakou T, Bogdanos DP. Anorexia Nervosa in Juvenile Systemic Lupus Erythematosus (SLE): A Causality Dilemma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:697. [PMID: 37189946 PMCID: PMC10137086 DOI: 10.3390/children10040697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/26/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
Juvenile-onset systemic lupus erythematosus (jSLE) is an autoimmune disorder with multifaceted clinical findings in different organ systems. Neuropsychiatric manifestations affect more than half of SLE patients, and there is increasing evidence that anorexia nervosa (AN), a feeding and eating disorder (FED) characterized by significantly reduced energy intake, is among them. Herein, a review of the literature on the potential association between jSLE and AN was performed. Reported clinical cases were identified, and putative pathophysiological mechanisms were sought that could potentially explain the observed relationship between these two pathological entities. Four reports of isolated cases and a case series including seven patients were identified. In this limited patient pool, the diagnosis of AN preceded that of SLE in the majority of cases, whereas in all cases both entities were diagnosed within a time span of two years. Many explanations for the observed relationships have been proposed. AN has been associated with the stress of chronic disease diagnosis; on the other hand, the chronic inflammation associated with AN may contribute to the development/appearance of SLE. Adverse childhood experiences, concentrations of leptin, shared autoantibodies, and genetic traits appear to be important factors in this well-established interplay. In essence, it seems important to increase clinician awareness of the concomitant development of AN and SLE and invite further research on the subject.
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Affiliation(s)
- Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Vasiliki Syrmou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Maria-Lydia Lioliopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Konstantinos Gkiouras
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Theodora Simopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Christina G. Katsiari
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Dimitrios P. Bogdanos
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
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Alturaymi MA, Almadhi OF, Alageel YS, Bin Dayel M, Alsubayyil MS, Alkhateeb BF. The Association Between Prolonged Use of Oral Corticosteroids and Mental Disorders: Do Steroids Have a Role in Developing Mental Disorders? Cureus 2023; 15:e37627. [PMID: 37200642 PMCID: PMC10185922 DOI: 10.7759/cureus.37627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
Background The use of oral corticosteroids has been linked to a variety of mental health problems, including mental disorders such as anxiety, depression, and psychosis. In a recent study, researchers investigated the prevalence of steroid-induced neuropsychiatric side effects in a population of patients receiving steroid treatment. This study aimed to evaluate the association between steroids and mental disorders among patients in King Abdulaziz Medical City. Methods A retrospective descriptive study was conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia from January 2016 to November 2022. Data were acquired from all the registered inpatients and outpatients who were using oral corticosteroids for more than 28 days. Data were entered into the Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp, Armonk, NY) for analysis after data collection. The numerical data were presented as mean and standard deviation and a test of significance was applied (p<0.05). For categorical data, frequency and percentages were computed. The chi-square test of significance was applied across groups and the test of significance was computed (p<0.05). Results The study included 3138 patients who were using oral corticosteroids for more than 28 days, and electronic medical records were screened for the presence of a concurrent mental disorder. Moreover, 142 out of 3138 developed a mental disorder after the prolonged use of oral corticosteroids. The most commonly reported mental disorder was anxiety followed by psychological sexual dysfunction and depressive disorders. Gender, age, and type of steroid prescribed had a significant association (p<0.001) with the development of psychiatric adverse events. Conclusion These findings highlight the importance of monitoring patients who are receiving oral corticosteroid treatment for signs of mental health problems and adjusting treatment as needed. Healthcare providers should also educate patients about the potential risks associated with corticosteroids and encourage them to seek medical attention if they experience any mental health symptoms.
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Affiliation(s)
- Mouath A Alturaymi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Omar F Almadhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Yazeed S Alageel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Majed Bin Dayel
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed S Alsubayyil
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Badr F Alkhateeb
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Ogyu K, Mashima Y, Nishi A, Kusudo K, Kato H, Kurose S, Uchida H, Fujisawa D, Mimura M, Takeuchi H. Intravenous pulse methylprednisolone and corticosteroid-induced psychiatric disorders: A retrospective study. J Psychosom Res 2023; 167:111179. [PMID: 36801660 DOI: 10.1016/j.jpsychores.2023.111179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Corticosteroids can cause psychiatric symptoms known as corticosteroid-induced psychiatric disorders (CIPDs). Little is known regarding the relationship between intravenous pulse methylprednisolone (IVMP) and CIPDs. Therefore, we aimed to examine the relationship between corticosteroid use and CIPDs in this retrospective study. METHODS Patients who were prescribed corticosteroids during their hospitalization at a university hospital and referred to our consultation-liaison service were selected. Patients diagnosed with CIPDs according to the ICD-10 codes were included. The incidence rates were compared between patients receiving IVMP and those receiving any other corticosteroid treatment. The association between IVMP and CIPDs was examined by classifying patients with CIPD into three groups according to the use of IVMP and timing of CIPD onset. RESULTS Of the 14,585 patients who received corticosteroids, 85 were diagnosed with CIPDs, with an incidence rate of 0.6%. Among the 523 patients who received IVMP, the incidence rate of CIPDs was 6.1% (n = 32), which was significantly higher than that in patients receiving any other corticosteroid treatment. Among the patients with CIPDs, 12 (14.1%) developed CIPDs during IVMP, 19 (22.4%) developed CIPDs after IVMP, and 49 (57.6%) developed CIPDs without IVMP. There was no significant difference in the doses at the time of CIPD improvement among the three groups when we excluded one patient whose CIPD improved during IVMP. CONCLUSION Patients receiving IVMP were more likely to develop CIPDs than those who did not receive IVMP. Furthermore, corticosteroid doses at the time of improvement of CIPDs were constant, regardless of IVMP use.
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Affiliation(s)
- Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Akira Nishi
- Department of Psychiatry, Sakuragaoka Memorial Hospital, Tokyo, Japan
| | - Keisuke Kusudo
- Department of Psychiatry, National Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Hideo Kato
- Department of Epileptology, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Functional Brain Imaging, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Division of Clinical Safety, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
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Koletsos N, Dipla K, Triantafyllou A, Dolgyras P, Aslanidis S, Zafeiridis A, Galanopoulou V, Douma S, Gkaliagkousi E. Depression in systemic lupus erythematosus: A manifestation of microcirculation dysfunction? Lupus 2023; 32:727-736. [PMID: 36989458 DOI: 10.1177/09612033231167792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVES Depression is highly prevalent among systemic lupus erythematosus (SLE) patients. Brain hypoperfusion in neuropsychiatric SLE patients might be associated with emotional difficulties. However, no previous study examined possible associations of depression with brain oxygenation during a mild physical stress in non-neuropsychiatric SLE patients. Our study aimed to identify possible differences in cerebral oxygenation during exercise in SLE patients with and without depressive symptoms using near-infrared spectroscopy (NIRS) and examine possible underlying mechanisms through evaluation of vascular cell adhesion molecule 1 (VCAM-1) levels. METHODS SLE patients without a known neuropsychiatric history or treatment with antidepressants or antipsychotic drugs were enrolled. Participants were assigned into groups based on Beck's Depression Inventory I (BDI-I). Patients with BDI-I score ≥10 comprised the SLE-depression group and those with BDI-I score <9 the SLE-non-depression group. All participants underwent a protocol involving a seated rest, a 3-min handgrip exercise (at 30% of maximal strength), and a 3-min recovery. NIRS was used to monitor changes in cerebral oxygenated hemoglobin (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb). VCAM-1 levels were measured in serum samples. RESULTS Twenty-three patients were enrolled. During exercise, the SLE-depression group exhibited a significantly lower increase in cerebral O2Hb [(peak-O2Hb (p = 0.039); O2Hb-area under the curve, AUC, p = 0.027) vs. SLE-non-depression group. BDI-I score was inversely correlated with AUC (rho = -0.493, p = 0.017) and positively correlated with VCAM-1 levels (rho = 0.501, p = 0.034). CONCLUSION This study suggests a possible association between emotional abnormalities and microvascular impairment (cerebral oxygenation and endothelial dysfunction) in SLE However, larger studies are needed to confirm these results.
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Affiliation(s)
- Nikolaos Koletsos
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantina Dipla
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, 37782Aristotle University of Thessaloniki, Serres, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Dolgyras
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- Rheumatology Department - 2nd Propedeutic Department of Internal Medicine, Hippokration General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Exercise Physiology & Biochemistry Laboratory, Department of Sport Sciences at Serres, 37782Aristotle University of Thessaloniki, Serres, Greece
| | | | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou General Hospital, 37782Aristotle University of Thessaloniki, Thessaloniki, Greece
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Loftus EV, Vermeire S, Feagan BG, Le Brun FO, Oortwijn A, Moerch U, Sandborn WJ, Hibi T. Corticosteroid-Sparing Effects of Filgotinib in Moderately to Severely Active Ulcerative Colitis: Data from the Phase 2b/3 SELECTION Study. J Crohns Colitis 2023; 17:211-220. [PMID: 36006011 PMCID: PMC10024544 DOI: 10.1093/ecco-jcc/jjac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Corticosteroid-free remission is an important treatment goal for patients with ulcerative colitis [UC]. The corticosteroid-sparing effects of filgotinib, an oral, Janus kinase 1 preferential inhibitor, were assessed in SELECTION, a placebo-controlled, phase 2b/3 trial in moderately to severely active UC. METHODS These post hoc analyses assessed 1-, 3-, 6-, and 8-month rates of corticosteroid-free clinical remission at Week 58 and change in median daily prednisone-equivalent dose over time. A matching-adjusted indirect comparison [MAIC] of maintenance studies assessed corticosteroid-free remission with filgotinib 200 mg, intravenous vedolizumab, subcutaneous vedolizumab, and oral tofacitinib. RESULTS The Maintenance Study full analysis set included 199 patients receiving filgotinib 200 mg and 98 receiving placebo. Among patients receiving corticosteroids at Maintenance Study baseline, at Week 58, 30.4%, 29.3%, 27.2%, and 21.7% receiving filgotinib had been in corticosteroid-free remission for ≥1, ≥3, ≥6, or ≥8 months, respectively, versus 6.4% receiving placebo across thresholds [p <0.05]. Median daily prednisone-equivalent dose decreased from 17.5 mg/day to 10.0 mg/day with filgotinib treatment during the Maintenance Study. Based upon the MAIC, filgotinib was associated with greater likelihood of corticosteroid-free clinical remission versus intravenous vedolizumab (odds ratio [OR], 15.2; 95% confidence interval [CI], 1.6-139.9; p <0.05]) and similar odds to subcutaneous vedolizumab [OR, 3.8; CI, 0.2-63.8; p = 0.36] in biologic-naïve patients, and similar odds to tofacitinib overall [OR, 2.0; 0.4-9.1; p = 0.39]. CONCLUSIONS Filgotinib 200 mg demonstrated corticosteroid-sparing effects and maintained corticosteroid-free clinical remission in patients with UC. MAIC results should be interpreted cautiously given the large CIs and differences in study design and patient populations. [ClinicalTrials.gov: NCT02914522].
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Affiliation(s)
- Edward V Loftus
- Corresponding author: Edward V. Loftus Jr, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA. Tel.: +1-507-266-0873; Fax: 1-507-284-0538;
| | - Séverine Vermeire
- Department of Gastroenterology & Hepatology, University Hospitals Leuven and KU Leuven University, Leuven, Belgium
| | - Brian G Feagan
- Department of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | | | - Ulrik Moerch
- Global Medical Affairs, Inflammation, Gilead Sciences, Inc., Copenhagen, Denmark
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Ma S, Wang W, Gong Q, Xiang D, Yao L, Xu S, Xie X, Wang H, Wang G, Yang J, Liu Z. Inflammatory bowel disease and the long-term risk of depression: A prospective cohort study of the UK biobank. Gen Hosp Psychiatry 2023; 82:26-32. [PMID: 36924701 DOI: 10.1016/j.genhosppsych.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Depression is more common in patients with chronic inflammatory diseases, but whether inflammatory bowel disease (IBD), a chronic, relapsing immune-mediated disease, is associated with a higher risk of depression remains uncertain. METHOD We studied 497,134 participants in the UK Biobank, including 3561 IBD patients. Multivariate Cox proportional risk models were constructed to investigate the risk associated with IBD and depression adjusting for potential confounding factors including sociodemographic, lifestyle, and family history variables. RESULTS The average age of participants was 56.54 ± 8.09 years; 54.3% were female and 90.4% were white. Over a mean follow-up period of 13.3 years, the cumulative incidence of depression was 8.2% (95% CI: 7.3%-9.1%) in IBD patients compared with 4.9% (95% CI: 4.9%-5.0%) in individuals without IBD. Compared with non-IBD participants, the adjusted hazard ratio (HR) for depression among IBD patients was 1.56 (95% CI: 1.39-1.76), with an adjusted HR of 1.54 (95% CI: 1.25-1.90) in Crohn's disease and 1.52 (95% CI: 1.30-1.78) in ulcerative colitis, respectively. CONCLUSION IBD patients had a significantly higher risk of depression than non-IBD participants after adjusting for multiple confounding factors. We recommend screening for depression in middle-aged adults with IBD and no established history of depression.
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Affiliation(s)
- Simeng Ma
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuxian Xu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinhui Xie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Gaohua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Yang
- School of Information Engineering, Wuhan University of Technology, Wuhan, China.
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China; Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan, China.
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Glucocorticoid-based pharmacotherapies preventing PTSD. Neuropharmacology 2023; 224:109344. [PMID: 36402246 DOI: 10.1016/j.neuropharm.2022.109344] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a highly disabling psychiatric condition that may arise after exposure to acute and severe trauma. It is a highly prevalent mental disorder worldwide, and the current treatment options for these patients remain limited due to low effectiveness. The time window right after traumatic events provides clinicians with a unique opportunity for preventive interventions against potential deleterious alterations in brain function that lead to PTSD. Some studies pointed out that PTSD patients present an abnormal function of the hypothalamic-pituitary-adrenal axis that may contribute to a vulnerability toward PTSD. Moreover, glucocorticoids have arisen as a promising option for preventing the disorder's development when administered in the aftermath of trauma. The present work compiles the recent findings of glucocorticoid administration for the prevention of a PTSD phenotype, from human studies to animal models of PTSD. Overall, glucocorticoid-based therapies for preventing PTSD demonstrated moderate evidence in terms of efficacy in both clinical and preclinical studies. Although clinical studies point out that glucocorticoids may not be effective for all patients' subpopulations, those with adequate traits might greatly benefit from them. Preclinical studies provide precise insight into the mechanisms mediating this preventive effect, showing glucocorticoid-based prevention to reduce long-lasting behavioral and neurobiological abnormalities caused by traumatic stress. However, further research is needed to delineate the precise mechanisms and the extent to which these interventions can translate into lower PTSD rates and morbidity. This article is part of the Special Issue on 'Fear, Anxiety and PTSD'.
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Barnes A, Spizzo P, Bampton P, Andrews JM, Fraser RJ, Mukherjee S, Mountifield R. Examining the influence of inflammatory bowel disease medications on sleep quality. JGH OPEN 2023; 7:190-196. [PMID: 36968569 PMCID: PMC10037038 DOI: 10.1002/jgh3.12871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/25/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Background and Aim Inflammatory bowel disease (IBD) can disrupt sleep, leading to poor sleep quality. This may in part be due to the symptoms of IBD and the influence of pro-inflammatory cytokines on sleep. This study aimed to investigate the potential influence of IBD medications on sleep quality. Methods An online survey of adults with IBD was conducted, which included measures of sleep quality, IBD activity, anxiety, depression, and physical activity. Logistic regression was used to investigate possible associations between IBD medications (corticosteroids, immunomodulators, biologics, aminosalicyate) and outcome of poor sleep. A generalized linear model was built for outcome of sleep quality score. Results There were 544 participants included in the final analysis, median age of 42, and 61% with Crohn's disease. Increased odds of poor sleep were seen in those taking opioids, medications for anxiety or depression, corticosteroids, vitamin D, methotrexate, and infliximab. A multivariate model was built incorporating demographic and IBD variables with opioids present in the final model and associated with increased odds of poor sleep. This was in addition to medications for sleep, depression, anxiety, IBD activity, and body weight. In a multivariate generalized linear model, opioids and methotrexate were associated with worse sleep quality scores. Conclusions Opioids were associated with increased odds of poor sleep independent of other factors. This provides further support for avoiding these medications in people with IBD. Infliximab was associated with increased body weight and consequently increased odds of poor sleep.
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Affiliation(s)
- Alex Barnes
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Paul Spizzo
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Peter Bampton
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Jane M Andrews
- Inflammatory Bowel Disease Service, Department of Gastroenterology and Hepatology (CAHLN) Royal Adelaide Hospital Adelaide South Australia Australia
- School of Medicine, Faculty of Health & Medical Sciences University of Adelaide Adelaide South Australia Australia
| | - Robert J Fraser
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
| | - Sutapa Mukherjee
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
- Department of Respiratory and Sleep Medicine Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
| | - Réme Mountifield
- Department of Gastroenterology Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine and Public Health Flinders University Bedford Park South Australia Australia
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Wunsch E, Krause L, Gevers TJ, Schramm C, Janik MK, Krawczyk M, Willemse J, Uhlenbusch N, Löwe B, Lohse AW, Milkiewicz P. Confidence in treatment is contributing to quality of life in autoimmune liver diseases. The results of ERN RARE-LIVER online survey. Liver Int 2023; 43:381-392. [PMID: 36177700 PMCID: PMC10091761 DOI: 10.1111/liv.15440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Autoimmune liver diseases (AILDs) are associated with impaired health-related quality of life (HrQoL). The aim of this project was to identify potentially modifiable factors related to HrQoL in a large transnational cohort of patients with AILDs. METHODS A cross-sectional online survey was conducted on patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or primary sclerosing cholangitis from 15 European countries. HrQoL was measured with EQ-5D-5L and EQ visual analogue scale (EQ-VAS) and analysed in relation to demographic, psychosocial, disease- and treatment-related factors. A Patient Health Questionnaire-2 score >3 indicated relevant depression. Multivariable linear regression analyses were used to identify potentially modifiable factors associated with HrQoL and confidence in treatment whilst adjusting for known confounders. RESULTS A group of 1178 European patients (79% female, mean age 48 ± 14 years) participated in the study. HrQoL was impaired in all three diseases (mean EQ-5D-5L = 0.75, mean EQ VAS = 68.9), most markedly in PBC (mean EQ-5D-5L = 0.73, mean EQ-VAS = 66.2). Relevant depression, which was detected in 17% of patients, was prominently associated with impaired HrQoL. In the regression analysis, treatment confidence was identified as an important modifiable factor positively contributing to HrQoL. This influence was observable even after adjusting for other covariates including depression. Management in a transplant centre, treatment with azathioprine in AIH, and with ursodeoxycholic acid in PBC, was associated with increased treatment confidence. Finally, improved patient-physician relationships contributed to treatment confidence. CONCLUSION Treatment confidence is a relevant modifiable determinant of HrQoL and should be further investigated to improve the standards of care for patients with AILDs.
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Affiliation(s)
- Ewa Wunsch
- Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.,RARE-LIVER European Reference Network
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tom Jg Gevers
- RARE-LIVER European Reference Network.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Christoph Schramm
- RARE-LIVER European Reference Network.,Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), Hamburg, Germany
| | - Maciej K Janik
- RARE-LIVER European Reference Network.,Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Krawczyk
- RARE-LIVER European Reference Network.,Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - José Willemse
- RARE-LIVER European Reference Network.,Dutch Liver Patients Association, Hoogland, The Netherlands
| | - Natalie Uhlenbusch
- RARE-LIVER European Reference Network.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- RARE-LIVER European Reference Network.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Wilhelm Lohse
- RARE-LIVER European Reference Network.,Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Piotr Milkiewicz
- Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.,RARE-LIVER European Reference Network.,Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
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Pour-Rashidi A, Namvar M, Iranmehr A, Carpaneto A, Hanaei S, Rezaei N. Psychological and Psychiatric Aspects of Brain and Spinal Cord Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:673-687. [PMID: 37452958 DOI: 10.1007/978-3-031-23705-8_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Central nervous system (CNS) tumors are mainly diagnosed by physical symptoms such as paralysis, visual field defect, seizure, and loss of consciousness. The psychological and psychiatric background of CNS tumors, whether in preoperative or postoperative period, has long been a neglected topic; however, lately, many authors and researchers have paid more attention to these manifestations. Neurocognition is a subset of parameters, including attention, memory, mood, emotions, language production, personality, executive function, problem-solving, calculation, and spatial cognition, making up the patient's cognitive performance. Also, it is worthy to say that neurocognition is considered a parameter of quality of life (QoL). Currently, we know that neurocognitive disorders are a group of symptoms presenting by the patients. These symptoms may be the first picture of CNS lesions, which result in incorrect treatment, a higher financial burden on the patient and health system, and finally, poorer QoL and performance scale if they are not diagnosed early. Psychological and psychiatric problems such as depression, anxiety, and phobia following the CNS tumors have two aspects. These may present before any treatment resulting from the tumoral mass effect, peritumoral edema, or cerebral tissue disruption due to the space-occupying lesion. On the other hand, we can see these features after a kind of therapy such as surgery, medical therapy, or adjuvant therapy. Sometimes, the CNS tumors lead to psychosocial complications postoperatively. Indeed, considering tumor surgery complications, some patients may find various degrees of deficits that make the patient isolated either socially or professionally. Obviously, the improvement rate and outcome of this specific situation depend on the mechanism of occurrence and its causes. For instance, postoperative symptom relief would be expected when the symptoms are related to the tumoral mass effect. Getting familiar with this constellation of the symptoms, realizing them, and then localizing them to the correct area of the CNS are very crucial. Accordingly, because of their importance in QoL, their influence on patient's survival even more than the extent of resection of the tumor, and somehow their ignorance, we will discuss different neurocognitive manifestations related to CNS tumors in this chapter.
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Affiliation(s)
- Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Mohamad Namvar
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Arad Iranmehr
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Allegra Carpaneto
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126, Turin, Italy
| | - Sara Hanaei
- Department of Neurosurgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Chary MA, Barbuto AF, Izadmehr S, Tarsillo M, Fleischer E, Burns MM. COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Xenobiotics). J Med Toxicol 2023; 19:26-36. [PMID: 36525217 PMCID: PMC9756926 DOI: 10.1007/s13181-022-00918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and alternative remedies used or proposed to treat COVID-19. Most repositioned xenobiotics have had neither the feared toxicity nor the anticipated efficacy. Repurposed viral replication inhibitors are not efficacious and frequently associated with nausea, vomiting, and diarrhea. Antiviral medications designed specifically against SARS-CoV-2 may prevent progression to severe disease in at-risk individuals and appear to have a wide therapeutic index. Colloidal silver, zinc, and ivermectin have no demonstrated efficacy. Ivermectin has a wide therapeutic index but is not efficacious and acquiring it from veterinary sources poses additional danger. Chloroquine has a narrow therapeutic index and no efficacy. A companion review covers vaccines, monoclonal antibodies, and immunotherapies. Together, these two reviews form an update to our 2020 review.
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Affiliation(s)
- Michael A Chary
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.
- Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alexander F Barbuto
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
- Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc Tarsillo
- Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Eduardo Fleischer
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Michele M Burns
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Synthetic Pharmacotherapy for Systemic Lupus Erythematosus: Potential Mechanisms of Action, Efficacy, and Safety. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010056. [PMID: 36676680 PMCID: PMC9866503 DOI: 10.3390/medicina59010056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
The pharmacological treatment of systemic lupus erythematosus (SLE) aims to decrease disease activity, progression, systemic compromise, and mortality. Among the pharmacological alternatives, there are chemically synthesized drugs whose efficacy has been evaluated, but which have the potential to generate adverse events that may compromise adherence and response to treatment. Therapy selection and monitoring will depend on patient characteristics and the safety profile of each drug. The aim of this review is to provide a comprehensive understanding of the most important synthetic drugs used in the treatment of SLE, including the current treatment options (mycophenolate mofetil, azathioprine, and cyclophosphamide), review their mechanism of action, efficacy, safety, and, most importantly, provide monitoring parameters that should be considered while the patient is receiving the pharmacotherapy.
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Sajid S. Comment on "Clinical features and psychological impact of celiac disease at diagnosis". Dig Liver Dis 2022; 54:1729. [PMID: 36192341 DOI: 10.1016/j.dld.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Samar Sajid
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Sindh 74200, Pakistan.
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Bruscoli S, Puzzovio PG, Zaimi M, Tiligada K, Levi-Schaffer F, Riccardi C. Glucocorticoids and COVID-19. Pharmacol Res 2022; 185:106511. [PMID: 36243331 PMCID: PMC9556882 DOI: 10.1016/j.phrs.2022.106511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Abstract
Coronavirus Disease 19 (COVID-19) is associated with high morbidity and mortality rates globally, representing the greatest health and economic challenge today. Several drugs are currently approved for the treatment of COVID-19. Among these, glucocorticoids (GCs) have received particular attention due to their anti-inflammatory and immunosuppressive effects. In fact, GC are widely used in current clinical practice to treat inflammatory, allergic and autoimmune diseases. Major mechanisms of GC action include inhibition of innate and adaptive immune activity. In particular, an important role is played by the inhibition of pro-inflammatory cytokines and chemokines, and the induction of proteins with anti-inflammatory activity. Overall, as indicated by various national and international regulatory agencies, GCs are recommended for the treatment of COVID-19 in patients requiring oxygen therapy, with or without mechanical ventilation. Regarding the use of GCs for the COVID-19 treatment of non-hospitalized patients at an early stage of the disease, many controversial studies have been reported and regulatory agencies have not recommended their use. The decision to start GC therapy should be based not only on the severity of COVID-19 disease, but also on careful considerations of the benefit/risk profile in individual patients, including monitoring of adverse events. In this review we summarize the effects of GCs on the major cellular and molecular components of the inflammatory/immune system, the benefits and the adverse common reactions in the treatment of inflammatory/autoimmune diseases, as well as in the management of COVID-19.
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Affiliation(s)
- Stefano Bruscoli
- Department of Medicine and Surgery, Section of Pharmacology, University of Perugia, Perugia, Italy
| | - Pier Giorgio Puzzovio
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maria Zaimi
- Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Tiligada
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel,Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carlo Riccardi
- Department of Medicine and Surgery, Section of Pharmacology, University of Perugia, Perugia, Italy,Corresponding author
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Investigation and Analysis of Anxiety and Quality of Life among Systemic Lupus Erythematosus Patients in Northwestern China. Healthcare (Basel) 2022; 10:healthcare10112180. [DOI: 10.3390/healthcare10112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/04/2022] Open
Abstract
The aim of this study was to provide targeted psychological support and effective nursing for systemic lupus erythematosus (SLE) patients. SLE is a complex, systemic autoimmune disease characterized by recurrent episodes and the involvement of multiple organs. With improvements in SLE treatment and the corresponding increase in patients’ survival time, the quality of life (QoL) of SLE patients has become an important indicator for evaluating the effectiveness of clinical treatments. To explore the anxiety states and health-related QoL of SLE patients, 106 SLE patients were asked to provide responses for the short-form 36 health survey (SF36), and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Visual Analog Scale(VAS). Additionally, the Systemic Lupus Collaborative Clinics Damage Index (SDI) was analyzed. Data regarding patients’ age, gender, education level, occupation, family income, and duration of disease were collected. Regression analysis was performed to identify factors related to patients’ health-related QoL. For the SF36, the mental components score (MCS), mental health (MH), and bodily pain (BP) occupied dominant positions. Additionally, the MH domain was significantly associated with anxiety in SLE patients. Negative relationships were identified between irregular sleep and the scores for role limitations due to physical problem (RP), vitality (VT), and role limitations due to emotional problem (RE) domains. From the analysis of SLEDAI and SDI scores, anxiety among SLE patients was mainly affected by disease activity and quality of life. This study provides a preliminary understanding of the QoL of SLE patients in western China and highlights the need for the future development of strategies to provide targeted psychological support and effective nursing for SLE patients, in order to improve patients’ self-awareness, mental health, and QoL.
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Targeted delivery of an anti-inflammatory corticosteroid to Ly6C/G-positive cells abates severity of influenza A symptoms. Proc Natl Acad Sci U S A 2022; 119:e2211065119. [PMID: 36252038 PMCID: PMC9618054 DOI: 10.1073/pnas.2211065119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The distribution of Ly6C/G-positive cells in response to an infection of the mouse respiratory tract with influenza A virus was followed noninvasively over time by immuno-positron emission tomography. We converted nanobodies that recognize Ly6C and Ly6G, markers of neutrophils and other myeloid cells, as well as an influenza hemagglutinin-specific nanobody, into 89Zr-labeled PEGylated positron emission tomography (PET) imaging agents. The PET images showed strong accumulation of these imaging agents in the lungs of infected mice. Immunohistochemistry of influenza virus-infected mice and control mice, injected with a biotinylated and PEGylated version of the Ly6C/G-specific nanobody, showed the presence of abundant Ly6C/G-positive myeloid cells and positivity for Ly6C/G on bronchial epithelium in influenza virus-infected mice. This is consistent with focal inflammation in the lungs, a finding that correlated well with the immuno-PET results. No such signals were detected in control mice. Having shown by PET the accumulation of the Ly6C/G-specific nanobody in infected lungs, we synthesized conjugates of Ly6C/G-specific nanobodies with dexamethasone to enable targeted delivery of this immunosuppressive corticosteroid to sites of inflammation. Such conjugates reduced the weight loss that accompanies infection, while the equivalent amount of free dexamethasone was without effect. Nanobody-drug conjugates thus enable delivery of drugs to particular cell types at the appropriate anatomic site(s). By avoiding systemic exposure to free dexamethasone, this strategy minimizes its undesirable side effects because of the much lower effective dose of the nanobody-dexamethasone conjugate. The ability to selectively target inflammatory cells may find application in the treatment of other infections or other immune-mediated diseases.
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Lašaitė L, Navardauskaitė R, Semėnienė K, Verkauskienė R. Psychological stress, emotions, and quality of life in men and women with congenital adrenal hyperplasia. J Endocrinol Invest 2022; 45:1925-1934. [PMID: 35612812 DOI: 10.1007/s40618-022-01824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/08/2022]
Abstract
AIM The aim was to assess perceived psychological stress, emotional state, and quality of life (QoL) in men and women with congenital adrenal hyperplasia (CAH) in comparison to age- and sex-matched control individuals. METHODS Participants: 26 patients with CAH (11 men, 15 women, age 14-48 years) and 26 age- and sex-matched control individuals without CAH. Psychological assessment: Perceived Stress Scale, Profile of Mood States2, and WHO Brief Quality of Life Questionnaire. RESULTS There were no significant differences in perceived stress, emotional state and QoL scores between men with CAH and control men. Perceived distress (median 14.0 score vs. 10.0 score, p = 0.020), tension-anxiety (median 9.0 score vs. 3.5 score, p = 0.026), depression-dejection (median 12.0 score vs. 5.0 score, p = 0.040), fatigue-inertia (median 13.0 score vs. 7.5 score, p = 0.007) were higher and environmental domain of QoL (median 16.0 score vs. 17.0 score, p = 0.001) was lower in women with CAH than in control women. CONCLUSION Women with congenital adrenal hyperplasia have higher perceived distress, tension-anxiety, depression dejection, fatigue-inertia, and worse environmental aspect of quality of life than age-matched control women, while perceived psychological stress, emotional state and quality of life in men with congenital adrenal hyperplasia do not differ from that of age-matched control men.
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Affiliation(s)
- L Lašaitė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Eivenių 2, 50161, Kaunas, Lithuania.
| | - R Navardauskaitė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Eivenių 2, 50161, Kaunas, Lithuania
| | - K Semėnienė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Eivenių 2, 50161, Kaunas, Lithuania
| | - R Verkauskienė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Eivenių 2, 50161, Kaunas, Lithuania
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