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Vinhosa Bastos MA, da Silva Caires I, Boschi Portella R, Nascimento Martins R, Reverdito R, Reverdito S, Moro N. Insulinoma with peripheral neuropathy: a case report. J Med Case Rep 2023; 17:241. [PMID: 37308982 DOI: 10.1186/s13256-023-03963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/01/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Insulinomas are rare neuroendocrine tumors that typically present with hypoglycemic crises. Peripheral neuropathy is an uncommon complication of insulinoma. Most clinicians expect peripheral neuropathy symptoms to reverse completely after the insulin-secreting tumor is resected, but this may be a misassumption. CASE REPORT We report a case of a 16-year-old Brazilian boy with clonic muscle spasms of the lower limbs for almost one year. Disabling paraparesis and confusional episodes had progressively set in as well. There were no sensorial abnormalities in the lower limbs, upper limbs or cranial nerves. An electromyography revealed a motor neuropathy of the lower limbs. The diagnosis of insulinoma was established as serum insulin and C-peptide concentrations were inappropriately normal during spontaneous episodes of hypoglycemia. Following a normal abdominal magnetic resonance scan, the imaging work-up continued with an endoscopic ultrasound, which localized the tumor at the pancreatic body-tail transition. Once localized, a prompt surgical removal (enucleation) of the tumor was undertaken, leading to an immediate and complete resolution of hypoglycemia. The time length between the onset of symptoms and tumor resection was 15 months. After surgery, the symptoms of peripheral neuropathy of the lower limbs showed a slow and only partial improvement. At a two-year follow-up after surgery, although being able to lead a normal and productive life, the patient still reported symptoms of reduced muscular strength in the lower limbs and a new electroneuromyography analysis showed chronic denervation and reinnervation in the legs' muscles-indicating chronic neuropathic injury. CONCLUSION The events of this case reinforce the importance of an agile diagnostic work-up and spry definitive treatment for patients with this uncommon disease, enabling the cure of neuroglycopenia before permanent bothersome complications ensue.
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Affiliation(s)
- Marco Aurélio Vinhosa Bastos
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, s/n Cidade Universitária, Campo Grande, MS, 79070-900, Brazil.
| | - Iago da Silva Caires
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, 79070-900, Brazil
| | - Renata Boschi Portella
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Av. Senador Filinto Muller, s/n Cidade Universitária, Campo Grande, MS, 79070-900, Brazil
| | - Rogério Nascimento Martins
- Serviço de Endoscopia Digestiva, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, 79070-900, Brazil
| | - Ronald Reverdito
- Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, 79070-900, Brazil
- Hospital Santa Casa de Campo Grande, Campo Grande, MS, 79002-251, Brazil
| | - Stephen Reverdito
- Hospital Santa Casa de Campo Grande, Campo Grande, MS, 79002-251, Brazil
| | - Nilson Moro
- Hospital São Julião, Campo Grande, MS, 79017-200, Brazil
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Augusto TRDL, Peroni J, de Vargas W, Santos PC, Dantas W, Padavini RL, Koch R, Saraiva E, Bastos MAV, Müller PDT. Carotid-body modulation through meditation in stage-I hypertensive subjects: Study protocol of a randomized and controlled study. Medicine (Baltimore) 2023; 102:e32295. [PMID: 36607871 PMCID: PMC9829266 DOI: 10.1097/md.0000000000032295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Adjunctive therapy for hypertension is in high demand for clinical research. Therefore, several meta-analyses have provided sufficient evidence for meditation as an adjunct therapy, without being anchored on reliable physiological grounds. Meditation modulates the autonomic nervous system. Herein, we propose a hierarchical-dependent effect for the carotid body (CB) in attenuating blood pressure (BP) and ventilatory variability (VV) fine-tuning due to known nerve connections between the CB, prefrontal brain, hypothalamus, and solitary tract nucleus. The aim of this exploratory study was to investigate the role of CB in the possible decrease in BP and changes in VV that could occur in response to meditation. This was a prospective, single-center, parallel-group, randomized, controlled clinical trial with concealed allocation. Eligible adult subjects of both sexes with stage 1 hypertension will be randomized into 1 of 2 groups: transcendental meditation or a control group. Subjects will be invited to 3 visits after randomization and 2 additional visits after completing 8 weeks of meditation or waiting-list control. Thus, subjects will undergo BP measurements in normoxia and hyperoxia, VV measurements using the Poincaré method at rest and during exercise, and CB activity measurement in the laboratory. The primary outcome of this study was the detection of changes in BP and CB activity after 8 weeks. Our secondary outcome was the detection of changes in the VV at rest and during exercise. We predict that interactions between hyperoxic deactivation of CB and meditation; Will reduce BP beyond stand-alone intervention or alternatively; Meditation will significantly attenuate the effects of hyperoxia as a stand-alone intervention. In addition, VV can be changed, partially mediated by a reduction in CB activity. Trial registration number: ReBEC registry (RBR-55n74zm). Stage: pre-results.
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Affiliation(s)
- Tiago Rodrigues de Lemos Augusto
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Juliana Peroni
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Wandriane de Vargas
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Priscilla Caroll Santos
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Wendel Dantas
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Roberta Lazari Padavini
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Rodrigo Koch
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | | | - Marco Aurélio Vinhosa Bastos
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
| | - Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology (LAFIR), Maria Aparecida Pedrossian Universitary Hospital (HUMAP), Campo Grande, Mato Grosso do Sul, Brazil
- * Correspondence: Paulo de Tarso Müller, Laboratory of Respiratory Pathophysiology (LAFIR); Respiratory Division of University Hospital, Federal University of Mato Grosso do Sul (UFMS), Rua Filinto Müller S/N, Vila Ipiranga CEP:79080-090, Campo Grande, Brazil (e-mail: )
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Bastos MAV, Bastos PRHDO, e Paez LEF, de Souza EO, Bogo D, Perdomo RT, Portella RB, Ozaki JGO, Iandoli D, Lucchetti G. "Seat of the soul"? The structure and function of the pineal gland in women with alleged spirit possession-Results of two experimental studies. Brain Behav 2020; 10:e01693. [PMID: 32506697 PMCID: PMC7375051 DOI: 10.1002/brb3.1693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cultural traditions attribute to pineal gland an important role for spiritual experiences. Mediumship and spirit possession are cultural phenomena found worldwide which have been described as having dissociative and psychotic-like characteristics, but with nonpathological aspects. A sympathetic activation pattern in response to spirit possession has been reported in some studies, but empirical data on pineal gland is scarce in this context. METHODS We aimed to investigate pineal gland and pituitary volumes, as well as urinary 6-sulfatoxymelatonin levels in 16 alleged mediums (Medium Group-MG) compared with 16 healthy nonmedium controls (Control Group) (Experiment 1). Furthermore, we aimed to evaluate urinary 6-sulfatoxymelatonin and stress reactivity in GM (n = 10) under different physiological conditions (Experiment 2). RESULTS In Experiment 1, MG presented higher scores of anomalous experiences, but there were no between-group differences regarding mental health or subjective sleep quality. Similar pineal gland and pituitary volumes were observed between groups. There were no between-group differences in urinary 6-sulfatoxymelatonin collected under equivalent baseline conditions. In Experiment 2, the rise of anxiety and heart rate in response to mediumistic experience was intermediate between a nonstressful control task (reading) and a stressful control task (Trier Social Stress Test-TSST). No significant differences were observed in 6-sulfatoxymelatonin urinary levels between the three conditions. The pattern of stress reactivity during the TSST was normal, but with an attenuated salivary cortisol response. CONCLUSION The normal neuroimaging and stress reactivity findings in MG contrast with the abnormal results usually observed in subjects with psychotic and dissociative disorders.
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Affiliation(s)
| | | | | | | | - Danielle Bogo
- School of Pharmaceutical SciencesFederal University of Mato Grosso do SulCampo GrandeBrazil
| | - Renata Trentin Perdomo
- School of Pharmaceutical SciencesFederal University of Mato Grosso do SulCampo GrandeBrazil
| | | | | | - Décio Iandoli
- School of MedicineAnhanguera‐Uniderp UniversityCampo GrandeBrazil
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Bastos MAV, Oliveira Bastos PRHD, Portella RB, Soares LFG, Conde RB, Rodrigues PMF, Lucchetti G. Pineal gland and schizophrenia: A systematic review and meta-analysis. Psychoneuroendocrinology 2019; 104:100-114. [PMID: 30831343 DOI: 10.1016/j.psyneuen.2019.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/17/2019] [Accepted: 02/24/2019] [Indexed: 12/29/2022]
Abstract
Melatonin (MLT), the main hormone of the pineal gland (PG), is assumed to support initiation and maintenance of sleep, and a stable sleep-wake cycle, exerting antioxidative and neuroprotective actions. Evidence demonstrates that sleep and circadian rhythm abnormalities are very common in schizophrenia patients. Some imaging studies suggest structural abnormalities of the PG in these patients as well. We aimed to critically appraise the literature on PG imaging and melatonin secretion in schizophrenia patients, in comparison to matched healthy controls, and to review placebo-controlled trials of add-on exogenous MLT treatment in schizophrenia patients. In this systematic review, twenty-nine studies were included. Meta-analytical evaluation of data was possible only for MLT secretion finding that midnight plasma levels were significantly reduced in individuals with schizophrenia as compared to healthy controls (Hedge`s g = 1.32, p < 0.01). Imaging studies demonstrated greater prevalence of enlarged calcifications (>1 cm) of the PG (2 out of 2 computed tomography studies) and smaller PG volume (2 out of 3 magnetic resonance studies) compared with healthy controls. Anatomic and functional abnormalities of the PG were not associated with duration of illness or with treatment factors, maybe suggesting them to be primary characteristics of the disease and genetically based. Add-on MLT treatment leads to a modest improvement of objective and subjective sleep quality, of metabolic adverse effects of antipsychotics, and of tardive dyskinesia symptoms in schizophrenia patients. It remains to be established whether MLT treatment in prodromal phases of the disease could prevent neurostructural abnormalities.
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Affiliation(s)
- Marco Aurélio Vinhosa Bastos
- Federal University of Mato Grosso do Sul, Postgraduate Program in Health and Development, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS, 79070-900, Brazil.
| | - Paulo Roberto Haidamus de Oliveira Bastos
- Federal University of Mato Grosso do Sul, Postgraduate Program in Health and Development, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS, 79070-900, Brazil
| | - Renata Boschi Portella
- Federal University of Mato Grosso do Sul, Faculty of Medicine, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS, 79070-900, Brazil
| | - Leonardo Fabrício Gomes Soares
- Federal University of Mato Grosso do Sul, Postgraduate Program in Health and Development, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS, 79070-900, Brazil
| | - Ricardo Brilhante Conde
- Proexames Imaging Clinic, Av. Mato Grosso, 1772 - Centro, Campo Grande, MS, 79020-201, Brazil
| | | | - Giancarlo Lucchetti
- Federal University of Juiz de Fora, School of Medicine, Av. Eugênio do Nascimento, s/n - Dom Bosco, Juiz de Fora, MG, 36036-330, Brazil
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Vinhosa Bastos MA, Haidamus de Oliveira Bastos PR, Dos Santos ML, Iandoli D, Boschi Portella R, Lucchetti G. Comparing the Detection of Endogenous Psychedelics in Individuals With and Without Alleged Mediumistic Experiences. Explore (NY) 2018; 14:448-452. [PMID: 30241696 DOI: 10.1016/j.explore.2018.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT Mediumship is the alleged ability to communicate with deceased personalities. Previous studies have suggested that the endogenous psychotomimetic molecules bufotenine (BT) and dimethyltryptamine (DMT) may play a role in the pathogenesis of psychotic disorders. Distortion of perceptions observed during spiritual experiences could supposedly relate to these substances. OBJECTIVE To compare the presence of BT and DMT in human urine samples between individuals with and without mediumistic experiences. METHODS All participants (5 from medium's group - MG and 5 from non-medium's group - CG) undertook a single night continuous 6-h urine pool collection (6:00-11:59 PM). Mediums collected urine samples in nights when they reported having experienced mediumistic communication. A sensitive high-performance liquid chromatography-mass spectrometry (HPLC-MS) assay was used. Questionnaires were used to detect common mental disorders symptoms, and to screen and quantify anomalous experiences. RESULTS DMT was not detected in any urine specimen tested. The presence of BT detection in urine samples was greater in CG (2/5) than in MG (1/5), with no significant differences (p > 0.99). MG reported more anomalous experiences than CG (6.6±0.8 vs. 2.2±1.5, p = 0.03), but there was no difference concerning their mental health. CONCLUSION There were no differences between individuals with and without alleged mediumistic experiences concerning endogenous psychedelics. Both BT and DMT are highly sensitive to metabolism by monoamine oxidase and to N-oxidation, and do not survive in the periphery for long. Alternative strategies should be considered to further investigate the putative role of the endogenous psychedelics pathway for the spiritual experiences.
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Affiliation(s)
- Marco Aurélio Vinhosa Bastos
- Federal University of Mato Grosso do Sul - Postgraduate Program in Health and Development, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS 79070-900, Brazil.
| | - Paulo Roberto Haidamus de Oliveira Bastos
- Federal University of Mato Grosso do Sul - Postgraduate Program in Health and Development, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS 79070-900, Brazil
| | - Maria Lucília Dos Santos
- University of Brasília - Institute of Chemistry, Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, DF 70910-900, Brazil
| | - Décio Iandoli
- Anhanguera-Uniderp University, Rua Ceará, 333 - Miguel Couto, Campo Grande, MS 79003-010, Brazil
| | - Renata Boschi Portella
- Federal University of Mato Grosso do Sul - Faculty of Medicine, Av. Senador Filinto Muller, s/n - Cidade Universitária, Campo Grande, MS 79070-900, Brazil
| | - Giancarlo Lucchetti
- Federal University of Juiz de Fora - School of Medicine, Av. Eugênio do Nascimento, s/n - Dom Bosco, Juiz de Fora, MG 36036-330, Brazil
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Bastos MAV, Bastos PRHDO, Osório IHS, Pinheiro SAM, Iandoli D, Lucchetti G. Physiologic correlates of culture-bound dissociation: A comparative study of Brazilian spiritist mediums and controls. Transcult Psychiatry 2018. [PMID: 29521578 DOI: 10.1177/1363461518759202] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Mediumship and spirit possession are cultural phenomena found in many societies worldwide. In Brazil, Spiritism (a tradition in which mediumship is emphasized) is the third largest religious denomination. The present study aimed to investigate physiologic correlates of nonpathological dissociative experiences by comparing 20 female spiritist mediums with several years of socially sanctioned practice to 20 female nonmedium control subjects from the same religious context. We measured plasma levels of hormones and neuroactive substances, as well as vital signs and heart rate variability (HRV) parameters, before and immediately after spirit communication. Although no between-group differences were noted in basal physiological parameters, in response to the possession experiences the groups differed in heart rate and in plasma concentrations of noradrenaline, thyroid-stimulating hormone (TSH), prolactin, and creatine phosphokinase (CPK). The changes in parameters indicated an arousal response in mediums and a relaxation response in control participants, and the same pattern of changes was observed in HRV parameters from each group during the possession experiences. However, the changes in physiologic parameters for mediums were mild and of short duration: 1 hour after the possession experiences, no difference in cardiac autonomic regulation was noted. No significant group effect was noted for melatonin. Cognitive control processes may explain the arousal associated with the dissociative state. Findings from this study suggest that pathological and nonpathological dissociation may have different physiological correlates.
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