Introduction
The Capgras syndrome (CS), firstly described in 1899, is a delusional conviction that a person emotionally close has been replaced by an imposter or duplicate. It has been associated to ...primary psychiatric disturbances as well as neuropsychiatric syndromes. Its etiology and management have been debated throughout the years. We describe a case of a 75 years old male who was admitted to our psychiatric ward due to aggressiveness towards his spouse, believing she was an imposter.
Objectives
In light of this case, we aim to discuss its etiology and review the association between the Capgras syndrome and neurodegenerative diseases.
Methods
Classically, CS was associated to psychotic illnesses such as schizophrenia, schizoaffective disorder and substance abuse. However, recent studies shed light on other possible etiologies, such as neurodegenerative and nonneurodegenerative diseases. In older ages, it has been associated to Alzheimer’s and, most commonly, Lewy body dementia subtype. Research also shows that other misidentification syndromes are frequently present in association with CS. Patients are more likely to be aggressive towards caregivers under these circumstances. Studies suggest there is a higher prevalence of right hemisphere lesions in CS, namely frontal and temporal lobes, that impair facial processing. Various brain circuits are being proposed as possible etiopathogenesis.
In this case, parkinsonian signs were observed in our patient, such as resting tremor, imbalance gait and rigidity. Those had not been described before his hospitalization. His family stated memory loss and difficulty in executive functions were present for at least a year. This patient had no previous psychiatric history. Brain CT scan showed cortical atrophy.
Results
A neurodegenerative cause was assumed, and the patient was started on a cholinesterase inhibitor and on a second-generation antipsychotic. Improvement was observed.
Conclusions
This case is an example of the heterogenous etiology of the CS. It is important to consider different diagnosis, especially in older ages. More studies are needed to improve the knowledge on CS etiopathogenesis as well as the brains circuits involved. Psychopharmacology tackling theses syndromes is also a growing.
Disclosure of Interest
None Declared
IntroductionThe Capgras syndrome, also known as the delusion of doubles, is a delusional misidentification syndrome, defined in 1923 by Joseph Capgras, who referred to it as “l’illusion des sosies”, ...which means “the illusion of look-alikes”. In this syndrome, people falsely believe that someone significant to them has been replaced by an identical-looking impostor.ObjectivesTo review the evolution of the conceptualization of Capgras syndrome and its relationship with neurological disorders, such as dementia.MethodsNon-systematic review of the literature with selection of scientific articles published in the last 10 years, using PUBMED as database and the following keywords: «Capgras syndrome» and «dementia». 11 studies were included.ResultsOriginally, Capgras syndrome was seen exclusively as a psychiatric disorder: a delusional disorder, which can be associated to schizophrenia, bipolar or schizoaffective disorder. Since 1980, when organic brain lesions were identified in patients with Capgras syndrome, it started to be understood as a neuropsychiatric disorder. Previous studies revealed that in Capgras syndrome there is damage in the bifrontal, temporal cortex and the limbic system, structures that are involved in emotional arousal to familiar faces. In fact, Capgras Syndrome can be experienced in neurological conditions, including Alzheimer’s disease, dementia with Lewy body, Parkinson’s disease, epilepsy, cerebrovascular disease, subarachnoid hemorrhage, pituitary tumors and head injury. A 2014’s study showed that 73% of Capgras syndrome cases had comorbid diagnosis of schizophrenia, 26,4% had dementia and 16,7% had mood disorders. The prevalence of Capgras syndrome in neurodegenerative disorders is well known, and it is higher in dementia with Lewy body than in Alzheimer’s disease and frontotemporal dementia. In patients without a neurodegenerative disease, Capgras syndrome typically occurs at a younger age and is associated with psychiatric disease, cerebrovascular events, or illicit drug use. To date, it is unclear whether there are differences between Capgras syndrome as it occurs in neurodegenerative compared with non-neurodegenerative diseases.ConclusionsCurrently, it is believed that Capgras syndrome can be associated not only with psychiatric diseases (a delusional syndrome, when belief evaluation is affected) but also with neurological diseases, such as neurodegenerative disorders. Therefore, when addressing a Capgras syndrome it is necessary to rule out these neurological conditions. Also, correct early identification of the Capgras syndrome in dementia cases will improve the clinical management, outcome and quality of life of patients and caregivers.Disclosure of InterestNone Declared
Inadequately reprocessed reusable surgical instruments (RSIs) may harbour infectious agents which may then be transferred to a suitable site for replication.
To determine the cumulative effect of 20 ...cycles of contamination, cleaning (manual or manual followed by automated) and steam sterilization on high-complex-design RSIs used for orthopaedic surgery.
New flexible medullary reamers and depth gauges were contaminated by soaking in tryptone soya broth, containing 5% sheep blood and 109 cfu/mL of Staphylococcus aureus (ATCC 25923), for 5 min. To mimic a worse-case scenario, RSIs were dried 7 h and subjected to either (a) rinsing in distilled water, (b) manual cleaning or (c) manual plus automated cleaning (reference standard), and steam sterilization. The contamination, cleaning, and sterilization cycle was repeated 20 times. Adenosine triphosphate (ATP) was measured after cleaning procedures; microbial load and residual protein were measured following the 10th and 20th reprocessing, in triplicate. Scanning electron microscopy (SEM) was used to confirm soil and biofilm presence on the RSIs after the 20th reprocessing.
Manual and manual plus automated cleaning significantly reduced the amount of ATP and protein residues for all RSIs. Viable bacteria were not detected following sterilization. However, SEM detected soil after automated cleaning, and soil, including biofilms, after manual cleaning.
Soil and/or biofilms were evident on complex-design RSIs following 20 cycles of contamination and reprocessing, even using the reference standard method of cleaning. Although the depth gauges could be disassembled, biological residues and biofilm accumulated in its lumen. The current design of these RSIs prevents removal of all biological soil and this may have an adverse effect on patient outcome.
•DnaK-induced polarization of macrophages depends not only on IL-10 production, but also on IL-10 receptor signaling.•DnaK induces TGF-β mRNA transcription, but not translation, in macrophages in ...vitro.•Tgfb1 mRNA transcription induced by DnaK in macrophages is dependent on IL-10.•DnaK-polarized macrophages effect on allograft tumor growth in vivo depends on IL-10.
Macrophages are key cells in the innate immune system. They phagocytose pathogens and cellular debris, promote inflammation, and have important roles in tumor immunity. Depending on the microenvironment, macrophages can polarize to M1 (inflammatory) or M2 (anti-inflammatory) phenotypes. Extracellular DnaK (the bacterial ortholog of the mammalian Hsp70) from Mycobacterium tuberculosis (Mtb) was described to exert immune modulatory roles in an IL-10 dependent manner. We have previously observed that endotoxin-free DnaK can polarize macrophages to an M2-like phenotype. However, the mechanisms that underlie this polarization need to be further investigated. IL-10 has been described to promote macrophage polarization, so we investigated the involvement of this cytokine in macrophages stimulated with extracellular DnaK. IL-10 was required to induce the expression of M2 markers - Ym1 and Fizz, when macrophages were treated with DnaK. Blockade of IL-10R also impaired DnaK induced polarization, demonstrating the requirement of the IL-10/IL-10R signaling pathway in this polarization. DnaK was able to induce TGF-β mRNA in treated macrophages in an IL-10 dependent manner. However, protein TGF-β could not be detected in culture supernatants. Finally, using an in vivo allogeneic melanoma model, we observed that DnaK-treated macrophages can promote tumor growth in an IL-10-dependent manner. Our results indicate that the IL-10/IL-10R axis is required for DnaK-induced M2-like polarization in murine macrophages.
The skin of amphibians is widely exploited as rich sources of membrane active peptides that differ in chain size, polypeptide net charge, secondary structure, target selectivity and toxicity. In this ...study, two small antimicrobial peptides, temporin-Ra and temporin-Rb, originally isolated from the skin of the European marsh frog (
Rana ridibunda
), described as active against pathogen bacteria and presenting low toxicity to eukaryotic cells were synthesized and had their physicochemical properties and mechanism of action investigated. The temporin peptides were examined in aqueous solution and in the presence of membrane models (lipid monolayers, micelles, lipid bilayers and vesicles). A combined approach of bioinformatics analyses, biological activity assays, surface pressure measurements, synchrotron radiation circular dichroism spectroscopy, and oriented circular dichroism spectroscopy were employed. Both peptides were able to adsorb at a lipid-air interface with a negative surface charge density, and efficiently disturb the lipid surface packing. A disorder-to-helix transition was observed on the secondary structure of both peptides when either in a non-polar environment or interacting with model membranes containing a negative net charge density. The binding of both temporin-Ra and temporin-Rb to membrane models is modulated by the presence of negatively charged lipids in the membrane. The amphipathic helix induced in temporin-Ra is oriented parallel to the membrane surface in negatively charged or in zwitterionic lipid bilayers, with no tendency for realignment after binding. Temporin-Rb, instead, assumes a β-sheet conformation when deposited into oriented stacked lipid bilayers. Due to their short size and simple composition, both peptides are quite attractive for the development of new classes of peptide-based anti-infective drugs.
Introduction
Animal hoarding is characterized by hoarding of a large number of animals without providing minimum conditions of nutrition and sanitation, accompanied by lack of insight for the ...behavior and by social isolation. Despite studies detecting an increasing incidence, the behavior is still poorly understood.
Objectives
To review clinical evidence on animal hoarding and to report a clinical case.
Methods
We report a clinical case based on patient’s history and clinical data, along with a review of the literature on animal hoarding. The terms “Noah syndrome” and “animal hoarding disorder” were searched on PubMed® database.
Results
We present the case of a 51-years-old woman, living alone, with higher education. His first contact with psychiatry was in August 2019 upon aggravated self-neglect and behavioral disorganization. She was living with around 40 cats, her home was extremely deteriorated. In December 2019 she was admitted to a psychiatric unit. A schizophrenia diagnosis was established and pharmacological treatment was initiated. She was discharged to a chronic psychiatric institution. Studies found out that animal hoarders are typically middle age/older women living alone in squalid conditions. Animal hoarding is characterized by a chronic course and intense emotional attachment to animals. It seems to be associated with traumatic situations, as well as mental disorders such as schizophrenia or dementia. Published data on intervention and treatment is still limited.
Conclusions
Animal hoarding phenomenon requires further investigation, regarding developmental risk factors and co-morbid mental disorders. Comprehensive approaches to clinical intervention and management strategies in animal hoarding are necessary.
Improvement of sensory strategies is a relevant part of balance rehabilitation in multiple sclerosis (MS). This study aimed to Assess the effectiveness of visual-feedback exercises in improving ...balance in MS. We divided 36 patients into Wii and control-treated groups that underwent balance rehabilitation. Outcomes were obtained for Berg Balance Scale (BBS), Modified Fatigue Impact Scale, and sway area under conditions of opened and closed eyes. BBS showed a statistically significant improvement (from 49.6 to 54.6 points, p < 0.05) in the Wii group. Interactive visual-feedback exercises such as Wii could be more effective than the current standard protocol in improving balance disorders in MS.
Background Although EUS-guided cyst-gastrostomy is increasingly being performed, there are no studies that compare the clinical outcomes and cost-effectiveness with surgical cyst-gastrostomy. ...Objectives To compare the clinical outcomes of EUS-guided cyst-gastrostomy with surgical cyst-gastrostomy for the management of patients with uncomplicated pancreatic pseudocysts and to perform a cost analysis of each treatment modality. Design A retrospective case-controlled study. Setting A tertiary-referral center. Patients Consecutive patients with uncomplicated pancreatic pseudocysts managed by surgical and EUS-guided cyst-gastrostomy. Methods An independent observer blinded to all clinic outcomes matched each patient who underwent a surgical cyst-gastrostomy with 2 patients who underwent an EUS-guided cyst-gastrostomy for age, etiology of pancreatitis, and the size of the pseudocyst. Main Outcome Measurements Rates of treatment success, complications, and reinterventions; length of postprocedure hospital stay; and cost associated with each treatment modality. Results Ten patients (6 men; mean age 42.3 years, range 22-65 years) who underwent surgical cyst-gastrostomy were matched with 20 patients who underwent an EUS-guided cyst-gastrostomy. There were no significant differences in demographics, major comorbidities, and clinical characteristics between both cohorts. Although there were no significant differences in rates of treatment success (100% vs 95%, P = .36), procedural complications (none in either cohort), or reinterventions (10% vs 0%, P = .13) between surgery versus an EUS-guided cyst-gastrostomy, the mean length of a postprocedure hospital stay for an EUS-guided cyst-gastrostomy was significantly shorter than for surgical cyst-gastrostomy (2.65 vs 6.5 days, P = .008). The average direct cost per case for EUS-guided cyst-gastrostomy was significantly less when compared with surgical cyst-gastrostomy ($9077 vs $14,815, P = .01), which corresponded to a cost savings of $5738 per patient. Limitations Retrospective, nonrandomized design; patients with pancreatic abscess or necrosis were not evaluated; a limited sample size and a short duration of follow-up. Conclusions EUS-guided cyst-gastrostomy should be considered as a first-line treatment approach for patients with uncomplicated pancreatic pseudocysts, because the procedure is cost saving and is associated with a shorter length of a postprocedure hospital stay when compared with surgical cyst-gastrostomy. There was no significant difference in clinical outcomes between both treatment modalities.
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Transparent, flexible and conductive thin films of reduced graphene oxide or different types of carbon nanotubes have been prepared through the liquid-liquid interfacial method, and ...deposited over two different substrates, glass or polyethylene terephthalate (PET). Sheet resistance, morphology, transmittance and electrochemical measurements of the films have been evaluated in order to verify potential application as transparent electrodes. The effect of the amount of carbon nanostructures on the properties of the films, as well as the effect of the annealing treatment at different temperatures, has been also evaluated. Results shown that all films can be successfully used as electrodes, presenting optimized sheet resistances ranging from 1.7 to 50kΩ/□ and transmittances at 550nm up to 85 %. Flexible and transparent electrodes presenting high stability have been obtained by the carbon nanostructure films deposited over PET. A modification of the electrodes has been demonstrated, through an electropolymerization of aniline, confirming the potential for further application as flexible devices.
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