Drug-Induced Hyperprolactinemia and Hyponatremia - Biological Markers of Unfavorable Evolution in Schizophrenia

Adverse reactions to psychotropic medication can be considered as risk indicators for an unfavorable evolution of patients with schizophrenia, based on particular pathogenic mechanisms that can be used in the personalized therapeutic approach. The combination of antidepressants with antipsychotic drugs in schizophrenia has a risk of synergistic action of excessive blockade of dopamine receptors, which causes hyperprolactinemia. Primary hyponatremia occurs during pregnancy and can be an important marker for signaling neurodevelopmental abnormalities, while secondary hyponatremia has a major clinical dimension and is induced by psychotropic drugs. The pathogenic mechanisms presented can be objectified by neuroimaging examinations that bring benefits in the diagnostic accuracy and re-evaluation of the therapeutic approach, especially in correlation with the severity of biological markers such as prolactin and sodium. The persistence of high prolactin and low sodium levels is an alarm signal that announces a negative evolution of the patient or a major risk of severe cardiac, metabolic, vascular or renal comorbidities. Recognition of pathogenic mechanisms of neurodevelopment, including ventriculomegaly, hyponatremia, focal cortical dysplasia, hippocampal or temporal lobe lesions, in association with a positive history of neonatal or febrile seizures, requires prophylaxis due to high risk of onset of schizophrenia in childhood. Fetal cortical dysplasia is associated with the risk of neonatal seizures. This vulnerability favors the appearance of febrile convulsions or enuresis with changes in brain structure. Enuresis may be an important marker of neurodevelopmental potential for schizophrenia. Neonatal seizures are correlated with hyponatremia and severe hypertension, which appeared in the third trimester of pregnancy, can trigger eclampsia. Neuroimaging monitoring in patients with neurodevelopmental abnormalities, hyperprolactinemia and primary or secondary hyponatremia, acquires a major importance, being able to delimit the boundary between a functional lesion, potentially reversible, with an irreversible lesion.</em

The Implications of Adverse Pharmacologic Reactions and Complex Pathogenic Mechanisms in Schizophrenia

Schizophrenia is a major health problem in which diversification and increase in the quality of antipsychotic molecules did not yield the anticipated results. that the etiopathogenesis of schizophrenia accounts for a combination of genetic factors forming the genetic spectrum of vulnerability for schizophrenia. The neurodevelopmental anomalies correlated with the gestational period and obstetric traumatisms raises major pharmacological management issues. The two levels of vulnerability (genetic and neurodevelopmental) are the basis of the pathogeny of side effects induced by antipsychotic medication. The most severe side effects are related to extrapyramidal symptoms, hyperhomocysteinemia, hypofrontality, impairment of the neurovascular unit and neuronal metabolic processes. Understanding these particular mechanisms will allow the clinician to identify the pathogenic model of schizophrenia, customized for each specific case. The adverse drug reaction decreases the compliance and adherence to the treatment, determining repeated discontinuations with psychotic relapses, and may trigger psychopathogenic bursts deteriorating the structural and cerebral functional balance. The type of psychotropic medication must be taken into account, as well as the concomitant medication administered for comorbidities associated with schizophrenia. The cerebral vascular modifications are correlated with the metabolic syndrome induced by antipsychotic medication. This complex syndrome, associated also with modifications in the homocysteine metabolism, determines weight gain, obesity, high blood pressure, ischemic cardiopathy, hyperglycemia and dyslipidemia. Identification of possible biological or neuroimaging markers helps and their early correction may prevent the onset of neurodegenerative evolution and irreversible cerebral atrophies, as well as decrease the risk of side effect that may endanger the life of the schizophrenic patient. The complexity of the pathogenic mechanisms requires a prophylactic behavior, not based on therapeutic switch, but on the proactive, customized pharmacologic intervention, addressing the pathogenic chains.</p

Depression and Anxiety - Risk Factors in the Evolution of Breast Cancer in Women

Psychological evaluation of women with suspected or diagnosed breast cancer can provide psychooncological elements for predicting the evolution of the disease and imperative customization of specific oncological therapies. In this study, we assessed the psychological status in terms of depression, anxiety and dysfunctional attitudes in both the group of patients with a confirmed diagnosis of breast cancer and that of patients with suspected breast cancer who are in the stage of histopathological evaluation of the diagnosis. The results of the psychometric evaluations allowed the development of a common neurobiological model for the two categories of patients. Given the staging model of breast cancer, the clinical and psychometric data obtained through our study allowed us to develop an integrative neurobiological model based on the evolutionary staging of anxiety and depressive disorders (Zhao et al., 2013). Based on these hypotheses, we argue that the staging of psychological disorders, the customization of specific psychotherapeutic prophylaxis strategies and the prudent pharmacological approach to these psychological changes can significantly improve the evolution and prognosis of cancer and the quality of life of patients. The state of relative psychoemotional balance (objectified by psychometric scales), without its validation by normalizing multisystemic biological indicators of depression (C-reactive protein, proinflammatory cytokines, blood-brain barrier disruption and cerebral blood flow decrease), suggests the risk of progression of the neoplastic process. We argue that when communicating the diagnosis and the therapeutic plan, a special methodology (specific protocol) must be applied to reduce distress, correct emotional balance and improve cognitive dysfunction by supporting the motivation to survive, as well as increasing patients' self-esteem.</p

SINDROMUL INCISIVULUI MAXILAR MEDIAN UNIC

Sindromul incisivului maxilar median unic este o afecţiune complexă, datorată unor defecte multiple de dezvoltare, în special pe linia mediană, secundar acţiunii unor factori necunoscuţi, care acţionează în zilele 35-38 de viaţă intrauterină. Autorii prezintă cazul copilului V.C. în vârstă de 13 ani 9 luni, cu repetate internări în vederea evaluării pentru hipostatură şi retard mental. La vârsta de 5 ani a fost diagnosticat cu astm bronşic, iar la vârsta de 10 ani cu panhipopituitarism; a urmat tratament de substituţie tiroidiană şi cu hormon de creştere, dar inconstant. Examenul clinic: retard statural marcat, facies dismorf, obstrucţie nazală cronică, prezenţa incisivului maxilar median unic, retard mental moderat, cu defi cit de atenţie. Examinări paraclinice: CT cranian – hipoplazie hipofi zară, determinările hormonale au confi rmat diagnosticul de panhipopituitarism

PERIODONTAL CHANGES IN PATIENTS WITH TYPE 1 DIABETES – CLINICAL ASPECTS

Diabetes, a pathology that is extremly widespread, involves an alteration homeostasis in the glucose metabolism. Periodontitis is a infectious disease resulting in irreversible destruction of the tooth attachment apparatus. At present, periodontitis is one of the major reasons for adult tooth loss. The periodontal clinical examination determined the following diagnosis categories: chronic gingivitis and chronic periodontitis , all of them being modulated by the systemic disease. Aim of the study is to highlight possible correlations between periodontal status and diabetic clinical parameters characterizing patients diagnosed with type 1 diabetes(T1D). Material and methods This study was conducted on 62 patients. We analysed the general information of the patients and an oral examination for establishing the parodontal diagnosis. The probing depth has been established, number of teeth with pockets Larbert than 6mm and the plaque index Silness and Loe. Results Significant differences were found between the IP values on children and adults but there were no significant differences between IP on GTA and GCA or between IP on GTC and GCC. We did not find a statistically significant correlation between HbA1c and severity of periodontal diagnosis GTC. But found a direct correlation between HbA1c and statistically significant in periodontal diagnosis GTA. Conclusions The results obtained in this study show a possible relationship between metabolic changes caused by periodontal T1D and, especially in the group of adult patients

Retinal Microvascular Alterations in a Patient with Type 1 Diabetes Mellitus, Hemoglobin D Hemoglobinopathy, and High Myopia—Case Report and Review of the Literature

Type 1 diabetes mellitus (type 1 DM) is one of the most prevalent endocrinological diseases among children and young adults, with a growing incidence rate reaching up to 2.9 new cases per year per 100,000 persons below 15 years of age. We report a rare case of a 20-year-old female patient with type 1 DM, hemoglobin D (HbD) heterozygote variant and high myopia of −10.00 spheric diopters, and describe the retinal microvascular alterations visible on OCT angiography (angio-OCT). The patient also presented with a severe stature deficit (less than three standard deviations) and delayed puberty, which could not be explained only by suboptimal glycemic control and indicated possible hypopituitarism. HbA1c level evaluated with the high-performance liquid chromatography (HPLC) method was 6.5%, a falsely low value due to HbD hemoglobinopathy. On ophthalmic evaluation, the angio-OCT scan showed the following retinal microvascular alterations in the right eye (RE): the FAZ (Foveal Avascular Zone) area was 0.39 mm2, the FAZ perimeter was 2.88 mm, and the circularity index was 0.58. The following alterations were shown in the left eye (LE): the FAZ area was 0.34 mm2, the FAZ perimeter was 3.21 mm, and the circularity index was 0.41. Clinicians should consider high-performance retinal screening methods such as angio-OCT evaluation for young type 1 DM patients, especially for those with associated pathologies like high myopia and hemoglobinopathies. Moreover, multiple evaluation methods of HbA1c values are mandatory as hemoglobinopathies can interfere with the accuracy of HbA1c assay methods

Early Retinal Microvascular Alterations in Young Type 1 Diabetic Patients without Clinical Retinopathy

The purpose of this study is to identify and quantify preclinical changes with the help of optical coherence tomography angiography (OCTA) within the retinal microcirculation of young type 1 diabetes (T1D) patients without clinical signs of diabetic retinopathy (DR) and to compare these results with those obtained from healthy age-matched subjects. OCTA is currently used for monitoring diabetic retinopathy; however, there is no current consensus on which OCTA parameter alterations predict the first clinical signs of diabetic retinopathy. The main challenge that young patients with T1D face during the course of the disease is that they can rapidly progress to the development of DR, especially during adolescence. Moreover, they also present an increased risk of rapid progression toward advanced stages of DR and vision loss compared to type 2 diabetes patients, indicating the importance of early diagnosis and intervention. The limitations of the currently used screening procedures that led to the conceptualization of our study are the difficulties in performing fluorescein angiography tests for diagnosing the clinical signs of DR on young patients, namely the invasive procedure of dye injection, the risk of allergic reactions and the long duration of the examination. Moreover, given the long life expectancy of young T1D patients, it is essential to identify the preclinical changes in retinal microvasculature before reaching the first clinical signs quantifiable by FFA. The clinical study enrolled 119 subjects aged between 4 and 30 years old with a mean age of 13 years old, comprising 61 T1D patients with a mean duration of the disease of 4 years and 8 months and 58 healthy age-matched subjects for the control group. OCTA scans were performed using the RevoNX 130 OCTA device (Optopol) to evaluate the following retinal parameters: foveal avascular zone (FAZ) area, perimeter and circularity, overall foveal thickness, and superficial and deep vessel densities. Statistically significant differences between the two groups were identified for the following parameters: the FAZ area in the T1D group (0.42 ± 0.17) was larger than the control group (0.26 ± 0.080), the FAZ circularity (0.41 ± 0.11) was decreased compared to the control group (0.61 ± 0.08) and the FAZ perimeter was larger (3.63 ± 0.97) compared to the control group (2.30 ± 0.50). The overall foveal thickness was decreased in the T1D group (222.98 ± 17.33) compared to the control group (230.64 ± 20.82). The total vessel density of the superficial capillary plexus (SCP) on an investigated area of 6 X 6 mm centered around the fovea was decreased in the T1D group (37.4164 ± 2.14) compared to the control group (38.0241 ± 2.44). Our data suggest that specific imaging biomarkers such as FAZ perimeter, area and circularity, decreased overall foveal thickness and decreased vessel density in the SCP precede the clinical diagnosis of DR in young T1D patients and represent useful parameters in quantifying capillary nonperfusion in T1D patients without clinical signs of DR

Effectiveness of Psychostimulant and Non-Psychostimulant Drug Therapy in the Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperkinetic Disorder (ADHD) is a neurobiological behavioral disorder of the child, adolescent, and adult characterized by problems of concentration, hyperactivity, and impulsivity caused by an imbalance of chemical neurotransmitters in the brain—dopamine and noradrenaline. ADHD first-line drugs are divided in psychostimulant, as Methylphenidate and Amphetamines and non-psychostimulant medications-Atomoxetine (the only representative non-psychostimulant medication approved in our country in children and adolescents). The purpose of our research was to assess the clinical evolution of patients with ADHD based on the drug treatment that is administered: psychostimulant or non-psychostimulant. Both psychostimulant—Methylphenidate, and non-psychostimulant therapy—Atomoxetine, proved to significantly improve the symptoms of attention deficit hyperkinetic disorder. There was a significant reduction in the severity of ADHD symptoms at six months and at one year from the start of treatment in the case of the psychostimulant group, whereas in the non-psychostimulant group, the significant reduction in severity of symptomatology occurs only at six months after the start of treatment. We can conclude that both types of drugs are effective in reducing the severity of symptoms and in improving the clinical condition of patients with ADHD, but the comparative analysis of the two groups demonstrated that significantly better results are obtained with psychostimulant treatment