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We describe a patient who developed lip necrosis and a nasal septal defect after excessively nasal abuse of cocaine. Necrosis of the lip can be caused by local vasoconstriction of the vessels of the skin, by the anesthetic effects of cocaine, by local irritation and inflammation and by the effects of adulterants. The patient was unable to stop using cocaine on her own and was compulsorily admitted. The surgical reconstruction of the lip was planned, but not performed because of the constant use of cocaine.
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Transtornos Relacionados ao Uso de Cocaína , Lábio , Necrose , Humanos , Transtornos Relacionados ao Uso de Cocaína/complicações , Feminino , Lábio/patologia , Necrose/induzido quimicamente , AdultoRESUMO
BACKGROUND: It is difficult to qualify patients with substance-related and addictive disorders for the Dutch Compulsory Care Act (Wvggz) AIM: Investigating factors that influence rejections of substance-related and addictive disorders as mental disorders in the Wvggz RESULTS: Substance-related and addictive disorders are assessed differently as mental disorder than other psychiatric disorders under both the old Dutch Special Admissions Act (Bopz) and the Wvggz. It is often not made clear whether the assessment is made from the medical-psychiatric or legal domain. CONCLUSION: To qualify patients with substance-related and addictive disorders for the Wvggz, a medical-psychiatric classification and/or diagnosis must be converted into the required legal terms in as structured a manner as possible. It is also undesirable for a law and therefore the court to determine whether there is a mental disorder. This belongs to the medical-psychiatric domain.
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Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Humanos , Países Baixos , Transtornos Relacionados ao Uso de Substâncias/terapia , Transtornos Mentais/terapia , Transtornos Mentais/diagnóstico , Internação Compulsória de Doente Mental/legislação & jurisprudênciaRESUMO
BACKGROUND: cultivated and wild plants are used to treat different ailments. The Astragalus genus is found in temperate and dry climates; thus, it is found in Egypt and the arab world. Astragalus caprinus has a good amount of bioactive chemicals, which may help explain its therapeutic effects in reducing the risk of consequences from disease. METHOD: The phytochemical investigation of the herb and roots of Astragalus caprinus L. included the analytical characterization for the petroleum ether components by GC/MS, unsaponifiable matter (unsap. fraction), and fatty acids (FAME) investigation by GLC analysis. Main flavonoids were chromatographically isolated from ethyl acetate and n-butanol extracts. In vitro antimicrobial activity has been tested against the Gram-positive bacteria Staphylococcus aureus and Streptococcus mutans for different plant extracts, the Gram-negative bacteria Pseudomonas aeruginosa and Klebsiella pneumonia, the fungus Candida albicans and Aspergillus niger, and the Escherichia coli bacterium. Metabolite cytotoxicity was examined using the MTT assay against HepG-2 (human liver carcinoma) and MCF-7 (breast carcinoma). RESULTS: Identifying the important components of the herb and root petroleum ether extracts was achieved. Using column chromatography, luteolin, cosmosiin (apigenin-7-O-glucoside), and cynaroside (luteolin-7-O-glucoside) were separated and identified using UV, NMR, and Mass Spectroscopy. Root extracts displayed potential antimicrobial activity against most of the tested pathogens. Both extracts (herb and roots) were active against the MCF-7 cell line and HepG-2 cell line with IC50 62.5 ± 0.64 and 72.4 ± 2.3 µg/ml, and 75.9 ± 2.5 and 96.8 ± 4.2 µg/ml, respectively. CONCLUSION: Astragalus caprinus seems to be a promising source of bioactive compounds that could potentially aid in preventing disease complications and address common health issues in developing countries. Moreover, the various parts of this plant could be utilized as natural raw materials for producing health-boosting products that could address common health issues in developing countries.
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Astrágalo , Compostos Fitoquímicos , Extratos Vegetais , Extratos Vegetais/farmacologia , Extratos Vegetais/química , Humanos , Astrágalo/química , Compostos Fitoquímicos/farmacologia , Compostos Fitoquímicos/química , Testes de Sensibilidade Microbiana , Células MCF-7 , Anti-Infecciosos/farmacologia , Anti-Infecciosos/química , Raízes de Plantas/química , Egito , Células Hep G2 , Flavonoides/farmacologiaRESUMO
Acute anticholinesterase pesticide poisoning is a serious clinical problem, particularly in developing countries. Atropine is the most acceptable treatment for acute anticholinesterase poisoning. However, it only stops fluid production. Albuterol is a beta-2 receptor agonist that can increase fluid removal and speed the return of effective oxygen exchange. This study aims to evaluate the safety and efficacy of nebulized albuterol as an adjuvant therapy in patients with acute anticholinesterase poisoning. This stratified block randomized, single-blinded, placebo-controlled, parallel-group clinical trial was conducted between November 2020 and October 2021. It enrolled 80 patients with acute anticholinesterase pesticide poisoning who were admitted to Tanta University Poison Control Center. Patients were allocated into two groups (40 patients each). The strata were based on the severity of poisoning (moderate and severe). Patients in group I received 10 mg of nebulized albuterol. Group II received an equivalent volume of nebulized normal saline. Additionally, standard treatment was provided to both groups. Outcomes included oxygenation, mortality, need for endotracheal intubation and mechanical ventilation, hospital stay duration, time to atropinization, and total doses of atropine and oxime. We found insignificant differences in sociodemographics, exposure characteristics, clinical manifestations, or routine laboratory tests between the studied groups. The median values of oxygen saturation by pulse oximetry were 99% in the albuterol moderate toxicity group and 98% in the control moderate toxicity group. Albuterol significantly improved oxygen saturation in moderate intoxicated patients (P = 0.039). Therefore, nebulized albuterol is a safe drug. Moreover, it may improve oxygenation in acute anticholinesterase pesticide poisoning.
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Hepatitis C virus (HCV) infection is a major health problem worldwide and its eradication is mandatory. Direct acting HCV polymerase inhibitors, such as Sofosbuvir (SOF), is an effective regimen. However, it has some side effects like mutagenesis, carcinogenesis, and the impairment of testicular function. It is important to evaluate the safety of SOF on the ovary, as there are no studies yet. Increasing the production of Reactive Oxygen Species (ROS), causes oxidative stress, which affects ovulation process, female reproduction, and fertility. Accumulation of SOF in the cells was demonstrated to promote ROS generation. Vitamin E (Vit E) is an antioxidant agent that has an essential role in the female reproductive system, its deficiency can cause infertility. We explored the effect of SOF treatment alone and co-treated with Vit E on ovarian ROS level and ovarian morphology experimentally using biochemical and immunohistochemical studies. Significant changes in oxidative stress markers; nitric oxide and malondialdehyde lipid peroxidation, antioxidant enzymes; catalase, super oxide dismutase, and reduced glutathione, proliferating markers; proliferation cell nuclear antigen and Ki-67 antigen and caspase 3 apoptotic marker were demonstrated. It was shown that where SOF induced oxidative stress, it also aggravated ovarian dysfunction. The essential role of Vit E as an antioxidant agent in protecting the ovarian tissue from the effect of oxidative stress markers and preserving its function was also displayed. This could be guidance to add Vit E supplements to SOF regimens to limit its injurious effect on ovarian function.
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BACKGROUND: Thymic malignancies are rare intrathoracic tumors, which may be aggressive and difficult to treat. They represent a therapeutic challenge in the advanced/metastatic setting, with limited treatment options after the failure of first-line platinum-based chemotherapy. They are frequently associated with autoimmune disorders that also impact oncological management. MATERIALS AND METHODS: NIVOTHYM is an international, multicenter, phase II, two-cohort, single-arm trial evaluating the activity and safety of nivolumab [240 mg intravenously (i.v.) q2 weeks] alone or with ipilimumab (1 mg /kg i.v. q6 weeks) in patients with advanced/relapsed type B3 thymoma or thymic carcinoma, after exposure to platinum-based chemotherapy. The primary endpoint is progression-free survival rate at 6 months (PFSR-6) based on RECIST 1.1 as per independent radiological review. RESULTS: From April 2018 to February 2020, 55 patients were enrolled in 15 centers from 5 countries. Ten patients (18%) had type B3 thymoma and 43 (78%) had thymic carcinoma. The majority were male (64%), and the median age was 58 years. Among the 49 eligible patients who started treatment, PFSR-6 by central review was 35% [95% confidence interval (CI) 22% to 50%]. The overall response rate and disease control rate were 12% (95% CI 5% to 25%) and 63% (95% CI 48% to 77%), respectively. Using the Kaplan-Meier method, median progression-free survival and overall survival by local assessment were 6.0 (95% CI 3.1-10.4) months and 21.3 (95% CI 11.6-not estimable) months, respectively. In the safety population of 54 patients, adverse events (AEs) of grade 1/2 were observed in 22 (41%) patients and grade 3/4 in 31 (57%) patients. Treatment-related AEs of grade 4 included one case of neutropenia, one case of immune-mediated transaminitis, and two cases of myocarditis. CONCLUSIONS: Nivolumab monotherapy demonstrated an acceptable safety profile and objective activity, although it has been insufficient to meet its primary objective. The second cohort of NIVOTHYM is currently ongoing to assess the combination of nivolumab plus ipilimumab.
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Timoma , Neoplasias do Timo , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Nivolumabe/efeitos adversos , Ipilimumab/efeitos adversos , Timoma/tratamento farmacológico , Timoma/induzido quimicamente , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/induzido quimicamente , Intervalo Livre de ProgressãoRESUMO
In vitro vascular wall bilayer models for drug testing and disease modeling must emulate the physical and biological properties of healthy vascular tissue and its endothelial barrier function. Both endothelial cell (EC)-vascular smooth muscle cell (SMC) interaction across the internal elastic lamina (IEL) and blood vessel stiffness impact endothelial barrier integrity. Polymeric porous track-etched membranes (TEM) typically represent the IEL in laboratory vascular bilayer models. However, TEM stiffness exceeds that of diseased blood vessels, and the membrane pore architecture limits EC-SMC interaction. The mechanical properties of compliant honeycomb film (HCF) membranes better simulate the Young's modulus of healthy blood vessels, and HCFs are thinner (4 vs. 10 µm) and more porous (57 vs. 6.5%) than TEMs. We compared endothelial barrier integrity in vascular wall bilayer models with human ECs and SMCs statically cultured on opposite sides of HCFs and TEMs (5 µm pores) for up to 12 days. Highly segregated localization of tight junction (ZO-1) and adherens junction (VE-cadherin) proteins and quiescent F-actin cytoskeletons demonstrated superior and earlier maturation of interendothelial junctions. Quantifying barrier integrity based on transendothelial electrical resistance (TEER), membranes showed only minor but significant TEER differences despite enhanced junctional protein localization on HCF. Elongated ECs on HCF likely experienced greater paracellular diffusion than blocky ECs on TEM. Also, larger populations of plaques of connexin 43 subunit-containing gap junctions suggested enhanced EC-SMC communication across the more porous, thinner HCF. Compared with standard TEMs, engineered vascular wall bilayers cultured on HCFs better replicate physiologic endothelial barrier integrity.
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Células Endoteliais , Endotélio Vascular , Humanos , Porosidade , Células Endoteliais/metabolismo , Comunicação Celular , Junções Íntimas/fisiologia , Células Cultivadas , Junções Aderentes/fisiologiaRESUMO
BACKGROUND: Patients with opiate use disorder may be treated medicamentally with methadone and sublingual buprenorphine. However, also two forms of subcutaneous buprenorphine that can be administered weekly or monthly are available. AIM: To describe the effectiveness and the side effects of the buprenorphine depot. METHOD: Embase was searched and cross-references were sought in the included studies and previous reviews. RESULTS: Nine articles were included. One randomized study (n = 428) compared buprenorphine depot to the sublingual form, with the depot being more effective after 12-24 weeks. The other randomized study (n = 504) compared the depot with placebo. The depot was found to be effective. In two comparative non-blinded studies, no significant difference in abstinence was reported between the depot and sublingual administration. Medium-term effectiveness (16-52 weeks) was confirmed in five follow-up studies, in which the depot preparation proved both effective and well tolerated. CONCLUSION: The buprenorphine depot is described as promising in the international literature. However, there are still several uncertainties that make its prescription should be done with great caution.
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Buprenorfina , Alcaloides Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Buprenorfina/uso terapêutico , Buprenorfina/efeitos adversos , Antagonistas de Entorpecentes/efeitos adversos , Alcaloides Opiáceos/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Metadona/uso terapêuticoRESUMO
BACKGROUND: Psychiatric patients have an increased risk of infection with SARS-CoV-2 and morbidity and mortality rates are higher. Willingness to get vaccinated against SARS-CoV-2 may be less compared to the general population. AIMS To gain more knowledge about the willingness to be vaccinated and about underlying arguments among clinical psychiatric patients. METHOD: We submitted a questionnaire to clinical psychiatric patients, in which we assessed the willingness to be vaccinated and presented a number of statements about vaccination. RESULTS: In total, 70 patients were invited to participate in this study of which 56 patients (80%) completed the questionnaires. The willingness to be vaccinated was 63%. Of the 56 patients included, 5 indicated to have had SARS-CoV-2 (9%) and 16 patients (29%) had been vaccinated. Patients who refused vaccination reported being afraid of side effects of the vaccine (28%) and long-term effects of vaccination on their health (25%). Furthermore, patients found it complicated to make a vaccination appointment. CONCLUSION: In this study the willingness to be vaccinated appears to be low. We recommend on the basis of this study that in order to improve the vaccination coverage among psychiatric patients, more attention should be paid to vaccination in the psychiatric wards.
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Vacinas contra COVID-19 , COVID-19 , Humanos , SARS-CoV-2 , Inquéritos e Questionários , VacinaçãoRESUMO
Somatoparaphrenia is a disorder of body perception, usually on the left side. One or both limbs are seen as foreign or as belonging to somebody else. In the literature this rare phenomenon has been described in patients with brain damage, usually due to an infarction or other lesion to the right parietal lobe. We describe a patient with schizophrenia and addiction problems who believed that his left forearm was not his, but rather belonged to a Spanish girl. An EEG and an MRI of the brain showed no abnormalities. Despite years of antipsychotic treatment, the delusion persisted. To rule out neurological causes we recommend auxiliary investigations in all patients with somatoparaphrenia. No evidence-based treatments are known for this monothematic delusion in the context of schizophrenia.
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Esquizofrenia , Braço , Encéfalo , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Androgen deprivation therapy (ADT) is a libido-inhibiting medication that may be necessary to reduce recidivism in the treatment of paraphilic disorders, especially in those with a pedophilic disorder. However, there is a significant risk to develop osteoporosis while using ADT and thereby an increased risk to develop fractures. These risks and benefits must be carefully weighed in the treatment of these patients. We describe a case in which this dilemma is further explained and clarified. We recommend to request a second opinion and a structured risk assessment. If the risk for recidivism remains increased, despite psychotherapeutic interventions, we advise to suspend further rehabilitation into society, and let the reduction of the risk of recidivism prevail over the wishes of the patient.
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Fraturas Ósseas/induzido quimicamente , Osteoporose/induzido quimicamente , Pedofilia/tratamento farmacológico , Reincidência/psicologia , Antagonistas de Androgênios/efeitos adversos , Antagonistas de Androgênios/uso terapêutico , Androgênios , Densidade Óssea , Humanos , Masculino , Pedofilia/psicologiaRESUMO
PURPOSE: Liver cirrhosis (LC) is considered to be the end stage of chronic hepatopathies which may lead to hepatocellular carcinoma (HCC). Glypican-3 is one of the most promising serum markers for HCC. Abnormal expression of miRNAs may participate in cancer development and progression. In this study, we aimed to evaluate the relation between the expression of miR-1291 and GPC3 production as a non-invasive tool to differentiate patients with LC and HCC. METHODS: HCV patients (100) were divided into two groups; HCC (I) and LC (II). Fifty hepatitis-free subjects served as the control group (III). Expression of serum GPC3 was performed by enzyme-linked immunosorbent assay, and expression of circulating miR-1291 was performed by quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Serum levels of GPC3 were significantly elevated in patients with HCC compared with the LC group. Both groups have increased GPC3 levels in relation to healthy controls. Serum GPC3 levels with a cutoff value of 619.5 pg/ml had a 50% sensitivity and 89.3% specificity while alpha-fetoprotein (AFP) with a cutoff value of 8.5 ng/ml had a higher sensitivity (87.5%) and specificity (100%) in the detection of HCC. The primary use of both markers improved the specificity to 100%. miR-1291 was significantly upregulated in HCC and LC patients compared with control subjects. CONCLUSIONS: Our findings might indicate that miR-1291 exert oncogenic effects in hepatic carcinogenesis through positive regulation of GPC3 expression. We propose that GPC3 overexpression and its associated oncogenic effects are linked to the upregulation of miR-1291 in HCV patients.
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Carcinoma Hepatocelular/sangue , Glipicanas/biossíntese , Cirrose Hepática/sangue , Neoplasias Hepáticas/sangue , MicroRNAs/sangue , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/patologia , Estudos de Casos e Controles , Feminino , Glipicanas/genética , Humanos , Cirrose Hepática/genética , Neoplasias Hepáticas/patologia , Masculino , MicroRNAs/genética , Pessoa de Meia-IdadeRESUMO
BACKGROUND: In the past years numerous studies have investigated the efficacy of baclofen for alcohol dependence. After publication of several reviews a number of new randomized controlled trials have been published. Two recent meta-analyses, based on largely the same studies, reported contrary results. One meta-analysis showed a positive effect on time to relapse and abstinence at endpoint. The other meta-analysis did not show an effect on the primary outcome measures.
AIM: To clarify the clinical relevance of the effect of baclofen on alcohol use in patients with a disorder in the use of alcohol, in the light of the positive and the negative meta-analysis.
METHOD: A systematic literature search using Medline, Embase and PsycINFO (Prisma guideline).
RESULTS: We found 16 randomized controlled trials in which the effect of baclofen was studied. Seven of them showed a significant positive effect of baclofen on (one or more of the) primary outcome measures.
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Alcoolismo/tratamento farmacológico , Baclofeno/uso terapêutico , Agonistas dos Receptores de GABA-B/uso terapêutico , Humanos , Resultado do TratamentoRESUMO
AIM: To provide an overview of the literature on transitions towards smoke-free psychiatric hospitals and the risk of aggression.
METHOD: A systematic search was made in medline, Embase and Psycinfo. Studies were included if they reported data on: a smoke-free intervention in a psychiatric hospital or ward, the number of aggressive incidents, and seclusions or prn drugs.
RESULTS: A total of 17 studies matched the inclusion/exclusion criteria; 5 reported a decrease in the number of aggressive incidents after implementation of a smoke-free ward, 7 showed an increase in the number of incidents, and 5 studies reported no differences. Heterogeneity between the studies was high with respect to the definition and implementation of the intervention, the definition and measurement of aggression, study design, length of follow-up, and the sample size.
CONCLUSION: These findings suggest that, after changing the policy towards a smoke-free psychiatric hospital, the risk of aggression is limited. However, several precautions related to the preparation and implementation of this transition seem to be essential. The results support further investment in the implementation of smoke-free psychiatric hospitals in the Netherlands, while maintaining safety.
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Agressão , Hospitais Psiquiátricos/legislação & jurisprudência , Política Antifumo , Agressão/psicologia , Humanos , Países Baixos , Abandono do Hábito de Fumar , ViolênciaRESUMO
BACKGROUND: The co-occurrence of PTSD and alcohol use disorder (AUD) is common. Therefore, it is important to know which treatments are effective for the group of patients suffering from both disorders.
AIM: To explore the evidence of medical treatment options for PTSD and AUD.
METHOD: We systematically searched the literature using MEDLINE, Embase and psycINFO (PRISMA guideline).
RESULTS: Ten studies were included of which 9 were randomised controlled trials (RCT). Only one or a few RCTs examined several drugs. The combination of sertraline, naltrexone and disulfiram showed the biggest effect, although the results were limited and partly contradictory.
CONCLUSION: At the moment, there is little evidence for a clear pharmacological preference for the treatment of both PTSD and AUD. Based on the current studies there is, although limited, most evidence for the combination of naltrexone and sertraline or monotherapy with disulfiram. Further research is necessary in order to adequately treat this double diagnosis.
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Transtornos Relacionados ao Uso de Álcool/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Dissulfiram/uso terapêutico , Quimioterapia Combinada , Humanos , Naltrexona/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
BACKGROUND: Dual diagnosis (substance use disorder combined with a comorbid mental illness) is a common problem. One of the methods to treat this is integrated dual diagnosis treatment (IDDT). IDDT consists of the simultaneous, integrated application of different treatment components. Their efficacy, however, has only been studied separately. As a result, the effectiveness of the IDDT program as a whole remains unclear. AIM: To evaluate the scientific evidence relevant to the effectiveness of IDDT in dual diagnosis patients. METHOD: A systematic literature review using MEDLINE, Embase and PsycINFO (Prisma guideline). RESULTS: Six studies were found: a randomised controlled study (RCT), two non-randomised controlled studies, and three uncontrolled pre-post studies . There was a notably large diversity in outcome measures. The results differed significantly, including some studies concluding a significant (additional) effect, while others concluded that there was no indication of a significant effect of IDDT. CONCLUSION: In clinical practice, IDDT is recommended and chosen frequently as the treatment for patients with dual diagnosis. However, it is remarkable how limited and unthorough the research is pertaining to the effects of the full IDDT program on dual diagnosis.
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Comorbidade , Diagnóstico Duplo (Psiquiatria) , Transtornos Mentais/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Humanos , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
BACKGROUND: Although there is a great need for staging and profiling in psychiatry, no-one has so far devised a staging and profiling model to aid diagnosis and treatment. AIM: To devise a basic staging and profiling strategy that can be used to treat patients suffering from both substance abuse disorder and a psychiatric disorder. METHOD: On the basis of existing staging model for addiction, we explore how staging could also be useful for the treatment of comorbidity in psychiatry. RESULTS: Since there is hardly any evidence of the use of staging for this kind of comorbidity, we present a staging model that might help to provide a solution. To the described stages we add a recommended treatment setting or treatment intensity. CONCLUSION: Further research is needed to ascertain whether the staging model that we have presented will lead to improvements in the prognosis and treatment of patients with dual disorders referred to Dutch psychiatrists.