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The global emergence of -COVID-19 has prompted rapid therapeutic and vaccine advancements; however, clinical evidence remains limited. With around a 50% fatality rate for COVID-19 patients with acute respiratory distress syndrome (ARDS), early intervention is crucial. This report details a severe case of post-COVID-19 thrombocytopenia in a 79-year-old man and emphasizes its critical nature. Despite negative initial COVID-19 test results, subsequent positive results led to treatment initiation, and severe thrombocytopenia persisted resulting in bleeding complications and death. Recognized as a hematological manifestation of COVID-19, thrombocytopenia in this geriatric patient highlights the need for extended post-COVID-19 monitoring and management. This underscores the importance of vigilance and timely intervention, especially in vulnerable populations, and emphasizes the need for further research to understand the intricate relationship between COVID-19 and thrombocytopenia.
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INTRODUCTION: International standards for enteral feeding involving the use of feeding tubes with junctions have been introduced. If these junctions are not properly cleaned, they can become contaminated, leading to microbial infections. We aimed to compare the ease and effectiveness of cleaning of four methods using the number of bacteria. METHODS: We compared enteral nutrition tube junctions cleaned using four methods such as water, toothbrush, cotton swab, and EnClean® brush with an uncleaned control. Once daily for 7 days, the tubes were injected with nutrients, cleaned, and incubated at 37°C. Samples for bacterial culture were collected before injections on days 7, 14, 21, and 28. The culture samples were incubated at 37°C for 48 h, and the number of colonies was counted. RESULTS: The number of residual bacteria on day 28 did not differ between the four cleaning methods and the control group. Moreover, no significant difference was observed in bacterial counts among the four wash methods. The number of washes did not differ among cleaning methods. CONCLUSION: The bacterial count in the ISO-standardized tube junction increased, and none of the cleaning methods decreased the counts.
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Nutrição Enteral , Intubação Gastrointestinal , Bactérias , Nutrição Enteral/métodos , HumanosRESUMO
AIM: Atomoxetine (ATX) is a non-central stimulant and a standard treatment for adult attention-deficit/hyperactivity disorder (ADHD). The long-term efficacy of Atomoxetine is about 40% at 6 months. The variability in efficacy between individuals is thought to be related to patient-specific factors, but no detailed research has been conducted. In this retrospective cohort study, we aimed to identify the factors associated with Atomoxetine efficacy. METHODS: A total of 147 patients with attention-deficit/hyperactivity disorder aged ≥18 years who were using Atomoxetine for the first time were included in this study. The outcome was treatment success (treatment maintained for at least 6 months and improvement in symptoms). Symptom assessment was based on the overall improvement in symptoms judged by an expert physician. RESULTS: Of the patient sample, 103 (70.1%) achieved the outcome. Logistic regression analysis identified "the maximum dose of ATX" and "gambling habit" as factors associated with efficacy ( P < 0.05). In the process of Atomoxetine titration, the larger the maximum dose, the higher the efficacy was shown to be. Gambling habits may be indicative of impulsivity, which is among the core symptoms of attention-deficit/hyperactivity disorder. Thus, a gambling habit may be considered a surrogate marker for impulsivity. CONCLUSIONS: Knowledge of these factors will help healthcare professionals to predict the likely efficacy of Atomoxetine in a given patient before subscribing it, facilitating individualized pharmacotherapy for adult attention-deficit/hyperactivity disorder.
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Transtorno do Deficit de Atenção com Hiperatividade , Adolescente , Inibidores da Captação Adrenérgica/uso terapêutico , Adulto , Cloridrato de Atomoxetina/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Humanos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: We conducted a historical cohort study of patients with schizophrenia to identify more robust risk factors at discharge that contribute to readmission within a year. METHODS AND FINDINGS: The subjects underwent brief psychoeducation during hospitalization. Multivariate analysis was conducted using factors selected in the univariate analysis. Using logistic regression analysis, the number of hospital admissions (P = .01) and Schedule for Assessment of Insight Japanese version score (P = .04) were identified as risk factors for readmission, with odds ratios of 0.70 and 1.18, respectively. CONCLUSIONS: These results suggest that improvement in insight and early intervention may lead to a more stable community life.
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Esquizofrenia , Estudos de Coortes , Humanos , Alta do Paciente , Readmissão do Paciente , Fatores de Risco , Esquizofrenia/epidemiologia , Esquizofrenia/terapiaRESUMO
PURPOSE: To identify factors for choking in psychiatric wards that can be easily screened. DESIGN AND METHODS: Data were collected from patients admitted to the acute phase psychiatric wards who were assessed for swallowing function by dentists. We defined 47 and 102 patients of choking in the high- and low-risk groups, respectively. FINDINGS: Through multivariate analysis, we identified basal metabolic index and two Drug-induced Extra-pyramidal Symptoms Scale items, bradykinesia and tremor, as independent choking factors. PRACTICE IMPLICATIONS: Choking risk is related to patient tolerability rather than to the absolute severity of psychiatric symptoms or psychotropic dose.