Supratherapeutic lithium levels in COVID-19 infection.

Lithium levels are often checked in the inpatient setting when a patient has clear indications of acute kidney injury. Lithium levels can become supratherapeutic in COVID-19 infection even after normalization of creatinine. Lithium levels should be checked routinely in patients with COVID-19 infection in order to avoid supratherapeutic levels.

Mesiotemporal Disconnection and Hypoactivity in Klüver-Bucy Syndrome: Case Series and Literature Review.

OBJECTIVE: Klüver-Bucy syndrome (KBS) is often perceived as rare and limited to cases with bilateral amygdala destruction. In fact, various alternate mechanisms may be involved, warranting exploration of the syndrome's presentation, pathophysiology, prognosis, and management. DATA SOURCES: Clinical management and the electronic medical records were examined for 2 patients diagnosed with partial KBS (ICD-10 F07.0) after experiencing ≥ 3 of the following: placidity, indiscriminate dietary behavior, hyperorality, hypersexuality, visual agnosia, and hypermetamorphosis. A literature search was performed in April 2015 by using the keyword Kluver-Bucy in PubMed and Ovid databases for English language publications since inception. Additionally, the authors reviewed the reference list of these publications in order to identify additional reports. STUDY SELECTION: Studies were included if they had information about presentation, pathophysiology, syndrome treatment or management, and course of KBS. DATA EXTRACTION: Information about our KBS cases was obtained by reviewing electronic medical records and by direct observation of the patients. A total of 186 (PubMed) and 137 (Ovid) publications were identified in each database. We ultimately reviewed 109 articles containing information about KBS, finding 51 publications addressing relevant aspects of this syndrome. RESULTS: The first case demonstrates KBS secondary to mesiotemporal structural atrophy, and the second illustrates transient KBS due to functional, postictal, hypoactivity within such structures. Literature review and discussion regarding both prognosis and treatment of KBS follows. CONCLUSIONS: Klüver-Bucy syndrome may be underreported due to a limited understanding of the syndrome as one necessitating bilateral amygdaloid destruction. The syndrome can be seen with damage/hypofunction of the hippocampal-amygdaloid complex and its projections. The prognosis of KBS is variable, and its treatment is based on a combination of environmental and pharmacologic measures.

What the Psychiatrist Needs to Know About Ventricular Assist Devices: A Comprehensive Review.

BACKGROUND: The number of patients with end-stage heart failure using mechanical circulatory support has dramatically increased over the past decade. Left ventricular assist devices, the most common type of mechanical circulatory support, can be used as a bridge to transplant, destination therapy, and as a bridge to recovery. As this patient population continues to grow, consultation-liaison psychiatrists will become increasingly involved in their care. A thorough biopsychosocial assessment is required to ensure adequate recognition and management of medical, psychiatric, social, and ethical challenges posed by this population. METHODS: We performed a literature review to identify key issues relevant to the practice of consultation-liaison psychiatrists. RESULTS: General functioning of left ventricular assist devices, device types, system components, life with a left ventricular assist device, preoperative evaluation, treatment of psychiatric comorbidities, and end-of-life decision-making are discussed. CONCLUSIONS: Consultation-liaison psychiatrists need to be familiar with the high prevalence of psychopathology in patients implanted with left ventricular assist devices. A detailed biopsychosocial formulation is required to adequately identify and, if possible, resolve a myriad of medical, psychiatric, social, and ethical challenges presented by this population. Future efforts should accurately identify and report specific psychiatric disorders and adverse events within this cohort.

Diffusional and transcriptional mechanisms involved in laccases production by Pleurotus ostreatus CP50.

The independent effects of hydrodynamic stress (assessed as the Energy Dissipation/Circulation Function, EDCF) and dissolved oxygen tension (DOT) on the growth, morphology and laccase production by Pleurotus ostreatus CP50 were studied using a 3(2) factorial design in a 10L reactor. A bell-shape function for fungus growth between 8 and 22% DOT was observed, as well as a significant negative effect on laccase production and the expression of poxc, the gene encoding for the most abundant laccase produced by P. ostreatus CP50. Increasing EDCF from 1 to 21 kW/m(3)s, had a positive effect on fungus growth, whereas no effect on poxc gene expression was observed. However, the increase in EDCF favored the specific laccase production due to the generation of smaller pellets with less diffusional limitations and increased metabolically active biomass. The results show, for the first time, that hydrodynamic effects on growth and laccase production are mainly physical and diffusional, while the influence of the dissolved oxygen is at transcriptional level.

Acute movement disorders in the medical setting.

Objective Psychosomatic medicine psychiatrists are often tasked with the evaluation and treatment of complex neuropsychiatric states which may be motoric in phenotype. Little energy has been dedicated to understanding acute movement disorders in the hospital environment. Method Recognizing the importance of frontal-subcortical (corticostriatothalamocortical) circuitry and basal ganglia structures, we present a case series of acute movement disorder phenotypes resulting from underlying medical conditions, commonly-administered medications, or the interaction of both. We organize these scenarios into neurodegenerative disorders, primary psychiatric disorders, neuroinflammation, and polypharmacy, demonstrating a clinical example of each followed by background references on a variety of clinical states and medications contributing to acute movement disorders. In addition, we offer visual illustration of implicated neurocircuitry as well as proposed neurotransmitter imbalances involving glutamate, gamma aminobutyric acid, and dopamine. Furthermore, we review the various clinical syndromes and medications involved in the development of acute movement disorders. Results Acute movement disorder's involve complex interactions between frontal-subcortical circuits and acute events. Given the complexity of interactions, psychopharmacological considerations become critical, as some treatments may alleviate acute movement disorders while others will exacerbate them. Conclusion Integrating underlying medical conditions and acutely administered (or discontinued) pharmacological agents offers an interactional, neuromedical approach to acute movement disorders that is critical to the work of psychosomatic medicine.

Health assessment of gasoline and fuel oxygenate vapors: generation and characterization of test materials.

In compliance with the Clean Air Act regulations for fuel and fuel additive registration, the petroleum industry, additive manufacturers, and oxygenate manufacturers have conducted comparative toxicology testing on evaporative emissions of gasoline alone and gasoline containing fuel oxygenates. To mimic real world exposures, a generation method was developed that produced test material similar in composition to the re-fueling vapor from an automotive fuel tank at near maximum in-use temperatures. Gasoline vapor was generated by a single-step distillation from a 1000-gallon glass-lined kettle wherein approximately 15-23% of the starting material was slowly vaporized, separated, condensed and recovered as test article. This fraction was termed vapor condensate (VC) and was prepared for each of the seven test materials, namely: baseline gasoline alone (BGVC), or gasoline plus an ether (G/MTBE, G/ETBE, G/TAME, or G/DIPE), or gasoline plus an alcohol (G/EtOH or G/TBA). The VC test articles were used for the inhalation toxicology studies described in the accompanying series of papers in this journal. These studies included evaluations of subchronic toxicity, neurotoxicity, immunotoxicity, genotoxicity, reproductive and developmental toxicity. Results of these studies will be used for comparative risk assessments of gasoline and gasoline/oxygenate blends by the US Environmental Protection Agency.

NMDA Receptor Activity in Neuropsychiatric Disorders.

N-Methyl-d-aspartate (NMDA) receptors play a variety of physiologic roles and their proper signaling is essential for cellular homeostasis. Any disruption in this pathway, leading to either enhanced or decreased activity, may result in the manifestation of neuropsychiatric pathologies such as schizophrenia, mood disorders, substance induced psychosis, Huntington's disease, Alzheimer's disease, and neuropsychiatric systemic lupus erythematosus. Here, we explore the notion that the overlap in activity of at least one biochemical pathway, the NMDA receptor pathway, may be the link to understanding the overlap in psychotic symptoms between diseases. This review intends to present a broad overview of those neuropsychiatric disorders for which alternations in NMDA receptor activity is prominent thus suggesting that continued direction of pharmaceutical intervention to this pathway may present a viable option for managing symptoms.

Risk factors for positive depression screens in hospitalized cardiac patients.

BACKGROUND: Depression is common in patients with cardiac illness and is independently associated with elevated morbidity and mortality. There are screening guidelines for depression in cardiac patients, but the feasibility and cost-effectiveness of screening all cardiac patients is controversial. This process may be improved if a subset of cardiac patients at high risk for depression could be identified using information readily available to clinicians and screened. OBJECTIVE: To identify risk factors for a positive depression screen at the time of admission in hospitalized cardiac patients. METHODS: A total of 561 consecutively screened cardiac inpatients underwent the Patient Health Questionnaire-2 (PHQ-2). A prospective chart review was performed to assess potential risk factors for depression that would be readily available to front-line clinicians. Rates of risk factors were compared between patients with positive and negative PHQ-2 depression screens, and multivariate logistic regression was performed to assess whether specific risk factors were independently associated with positive screens. RESULTS: Of the 561 patients screened, 13.5% (n=76) had a positive depression screen (PHQ-2≥2). In the univariate analyses, several variables were associated with a positive depression screen. On multivariate analysis, an elevated white blood cell (WBC) count (>10×10(9) cells per liter) and prescription of an antidepressant on admission were independently associated with a positive depression screen, while current smoking showed a trend toward significance. CONCLUSION: Information on these three identified risk factors (WBC count, antidepressant use, and smoking) is readily available to clinicians, and patients with these diagnoses may represent a cohort who would benefit from targeted depression screening in certain settings.

Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients.

Impaired adherence to medications and health behaviors may mediate the connection between psychiatric symptoms and mortality in cardiac patients. This study assessed the association between improvements in depression/anxiety and self-reported adherence to health behaviors in depressed cardiac patients in the 6 months after cardiac hospitalization. Data were analyzed from depressed patients on inpatient cardiac units who were hospitalized for acute coronary syndrome, heart failure, or arrhythmia and enrolled in a randomized trial of collaborative care depression management (n = 134 in primary analysis). Measurements of depression (Patient Health Questionnaire-9), anxiety (Hospital Anxiety and Depression Scale, Anxiety subscale), and adherence to secondary prevention behaviors (Medical Outcomes Study-Specific Adherence Scale items) were obtained at baseline, 6 weeks 12 weeks, and 6 months. The association between improvement in depression/anxiety and adherence was assessed by linear regression after accounting for the effects of multiple relevant covariates. At all time points improvement in the Patient Health Questionnaire-9 was significantly and independently associated with self-reported adherence to medications and secondary prevention behaviors. In contrast, improvement in the Hospital Anxiety and Depression Scale, Anxiety subscale was associated with improved adherence only at 6 weeks. In conclusion, in a cohort of depressed cardiac patients, improvement in depression was consistently and independently associated with superior self-reported adherence to medications and secondary prevention behaviors across a 6-month span, whereas improvement in anxiety was not.

Depressogenic effects of medications: a review.

The literature is filled with reports that link medications with the onset or progression of depression. Because depression is so common in patients with medical illness, assessing whether a medication has in fact caused depression, or whether the relationship is coincidental, can be challenging. In this article, we review the literature on the association between medications and depression. For most agents, there are case reports or small studies linking the medication with the onset of depression, but more rigorous prospective studies are either lacking or found no association between the agent and depression. However, several medications, (eg, barbiturates, vigabatrin, topiramate, flunarizine, corticosteroids, mefloquine, efavirenz, and interferon-alpha) do appear to cause depression in some patients and should be used with caution in patients at risk for depression.

[Epidemiology and risk factors for microtia in Colombia]. / Epidemiología y factores de riesgo para microtia en Colombia.

INTRODUCTION AND OBJECTIVES: Microtia is a major malformation of the auricle, comprising a clinical spectrum ranging from a slight reduction in the size of the auricle or one of its parts to the complete absence of the pinna (anotia). Its prevalence varies according to the region of the world it is evaluated in. We analyzed a range of maternal, neonatal, and familial variables in a case group and a control group, and compared them with the existing literature. METHODS: We collected information from the Latin-American Collaborative Study on Congenital Malformations (ECLAMC) gathered between 2001 and 2006, where we found 27 cases of isolated microtia; we also collected information from 103 control subjects. Data were analyzed using Student's t and odds ratio (OR). RESULTS: Microtia distribution was 3 (11.1%) patients with grade I microtia, 19 (70.4%) with grade II microtia, 2 (7.4%) with grade III microtia. We found no patients with anotia. Regarding laterality, the right side was involved more often. Male-to-female ratio was 1.7:1. Birthweight pound 2,500 g produces an OR of 3.25 (95% CI, 1.11-9.58) for the development of microtia. CONCLUSIONS: Microtia may be directly or indirectly associated with the early onset of labour. Future studies should include long-term follow up of the patients in order to detect possible anomalies of the oculo-auriculo-vertebral spectrum. It is also important to take anthropometric measurements to increase the likelihood of detecting cases of grade I microtia and mid-face hypoplasia, and to define with greater accuracy whether isolated microtia is the mildest form of the oculo-auriculo-vertebral syndrome.

Experiencia en el tratamiento de la eyaculación precoz con alta bloqueadores asociados a terapia conductual / Experience in the treatment of premature eyaculation with alpha blockers associated with behavioral therapy

Se tratan 54 pacientes que padecen de eyaculación precoz o incontinencia eyaculatoria con fenoxibenzamina. Se administró por vía oral la droga a 40 pacientes en dosis de 10 mg diarios por un tiempo que fluctuó entre 5 y 7 semanas. A 14 pacientes se le administró placebo en la misma forma. Se obtuvo éxito en 80% (32/40) de los tratados con fenoxibenzamida y en 57,2% (8/14) de los que recibieron placebo. El resultado se considera promisorio, dado que el 58% de los tratados con droga acusaron efectos excelentes y buenos mientras que el placebo produjo sólo un 21,5% de resultados buenos y ninguno excelente. En los casos que fracasaron el tratamiento se prolongóm por cuatro semanas, indicándoseles además, la autoterapia de Lopicolo. Se logró así un 100% de rendimiento con fenoxibenzamina y un 78,5% con placebo, diferencia que es estadísticamente significativa (p < 0.01)

Analisis crítico retrospectivo de la uretrotomía interna endoscópica / Retrospective critical analysis of internal endoscopic urethrotomy

Se presenta un análisis retrospectivo de los resultados alcanzados en 136 uretrotomías internas endoscópicas practicadas en 95 pacientes portadores de estrecheces uretales en su mayoría inflamatorias (39%) y traumáticas (26%) localizadas de preferencia a nivel de la uretra bulbar (60%) y membranosa (30%). El 2,2% de las intervenciones fracasaron. Se registró un 17,6% de complicaciones siendo las más frecuentes la creación de falsa vía y la uretrorragia. Las recidivas ocurrieron en el 43,2% de los pacientes. De ellas el 46% se presentó antes del año y el 54% entre 1 y 4 años después de la uretrotomía inicial. En resumen, y desde un ponto de vista global, se considera que la uretrotomía endoscópica fue exitosa en el 56,8% de la casuística. Este porcentaje relativamente bajo induce a pensar en la necesidad de modificar la técnica del procedimientro o de complementarlo con dilataciones y calibraciones periódicas

Tratamiento de la impotencia coeundi con sustancias vasoactivas / Treatment of erectile impotence with vasoactive substances

Se define la impotencia coeundi o disfunción erectiva y se señala que obedece a causas psicogénicas o orgánicas. Entre estas últimas, que para algunos autores explican hasta el 80% de los casos, destacan la diabetes tipo I y II; la hipertensión arterial y la arterioesclerosis; el alcoholismo y el tabaquismo; los traumatismos y la cirugía perineal, etc. Se menciona la importancia de algunos neurotransmisores y entre ellos del VIP, en el mecanismo de la erección al relajar la musculatura lisa del tejido cavernoso. Se señalan los promisorios resultados alcanzados, hasta ahora, con el procedimiento de "prótesis farmacológica" basado en la inyección intracavernosa de medicamentos vasodilatadores y en particular de papaverina. Si el tiempo confirma los resultados preliminares, este procedimiento reducirá las indicaciones de las prótesis peneanas y de las operaciones de revascularización