In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

OBJECTIVE: During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. METHODS: Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. RESULTS: We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. CONCLUSIONS: Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.

Stabilization treatment of remitted psychotic depression: the STOP-PD study.

OBJECTIVE: We conducted a 12-week double-blind study of stabilization pharmacotherapy in patients with remitted psychotic depression (PD). METHODS: Seventy-one persons aged 18 years or older who had achieved remission of PD when randomized to either olanzapine plus sertraline or olanzapine plus placebo were continued on the double-blind treatment associated with remission. Symptoms of depression and psychosis, and weight, were measured once every 4 weeks. Cholesterol, triglycerides, and glucose were measured at stabilization phase baseline and Week 12/termination. RESULTS: The effect of treatment did not significantly change with time for depression, weight, or metabolic measures in the stabilization phase. Eight of the 71 participants (11.3%; 95% CI: 5.8, 20.7) experienced a relapse of major depression, psychosis, or both. Treatment groups did not differ in the frequency of relapse. In the entire study group, the adjusted estimate for change in weight was an increase of 1.66 kg (95% CI: 0.83, 2.48) and the adjusted estimate for change in total cholesterol was a decrease of 14.8 mg/dL (95% CI: 3.5, 26.1) during the 12-week stabilization phase; the remaining metabolic measures did not significantly change. CONCLUSION: Continuation of acute treatment was associated with stability of remission.

Evaluation of a gastric delivery system for iron supplementation in pregnancy.

The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system (GDS). Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present (hemoglobin concentration 80-110 g/L). The participants were randomly assigned to one of three study groups given no iron, two FeSO4 tablets (100 mg Fe) daily, or one GDS capsule (50 mg Fe) daily. Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes, including serum transferrin receptor. There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement. We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily, a GDS offers significant advantages for iron supplementation of pregnant women.

A comparison of the safety, efficacy, and distribution of ceforanide and cephalothin in coronary artery bypass graft surgery.

Antibiotic prophylaxis in open-heart operations is a widely accepted practice. Introduction of new antibiotics with differences in tissue distribution, spectrum of activity and therapeutic index prompts their evaluation as possible effective prophylactic agents. We compared the distribution, clinical efficacy, and safety of ceforanide with cephalothin as a prophylactic agent in coronary artery bypass graft (CABG) procedures. The results indicated that the intravenous administration of ceforanide at the dose of 1 gm every 12 hours for 2.5 days was equivalent to cephalothin 1 gm every 6 hours for 2.5 days. Serum, muscle, and bone concentrations of ceforanide were significantly greater than those of cephalothin. These concentrations consistently exceeded the minimal inhibitory concentration for Staphylococcus aureus, the major pathogen implicated in wound infections. No toxicty was observed with either antibiotic. Ceforanide merits consideration as a prophylactic antibiotic in CABG operations.

Clinical evaluation of the Codman microsensor intracranial pressure monitoring system.

INTRODUCTION: The use of the Camino fibre-optic subdural device for measuring Intracranial Pressure (ICP) in patients, has been shown to correlate well with recordings from the "gold standard" intraventricular fluid filled catheter [1]. Following this work, its use has become standard in the clinical monitoring of patients. More recently, laboratory studies have demonstrated accuracy, acceptable drift and high fidelity for the new Codman Microsensor ICP Transducer, a miniature strain gauge mounted on a flexible nylon catheter [3]. Its performance in patients, however, has yet to be fully assessed, in comparative studies. METHODS: Eight patients (5 head injured, 3 with an Intracerebral haematoma) had a Codman Microsensor inserted. A Camino Transducer was fitted immediately adjacent to it. A computerised system was used to continuously record both ICP readings. RESULTS: In total 140,323 recordings were made over a wide range of ICP values. Study periods ranged from 0.5 to 116 hours. In one patient the Codman transducer tracing failed after several days, probably due to fracture of electrical cable close to the interface box. The readings from the two ICP transducers were compared on Time Series, logistic regression and Altman-Bland plots. Drift of the ICP recorded by the Codman microsensor, was noted in 2 patients, 1 in positive direction (maximum 30 mmHg), 1 negative (max. 20 mmHg). In both cases the Camino ICP recording was relatively stable. In 24% of the recordings the Codman microsensor recorded ICP as 5 or more mmHg greater than the Camino, this difference was 10 mmHg or greater in 9% of recordings. Conversely the Camino recording was 5 mmHg or more, than the Codman, in 5% of all recordings, and 10 mmHg or more in 3%. CONCLUSION: These differences could in the majority of cases (excepting the negative drift) be explained by a constant offset of the Codman transducer, as described previously [6]. Further examination of this device is required.

[The Dufourmentel flap-plasty for treatment of chronic pilonidal sinus]. / Die Dufourmentel-Lappenplastik zur Behandlung des chronischen Sinus pilonidalis.

Thirty-seven patients with chronic sinus pilonidalis were treated after total excision by Dufourmentel flap. We saw seroma complications in three and wound infections in two cases. Patients stayed in hospital 6.3 days on an average and were able to work after 2.5 weeks. The method is easy to use. We have not seen a return to sinus problems in any of this cases.

Is oxygen required before atropine administration in organophosphorus or carbamate pesticide poisoning? - A cohort study.

BACKGROUND: Early and adequate atropine administration in organophosphorus (OP) or carbamate insecticide poisoning improves outcome. However, some authors advise that oxygen must be given before atropine due to the risk of inducing ventricular dysrhythmias in hypoxic patients. Because oxygen is frequently unavailable in district hospitals of rural Asia, where the majority of patients with insecticide poisoning present, this guidance has significant implications for patient care. The published evidence for this advice is weak. We therefore performed a patient cohort analysis to look for early cardiac deaths in patients poisoned by anticholinesterase pesticides. METHODS: We analysed a prospective Sri Lankan cohort of OP or carbamate-poisoned patients treated with early atropine without the benefit of oxygen for evidence of early deaths. The incidence of fatal primary cardiac arrests within 3 h of admission was used as a sensitive (but non-specific) marker of possible ventricular dysrhythmias. RESULTS: The cohort consisted of 1957 patients. The incidence of a primary cardiac death within 3 h of atropine administration was 4 (0.2%) of 1957 patients. The majority of deaths occurred at a later time point from respiratory complications of poisoning. CONCLUSION: We found no evidence of a high number of early deaths in an observational study of 1957 patients routinely given atropine before oxygen that might support guidance that oxygen must be given before atropine. The published literature indicates that early and rapid administration of atropine during resuscitation is life-saving. Therefore, whether oxygen is available or not, early atropinisation of OP- and carbamate-poisoned patients should be performed.

Postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is a widespread and often underestimated problem that invariably falls onto the shoulders of nursing staff. In order to find out how nurses view this condition, a major survey was conducted amongst members of the National Association of Theatre Nurses.

The metabolism of androgens in male pattern alopecia: a review.

Synopsis The studies carried out on the metabolism of testosterone and other circulating androgens in human scalp skin and hair follicles have been reviewed with the aim of understanding the role of these androgens in male pattern alopecia (baldness).

An evaluation of the HemoCue for measuring haemoglobin in field studies in Jamaica.

The HemoCue system utilizes the principle of oxidation of haemoglobin to hemiglobin by sodium nitrite and the subsequent conversion of hemiglobin to hemiglobinazide by sodium azide. The reagents for these reactions are contained within a small disposable microcuvette of approximately 10 microliters in volume. A venous or capillary sample is introduced into the microcuvette by capillary action and, after reaction with the reagents, the absorbance is read in the HemoCue photometer at 565 and 880 nm. The haemoglobin concentration is then displayed as a digital reading, in either g/dl or mmol/l in 15-45 seconds. We compared haemoglobin values obtained by the HemoCue system with those from the Coulter Counter S-Plus IV in 366 pregnant women in urban Jamaica, and found a highly significant correlation (r = 0.78, P < 0.01). However, because of the convenience and ease of use of this instrument and considering the relatively high cost, we recommend it for use only as a research tool in field studies where accurate and rapid haemoglobin determinations are required.