Acute exacerbation of OCD symptoms precipitated by media reports of COVID-19.

The emergence of COVID-19 has recently dominated public discourse given its serious impact on vulnerable patient groups. Advice in relation to reducing risk of contamination has justifiably been circulated widely during the COVID-19 crisis. Contamination fear is a common obsessional theme in patients with obsessive-compulsive disorder (OCD), and there is a need for increased research on how infectious disease epidemics affect patients with OCD. We present the case of a lady in her 30s with a history of well-controlled contamination OCD who presented acutely with a significant exacerbation of OCD symptoms precipitated by media reports of COVID-19. The case highlights the potential psychological impacts of infectious disease epidemics on individuals with mental illness. We also highlight some of the risks posed to such patients in response to epidemics such as the COVID-19 crisis.

A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in paediatric chronic inflammatory bowel disease.

BACKGROUND: The breakdown of glycosaminoglycans is an important consequence of inflammation at mucosal surfaces, and inhibition of metalloprotease activity may be effective in treating chronic inflammation. AIM: To report an alternative approach, using the nutriceutical agent N-acetyl glucosamine (GlcNAc), an amino-sugar directly incorporated into glycosaminoglycans and glycoproteins, as a substrate for tissue repair mechanisms. METHODS: GlcNAc (total daily dose 3-6 g) was administered orally as adjunct therapy to 12 children with severe treatment-resistant inflammatory bowel disease (10 Crohn's disease, 2 ulcerative colitis). Seven of these children suffered from symptomatic strictures. In addition, similar doses were administered rectally as sole therapy in nine children with distal ulcerative colitis or proctitis resistant to steroids and antibiotics. Where pre- and post-treatment biopsies were available (nine cases), histochemical assessment of epithelial and matrix glycosaminoglycans and GlcNAc residues was made. FINDINGS: Eight of the children given oral GlcNAc showed clear improvement, while four required resection. Of the children with symptomatic Crohn's stricture, only 3 of 7 have required surgery over a mean follow-up of > 2.5 years, and endoscopic or radiological improvement was detected in the others. Rectal administration induced remission in two cases, clear improvement in three and no effect in two. In all cases biopsied there was evidence of histological improvement, and a significant increase in epithelial and lamina propria glycosaminoglycans and intracellular GlcNAc. CONCLUSIONS: GlcNAc shows promise as an inexpensive and nontoxic treatment in chronic inflammatory bowel disease, with a mode of action which is distinct from conventional treatments. It may have the potential to be helpful in stricturing disease. However, controlled trials and an assessment of enteric-release preparations are required to confirm its efficacy and establish indications for use.

Comparative absorption of theophylline following multiple doses of a sustained-release formulation and an elixir in humans.

This multiple-dose, crossover study in 18 healthy adult men compared the oral absorption of theophylline from Theolair-SR sustained-release tablets (TSR) given two times a day with that from a reference elixir given four times a day. No difference in the extent of absorption of theophylline from either formulation was seen. At steady state (day 5), the ratio of the AUC for TSR over a 12-hour dosing interval to the AUC for the elixir over a six-hour dosing interval, was 0.944 +/- 0.191 (mean +/- SD). Thus the extent of theophylline absorption from TSR is equivalent to that from the reference elixir (P greater than 0.25). TSR has the advantage of allowing less frequent dosing intervals than are necessary for the elixir.

N-acetylglucosamine changes permeability of peritoneum during chronic peritoneal dialysis in rats.

OBJECTIVE: To evaluate the effect of supplementation of dialysis fluid with N-acetylglucosamine (NAG) on the permeability of peritoneum during chronic peritoneal dialysis in rats. DESIGN: Experiments were performed on rats with surgically implanted peritoneal catheters. Dialysis solution [Dianeal 1.5% (Baxter, Deerfield, IL, U.S.A.) supplemented with either NAG 50 mmol/L or glucose 50 mmol/L (control)] was infused intraperitoneally twice, every day, for 8 weeks. Peritoneal equilibration tests (PET) were performed in all animals at the beginning of the study and after 8 weeks of dialysis. Additionally, at the end of each week, dialysis solution infused in the morning was drained after 4 hours of intraperitoneal dwell. White blood cell count, creatinine, and total protein concentrations were measured in the effluent dialysate. After 8 weeks of dialysis, the morphology of the peritoneum was studied. RESULTS: In rats exposed to dialysis fluid supplemented with NAG, peritoneal permeability to creatinine and proteins was reduced when compared to animals dialyzed with glucose solution. In NAG treated animals, staining with alcian blue for polyanions in the peritoneal interstitium was significantly stronger than in rats dialyzed with glucose solution. CONCLUSIONS: Chronic peritoneal dialysis with dialysis solution supplemented with N-acetylglucosamine causes accumulation of glycosaminoglycans in the peritoneal interstitium, which results in a change of peritoneal permeability.

The effect of N-acetylglucosamine as a substrate for in vitro synthesis of glycosaminoglycans by human peritoneal mesothelial cells and fibroblasts.

The effect of N-acetylglucosamine (NAG) on in vitro synthesis of glycosaminoglycans by human peritoneal mesothelial cells and fibroblasts was studied. In contrast to isosmotic concentrations of glucose, NAG increases the synthesis of hyaluronan by mesothelial cells and fibroblasts in a dose-dependent manner. This effect of NAG can be demonstrated in the presence of increased glucose levels in a medium, or in a medium mixed with effluent dialysate obtained from continuous ambulatory peritoneal dialysis (CAPD) patients. Glucose inhibits synthesis of sulphated glycosaminoglycans by peritoneal mesothelial cells and fibroblasts, whereas NAG stimulates their production. Our results demonstrate that NAG is an effective stimulator of the in vitro glycosaminoglycans synthesis by human peritoneal mesothelial cells and fibroblasts.

The effect of topical L-selenomethionine on minimal erythema dose of ultraviolet irradiation in humans.

The purpose of this study was to determine whether topical L-selenomethionine reduces the degree of acute damage to the skin (i.e., sunburn) induced by ultraviolet (UV) irradiation in humans. Eight women volunteers were treated for 2 weeks first with lotion vehicle then with topical L-selenomethionine for two weeks at each of three concentrations (0.002%, 0.02%, and 0.05%). At the end of each 2-week treatment period, the minimal erythema dose (MED) of UV irradiation was measured using a Multiport Solar Ultraviolet Simulator. It was found that topical L-selenomethionine was effective in protecting against acute UV damage to the skin. A response curve demonstrated that increasing concentrations of topical L-selenomethionine gave increasing MED, with a plateau of maximal protection attained at a concentration between 0.02% and 0.05%. Although previous studies in rats and mice demonstrated percutaneous absorption of selenium after application of L-selenomethionine, in the concentrations used here, the topical L-selenomethionine did not result in increased levels of selenium in the blood plasma of the patients tested.