Therapeutic Potential of Buprenorphine in Depression: A Meta-Analysis of Current Evidence.

Background: Emerging research indicates buprenorphine, used in management of opioid use disorder, has attracted interest for its potential in treating a variety of psychiatric conditions. This meta-analysis aimed to determine the efficacy of buprenorphine in treating symptoms of depression. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a search was conducted of several databases until April 25, 2022, for English language articles related to buprenorphine and its use in treating various mental health conditions. Standardized mean differences (SMDs) and its 95% confidence intervals (CIs) were reported for the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS) scores. Statistical analyses were performed using Cochrane RevMan 5. Results: Of the 1,347 identified studies, six clinical trials were included. MADRS-10 least square mean difference (LSMD) inter-group assessment favored buprenorphine over placebo, but it lacked statistical significance. Similarly, MADRS scores as well as HAM-D inter-group assessment were in favor of buprenorphine, however, were not statistically significant. These findings suggest a potential therapeutic role for buprenorphine in treating depression, albeit with caution due to the observed lack of statistical significance and the potential for confounding factors. Conclusions: Preliminary evidence suggests potential efficacy of buprenorphine at lower doses in improving improving outcomes specifically related to depression. However, due to limitations in statistical significance and possible confounding factors, entail cautious interpretation. Further rigorous research is needed to investigate the long-term effects, optimal dosing, and determine the role of adjuvant drug therapy.

Wilson's Disease Manifestation in Late Adulthood: A Case Report and Literature Review.

Wilson's disease is a rare inherited condition that results in an excessive copper buildup in various organs, especially the liver, brain, and other vital organs, leading to cirrhosis, liver failure, neurological problems like involuntary movements, clumsy gait, speech difficulties, and psychological issues, in addition to other symptoms. It is an ATP7B gene mutation-driven autosomal recessive condition. Although the condition is present from birth, symptoms often start to show up between the ages of five and 35, when the body has accumulated enough copper. Wilson's disease may become fatal if an excessive amount of copper is accumulated in the body. It is treatable and has a good prognosis if diagnosed early. Early identification, however, is not always straightforward since symptoms might resemble those of other diseases and develop later in life when copper is absorbed by food and drink and gradually accumulates in the body's many organs. In addition to medicine, physicians advise people with Wilson's disease to avoid foods and beverages containing copper. Our patient was diagnosed with Wilson's disease at the age of 16 and was on Cuprimine which helped her to survive. Her younger sister was diagnosed at an early age and was started on a treatment regimen, which is why her sister's manifestation of Wilson's disease was less severe than hers.

Cerebral Malaria Presenting With Shock in an Adolescent: A Case Report.

Cerebral malaria (CM) is a severe infection of the brain caused by the parasite Plasmodium falciparum. It is commonly found as a complication of infection traveling to the brain. CM has a poor prognosis unless promptly identified and treated. This case report describes a 15-year-old girl who suddenly started experiencing a tonic-clonic seizure while playing. At the time of arrival at the emergency department, her vital signs were consistent with shock. She had hepatomegaly on physical examination, a hallmark of malarial infection due to an immune response against the proliferation of the protozoa. Peripheral blood smear for malaria parasites was positive for P. falciparum and P. vivax. The patient was started on intravenous (IV) saline, IV phenytoin, and IV metoclopramide. She was also transfused with two units of packed red blood cells. The patient was subsequently diagnosed with CM. For most patients, the course of treatment includes aggressive therapy with anti-malarial medications. She was started on broad-spectrum antibiotics and anti-malarial medications. Following two weeks of treatment, her condition improved significantly and she was discharged.

Li-Fraumeni Syndrome: A Rare Genetic Disorder.

Li-Fraumeni syndrome (LFS) is an inherited genetic condition that makes individuals predisposed to specific types of cancer. As a result, cancer risk can be passed down from generation to generation. TP53 is the genetic blueprint for a protein called p53 and most commonly causes this condition by mutations or alterations in that gene. Mutations prevent the gene from functioning properly. LFS is associated with TP53 gene mutations in approximately 70% of families. Most patients with LFS have one normal copy of TP53 and one mutated copy of TP53, usually inherited from a parent with the condition. This is a case report of a 40-year-old female who underwent genetic testing to determine her p53 mutation status. Her mother was diagnosed with breast cancer at a young age, despite the fact that her brothers and sisters' genetic tests came out normal. The genetic testing showed her as a carrier for the TP53 gene mutation. Despite the fact that she had no signs or symptoms of any linked tumors associated with the condition, she was diagnosed with LFS.

Culture-Negative Emphysematous Pyelonephritis as a Complication of Uncontrolled Diabetes Mellitus: A Case Report.

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma. It is commonly found as a complication of uncontrolled diabetes mellitus (DM). EPN has a terrible prognosis unless promptly identified and treated. In this case study, a 38-year-old man with type 2 diabetes mellitus (T2DM) was admitted due to complaints of excruciating abdominal pain, vomiting, and non-adherent to his insulin medication. The patient was subsequently diagnosed with EPN. For most patients, the current course of treatment includes nephrectomy along with antimicrobial medications. In this case report, however, the patient improved with conservative treatment such as IV fluids, antibiotics, and blood glucose control.

Ocular Migraine With Amaurosis Fugax of the Left Eye: A Case Report.

In amaurosis fugax, there is a sudden loss of vision in one eye. Patients gain their vision after a few minutes. The most common underlying cause is atherosclerosis of the internal carotid artery. Other underlying causes include vasospasm of the internal carotid artery, which leads to hypoperfusion and is seen in vasculitis, ocular migraines, and systemic lupus erythematosus. In this case study, a 44-year-old male with a past medical history of migraine with aura presented to the emergency room with transient vision loss in the left eye, which lasted for two minutes. A computed tomography scan of the brain was negative for stroke. The patient was treated with intravenous fluid, aspirin, and enoxaparin sodium and instructed to follow up with neurology. A medical emergency such as amaurosis fugax caused by ocular migraine must be managed aggressively, and prompt imaging is necessary to exclude other causes.

Risk of Suicide in Patients With Bipolar Disorder Having Comorbid Chronic Pain Disorders: Insights From the Nationwide Inpatient Sample Data From 2016 to 2018.

ABSTRACT: Bipolar disorders (BDs) are associated with significant risk of suicide. BD patients (age ≥18 years) admitted to the hospital were identified from the National Inpatient Sample dataset. Based on the secondary diagnosis of chronic pain disorder (CPD), patients were stratified into two groups (1) BD with CPD (BD + CPD) and (2) BD without CPD (BD - CPD). Groups were matched (1:1) for the type of BD and compared for baseline characteristics and suicidal ideation/attempt (SI/SA). Compared with BD - CPD, most patients in the BD + CPD group were older (mean age, 47.6 vs. 40.4 years), female (58.4% vs. 55.2%), and white (77.2% vs. 66.7%). After adjusting for covariates, compared with the BD - CPD group, the BD + CPD group had 21% more risk of SI/SA (odds ratio, 1.21, p < 0.001). CPD is independently associated with the increased risk of suicide among patients with BD. Thus, comorbid CPD among patients admitted for BD can be an essential risk factor for suicide.

The Association of Psychological Stressors With Cannabis Use During Pregnancy: Findings From the National Survey on Drug Use and Health 2017-2019.

ABSTRACT: Even though marijuana is illegal on the federal level, it is one of the most used drugs in the United States during pregnancy. Our study investigates the relationship between numerous socioeconomic, demographic, and mental health risk variables and substance use during pregnancy. We examined data from the National Survey on Drug Use and Health from 2017 to 2019. Compared with the no serious psychological distress (SPD) group, the odds of using cannabis were higher in pregnant women with past-month SPD. In this study, in comparison with unmarried pregnant women, married pregnant women had a 67% lower chance of currently using cannabis. Racially, Hispanic pregnant women had 3 to 4 times higher odds for current use of cannabis as compared with the other races. Preventing cannabis use and its adverse effects by screening pregnant women could be part of the current strategy for reducing cannabis use.