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.

Novel Disulfiram Derivatives as ALDH1a1-Selective Inhibitors

Aldehyde dehydrogenase-1a1 (ALDH1a1), the enzyme responsible for the oxidation of retinal into retinoic acid, represents a key therapeutic target for the treatment of debilitating disorders such as cancer, obesity, and inflammation. Drugs that can inhibit ALDH1a1 include disulfiram, an FDA-approved drug to treat chronic alcoholism. Disulfiram, by carbamylation of the catalytic cysteines, irreversibly inhibits ALDH1a1 and ALDH2. The latter is the isozyme responsible for important physiological processes such as the second stage of alcohol metabolism. Given the fact that ALDH1a1 has a larger substrate tunnel than that in ALDH2, replacing disulfiram ethyl groups with larger motifs will yield selective ALDH1a1 inhibitors. We report herein the synthesis of new inhibitors of ALDH1a1 where (hetero)aromatic rings were introduced into the structure of disulfiram. Most of the developed compounds retained the anti-ALDH1a1 activity of disulfiram; however, they were completely devoid of inhibitory activity against ALDH2.

COMPARATIVE CHARACTERISTICS OF EFFECTIVENESS AND SAFETY OF ADJUVANT SEDATION OF PATIENTS WITH ALCOHOLIC DELIRIUM

Chronic alcoholism is one of the factors of early mortality in the world. The most formidable complication of this addiction is the state of alcohol withdrawal with delirium. It is based on a long-term imbalance of the GABA and glutamatergic systems in the brain. Today, the search for an optimal sedation regimen that would be effective on the one hand, and, on the other hand, would have a sufficient safety profile, remains relevant. Three sedation regimens with the addition of ketamine, sodium oxybutyrate and dexmedetomidine were investigated. All were compared with the traditional sedation (control) regimen and with each other. The control points of the study were the following parameters: the duration of the episode of delirium, hemodynamics, plasma cortisol and serotonin, laboratory parameters of the state of the kidneys and liver. As a result of the study, we found that all of the proposed schemes had a shorter duration of delirium compared to the control. The shortest episodes of delirium were observed in the dexmedetomidine group. None of the proposed groups could adequately normalize hemodynamic parameters. We believe that the reason for this is both the peculiarities of the mechanism of action of the drugs we have chosen, and electrolyte imbalance, in particular, hypomagnesemia. The safety of our proposed sedation regimens requires further comprehensive research

Prognostic factors influencing the outcome of empyema surgical management: prospective study in a Moroccan university center.

Background: Pleural empyema is a public health problem, and is the most frequent complication of pleural infection with significant morbidity and mortality worldwide. Our study aims to highlight the management of pleural empyema and evaluate its prognosis factors involved especially in surgical treatment. Patients and Methods: A prospective analysis of 53 patients who underwent surgical treatment of pleural empyema, from January 2015 to December 2019 at the thoracic surgery department in a tertiary referral university teaching hospital. Our study included patients who required surgical treatment for pleural empyema and were excluded patients with destroyed lungs associated with pyothorax. Results: The mean age of patients was 39.24±15.89 years and 79,24% of them were males. In 85.7% of the cases, the etiology was undetermined in 34%, parapneumonic in 1.9%, of tuberculosis in 54.71%, post-traumatic in 11, 3%, postoperative in 7.5% and iatrogenic in 1.9%. 45 patients were treated with broad-spectrum antibiotics therapy adapted after antibiogram 14.38±21.76 days before the operation. A complete debridement and decortications were performed by VATS in 28 and by PLT in 22 patients. No major complications occurred. At a mean term follow-up of 20 months (3months—3 years); all patients were alive with no recurrence. The analysis of the results showed 4 factors of poor prognosis: delay of diagnosis and surgery (P = 0.02), chronic alcoholism (P = 0.034), preoperative ventilation disorder/COPD (P = 0.04) and active tuberculosis (P= 0, 05). Conclusion: The success of surgical management of pleural empyema depends on several factors, which predict the prognosis, but can be prevented.

Campylobacter fetus subspecies venerealis meningitis associated with a companion dog in a young adult: a case report

Background Campylobacter spp., common commensals in the gastrointestinal tract of animals, especially poultry, can cause acute gastrointestinal illness in humans through animal-to-human transmission. Although Campylobacter fetus, especially subspecies fetus, rarely leads to systemic infections such as bacteremia in immunocompromised patients, it is unclear whether Campylobacter fetus subspecies venerealis (Cfv) causes infectious diseases in humans. Case presentation A 28-year-old man with a history of chronic alcoholism visited the emergency department with weakness of the left extremities. The patient was clinically diagnosed with community-acquired bacterial meningitis. The organism from the blood culture was subsequently identified as Campylobacter fetus. On phylogenetic analysis, the 16S rRNA sequence showed 99.93% similarity with other Cfv 16S rRNA sequences. The patient had no exposure to identifiable sources except for close contact with a companion dog, which could have been a possible source of transmission. Conclusions This case suggests that Cfv could lead to human systemic infections such as meningitis and that companion animals, in addition to well-known animal hosts, could be sources of transmission.

Co-infection leprosy and tuberculosis: a systematic review

Leprosy and tuberculosis are endemic in several countries. The aim of this study was to describe factors associated with co-infection among both diseases. A systematic review was carried out, following the Quality of Reporting of Meta-analyses, with the PubMed and Biblioteca Virtual em Saúde (BVS) portals as sources, under eligibility criteria: cross-sectional, cohort, case-control studies or case reports, published in Portuguese, English, French and Spanish, from 2015 to 2020. Studies that dealt with leprosy and tuberculosis not in the context of co-infection were excluded. The initial phase resulted in 1079 articles; 13 went on to a final stage. All were case reports. Thirteen (72.2%) participants were male, aged between 17 and 72 years. Life habits were found in 8 (44.4%) of the articles: 1 (12.5%) reported chronic alcoholism, 1 (12.5%) reported chronic smoking and alcoholism and 1(12.5%) reported chronic smoking, alcoholism and use of illicit drugs. Pathological history was mentioned by 14 (77.8%) patients; 1 (7.1%) reported HIV/AIDS. Three patients (16.6%) described previous history of tuberculosis and/or leprosy. Seven (38.9%) participants reported vaccination with Bacillus Calmette-Guérin. The pulmonary form of tuberculosis predominated and one third of the patients presented resistance to, at least, one tuberculostatic. All cases had multibacillary leprosy. The study did not highlight any comorbidity, and there was no change in the course of the conditions owing to co-infection.

Camel milk ameliorates inflammatory mechanisms in an alcohol-induced liver injury mouse model

Camel milk (CM) is considered to protect the liver in the practice of traditional medicine in nomadic areas. The purpose of the present study was to investigate the effects of CM on the hepatic biochemical and multiple omics alterations induced by chronic alcoholic liver disease (ALD). An intragastric gavage mice Lieber DeCarli + Gao binge model (NIAAA model) was employed to investigate the inflammatory mechanism of camel milk on the liver tissue of mice. A gut microbiota of the feces of mice and transcriptomic and proteomic analyses of the liver of mice were performed. Analysis of serum and liver biochemical indexes revealed that camel milk not only prevents alcohol-induced colonic dysfunction and lipid accumulation, but also regulates oxidative stress and inflammatory cytokine production to protect against chronic ALD in mouse. The gut microbial community of mice treated with camel milk was more similar to the untreated control group than to the model group, indicating that the intake of camel milk pre- and post-alcohol gavage effectively prevents and alleviates the intestinal microbial disorder caused by chronic alcoholism in mice. Furthermore, the results of the transcriptomic and proteomic analyses of the liver tissue showed that camel milk can improve alcoholic liver injury in mice by regulating inflammatory factors and immune system disruptions. This study provides insights into the molecular mechanism by which camel milk can be developed as a potential functional food with no side effects and against liver injury.

Neurologic Complications of Nutritional Disorders

A number of medical and neurologic conditions may result from inadequate ingestion, absorption, transport, or storage of critical vitamins and micronutrients. Individuals at risk for inadequate dietary intake include those who are receiving prolonged parenteral nutrition for various chronic medical conditions, those who have eating disorders or chronic alcoholism, and those who are part of a resource-limited population. Malabsorption may result from several conditions, including chronic gastrointestinal disorders and gastrointestinal surgeries. Excessive intake of vitamins such as vitamin B6 may directly cause neurotoxicity, and copper deficiency myeloneuropathy may result from excessive ingestion of zinc (often in the form of denture cream aggressively used for loose-fitting dentures), which competes with copper for absorption within the gastrointestinal tract.

Multivariate analysis of medical and economic factors in the spread of socially significant diseases (on the example of the Khabarovsk Territory)

Methodological approaches to determining the possible social conditioning of certain diseases are considered. The method is based on studying the distribution of the disease under study in the population using factor analysis tools. The average annual population incidence of diseases in the administrative districts of the Khabarovsk Territory has been determined. The socio-economic characteristics of the districts of the remote region of Russia have been studied. The matrix obtained in the course of the study is used for regression analysis, which makes it possible to determine the degree of influence of social factors on the features of the territorial distribution of the disease under study. The use of the multiple regression method in a population-epidemiological study showed that socio-economic factors have a significant impact on the territorial spread of tuberculosis, sexually transmitted diseases, chronic alcoholism and drug addiction, but not on the spread of malignant neoplasms.

On the mechanism of the antiarrhythmic action of fabomotizole hydrochloride in alcoholic cardiomyopathy

It is known that the alcoholic cardiomyopathy (ACMP) is the main reason for lethality from chronic alcoholism. For ACMP the risk of development of malignant violations of a heart rhythm which result approximately at 40% of such patients is sudden heart death is extremely high. Materials and methods. Experiments were made on the ACMP translational model developed by us which is formed at rats by the end of the 24th week of compulsory reception of 10 % of ethanol solution. For studying the mechanisms which are the responsible of antiarrhythmic action of a fabomotizole dihydrochloride used a complex of morphohistological, electrophysiological and molecular researches. Results. It is shown that against the background of systematic therapy fabomotizole dihydrochloride (15 mg/kg, i.p.) daily within 28 days after 24 weeks of alcoholization, in comparison with alcoholized control the fat dystrophy of a myocardium significantly decreases and the threshold of electric fibrillation of heart ventricles is restored. According to results of molecular researches, a fabomotizole dihydrochloride significantly suppresses revealed in control alkoholized animals the abnormal mRNA expression of key receptor genes and proteins responsible for maintenance in cardiomyocytes of a homeostasis of ions of Ca++ and regulation of their rhythmic activity: regulatory proteins Epac1 (p = 0.021), Epac2 (p = 0.018), CaM (p = 0.00001) and also RyR2 (p = 0.031), IP3R2 (p = 0.006) receptors. Conclusion. The obtained results suggest that antiarrhythmic action of a fabomotizole dihydrochloride in the conditions of ACMP is connected with its ability to suppress abnormal activity of regulatory proteins Epac2 and RyR2, IP3R2 receptors.