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Differential diagnosis of cognitive dysfunction in a multi-morbid patient
- S. Luna, S. González, R. J. Cortés, O. Kawas
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S996-S997
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Introduction
Patients with systemic lupus erythematosus (SLE) have cognitive dysfunctions as a neuropsychiatric manifestation, associated with disabling symptoms. However, the presence of other medical or psychiatric comorbidities can delay or lead to a misdiagnose.
ObjectivesTo present a case of a patient with diagnostic difficulty in the face of multiple medical and neurocognitive comorbidities.
MethodsDescription of a case report.
Results19-year-old female, Mexican, unemployed, with incomplete high school, with medical history of preterm birth by cesarean at 30 weeks due to placenta previa, history of early puberty, 4 years evolution of focal epilepsy, 1 year evolution of hypothyroidism and mild depression.
She began her symptoms 4 years ago, characterized by an abrupt onset of memory disturbances, decreased concentration, poor academic performance, infantile behavior, need for affection, alternated with irritability periods, verbal and physical aggression, repetitive and erratic behavior. She went to multiple specialists with different therapeutic approaches without clinical improvement. In 2020, she was referred to our service for evaluation, evidenciating a mild depressive episode and psychotherapeutic treatment was started.
Mental and neurological examination without alterations, normal vital signs, at physical examination: malar rash, oral ulcers, alopecia. Labs: increased erythrocyte sedimentation rate, normocytic anemia, leukopenia, rest normal. An electroencephalogram was requested, without alterations. Simple brain MRI was performed (Figure 1).
Psychological (figure 2) and Neuropsychological tests (table 1) were performed, showing alterations in memory recall and inhibitory control.
Due to the symptoms presented by the patient, SLE was suspected, and rheumatology evaluation was requested, integrating a diagnosis of incomplete SLE, and started treatment. The patient presented symptomatic improvement in cognitive symptoms and systemic signs. Likewise, a genetic evaluation was requested, without meeting the criteria for a genetic syndrome. The patient continues with symptomatic improvement and multidisciplinary treatment.
Total scores Natural Normalized Diagnosis Orbitomedial 180 83 Mild alteration Pref-Anterior 22 106 Normal Dorsolateral 207 88 Normal BANFE total 409 104 Normal Image:
Image 2:
ConclusionsNeurocognitive alterations are one of the most frequent manifestations of neurolupus, although its diagnosis and treatment may be delayed in the absence of clinical suspicion, mainly in multi-comorbid patients.
In the case, the patient presented multiple diseases that can explain a picture of neurocognitive impairment, such as epilepsy, depression, hypothyroidism. However, in these cases, a multidisciplinary approach is imperative, requiring to rule out the different causes of the patient’s symptoms.
Disclosure of InterestNone Declared
Review: Are there indigenous Saccharomyces in the digestive tract of livestock animal species? Implications for health, nutrition and productivity traits
- J. F. Garcia-Mazcorro, S. L. Ishaq, M. V. Rodriguez-Herrera, C. A. Garcia-Hernandez, J. R. Kawas, T. G. Nagaraja
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All livestock animal species harbour complex microbial communities throughout their digestive tract that support vital biochemical processes, thus sustaining health and productivity. In part as a consequence of the strong and ancient alliance between the host and its associated microbes, the gut microbiota is also closely related to productivity traits such as feed efficiency. This phenomenon can help researchers and producers develop new and more effective microbiome-based interventions using probiotics, also known as direct-fed microbials (DFMs), in Animal Science. Here, we focus on one type of such beneficial microorganisms, the yeast Saccharomyces. Saccharomyces is one of the most widely used microorganisms as a DFM in livestock operations. Numerous studies have investigated the effects of dietary supplementation with different species, strains and doses of Saccharomyces (mostly Saccharomyces cerevisiae) on gut microbial ecology, health, nutrition and productivity traits of several livestock species. However, the possible existence of Saccharomyces which are indigenous to the animals’ digestive tract has received little attention and has never been the subject of a review. We for the first time provide a comprehensive review, with the objective of shedding light into the possible existence of indigenous Saccharomyces of the digestive tract of livestock. Saccharomyces cerevisiae is a nomadic yeast able to survive in a broad range of environments including soil, grass and silages. Therefore, it is very likely that cattle and other animals have been in direct contact with this and other types of Saccharomyces throughout their entire existence. However, to date, the majority of animal scientists seem to agree that the presence of Saccharomyces in any section of the gut only reflects dietary contamination; in other words, these are foreign organisms that are only transiently present in the gut. Importantly, this belief (i.e. that Saccharomyces come solely from the diet) is often not well grounded and does not necessarily hold for all the many other groups of microbes in the gut. In addition to summarizing the current body of literature involving Saccharomyces in the digestive tract, we discuss whether the beneficial effects associated with the consumption of Saccharomyces may be related to its foreign origin, though this concept may not necessarily satisfy the theories that have been proposed to explain probiotic efficacy in vivo. This novel review may prove useful for biomedical scientists and others wishing to improve health and productivity using Saccharomyces and other beneficial microorganisms.
Contributors
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- By Farook Al-Azzawi, Wita Angrianni, Sanjay Asthana, Stephan Bandelow, Kathryn J. Bryan, Cynthia M. Carlsson, Jenna C. Carroll, Gemma Casadesus, Monique M. Cherrier, Laura H. Coker, María M. Corrada, Vita Priantina Dewi, Roberta Diaz Brinton, Mark A. Espeland, Mirjam I. Geerlings, Robert B. Gibbs, Carey E. Gleason, Victor W. Henderson, Patricia E. Hogan, Eef Hogervorst, Claudia H. Kawas, Anna Khaylis, Philip Kreager, Linda Kushandy, Donald Lehmann, Jin Li, Mary E. McAsey, Pauline M. Maki, Ralph N. Martins, Scott D. Moffat, Majon Muller, Theresia Ninuk, Annlia Paganini-Hill, George Perry, Christian J. Pike, Bevin N. Powers, Tri Budi W. Rahardjo, Natalie L. Rasgon, Susan M. Resnick, Emily R. Rosario, Sabarinah, Tony Sadjimim, Barbara B. Sherwin, Sally A. Shumaker, Mark A. Smith, Robert G. Struble, Chris Talbot, Wulf H. Utian, Giuseppe Verdile, Robert B. Wallace, Whitney Wharton, Katherine E. Williams, Oliver T. Wolf, Tonita E. Wroolie, Amina Yesufu, Yudarini, Liqin Zhao
- Edited by Eef Hogervorst, Loughborough University, Victor W. Henderson, Stanford University, California, Robert B. Gibbs, University of Pittsburgh, Roberta Diaz Brinton, University of Southern California
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- Book:
- Hormones, Cognition and Dementia
- Published online:
- 06 July 2010
- Print publication:
- 24 September 2009, pp vii-x
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