Medscape Databases Research Articles

Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case)

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immuno­histochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Im­munohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Cerebral edema in an adolescent patient with diabetic ketoacidosis: a case report with a review of literature

The objective was to describe a case of cerebral edema (CE) in an adolescent patient with type 1 diabetes mellitus (DM) complicated with diabetic ketoacidosis (DKA), and to perform an analysis and review of publications devoted to this topic.Materials and methods. We describe the rare clinical case of CE complicated with DKA in the 14-year-old adolescent patient, including the dynamics of the patient’s clinical condition and laboratory test results. The topic of interest was researched through analysis of publications found in the Cochrane Library, PubMed, eLibrary.ru and Medscape databases using the following search terms: diabetic ketoacidosis, children and adolescents, cerebral edema, intensive therapy. A total of 38 publications in Russian and English were selected for being fully compliant with the purpose of this work. The features of the reported clinical case were analyzed and compared with information obtained from the current scientific literature.Results: This case demonstrates specific features presenting in the course of CE and describes aspects of the intensive treatment provided to the patient. Manifestations of severe hypokalemia and hypernatremia have been recorded as rare electrolyte disturbances in CE in the adolescent with DKA. The report demonstrates that the steps and specific parameters of the provided intensive treatment are unlikely to have triggered the development of CE in the clinic in this particular clinical case. It cannot be ruled out that the development of this complication was triggered by the delayed initiation of treatment (caused by the patient) at the prehospital stage, including the patient’s rude noncompliance with the prescribed insulin treatment scheme.Conclusions. CE is the rare but severe (with a high fatality rate) complication of DKA in patients with type 1 DM. Timely initiation of emergency care for CE may reduce risks associated with this complication and improve treatment outcomes and patient prognosis.

Investigation of polypharmacy, antimicrobial-related potential drug-drug interactions in patients with hematological malignancies.

Drug-drug interactions (DDIs) occur when one drug interferes with the pharmacological activity of another and can lead to increased side effects. The purpose of this study was to examine potential interactions between antimicrobials and other drugs in patients with hematological malignancies (HMs). The medications used by 233 patients with HMs before and during hospitalization in Ankara City Hospital Hematology Clinic services between January 2021 and July 2021 were examined. Potential DDIs (pDDIs) were identified through UptoDate, Drugs.com, and MedScape databases. The effects of major antimicrobial-related pDDIs on patients were examined. Agreement between the two interaction systems was judged based on the kappa test. SPSS R Version 4.0.2 was used in the statistical analysis of the data, p<.05 was considered significant. The prevalence of polypharmacy before hospitalization was determined as 22.7%. Diagnosed with acute leukemia and multiple myeloma, more antimicrobial-related pDDIs were detected during hospitalization (p<.001). A total of 758 antimicrobial-related pDDIs, which were in the major category in at least one of the three databases, were detected in 72.5% (169/233) of the participants. It was determined that the total hospitalization period of patients with major antimicrobial-related pDDIs was longer (p<.001). There was negligible agreement between UptoDate and Dugs.com and between Drugs.com and MedScape (kappa: 0.008 for both). There was no compatibility between UptoDate and MedScape (kappa<0). Interactions between antimicrobials and other drugs are undesirable problems. Further studies are required to evaluate the clinical and economic effects of the interactions on patients with HMs.

Dietary Influences on Skin Health in Common Dermatological Disorders.

The role of diet in the development of skin disorders is well-established, with nutritional deficiency often identified as a risk factor for skin diseases. Imbalances in the skin can be caused by nutritional deficiencies, excessive intake, insufficient nutrients, and hazardous ingredients. Patients frequently inquire about the impact of dietary patterns on skin health when consulting dermatologists in clinical settings. Simultaneously, the popularity of using nutritional supplements containing vitamins, minerals, and nutraceutical blends has been on the rise. It is crucial for dermatologists, primary care physicians, and other healthcare providers to be acquainted with evidence-based dietary interventions, distinguishing them from those that are more market-driven than truly efficacious. This review explores the modification of diet, encompassing both dietary exclusion and supplementation, as a therapeutic approach for conditions such as psoriasis, atopic dermatitis, bullous disease, vitiligo, and alopecia areata. A comprehensive literature search, utilizing the PubMed/Medline, Google Scholar, and Medscape databases, was conducted to investigate the relationship between each nutrient and various inflammatory skin diseases. The findings emphasize the significance of a well-balanced and thoughtfully planned diet in supplying adequate amounts of proteins, vitamins, and minerals to support optimal skin health. Additionally, this comprehensive review navigates through various dietary recommendations, offering insights into their multifaceted impacts on the immune system, gut microbiome, and skin health. The goal is to pave the way for informed and targeted dietary interventions for individuals dealing with food allergies and associated skin conditions.

Febrile seizures in pediatric practice: Risk factors, clinical manifestations, and intensive therapy

Introduction. Febrile seizures (FS) is the most common type of epileptic seizure experienced by young children. Study of methods of intensive treatment (IT) of FS represents a vital area of research in today’s pediatric science. The aim of this work: to assess the current approaches to risk factors, clinical manifestations and emergency care for patients with FS in pediatric practice. Materials and methods. The authors performed an analysis of publications that were found in the Cochrane Library, PubMed, eLibrary.ru, and Medscape databases using the following search terms: febrile seizures, children and adolescents, intensive treatment, anticonvulsants. A total of 64 published sources were chosen for review. Results and Discussion. The risk factors for FS may be numerous, with the main etiological causes in children being genetic susceptibility, viral infections and vaccination. The clinical presentation of FS is characterized by the development of a generalized tonic-clonic seizure in the setting of a high body temperature (≥39°C). FS are subdivided into three main clinical types: simple, complex and febrile status epilepticus (FSE). History taking and physical examination represent the main diagnostic means for determining the type of FS and discovering the cause of infection. Laboratory tests, electroencephalography, neuroimaging studies and lumbar puncture are used on a limited basis, mainly in children with complicated FS accompanied by a brain infection. Hospitalization for IT is necessary if the child has prolonged febrile seizures or FSE. The drugs of choice for relieving FS are benzodiazepines. Barbituric acid derivatives and valproic acid also possess therapeutic efficacy against FS. Antipyretic agents are effective only in relieving the toxic syndrome, but have no effect on the severity of FS and do not prevent relapses. The main antipyretic medications used for treatment of FS in pediatric practice are paracetamol, ibuprofen and nimesulide. Besides benzodiazepines, IT of FSE involves the use of intravenous fosphenytoin, phenobarbital or levetiracetam. Conclusion. Improvement of the quality of IT in pediatric practice may improve the therapeutic prognosis in patients with FS and bring down complication and mortality rates.

Disruption of the dopaminergic system in the pathophysiology of diabetes mellitus

Introduction. Diabetes mellitus (DM) is the most common endocrinopathy with a high incidence and a high number of complications.The aim of this work was to conduct an analytical literature review assessing the state of the problem of dopaminergic dysfunction in diabetes from a pathophysiological perspective.Materials and methods. Searching Cochrane Library, PubMed, eLibrary, Medscape databases and digital libraries using the search words: diabetes mellitus, dopamine, insulin, dopaminergic system, diabetic encephalopathy. A total of 66 sources were selected for the review.Results and discussion. Dopaminergic system dysfunction can be considered an important component of the pathophysiology of diabetes. Hyperactivation of dopamine (DA) production in the setting of diabetes inhibits insulin synthesis, resulting in hyperglycemia. On the other hand, hypoinsulinemia triggers activation of the dopaminergic system, forming a vicious circle. Increased DA production in diabetes plays an important role in the development of secondary central nervous system dysfunction, primarily through the development of cerebral insufficiency. Numerous preclinical studies confirm the dysfunction of the dopaminergic system (its activation) in diabetes. Clinical studies on this issue are scarce and require further investigation.Conclusion. Dysfunction of the dopaminergic system in diabetes is an important area of research into the pathophysiology of symptomatic neurological disorders in this disease. Type 1 and type 2 diabetes are pathogenetically different diseases, and therefore impaired DA production may be due to insulin deficiency in patients with type 1 diabetes, different timing of manifestation, with hyperinsulinemia and insulin resistance in type 2 diabetes. Finding reliable methods to diagnose dysfunction of the dopaminergic system may improve understanding of the ongoing pathological processes in the neuroendocrine system in diabetes, which is important in addressing their correction in addition to pathogenetic therapy.

Intellectual conflicts of interest among cardiology and pulmonology clinical practice guidelines.

Intellectual conflicts of interest (COI), like financial COI, may threaten the validity and trustworthiness of clinical practice guidelines (CPGs). However, comparatively little is known about intellectual COI in CPGs. This study sought to estimate the prevalence of intellectual COI and corresponding management strategies among cardiology and pulmonology CPGs. We conducted a retrospective document review of CPGs published by cardiology or pulmonology professional societies from the United States, Canada, or Europe from 2018 to 2019 available via the Emergency Care Research Institute, Guidelines International Network, or Medscape databases. We assessed the percentage of authors with an intellectual COI, defined as i) authorship on a study reviewed by the CPG, ii) authorship of a prior editorial related to a CPG recommendation, or iii) authorship of a prior related CPG. Management strategies assessed included use of GRADE methodology, inclusion of a methodologist, and recusals due to intellectual COI. Outcomes were assessed overall and compared between cardiology and pulmonology CPGs. Among the 39 CPGs identified (14 cardiology, 25 pulmonology), there were a total of 737 authors, of whom 473 (64%) had at least one intellectual COI. Among all CPGs, a median of 67% (Interquartile Range 50%-76%) of authors had at least one intellectual COI, and COI was more prevalent among cardiology compared with pulmonology CPGs (84% vs 57%, p<0.001). There was variable use of management strategies among the CPGs, including use of GRADE methodology (64% of CPGs), inclusion of a methodologist (49%), and recusals due to intellectual COI (0%). Intellectual conflicts of interest appear to be highly prevalent and under-reported among cardiology and pulmonology CPGs, which may threaten their validity. Greater attention to and improved management of intellectual COI by CPG-producing organizations is needed.

PROGNOSTIC VALUE OF LIQUID BIOPSY IN CRC: A LITERATURE REVIEW

Relevance: Liquid biopsy is a modern, quite appropriate, and promising method for diagnosing malignant neoplasms for oncology. The method allows us to determine the level of freely circulating tumor cells – micrometastases, tumor DNA, microRNA, and exosomes in blood plasma- and detect various genetic changes. A literature review of current scientific publications on liquid biopsy techniques, indexed in Medline, PubMed, and Medscape, was carried out as part of the work.&#x0D; The study aimed to review is to assess the prognostic significance of liquid biopsy, to determine the place of the method in current recommendations, and its expediency from the point of view of the practice.&#x0D; Methods: The information search was conducted in the Medline, PubMed, and Medscape databases, with a search depth of 8 years. Data from randomized controlled trials, clinical trials, reviews, systematic reviews, and meta-analyses were analyzed. The review includes both full-fledged articles in the public domain and abstracts to obtain complete information on the problem.&#x0D; Results: Liquid biopsy surpasses tissue biopsy in simplicity and speed of research, easy repeatability, and minimal invasiveness, as well as the possibility of dynamic monitoring of progression – the overall clonal transformation of the tumor and the emergence of resistance to treatment.&#x0D; The disadvantages of this method are low sensitivity, difficulty in correctly interpreting biomarkers and determining their specificity, and high risk of false positive and false negative results due to dormant tumor cells.&#x0D; Conclusion: At present, the Liquid biopsy method is relevant and in demand, but it needs to be tested on a validated sample of the main population, and in order to achieve effective clinical use, important work needs to be done to standardize both preanalytical and analytical procedures and generalize them for all components of liquid biopsy.

PROGNOSTIC VALUE OF LIQUID BIOPSY IN CRC: A LITERATURE REVIEW

Relevance: Liquid biopsy is a modern, quite appropriate, and promising method for diagnosing malignant neoplasms for oncology. The method allows us to determine the level of freely circulating tumor cells – micrometastases, tumor DNA, microRNA, and exosomes in blood plasma- and detect various genetic changes. A literature review of current scientific publications on liquid biopsy techniques, indexed in Medline, PubMed, and Medscape, was carried out as part of the work.&#x0D; The study aimed to review is to assess the prognostic significance of liquid biopsy, to determine the place of the method in current recommendations, and its expediency from the point of view of the practice.&#x0D; Methods: The information search was conducted in the Medline, PubMed, and Medscape databases, with a search depth of 8 years. Data from randomized controlled trials, clinical trials, reviews, systematic reviews, and meta-analyses were analyzed. The review includes both full-fledged articles in the public domain and abstracts to obtain complete information on the problem.&#x0D; Results: Liquid biopsy surpasses tissue biopsy in simplicity and speed of research, easy repeatability, and minimal invasiveness, as well as the possibility of dynamic monitoring of progression – the overall clonal transformation of the tumor and the emergence of resistance to treatment.&#x0D; The disadvantages of this method are low sensitivity, difficulty in correctly interpreting biomarkers and determining their specificity, and high risk of false positive and false negative results due to dormant tumor cells.&#x0D; Conclusion: At present, the Liquid biopsy method is relevant and in demand, but it needs to be tested on a validated sample of the main population, and in order to achieve effective clinical use, important work needs to be done to standardize both preanalytical and analytical procedures and generalize them for all components of liquid biopsy.

Kuzey Kıbrıs'ta bir eğitim hastanesindeki pediatrik hastalarda Potansiyel İlaç-İlaç Etkileşimleri: Retrospektif Bir Çalışma.

Hospitalized infants and children are exposed to various medications, leading to potential drug-drug interactions (pDDIs). A retrospective observational study was conducted in a Northern Cyprus tertiary hospital to determine the frequency, types and associated factors of pDDIs in hospitalized pediatric patients. All charts of pediatric patients hospitalized between September 1st, 2017, and August 30, 2018, were reviewed. Medications used concomitantly during hospitalization were screened for pDDIs using three DDI databases; Lexicomp TM 3.0.2, drugs.com, and Medscape. Of the 332 patients examined, 230 (69.2%) patient files met the inclusion criteria. The prevalence rates of pDDIs were 27.8%, 24.8%, and 23%, according to Lexicomp, Drugs.com, and Medscape databases, respectively. Young children (aged 2-6) had the highest percentage of pDDIs with a significant difference between databases (P &lt; 0.05). Patients with pDDIs had longer hospital stays and were on more medications than those without (P &lt; 0.05).&#x0D; Our study revealed that moderate severity pDDIs were common, and there were significant variations between databases. While severe pDDIs are rare, they may be life-threatening. Collaborative efforts involving pediatricians and clinical pharmacists are necessary to address pDDIs in pediatric medication management. Utilizing multiple databases to enhance pDDI identification and prevention is also crucial.

Assessment of Salvage Surgery in Persistent Cervical Cancer after Definitive Radiochemotherapy: A Systematic Review.

Background and Objectives: The standard treatment approach in locally advanced cervical cancer (LACC) is exclusive concurrent chemoradiation therapy (RTCT). The risk of local residual disease after six months from RTCT is about 20-30%. It is directly related to relapse risk and poor survival, such as in patients with recurrent cervical cancer. This systematic review aims to describe studies investigating salvage surgery's role in persistent/recurrent disease in LACC patients who underwent definitive RTCT. Materials and Methods: Studies were eligible for inclusion when patients had LACC with radiologically suspected or histologically confirmed residual disease after definitive RTCT, diagnosed with post-treatment radiological workup or biopsy. Information on complications after salvage surgery and survival outcomes had to be reported. The methodological quality of the articles was independently assessed by two researchers with the Newcastle-Ottawa scale. Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in May 2022. We applied no language or geographical restrictions but considered only English studies. We included studies containing data about postoperative complications and survival outcomes. Results: Eleven studies fulfilled the inclusion criteria and all were retrospective observational studies. A total of 601 patients were analyzed concerning the salvage surgery in LACC patients for persistent/recurrent disease after RTCT treatment. Overall, 369 (61.4%) and 232 (38.6%) patients underwent a salvage hysterectomy (extrafascial or radical) and pelvic exenteration (anterior, posterior, or total), respectively. Four hundred and thirty-nine (73%) patients had histologically confirmed the residual disease in the salvage surgical specimen, and 109 patients had positive margins (overall range 0-43% of the patients). The risk of severe (grade ≥ 3) postoperative complications after salvage surgery is 29.8% (range 5-57.5%). After a median follow-up of 38 months, the overall RR was about 32% with an overall death rate of 40% after hysterectomy or pelvic exenteration with or without lymphadenectomy. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of salvage surgery on survival and recurrence cannot be adequately estimated. Future homogeneous studies with an appropriately selected population are needed to analyze the safety and efficacy of salvage hysterectomy or pelvic exenteration in patients with residual tumors after definitive RTCT.

Role of radial k –space sampling technique in non-cooperative patients for the compensation of motion artifact in magnetic resonance imaging (MRI).

Objective: To access the role of radial K-space sampling technique for the compensation of motion artifact in magnetic resonance imaging (MRI). Study Design: Systematic Literature Search. Setting: Department of Radiology, Shalimar Hospital, Lahore. Period: March 2019 to Oct 2019. Material &amp; Methods: Was conducted with the help the of following search engines: Google scholar, PubMed, NCBI, Medline and Medscape databases from 1999 up to 2019 for names or acronyms of Radial K-space sampling, propeller sequence, management of motion artifact in MRI, RADAR sequence for motion compensation in MRI, k-space in clinic and multivane. Only those studies were included in this review study which shows the role of radial K-space sampling Technique for compensation of motion artifact. Total 104 studies were selected and after evaluation only 42 studies were included. Results: According to literature radial k-space sampling improved the quality of image and provided the scans with reduced motion artifact. Whereas in case of specificity (N= 16) the mean calculated value was 80.87 and Std. Deviation was 7.022. In case of radial k-space sampling technique (N=42) calculated mean was .26 and std. deviation was .701. The main disadvantage of radial k-space sampling is increased scan time. Conclusion: After reviewing literature of 42 studies, it was assessed that the use of radial K-space sampling technique or propeller sequence adjacent to the standard MRI sequences can reduce the motion artifact and will increase the image quality.

SONOGRAPHIC ASSESSMENT OF INTIMA-MEDIA THICKNESS OF CAROTID ARTERIES - A REVIEW OF LITERATURE

We conducted a systematic review of the literature that has examined carotid arteries using ultrasonography in order to better explain the association between diabetes, hypertension, and intima-media thickness (IMT). The goal of this study was also to get a precise evaluation of increasing intima-media thickness predictive value for clinical cardiovascular outcomes. From 2000 through 2021, we searched the Google Scholar, NCBI, PubMed, and Medscape databases. The following essential keywords were looked up: ultrasound of carotid arteries, ultrasound of common carotid arteries intima-media thickness, and carotid IMT in diabetes and hypertension. Of the 135 retained studies the percentage of detection was used to calculate the diseases that affect intima–media thickness. As a result following were the causes that alter intima–media thickness: diabetes and hypertension at 81.4 % and 80 % respectively. Coronary artery disease at 21.4%, dyslipidemia and stroke at 14.8% and 5.2% respectively. Microalbuminuria at 3%. However, non-alcoholic fatty liver disease, peripheral arterial disease (PAD) and chronic kidney disease (CKD) at an equal effect of 2.2%, MI at 1.5%. Breast arterial calcification, polycystic kidneys and glomerulonephritis at an equal effect of 0.7%. In conclusion, patients with hypertension and diabetes are most at risk of developing coronary artery disease.

Is Adnexectomy Mandatory at the Time of Hysterectomy for Uterine Sarcomas? A Systematic Review and Meta-Analysis.

Background and Objectives: Uterine sarcomas represents only 3% of all the female genital tract ones. The tumoral stage is the most significant prognostic factor. The role of the bilateral salpingo-oophorectomy (BSO) in the surgical management of FIGO stage IA and IB appears still controversial. This review aims to investigate the impact of bilateral adnexectomy in the treatment of uterine sarcoma. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in February 2022. We applied no language or geographical restrictions, but we considered only English studies. We included the studies containing data about Recurrence Rate (RR), Disease-free Survival (DFS), and Overall Survival (OS). We used comparative studies for meta-analysis. Results: Seventeen studies fulfilled the inclusion criteria; 2 retrospective observational studies, and 15 retrospective comparative studies, And 14 out of the 15 comparative studies were enrolled in meta-analysis. A total of 3743 patients were analyzed concerning the use of adnexectomy with hysterectomy in patients with uterine sarcoma and compared with those who did not. Meta-analysis highlighted a non-significant worsening of the OS in the BSO group compared to the OP group and showed that adnexectomy does not improve the DFS (BSO OR 1.23 (95% CI 0.81–1.85) p = 0.34; I2 = 24% p = 0.22). Conclusions: Most studies selected for our review showed that adnexectomy does not significantly affect the RR, OS, and PFS in treating FIGO stage I uterine sarcomas. Therefore, even if there is a unanimous consensus about bilateral adnexectomy in menopausal patients, preservation of ovarian tissue may be considered in premenopausal women. Nonetheless, there are not enough cases in the literature to recommend this procedure.

Migraine and pregnancy

Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and Methods. We performed a literature review searching relevant information on the subject in PubMed and Medscape databases. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.

Electroconvulsive therapy for Depression in Anorexia Nervosa. A review

IntroductionAnorexia nervosa has an important burden on both patients and families, with important comorbidities such as depression and obsessive symptoms. These are more resistant to pharmacological treatment than in non-anorexia patients, due to both biological and psychological mechanisms. Electroconvulsive therapy is the best available therapy for treatment resistant depression making it a treatment to consider in treatment resistant depression in anorexia though only case reports exist.ObjectivesTo review the current evidence for electroconvulsive therapy of depression in patients with anorexia nervosa as well as it’s ethical challengesMethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “anorexia nervosa”.ResultsElectroconvulsive therapy in anorexia has no controlled trials with mostly case reports available on scientific databases. It presents important challenges due to patient age, medical status and ethical challenges. Even less evidence exist for electroconvulsive therapy in children and adolescents than for adults, anorexia can complicate medical status presenting an anesthetic and life-support challenge and it’s egosyntonicity can place a legal and ethical challenge when patient refuses treatment.ConclusionsAnorexia has a dramatic burden on patients and families affected, with integrated evidence-based treatment being necessary both for treating the current episode and for remission prevention. Case-reports show that electroconvulsive therapy can play a role on treatment resistant depression in anorexia.DisclosureNo significant relationships.

Shame and psychopathology. Its role in the genesis and perpetuation of different disorders

IntroductionShame is a profound negative emotion that can sometimes be cover up by guilt and remain undiagnosed. Shame and guilt have been described as self-conscious and moral emotions as they both involve self-evaluation and lay a role in facilitating moral conduct. They derive from the notion of responsibility, but some authors suggest that while guilt focuses only on the act at hand shame focuses on the one executing it. The self is the object.ObjectivesTo review the literature on shame and its role in different disorders both as a causing agent and as a perpetuating agentMethodsNon-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “shame”, “psychopathology.ResultsSince shame globally decreases self-esteem and is an awareness of personal flaws it can lead to the feelings of helplessness and the development or worsening of mental disorders. As such it is no wonder to find shame being studied in many different forms, more and less structured with important connections being made with social anxiety, eating disorders, dysmorphic disorders, personality disorders and bereavement.ConclusionsShame’s role, independently from guilt can have an impact on both the genesis and perpetuation of mental disorders. Its study can uncover missing links between different types of experiences and the pathological reactions that may subsequently follow.DisclosureNo significant relationships.

Body dysmorphic disorder treatment: about a clinical case

IntroductionBody dysmorphic disorder (BDD) is a relatively common disorder characterized by a preoccupation with non-existent or slight defects in appearance. It was first described in 1886 by Morselli as dysmorphophobia.ObjectivesThis work reviews the current available data on BDD and its treatment options and describes a clinical case that reports an improvement in symptomatology after surgery.MethodsNon-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “body dysmorphic disorder”, “dysmorphophobia”. Clinical file consultation.ResultsThe usual treatment involves a combination of psychotherapy and pharmacotherapy. Antidepressant medication, mainly selective serotonin reuptake inhibitors (SSRIs) have been used. If the symptoms do not improve, a different SSRI can be considered or clomipramine, venlafaxine or second-generation antipsychotics can be useful.ConclusionsThe role of surgery remains controversial, several studies indicating that the symptoms typically worsen after an aesthetic procedure because the preoccupation shifts to a different body area. However a recent study reported 32 of the 41 patients that underwent surgery were highly satisfied with the outcome. In our clinical case, our patient, a 20-year-old female with non-delusional dysmorphic ideas about her nose initiated treatment with paroxetine with poor response and was, against medical opinion, submitted to a rhinoplasty. Three weeks after the surgery there was an improvement in preoccupation about her nose. More research should be made to clarify the role of surgery in this disorder that often lacks adequate therapeutical response.DisclosureNo significant relationships.

Electroconvulsive therapy for Patients with Intellectual Disability. When and how?

IntroductionIntelectual disability is an illness with an important burden on patients and caregivers, especially when severe and when comorbidities such as other psychiatric disorders are present. There are case reports of treatment resistant self-aggression, agitation, epilepsy, catatonia and psychosis successfully treated with electroconvulsive therapy although controlled studies were not found.ObjectivesThis work reviewed the current evidence for the use of electroconvulsive therapy in the management of patients with intellectual disability as well as its ethical and methodological implications.MethodsNon-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “intellectual disability”.ResultsPatients with intellectual disability can have incapacitating comorbilities that greatly impair quality of life, and may require withdrawl from the community Treatment often differs from the general population as psychotropic medication can worsen other comorbilities. Electroconvulsive therapy can be a relevant treatment option for comorbidities in this population due to its safety profile. Ethical considerations should be taken into account, especially with non-verbal patients or when adequate representatives have not been chosen or cannot be reached. Different legal challenges may be present on different countries.ConclusionsElectroconvulsive therapy and intellectual disability share the burdens of heavy stigma and low investment. Intellectual disability and it’s commorbidites present both a diagnostic and treatment challenge. Electroconvulsive therapy is an important weapon capable of restoring patients to their families and diminishing the burdens of caregivers and healthcare systemsDisclosureNo significant relationships.

Folie à deux: contagious mental illness? Report of a clinical case

IntroductionFolie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists.ObjectivesThe aim of this article is to report a clinical case of folie à deux, between na inducer son and an induced mother. Review the nosological significance of folie à deux and to explore the disorder among patients with psychosis.MethodsSearch in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.ResultsWe presente a case of folie à deux between na inducer son 28 years old and the induced, his mother. They were found to be sharing similiar delusional beliefs. The patient has assumed the role of “man of the house” since his father’s death.ConclusionsMany years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists. Its recognition and correct referral for a rare diagnosis, such as folie a deux, are extremely important.DisclosureNo significant relationships.