Potential Triggering Factors Research Articles

Guillain-Barr\xe9 syndrome triggered by surgery in a Chinese population: a multicenter retrospective study

BackgroundSurgery is a potential trigger of Guillain-Barré syndrome (GBS), a disorder which leads to an autoimmune-mediated attack of peripheral nerves. The present study was designed to explore clinical features of post-surgical GBS compared with those of general GBS in order to provide better clinical advice to patients undergoing surgery.MethodsThe medical records of GBS patients who were seen at 31 tertiary hospitals in southern China between January 1, 2013 and September 30, 2016 were retrospectively analyzed. Post-surgical GBS was defined as symptoms of GBS within 6 weeks after surgery. Clinical features of post-surgical GBS are described and are compared with general GBS.ResultsAmong the 1001 GBS patient cases examined in this study, 45 (4.5%) patient cases exhibited symptoms of GBS within 6 weeks of undergoing surgery. Within this group, 36 (80.0%) patients developed initial symptoms of limb weakness. The average interval between surgery and symptom onset was 13.31 days. The most common type of surgery which triggered GBS was orthopedic surgery, followed by neurological surgery. Compared to general GBS, post-surgical GBS was characterized by a higher proportion of severe patients (Hughes functional grading scale (HFGS) score ≥ 3) upon admission and at nadir, higher HFGS scores at discharge, and longer hospital stays. Post-surgical GBS patients also had a significantly higher frequency of the acute motor axonal neuropathy subtype (37.9 vs. 14.2, respectively; P = 0.001).ConclusionSurgery is probably a potential trigger factor for GBS, especially orthopedic surgery. Infections secondary to surgery may play a role. The possibility of preceding (post-operative) infections was not excluded in this study. Clinical presentation of post-surgical GBS is characterized by a more severe course and poorer prognosis, and should be closely monitored.Trial registrationchicTR-RRc-17,014,152.

Displacement history and potential triggering factors of Baige landslides, China revealed by optical imagery time series

In this study, on the basis of the image correlation technique and the time-series images of Landsat-8 (L8), Sentinel-2 (S2), and GaoFen-2 (GF2), a systematic technical process is designed to investigate the precursory displacement evolution of two successive slope failures occurred in Baige Village, China on Oct. 11, 2018 and Nov. 3, 2018. An innovative fusion strategy is proposed to investigate the displacement history of the Oct. 11, 2018 Baige landslide, which has two steps: (1) selecting the optimal correlation window size and search step to eliminate the inconsistency of image correlation for different sensors, and (2) inverting the fused displacement time-series from correlation results to enhance the temporal sampling density. The normalized displacement velocity indicates that the Oct. 11, 2018 Baige landslide is characterized by high-speed sliding (28 m/yr) and high shear outlet with an average elevation difference of around 82 m. The fused displacement time series indicates that the whole phase transformation can be from the secondary stage to the tertiary stage on Mar. 26, 2017. Furthermore, the displacement velocity shows four quiescence phases in the secondary stage and two acceleration phases in the tertiary stage. The seasonal precipitation is assumed as the main external triggering factor, and it combined with the brittle geological material attributes to control the precursory landslide displacement evolution and caused the catastrophic slope failure on Oct. 11, 2018. The precursory displacement signals with a magnitude above 5 m/day of the second landslide (Nov. 3, 2018) is quantified by the S2 image correlation. This study highlights the prospects of optical observation time series with medium-/high-resolution in detecting and quantifying the spatio-temporal evolution characteristics of long-term creeping landslides which may play a significant role in the early warning of the catastrophic slope failure.

Atopic dermatitis, inhalant allergy and food allergy: A paediatric approach.

Food and inhalant allergens have also been identified as potential trigger factors of atopic dermatitis symptoms. Here we aimed to investigate relationships between atopic dermatitis and inhalant-food allergen sensitization in Turkish children with atopic dermatitis. We included 70 patients (42 male, 28 female) with atopic dermatitis and 45 controls (30 male, 15 female) with no atopy, no atopy familial history, no atopy clinical findings no atopic dermatitis. We noted patients' and controls' age, gender, passive smoking exposure, atopy, xerosis, bath water temperature, shower gel type, clothes detergent type, blood hemoglobin, blood eosinophil count, blood eosinophil percent, values of serum immunoglobulin E, serum immunoglobulin A, serum immunoglobulin G, serum immunoglobulin M, results of inhalant allergen, and food allergen testing. We found that nine cases had inhalant allergen sensitization and 21 cases had food allergen sensitization. There were significant relationships between cases and controls in terms of count of eosinophil and percent of eosinophil (P = .008, P = .009, respectively). Humoral and cellular allergen-specific immune responses to food and inhalant allergens can be detected in patients with atopic dermatitis. Accordingly, we believe that blood eosinophil count and percent are more valuable laboratory parameters than serum total IgE for following patients with atopic dermatitis.

Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice

Purpose and ObjectiveA proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require ad hoc treatment re-planning. The aim of this retrospective study is to analyze the patients who required ad hoc re-planning and to identify factors, which may predict need for re-planning.Materials and MethodsA single center evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January and December 2016 was undertaken. Patients who underwent ad hoc re-planning during the treatment were identified in electronic records. Reasons for re-planning were categorized as: weight loss, tumor shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumor site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated.Results31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy required re-planning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for re-planning were tumor shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumor/treatment factors, nasopharyngeal primary site (p = 0.013) and use of concurrent chemotherapy with radiotherapy (p = 0.034) were found to be significantly correlated with the need for re-planning.ConclusionEffective on-treatment verification schedules and close follow up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualized triggered approach to ART rather than scheduled strategies as it is likely to be more feasible in terms of utilization of workload and resources.

Synthesis and Detection of Publication Bias in Relationship between Motivation and Teacher Performance: A Meta-analysis Review

The relationship between motivation and teacher performance has been extensively investigated by using various models of relationship analysis. As a result, the relationship between the two variables is relatively poorly understood and requires separate analysis to ascertain the extent of the relationship between the two variables. In addition, a number of studies have reported that motivation has a significant relationship with teacher performance. However, the accuracy of the information reported by these studies is an important aspect to explore to ensure that there is no publication bias. This research aims to analyze the relationship between motivation and teacher performance based on a meta-analysis review of a number of published studies. The research data used were 30 correlational research results from journal articles published from 2010 to 2019. The random effects model was used as an effect size in this meta-analysis study. The effect summary results show that there is a significant relationship between motivation and teacher performance with an r coefficient of 0.446 and the confidence interval is moderate category with a value range between 0.371 - 0.515. By using the Trim and Fill method in this meta-analysis procedure, it was found that this research did not indicate publication bias. The results of this research can be an important reference for education providers, especially school administrators, to plan strategies for increasing school productivity. Motivation can be a potential trigger factor for improving teacher performance. Thus, school administrators can design appropriate motivational strategies to improve their teacher performance.

Parasomnias in patients with addictions-a systematic review.

Parasomnias are involuntary behaviors or subjective experiences during sleep. Our objective was to review existing information on the presence of parasomnias in patients with addictions or during treatment for addictions. Information about parasomnias related to rapid-eye-movement (REM) and non-REM sleep in patients with addictions, while using substances or in abstinence, was reviewed. A systematic search of published articles reporting parasomnias as a consequence of drug use or abuse was conducted in the PubMed and SciELO databases. The search for the studies was performed in three phases: (1) by title, (2) by abstract, and (3) by complete text. The search was performed independently by two researchers, who then compared their results from each screening phase. Seventeen articles were found. The consumption of alcohol was reported in association with arousal disorders, such as sexsomnia and sleep-related eating disorder; and REM sleep behavior disorder was reported during alcohol withdrawal. Cocaine abuse was associated with REM sleep behavior disorder with drug consumption dream content. Overall, we found that several types of parasomnias were very frequent in patients with addictions. To avoid accidents in bedroom, legal problems, and improve evolution and prognosis; must be mandatory to include security measures related to sleep period; avoid pharmacological therapy described as potential trigger factor; improve sleep hygiene; and give pharmacological and behavioral treatments for patients with these comorbid sleep disorders.

1524P Sleep disorders among Tunisian cancer patients: Prevalence and potential risk factors

Insomnia has been reported to affect 30% to 60% of cancer patients, although conflicting data have been postulated regarding its potential triggering factors. The aim of our study was to evaluate the prevalence and to determine the main factors associated with cancer-related insomnia (CRI). From October 2019 to February 2020, data were collected from a questionnaire distributed to 125 cancer patients on their last month’s sleep-quality. Insomnia severity was assessed using the Insomnia Severity Index (ISI). Data were processed using SPSS version 21. We interrogated 125 patients with a median age of 52 years old [17-78]. Most of them were women (69% vs 31%). Of the patients interviewed, 46.8% had breast cancer, 30% had gastro-intestinal malignancies, 4.8% had genitourinary cancers, 4%, had gynaecologic cancers and 14.4% had other neoplasms. Insomnia affected 55.6% of patients and was subthreshold in 23%, moderate in 27%, and severe in 5.6%. Age and comorbidities did not seem to trigger sleeping disorders (P=0.335 and P = 0.41, respectively). Compared to men, female patients were more likely to experience moderate to severe insomnia (MSI) (P=0.4) and to seek medical care for their sleep disorders (23% vs 11%, P=0.3). Disease stage did not appear to interfere with ISI scores (P=0.68), while time from diagnosis significantly affected sleep quality - patients during the first 6 months from diagnosis had an 8-fold increased risk of developing MSI (P=0.04). In these patients the main difficulties reported were falling asleep in 86%, maintaining sleep in 78% and experiencing early awakening in 64% of cases. Among patients presenting MSI, 27% reported pain-related insomnia-mainly due to post-mastectomy neuropathic pain in 71%, stoma irritation and bleeding in 12%, and bone and liver metastases-related pain in 12%. Insomnia management mainly consisted of sleep hygiene education in 56.4%, homeopathic remedies in 17% and benzodiazepines in 5% with enhanced pain management for patients with pain-related insomnia. CRI is often under-diagnosed although it affects more than half of cancer carriers. During the first 6 months of diagnosis, patients exhibited an 8-fold increased risk of MSI. Management of insomnia in these patients should be integrated more effectively within cancer care.

The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy.

PurposeChronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential triggering factor of TCM. The association between COPD and in-hospital outcomes and complications among TCM patients is not well established. We sought to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM.MethodsWe conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD using the latest National Inpatient Sample from 2016–2017. We identified 3139 patients admitted with a primary diagnosis of TCM by the ICD-10-CM coding system; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis.ResultsBefore matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs 3.27±3.39 days, p<0.001), hospitalization charges ($55,242.68±47,637.40 vs $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs1.0%, p=0.005), longer LOS (4.02±3.00 days vs 3.40±3.54 days, p<0.001), higher hospitalization charges ($55,409.23±47,809.13 vs $46,469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs 8.2%, p<0.001) and cardiogenic shock (5.6% vs 3.3%, p=0.024), respectively.ConclusionPatients with COPD who are hospitalized for TCM have higher rates of inpatient mortality, ARF, cardiogenic shock, as well as a longer LOS, and higher charges of stay than those without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short- and long-term outcomes of TCM.

Luminescence reveals micro discharge as a potential triggering factor for surface flashover

The undetermined surface flashover of insulators limits the development of ultra-high voltage AC gas insulated equipment. In this paper, we report a micro discharge potentially triggered surface flashover phenomenon, which is revealed directly by luminescence activities of samples with different micro morphologies. The results show that sandblasted samples, which are prone to a lower surface flashover voltage, present luminescence pulses corresponding to micro discharge activities over the surface. Polished samples have the mold release agent layer removed and inhibit local micro ionization, which eliminates the pulse luminescence and improves the surface flashover voltage. This paper brings novel ideas to insulation surface flashover mechanism under AC voltage and lays a foundation for further developing high reliable gas insulted equipment.

Remote analysis of an open-pit slope failure: Las Cruces case study, Spain

Slope failures occur in open-pit mining areas worldwide, producing considerable damage in addition to economic loss. Identifying the triggering factors and detecting unstable slopes and precursory displacements —which can be achieved by exploiting remote sensing data— are critical for reducing their impact. Here we present a methodology that combines digital photogrammetry, satellite radar interferometry, and geo-mechanical modeling, to perform remote analyses of slope instabilities in open-pit mining areas. We illustrate this approach through the back analysis of a massive landslide that occurred in an active open-pit mine in southwest Spain in January 2019. Based on pre- and post-event high-resolution digital elevation models derived from digital photogrammetry, we estimate an entire sliding mass volume of around 14 million m3. Radar interferometry reveals that during the year preceding the landslide, the line of sight accumulated displacement in the slope reached − 5.7 and 4.6 cm in ascending and descending geometry, respectively, showing two acceleration events clearly correlated with rainfall in descending geometry. By means of 3D and 2D stability analyses we located the slope instability, and remote sensing monitoring led us to identify the likely triggers of failure. Las Cruces event can be attributed to delayed and progressive failure mechanisms triggered by two factors: (i) the loss of historical suction due to a pore-water pressure increase driven by rainfall and (ii) the strain-softening behavior of the sliding material. Finally, we discuss the potential of this methodological approach either to remotely perform post-event analyses of mining-related landslides and evaluate potential triggering factors or to remotely identify critical slopes in mining areas and provide pre-alert warning.

Linking Western Tethyan Rhynchonellide morphogroups to the key post-Palaeozoic extinction and turnover events

Genetic control undoubtedly plays the most decisive role in the development of characters in rhynchonellides, especially in those structural features such as shell microstructure and brachidial architecture. However, considering the relationship between shell microstructure and type of crura in post-Palaeozoic rhynchonellides supported by recent growing research, the present study links this striking matching to the distribution of rhynchonellide morphogroups around the main post-Palaeozoic mass extinction and diversification events, innovatively introducing the ribbing pattern as a feature widely argued as indicator of deeper/shallower habitats and particular ecological conditions. The analyses performed on the Western Tethys rhynchonellide database and, directly on 28 species from the peri-Iberian margins around selected post-Palaeozoic extinction/diversification episodes, reveal a recurrent distribution pattern according to the habitat considered (epicontinental vs. epioceanic). The smooth, eurinoid, septifal/arcual body plan is the distinctive inhabitant of deeper epioceanic environments, also being the last to withdraw from the epicontinental platforms when the environmental conditions were adverse, and the pioneers or opportunistic taxa conducting repopulation of these epicontinental habitats when the conditions were re-established after crises. The ribbed, eurinoid, falciform morphogroup seems to be the more resilient stock on epicontinental platforms in relation to ecological crises. Conversely, the ribbed, leptinoid, raducal group is typical inhabitant of epicontinental seas when normal conditions prevail and shows an uneven distribution unlinked to critical events, suggesting a more specialist pattern with a diversification related with a secondary differentiation. It is suggested that this distribution dynamic of morphogroups was controlled by the availability of requirements to generate each type of crura and microstructure in epicontinental/epioceanic habitats, such as metabolic or oxygen restrictions, or the filter-feeding efficiency of the lophophore. A research line starting-point is thus herein introduced which can lead to shed light into the adaptive strategies of rhynchonellides, relating particular morphotypes with potential triggering factors of mass extinction events.

Sub-monthly evolution of the Caribbean Low-Level Jet and its relationship with regional precipitation and atmospheric circulation

The summer spatial structure and sub-monthly temporal evolution of one of the key dynamical features of Central American climate, the Caribbean Low-Level Jet (CLLJ), is investigated by means of extended empirical orthogonal functions (EEOFs). The Caribbean 925-hPa zonal wind from the CFSR reanalysis for the period 1979 – 2010 is used for the analysis. This approach reveals new insights into the dynamical processes and spatio-temporal evolution of the CLLJ summer intensification, and through lead and lag linear regressions, significant climate links in the broader Caribbean region are identified. The results show that the CLLJ generates significant precipitation and temperature responses with a distinct temporal evolution over the Caribbean-Atlantic domain to that over the tropical Pacific, which hints at different underlying controlling mechanisms over these two large-scale regions. These anomalies are linked with the mid and upper tropospheric circulation, where a vertical cell over the Caribbean (ascending at the jet exit and subsiding at its entrance) varies in phase with large-scale divergence over the Pacific Ocean. Extratropical hemispheric-wide waves and the weakening of a thermal low in northeast Mexico-central US are identified as potential triggering factors for the CLLJ summer intensification. Two leading modes of tropical variability, El Niño Southern Oscillation and the Madden-Julian Oscillation, are found to modulate the CLLJ by intensifying it and prolonging its life cycle. Details of the underlying mechanisms are provided. These results help to advance the understanding of the processes that modulate local climate variations, which is an important issue in view of the rapid climate change the region is undergoing.

Acute Psychological Stress is a Trigger for Stroke: A Case-Crossover Study

BackgroundConventional risk factors for stroke that have been identified are mostly chronic diseases that explain much of the variation as to who develops stroke. However, these risk factors do not equip us with the means to predict when an event like stroke will occur. It has been observed that acute events like stroke and coronary heart disease are preceded by episodes of acute stress. The present study was undertaken to determine whether acute psychological stress is a potential triggering factor for the occurrence of stroke. MethodsIn accordance with the case-crossover study design, patients or Legally Authorized Representative (LAR) were asked to report psychological stress during the two-hour hazard period before the event and during the control period, which was the same 2-hour time period the day before the event. Conditional logistic regression was used to compare each person's exposure during the hazard period to their exposure during the control period. ResultsA total of 151 stroke patients were interviewed. Acute psychological stress was associated with transient increased odds of stroke in the subsequent 2 hours that was 3.4 times higher than the odds during periods with no exposure to these triggers (95% confidence interval 1.55-7.50). ConclusionsAcute psychological stress is a potential independent triggering factor for the occurrence of stroke. Further confirmatory studies are required to help corroborate these findings and elucidate the mechanisms underlying this short-term increase in risk.

Vulvar pruritus-Causes, Diagnosis and Therapeutic Approach.

In Germany, 17-23% of the population suffers from chronic itching of the skin; in 5-10% of cases, the female genitalia are affected, specifically, the vulva. Vulvar pruritus is thus a common symptom that often markedly impairs the affected women's quality of life. This review is based on pertinent publications that were retrieved by a selective search in MEDLINE/PubMed for articles on the pathogenesis, diagnosis, and treatment of vul- var pruritus. The search terms were (in German and English) "vulvärer Juckreiz," "pruritus vulvae," and "genital itch," alone and in combination with "Behandlung," "Therapie," or "treat- ment." The most common cause of vulvar pruritus is vulvo- vaginal candidiasis followed by chronic dermatoses, such as lichen sclerosus and vulvar eczema. Especially in refractory cases, an invasive or preinvasive lesion such as squamous epithelial dysplasia (VIN, vulvar intraepithelial neoplasia) should be borne in mind in the differential diagnosis. Rarer causes include infection, atrophy, and vulvodynia. The essen- tial elements of treatment are topical/oral antimycotic drugs and high-potency glucocorticoids, along with consistently ap- plied, basic moisturizing care and the avoidance of potential triggering factors. As vulvar pruritus has multiple causes, standard- ization of its diagnostic evaluation and treatment would be l efficacy and to meet the diverse needs of women who suffer from this condition.

Using Baseline and Peak Serum Tryptase Levels to Diagnose Anaphylaxis: a Review.

The diagnosis of anaphylaxis relies on a suggestive clinical history after exposure to a potential triggering factor. Serum tryptase concentrations increase on degranulation of mast cells and therefore serum tryptase levels are measured to diagnose anaphylaxis. There is no standardized method for assessing total serum mast cell tryptase (MCT) in anaphylaxis. The Working Conference in 2010 proposed a consensus equation (peak MCT should be > 1.2x baseline tryptase + 2ng/L) to diagnose acute mast cell activation (aMCA). Our objective was to narratively review the literature since the Working Conference in 2010, examining the use of the consensus equation and other equations comparing baseline and peak serum tryptase during anaphylaxis. Computerized bibliographic searches of PUBMED and EMBASE were supplemented with a manual search of reference lists. English-language studies were included. Eleven studies met our inclusion criteria with a total of 4551 participants. However, only four studies with 653 participants used the consensus equation. The other seven studies used other methods to compare peak and baseline serum tryptase concentrations. Measuring serum tryptase levels is valuable in the diagnosis of anaphylaxis but is unable to detect all anaphylactic reactions. Based on our current literature review, the consensus equation is underused in the diagnosis of anaphylaxis. There is also a need for exploration of other biomarkers which could be used in parallel to peak and baseline serum tryptase measurements for further diagnostic certainty. Serum tryptase is the most studied biomarker in anaphylaxis but is still far from being the ideal biomarker for this. There is a need to identify new potential useful biomarkers. Serum tryptase levels are valuable in the diagnosis of anaphylaxis, but are unable to detect all anaphylactic reactions. Additionally serial tryptase measurements are laborious in daily clinical practice.

Exercise as a therapeutic strategy in epilepsy: a literature review

Epilepsy is a common neurologic disease with emotional and physical consequences. Thirty percent of patients have drug-resistant epilepsy, therefore adjuvant non-pharmacological therapies, such as physical activity, have been proposed. This study reviews the literature about physical activity in people with epilepsy, to evaluate the benefits, potential side effects, impact on comorbidities, the risk classification of sports, and the barriers to their practice. Multiple animal and human models evaluate the benefits of exercise in epilepsy, explained by modulation on neurotransmitters, hormones, and neurotrophic factors. Furthermore, exercise demonstrates positive impact on comorbidities such as obesity, cardiovascular disease, depression, and osteoporosis. Despite being a practice that has been shown to be safe, people with epilepsy are less physically active due to barriers that limit their practice. Physical activity is beneficial and safe for people with epilepsy. Literature suggests better control of seizures, psychosocial benefits, and improvements on the comorbidities. There is a low risk of injury associated. Exercise should be promoted after a careful clinical evaluation, considering seizure control in the last year, potential triggering factors and the sport chosen.

Charcot Neuroarthropathy: From the Laboratory to the Bedside.

The diabetic Charcot foot syndrome is a serious and potentially limbthreatening lower-extremity complication of diabetes. The present review provides a concise account of the advances made over the last twentyfive years in understanding the pathogenesis and management of Charcot neuroarthropathy (CN). In this study, the widely known pathogenetic mechanisms underpinning CN are brought into focus, particularly the role of RANKL/RANK/OPG system and advanced glycation end production in the pathogenesis of CN. Furthermore, other potential triggering factors, namely nitric oxide, endothelial dysfunction, macro calcifications and body weight that influence CN have also been discussed. The wide range of diagnostic tools available to clinicians for accurate staging of this pathology has been examined, particularly radiological and nuclear medicine imaging. Additionally, the difficult differential diagnosis between osteomyelitis and CN is also elucidated. The review concludes with the comprehensive summary of the major promising therapeutic strategies, including conservative treatment involving orthopedic devices, pharmacological approach, and the most common surgical techniques currently employed in the diagnosis and treatment of this acute disease.

Glutathione Deficiency and Alterations in the Sulfur Amino Acid Homeostasis during Early Postnatal Development as Potential Triggering Factors for Schizophrenia-Like Behavior in Adult Rats.

Impaired glutathione (GSH) synthesis and dopaminergic transmission are important factors in the pathophysiology of schizophrenia. Our research aimed to assess the effects of l-buthionine-(S,R)-sulfoximine (BSO), a GSH synthesis inhibitor, and GBR 12909, a dopamine reuptake inhibitor, administered alone or in combination, to Sprague–Dawley rats during early postnatal development (p5–p16), on the levels of GSH, sulfur amino acids, global DNA methylation, and schizophrenia-like behavior. GSH, methionine (Met), homocysteine (Hcy), and cysteine (Cys) contents were determined in the liver, kidney, and in the prefrontal cortex (PFC) and hippocampus (HIP) of 16-day-old rats. DNA methylation in the PFC and HIP and schizophrenia-like behavior were assessed in adulthood (p90–p93). BSO caused the tissue-dependent decreases in GSH content and alterations in Met, Hcy, and Cys levels in the peripheral tissues and in the PFC and HIP. The changes in these parameters were accompanied by alterations in the global DNA methylation in the studied brain structures. Parallel to changes in the global DNA methylation, deficits in the social behaviors and cognitive functions were observed in adulthood. Only BSO + GBR 12909-treated rats exhibited behavioral alterations resembling positive symptoms in schizophrenia patients. Our results suggest the usefulness of this neurodevelopmental model for research on the pathomechanism of schizophrenia.

Cardiogenic shock triggered by phaeochromocytoma crisis after an oral glucose tolerance test: a case report.

BackgroundPhaeochromocytomas are rare catecholamine-producing tumours which typically present with comparatively benign symptoms such as headache, palpitations, sweating, hypertension, and insulin resistance. In rare cases, severe cardiac manifestations have been reported. We describe a patient who developed severe hypoglycaemia after an oral glucose tolerance test (OGTT), potentially triggering a phaeochromocytoma crisis and cardiogenic shock. To the best of our knowledge, only four other cases of hypoglycaemia after OGTT have been reported in patients with phaeochromocytoma, of which none developed a phaeochromocytoma crisis.Case summaryA 53-year-old woman with hypertension, dyslipidaemia, and prediabetes presented to the Emergency Department with hypoxia, hyperglycaemia, lactic acidosis, severe left ventricular dysfunction, and pulmonary oedema followed by cardiogenic shock. Onset of symptoms was only few hours after an OGTT during which she had developed severe transient hypoglycaemia. Angiography was performed due to elevated troponin levels and showed a midventricular contraction pattern typical of takotsubo. This was subsequently confirmed by cardiac magnetic resonance imaging. The patient’s condition improved during the first 36 h and she was discharged home on Day 7. A positive catecholamine test prompted readmission to the Endocrinology Unit, where computer tomography confirmed the diagnosis of phaeochromocytoma. An adrenalectomy was performed, and the diagnosis was verified histopathologically.DiscussionThe possibility of a phaeochromocytoma must be considered as a potential triggering factor in patients presenting with takotsubo cardiomyopathy, in particular, when blood glucose levels fluctuate between severe hypo- and hyperglycaemia.

Mupirocin Pemphigus-Like Drug Reaction in a Dog

Background: Pharmacodermia is defined as adverse reaction in skin, mucosa and appendages, which generates morpho-functional alterations in cutaneous barrier, inducing autoimmune diseases, such as pemphigus foliaceous, which is known as the most common autoimmune skin disease in dogs. This disease involves autoantibodies against desmoglein and desmocolin molecules, being induced by the use of certain drugs. Mupirocin (pseudomonic acid A) is a broad-spectrum antibiotic with bacteriostatic activity, being effective against Gram-positive pathogens and used to control superficial bacterial folliculitis. Based on that, the aim of this study was to report a pemphigus-like lesions after topical use of mupirocin in dog.Case: An 1-year-old, uncastrated male, Poodle dog, weighing 13.8 kg was treated in a private clinic in Fortaleza. The main complaint was related to pruritus in abdominal and inguinal region, in addition of legs licking. Dermatological examination revealed melanic crusts, epidermal collars and diffuse pustules in inguinal, abdominal, perianal and thoraco-lumbar regions. The therapy was based on topical use of Mupirocin in form of 0.2% aquous spray. After drug administration, the animal presented urticaria, diffuse epidermal collars, papulo-crusted and pustular lesions, which were more evident in abdominal and inguinal region. Nasal erythema, binocular blepharitis, apathy and fever were also observed. Cytological examination and bacterial culture were performed, revealing inflammatory and acantholytic cells and no bacterial growth. Biopsy procedure revealed subcorneal pustule with presence of epithelial acantholytic cells and neutrophils, compatible with canine pemphigus foliaceous. The topical treatment of ocular lesions with 0.1% Tacrolimus associated with systemic treatment with high dose of prednisolone (1.2 mg kg-1). The patient improved the dermatological clinical signs, however, some side effects have already become evident, such as the presence of telangiectasia, polyuria, polyphagia and polydipsia. Heterodox therapy based on the use of azathioprine (2 mg kg-1) was chosen in order to reduce corticoid dose. After 3 days of therapy, blood material was collected for hepatic evaluation, detecting hepatotoxicity. From the results, azathioprine therapy was suspended, and only high-dose corticosteroid therapy (1.5 mg kg-1) was maintained. The patient presented a considerable improvement in the lesion after 10 days of treatment.Discussion: There have been reports that pharmacodermic reactions may be associated with the development of autoimmune diseases, such as pemphigus foliaceus and vulgaris. In some cases, the lesions regress after drug discontination. In others, the medication acts as a triggering factor, activating the genetic predisposition of patient, which develops the pathology even after therapy interruption. The drug related pemphigus-foliaceous is a well-recognized disease in humans, however this disease is limited to sporadic cases in dogs. The therapy was based in use of a high dose of prednisolone, which caused some side effects. Therefore, a heterodox therapy was chosen in order to reduce the corticoid dosage. At the first hemato-biochemical evaluation, the patient already presented significant alterations, being requested to suspend the prescribed treatment, although the owners already reported improvement of the dermatological lesions. Due to this, a higher dose of prednisolone was chosen, obtaining the best response among the therapies used since the beginning of the treatment. After clinical improvement, the gradual reduction of steroidal therapy was started in order to avoid side effects related to suppression of the hypothalamic-pituitary-adrenal axis. This report provides evidences of Mupirocin as a potential triggering factor of pemphigus-like lesions in dogs.