OLANZAPINE INDUCED BRUXISM

Iatrogenic or drug induced disease is of great clinical significance in therapeutics. Treatment with antidepressants like selective serotonin reuptake inhibitors (SSRIs) and antipsychotics reveal Bruxism (excessive grinding and clenching of the teeth) as such type of iatrogenic disease, however it is rarely found with atypical antipsychotic drugs like Olanzapine. A 50-year male patient, suffering from schizophrenia was under regular antipsychotic medication receiving Tab. Olanzapine 5 mg O.D., Tab. Clonazepam 0.5 mg O.D. regularly for past 25 years. Recently he gradually developed excessive grinding and clenching of teeth despite of any dental and ENT clinical complications. Biochemical and hematological tests also showed normal result. On admission with the complication of bruxism, tab. Olanzapine dose was reduced to 2.5 mg OD, however even after dose reduction there was not much improvement in bruxism. On the 4th day of the admission tab. Olanzapine has been substituted with tab. Clozapine 50 mg TDS. After 1 week of withdrawal of Olanzapine there was no complain of bruxism and he was discharged. On follow up after 1month the complication was occasional. Causality assessment revealed a probable relation between Olanzapine and Bruxism. Though among the atypical neuroleptics, extrapyramidal side effects are thought to be less common with olanzapine, but it may cause fatal consequences. Therefore, this case study and proper investigation may be helpful in designing the treatment strategy in more effective way and also aware all the healthcare professionals to monitor the patients on neuroleptics.

Can trace element supplementations (Cu, Se, and Zn) enhance human immunity against COVID-19 and its new variants?

Background Coronavirus-19 (SARS-CoV-2) is constantly changed through mutation, and new stains of this virus are detected throughout the world such as B.1.1.7 (UK), B.1.351 (South Africa), and P.1 (Brazil). These strains seem to be more easily transmissible than other variants, which may lead to more cases and more deaths. Currently, there are many vaccines for SARS-CoV-2 available in the market but without full clinical data beside. Despite the existence of these vaccines, the numbers of outpatients are still increasing in many countries around the world, and the reliability of these vaccines still remains elusive. It is well known that trace element deficiencies increase the individual susceptibility to immune dysfunction and lead to global health problem. In this context, improving the immune defense system to combats this pandemic is absolutely necessary. The purpose of this review is to establish the probable relation between trace elements supplementation and COVID-19. Main body Several clinical studies confirmed that Cu, Se, and Zn insufficiencies alter the immune system and increase the vulnerability to viral infections. Based on antiviral and anti-inflammatory effects of these micronutrients, it seems logical that dietary supplementations of these components might enhance human immune system and lower the graveness of COVID-19 infection. Conclusion Based on available data, we hypothesize that the clinical use of some essential trace element supplementations such as copper, selenium, and zinc might be a preventive and promising option to enhance human immunity against the new pandemic COVID-19 and its new strains. Graphical abstract

Job’s Syndrome With a Family History of Kawasaki Disease: A Case Presentation and Review of Literature

Background: Job’s syndrome or hyper-immunoglobulin E (IgE) syndrome (HIES) is an extremely rare primary immunodeficiency disease with an approximate annual incidence of less than 1/1000000. It is characterized by recurrent cold staphylococcal infections, unusual eczematous dermatitis, severe lung infections, and extensively high concentrations of the serum antibody IgE. Case Presentation: A typical case of Job’s syndrome with a family history of Kawasaki disease is presented in this study aiming at identifying the clinical features, investigational procedures, and management strategy, as well as evaluating the role of the ear, nose, and throat specialist and highlighting the probable relation between Job’s syndrome and Kawasaki disease. Conclusions: In general, early detection with proper care can prevent the progression of Job syndrome. In addition, the initiated treatment at the first signs of infection is mandatory for preventing long-term complications. There is a probable relation between Job and Kawasaki which requires more consideration.

Vedolizumab-Induced Liver Injury

Drug-induced liver injury is an important cause of acute liver injury. Immunomodulatory therapies, such as vedolizumab (VDZ), are being increasingly used for the treatment of several diseases, most importantly inflammatory bowel disease. Several studies have demonstrated the safety of this substance. To date, only one post-marketing study has reported a case of hepatotoxicity attributable to VDZ. The authors present the case of a 41-year-old woman followed at the gastroenterology outpatient clinic for ulcerative colitis (UC) and autoimmune hepatitis (AIH). This patient was being treated with low-dose glucocorticoids for AIH (prednisolone 10 mg), with adequate disease control. Additionally, she was being treated with oral salicylates (mesalamine 3 g/day) and oral budesonide (9 mg/day) for her UC. For uncontrolled UC, she was started on VDZ. Two weeks after the first infusion of VDZ, the patient developed a clinical and analytical phenotype compatible with acute hepatitis. Diagnostic workup for causes of hepatocellular liver injury retrieved no results. A liver biopsy corroborated the diagnosis of toxic hepatitis overlapping chronic liver disease. VDZ was withdrawn and the patient experienced complete recovery of liver tests over the following weeks. In this case report, we present the first post-marketing case of hepatocellular liver injury in probable relation to VDZ.

Single Individual Haplotype Reconstruction Using Fuzzy C-Means Clustering With Minimum Error Correction

Evolution of human genetics is one of the most interesting areas for researchers. Determination of Haplotypes not only makes valuable information for this purpose but also performs a major role in investigating the probable relation between diseases and genomes. Determining haplotypes by experimental methods is a time-consuming and expensive task. Recent progress in high throughput sequencing allows researchers to use computational methods for this purpose. Although, several algorithms have been proposed but they are less accurate when the error rate of input fragments increases. In this paper, first, a fuzzy conflict graph is constructed based on the similarities of all input fragments and next, the cluster centers are used as initial centers by fuzzy c-means (FCM) algorithm. The proposed method has been tested on several real datasets and compared with some current methods. The comparison with the existing approaches shows that our method can be a complementary role among the others.

Risks associated with vortioxetine in the established therapeutic indication

Background: Vortioxetine is approved for the treatment of Major Depressive Disorder (MDD). However, the safety of this drug in a large group of populations is still unclear. Thus, we have tried to analyze the risk profile of vortioxetine. Material and Methods: The data related to the risk profile of vortioxetine has been extracted from Pub-Med from January 2014 to May 2019. The adverse drug reactions (ADRs) have been categorized into a listed and unlisted categories as per Summary of product characteristics (SmPC) of the innovator. Further, unlisted ADRs have been analyzed as per Naranjo Scale. Results: The galactorrhea, hyperprolactinemia, glycolimia, exacerbation of anxiety, weight gain, edema, excessive itching, petechiae, and ecchymoses have been observed with the use of vortioxetine and falls under the unlisted category. Further, the causality assessment results have shown probable relation between vortioxetine and galactorrhea, hyperprolactinemia, edema, excessive itching, ecchymoses, and petechiae. The weight gain, glycolimia and exacerbation of anxiety have a possible relationship with vortioxetine. The common ADRs observed with the use of vortioxetine are nausea, diarrhea, constipation, vomiting, pruritus including pruritus generalized, abnormal dreams, and dizziness. Conclusion: In conclusion, more data is required to establish the strong relationship between vortioxetine and reported unlisted ADRs.

Glioblastoma with primitive neuronal component: A case report and considerations of fluorescence-guided surgery

Background: Glioblastoma with primitive neuronal components (GB/PNC) is an extremely rare type of glioblastoma characterized by presenting histological and cytogenetic features of both entities. The mixed nature of these tumors limits the imaging diagnosis and supposes a therapeutic dilemma. Case Description: We present the case of a 77-year-old female with a GB/PNC who is treated with surgery and adjuvant radiochemotherapy according to the STUPP protocol, where an abnormal uptake of 5-aminolevulinic acid (5-ALA) is evident during surgery in probable relation to the mixed nature of GB/PNC. Conclusion: GB/PNC is extremely rare tumors. Given its low prevalence, there are no studies that refer to the macroscopic characteristics of the tumor as well as evidence of the effectiveness of adjuvant treatment. Fluorescence-guided resection with 5-ALA is the surgical treatment of choice in surgery for high-grade gliomas; however, in GB/PNC, it may not be as useful since PNC may have less fluorescent marker uptake and be more dimly visualized when excited by light using the surgical microscope.

Clinical and Epidemiological characterization of an outbreak by carbapenemase-producing Klebsiella pneumoniae. January-March, 2017, Portoviejo, Ecuador.

Infection Control reported three cases of Kpn-KPC with a probable relation among them in the adult intensive care unit UCI-A in the hospital “Dr. Verdi Cevallos Balda” from Portoviejo, Manabi, Ecuador. This observational and descriptive study aims to characterize this outbreak, according time, space and person. Laboratory tests are analyzed, and the correlation between cases and positive result of the study is shown. Clinical epidemiological aspects of patients with Kpn-KPC carbapenemases producing Klepsiella pneumoniae infection were recorded (January to March 2017). The ICU-A Adult Intensive Care Unit and family environment are a probable factor of dissemination of the disease. The isolation of KPC is an alternative to clinical suspicion. The implementation of infection control measures is essential to reduce nosocomial transmission of Kpn-KPC.

Absence of Concordance between Polyembryony and Apomixis in Maize Confirmed through DNA Sequencing

Maize (Zea mays L.) polyembryony is a useful feature for genetic improvement of this specie, not only by its potential to generate multiple plants per seed, but also by its influence on increasing of fatty acids and amino acids content in the grain. It has been considered a possible association between apomixis and polyembryony in maize. With the objective to evidence the relation between apomixes and polyembryony, were used sequences of internal transcribed spacers (ITS), and intergenic spacers (IGS) and amplification of simple repeated sequences (SSR). The analyses were performed in 5 families derived from the IMM-UAAAN-BAP (“D”) maize population. Within each of the families were analysed the female parent plant, and two types of progenies (individual and polyembryonic). Nucleotide sequences and genotypic class were compared and also a molecular variation analysis was performed. In these analyses only a close but not identical relationship between polyembryonic plants was found. With the use of these techniques, it was demonstrated that reproduction of the maize plants is of a sexual type, and that based on the molecular markers used, no evidence was obtained about the probable relation- ship of a common genetic basis between polyembryony and apomixis. Sequencing of the ITS and IGS regions, and use of SSR microsatellites of different chromosomes, was a practical and economical tool for the assessment of similarity between genotypes.