Investigation of brain iron in anorexia nervosa, a quantitative susceptibility mapping study.

BACKGROUND: Anorexia nervosa (AN) is a potentially fatal psychiatric condition, associated with structural brain changes such as gray matter volume loss. The pathophysiological mechanisms for these changes are not yet fully understood. Iron is a crucial element in the development and function of the brain. Considering the systemic alterations in iron homeostasis in AN, we hypothesized that brain iron would be altered as a possible factor associated with structural brain changes in AN. METHODS: In this study, we used quantitative susceptibility mapping (QSM) magnetic resonance imaging to investigate brain iron in current AN (c-AN) and weight-restored AN compared with healthy individuals. Whole-brain voxel wise comparison was used to probe areas with possible group differences. Further, the thalamus, caudate nucleus, putamen, nucleus accumbens, hippocampus, and amygdala were selected as the regions of interest (ROIs) for ROI-based comparison of mean QSM values. RESULTS: Whole-brain voxel-wise and ROI-based comparison of QSM did not reveal any differences between groups. Exploratory analyses revealed a correlation between higher regional QSM (higher iron) and lower body mass index, higher illness severity, longer illness duration, and younger age at onset in the c-AN group. CONCLUSIONS: This study did not find evidence of altered brain iron in AN compared to healthy individuals. However, the correlations between clinical variables and QSM suggest a link between brain iron and weight status or biological processes in AN, which warrants further investigation.

In Vivo 7-Tesla MRI Investigation of Brain Iron and Its Metabolic Correlates in Chronic Schizophrenia.

Brain iron is central to dopaminergic neurotransmission, a key component in schizophrenia pathology. Iron can also generate oxidative stress, which is one proposed mechanism for gray matter volume reduction in schizophrenia. The role of brain iron in schizophrenia and its potential link to oxidative stress has not been previously examined. In this study, we used 7-Tesla MRI quantitative susceptibility mapping (QSM), magnetic resonance spectroscopy (MRS), and structural T1 imaging in 12 individuals with chronic schizophrenia and 14 healthy age-matched controls. In schizophrenia, there were higher QSM values in bilateral putamen and higher concentrations of phosphocreatine and lactate in caudal anterior cingulate cortex (caCC). Network-based correlation analysis of QSM across corticostriatal pathways as well as the correlation between QSM, MRS, and volume, showed distinct patterns between groups. This study introduces increased iron in the putamen in schizophrenia in addition to network-wide disturbances of iron and metabolic status.

Impact of COVID-19 on Neuropsychiatric Disorders.

Since the Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many studies have shown that besides common COVID-19 symptoms, patients may develop various neuropsychiatric conditions including anxiety, mood disorders, psychosis, neurodegenerative diseases (e.g., dementia), insomnia, and even substance abuse disorders. COVID-19 can also worsen the patients underlying neuropsychiatric and neurodevelopmental conditions during or after the system phase of disease. In this review, we discuss the impact of SARS-CoV-2 infection on development or status of neuropsychiatric conditions during or following COVID-19.

Cerebrospinal fluid neurofilament light chain differentiates primary psychiatric disorders from rapidly progressive, Alzheimer's disease and frontotemporal disorders in clinical settings.

INTRODUCTION: Many patients with cognitive and neuropsychiatric symptoms face diagnostic delay and misdiagnosis. We investigated whether cerebrospinal fluid (CSF) neurofilament light (NfL) and total-tau (t-tau) could assist in the clinical scenario of differentiating neurodegenerative (ND) from psychiatric disorders (PSY), and rapidly progressive disorders. METHODS: Biomarkers were examined in patients from specialist services (ND and PSY) and a national Creutzfeldt-Jakob registry (Creutzfeldt-Jakob disease [CJD] and rapidly progressive dementias/atypically rapid variants of common ND, RapidND). RESULTS: A total of 498 participants were included: 197 ND, 67 PSY, 161 CJD, 48 RapidND, and 20 controls. NfL was elevated in ND compared to PSY and controls, with highest levels in CJD and RapidND. NfL distinguished ND from PSY with 95%/78% positive/negative predictive value, 92%/87% sensitivity/specificity, 91% accuracy. NfL outperformed t-tau in most real-life clinical diagnostic dilemma scenarios, except distinguishing CJD from RapidND. DISCUSSION: We demonstrated strong generalizable evidence for the diagnostic utility of CSF NfL in differentiating ND from psychiatric disorders, with high accuracy.

Systematic Review: Quantitative Susceptibility Mapping (QSM) of Brain Iron Profile in Neurodegenerative Diseases.

Iron has been increasingly implicated in the pathology of neurodegenerative diseases. In the past decade, development of the new magnetic resonance imaging technique, quantitative susceptibility mapping (QSM), has enabled for the more comprehensive investigation of iron distribution in the brain. The aim of this systematic review was to provide a synthesis of the findings from existing QSM studies in neurodegenerative diseases. We identified 80 records by searching MEDLINE, Embase, Scopus, and PsycInfo databases. The disorders investigated in these studies included Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, Wilson's disease, Huntington's disease, Friedreich's ataxia, spinocerebellar ataxia, Fabry disease, myotonic dystrophy, pantothenate-kinase-associated neurodegeneration, and mitochondrial membrane protein-associated neurodegeneration. As a general pattern, QSM revealed increased magnetic susceptibility (suggestive of increased iron content) in the brain regions associated with the pathology of each disorder, such as the amygdala and caudate nucleus in Alzheimer's disease, the substantia nigra in Parkinson's disease, motor cortex in amyotrophic lateral sclerosis, basal ganglia in Huntington's disease, and cerebellar dentate nucleus in Friedreich's ataxia. Furthermore, the increased magnetic susceptibility correlated with disease duration and severity of clinical features in some disorders. Although the number of studies is still limited in most of the neurodegenerative diseases, the existing evidence suggests that QSM can be a promising tool in the investigation of neurodegeneration.

Temperament and character in patients with systemic lupus erythematosus.

BACKGROUND: In addition to identified neuropsychiatric characteristic of systemic lupus erythematosus (SLE), changes in personality seem to occur in patients with SLE. Even in absence of an axis I psychiatric diagnosis, personality variations play important role in general wellbeing of these patients. This study investigated personality features in patients with SLE using Temperament and Character Inventory (TCI). METHOD: In this case-control study personality features of 59 patients with confirmed diagnosis of SLE were evaluated using Persian version of TCI-125 questionnaire. Collected data from patients with SLE were statistically compared with normative data for Iranian population. RESULTS: Among four subscales of temperament, reward dependence (RD) and harm-avoidance (HA) were significantly lower than general population. Self-directedness (SD) character dimension was significantly lower in SLE patients compared to normative data. No significant difference was noted in novelty-seeking (NS) and persistence (PS) temperament scales and cooperativeness (CO) and self-transcendence (ST) character scales. CONCLUSION: Personality changes in SLE is characterized by higher HA and RD along with low SD. These features are associated with higher anxiety, social withdrawal and lower resourcefulness and purposefulness.

Comparison of anti-mullerian hormone level in non-endometriotic benign ovarian cyst before and after laparoscopic cystectomy.

BACKGROUND: Benign ovarian cysts are common among both pre- and postmenstrual women. Surgical intervention for excision of an ovarian cyst is mandated when symptomatic, or chance for malignancy is high. The damaging effect of surgical ovarian cystectomy on ovarian reserve is debated in recent studies. OBJECTIVE: In the present study we investigated serum level of anti-mullerian hormone (AMH) as an indicator of ovarian reserve before and after surgical cystectomy. MATERIALS AND METHODS: 60 patients with dermoid cyst, serous cystadenoma, and mucinous cystadenoma were recruited. Measurement of serum AMH was performed prior to surgery, and at one and 3 months after laparoscopic cystectomy. Serum AMH levels were compared before and after the surgery and between various types of ovarian cyst. RESULTS: Serum AMH level declined significantly after the surgery which recovered to 65% of its baseline value three months later. CONCLUSION: Decreased serum AMH can be contributed to decreased ovarian reserve after laparoscopic ovarian cystectomy. This can result from thermo-coagulation used for hemostasis during the operation.

Determinants of Successful Non-Operative Management of Intra- Peritoneal Bleeding Following Blunt Abdominal Trauma.

OBJECTIVES:  To identify the  predictive factors of successful non-operative  management  of patients  with intraperitoneal bleeding following blunt abdominal trauma. METHODS: This was cross-sectional study being performed in our Level I trauma center in southern  Iran between 2010 and 2011. We included adult (>14 years) patients with blunt  abdominal trauma  and intra-peritoneal hemorrhage  detected by CT-Scan who were hemodynamically stable and did not  require any surgical intervention. Patients were managed conservatively in ICU. Those who required laparotomy during the study period were named as non-operative  management failure (NOM-F) while the other were non- operative management success (NOM-S). The baseline, clinical and laboratory characteristics were compared between two study groups in order to detect the predictors of successful NOM of intra-peritoneal bleeding. RESULTS: Overall we included 80 eligible patients among whom there were 55 (68.7%) men and 25 (31.3%) women with mean  age of 30.63.6± years. Finally, 43 (53.8%) were successfully managed conservatively (NOM-S) while 37 (46.2%) required laparotomy (NOM-F). We found that those who underwent emergency laparotomy had significantly higher EHb (p=0.016) and lower base deficit (p=0.005) when compared to those who were successfully managed conservatively. Those who required surgical intervention had significantly lower baseline systolic blood pressure (p<0.001) and higher shock index (p=0.002). The other parameters such as pulse rate and respiratory rate were comparable between two study groups. CONCLUSION: In patients with intra-peritoneal bleeding following blunt abdominal trauma, the most reliable predictive clinical and para-clinical factor of successful non-operative  management  are shock index and systolic blood pressure on arrival, base deficit and hemoglobin drop within first 12 hours of admission.

Profound Bradycardia following Patent Ductus Arteriosus Closure; A Rare but Correctable Event.

Proximity of the vagus nerve to  a patent  ductus  arteriosus (PDA) can cause traction  or  entrapment  of vagus nerve during surgical closure of the in rare occasions. This can lead to a life threatening postoperative bradycardia. Herein, we report a case of bradycardia caused by unexpected irritation of the vagal trunk by the end of operation. The patient was managed by re-opening the chest, lung retraction and removal of mediastinal pleura sutures. The vagal trunk entrapped in the suture line was released immediately. Heart rate accelerated and hemodynamic restored after a short period of observation. The operation terminated as routine, patient extubated in OR and discharged within 24 hours with no further complication. This irritation of vagus results in vagal bradycardia during or by the end of operation. Awareness of a surgeon of this issue can minimize the risks and complications of the open closure of PDA.