Gender Differences in Clinical and Psychosocial Features Among Persons With Schizophrenia: A Mini Review

An extensive literature regarding gender differences relevant to several aspects of schizophrenia is nowadays available. It includes some robust findings as well as some inconsistencies. In the present review, we summarize the literature on gender differences in schizophrenia relevant to clinical and social outcome as well as their determinants, focusing on clinical variables, while gender differences on biological factors which may have an impact on the outcome of the disorder were not included herewith. Consistent findings include, in male with respect to female patients, an earlier age of illness onset limited to early- and middle-onset schizophrenia, a worse premorbid functioning, a greater severity of negative symptoms, a lower severity of affective symptoms and a higher rate of comorbid alcohol/substance abuse. Discrepant findings have been reported on gender differences in positive symptoms and in social and non-social cognition, as well as in functional outcome and rates of recovery. In fact, despite the overall finding of a more severe clinical picture in males, this does not seem to translate into a worse outcome. From the recent literature emerges that, although some findings on gender differences in schizophrenia are consistent, there are still aspects of clinical and functional outcome which need clarification by means of further studies taking into account several methodological issues.

SARS-CoV-2 N Protein Targets TRIM25-Mediated RIG-I Activation to Suppress Innate Immunity

A weak production of INF-β along with an exacerbated release of pro-inflammatory cytokines have been reported during infection by the novel SARS-CoV-2 virus. SARS-CoV-2 encodes several proteins able to counteract the host immune system, which is believed to be one of the most important features contributing to the viral pathogenesis and development of a severe clinical picture. Previous reports have demonstrated that SARS-CoV-2 N protein, along with some non-structural and accessory proteins, efficiently suppresses INF-β production by interacting with RIG-I, an important pattern recognition receptor (PRR) involved in the recognition of pathogen-derived molecules. In the present study, we better characterized the mechanism by which the SARS-CoV-2 N counteracts INF-β secretion and affects RIG-I signaling pathways. In detail, when the N protein was ectopically expressed, we noted a marked decrease in TRIM25-mediated RIG-I activation. The capability of the N protein to bind to, and probably mask, TRIM25 could be the consequence of its antagonistic activity. Furthermore, this interaction occurred at the SPRY domain of TRIM25, harboring the RNA-binding activity necessary for TRIM25 self-activation. Here, we describe new findings regarding the interplay between SARS-CoV-2 and the IFN system, filling some gaps for a better understanding of the molecular mechanisms affecting the innate immune response in COVID-19.

A Possible COVID-19 Reinfection Case in a Healthcare Professional

In these days when the effect of the COVID-19 pandemic is felt with all its severity, the findings of re-infection in people who have had COVID-19 disease have led to some questions about the natural immunity against this disease. Here, we report a possible COVID-19 reinfection. The second episode confirmed by RT-PCR with a more severe clinical picture one month after an incidentally detected first episode with mild symptoms of a doctor working as a microbiologist at a training research hospital. While a 47-year-old female doctor was working in a tertiary hospital serving as a reference hospital for the diagnosis and treatment of COVID-19 patients, symptoms of sore throat, cough and runny nose appeared on October 25. The patient, with a history of chronic tendinitis, COPD, asthma and allergic rhinitis, attributed these symptoms to her previous clinical diagnosis and did not consider consulting a doctor or testing for COVID-19 due to the mild course of symptoms. SARS-CoV-2 Ig G antibodies were found to be positive in a screening study conducted on November 11 in the patient whose complaints resolved within a few days. RT-PCR performed thereafter was reported as negative. The RT-PCR test performed on December 2 of the patient who complained of fever and severe weakness, immediately after her colleague had COVID-19, was interpreted as positive. No signs of viral pneumonia were found in the thoracic CT when the cough complaint of the patient who received COVID-19 treatment did not improve. The patient's complaints regressed with the addition of phenocodine to her treatment, and the RT-PCR test on December 12 was reported as negative. Further analysis of the frequency and possible causes of COVID-19 reinfections will be needed in the near future. Keywords: SARS-CoV-2, COVID-19, reinfection, coronavirus

Irritable Mood and Subthreshold Hypomanic Episodes Correlate with More Severe Major Depression

Introduction: Irritable mood (IM) and subthreshold hypomanic symptoms are reported in half and two-fifths of major depressed subjects respectively, but their clinical and prognostic meanings remain unclear. The aim of this study was to test the clinical usefulness of 2 specifiers in DSM-IV major depressive disorder (MDD): IM occurring during an index episode (IM+) and lifetime episodes of elated mood or IM with at least 2 concurrent hypomanic symptoms (subthreshold hypomanic episodes [SHEs]). Method: We included 482 outpatients with MDD participating in the Combining Medications to Enhance Depression Outcome study (mean age 43.14 ± 12.46 years, 144 males – 30%). The main aim of the original study was to test whether 2 different medications when given in combination as the first treatment step, compared to 1 medication, would improve antidepressant response. Results: IM + subjects (N = 349; 70%) were younger and more often females, with a more severe depression, a more marked social impairment, and more psychiatric comorbidities. The IM + group was also characterized by higher levels of suicidal ideation and more cases of emotional abuse. The combination of IM+ and SHEs was associated with an even more severe clinical picture. Limitations include the post hoc method, incomplete assessment of bipolar validators (e.g., family history of bipolar illness), personality disorders and suicide attempts. Conclusions: The presence of IM and SHEs in MDD correlate with an overall more severe clinical condition.

Automatic Evaluation of the Lung Condition of COVID-19 Patients Using X-ray Images and Convolutional Neural Networks

COVID-19 represents one of the greatest challenges in modern history. Its impact is most noticeable in the health care system, mostly due to the accelerated and increased influx of patients with a more severe clinical picture. These facts are increasing the pressure on health systems. For this reason, the aim is to automate the process of diagnosis and treatment. The research presented in this article conducted an examination of the possibility of classifying the clinical picture of a patient using X-ray images and convolutional neural networks. The research was conducted on the dataset of 185 images that consists of four classes. Due to a lower amount of images, a data augmentation procedure was performed. In order to define the CNN architecture with highest classification performances, multiple CNNs were designed. Results show that the best classification performances can be achieved if ResNet152 is used. This CNN has achieved AUCmacro¯ and AUCmicro¯ up to 0.94, suggesting the possibility of applying CNN to the classification of the clinical picture of COVID-19 patients using an X-ray image of the lungs. When higher layers are frozen during the training procedure, higher AUCmacro¯ and AUCmicro¯ values are achieved. If ResNet152 is utilized, AUCmacro¯ and AUCmicro¯ values up to 0.96 are achieved if all layers except the last 12 are frozen during the training procedure.

Interaction of concurrent infection pathogens in complex comorbidity (theoretical and practical issues)

In case of co-infections, the human body and the pathogen form a complex parasitic system. Also, the development of the infectious process is possible according to the following scenarios: infectious process activation caused by all pathogens; predominant activation of one of the infectious processes; absence of the infectious process activation; absence of combined infection interaction. Infectious pathogens affect the human body in different ways both at the site of permeation, launching a cascade of pathological processes, and at the site of the main localization. The formation of complex comorbidity depends on the non-specific immune defense, the biological properties of pathogens, the simultaneity or sequence of infection, the intervals between infection with various pathogens, etc. This article discusses the reasons for the predominance of one of the disease clinical manifestations in concurrent infections: synergism, antagonistic microorganisms, the chain of infection, the incubation period duration. The following variants of the co-infection course and their influence on complex comorbidity are considered: the dominance of one infection clinical manifestations; the same severity of symptoms of all infections, or the formation of a more severe clinical picture compared to single infections; the aggravating effect of one infection on another; the clinical picture overlap of one infection on another. KEYWORDS: mixed infection, concurrent infection, complex comorbidity, etiology, interaction of pathogens, parasitic system, infectious process, epidemic process. FOR CITATION: Shkarin V.V., Saperkin N.V. Interaction of concurrent infection pathogens in complex comorbidity (theoretical and practical issues). Russian Medical Inquiry. 2021;5(11):737–743 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-737-743.

A Novel and Severe Clinical Picture Related to COVID-19: Multi-Inflammatory Syndrome in Children

Preliminary data have suggested that children have milder COVID-19 disease course compared to adults. However, pediatric cases with severe clinical findings caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) are being reported since April 2020. These children have been presented with significant hyperinflammatory states resembling Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. However, they had several distinct features, as well. Therefore, this novel condition was considered a unique disease and named Multi-inflammatory syndrome in children (MIS-C). Thus, new concerns have been raised regarding the vulnerability of the children. However, it has been realized that this condition is extremely rare. Nonetheless, considering that it is a life-threatening disease and may cause devastating consequences, clinicians should be aware of MIS-C while evaluating children with persistent fever and history of COVID-19 contact or active infection.

Can COVID-19 Be Transmitted Sexually by Semen?

Information on the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has amplified quickly since its spread; however, many issues remain unclear. SARS-CoV-2 is mainly transmitted through respiratory secretions. However, the potential for SARS-CoV-2 sexual transmission by semen is worthy of study. The cell-receptors of SARS-CoV-2, the angiotensin-converting enzyme-2 receptors, are highly expressed in human testis and may enable this virus to cause testicular tissue damage with bad effect on male fertility. SARS-CoV-2 presentation ranges from asymptomatic carriage to acute respiratory distress and fatal pneumonia, and elderly persons with underlying comorbidities usually suffer from a severe clinical picture. Asymptomatic individuals can spread the virus through their respiratory secretions and possibly through sexual transmission. SARS-CoV-2 can persist viable if cryopreserved in semen samples in sperm cryobankes. As far as I know, there is a gap in knowledge about SARS-CoV-2 transmission through semen, indicating the need for further research. This review attempts to understand the SARS-CoV-2 sexual transmission by semen. One recent study confirmed the theoretical risk of SARS-CoV-2 transmission by semen, but few studies negate this theory. Given that, an increasing number of asymptomatic and reactivated SARS-CoV-2 cases are being reported, attention to semen safety and SARS-CoV-2 transmission should be considered particularly in high-risk areas, to ensure the safety of male gametes for artificial reproduction and the general public. Avoiding cryopreservation of male gametes, condom use or even abstinence might be of paramount importance for these persons.

COVID-19 and ophthalmic manifestations: review of the literature

The epidemics of COVID-19 started in December 2019 in Wuhan, China, and the World Health Organization (WHO) officially declared a pandemic in March 2020. COVID-19 can also affect the eyes. Ophthalmic manifestations of the virus are not so frequent; the prevalence is about 3% up to now. Recognizing the possibility of ophthalmic transmission and manifestation of the virus is of significant importance for ophthalmologists and health workers. According to published studies, the most common ophthalmic manifestation is follicular conjunctivitis with all the symptoms and signs of viral conjunctivitis. It is usually bilateral, and patients present adenoviral-like symptoms, discomfort, foreign body sensation, redness, or they have no subjective symptoms. The symptoms are more pronounced in patients with a more severe clinical picture of the disease. One of the described non-specific manifestations of COVID-19 as an initial manifestation is keratoconjunctivitis. The effects of the virus on the retina and blood vessels have not been fully investigated, yet. It has been proven that COVID-19 can be isolated from tears and from ocular surface by PCR conjunctival swab. The most common mode of transmission is through direct contact and through aerosols. Through the nasolacrimal system, the eyes can be the entrance for respiratory infection and hematogenous spread of the virus can occur through the lacrimal gland. Early recognition of the ophthalmic symptoms by ophthalmologists as well as the other health workers during this pandemic is necessary because sometimes they can be the only manifestation of COVID-19, and on the other hand, it will lead to greater protection and prevention of the virus spreading. Prevention measures should be focused on the application of administrative protocols, personal protection and environmental control.

Perfect storm: a rheumatologist's point of view on COVID-19 infection

: New corona virus infection (Covid-19) is a pandemic that affects the whole world and progresses with high morbidity and mortality. It has a high contagion rate and a course capable of rapidly lung involvement with severe acute respiratory distress syndrome (ARDS) and pulmonary insuficiency. Severe clinical picture develops as a result of a “perfect cytokin storm” as a result of possible immunological mechanisms triggered by viral infection. Immun system disregulation and possible autoinflammatory and autoimmune mechanisms are responsible for higher amount cytokines release from immune cells. Although there is no clear treatment of Covid-19 infection yet, it is argued that some disease modifying anti-rheumatic drugs (DMARDs) may be effective in addition to anti-viral treatments. These drugs (antimalarial drugs, colchicum dispert, biologics) have been well known to rheumatologists for years, because they have been used in the treatment of many inflammatory rheumatologic diseases, so now all eyes are on rheumatologists. Another important issue is whether DMARDs, which can cause severe immunosuppression, pose a risk for Covid-19 infection and whether they are discontinued beforehand. Although there are insufficient data on this subject, considering the risk of disease reactivation, patients may continue their DMARDs treatment under the supervision of the rheumatologist. In this article, the possible immunological mechanisms in the pathogenesis of Covid-19 infection and the efficacy and safety of various DMARDs used in the treatment have been discussed with a rheumatologist perspective in the light of recent literature data.