Understanding psychosis: diagnosis and clinical presentation (updates for clinicians)

Psychosis is understood as the brightest manifestations of mental illness, in which the patient's mental activity does not correspond to the surrounding reality, the reflection of the real world in consciousness is sharply distorted, which manifests itself in behavioral disorders, abnormal pathological symptoms and syndromes. Psychosis is a combination of biological (genetic, neuroanatomical, neurophysiological), psychological and social factors in various proportions. Psychoses are classified according to their origin (etiology) and reasons (pathogenetic mechanisms of development) into endogenous (including endogenous psychoses include schizophrenia, schizoaffective disorder, some psychotic forms of affective disorders), organic, somatogenic, psychogenic (reactive, situational), intoxication, withdrawal and post-withdrawal. Most often, psychoses develop in the framework of so-called endogenous disorder. The concepts of psychosis and schizophrenia are often equated, which is incorrect as psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease and other types of dementia, chronic alcoholism, drug addiction, epilepsy, intellectual disabilities, etc. Other types of psychosis, such as infectious, somatic and intoxication psychoses are quite often find among patients in non-psychiatric practices. This review article is a good educational material for medical and psychological practitioners whose goal is to improve knowledge and diagnostic processes of psychosis and its related disorders.

Isolated pericardial cystic Echinococcosis: A rare clinical presentation

Isolated pericardial Hydatid cyst without involvement of other viscera is a rare condition with reported incidence of 0.5-2% of all cases of cystic echinococcosis even in the countries endemic for the disease. Hydatid disease is a major public health concern in the animal raising regions worldwide. Pericardial hydatid disease can be asymptomatic or present with varying symptoms from atypical chest pain, arrhythmias, rupture and tamponade to anaphylaxis. Early diagnosis and surgical treatment is necessary to prevent fatal complications. Here we report a case of symptomatic isolated pericardial hydatid cyst who presented with epigastric pain. doi: https://doi.org/10.12669/pjms.38.3.4965 How to cite this:Thapaliya P, Ali TA, Bhutta MM. Isolated pericardial cystic Echinococcosis: A rare clinical presentation. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4965 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Miller fisher syndrome – A rare complication of covid-19 infection

The COVID-19 virus can present with various neurological signs and symptoms involving both the central and peripheral nervous systems. Miller Fisher syndrome (M.F.S.), a variant of Landry Guillain Barre Syndrome (L.G.B.S.), presents with ataxia, areflexia, and ophthalmoplegia. It can develop during and after COVID-19 illness. We are reporting a case of the Miller Fisher variant of L.G.B.S. following a COVID-19 infection. We found no difference in clinical presentation, electrophysiological studies, severity, recovery, and treatment in our patient compared to a non-covid related M.F.S. Our goal is to add a case of the COVID-19-associated Miller Fisher variant of L.G.B.S. to already existing limited literature through this case report.

Unicentric Castleman Disease and Pheochromocytoma

Castleman disease is an uncommon and heterogenous lymphoproliferative disorder which is classified as unicentric or multicentric depending on the number of lymph nodes involved. Each type has a different clinical presentation, aetiology, treatment and prognosis. We report the case of a young woman who presented with cervical lymphadenopathy and a retroperitoneal mass, and was diagnosed with unicentric Castleman disease and pheochromocytoma. We describe the diagnostic steps, the complications that developed, and the importance of the differential diagnosis in the evaluation of these patients.

The Increase of The Relative Amount of Nodular Calcification In Femoral Plaques is Associated With Milder Lower Extremity Arterial Disease

Vascular calcification exists in different forms that reflect variable clinical and histological implications. Categories of calcification have not been quantified in relation to the clinical presentation of lower extremity arterial disease. The study analyzed 51 femoral plaques collected during femoral endarterectomy, characterized by > 90% stenosis. The plaques were longitudinally sectioned, stained with Hematoxylin and Eosin and digitized for a deep learning platform for quantification of the relative area of nodular calcification to the plaque section area. Vessel measurements and quantity of each calcification category was compared to the clinical risk factors and outcomes. nodular calcification area proportion is associated with reduced risk of severely lowered toe pressure (< 30mmHg) (OR=0.910, 95%CI =0.835-0992, p<0.05), severely lowered ankle brachial index (<0.4), (OR=0.912, 95%CI=0.84-0.986, p<0.05), and semi-urgent operation (OR=0.882, 95%CI=0.797-0.976, p<0.05). The analysis was adjusted by age, gender, hypertension, diabetes and dyslipidaemia. Increase of the relative amount of nodular calcification in femoral plaques with over 90% stenosis is associated with protection against severe LEAD, identified by severely lowered toe pressure and ankle brachial index and semi-urgent operations. Nodular calcification may contribute to a slower obstruction, hence milder obstructive ischaemic presentation.

Asterixis and dysarthria-clumsy hand originated of lacunar infarction: A series of six cases

Asterixis and dysarthria-clumsy hand are uncommon neurological signs following to movement disorders after a stroke, clinically are classified as a part of lacunar infarction and most of the cases resolved spontaneously within ten days to one month. The aim of this study was to describe the clinical characteristics of six patients with lacunar infarction and mild motor symptoms of dysarthria and asterixis with no signs of dementia. All patients had as comorbidities hypertension and/or type 2 diabetes. In conclusion, it is important due to the transience of the abnormal neurological movements, the promptly recognition of the characteristic clinical presentation and confirmation of the diagnosis with noninvasive studies. The patients should be treated to prevent recurrent stroke with more severe consequences.

Chronic inducible urticaria: Clinical presentation, diagnosis, and management

Chronic inducible urticaria (CIndU) is a subtype of chronic urticaria characterized by recurrent itchy wheals and/or angioedema for more than 6 weeks. CIndU has a longer disease duration than chronic spontaneous urticaria (CSU) and wheals are shorter lasting than CSU. CIndU incudes physical and non-physical urticaria. Triggers and diagnosis of subtypes of CIndU differ from each other. Patient education for avoiding triggers is an important aspect of the treatment of CIndU. There is no significant difference in the treatment approach for CIndU and CSU. In this article, we have discussed different types of CIndU, their clinical features, diagnosis, and management.

Viral Coinfection and Nasal Cytokines in Children With Clinically Diagnosed Acute Sinusitis

Objective: Children with no pathogenic bacteria in the nasopharynx are unlikely to have acute bacterial sinusitis. We evaluated whether information on clinical presentation, viral co-detection, and mucosal cytokine levels could be used to predict presence of bacteria in the nasopharynx.Method: We obtained nasopharyngeal (NP) swabs from children diagnosed with acute sinusitis. NP swabs were processed for bacterial culture, viral PCR testing, and cytokine expression. We examined whether results of the bacterial culture could be predicted based on the presence of clinical information, presence of viruses or mucosal cytokine levels.Results: We enrolled 174 children; 123 (71%) had a positive culture for potentially pathogenic bacteria and 51 (29%) had normal flora. 122/174 (70%) tested positive for one or more viruses. Compared to children with normal flora, children with pathogenic bacteria were more likely to have viruses (p &lt; 0.01), but this relationship disappeared when we adjusted for age. Children with pathogenic bacteria in their nasopharynx and children with normal flora had similar levels of nasal cytokines.Conclusion: In children with clinically diagnosed acute sinusitis, clinical presentation, levels of nasal cytokines, and presence of viruses do not differentiate children with and without pathogenic bacteria in their nasopharynx.

Squamous Cell Carcinoma of the Foot Occurring in a Wart

Verrucous carcinoma is a rare form squamous cell carcinoma which appears similar to a wart. When it occurs in the feet, it can be easily misdiagnosed. It rarely metastasizes or recurs posttreatment. We report a case of a septuagenarian with recurrence of verrucous carcinoma diagnosed within 6 months at the site of previous treatment. Unique features in our patient’s clinical presentation include his advanced age, being nondiabetic, and the rapid recurrence of carcinoma. Level of Evidence: Level IV: Case report