Psychotropic Medication Prescriptions for Home-Based Palliative Care Oncology Patients.

Objective: To examine the complexities of psychotropic medication prescription in home-based palliative care for oncology patients.Methods: A retrospective analysis of 125 medical records of patients receiving palliative home care for cancer was conducted at a tertiary hospital, with a specific focus on the prescription patterns of psychotropic medications. The data were collected in September 2023.Results: Among 125 cases, the mean age was 64.4 ± 14.9 years, with 50.4% females. Breast cancer (14.4%) and lung cancer (13.6%) were the most common diagnoses. Psychotropic medication was administered to 35.2% of patients. Treatment was initiated by palliative care doctors in 75% of cases, while psychiatrists handled 25%. Medication selection was predominantly symptom driven (63%), with anxiety prompting benzodiazepine prescriptions in 50% of cases, depression resulting in antidepressant use in 22%, and psychosis leading to antipsychotic treatment in 18%. Specific diagnoses were the target in only 36% of prescriptions, with delirium (27%) being the most prevalent, followed by depression and bipolar disorder. Benzodiazepines were the most commonly prescribed class of medications (56.8%), with clonazepam being the most prevalent (40.9%), followed by alprazolam and lorazepam (15.9%). Atypical antipsychotics made up 43.1% of prescriptions, with quetiapine being the most frequently prescribed (34%), along with olanzapine and risperidone (11%). Antidepressants accounted for 31.8% of prescriptions, including selective serotonin reuptake inhibitors at 18% and mirtazapine and amitriptyline at 6% each. Haloperidol, a typical antipsychotic, was prescribed in 13.6% of cases. Polypharmacy was observed in 35.6% of patients.Conclusion: In palliative home care, psychotropic medications are frequently prescribed by palliative doctors primarily for symptom management, with limited psychiatric consultations and challenges in accessing psychological evaluations. Collaborative efforts among regional or institutional medical bodies, including psychiatrists, psychologists, palliative doctors, and social workers, are needed to establish ethical guidelines for appropriate and effective psychotropic prescription.Prim Care Companion CNS Disord 2024;26(2):23m03668. Author affiliations are listed at the end of this article.

Sensorineural hearing loss as an atypical presentation of typhoid fever: A case report.

Typhoid fever, also known as enteric fever, is a multisystemic infection primarily caused by Salmonella enterica serotype Typhi, and less commonly by Salmonella enterica serotypes Paratyphi A, B, and C. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. If left untreated, typhoid fever can progress to delirium, obtundation, intestinal haemorrhage, bowel perforation, and death within a month of onset. However, the clinical course can deviate from the classic stepladder fever pattern, which now occurs in as few as 12% of cases.1 In this report, we describe an atypical presentation as sensorineural hearing loss in an otherwise healthy young male.

Molecular docking studies on α-amylase inhibitory peptides from milk of different farm animals.

Milk-derived peptides have emerged as a popular mean to manage various lifestyle disorders such as diabetes. Fermentation is being explored as one of the faster and efficient way of producing peptides with antidiabetic potential. Therefore, in this study, an attempt was made to comparatively investigate the pancreatic α-amylase (PAA) inhibitory properties of peptides derived from milk of different farm animals through probiotic fermentation. Peptide's identification was carried out using liquid chromatography-quadrupole time-of-flight mass spectrometry and inhibition mechanisms were characterized by molecular docking. Results obtained showed a PAA-IC50 value (the amount of protein equivalent needed to inhibit 50% of enzymes) between 2.39 and 36.1 µg protein equivalent for different fermented samples. Overall, Pediococcus pentosaceus MF000957-derived fermented milk from all animals indicated higher PAA inhibition than other probiotic derived fermented milk (PAA-IC50 values of 6.01, 3.53, 15.6, and 10.8 µg protein equivalent for bovine, camel, goat, and sheep fermented milk). Further, molecular docking analysis indicated that camel milk-derived peptide IMEQQQTEDEQQDK and goat milk-derived peptide DQHQKAMKPWTQPK were the most potent PAA inhibitory peptides. Overall, the study concluded that fermentation derived peptides may prove useful in for managing diabetes via inhibition of carbohydrate digesting enzyme PAA.

Clinical efficacy of neurofeedback protocols in treatment of Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review.

Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder of childhood and its effects mostly continue to adulthood. Neurofeedback training has shown promising results in the treatment of ADHD. However, there is no yet consensus as to the efficacy of neurofeedback in comparison to stimulant medication. Despite a large number of meta-analyses and comparative reviews on the effects of neurofeedback in the treatment of ADHD, there is a lack of comparative reviews on the efficacy of neurofeedback protocols. This review aims at examining the effect of different training protocols on the efficacy of neurofeedback in the treatment of ADHD across specific research studies published between 2017 and 2022. Altogether, a total of 916 records were identified and 18 articles met the inclusion criteria. Findings show that the efficacy of different neurofeedback protocols has been comparable to the efficacy of stimulant medications. Nevertheless, there is still room for more clinical trials on neurofeedback protocols for ADHD since some studies suggest not using neurofeedback as a stand-alone treatment for ADHD. To my knowledge, this systematic review is the first to review neurofeedback protocols for ADHD. This study provides significant implications and directions for researchers to conduct research, on alternatives to stimulant medications for ADHD, in the future.

Outcomes of Neurorehabilitation Among Patients With Prolonged Disorders of Consciousness.

BACKGROUND:  The impact of neurorehabilitation on patients with prolonged disorders of consciousness (PDOC) is not well known. We assessed the range of motion (ROM), muscle girth and power, level of consciousness, development of musculoskeletal deformity, and superficial sensation. METHODS:  A retrospective observational record-based study was done, which included the data of patients diagnosed with PDOC admitted at Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, UAE, between 2020 and 2022. Data on the "range of motion", "muscle girth and power", "level of consciousness", "development of musculoskeletal deformity", and "superficial sensation" were collected and analyzed. The SPSS software version 27 (IBM Corp., Armonk, NY, USA) was used for analysis. The chi-square test was used to assess association, and the t-test was used to test the mean difference. RESULTS:  We assessed the data of 21 patients with PDOC. The superficial sensation was found to have increased significantly (p<0.025). There was a decrease in the proportion of patients with musculoskeletal deformities during the follow-up period. The ROM, muscle girth, and muscle power were also preserved without significant deterioration. However, the level of consciousness measured by the Glasgow coma scale (GCS) showed no improvement. CONCLUSIONS: Our research showed that neurorehabilitation significantly improves superficial sensation and prevents the development of musculoskeletal deformities. However, the mean level of consciousness remained the same. There was also no decrease in ROM. Both muscle girth and power were preserved over two years.

The potential effect of infliximab, dimethyl fumarate (DMF), and their combination in ciprofloxacin-induced renal toxicity in male rats.

The aim of this study was to evaluate the effectiveness of infliximab and dimethyl fumarate (DMF) in reducing renal damage induced by ciprofloxacin. Forty rats were divided into five groups of eight each, with normal saline and CIP 600 mg IP administered to all animals in Groups 1 and 2 for ten days. Groups 3 and 4 were administered infliximab 7 mg/kg and DMF 30 mg/kg 24 hours before the CIP injections. Group 5 received a combination of infliximab/DMF after 24 hours of CIP. The levels of TNF-α, NF-Bp65, and IL-6 were measured, and the results showed that both infliximab and DMF had similar effects. However, the combination of infliximab and DMF had a robust anti-inflammatory and antiapoptotic impact, reducing TNF-α, NF-Bp65, IL-6, and Bcl-2 compared to the renal control group. Bcl-2 immuno-expression was lower in the ciprofloxacin group compared to the control group. DMF and infliximab had no effect on Bcl-2-positive cells, whereas infliximab increased the percentage of Bcl-2-positive cells substantially. CIP induced nephrotoxicity by increasing cytokine release and cell death signaling. Both infliximab and DMF are powerful TNF-α blockers that suppress cytokine release, preventing cell death and apoptosis caused by cytokines. Controlling inflammation and apoptosis can prevent nephrotoxicity.

Remotely Monitoring COVID-19 Patient Health Condition Using Metaheuristics Convolute Networks from IoT-Based Wearable Device Health Data.

Today, COVID-19-patient health monitoring and management are major public health challenges for technologies. This research monitored COVID-19 patients by using the Internet of Things. IoT-based collected real-time GPS helps alert the patient automatically to reduce risk factors. Wearable IoT devices are attached to the human body, interconnected with edge nodes, to investigate data for making health-condition decisions. This system uses the wearable IoT sensor, cloud, and web layers to explore the patient's health condition remotely. Every layer has specific functionality in the COVID-19 symptoms' monitoring process. The first layer collects the patient health information, which is transferred to the second layer that stores that data in the cloud. The network examines health data and alerts the patients, thus helping users take immediate actions. Finally, the web layer notifies family members to take appropriate steps. This optimized deep-learning model allows for the management and monitoring for further analysis.

Massive purulent pericardial effusion with ultrasound features of tamponade secondary to non-typhoid Salmonella infection.

Purulent pericardial effusions are rare and represent the most severe form of bacterial pericarditis. The authors present a case of a male in his 40s with a massive purulent pericardial effusion due to non-typhoid Salmonella, who presented with ultrasound features of a cardiac tamponade. Invasive non-typhoid Salmonella cardiac infection is a rare but important consideration in immunocompromised individuals. This of particular concern in sub-Saharan Africa, where there is a high prevalence of HIV-infected individuals.

Impact of automated drug dispensing system on patient safety.

Objectives: Automated drug dispensing system (ADDs) is an emerging technology positively impacts drug dispensing efficiency by minimizing medication errors. However, the pharmacist perception of the impact of ADDs on patient safety is not well-established. This cross-sectional observational study aimed to evaluate the dispensing practice and pharmacist perception of ADDs towards patient safety through a validated questionnaire. Methods: A self-designed questionnaire was validated and the pharmacist perception of dispensing practice was compared between two hospitals adopting ADDs and traditional drug dispensing system (TDDs). Results: The developed questionnaire had an excellent internal consistency (both Cronbach's α and McDonald's ω coefficients were >0.9). Factor analysis retained three significant factors (subscales) that explained pharmacist perception of dispensing system, dispensing practice, and patient counseling (p<0.001 for each factor). The average number of prescriptions dispensed per day, drugs contained in each prescription, average time for labeling each prescription and inventory management were significantly varied between ADDs and TDDs (p=0.027, 0.013 0.044 and 0.004, respectively). The perception of pharmacists using ADDs on three domains were higher than the TDDs. The pharmacists in ADDs agreed that they had enough time to review the medications before dispensing than TDDs and this difference was found to be statistically significant (p=0.028). Conclusions: ADDs was highly effective in improving dispensing practice and medication review; however, the pharmacists need to emphasize the importance of ADDs to translate the pharmacists' freed-time towards patient care.

Tinnitus after Blast Injury; a Prospective Study in Basrah, Iraq.

BACKGROUND: There is many civilians and soldiers who exposed to explosions in Iraq each month and they need an otolaryngological and audiological assessment. OBJECTIVE: To recognize the possible auditory insults and the recovery period of the acquired damages that may resulted from explosion and help for planning of optimal management strategies of otological manifestations and prevent undesirable consequences. PATIENTS AND METHODS: A prospective, descriptive study included forty-seven patients who were exposed to blast injuries within two weeks came to otolaryngology unit in Basrah Teaching Hospital complaining from otological symptoms from July 2017 tell January 2019. Three periodic assessments were done for each patient. An initial evaluation was done in the 1st visit included a detailed history and examination to evaluate the symptoms and assess the associated non-otological injury. An otological examination were done for all patients in the three visits, included microscopic ear examination, photos for the perforated tympanic membrane were taken to grade the perforations depending on their surface area, Pure tone audiometry and tympanometry. Thirty-eight patients were available to follow up in the 2nd and 3rd visits. RESULTS: All of the 47 patients were young and middle age male, hearing loss and tinnitus were the most presenting symptoms, which improved with time. Hearing impairment mostly in the high frequencies however there was improvement in the subsequent visits. The majority of patients (93.6%) presented with tympanic membrane perforation mostly grade I which usually healed spontaneously. There was a statistically significant associations between the degree of tympanic membrane perforation and associated nonotological injuries and with the explosions if occurred in closed space. CONCLUSION: Blast related otological injury constitute the main cause of morbidity as the ear is the most sensitive organ to explosive blast injury. Hearing loss was the dominant symptoms at presentation mainly in high frequencies, but fortunately most of patients improved with time. Tympanic membrane perforation constituted the mostly seen sign, however spontaneous healing can be expected in the majority of cases.

Determinants Of Bowel Resection In Childhood Intussusception.

BACKGROUND: Intussusception is an acute surgical emergency and one of the most common causes of acute abdomen in early paediatric age group with peak incidence between 3 months to 3 years. It is considered the most common cause of intestinal obstruction in first two years of life. Early diagnosis and management may prevent major complications of bowel ischemia and necrosis thus avoiding morbidity and mortality. Our objective was to evaluate the risk factors or determinants of bowel resection in childhood intussusception. METHODS: It is a prospective, descriptive and cross-sectional study in which 102 consecutive cases of intussusception presenting to The Children's Hospital PIMS, from January 2018 to May 2019, were included. RESULTS: Total 102 patients were included in the study. Seventy-three (71.6%) were male and 29 (28.4%) were female. Mean age at presentation was 16.30 months (ranged from 1 day to 9 years). Mean duration of symptoms was 3.1 days. 52.9% (53/102) patients had mass palpable on abdominal examination while 22.5% (23/102) had palpable mass on digital rectal examination (DRE). Mean haemoglobin at presentation was 10.2 g/dL (min 4g/dL, max 26g/dL) and mean haematocrit was 32.6%. The most common type of intussusception was ileo-colic (57.8%) followed by ileo-ileal (21.6%). 36.3% (37/102) patients had to undergo bowel resection due to bowel gangrene/necrosis while in 66 (64.7%) patients had manual reduction. Statistically significant relationship was found between resection and duration of symptoms more than 24 hours (p=0.01, CI=95% OR= 6.24), haemoglobin less than 10g/dL (p=0.022, CI=95% OR=2.78) and haematocrit less than 30% (p=0.028, CI=95% OR=2.63). CONCLUSIONS: Prevention of anaemia and early presentation to a facility where trained paediatric surgeons are available can reduce the chances of bowel resection in childhood intussusception.

Electrocardiogram screening of deaf children for long QT syndrome: An Egyptian experience.

BACKGROUND: Jervell and Lange-Nielsen syndrome is an autosomal recessive form of long QT syndrome (LQTS), clinically manifested by long QT interval and bilateral sensorineural hearing loss (SNHL) with the highest prevalence in Norway and Sweden. No data are available about the prevalence of such syndrome in Egypt. OBJECTIVES: This study aimed to assess by electrocardiogram (ECG) the prevalence of LQTS among Egyptian children with SNHL. METHODS: One thousand and twelve patients, aged ≤ 10 years (mean age 5.8 ± 2.6), were included in this study, 578 male patients (57%) and 434 female patients (43%). A 12-lead ECG was recorded for all patients and the corrected QT interval (QTc) was calculated by Bazett's formula. The probability of LQTS was evaluated by Schwartz criteria and laboratory investigations were done on all patients with long QT interval. RESULTS: In the current study, the mean QTc interval was 411.7 ± 25.3 ms (range 343-675 ms). Twenty-one patients (2.1 %) had probable LQTS; of these, 11 patients had intermediate probability (Schwartz score 1.5-3 points) and 10 patients had high probability (Schwartz score ≥ 3.5 points). CONCLUSION: This study shows that 2.1% of Egyptian children with SNHL in a tertiary care setting have LQTS.

Tuberculous lumbar spinal epidural abscess in a young adult (case report).

INTRODUCTION: Spinal Epidural abscess (SEA) is an uncommon pathology that needs an urgent intervention to decompress the pressure on the spinal epidural sac, cord, and roots. The authors report a rare case of a young adult with lumbar spinal epidural tuberculous abscess occupying the spinal canal from L2-L5 vertebrae with extesion to the posterior paraspinal muscles and presenting with bilateral progressive lower limb weakness.   Case report: A 42 years old male teacher presented with a 15-day history of progressive difficulty to walking and bilateral lower limb weakness associated with fever, malaise and later on urinary incontinence. A magnetic resonance imaging (MRI) scan revealed a paraspinal intermuscular abscess and an abscess occupying the spinal canal compressing the dural sac from L2-L4/5, without any signs of vertebral involvement. Surgery was done by a posterior midline incision. Pus was evacuated from multiple pockets through the paraspinal muscle layers. Laminectomy for L3/4, and hemilaminectomy for L2/3, and L4/5 were performed. Pus and bone specimens were negative for acid-fast bacilli. However, both histopathological studies and Polymerase Chain Reaction (PCR) testing confirmed the presence of tuberculosis (TB). The patient received TB antibiotics, and a follow-up MRI scan at 2 months showed complete evacuation of the abscess. However, signs of L5 spondylitis were evident. No further surgery was needed as there was no vertebral collapse or neural compression and the patient's clinical condition was improving. He had normal right lower limb power and sensation and grade 4+ motor power of the left lower limb. Bowels and bladder function was normal. CONCLUSION: Isolated tuberculous spinal epidural abscess is a rare disease and should be treated urgently with evacuation and decompression. Signs of spondylitis or spondylodiscitis may appear later and therefore long follow up is recommended in tuberculous cases presenting with an isolated epidural abscess.

Occupational therapy in Oman: the impact of cultural dissonance.

Occupational therapy theory and philosophy are broadly considered to be based on Western cultural values. In contrast, the application of theory and practice in the Sultanate of Oman, historically based on traditional Middle Eastern and Islamic cultural values, provides a case exemplar, which highlights both paradigmatic differences and cultural dissonance. Drawing on the experiences of occupational therapists working in Oman, this study found that the application of therapeutic goals aimed at patient independence and autonomy were difficult to achieve in an environment where family duty and responsibility for care were highly prized. Dressing and cooking assessments were challenging, and issues related to gender proved problematic. Therapists found the need to adapt practice to acknowledge these differences, and to adopt pragmatic problem-solving strategies, without resolving the underpinning philosophical contradictions. Occupational therapy in Oman is under-researched; further work is needed to confirm the cross-cultural validity of specific assessments and practice models.