Metabolomic Biomarkers Related to Non-suicidal Self-injury in Patients with Bipolar Disorder

Background: Non-suicidal self-injury (NSSI) is an important symptom of bipolar disorder (BD) and other mental disorders and has attracted the attention of researchers lately. Metabolomics is a relatively new field that can provide complementary insights into data obtained from genomic, transcriptomic, and proteomic analyses of psychiatric disorders. The aim of this study was to identify the metabolic pathways associated with BD with NSSI and assess important diagnostic and predictive indices of NSSI in BD.Method: Nuclear magnetic resonance spectrometry was performed to evaluate the serum metabolic profiles of patients with BD with NSSI (n = 31), patients with BD without NSSI (n = 46), and healthy controls (n = 10). Data were analyzed using an Orthogonal Partial Least Square Discriminant Analysis and a t-test. Differential metabolites were identified (VIP > 1 and p < 0.05), and further analyzed using Metabo Analyst 3.0 to identify associated metabolic pathways.Results: Eight metabolites in the serum and two important metabolic pathways, the urea and glutamate metabolism cycles, were found to distinguish patients with BD with NSSI from healthy controls. Eight metabolites in the serum, glycine and serine metabolism pathway, and the glucose-alanine cycle were found to distinguish patients with BD without NSSI from healthy controls. Five metabolites in the serum and the purine metabolism pathway were found to distinguish patients with BD with NSSI from those with BD without NSSI.Conclusions: Abnormalities in the urea cycle, glutamate metabolism, and purine metabolism played important roles in the pathogenesis of BD with NSSI.

A Rare Presentation of Coeliac Disease; Intractable Itching with Recurrent Heart Attack and Dermatitis Herpetiformis

Coeliac disease (CD) is a systemic disease of the unwarranted immune reaction to gluten and is associated with a 10% increased risk of cardiovascular disease. Here we present a patient with recurrent myocardial ischemia and intractable itching who was eventually diagnosed with CD. A 53-year-old man presented to the allergy department due to intractable itching that was resistant to antihistamine therapy. In addition, despite successful percutaneous intervention with stent implantation to the right coronary artery, there was an ST segment elevation with myocardial infarction (MI) in the lower wall that had occurred three times. After dermatitis herpetiformis was reported as a result of the biopsy performed from the lesions, duodenal biopsy confirmed the diagnosis of CD. Diagnosis of CD with atypical presentation can be difficult. Cardiovascular risk is increased in patients with celiac disease compared to the normal population. Itching is an important symptom that needs to be evaluated in detail, even without the typical gastrointestinal manifestations of CD. Keywords: Allergy, coeliac disease, dermatitis herpetiformis, myocardial infarction, omalizumab, recurrent stenosis

An altered skin microbiome is the most important symptom of atopic dermatitis.

Fast traslate Icon translate Fast traslate Icon translate The progressive increase in the incidence of atopic dermatitis among children, an increase in persistence in adulthood, combined with an inevitable decrease in the quality of life of patients, determine the relevance of studying the mechanisms of the development of this disease not only for dermatology, but also for the entire health care system. Thus, the prerequisites for the emergence of new concepts of pathogenesis and the search for the most effective therapeutic modalities arise. At the moment, atopic dermatitis is considered as the interaction of endogenous (impaired immune response, insufficient function of the epidermal barrier) and exogenous (exposure to allergens, chemical or physical irritants, microorganisms) factors. Environmental factors such as temperature and humidity, genetic makeup, antibiotic use, and good hygiene play a critical role in the maintenance and stability of the skin microbiome. Normally, the skin microbiota is mainly formed by bacteria of the genus Staphylococcus, Propionibacterium, Corynebacterium and Streptococcus. While in patients with AD, in 70% of cases, there is colonization of Staphylococcus aureus on the affected skin, in 39% on intact skin, which secondarily contributes to the development of immune imbalance and increased skin xerosis. This fact determines the importance of the use of basic therapy, which, on the one hand, helps to strengthen the epidermal barrier, and on the other hand, normalizes the microbiome of the skin, reducing the colonization of Staphylococcus aureus.

Screening the Revelation: Bill Viola — Andrei Tarkovsky

The article is devoted to the problem of generating symbolic content in contemporary art. The problem is directly related to the vitality of art itself, which depends on the ability to create a universal picture of the world. In the art of the 20th century, the process of replacing symbolism with symptomatology begins, which gradually leads to a narrowing of the sphere of the symbolic content of culture, since ambiguous symbols are replaced by completely unambiguous symptoms or signs of a particular traumatic problems. This process is associated with the materialization of the symbolic and, in general, with the strengthening of the materialist dominant in the culture of the 1920s–1960s. The article examines the problem of the embodiment of symbols using the example of the work of film director Andrei Tarkovsky and video artist Bill Viola, who largely inherited Tarkovsky in the 1980s–2010s. The comparative analysis is based on the works of Tarkovsky and Viola, in which both masters strive to create moments of revelation. These symbolic moments, Goethe and his interpreter, the philosopher Karen Swassjan, call the revelations of the unsearchable — the universal, open in the private. Tarkovsky and Viola strive to create such moments on the screens, most often resorting to showing the interaction of the characters with the symbolic elements of fire and water. Also, both of them reconstructed different European paintings of the Renaissance and Baroque as a reserve of symbolic. Their search is not always successful precisely because of the substitution of a symbolic image for a symptomatic one: replacement of the unsearchable or unimaginable with scenes of dreams or hallucinosis. However, the search for Tarkovsky and Viola is so intense that the very ambiguity of the results is the most important symptom of the state of modern culture, testifying to a crisis in understanding the possibilities of representation. Turning to screen art, to that form of life that becomes structure-forming, both Viola and Tarkovsky strive to recreate in it the possibility of revelation, the presence of a supermaterial image that opens a saving life path.

Prevalence and duration of loss of smell and taste among COVID-19 affected dentists

Objectives: This study was aimed to look into the prevalence of Sensory loss of Smell and taste among dentists and dental faculty affected with COVID-19 during the current pandemic. Methods: This cross sectional study was conducted in August, 2021, carrying out detailed evaluation of onset, temporal development and resolution of loss of taste and smell among 207 COVID-19 patients with confirmatory PCR lab reports. Clinical and epidemiological variables of COVID-19 symptoms were studied that included age categories, gender, onset and resolution of loss of taste and smell as compared with other symptoms. This study also included altered taste aspect experienced by the COVID-19 affected dentists. Results: Of 207 previous patients of COVID-19, 168 (81%) reported that they experienced loss of smell and/or loss of taste during the ailment. Of these 168, 151 (89.88%) patients experienced both loss of taste and smell while 17 (10.11%) reported to have been afflicted with isolated loss of smell or isolated loss of taste. Among 114 (67.85%) patients, Onset of loss of smell and taste was reported to be occurring at the same time along with other symptoms. A vast majority of the patients 141 (89.24%) also reported altered taste associated with recovery period of COVID-19. Conclusion: Sensory loss of smell and taste should be regarded as important symptom at the very early stage of COVID-19 and patients should take isolation measures upon appearing of these symptoms. Key Words: Anosmia, Hyposmia, COVID-19, Dysgeusia

Acute Compartment Syndrome of the Extremities and Paraspinal Muscles

Acute compartment syndrome (ACS) occurs when the pressure within the closed osteo-fascial compartment raises above perfusion pressure leading to irreversible tissue ischemia and necrosis. Any closed compartment in the body can be affected by ACS. The leg is the commonest site. Trauma is the common cause of compartment syndrome in young patients. In older patients, medical causes can cause it. The diagnosis in a conscious patient can be made based on clinical features. Pain out of proportion to the injury is the most important symptom. Exacerbation of pain on stretching the affected muscles and paresthesia are the common signs. Compartment pressure measurement is important for the diagnosis in unconscious and uncooperative patients. The treatment of established ACS is emergency fasciotomy. Untreated compartment syndrome can lead to neurovascular injuries and muscle contractures. In this chapter, we will see the etiologies, clinical features, investigations, and management of acute compartment syndrome of the extremities and the paraspinal region.

Optimizing COVID-19 Symptom Screening in the Pediatric Population

Background: Research analyzing COVID-19 symptom screening has primarily focused on adult patients. In efforts to safely reopen schools, symptom screeners are being widely utilized. However, pediatric-specific outpatient data on which symptom combinations best identify children with COVID-19 are lacking. Such data could refine school symptom screening by improving screener sensitivity and specificity. In this study, we assessed the frequency of symptoms and symptom combinations in children tested for SARS-CoV-2 in outpatient settings. We aim to contribute to the optimization of pediatric COVID-19 screening questionnaires, to ultimately minimize both COVID-19 transmission in schools and missed school days. Methods: We conducted a retrospective analysis of outpatient symptoms screens, SARS-CoV-2 test results, and demographics of children (≤18 years) tested for SARS-CoV-2 between March 30 and November 30, 2020, at 3 UCSF-affiliated COVID-19 outpatient screening clinics in northern California. Those with incomplete symptom screens, >7 days between symptom documentation and test, and invalid test results were excluded. Results: Of 473 children tested at 1 site, 21 children had positive SARs-CoV-2 results and 452 children had negative results (4.4% positivity rate). Moreover, 85.7% of SARS-CoV-2–positive children had a known exposure to COVID-19 (Table 1). Of SARS-CoV-2–positive children, 61.9% had >1 symptom. Also, 52.4% of SARS-CoV-2–positive children had at least 1 symptom (fever, cough, or loss of taste or smell) versus 62.8% of SARS-CoV-2–negative children (Table 2). Runny nose or nasal congestion was the most frequently reported symptom in the SARS-CoV-2–positive group (47.6%) as well as the SARS-CoV-2–negative group (58.6%). Also, 14.3% of SARS-CoV-2–positive children had eye redness or discharge versus 3.1% of SARS-CoV-2–negative children. Isolated runny nose presented in 10.8% of SARS-CoV-2–negative versus 9.5% of SARS-CoV-2–positive children. All children with isolated diarrhea (n = 5), isolated headache (n = 3), and isolated rash (n = 2) tested negative. Preliminary symptom data based on 176 children from a second site showed that 9.9% of symptomatic children had a positive test result. Conclusions: Runny nose or nasal congestion was the most frequently reported symptom in all children tested for SARS-CoV-2. However, isolated runny nose or nasal congestion identified 2 cases of COVID-19 in our cohort. Eye redness or discharge may be an important symptom to screen for COVID-19 in children. Further research with a larger number of positive cases is needed to make conclusions about improving efficiency and efficacy of symptom screeners for COVID-19 in children.Funding: NoDisclosures: None

A Case Study on Management of Tinea Cruris with Classical Vaman Karma

Tinea Cruris is the disease of fungal infection of groin by dermatophyte fungi. It is commonly seen in men, and also called as Jock Itch as the other name. It is the condition which shows characteristics of disease as erythema, itching, burning sensation, cracked skin, skin rashes which worsen by exercise, skin discoloration and important symptom like rashes does not clears but increases due to antifungal creams. The management of the condition can be done in Ayurvedic perspective. According to Ayurveda all the classified disease of skin are considered as in Kushta Roga (skin disease), where the conditions of fungal infections are correlated with the Dadru Kshudra Kushta (Tinea). Due the clinical features of itch, redness, circular patches. The disease having exaggerated state of Pitta and Kapha Dosha, moreover Kapha. The treatment principle in such conditions is Shodhan Purificaton therapy along with Shaman (Pacificatory) therapy, as both therapies are considered best in Kushta Roga according to Acharyas. This case report is of the female patient suffered from itching over left thigh region along with redness, pimples, and round patches since 3 months, the patient finds the relief after following the Ayurvedic treatment as Shodhan Karma and Shaman Karma with lifestyle changes. The symptoms were diminished by Vaman Karma (emesis). She got 80-90% relief after Shodhan Karma as if one can consider the best treatment for tinea cruris.

Prevalence of pulmonary tuberculosis among the tribal populations in India

Importance There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. Objective To estimate the prevalence of TB among the tribal populations in India. Design, participants, setting A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. Main outcome and measures Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. Results A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. Conclusion and relevance The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.

ANOSMIA IN COVID-19 INFECTION - A CASE SERIES

Background:The aim of this study is to highlight anosmia as an important symptom to predict SARS-CoV-2 infection. The presentation of the disease commonly includes fever, cough, weakness, myalgia and breathlessness making anosmia a rare symptom. Methods:We included a total of 10 patients in the study who were between the age group of 18-70 years with the complaints of anosmia. Results:8 out of the 10 patients had come with fever and cough initially and developed anosmia later. However, 2 patients had presented to us with anosmia alone as the first symptom and then on further evaluation were found to be COVID-19 positive. The available clinical data was collected, recorded and the results were analyzed. Conclusion:Anosmia is a rare or late, but contributory symptom of the coronavirus disease. Thus, clinicians should keep in mind the diagnosis of COVID-19 while treating patients presenting with such atypical symptoms for early detection & in-time treatment of COVID 19 infection to prevent complications associated with the disease.