Potential Benefits of Psilocybin for Lupus Pain: A Case Report.

INTRODUCTION: Outcomes of treatment for patients with Lupus have shown overall improvement and benefit from the more aggressive use of immunosuppressants and biological agents through a treat-to-target approach. However, chronic musculoskeletal pain can be refractory to treatment despite the use of non-steroidal anti-inflammatory drugs, corticosteroids, and other analgesic agents, leading to patient dissatisfaction. The concept of new neural pathways from psilocybin usage has been proposed in a variety of pain syndromes; however, it is not trialed for patients with Lupus pain. CASE PRESENTATION: The patient was a 67-year-old male with positive anti-dsDNA antibody Lupus with a predominance of chronic polyarticular joint pain treated with hydroxychloroquine and non-steroidal anti-inflammatory drugs without pain relief. Pain dramatically improved after a one-time macro-dosing of 6 grams of Psilocybin cubensis in Oregon, which he expected would only provide a sense of enlightenment. After 12 months, he continued without debilitating joint pain. CONCLUSION: The serotonin-2A receptor's activation triggers an array of neurophysiological reactions that disrupt the functional connections in areas of the brain that are associated with chronic pain. These neuroplastic effects can generate healthy connections, resulting in long-lasting pain relief. However, this is a process that has not been fully analyzed. While there is anecdotal evidence to suggest the therapeutic benefits for autoimmune diseases, including rheumatoid arthritis and psoriasis, there is no specific research that explores its use for lupus-related pain. Since this is the first case that shows the benefit of psilocybin in a patient with Lupus, further studies on macro-dosing psilocybin to treat Lupus pain are warranted.

Rituximab Induced Flare of Psoriatic Arthritis in a Patient with Devic's Syndrome: A Case Report.

INTRODUCTION/BACKGROUND: Devic's syndrome is a rare autoimmune disorder that occurs when the body's immune system damages and mistakenly attacks the optic nerves and the spinal cord, leading to numerous neurological. Symptoms, such as inflammation, weakness, numbness, and vision problems. Rituximab has mainly been utilized as an immunosuppressive therapy for patients with Devic's syndrome. Although evidence has shown that rituximab is efficient and well tolerated in treating patients with Devic's syndrome, there is the possibility of rituximab exacerbating severe psoriasis and psoriatic arthritis flare. CASE PRESENTATION: In this paper, we describe a case of a 58-year-old female with Devic's syndrome, blindness, and neurological involvement who responded exceptionally well to rituximab. However, she developed a severe flare of psoriatic arthritis. After withdrawing from the use of rituximab, her psoriatic arthritis symptoms had resolved. However, she did have another episode of blindness, and rituximab was started once again. Although her vision improved, her psoriatic arthritis symptoms had reoccurred. The patient was switched to eculizumab and ustekinumab, which controlled both her psoriatic arthritis and Devic's syndrome. CONCLUSION: Very few reports have identified rituximab to induce a flare-up of psoriatic arthritis, raising uncertainty regarding its potential effects on psoriatic symptoms. The precise mechanism underlying the exacerbation of psoriatic arthritis by rituximab remains uncertain. This case report highlights that rituximab can worsen psoriasis and psoriatic arthritis, and that the complexities of Devic's syndrome may require medication adjustments.

Sleep Duration and Risk of Obesity by Sex: Nine-Year Follow-Up of the Young Lives Study in Peru.

Background: We aimed to evaluate if there is association between hours of sleep and the risk of obesity among children and whether this association differs by sex. Methods: A secondary data analysis, using information of the Young Lives study, was conducted. The outcome was obesity, based on the BMI for age z-score; the exposure was child's sleep duration (reported by parents) categorized using the National Sleep Foundation guidelines, and as a numerical variable. Baseline and three follow-ups information were used to evaluate association, reporting relative risks (RRs), and 95% confidence intervals (CIs), as well as coefficients and 95% CI. Results: Data from 1949 children, baseline mean age 4.3 (standard deviation: 0.3) and 962 (49.5%) females, were analyzed. Short sleep duration was present in 26.0% (95% CI: 24.0-28.0) at baseline. After 9.6 years of follow-up, the incidence of obesity was 0.83 (95% CI: 0.70-0.98) per 100 person-years at risk. In multivariable model (n = 1579), there was no association between short sleep duration and obesity in the whole sample (p = 0.13); but the risk of obesity was lower among girls (n = 816; RR = 0.45; 95% CI: 0.21-0.96; p = 0.03) compared with boys (n = 763; RR = 1.43; 95% CI: 0.95-2.14; p = 0.09). On the contrary, each additional hour of sleep was associated with an increase of boy's BMI mean (0.05; 95% CI: 0.02-0.08; p < 0.001), but not among girls (-0.02; 95% CI: -0.05 to 0.01; p = 0.11). Conclusions: Our results evidenced a lower risk of obesity due to short sleep duration in girls, but not in boys. Each additional hour of sleep was associated with an increase of BMI in boys, but not in girls. Strategies are needed to guarantee adequate sleep duration in Peruvian children.

Molecular characterization and antifungal susceptibility of Cryptococcus neoformans strains collected from a single institution in Lima, Peru.

BACKGROUND: Cryptococcosis is a fungal infection with a worldwide distribution, mainly caused by Cryptococcus neoformans and Cryptococcus gattii. AIMS: To molecularly characterize the mating-types, serotypes, genotypes and antifungal susceptibility profiles of a set of retrospectively isolated C. neoformans strains from Lima, Peru. METHODS: A set of 32 Cryptococcus spp. strains from the Institute of Tropical Medicine of the National University of San Marcos, Lima, Peru, were included in this retrospective study. Twenty-four strains were isolated from patients, while the remaining 8 were isolated from the environment. RESULTS: Using conventional PCR, 27 (84.4%) of the isolates were identified as C. neoformans var. grubii mating-type alpha and serotype A. Using the AFLP fingerprinting, it was shown that 16 (50%) of the C. neoformans strains were genotype AFLP1, 13 (40.6%) were genotype AFLP1B, 2 (6.3%) were genotype AFLP2, and 1 (3.1%) was found to be a hybrid between both C. neoformans varieties (genotype AFLP3). The antifungal susceptibility profiles for amphotericin B, fluconazole and voriconazole showed that all the 32 C. neoformans are sensitive to these antifungal compounds. CONCLUSIONS: In this study we observed that C. neoformans var. grubii (AFLP1 and AFLP1B) and C. neoformans var. neoformans (AFLP2) were the only cryptococcal varieties involved. All strains were found to be sensitive to the antifungals tested, results that are consistent with those found in the international literature.

Molecular characterization and antifungal susceptibility of Cryptococcus neoformans strains collected from a single institution in Lima, Peru / Caracterización molecular y sensibilidad antifúngica de cepas de Cryptococcus neoformans provenientes de una institución de Lima, Perú

Background: Cryptococcosis is a fungal infection with a worldwide distribution, mainly caused by Cryptococcus neoformans and Cryptococcus gattii. Aims: To molecularly characterize the mating-types, serotypes, genotypes and antifungal susceptibility profiles of a set of retrospectively isolated C. neoformans strains from Lima, Peru. Methods: A set of 32 Cryptococcus spp. strains from the Institute of Tropical Medicine of the National University of San Marcos, Lima, Peru, were included in this retrospective study. Twenty-four strains were isolated from patients, while the remaining 8 were isolated from the environment. Results: Using conventional PCR, 27 (84.4%) of the isolates were identified as C. neoformans var. grubii mating-type alpha and serotype A. Using the AFLP fingerprinting, it was shown that 16 (50%) of the C. neoformans strains were genotype AFLP1, 13 (40.6%) were genotype AFLP1B, 2 (6.3%) were genotype AFLP2, and 1 (3.1%) was found to be a hybrid between both C. neoformans varieties (genotype AFLP3). The antifungal susceptibility profiles for amphotericin B, fluconazole and voriconazole showed that all the 32 C. neoformans are sensitive to these antifungal compounds. Conclusions: In this study we observed that C. neoformans var. grubii (AFLP1 and AFLP1B) and C. neoformans var.neoformans (AFLP2) were the only cryptococcal varieties involved. All strains were found to be sensitive to the antifungals tested, results that are consistent with those found in the international literature (AU)

Antecedentes: La criptococosis es una infección fúngica de distribución mundial, causada principalmente porCryptococcus neoformans y Cryptococcus gattii. Objetivos: Determinar el tipo de apareamiento, los serotipos, los genotipos y la sensibilidad antifúngica de las cepas de C. neoformans provenientes de Lima Perú. Métodos: Se analizaron 32 cepas de Cryptococcus spp. del Instituto de Medicina Tropical de la Universidad Nacional Mayor de San Marcos de Lima, Perú. Veinticuatro cepas provenían de pacientes y 8 cepas fueron obtenidas de muestras ambientales. Resultados: Mediante la técnica de reacción en cadena de la polimerasa se determinó que 27 (84,4%) aislamientos eran C. neoformans var. grubii, serotipo A, con el tipo de apareamiento alfa. Asimismo, empleando la técnica AFLP, se determinó que 16 (50%) cepas de C. neoformans eran del genotipo AFLP1 y 13 (40,6%) del genotipo AFLP1B; además, 2 (6,3%) eran del genotipo AFLP2 (C. neoformans var.neoformans) y 1 (3,1%) resultó ser un híbrido entre ambas variedades (AFLP3). Los perfiles de sensibilidad antifúngica para anfotericina B, fluconazol y voriconazol mostraron que las 32 cepas de C. neoformans eran sensibles al panel de antifúngicos. Conclusiones: En el presente estudio observamos que C. neoformans var. grubii (AFLP1 y AFLP1B) y C. neoformansvar. neoformans (AFLP2) fueron las variedades encontradas. Además, todas las cepas resultaron sensibles al panel de antifúngicos, en concordancia con la literatura internacional (AU)