RESUMEN
Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to a chronic inflammatory process in tissues and organs. The neuropsychiatric systemic lupus erythematosus (NPSLE) is a set of neuropsychiatric symptoms that derive from the central and peripheral nervous system and are observed in the course of SLE. Case Report and Final Diagnostic and Therapeutic Results: A diagnostic and therapeutic process in a patient with the signs and symptoms of SLE and bipolar disorder (BD) has been described. Bipolar disorder has been diagnosed as a primary disorder while SLE as a comorbid disease. Discussion: Common immunological mechanisms in BD and SLE are the reason for difficulties in diagnosing BD with co-occurring SLE. It should be determined whether BD is a primary disorder or a secondary component of a clinical picture of SLE (NPSLE) or whether mood and/or psychotic disorders are the result of steroid therapy in the course of SLE (steroid-induced mood and psychotic disorders, SIMPD). Conclusion and the Patient's Perspective: The presented case report is a unique description of a patient with a primary diagnosis of BD with comorbid SLE.
RESUMEN
A growing body of evidence confirms abnormal fatty acid (FAs) metabolism in the pathophysiology of schizophrenia. Omega-3 polyunsaturated fatty acids (PUFAs) are endogenous ligands of the G protein-coupled receptors, which have anti-inflammatory properties and are a therapeutic target in many diseases. No clinical studies are concerned with the role of the GPR120 signaling pathway in schizophrenia. The aim of the study was to determine the differences in PUFA nutritional status and metabolism between patients with schizophrenia (SZ group) and healthy individuals (HC group). The study included 80 participants (40 in the SZ group, 40 in the HC group). There were no differences in serum GPR120 and PUFA concentrations and PUFA intake between the examined groups. In the HC group, there was a relationship between FAs in serum and GPR120 concentration (p < 0.05): α-linolenic acid (ALA) (R = -0.46), docosahexaenoic acid (DHA) (R = -0.54), omega-3 PUFAs (R = -0.41), arachidonic acid (AA) (R = -0.44). In the SZ group, FA serum concentration was not related to GPR120 (p > 0.05). In the HC group, ALA and DHA serum concentrations were independently associated with GPR120 (p < 0.05) in the model adjusted for eicosapentaenoic acid (EPA) and accounted for 38.59% of GPR120 variability (p < 0.05). Our results indicate different metabolisms of FAs in schizophrenia. It is possible that the diminished anti-inflammatory response could be a component connecting GPR120 insensitivity with schizophrenia.
RESUMEN
Schizophrenia has been considered a disorder linked with faulty lipid homeostasis, and the proposed tool for assessment of these disruptions is the niacin skin flush test. The aims of the study were: 1. Create a new tool to analyze results of the niacin skin flush test more precisely and objectively. 2. Verify the utility of a self-created tool for differentiating between schizophrenia (SZ; n = 56), bipolar disorder (BD; n = 29) and healthy control (HC; n = 45) individuals. The proposed developed method, based on the Skin Reaction Measurement Computer System (SKINREMS), allows one to evaluate the response to the niacin skin flush test quickly and objectively. SKINREMS showed good accuracy in discriminating SZ from BD (with sensitivity 91% and specificity 72%), and SZ from HC (71% and 66%, respectively), and sufficient but not excellent accuracy in discriminating BD from HC (55% and 54%, respectively). The pathophysiological pathways and features shared by schizophrenia and bipolar disorder may be the reason for difficulties in fully discriminating between these two mental disorders using the niacin challenge test. The management of disruptions in the phospholipid metabolism and the inflammatory process could potentially become an individualized form of therapy in a subgroup of psychiatric patients.
RESUMEN
Although schizophrenia and anorexia nervosa are seemingly very distinct psychiatric disorders, their symptoms are connected by various types of relationships. The present article reviews the literature and recapitulates the views of various authors on the links between these two disorders. Symptoms of anorexia may 1) precede the onset of psychosis; 2) evolve in its active phase or more rarely manifest in remission; and, conversely, 3) psychotic symptoms may occur transiently in the course of anorexia nervosa. When anorexia precedes the manifestation of psychosis, symptoms of anorexia can be treated as a component of the prodromal phase of schizophrenia. Another possibility of co-existence of a psychosis (e.g., schizophrenia) with anorexia is when the eating disorder syndrome manifests at the same time as the full-blown psychotic syndrome. In such cases, when the symptoms of the two disorders occur simultaneously, it is often difficult to say whether the patient is suffering from schizophrenia, in the course of which anorexia has arisen secondary to psychotic symptoms or whether he/she is suffering from anorexia during which he/she has developed psychotic symptoms, usually thematically associated with eating. Studies published so far, mainly case reports, point to the complex nature of the interrelationships between schizophrenia and anorexia nervosa. Further research is needed to conclusively explain the relationships between psychotic disorders and anorexia nervosa, which would allow physicians to use more effective methods of treatment in this group of patients.
Asunto(s)
Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/epidemiología , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Anorexia Nerviosa/psicología , Imagen Corporal , Comorbilidad , Humanos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Psicología del Esquizofrénico , AutoimagenRESUMEN
BACKGROUND: Ischaemia of the lower limbs is frequently followed by inflammation and, in advanced cases, necrosis of peripheral tissues. Whether this is caused by arterial hypoperfusion only or by the presence of bacteria in the arterial walI as well remains unclear. The aim of the study was to prove the presence and source of bacteria in arterial specimens and evaluate their chemotactic properties resulting in the formation of periarterial cellular infiltrates. MATERIALS AND METHODS: Bacterial culture and testing for 16sRNA were performed in fragments of popliteal artery harvested from amputated limbs. Carotid artery plaques served as controls. Fragments of arteries were transplanted into scid mice to evaluate their chemotactic activity for macrophages. RESULTS: a) higher prevalence of isolates and 16sRNA in atherosclerotic popliteal than carotid arteries, b) high density of plaque and periarterial infiltrates and mRNA level for pro-inflammatory cytokines in popliteal arteries, c) prevalent microbes were Staphylococcus aureus, S. epidermidis and Enterococci, d) foot skin and arterial bacterial phenotypes and DNA revealed evident similarities, and e) more intensive mouse macrophage accumulation in popliteal than carotid implants into scid mice. CONCLUSIONS: The presence of bacteria in the lower limb arterial wall was documented. They may predispose to inflammation secondary to ischaemic changes.
Asunto(s)
Aterosclerosis/microbiología , Bacterias/genética , ADN Bacteriano/genética , Inflamación/microbiología , Extremidad Inferior/irrigación sanguínea , Placa Aterosclerótica , Arteria Poplítea/microbiología , ARN Ribosómico 16S/genética , Anciano , Amputación Quirúrgica , Animales , Aterosclerosis/diagnóstico , Aterosclerosis/metabolismo , Aterosclerosis/cirugía , Bacterias/clasificación , Arterias Carótidas/microbiología , Arterias Carótidas/trasplante , Citocinas/metabolismo , Femenino , Xenoinjertos , Humanos , Inflamación/diagnóstico , Inflamación/metabolismo , Mediadores de Inflamación/metabolismo , Macrófagos/metabolismo , Macrófagos/microbiología , Masculino , Ratones SCID , Persona de Mediana Edad , Arteria Poplítea/metabolismo , Arteria Poplítea/patología , Arteria Poplítea/trasplante , RibotipificaciónRESUMEN
BACKGROUND: We documented previously the presence of bacterial flora in vascular bundles, lymphatics, and lymph nodes of ischemic lower limbs amputated because of multifocal atheromatic changes that made them unsuitable for reconstructive surgery and discussed their potential role in tissue destruction. The question arose why bacterial strains inhabiting lower limb skin and considered to be saprophytes become pathogenic once they colonize deep tissues. Bacterial pathogenicity is evoked by activation of multiple virulence factors encoded by groups of genes. METHODS: We identified virulence genes in bacteria cultured from deep tissue of ischemic legs of 50 patients using a polymerase chain reaction technique. RESULTS: The staphylococcal virulence genes fnbA (fibronectin-binding protein A), cna (collagen adhesin precursor), and ica (intercellular adhesion) were present in bacteria isolated from both arteries and, to a lesser extent, skin. The IS256 gene, whose product is responsible for biofilm formation, was more frequent in bacteria retrieved from the arteries than skin bacteria. Among the virulence genes of Staphylococcus epidermidis encoding autolysin atlE, icaAB (intercellular adhesion), and biofilm insert IS256, only the latter was detected in arterial specimens. Bacteria cultured from the lymphatics did not reveal expression of eta and IS256 in arteries. The Enterococcus faecalis asa 373 (aggregation substance) and cylA (cytolysin activator) frequency was greater in arteries than in skin bacteria, as were the E. faecium cyl A genes. All Pseudomonas aeruginosa virulence genes were present in bacteria cultured from both the skin and arteries. Staphylococci colonizing arterial bundles and transported to tissues via ischemic limb lymphatics expressed virulence genes at greater frequency than did those dwelling on the skin surface. Moreover, enterococci and Pseudomonas isolated from arterial bundles expressed many virulence genes. CONCLUSIONS: These findings may add to the understanding of the mechanism of development of destructive changes in lower limb ischemic tissues by the patient's, but not hospital-acquired, bacteria, as well as the generally unsatisfactory results of antibiotic administration in these cases. More aggressive antibiotic therapy targeted at the virulent species should be applied.
Asunto(s)
Bacterias/patogenicidad , Infecciones Bacterianas/microbiología , Isquemia/complicaciones , Extremidad Inferior/patología , Linfadenitis/microbiología , Vasculitis/microbiología , Factores de Virulencia/análisis , Anciano , Bacterias/aislamiento & purificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la PolimerasaRESUMEN
BACKGROUND: Infections and inflammation of the lower limb skin, soft tissues, and vessels are more common than in other body regions. The aim was to determine whether cryptic bacteria dwelling in deep tissues are the cause. METHODS: We performed bacteriologic studies of specimens harvested from arteries of amputated ischemic legs, leg varices, and tissue fluid/lymph and lymphatics in lymphedema. RESULTS: Calf arteries contained isolates in 61% and femoral arteries in 36%, whereas normal cadaveric organ donors' arteries in 11%. Bacterial deoxyribonucleic acid (DNA) was detected in 70%. The majority of isolates belonged to the coagulase-negative staphylococci and Staphylococcus aureus; however, highly pathogenic bacteria were also detected. All were sensitive to all antibiotics except penicillin. Saphenous vein varices contained bacterial cells in 40% and controls 4%; bacterial DNA was found in 69%. The majority of bacteria were S. epidermidis and S. aureus susceptible to all antibiotics except penicillin, Lymph and epifascial lymphatics limb contained bacteria in 60% and 33% samples, respectively and controls in 7%. Most were S. epidermidis susceptible to all antibiotics except penicillin. CONCLUSION: Cryptic bacteria are present in lower limb tissues and may play a pathologic role in surgical site infections. Proper antibacterial prophylaxis should be considered when planning surgical interventions.
Asunto(s)
Infecciones Bacterianas/complicaciones , Isquemia/etiología , Extremidad Inferior/microbiología , Extremidad Inferior/patología , Linfedema/etiología , Infecciones de los Tejidos Blandos/etiología , Várices/etiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Isquemia/microbiología , Linfedema/microbiología , Masculino , Persona de Mediana Edad , Infecciones de los Tejidos Blandos/microbiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/microbiología , Várices/microbiologíaRESUMEN
The mechanism of action of antipsychotic drugs is mainly associated with changes in dopaminergic system. The application of antipsychotic agents simultaneously produces changes in concentrations of metabolites (e.g. kynurenic acid - KYNA, 3-hydroxykynurenine - 3-OHKYN, kynurenine - KYN) of the kynurenine pathway, the pathway engaged in glutamatergic transmission. The increase in KYNA levels in certain areas of the central nervous system results in inhibition of glutamatergic transmission. Pharmacologically induced elevation of KYNA levels produces effects similar to those observed after administering ketamine or phencyclidine (the noncompetitive NMDA receptor antagonist), concerning increased activity of mesolimbic dopamine neurons, as well as reduction in dopamine release from the prefrontal cortex. Recent research results confirm the predictive value of changes in concentrations of kynurenine pathway metabolites for assessment of effectiveness of antipsychotic treatment. Significant relationships were found 1) in schizophrenia between the reduction of psychopathological symptoms and variations in 3-OHKYN levels as well as changes in KYNA/3-OHKYN and KYN/KYNA ratios, 2) in mania between varying tryptophan concentrations and the reduction in manic symptoms achieved with antipsychotic treatment. The research as well presented the possibilities of kynurenine pathway modifications, raising high hopes for their future application as target points for the action of novel antipsychotic agents.
Asunto(s)
Antipsicóticos/farmacología , Ácido Quinurénico/metabolismo , Quinurenina/efectos de los fármacos , Quinurenina/metabolismo , Esquizofrenia/tratamiento farmacológico , Animales , Antipsicóticos/administración & dosificación , Humanos , Vías Nerviosas/efectos de los fármacos , Vías Nerviosas/metabolismo , Transducción de Señal/efectos de los fármacosRESUMEN
UNLABELLED: Despite rapid development of research on social cognition (SC) impairments in schizophrenia, efforts are still made to generate new, broader theoretical models which include the neural network approach to those dysfunctions. The aim of this study was the evaluation of the structure of SC in patients with schizophrenia in comparison to healthy subjects. METHODS: The studied groups consisted of 55 subjects: 30 patients with paranoid schizophrenia according to DSM-IV criteria, and 25 control healthy subjects matched for age, gender and education to the clinical group. In order to assess processes of SC, a battery of tests was administered: Theory of Mind Picture Stories to assess theory of mind, trials "Faces" (from Ekman and Friesen's set of emotional expressions) and "Figures" (from the publication by Argyle) to evaluate recognition of emotions from facial and gesture expression. The methods included also an assessment of self-criticism (insight) relating to the subject's processes of SC. RESULTS: The level of efficacy of SC was lower in the patients compared to the controls. In the clinical group, theory of mind was the most important factor for the overall level of SC and its impairments. There was inadequate, decreased patients' self-criticism regarding their execution of SC tests. The insight did not correlate with any other SC variables in the clinical group. In general, the group characterized by lower integration of social cognitive processes, also obtained lower scores in individual dimensions of SC. CONCLUSIONS: The structure of social cognitive processes in schizophrenic group, unlike in healthy subjects, shows characteristics of generalized disintegration.
Asunto(s)
Trastornos del Conocimiento/etiología , Esquizofrenia Paranoide/complicaciones , Autoeficacia , Conducta Social , Percepción Social , Adulto , Estudios de Casos y Controles , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reconocimiento en Psicología , Psicología del Esquizofrénico , Adulto JovenRESUMEN
Slime production is a very important factor related to biofilm formation. The objective of the present study was to determine the frequency of slime production by Staphylococcus aureus and Staphylococcus epidermidis strains recovered from 50 patients with diabetic foot ulcers. Slime production was determined using the Congo red agar (CRA) method and compared with immunocytochemistry for the production of polysaccharide intercellular adhesin (PIA). Out of 55 S. aureus strains, 69% produced slime as shown by the CRA method. Of them, 84.2% also produced PIA. Of 17 CRA-negative strains, 70.6% produced PIA. Out of 20 S. epidermidis strains, 75% were CRA positive and 93.3% produced PIA. All CRA-negative S. epidermidis produced PIA. In conclusion, PIA production is a very common trait of S. aureus and S. epidermidis isolates obtained from diabetic foot ulcer patients.
Asunto(s)
Biopelículas , Pie Diabético/microbiología , Infecciones Estafilocócicas/metabolismo , Staphylococcus aureus/metabolismo , Staphylococcus epidermidis/metabolismo , Animales , Colorantes/metabolismo , Rojo Congo/metabolismo , Humanos , Polisacáridos Bacterianos/metabolismo , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/aislamiento & purificaciónRESUMEN
We examined whether foot ischemia or neuropathy with diabetic foot ulcer (DFU) promote selection of staphylococci species, evaluated frequency of MRSA and MRSE among strains yielded from patients with DFU and assessed multidrug resistance of isolates. Patients with DFU and foot osteomyelitis were divided into ischemic foot ulcer (IFU, n=21) and neuropathic foot ulcer (NFU, n=29) groups. Frequency of Staphylococcus epidermidis yielded from curettage of IFU was higher compared with NFU (P<0.05). S. epidermidis was also more frequently isolated from the toe web surface of patients with IFU compared with NFU (55% vs. 17.9%, respectively) and healthy volunteers (HV, n=20) (17.6%, P<0.05). These mostly MRSE strains (83.3-100%) originating from DFU patients were multidrug resistant (88.8%). Also, most of MRSA isolates were multidrug resistant (70.3%). Higher rates of MSSA from DFU patients than HV showed resistance to antimicrobials. This is the first report indicating that diabetic patients with IFU differ with NFU patients in higher frequency of S. epidermidis skin colonization and ulcer infection. We suggest that IFU should be defined as separate disease state of DFU and S. epidermidis should be appreciated as a nosocomial pathogen.
Asunto(s)
Pie Diabético/microbiología , Úlcera del Pie/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Staphylococcus epidermidis , Administración Oral , Adulto , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Angiopatías Diabéticas/microbiología , Pie Diabético/complicaciones , Neuropatías Diabéticas/microbiología , Femenino , Úlcera del Pie/complicaciones , Humanos , Isquemia/microbiología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/aislamiento & purificaciónRESUMEN
The aim of study was the molecular characteristic of S. aureus and S. epidermidis isolates obtained from skin surface, wounds, deep tissues of hospitalized patients and from skin surface of non-hospitalized patients. Genes encoding virulence factors were examined using PCR reaction and specific primers. Genes encoding adhesinsfnbA and cna and gene eta for epidermolytic toxin were mostly present in S. aureus isolates coming from wounds and deep tissues compared to these from skin surface. Gene atlE encoding autolysin of S. epidermidis was detected in all studied isolates, whereas gene icaAB was present in almost all isolates. Comparison of results obtained by PCR and conventional method of the resistance to methicillin estimation showed discrepances suggesting the need for using of both methods in some clinically difficult cases of S. aureus infection.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple/genética , Resistencia a la Meticilina/genética , Staphylococcus aureus/genética , Staphylococcus epidermidis/genética , Adhesinas Bacterianas/genética , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana , Coagulasa/genética , Cartilla de ADN , ADN Bacteriano/análisis , Genes Bacterianos/genética , Humanos , Reacción en Cadena de la Polimerasa , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/patogenicidad , Staphylococcus epidermidis/efectos de los fármacos , Staphylococcus epidermidis/aislamiento & purificación , Staphylococcus epidermidis/patogenicidad , Factores de Virulencia/genéticaRESUMEN
The aim of the study was the analysis of frequency of yeast-like fungi as etiological agents of fungemias in patients hospitalized in operative and conservative wards of Medical Academy Central Clinical Hospital in Warsaw in 1998-1999. Peripheral blood samples and collected from vascular catheters were incubated in BacT/Alert system(Organon Teknika, USA). Positive blood samples were inoculated on Sabouraud medium with chloramphenicol (bioMerieux, France) (the time of cultivation from 48 h to 7 days at 30 C) and on chromogenic medium BBL CHROMagar Candida (Becton Dickinson, USA). Fungal strains were identified by standard mycological procedures using ID 32 C strips (ATB system, bioMerieux, France) and tests of Sanofi Diagnostics Pasteur (France). The total number of positive blood cultures was 1724. Fifty eight fungal strains were isolated from blood samples (3.36%). Strains belonged to 4 genera: Candida (55), Trichosporon (1), Saccharomyces (1) and Pichia (1). Thirty eight fungal strains were isolated from peripheral blood samples. Forty seven fungal strains were cultured from patients hospitalized in operative wards. Among fungi isolated from peripheral blood samples C. albicans (10), C. glabrata (9) and C. parapsilosis (5) strains dominated. From blood samples collected from vascular catheters most often C. albicans (7), C. glabrata (4) and C. parapsilosis (3) were isolated.