Strongyloides hyperinfection syndrome, Cytomegalovirus enteritis with viremia and recurrent gram-negative sepsis in a patient with recurrent thymoma: a case report

Strongyloides stercoralis is an intestinal nematode which is endemic in tropical and subtropical countries.  It may cause asymptomatic infections, mild eosinophilia or hyperinfection syndrome in the most severe form. We are reporting a case of Strongyloides hyperinfection syndrome in an immunosuppressed patient with recurrent thymoma and myasthenic crisis. This patient is a 51-year-old man with myasthenia gravis on long term pyridostigmine and prednisolone and mycophenolate. He presented with copious diarrhoea and was in septic shock. His blood and urine cultures grew Klebsiella pneumoniae and Pseudomonas aeruginosa. Oesophago-gastro-duodenoscopy (OGD scopy) and biopsy showed severe active duodenitis with strongyloidiasis and moderate active antral gastritis with strongyloidiasis. He was diagnosed to have Strongyloides hyperinfection and was treated with oral Ivermectin. He recovered well. He was subsequently diagnosed to have CMV enteritis with viraemia and was treated with intravenous Ganciclovir. Our case emphasizes the association of Strongyloides hyperinfection with superimposed CMV infection and gram-negative sepsis due to prolonged immunosuppression and autoimmunity in Thymoma patients. Recurrent thymoma and high-grade infiltrative thymoma often poses difficulty in the management of myasthenia patients. A high index of suspicion and aggressive treatment is paramount in approaching a patient with multiple risk factors of hyperinfection syndrome and autoimmunity. This case is reported in view of its rarity and significance regarding the multidisciplinary approach in decreasing morbidity and mortality in hyperinfection syndrome with an autoimmune background

How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States

Background: Although a psychiatric history might be an independent risk factor for COVID-19 infection and mortality, no studies have systematically investigated how different clusters of pre-existing mental disorders may affect COVID-19 clinical outcomes or showed how the coexistence of mental disorder clusters is related to COVID-19 clinical outcomes. Methods: Using a retrospective cohort study design, a total of 476,775 adult patients with lab-confirmed and probable COVID-19 between March 06, 2020 and April 14, 2021 in South Carolina, United States were included in the current study. The electronic health record data of COVID-19 patients were linked to all payer-based claims data through the SC Revenue and Fiscal Affairs Office. Pre-existing mental disorder diagnoses from Jan 2, 2019 to Jan 14, 2021 were extracted from the patients\u27 healthcare utilization data via ICD-10 codes. Results: There is an elevated risk of COVID-19-related hospitalization and death among participants with pre-existing mental disorders adjusting for key socio-demographic and comorbidity covariates. Co-occurrence of any two clusters was positively associated with COVID-19-related hospitalization and death. The odds ratio of being hospitalized was 1.26 (95% CI: 1.151, 1.383) for patients with internalizing and externalizing disorders, 1.65 (95% CI: 1.298, 2.092) for internalizing and thought disorders, 1.76 (95% CI: 1.217, 2.542) for externalizing and thought disorders, and 1.64 (95% CI: 1.274, 2.118) for three clusters of mental disorders. Conclusions: Pre-existing internalizing disorders and thought disorders are positively related to COVID-19 hospitalization and death. Co-occurrence of any two clusters of mental disorders have elevated risk of COVID-19-related hospitalization and death compared to those with a single cluster

A tale of two comorbidities: Understanding the neurobiology of depression and pain

The comorbidity of chronic pain and depression has been consistently associated with a poor prognosis and greater disability in patients as compared to those suffering from each illness alone. This further has implications on significant financial costs to the patients and to our society. The biological underpinnings of major depression and chronic pain have considerable overlap in the areas of genetic, structural, functional, neuroendocrine and neurotransmitter functionality. Although the field has evolved in the past decade, more efforts should now focus on understanding the biological underpinnings of this shared comorbidity, while shedding light on treatment implications for these two devastating conditions

M25. Development and Validation of the Brief Assessment of Validation in Schizophrenia (BAC-App)

Background: The Brief Assessment of Cognition in Schizophrenia (BACS) is a pen-and-paper cognitive assessment tool that has been used in hundreds of research studies and clinical trials, and has normative data available for generating age- and gender-corrected standardized scores. A tablet-based version of the BACS called the BAC App has been developed to allow standardized presentation of task instructions and stimuli, audio-recording of subject responses, and automatized scoring and data management. Development of the BAC App was aimed at reducing rater burden and variability. Our validation study compared performance on the traditional BACS and the BAC App in patients with schizophrenia and healthy controls. Test equivalency was assessed, and the applicability of paper-based normative data was evaluated. An ongoing follow-up study examines BAC App performance in large-scale census-matched normative sample. Methods: Participants in the validation study included 48 patients (23 female) with schizophrenia and 50 healthy controls (25 female) recruited from 3 academic sites including the University of California-San Diego, the University of Miami—Miller School of Medicine, and the University of South Carolina. All participants were assessed with the standard pen-and-paper BACS and the BAC App. Ongoing normative evaluation of the BAC App will include a community sample of 650 individuals matched to the US census on age, education, race and gender. Results: In the validation study, distributions of standardized composite scores for the tablet-based BAC App and the pen-and-paper BACS were indistinguishable in both schizophrenia patients and healthy controls. Between-methods mean differences were not statistically significant. The discrimination between patients and controls was similarly robust with the BAC App ( d  = 1.34) and the BACS ( d  = 1.24). The between-methods correlations for individual measures in patients were r > .70 except Token Motor ( r  = .43) and Tower of London ( r  = .61). In patients, performance between the test methods was not significantly different on any test except the Token Motor Test. When data from the Token Motor Test were removed, the between-methods correlation of composite scores improved to r  = .88 ( df  = 48; P <.001) in healthy controls and r  = .89 ( df  = 46; P < .001) in patients, consistent with the test-retest reliability of each measure. Interim findings from the ongoing normative study ( N  = 52 to date) suggest that the BAC App is well-tolerated by a diverse community population, with 78.9% ( N  = 41) of subjects rating their experience with the BAC App as “pleasant” on a 7-point Likert scale. Conclusion: The tablet-based BAC App is generates results consistent with the traditional pen-and-paper BACS. These data support the notion that the BAC App can now be used in clinical trials and clinical practice

Validation of a Computerized test of Functional Capacity

Regulatory guidance for schizophrenia cognition clinical trials requires that the assessment of cognitive change is accompanied by a functionally meaningful endpoint. However, currently available measures are challenged by resistance to change, psychometric weaknesses, and for interview-based assessments, dependence upon the presence of an informant. The aims of the current study were to: 1) assess the validity, sensitivity, and reliability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) as a measure of functional capacity; 2) determine the association between performance on the VRFCAT and performance on the MATRICS Consensus Cognitive Battery (MCCB); and 3) compare the metrics of the VRFCAT with the UCSD Performance-based Skills Assessment (UPSA). 167 patients with schizophrenia and 166 healthy controls completed the VRFCAT, UPSA, and the MCCB at baseline. The VRFCAT and UPSA were completed again at follow-up. The VRFCAT, MCCB, and UPSA were very sensitive to impairment in schizophrenia (d=1.16 to 1.22). High test-retest reliability was demonstrated for VRFCAT total completion time and the UPSA total score in patients (ICC=0.81 and 0.78, respectively). The UPSA demonstrated significant practice effects in patients (d=0.35), while the VRFCAT did not (d=-0.04). VRFCAT total completion time was correlated with both UPSA (r=-0.56, p&lt;0.0001 for patients and -0.58, p&lt;0.0001 for controls) and MCCB Composite (r=-0.57, p&lt;0.0001 for patients and -0.68, p&lt;0.0001 for controls). The VRFCAT is a highly reliable and sensitive measure of functional capacity with associations to the UPSA and MCCB. These results provide encouraging support for a computerized functional capacity assessment for use in schizophrenia

Validation of a Computerized test of Functional Capacity.

Regulatory guidance for schizophrenia cognition clinical trials requires that the assessment of cognitive change is accompanied by a functionally meaningful endpoint. However, currently available measures are challenged by resistance to change, psychometric weaknesses, and for interview-based assessments, dependence upon the presence of an informant. The aims of the current study were to: 1) assess the validity, sensitivity, and reliability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) as a measure of functional capacity; 2) determine the association between performance on the VRFCAT and performance on the MATRICS Consensus Cognitive Battery (MCCB); and 3) compare the metrics of the VRFCAT with the UCSD Performance-based Skills Assessment (UPSA). 167 patients with schizophrenia and 166 healthy controls completed the VRFCAT, UPSA, and the MCCB at baseline. The VRFCAT and UPSA were completed again at follow-up. The VRFCAT, MCCB, and UPSA were very sensitive to impairment in schizophrenia (d=1.16 to 1.22). High test-retest reliability was demonstrated for VRFCAT total completion time and the UPSA total score in patients (ICC=0.81 and 0.78, respectively). The UPSA demonstrated significant practice effects in patients (d=0.35), while the VRFCAT did not (d=-0.04). VRFCAT total completion time was correlated with both UPSA (r=-0.56, p&lt;0.0001 for patients and -0.58, p&lt;0.0001 for controls) and MCCB Composite (r=-0.57, p&lt;0.0001 for patients and -0.68, p&lt;0.0001 for controls). The VRFCAT is a highly reliable and sensitive measure of functional capacity with associations to the UPSA and MCCB. These results provide encouraging support for a computerized functional capacity assessment for use in schizophrenia