Transient Lactic Acidosis and Elevation of Transaminases after the Introduction of Remdesivir in a Patient with Acute Kidney Injury.

A 56-year-old woman was transferred to the intensive care unit (ICU) two days after an allogeneic stem cell transplantation (ASCT) when she presented acute respiratory distress due to the relapse of a SARS-CoV-2 infection. Following that, she received two intravenous doses of 100 mg remdesivir. Subsequently, the patient developed multiple instances of diarrhea, progressing to oliguria and acute kidney injury, necessitating continuous venovenous hemofiltration (CVVH). Despite the absence of signs of hypoxemia or cardiocirculatory failure requiring vasopressor intervention, a progressive lactic acidosis emerged. Two days after the onset of lactic acidosis, a significant rise in aminotransferases and lactate dehydrogenase occurred, in the absence of encephalopathy and coagulation disorders. Remdesivir therapy had been interrupted upon the initial signs of lactic acidosis. Despite an improvement in liver function tests and lactic acidosis, the patient's condition deteriorated, ultimately leading to her demise on day 29 due to newly arising hematological complications.

Tele-Operated Echography and Remote Guidance for Performing Tele-Echography on Geographically Isolated Patients.

OBJECTIVE: To evaluate the performance of three tele-echography systems for routine use in isolated medical centers. METHODS: Three systems were used for deep (abdomen, pelvis, fetal) and superficial (muscle, thyroid, carotid artery) examinations: (a) a robotic arm (RA) holding an echographic probe; (b) an echograph with a motorized probe (MP); and (c) remote guidance (RG) where the patient site operator performed the examination assisted by an expert via videoconference. All systems were tested in the same medical center located 60 km away from the university hospital. RESULTS: A total of 340 remote echography examinations were performed (41% RA and MP, 59% RG). MP and RA allowed full control of the probe orientation by the expert, and provided diagnoses in 97% of cases. The use of RG was sufficient for superficial vessel examinations and provided diagnoses in 98% of cases but was not suited for deep or superficial organs. Assessment of superficial organs was best accomplished using the MP. DISCUSSION: Both teleoperated systems provided control of the probe orientation by the expert necessary for obtaining appropriate views of deep organs but the MP was much more ergonomic and easier to use than the RA. RG was appropriate for superficial vessels while the MP was better for superficial volumic organs.

Teleoperated Echograph and Probe Transducer for Remote Ultrasound Investigation on Isolated Patients (Study of 100 Cases).

PURPOSE: The objective of this study was to design and validate a "Tele-Operated UltRasound System" ("TOURS") to perform ultrasound examinations on patients located in isolated areas. MATERIALS AND METHODS: A commercially available portable echograph was modified to allow functions (Doppler, two-dimensional, three-dimensional, elastography, etc.) and settings (gain, depth, freeze, record, etc.) to be teleoperated through an Internet connection. Specialized probes were developed that contained motorized transducers that could be teleoperated to change the transducer orientation. The system was installed and tested in four medical centers 50 km, 60 km, 1,800 km, and 7,000 km away from the university hospital. RESULTS: Using the teleoperated system, 100 examinations were performed on the abdomen and pelvis (36%), vascular structures (42%), and small parts (thyroid and muscle, 22%), and 15 were performed on fetuses. During these examinations the expert sonographer was able to teleoperate the echograph and motorized probe to obtain images of sufficient quality for diagnoses in 97% of the cases. The average time for one examination was 17 ± 4 min. This new system (dimensions of 400 cm(3) and weighing 430 g) was found to be more ergonomic that a robotic arm previously developed by us for tele-echography (dimensions of 35 × 40 × 40 cm(3) and weighing 3-4 kg). In addition, the teleoperation of the echograph settings and functions allowed for greater ease in acquiring images, resulting in faster examinations with improved quality images. CONCLUSIONS: The results of this study demonstrate that the teleoperated echograph and probe system developed by our research group can be successfully used for ultrasound examinations in areas isolated from trained sonographers.

[Urban or rural psychiatric practice: Any differences?]. / Psy des villes, psy des champs : quelles différences ?

In this reflection, the author first discusses her current psychiatric practice in an outpatient urban clinic. She discusses stress affecting many patients and its impact on them. What is stress? What is post-traumatic stress? What are its implications? How do patients adapt? The author presents some clinical examples. She then addresses her psychiatric practice in a rural setting in order to identify various aspects that highlight the differences between psychiatric practice in an urban and rural setting.

The efficacy of omega-3 supplementation for major depression: a randomized controlled trial.

OBJECTIVE: To document the short-term efficacy of omega-3 supplementation in reducing depressive symptoms in patients experiencing a major depressive episode (MDE). METHOD: Inclusive, double-blind, randomized, controlled, 8-week, parallel-group trial, conducted October 17, 2005 through January 30, 2009 in 8 Canadian academic and psychiatric clinics. Adult outpatients (N = 432) with MDE (Mini-International Neuropsychiatric Interview, version 5.0.0, criteria) lasting at least 4 weeks, including 40.3% taking antidepressants at baseline, were randomly assigned to 8 weeks of 1,050 mg/d of eicosapentaenoic acid (EPA) and 150 mg/d of docosahexaenoic acid (DHA) or matched sunflower oil placebo (2% fish oil). The primary outcome was the self-report Inventory of Depressive Symptomatology (IDS-SR(30)); the secondary outcome was the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS: The adjusted mean difference between treatment and placebo was 1.32 points (95% CI, -0.20 to 2.84; P = .088) on the IDS-SR(30) and 0.97 points (95% CI, -0.012 to 1.95; P = .053) on the MADRS. Planned subgroup analyses revealed a significant interaction of comorbid anxiety disorders and study group (P = .035). For patients without comorbid anxiety disorders (n = 204), omega-3 supplementation was superior to placebo, with an adjusted mean difference of 3.17 points on the IDS-SR(30) (95% CI, 0.89 to 5.45; P = .007) and 1.93 points (95% CI, 0.50 to 3.36; P = .008) on the MADRS. CONCLUSIONS: In this heterogeneous sample of patients with MDE, there was only a trend toward superiority of omega-3 supplementation over placebo in reducing depressive symptoms. However, there was a clear benefit of omega-3 supplementation among patients with MDE without comorbid anxiety disorders. TRIAL REGISTRATION: controlled-trials.com Identifier: ISRCTN47431149.

Effects of different doses of venlafaxine on serotonin and norepinephrine reuptake in healthy volunteers.

Venlafaxine is generally considered to be a dual 5-HT and NE reuptake inhibitor when it is used at doses above 75 mg/d in humans. While its 5-HT reuptake-inhibiting property has been demonstrated, some controversy still exists regarding the doses of venlafaxine required to inhibit NE reuptake. Healthy male volunteers received, on a double-blind basis, paroxetine (20 mg/d), desipramine (100 mg/d), nefazodone (300 mg/d), or venlafaxine (150 or 300 mg/d) in the last 5 d of a 7-d period of administration. Inhibition of 5-HT reuptake was estimated by determining the degree of depletion of whole-blood 5-HT, while that of NE was assessed by measuring the attenuation of the systolic blood pressure increases produced by intravenous injections of tyramine. Paroxetine, both regimens of venlafaxine, and to a lesser extent desipramine significantly decreased whole-blood 5-HT content. Nefazodone failed to produce any significant change. Desipramine abolished the tyramine pressor response, whereas all other drug regimens left this parameter unaltered. Venlafaxine and paroxetine acted as potent 5-HT reuptake inhibitors in the present study. In contrast, neither the moderate nor the high dose of venlafaxine displayed any significant inhibiting activity in this model assessing NE reuptake in peripheral NE terminals. The validity of the model was confirmed by the potent inhibitory action of desipramine on NE reuptake. While the reasons for this unexpected lack of action remain unclear, venlafaxine appeared to be an effective NE reuptake agent in depressed patients using the same approach.

Differential physiological effects of a low dose and high doses of venlafaxine in major depression.

Venlafaxine is an antidepressant drug with demonstrated serotonin (5-HT) and norepinephrine (NE) reuptake blockade properties in electrophysiological and microdialysis experiments in laboratory animals. In healthy volunteers, its 5-HT reuptake-inhibiting potential has also been clearly documented, but not its NE reuptake blockade action. This double-blind study compared the effects of a low dose (75 mg) and of a forced titration of high (up to 375 mg in 1 wk) daily doses of venlafaxine. Forty-four patients with major depression according to DSM-IV criteria were assessed bi-weekly for the first 2 wk and weekly for the next 2 wk. Inhibition of 5-HT reuptake was estimated using the depletion of whole-blood 5-HT, while that of NE was assessed using the attenuation of the systolic blood-pressure elevations produced by intravenous injections of tyramine. Forty-two patients completed the study. Both the low and the high doses of venlafaxine decreased the levels of 5-HT to the same extent: the reduction was of about 55% after 1 wk and of 75% after 4 wk. The 75 mg/d dose of venlafaxine did not alter the tyramine pressor response, whereas, in patients receiving the higher regimens of venlafaxine, there was a significant attenuation of the pressor effect of tyramine. There was no significant difference between the two treatment arms regarding the modifications of the depression scores. The present data showed that, at its minimal effective dose in depression (75 mg/d), venlafaxine acted as a selective 5-HT reuptake inhibitor, whereas when administered at higher doses (225 and 375 mg/d), it acted as a dual 5-HT and NE reuptake inhibitor.