RESUMO
To optimize clinical care, it is imperative for providers to recognize their own inherent cognitive biases and the impact that has on their clinical decision making, thereby minimizing complications such as prolonged hospitalization, unnecessary healthcare spending, and impaired patient satisfaction and functional outcomes.
RESUMO
Omalizumab may be a beneficial adjunct treatment option for hEDS patients require to improve pain control, ability to perform ADLs and functionality and social engagement, and most importantly, quality of life.
Assuntos
Ácidos Cicloexanocarboxílicos , Acidente Vascular Cerebral , Síndrome de Abstinência a Substâncias , Humanos , Gabapentina , Acidente Vascular Cerebral/complicações , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/etiologia , Ácidos Cicloexanocarboxílicos/efeitos adversosRESUMO
Active pharmaceutical ingredients such as tricyclic antidepressants (TCAs) are contaminants of emerging concern which are commonly detected in wastewater effluent and which can disrupt the behavior of non-target organisms. In aquatic snails, the righting response is a critical behavior that has been shown to be inhibited by exposure to SSRI-type antidepressants. We exposed marine and freshwater snails to three tricyclic antidepressants (clomipramine, amitriptyline, and imipramine) for 1 h and measured righting response time. In the marine mud snail (Ilyanassa obsoleta), all three TCAs significantly increased righting time at concentrations as low as 156 µg/L. Similarly, in the freshwater snail Leptoxis carinata, all three TCAs increased righting time at concentrations as low as 263 µg/L. However, exposure to imipramine from 15.8 to 316 µg/L resulted in significantly faster righting time. Such low-dose stimulation and high-dose inhibition are characteristics of a hormetic response. We discuss the possible physiological mechanism of action of TCAs and other antidepressants on snail behavior, and the occurrence of non-monotonic, hormetic dose responses to human pharmaceuticals in the aquatic environment.