Acute Psychosis and COVID-19 Infection: Psychiatric Symptoms in Hospitalized Patients.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in various medical and psychosocial consequences globally. Respiratory infections are common among patients infected with the SARS-CoV-2 virus, the causative virus of coronavirus disease 2019 (COVID-19). However, various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported as well.  This study aimed to describe two clinical case reports of patients with no prior history of psychiatric illnesses admitted to the psychiatric inpatient unit with acute onset of psychosis. A 49-year-old woman with no past medical history and no past psychiatric history was admitted to the inpatient psychiatric unit with suicidal ideation and was noted to have acute psychosis. A 56-year-old woman with a history of hypertension with no past psychiatric history was admitted to the hospital with acute hypoxic respiratory failure secondary to COVID-19 pneumonia and was noted to have acute psychosis.  Various psychiatric and neurocognitive symptoms and sequelae of COVID-19 have been reported. However, the pathophysiology, direct biological effects of the disease, treatment modalities, worsening of symptoms due to various medications, and other long-term sequelae are not fully understood. Therefore, clinicians should be mindful of neuropsychiatric symptoms and conduct a detailed history and physical examination on all patients presenting with psychiatric symptoms in the context of COVID-19. It is also essential to assess for signs and symptoms of delirium in patients presenting with neuropsychiatric symptoms. Further research is needed to identify the etiology, predisposing factors, exacerbating or precipitating factors contributing to neuropsychiatric symptoms associated with infection with the SARS-CoV-2 virus. In addition, the pathophysiology contributing to these symptoms and pharmacological interventions for managing these sequelae need to be evaluated.

Clinical Characteristics and Diagnostic Challenges of COVID-19: An Update From the Global Perspective.

Clinical characteristics are essential for the correct diagnosis of diseases. The current review aimed to summarize the global clinical characteristics of the COVID-19 patients systematically and identify their diagnostic challenges to help the medical practitioners properly diagnose and for better management of COVID-19 patients. We conducted a systematic search in PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases for original articles containing clinical information of COVID-19 published up to 7th May 2020. Two researchers independently searched the databases to extract eligible articles. A total of 34 studies from 8 different countries with 10889 case-patients were included for clinical characteristics. The most common clinical symptoms were cough 59.6, fever 46.9, fatigue 27.8, and dyspnea 20.23%. The prominent laboratory findings were lymphocytopenia 55.9, elevated levels of CRP 61.9, aspartate aminotransferase 53.3, LDH 40.8, ESR 72.99, serum ferritin 63, IL-6 52, and prothrombin time 35.47%, and decreased levels of platelets 17.26, eosinophils 59.0, hemoglobin 29, and albumin 38.4%. CT scan of the chest showed an abnormality in 93.50% cases with bilateral lungs 71.1%, ground-glass opacity 48%, lesion in lungs 78.3%, and enlargement of lymph node 50.7%. Common comorbidities were hypertension, diabetes, obesity, and cardiovascular diseases. The estimated median incubation period was 5.36 days, and the overall case fatality rate was 16.9% (Global case fatality outside China was 22.24%: USA 21.24%, Italy 25.61%, and others 0%; whereas the case fatality inside the Hubei Province of China was found to be 11.71%). Global features on the clinical characteristics of COVID-19 obtained from laboratory tests and CT scan results will provide useful information to the physicians to diagnose the disease and for better management of the patients as well as to address the diagnostic challenges to control the infection.

Renal Cortical Necrosis; Five Consecutive Cases within Short Span of Time.

Renal cortical necrosis (RCN) is characterized by patchy or diffuse destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. It is a rare cause of acute kidney injury (AKI) in developed countries with frequency of 1.9%-2% of all patients of AKI. In contrast, the incidence of RCN is higher in developing countries ranging from 6%-7%. Obstetric complication is the main cause of RCN, earlier it was about 20%-30% which has been declining to 5% in the Indian subcontinent during the past two decades. The aim of this study is to review five consecutive cases of RCN diagnosed within very short span of time. Histopathologically, diagnosed five cases of RCN during one-month span in September 2016 at Armed Forces Institute of Pathology, Dhaka were included in this study. All the cases were referred cases from a tertiary level obstetric center of Dhaka city; the mean age was 24.2 ± 3.4 years. All the cases had the history of postpartum hemorrhage followed by septicemia. They all presented with acute renal failure dependent on hemodialysis for >21 days. On histological examination, three (60%) had patchy RCN and two (40%) had diffuse RCN. Two (40%) showed coagulative necrosis of all the glomeruli, two (40%) showed coagulative necrosis of >50% of glomeruli, and in one (20%) case necrosis of about 25% of glomeruli. One of the glomeruli showed global sclerotic change of most of the glomeruli. In all the cases, interstitium showed moderate focal lymphocytic infiltration and mild edema. Among all, one (20%) was found with immunoglobulin A nephropathy as an associated diagnosis. RCN is still encountered as an obstetric complication in our setting and this type of grave consequences should be prevented by better monitoring of pregnancies.

Histomorphological pattern of renal biopsy in Dhaka: A single center study.

Renal biopsy is a useful procedure to understand the histological pattern of renal disease. We present the histomorphological characteristics of renal biopsy specimen received at histopathology department, Armed Forces Institute of Pathology, Dhaka received during July 2015 to December 2015 for six months period was included in the study.

Validation of rapid neurodevelopmental assessment instrument for under-two-year-old children in Bangladesh.

OBJECTIVE: The objective of this study was to determine the reliability and validity of a comprehensive assessment procedure for ascertaining neurodevelopmental status of children aged 0 to 24 months for use by multidisciplinary professionals in a developing country. METHODS: We developed the Rapid Neurodevelopmental Assessment (RNDA) to determine functional status in the following domains: primitive reflexes, gross motor, fine motor, vision, hearing, speech, cognition, behavior, and seizures. Reliability was determined for 50 children who were aged <3 months and 30 children who were aged > or =3 to 24 months and were administered the RNDA by 8 different professionals (3 physicians, 4 therapists, and 1 special teacher). Validity was determined on 34 children aged <3 months in hospital and 81 children aged > or =3 to 24 months in urban (n = 47) and rural (n = 34) community-based populations by any 1 of the 8 professionals, with simultaneous administration of the adapted Bayley Scales of Infant Development II by a psychologist as the gold standard. RESULTS: Mean kappa coefficients of agreement among professionals in overall and individual domains in the 2 age groups ranged from good to excellent. For both younger and older children, there was good concurrent validity (ie, significantly lower mean Mental Development Index and Psychomotor Development Index scores) for children with > or =1 neurodevelopmental impairment and for children with impairments in most functional domains, compared with children with no impairments. Significantly more impairments were found in children from disadvantaged compared with socioeconomically more advantaged communities, indicating good discriminant validity. CONCLUSIONS: The RNDA can be used by professionals from a range of backgrounds with high reliability and validity for determining functional status of children who are younger than 2 years. The study findings have important practical implications for early identification and intervention to mitigate neurodevelopmental impairments in large populations that live in developing countries where professional expertise is sparse.

Construct validity of the Motivated Strategies for Learning Questionnaire.

This study examined the construct validity of the motivational component of the Motivated Strategies for Learning Questionnaire using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). 327 students enrolled in Bachelor of Education and Graduate Diploma Education courses at the University of Auckland participated in this study (278 women, 49 men). The results of the EFA did not generate support for either a six-factor or three-factor model. The CFA tested a six-factor correlated original model and a respecified model and found a good fit for the respecified model and a better fit of the original 31-item model in comparison with previous studies. In addition, alternative second-order and hierarchical models were tested, none of which showed better fit than the six-factor correlated models. The reasons for the lack of fit of the original model are discussed in light of nonnormality condition, specification error, and latent variables. Finally, possible explanations for the slight variation in patterns of subscale correlations are discussed.

Bioterror, agroterror, and new diseases.

As research techniques and biotechnology advance, the risk for potential bioterrorism increases due to the ease of creating or modifying virulent pathogenic microorganisms. In addition, the destruction of natural habitats to a range of animals and microbial species that are normally sequestered in these areas may bring forth new diseases to humans.

Treatment of viral and neoplastic diseases with double-stranded RNA derivatives and other new agents.

Many attempts have been made to inhibit viral and neoplastic diseases by targeting the RNA system. The pathophysiologic significance of the microRNA system and the therapeutic potential of its manipulation are discussed. Studies of double-stranded RNA derivatives are reviewed. The therapeutic potential of one of these compounds, polyI:MPC, is emphasized. Studies of other related antiviral and antineoplastic agents are discussed, including 2'-deoxyoligocytidilates and telomerase inhibitors.

Studies on splenic population size feedback control regulatory mechanisms.

In previous studies, experimental splenosis was produced in normal rodents and in animals following splenectomy. Splenosis was more in splenectomised than in normal animals. In the present study, in animals into whom splenic fragments were implanted subcutaneously, there were less peritoneal splenic growth areas than in controls. The hypothesis is presented that there is a population size feedback control regulatory mechanism operating in splenic growth and regeneration. If such regulators are present in the circulation, administration of normal plasma should inhibit splenosis and this may serve as a model to isolate such regulators. This was not the case in these experiments.

Studies on the radioprotective effect of etiocholanolone.

One-hundred forty male mice of an inbred strain (C3H/St) were divided into four groups of thirty-five each and were given total body irradiation of 750 cGy. After X-irradiation, one group was given etiocholanolone alone, the other was given bone marrow alone, a third was given both of these. One group was used as a control and was given no treatment after irradiation. The bone marrow used was obtained from the same inbred strain of mice. The most remarkable hematologic recovery was seen in the group which was given both etiocholanolone and bone marrow. The groups given only etiocholanolone or only bone marrow recovered better than the control group. Overall survival was best for the group receiving both modes of treatment and worst for the control group. Survival for the groups receiving a single mode of treatment lay in between the other two mentioned above.

Breast cancer in intraductal carcinogen-treated non-human primates.

Eight female Macaca arctoides monkeys were given dimethylbenzanthracene (DMBA) directly into the milk ducts. During a 4-year observation period, ending with euthanasia and autopsy, no mammary cancers were noticed. However, one animal developed a superficial localized squamous cell carcinoma. DMBA is highly carcinogenic in rodents, e.g. producing a high incidence of breast cancer in C3H mice. It was concluded that carcinogenicity testing should be extended beyond testing in rodents to non-human primates in order to distinguish "primary rodent carcinogens" from those highly active in primates as well. Studies are in progress to study carcinogens in human cell lines transplanted into nu/nu mice.

Free interferon-alpha/beta receptors in the circulation of patients with adenocarcinoma.

BACKGROUND: Many viral and neoplastic diseases are resistant to interferon-alpha/beta (IFN-alpha/beta) therapy or develop resistance during the course of IFN treatment. In patients with viral diseases, the authors identified four IFN inhibitors, of which the most important, most likely is a free IFN receptor of type 1 appearing in the circulation that captures and neutralizes IFN-alpha/beta. METHODS: Ninety-one cancer patients and 25 healthy individuals were studied. Free circulating IFN receptor-alpha/beta type 1 was studied. The patients were ages 35-75 years. The diagnoses were 24 cases of colon carcinoma, 7 cases of prostate carcinoma, 16 cases of breast carcinoma, 8 cases of ovarian carcinoma, 9 cases of uterine carcinoma, 5 cases of lung carcinoma, 3 cases of astrocytoma, 4 cases of transitional cell carcinoma of the bladder, 1 case of osteosarcoma, 3 cases of multiple myeloma, 4 cases of Hodgkin disease, 2 cases of non-Hodgkin lymphoma, 3 cases of myelodysplastic syndrome, and 2 disseminated tumors of unknown origin. RESULTS: All patients were found to have increased free IFN receptor-alpha/beta type 1 in the circulation, with the highest levels reported in patients with adenocarcinoma. CONCLUSIONS: High IFN inhibitory activity in patients with cancer may be a significant factor in their increased susceptibility to progressive disease, infectious complications, and resistance to IFN therapy. Ongoing studies are being performed with the objective of overcoming this inhibitory activity.