Impact of COVID-19-Related Social Distancing on the Incidence of Inpatient Aggression at a Public Psychiatric Hospital.

OBJECTIVE: This study explores the impact of coronavirus disease (COVID) pandemic-related social distancing measures on the incidence of inpatient aggression at a public psychiatric hospital Methods: Data was gathered from the hospital's unusual incident (UI) database for the time period ranging from January 1, 2015, to December 31, 2020. Based on the implementation of major social distancing measures, March 6, 2020, was set as a cutoff time point to categorize aggressive events into pre-COVID and post-COVID groups. Data was analyzed using Chi-square tests and general linear modeling. The p-value was set at ≤0.05. RESULTS: After the implementation of social distancing measures, there was a decrease in the absolute number of inpatient aggressive events from 15.0/week to 12.6/week (mean difference: 2.4/week, p=0.032). However, this decrease was primarily attributable to a decrease in hospital census. There was a decrease in the proportion of seven-day and 14-day post-admission aggressive events by 5.4% and 12.1%, respectively. Concurrently, there was a 4.9% increase in recurrent aggression. Emergency psychiatric medication administration and the use of physical restraint decreased during the COVID-19 pandemic. CONCLUSION: Consistent with previous results, this study reports a decrease in the incidence of inpatient aggression during the COVID-19 pandemic. Social distancing measures can be utilized as a tool to decrease the incidence of inpatient aggression and the use of physical restraints.

Isolated Neutropenia Due to Immune Checkpoint Inhibitors.

In this article, we explore the correlation between immune checkpoint inhibitors (ICIs) and neutropenia. Immune checkpoint inhibitors have revolutionized cancer treatment and management by maximizing the innate abilities of the immune system. However, this therapeutic potential is accompanied by a range of immune-related adverse effects (irAEs), including neutropenia, which is a rare but potentially life-threatening side effect of this mode of cancer treatment. Through an in-depth analysis of various case reports, we have compiled a detailed table summarizing the occurrences of neutropenia associated with different ICIs, the grades of neutropenia, treatments used, and patient outcomes. Management of neutropenia must include an approach based on early diagnosis of the condition and a treatment based on its severity. This review discusses different therapeutic interventions, ranging from the administration of corticosteroids and intravenous immunoglobulin (IVIG) to the use of granulocyte colony-stimulating factor (filgrastim) and, in very severe cases, a stem cell transplant. We have also enlisted salient side effects caused by these interventions. Our findings emphasize that while neutropenia is a relatively rare adverse effect of ICIs, its severity necessitates increased awareness among healthcare professionals. As ICIs continue to be seen as an integral component of cancer therapy, a comprehensive understanding of neutropenia as a side effect and its management is critical for optimizing patient outcomes. A crucial purpose of this review is to highlight the need to achieve a balance between acquiring the therapeutic benefits of various treatment strategies for irAEs and considering their potential side effects, especially with the use of steroids. Achieving this equilibrium is very important in optimizing patient care during immunotherapy, as these irAE management options can both mitigate the neutropenia triggered by ICIs and potentially give rise to secondary complications. Therefore, a careful assessment of the risks and benefits associated with each treatment approach is essential in tailoring irAE management.

Nivolumab-Induced Isolated Neutropenia.

Immune checkpoint inhibitors (ICIs) have been discovered to be associated with autoimmune toxicities that may present as dermatologic, gastrointestinal, hepatic, pulmonary, endocrine, and rarely hematologic reactions. Recent studies have also discovered hematological adverse effects as a result of ICI use of which isolated neutropenia is the gravest and the rarest manifestation. Asymptomatic neutropenia cannot be ignored, and close monitoring is, at least, warranted. Severe neutropenia with neutropenic fever needs hospital admission and prompt treatment to avoid further morbidity and/or mortality. In this report, we present a rare case of Grade 4 neutropenia resulting from nivolumab, anti-PD-1 antibody, in a patient diagnosed with invasive bladder cancer. The patient was successfully treated with steroids and supportive measures.

Artificial intelligence for neurodegenerative experimental models.

INTRODUCTION: Experimental models are essential tools in neurodegenerative disease research. However, the translation of insights and drugs discovered in model systems has proven immensely challenging, marred by high failure rates in human clinical trials. METHODS: Here we review the application of artificial intelligence (AI) and machine learning (ML) in experimental medicine for dementia research. RESULTS: Considering the specific challenges of reproducibility and translation between other species or model systems and human biology in preclinical dementia research, we highlight best practices and resources that can be leveraged to quantify and evaluate translatability. We then evaluate how AI and ML approaches could be applied to enhance both cross-model reproducibility and translation to human biology, while sustaining biological interpretability. DISCUSSION: AI and ML approaches in experimental medicine remain in their infancy. However, they have great potential to strengthen preclinical research and translation if based upon adequate, robust, and reproducible experimental data. HIGHLIGHTS: There are increasing applications of AI in experimental medicine. We identified issues in reproducibility, cross-species translation, and data curation in the field. Our review highlights data resources and AI approaches as solutions. Multi-omics analysis with AI offers exciting future possibilities in drug discovery.

Characterization of the short-term temporal variability of road dust chemical mixtures and meteorological profiles in a near-road urban site in British Columbia.

Implications: Non-tailpipe emissions driven by springtime road dust in northern latitude communities is increasing in importance for air pollution control and improving our understanding of the health effects of chemical mixtures from particulate matter exposure. High-volume samples from a near-road site indicated that days affected by springtime road dust are substantively different from other days with respect to particulate matter mixture composition and meteorological drivers. The high load of trace elements in PM10 on high road dust days has important implications for the acute toxicity of inhaled air and subsequent health effects. The complex relationships between road dust and weather identified in this study may facilitate further research on the health effects of chemical mixtures related to road dust while also highlighting potential changes in this unique form of air pollution as the climate changes.

Preimplantation genetic diagnosis of leukocyte adhesion deficiency type I.

OBJECTIVE: To describe the application of preimplantion genetic diagnosis (PF to a carrier couple for leukocyte adhesion deficiency type I disease (LAD-1), to achieve a healthy pregnancy. DESIGN: Case report. SETTING: Reproductive center and university hospital. PATIENT(S): A couple in which both partners were carriers for LAD-1; the female partner carried a G400A substitution in exon 4, and the male partner carried a C562T substitution in exon 5 in the CD18 gene. INTERVENTION(S): Day-3 cleavage-stage biopsy after standard in vitro fertilization (IVF) and genetic analysis of blastomeres for two mutations, along with a marker from chromosome 21. MAIN OUTCOME MEASURE(S): Birth of a child unaffected with LAD-1. RESULT(S): Fifteen oocytes were retrieved, of which 10 were fertilized; eight embryos were suitable for embryo biopsy. After genetic analysis, three embryos were found to be unaffected. According to embryo morphology, two embryos were transferred, resulting in the birth of an unaffected child. CONCLUSION(S): This is the first report of preimplantion genetic diagnosis for LAD-1. The successful birth of a healthy child provides evidence that for carrier couples of diseases for which traditional prenatal diagnosis and the decision of whether to terminate a pregnancy might not be acceptable, the application of PGD provides an alternative.

Natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes is a potential approach in infertility treatment.

OBJECTIVE: To describe pregnancies and live births that resulted from IVF of mature oocytes retrieved from dominant follicles in a natural cycle combined with in vitro maturation (IVM) of immature oocytes retrieved from small follicles. DESIGN: Case reports. SETTING: McGill Reproductive Center, Royal Victoria Hospital, McGill University. PATIENT(S): Three women with normal ovaries or polycystic ovaries who underwent infertility treatment. INTERVENTION(S): Administration of s.c. hCG (10,000 IU) 36 hours before oocyte retrieval in a natural cycle. After aspiration of all follicles, mature oocytes were inseminated immediately; immature oocytes were matured in vitro, inseminated by intracytoplasmic sperm injection (ICSI), and then the embryos transferred. MAIN OUTCOME MEASURE(S): Pregnancy and live birth. RESULT(S): Three pregnancies (two live births and one ongoing at time of writing) were achieved after the combination of natural-cycle IVF with IVM after transfer of the resulting embryos. CONCLUSION(S): Natural-cycle IVF combined with IVM might be a new approach to IVF treatment for women with various causes of infertility.

A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries.

OBJECTIVE: To establish the relative success of treatment by unstimulated in vitro maturation (IVM) of oocytes or stimulated in vitro fertilization (IVF) in women with polycystic ovaries undergoing assisted conception treatment. METHODS: The case-control study included 107 IVM and 107 IVF cycles matched for age and cause of infertility. In vitro maturation patients underwent transvaginal recovery of immature oocytes during an unstimulated cycle, in vitro oocyte maturation, and fertilization. Those in the IVF group underwent ovarian stimulation after pituitary suppression. Embryos were transferred in the same cycle in both groups. Main outcome measures included numbers of mature oocytes and embryos produced, and rates of implantation, pregnancy, live birth, and complications. RESULTS: In the IVM group after in vitro culture, 7.8 mature oocytes and 6.1 embryos were obtained per retrieval. With IVF, 12.0 mature oocytes (P <.01) and 9.3 embryos (P <.01) were obtained. The IVM pregnancy and live birth rates per retrieval were 26.2% and 15.9% compared with 38.3% and 26.2% for IVF (nonsignificant). The implantation rate of IVF-derived embryos was higher (17.1% versus 9.5%) than that for IVM (P <.01). There were 12 cases (11.2%) of moderate or severe ovarian hyperstimulation syndrome in IVF patients, compared with none in the IVM group (P <.01). CONCLUSION: Our results suggest that for women with polycystic ovaries who require assisted conception, IVM is a promising alternative to conventional IVF treatment.