A rare clinical presentation after COVID-19: Manic episode with psychotic features

Neuropsychiatric manifestations of the COVID-19, caused by SARS-CoV-2, are under close scrutiny as the virus is shown likely to either directly or indirectly affects the central nervous system although it mainly targets the respiratory tract. Here, we describe a middle-aged male who developed acute psychiatric symptoms after a recent COVID-19 infection with no prior personal or family history of psychiatric disorder. Although there are reported cases of diagnosed psychosis or affective disorders following COVID-19 infection in the literature, to our knowledge, this is the first case where the development of autoimmune encephalitis after COVID-19 was considered and ruled out. This case report describes the comprehensive evaluation of all possible organic etiology. We also aimed to discuss possible biological underpinnings of such an exceptional comorbidity.

The effects of childhood trauma on psychotic symptoms in bipolar disorder

Introduction

Although history of childhood trauma is present in nearly 50% of bipolar patients, the effects of childhood trauma on the course of bipolar disorder are rarely investigated. Thus, we aimed to investigate the effects of childhood trauma on psychotic symptoms seen in patients with bipolar disorder.

Methods

One-hundred DSM-IV-TR diagnosed bipolar patients who were either manic or depressive were recruited from inpatient units of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. Patients were initially evaluated by Young Mania Rating Scale (YMRS), Montgomery-Asperg Depression Rating Scale (MADRS), Scales for Assessment of Positive Symptoms. Patients were also evaluated by Childhood Trauma Questionnaire (CTQ) and Dissociative Experiences Scale in euthymia which was defined by scores of < 7 in YMRS, < 4 in MADRAS

Results

There were no differences between the patients with and without a history of psychotic episode in terms of age at onset, duration of illness and episode characteristics. Patients with a history of psychotic episode were hospitalized more. CTQ physical abuse scores were higher in male comparing to female. CTQ sexual abuse scores were higher in female comparing to male. CTQ emotional abuse, physical neglect, physical abuse and total scores were higher in patients who had at least one psychotic episode in lifetime than in patients without a history of psychotic episode.

Conclusion

The history of childhood trauma should be investigated and therapeutic interventions for childhood trauma should be added to the standard treatment plan of bipolar patients.

Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia

OBJECTIVE

The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models.

METHODS

Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-1 (PON-1) enzyme activities were evaluated in the samples obtained from each group.

RESULTS

The OSI level of the control group was 91.00±5.46 (mean ± SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50±11.16 and 301.75±19.98, respectively (p<0.05)). However, these levels decreased to 151.88±17.02 (mesenteric ischemia) and 108.88±9.46 (peripheral ischemia) after 6 hours. The PON-1 levels of Group III (mesenteric ischemia at 6 hours) (99.75±7.26), Group IV (peripheral ischemia at 2 hours) (96.88±4.09), and Group V (peripheral ischemia at 6 hours) (111.25±10.33) were slightly elevated over that of the control group (87.38±5.31). However, the PON-1 level of Group II (mesenteric ischemia at 2 hours) (42.88±3.14) was lower than that of the other groups (p<0.05).

CONCLUSION

Despite the increment of oxidative markers in early periods of ischemia (2(nd) hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.

Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion

OBJECTIVE

Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia.

METHODS

Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis.

RESULTS

Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022).

CONCLUSION

Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

Serum ischaemia-modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia

BACKGROUND

Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates.

METHODS

Twenty-four male Sprague-Dawley rats were included in the study. The rats were divided into three equal groups. Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy. The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III. The serum IMA levels were identified from the blood samples and the results obtained were compared statistically.

RESULTS

The serum IMA levels were determined to be 22±6 (22) μ/L, 34±7 (34) μ/L and 36±4 (37) μ/L in Groups I, II and III, respectively. The differences between the groups were not statistically significant.

CONCLUSION

Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.

The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain

AIM

The aim of this study is to investigate the relationship between fear and avoidance beliefs with the disability of patients with chronic low back pain and the prediction of quality of life.

MATERIAL AND METHODS

105 outpatients with chronic low back pain were included in the study. Patients were evaluated with a sociodemographic questionnaire Visual Analog Scale Roland Morris Disability Questionnaire Beck anxiety inventory Beck depression inventory, Somatosensory Amplification Scale Fear and avoidance beliefs questionaire and Short form-36 health survey questionnaire.

RESULTS

As pain intensity increased, FABQ increased. Higher levels of anxiety, depression, FABQ (work) leads to higher level of disability. The disability predictors were found to be pain intensity and level of anxiety. When levels of pain intensity, level of anxiety and depression, FABQ increased, physical function decreased. Pain intensity and FABQ (physical) were found to be the predictors of quality of life.

CONCLUSION

Findings of our study were compatible with the previous studies that evaluated the relationship between pain intensity and FAB with the disability of patients with chronic low back pain. We think that it'd have a role for the perception of disability and connected to this to prevent the impairment of life quality by implications for FAB in these patients.