A 68-Year-Old Man with Depression and Acute Renal Failure Due to Rhabdomyolysis Associated with Alcohol Intoxication While Taking Low-Dose Escitalopram: A Case Report.

BACKGROUND Rhabdomyolysis, an uncommon but recognized adverse effect of selective serotonin reuptake inhibitor (SSRI) antidepressants, can precipitate acute renal injury (AKI), especially when combined with risk factors such as alcohol consumption. This report describes a 68-year-old man with acute renal failure due to rhabdomyolysis associated with alcohol intoxication while taking low-dose escitalopram, an SSRI antidepressant. CASE REPORT The patient, with a history of bipolar affective disorder managed with escitalopram, presented with symptoms of general malaise, diarrhea, myalgias, and transient loss of consciousness following substantial ethanol consumption. Laboratory tests indicated severe rhabdomyolysis with a creatine kinase level of 37 672 U/L and myoglobin level >5710 ng/ml, leading to an AKI diagnosis. The discontinuation of escitalopram, along with hydration and renal replacement therapy, facilitated renal recovery. However, the reintroduction of escitalopram resulted in the recurrence of rhabdomyolysis, suggesting a probable causal link, confirmed using the Naranjo Adverse Drug Reaction Probability Scale. CONCLUSIONS This report highlights the importance of identifying the medication history in patients presenting with acute renal failure and rhabdomyolysis and the association with SSRIs, which can be exacerbated by alcohol. This case underscores the importance of vigilant medication history assessment in patients presenting with AKI and rhabdomyolysis, particularly concerning the use of SSRIs like escitalopram, which can pose heightened risks in the context of alcohol use. It highlights the need for clinical caution in managing patients on long-term SSRI therapy, especially when reintroducing such medications after an episode of rhabdomyolysis.

ChatGPT as an information tool in rhinology. Can we trust each other today?

PURPOSE: ChatGPT (Chat-Generative Pre-trained Transformer) has proven to be a powerful information tool on various topics, including healthcare. This system is based on information obtained on the Internet, but this information is not always reliable. Currently, few studies analyze the validity of these responses in rhinology. Our work aims to assess the quality and reliability of the information provided by AI regarding the main rhinological pathologies. METHODS: We asked to the default ChatGPT version (GPT-3.5) 65 questions about the most prevalent pathologies in rhinology. The focus was learning about the causes, risk factors, treatments, prognosis, and outcomes. We use the Discern questionnaire and a hexagonal radar schema to evaluate the quality of the information. We use Fleiss's kappa statistical analysis to determine the consistency of agreement between different observers. RESULTS: The overall evaluation of the Discern questionnaire resulted in a score of 4.05 (± 0.6). The results in the Reliability section are worse, with an average score of 3.18. (± 1.77). This score is affected by the responses to questions about the source of the information provided. The average score for the Quality section was 3.59 (± 1.18). Fleiss's Kappa shows substantial agreement, with a K of 0.69 (p < 0.001). CONCLUSION: The ChatGPT answers are accurate and reliable. It generates a simple and understandable description of the pathology for the patient's benefit. Our team considers that ChatGPT could be a useful tool to provide information under prior supervision by a health professional.

The Variation of Serotonin Values in Dogs in Different Environmental Conditions.

Serotonin is considered to be the neurotransmitter that controls several types of behavior: aggressiveness, impulsivity, food selection, stimulation, sexual behavior, reaction to pain, and emotional manifestations. The aim of this study was to determine the serotonin values in 43 dogs, divided into three different experimental variants: (1) between two groups of medium (n = 6) and small (n = 4) breed shelter dogs; (2) in dogs with (n = 15) and without (n = 10) owners after administration of pre-spaying/neutering anesthesia; (3) in different behavioral states (n = 8) classified as follows: M1-happy, M2-aggressive, M3-calmed status, post-exposure to a stressful situation, compared to the reference time referred to as M0. There were no significant differences (p ≥ 0.05) regarding the serotonin values between the two groups of medium and small breed shelter dogs. Following anesthesia, the average mean serotonin values were significantly lower (p ≤ 0.003), by 63.85 ng/mL, in stray dogs compared to dogs with owners. No significant differences (p ≥ 0.05) were found when comparing the reference time M0 to M1, M2, and M3. The differences decreased significantly (p ≤ 0.05), by 89.61 ng/mL, between M1 and M2 and increased significantly (p ≤ 0.008), by 112.78 ng/mL, between M2 and M3.

Paraclinical Changes Occurring in Dairy Cows with Spontaneous Subacute Ruminal Acidosis under Field Conditions.

This study was undertaken to investigate the changes in the blood and milk biochemical parameters found in naturally occurring and long-lasting spontaneous subacute ruminal acidosis (SARA), with the aim of identifying the patterns of paraclinical changes and providing valuable data for more accurately identifying SARA in cows under field conditions. The study was conducted on a dairy herd with a history of the occurrence of SARA-associated clinical signs. Twelve cows, between 20 and 150 days in milk, were randomly selected and subsequently subjected to venous blood, milk, and ruminal fluid collection. The mean pH value of the ruminal fluid was 5.56 ± 0.32, and 58% (7/12) of the tested cows were SARA positive (ruminal pH ≤ 5.5). The albumin, calcium, and phosphorus serum concentration values were significantly lower (p < 0.05) in the SARA group than in the group of healthy cows. Serum aspartate aminotransferase (AST) and glutamate dehydrogenase (GLDH) activity were significantly higher in the SARA cows (p < 0.05) than in the group of healthy cows. The mean values of milk fat, milk protein content, and milk fat-to-protein ratio were significantly lower (p < 0.05) in the tested cows of the SARA group than in the healthy group of cows. In conclusion, the results of the current study indicate that long-term SARA triggered by a high-concentrate diet is associated with clinically significant changes in both the blood composition (hypoalbuminemia, hypocalcemia, and increased serum AST and GLDH activity) and the milk composition (decreased fat and protein percentage and milk fat-to-protein ratio). Altogether, the obtained results provide a more reliable pattern of paraclinical changes and useful insights for detecting SARA in dairy cows under field conditions.

Long-term follow-up of olfactory and gustatory dysfunction in COVID-19: 6 months case-control study of health workers.

PURPOSE: The study aimed to determine the incidence and long-term evolution of COVID-related olfactory (OD) and gustatory (GD) dysfunction, the recovery timeline, and the association with other symptoms. The secondary objective was to identify the predictive clinical factors for the evolution of these symptoms. METHODS: A prospective case-control study was conducted from March 15 to October 15, 2020, in health workers with COVID-19 related symptoms in a tertiary care hospital. 320 patients were included after 6 months of follow-up: 195 in the case group and 125 in the control group. Olfactory dysfunction (OD), dysosmia, and gustatory dysfunction (GD) onset and recovery rate after 6 months follow-up are analyzed in both groups. RESULTS: There were 125 (64.1%) in case group patients with OD and 118 (60.5%) with GD. Total or partial recovery OD and GD was found in 89%, mainly in the first 2 months. In the control group, there were 14 (11.2%) patients with OD and 33 (26.4%) patients with GD, with 100% of total/partial recovery. CONCLUSION: In both groups, OD and GD showed high-resolution rates during the first two months after the onset of symptoms. Nevertheless, 11% of the case group patients did not show any recovery, and the partial resolution was present in 30% of our patients, at the 6 months follow-up. We found a high correlation between OD and GD, both in the appearance of symptoms and in their recovery. Nasal obstruction and dyspnea have been identified as risk factors for the persistence of symptoms.

Molecular detection of hemotropic mycoplasmas (hemoplasmas) in domestic cats (Felis catus) in Romania.

BACKGROUND: The hemotropic mycoplasmas (hemoplasmas) of the genus Mycoplasma are recognized as important bacteria that parasitize red blood cells, causing hemolytic anemia in many mammalian species, including cats. No information is available concerning the presence of feline hemoplasma infections in cats in Romania. Thus, the objective of the present study was to provide data on the occurrence and molecular characterization of hemotropic mycoplasmas in client-owned cats in Romania. METHODS: Blood samples from 51 unhealthy cats, originating from Timisoara Municipality, Romania, were screened for the presence of hemoplasmas using conventional polymerase chain reaction (PCR) targeting the 16S rRNA gene and sequencing assays. PCR-positive samples were subsequently analyzed by phylogenetic and population genetic analysis. RESULTS: Molecular analysis revealed 11 (21.6%) positive samples, consisting of 8 (72.7%) Candidatus Mycoplasma haemominutum and 3 (27.3%) Mycoplasma haemofelis confirmed positives. Candidatus Mycoplasma turicensis was not detected, and no co-infections were registered. No significant associations (p > 0.05) were found between the hemoplasma infection status and age, gender, breed, presence of ectoparasites, feline leukemia virus/feline immunodeficiency virus positivity of cats, or the sampling season. However, outdoor access was positively associated (p = 0.049) with infection and could be considered a risk factor (OR = 4.1) in acquiring feline hemotropic mycoplasmas. Phylogenetic analysis revealed that our sequences clustered with those selected from the GenBank database in two distinct clades. The registered population genetic indices were strongly supportive of the great variance in sequences between the recorded Mycoplasma species. CONCLUSIONS: The findings support the occurrence of feline hemoplasma infections in previously uninvestigated territories of Europe, providing useful information for small animal practitioners. To our knowledge, the present survey is the first reported molecular evidence of feline hemoplasma infections in Romania.

Cardiac Hemodynamics and Slight Regression of Left Ventricular Mass Index in a Group of Hemodialysed Patients.

Chronic kidney disease (CKD) is a major health problem and has a growing prevalence in Romania and worldwide. The concept of chronic kidney disease (CKD) is defined by abnormal kidney function and/or structure persisting for more than 3 months, influencing patients health. Patients with chronic kidney disease have a 20-30 times greater risk for cardiovascular morbidity and mortality than similar individuals without chronic kidney disease. We conducted a prospective observational study that included 33 patients on hemodialysis. All patients were performing hemodialysis for at least 6 months, 3 sessions per week at a private Haemodialysis Centre in Craiova. Left ventricular hypertrophy has a high prevalence in dialysis patients and increased left ventricular mass index (LVMI) is a major cardiovascular risk factor. We concluded that concentric and eccentric ventricular hypertrophy are present simultaneously in hemodialysis patients, LVH regression is possible, but requires an interventional approach on cardiovascular risk factors (anemia, blood pressure, secondary hyperparathyroidism) in hemodialysis patients, patients on dialysis with a higher fistula flow, over 1170ml/min have heart failure, and the fistula's constant increased flow is a risk factor for heart failure with a high flow.

Prevalence and management of post-BPPV residual symptoms.

OBJECTIVES: To evaluate the prevalence and management of residual symptoms in recovered BPPV patients. METHODS: We performed a retrospective study on BPPV patients of any of the three semicircular canals. Exclusion criteria were multiple-canal BPPV, refractory BPPV, central nervous system pathologies or other vestibular diseases. Patients were treated with repositioning maneuvers until the vertigo disappeared and evaluated for symptoms of instability at 1 month after resolution. A dynamic computerized posturography was then performed on every patient complaining of residual instability. We analyzed demographic data, the affected semicircular canal, number of repositioning maneuvers, presence of anxiety disorders, and we correlated these variables with the presence of residual disequilibrium 1 month after vertigo resolution. RESULTS: We included 361 patients. Residual disequilibrium was found in 107 patients (29.6%) with no significant difference between the rates associated with the three semicircular canals (p = 0.73). The group who needed more than one repositioning maneuver (1 maneuver-229 patients, ≥ 2maneuvers-132 patients) showed a significantly higher prevalence of instability (17.9 vs. 50%; p < 0.0001). 47.2% of the patients with anxiety disorders presented with instability symptoms (p = 0,01). Patients older than 65 showed a significantly higher percentage of residual symptoms (23.3 vs. 34.8%; p = 0.03). CONCLUSIONS: Persistence of residual symptoms 1 month after the acute BPPV can be associated with certain risk factors that should be taken into consideration (age, number of repositioning maneuvers needed, anxiety and/or depressive disorders). These patients could benefit of treatment with vestibular rehabilitation.

Renal anemia - risk factor for chronic kidney disease.

The purpose of this research was to analyze the influence of anemia on renal function in patients with chronic kidney disease. Were monitored for 12 months 165 patients with chronic kidney disease, 96 patients had anemia and a control group of 69 patients had no anemia. A value of hemoglobin under 120 g/L in women and under 130 g/L in men on admission defined anemia. Anemia was associated with a more severe renal damage, a lower residual diuresis, especially in the presence of other risk factors such as diabetes, inflammation or secondary hyperparathyroidism, so early diagnosis and correction of anemia is important for prognosis and evolution of these patients.