IgA nephropathy and atypical anti GBM disease: A rare dual pathology in a pediatric RPGN

Introduction: Anti-GBM nephritis in the pediatric age group is exceedingly rare with concurrent additional pathologies being even rarer. Tissue diagnosis requires a combination of crescentic histomorphology, immunofluorescence showing “Paint brush stroke” pattern of linear IgG or rarely IgA and serum anti-GBM antibodies subject to the disease course and treatment. The authors describe one such case with a dual pathology involving IgA nephropathy and atypical anti-GBM disease. Case presentation: A thirteen-year-old girl presenting with features of rapidly progressive glomerulonephritis underwent a renal biopsy showing a mesangioproliferative histology with crescents and an immunofluorescence pattern indicating a dual pathology of IgA Nephropathy and Anti GBM Nephritis. Additional ancillary testing including staining for IgG subclasses and galactose deficient IgA (KM55) helped to confirm the diagnosis. She responded to steroid pulses and plasma exchange therapy, was off dialysis after 8 weeks with serum creatinine of 1.5 mg/dl however remains proteinuric at last follow up. Conclusion: Concurrent Anti-GBM nephritis and IgA nephropathy is a rare occurrence and possibly arises from a complex interaction between the anti-GBM antibodies and the basement membrane unmasking the antigens for IgA antibodies. Additional newer techniques like immunofluorescence for KM 55 are helpful in establishing the dual pathology.

Dual Pathogenesis of Primary and Recurrent Pterygium: Immunohistochemical Proof

Introduction: Pterygium is a common ophthalmic problem in the Middle East where exposures to dust and sun rays are risk factors. The condition is more prevalent in middle-aged males and can be considered as an aging process. The aim of this study is to test both the degenerative and the proliferative components of Pterygium by both reduced glutathione and topoisomerase one activity. Methods: The study applied immunohistochemistry staining for both reduced glutathione and topoisomerase 1. Results: The samples expressed positive glutathione staining in most primary Pterygium conditions and all secondary Pterygium. On the other hand, the topoisomerase 1 immunohistochemistry expressed focal activity in secondary conditions suggesting a progenitor cell role in the pathogenesis of Pterygium in conjunction with oxidative stress. Conclusion: Pterygium represents dual pathology with a proliferative component and a degenerative one that needs further studies. It is possible to use combination immunohistochemistry markers to predict the prognosis of Pterygium behavior.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

Dual pathology in homeless people in the Health Area of Avilés

The main objective of the present study is to estimate the prevalence of severe mental and substance use disorders in homeless people (HP). The work was carried out on the basis of data obtained from a representative sample of HP in Avilés (Asturias) (n = 100) using the International Neuropsychiatric Interview (M.I.N.I.). The results of our study reveal a close relationship between substance use and homelessness. More than half of the HP have substance use disorders compared to substance use problems in the general population. Psychosocial care and the organization of a support network for the HP are discussed.

Occult focal cortical dysplasia may predict poor outcome of surgery for drug-resistant mesial temporal lobe epilepsy

Purpose The results of surgery in patients with mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) are favorable, with a success rate over 70% following resection. An association of HS with focal cortical dysplasia (FCD) in the temporal lobe is one of the potential causes for poor surgical outcome in MTLE. We aimed to analyzed seizure outcome in a population of MTLE patients and recognize the role of occult FCD in achieving postoperative seizure control. Methods We retrospectively analyzed postoperative outcomes for 82 consecutive adult patients with the syndrome of MTLE due to HS, who had no concomitant lesions within temporal lobe in MRI and who underwent surgical treatment in the years 2005–2016, and correlated factors associated with seizure relapse. Results At the latest follow-up evaluation after surgery, 59 (72%) were free of disabling seizures (Engel Class I) and 48 (58,5%) had an Engel Class Ia. HS associated with FCD in neocortical structures were noted in 33 patients (40%). Analyzes have shown that dual pathology was the most significant negative predictive factor for Engel class I and Engel class Ia outcome. Conclusions The incidence of dual pathology in patients with temporal lobe epilepsy seems to be underestimated. An incomplete epileptogenic zone resection of occult focal temporal dysplasia within temporal lobe is supposed to be the most important negative prognostic factor for seizure freedom after epilepsy surgery in MTLE-HS patients. The study indicates the need to improve diagnostics for other temporal lobe pathologies, despite the typical clinical and radiological picture of MTLE-HS.

Addictiveness: an independent dimension in the psychotic syndrome. Presentation of the Addictiveness in the Psychotic Syndrome Assessment Scale (APSAS)

Models of dual pathology habitually consider substance-use disorders (SUD) and the rest of mental disorders as two pathological conditions coincident in a same person. This study adopts a different point of view and accept adictivity as the nineth clinical dimension in the psychotic disorders to be added to hallucinations, delusion, disorganised speech, abnormal psychomotor behaviour, negative symptoms, cognitive deficit, depression, and mania. In the last term, all of them seems to derive from a common fronto-subcortical disfunction with dopaminergic, glutamatergic and gabaergic implication. The Scale for the Evaluation of Adictivity in the Psychotic Syndrome (SEAPS) is presented. It wants to be an integrated and easy to use tool for evaluating adictivity in the psychotic disorders. It is based in data collected with respect of first use, length of use, last use, frequency of use and addiction intensity regarding twelve types of substances or addictive behaviours. Results of the application of SEAPS on a sample of 105 psychotic subjects suggest good psychometric characteristics as well as the independency of adictivity respect with other clinical dimensions.

Anticholinergic Plant Misuse and Schizophrenia: Regarding a Case Report

Anticholinergic medication abuse is common in patients with schizophrenia. The recreational use of anticholinergic plants for their euphoria inducing and hallucinogenic properties is a rising concern in America and Eastern Europe, but rare in Portugal. Anticholinergic misuse poses a challenge to Psychiatrists treating patients with dual pathology, for its addictive potential. In managing antipsychotic medication and its side effects in this population one must have in mind the potential for abuse of anticholinergics. We present a case report of a patient with schizophrenia and abuse of anticholinergic plants, after receiving biperiden to treat extrapyramidal symptoms. Later we discuss anticholinergic effects and potential for addiction and explore ways to prevent and treat drug misuse in this context.

Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data

Background: The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. Method: The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. Results: Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). Conclusions: Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.