Case of New Onset Alice in Wonderland Syndrome in Adolescent After Prolonged Hospitalization

Alice in wonderland syndrome (AIWS) has been described as body image illusions involving distortions of the size, mass, or shape of the patient’s own body or its position in space, often occurring with depersonalization and derealization. Most cases typically affect young children. Common distortions are micropsia, macropsia, metamorphopsia, and pelopsia. The term was adopted from the book by Lewis Carroll, wherein the main character perceived her size and shape to change in different scenarios. These distortions are often expressed as sensory perceptions rather than illusions or hallucinations, and are often distressing to the patient. AIWS onset has been found to be associated with infection, among most frequent pathogens are epilepsy, migraine, depression, and Epstein Barr Virus. The most common which have been reported to show association are infection and migraine/head trauma. This case describes a relatively quick onset of symptoms of AIWS in a patient after a prolonged hospital stay

An Interesting Case of Factitious Disorder Superimposed on Self: Factitious Disorder vs Somatic Symptom Disorder

Factitious disorder superimposed on self (FDIS) was first described in 1951by Richard Asher, who associated the disorder with Baron Munchhausen, who narrated unrealistic and exaggerated stories about his life. Suspicion for FDIS should be raised when patients with atypical presentations of medical disorders seek excessive use of healthcare services despite ongoing lack of clinical evidence. Patients with FDIS often demand hospitalization for their symptoms, leading to unnecessary tests and treatments. These patients show signs of pathological lying, deceitfulness, are obstinate with medical staff, and display erratic behavior. When medical investigation does not support their symptoms, patients often develop new “symptoms” or “disease”, and often exhibit symptoms only when they are being observed. FDIS is a diagnosis of exclusion, therefore other disorders with similar presentations must be considered. One of these conditions is somatic symptom disorder (SSD). When FDIS is recognized by providers, it often leads to countertransference, frustration, and unwillingness for follow-up treatment by the provider. These patients deny falsifying symptoms and fail to acknowledge the presence of this mental illness. This further perpetuates a pattern of excessive hospitalizations or consultations when the patient’s demands aren’t met

Erratum to: Progress Note 2024: Curing HIV; Not in My Lifetime or Just Around the Corner?

Erratum to: Progress Note 2024: Curing HIV; Not in My Lifetime or Just Around the Corner? doi: 10.20411/pai.v8i2.665  In the original publication, the comments provided by Santiago Ávila-Ríos were mistakenly omitted. In this version, his comments are included in the “Comments by Leaders” section, and his name has been included in the list of authors.  --- Once a death sentence, HIV is now considered a manageable chronic disease due to the development of antiretroviral therapy (ART) regimens with minimal toxicity and a high barrier for genetic resistance. While highly effective in arresting AIDS progression and rendering the virus untransmissible in people living with HIV (PLWH) with undetectable viremia (U=U) [1, 2]), ART alone is incapable of eradicating the “reservoir” of resting, latently infected CD4+ T cells from which virus recrudesces upon treatment cessation. As of 2022 estimates, there are 39 million PLWH, of whom 86% are aware of their status and 76% are receiving ART [3]. As of 2017, ART-treated PLWH exhibit near normalized life expectancies without adjustment for socioeconomic differences [4]. Furthermore, there is a global deceleration in the rate of new infections [3] driven by expanded access to pre-exposure prophylaxis (PrEP), HIV testing in vulnerable populations, and by ART treatment [5]. Therefore, despite outstanding issues pertaining to cost and access in developing countries, there is strong enthusiasm that aggressive testing, treatment, and effective viral suppression may be able to halt the ongoing HIV epidemic (ie, UNAIDS’ 95-95-95 targets) [6–8]; especially as evidenced by recent encouraging observations in Sydney [9]. Despite these promising efforts to limit further viral transmission, for PLWH, a “cure” remains elusive; whether it be to completely eradicate the viral reservoir (ie, cure) or to induce long-term viral remission in the absence of ART (ie, control; Figure 1). In a previous salon hosted by Pathogens and Immunity in 2016 [10], some researchers were optimistic that a cure was a feasible, scalable goal, albeit with no clear consensus on the best route. So, how are these cure strategies panning out? In this commentary, 8 years later, we will provide a brief overview on recent advances and failures towards identifying determinants of viral persistence and developing a scalable cure for HIV. Based on these observations, and as in the earlier salon, we have asked several prominent HIV cure researchers for their perspectives

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

DISRUPTION OF E-CADHERIN PROMOTES INTESTINAL STEM CELL PROLIFERATION IN COLONOIDS

Reconstitution of the wounded epithelium is integral to achieve the full healing of the gut mucosa in treating Inflammatory Bowel Disease (IBD). The ability of intestinal stem cells (ISCs) to indefinitely self-renew while generating new functional epithelia makes them a potential therapeutic tool for IBD. Transmembrane protein E-cadherin, a calcium dependent cell-to-cell adhesion protein at adherens junctions, also regulates the Wnt signaling pathway. The canonical Wnt (β-catenin dependent) pathway is vital for the ISC homeostasis and regeneration. However, the role of E-cadherin in ISCs is an important yet notably understudied phenomenon. Disruption of E-cadherin increases unbound cytosolic β-catenin levels, which go to the nucleus and increase transcription of Wnt target genes. We hypothesize that disrupted E-cadherin will increase proliferation of ISCs. In our experiments, we disrupt E-cadherin with different concentrations of EGTA, a calcium chelator, and see the effect it has on colonoid growth and development. Our experiments showed that with EGTA there was greater proliferation; 1 mM EGTA experimental groups had larger colonoids than vehicle control colonoids on day 6 after seeding. This indicates that EGTA treatment may induce proliferation of the organoid with E-cadherin disruption. For future study, we will check and confirm the disruption of E-cadherin/β-catenin complex and Wnt target genes by real-time PCR and immunofluorescence studies. Ultimately our study will open novel therapeutic applications for patients living with IBD and other clinic inflammatory gut disorders

Progress Note 2024: Curing HIV; Not in My Lifetime or Just Around the Corner?

Once a death sentence, HIV is now considered a manageable chronic disease due to the development of antiretroviral therapy (ART) regimens with minimal toxicity and a high barrier for genetic resistance. While highly effective in arresting AIDS progression and rendering the virus untransmissible in people living with HIV (PLWH) with undetectable viremia (U=U) [1, 2]), ART alone is incapable of eradicating the “reservoir” of resting, latently infected CD4+ T cells from which virus recrudesces upon treatment cessation. As of 2022 estimates, there are 39 million PLWH, of whom 86% are aware of their status and 76% are receiving ART [3]. As of 2017, ART-treated PLWH exhibit near normalized life expectancies without adjustment for socioeconomic differences [4]. Furthermore, there is a global deceleration in the rate of new infections [3] driven by expanded access to pre-exposure prophylaxis (PrEP), HIV testing in vulnerable populations, and by ART treatment [5]. Therefore, despite outstanding issues pertaining to cost and access in developing countries, there is strong enthusiasm that aggressive testing, treatment, and effective viral suppression may be able to halt the ongoing HIV epidemic (ie, UNAIDS’ 95-95-95 targets) [6–8]; especially as evidenced by recent encouraging observations in Sydney [9]. Despite these promising efforts to limit further viral transmission, for PLWH, a “cure” remains elusive; whether it be to completely eradicate the viral reservoir (ie, cure) or to induce long-term viral remission in the absence of ART (ie, control; Figure 1). In a previous salon hosted by Pathogens and Immunity in 2016 [10], some researchers were optimistic that a cure was a feasible, scalable goal, albeit with no clear consensus on the best route. So, how are these cure strategies panning out? In this commentary, 8 years later, we will provide a brief overview on recent advances and failures towards identifying determinants of viral persistence and developing a scalable cure for HIV. Based on these observations, and as in the earlier salon, we have asked several prominent HIV cure researchers for their perspectives

Design, synthesis and biological evaluation of phosphorodiamidate prodrugs of antiviral and anticancer nucleosides

We herein report the application of the phosphorodiamidate phosphate prodrug approach to a series of thirteen nucleoside analogs with antiviral or anticancer activity. Twenty-five symmetrical phosphorodiamidates were synthesized, bearing esterified l-Alanine (and in one case d-Alanine) in the prodrug moiety, each as single stereoisomer. The presence of an achiral phosphorus represents a potential advantage over the phosphoramidate ProTide approach, where diastereoisomeric mixtures are routinely obtained, and different biological profiles may be expected from the diastereoisomers. Optimization of the synthetic pathway allowed us to identify two general methods depending on the particular nucleoside analogs. All the compounds were biologically evaluated in antiviral and anticancer assays and several showed improvement of activity compared to their parent nucleosides, as in the case of ddA, d4T, abacavir and acyclovir against HIV-1 and/or HIV-2. The biological results were supported by metabolism studies with carboxypeptidase Y monitored by 31P NMR to investigate their bioactivation. This work further validates the phosphorodiamidate approach as a monophosphate prodrug motif with broad application in the antiviral and anticancer fields

Migration and the search for a better way of life: a critical exploration of lifestyle migration

For the past few years, the term ‘lifestyle migration’ has been used to refer to an increasing number of people who take the decision to migrate based on their belief that there is a more fulfilling way of life available to them elsewhere. Lifestyle migration is thus a growing, disparate phenomenon, with important but little understood implications for both societies and individuals. This article outlines and explores in detail a series of mobilities that have in common relative affluence and this search for a better lifestyle. We attempt to define the limits of the term lifestyle migration, the characteristics of the lifestyle sought, and the place of this form of migration in the contemporary world. In this manner, we map the various migrations that can be considered under this broad rubric, recognising the similarities and differences in their migration trajectories. Further to this, drawing on the sociological literature on lifestyle, we provide an initial theoretical conceptualisation of this phenomenon, attempting to explain its recent escalation in various guises, and investigating the historical, sociological, and individualised conditions that inspire this migration. This article is thus the first step in defining a broader programme for the study of lifestyle migration. We contend that the study of this migration is especially important in the current era given the impact such moves have on places and people at both ends of the migratory chain