Venlafaxine deprescribing and thyroid function.

STUDY OBJECTIVE: This report highlights the effects of discontinuing venlafaxine on thyroid function in an older adult with previously well-managed Hashimoto thyroiditis and sleep apnea. DESIGN: Concurrent intervention. CASE STUDY: Setting Community-based psychiatry practice Patient - 66 year old female Intervention Over 8 months, a 66-year-old patient slowly reduced the venlafaxine dose. She was treated simultaneously for sleep apnea. Measurements Clinical data including venlafaxine and levothyroxine dosing, thyroid hormone laboratory values, subjective complaints, and objective electrocardiographic (ECG) findings were aggregated and analyzed. MAIN RESULTS: As venlafaxine dose was decreased over time, the patient complained of bounding heart palpitations shown to be premature ventricular contractions, and wide and narrow complex ventricular tachycardia on ECG. Thyroid-stimulating hormone decreased from a baseline value of 0.791 uIU/mL to a nadir of 0.18 uIU/mL during venlafaxine dosage reduction from 225 mg/day to 155 mg/day. Cardiac symptoms subsided following levothyroxine dosage reduction. CONCLUSIONS: There was a direct relationship between antidepressant dosage reduction and levothyroxine dosage requirements. Cautious monitoring is recommended during venlafaxine deprescribing in patients with pre-existing thyroid disease.

Game Theory-Based Authentication Framework to Secure Internet of Vehicles with Blockchain.

The Internet of Vehicles (IoV) is a new paradigm for vehicular networks. Using diverse access methods, IoV enables vehicles to connect with their surroundings. However, without data security, IoV settings might be hazardous. Because of the IoV's openness and self-organization, they are prone to malevolent attack. To overcome this problem, this paper proposes a revolutionary blockchain-enabled game theory-based authentication mechanism for securing IoVs. Here, a three layer multi-trusted authorization solution is provided in which authentication of vehicles can be performed from initial entry to movement into different trusted authorities' areas without any delay by the use of Physical Unclonable Functions (PUFs) in the beginning and later through duel gaming, and a dynamic Proof-of-Work (dPoW) consensus mechanism. Formal and informal security analyses justify the framework's credibility in more depth with mathematical proofs. A rigorous comparative study demonstrates that the suggested framework achieves greater security and functionality characteristics and provides lower transaction and computation overhead than many of the available solutions so far. However, these solutions never considered the prime concerns of physical cloning and side-channel attacks. However, the framework in this paper is capable of handling them along with all the other security attacks the previous work can handle. Finally, the suggested framework has been subjected to a blockchain implementation to demonstrate its efficacy with duel gaming to achieve authentication in addition to its capability of using lower burdened blockchain at the physical layer, which current blockchain-based authentication models for IoVs do not support.

Gastric Electrical Stimulation and Sacral Electrical Stimulation: A Long-Term Follow-Up Study of Dual-Device Treatment.

AIMS: The objective of this study was to investigate sacral electrical stimulation (SES) and gastric electrical stimulation (GES) by comparing upper and lower gastrointestinal (GI) and genitourinary (GU) symptoms and quality of life, before treatment and in the long term after treatment. We hypothesized that dual-device treatment would greatly improve upper and lower gastrointestinal and genitourinary symptoms, as well as quality of life. METHODS: Fifty-four patients who underwent dual-device treatment (GES and SES) were enrolled in this study. Patients who had surpassed 24 months since the second-device insertion were included. Patients were evaluated before and after both devices were implanted and given a symptom questionnaire regarding their upper GI, lower GI, and GU symptoms and their quality of life. RESULTS: With combined treatment, a statistically significant improvement was seen in upper GI, lower GI, and GU symptoms and quality of life. However, fecal incontinence and fecal urgency improvements did not reach statistical significance, likely due to the small sample size. CONCLUSION: The implantation of two stimulators appears to be safe and effective to improve patients' quality of life for those with upper GI symptoms, bowel problems, and bladder dysfunction.

Hepatic MRI for fat quantitation: its relationship to fat morphology, diagnosis, and ultrasound.

PURPOSE: The value of MRI and ultrasound in quantifying hepatic steatosis is assessed and the results compared with those obtained by liver biopsies. METHODS: A total of 38 patients undergoing hepatic biopsy for a variety of liver diseases were recruited for this study. Hepatic fat morphology and severity were assessed visually in each biopsy specimen. Steatosis pattern included macrovesicular, microvesicular, or mixed. The severity of hepatic steatosis was assessed by MRI through chemical shift imaging (n = 38) and by ultrasound through echogenicity (n = 31). RESULTS: MRI had a better correlation than ultrasound for microscopic fat content (r = 0.77, P < 0.001 vs. r = 0.41, P < 0.05). In macrovesicular steatosis, MRI and ultrasound both correlated well with microscopic fat content (r = 0.92, P < 0.001 vs. r = 0.90, P < 0.001). In nonalcoholic fatty liver disease, ultrasound revealed severe steatosis in all instances, but MRI fat content ranged greatly (19%-40%). In diagnoses excluding nonalcoholic fatty liver disease, increasing ultrasound severity did not correspond to advanced MRI fat content. CONCLUSION: Hepatic MRI and ultrasound are both useful in identifying heavy fat accumulation associated with nonalcoholic fatty liver disease. MRI is superior to ultrasound in detecting and quantifying minor degrees of fatty metamorphosis in the liver.

Isolated gastrointestinal histoplasmosis: case report and review of the literature.

The usual manifestation of histoplasmosis is in the form of respiratory illness. We report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for Clostridium difficile. He was found to have isolated colonic histoplasmosis infection, which was treated with itraconazole. There was no evidence of any disseminated disease. His only immunocompromised state was end-stage renal disease, for which he was on chronic hemodialysis. Although it is well documented as a part of disseminated histoplasmosis, our extensive review of the literature did not reveal any reported case of isolated colonic histoplasmosis in a patient on hemodialysis.