Leukopenia associated with lamotrigine initiation after COVID-19 vaccine booster: A case report and literature review.

Adverse lamotrigine effects are more likely with concomitant use of antiepileptic drugs, rapid dose titration, and multiple drug use, highlighting the importance of measuring its concentration. Here, lamotrigine was administered the day after the third mRNA vaccination to a 20-year-old bipolar woman with these risk factors. Leukopenia occurred on day 12 without rapid concentration increase, but leukocytes gradually recovered after 22 weeks without discontinuation of lamotrigine. The second mRNA vaccination did not induce leukopenia. Possibly, a synergetic immune response to simultaneous vaccination and lamotrigine caused leukopenia, which recovered as the response weakened. Lamotrigine initiation immediately after mRNA vaccination may be a leukopenia risk factor.

Impact of beta blockers on resting respiratory rate in older adults: A cross-sectional study.

[Purpose] Beta blockers, commonly prescribed for older adults, affect heart rates and blood pressure and may reduce respiratory rates, which are used to evaluate patient status and predict outcomes. However, limited clinical evidence is available on the impact of beta blockers on respiratory rates. This study aimed to investigate the impact of beta blockers on respiratory rates in older adults. [Methods] This cross-sectional study included patients aged ≥60 years who underwent an annual checkup. Patients were excluded if they had a diagnosis of severe heart failure, chronic obstructive pulmonary disease, interstitial pneumonitis, severe anemia, or neurodegenerative disease. Doubly robust estimation with inverse probability weighting was applied to estimate the mean differences between beta blocker users and non-users. The dose-response relationship between the administered beta blockers and respiratory rates was examined using multivariable regression models. [Results] Of 637 participants, 108 had received beta blockers regularly. The adjusted mean differences (95% confidence interval, CI) in respiratory rates, pulse rates, systolic blood pressure, and diastolic blood pressure between beta blocker users and non-users were 0.35 (-0.68 to 1.37), -3.56 (-6.34 to -0.78), -5.53 (-8.53 to -2.52), and -4.70 (-8.27 to -1.14), respectively. The adjusted mean differences (95% CI) in respiratory rates per 1 mg of a carvedilol equivalent dose in all beta blocker users, liposoluble beta blocker users, and carvedilol users were -0.10 (-0.18 to -0.02), -0.35 (-0.59 to -0.11), and -0.29 (-0.54 to -0.06), respectively. [Conclusions] Beta blockers may dose-dependently reduce the respiratory rates of older adults. However, in clinical settings, the impact of beta-blocker use or non-use on the respiratory rate may not occur at a clinically important level. Clinicians should note the potentially suppressive impact of beta blockers on respiratory rates according to the situation.

Poststroke Mania During the COVID-19 Pandemic.

ABSTRACT: The pandemic of coronavirus infection 2019 (COVID-19) is stressing people's daily lives and making them more susceptible to various mental illnesses. Depression and suicide attempt as well as, strangely enough, manic patients are on the rise. The main complication of COVID-19 infection is ischemic stroke. Multiple lacunar infarcts in the white matter of the right middle cerebral artery region induce an imbalance of blood flow in the left and right cerebral cortex and risk causing mania. The increase in mania during the COVID-19 must be considered not only a primary increase due to stress but also poststroke mania secondary to COVID-19 infection.

PAIN THRESHOLD PARADOX IN SCHIZOPHRENIA: A NARRATIVE REVIEW BASED ON THE LASTEST NEUROSCIENCE.

INTRODUCTION: Pain is one of the basic defense responses of living organisms. Although the threshold for pain perception varies from person to person, there is no doubt that pain reduces a person's quality of life. Assessing the subjective experience of pain is especially important in the treatment of patients with schizophrenia. In light of recent advances in neuroscience, we discuss pain thresholds in patients with schizophrenia. METHODS: A narrative review of pain thresholds in patients with schizophrenia was conducted. We electronically searched the PubMed and Google Scholar databases for articles in English with "pain," "schizophrenia," "neural circuits," and "neurotransmitters" in the title or abstract, for the period January 2000 through June 2022. RESULTS: A seemingly contradictory phenomenon has been noted with regard to pain thresholds in patients with schizophrenia. One phenomenon is a high pain threshold for nociceptive stimuli, and the other is a low pain threshold in chronic pain. As a result, a pain threshold paradox has been observed. CONCLUSIONS: Many schizophrenia patients appear to have an excess of dopamine in the mesolimbic system, which stimulates both the descending pain inhibitory pathway and the salience network. As a result, a pain threshold paradox has been observed, in which the threshold for acute nociceptive pain is high and the threshold for chronic pain is low.

Transient global amnesia with transient anosmia: a curious case suggestive of middle cerebral artery occlusion.

BACKGROUND: Transient global amnesia (TGA) is an enigmatic amnestic syndrome and affects people in middle or older age. During an episode of TGA, a person is not able to make new memories, which indicates hippocampal damage. The symptom anosmia may be associated with memory impairment. CASE PRESENTATION: A 70-year-old woman presented to our emergency room with transient spatial memory loss. She also complained of a sudden loss of smell. Magnetic resonance angiography confirmed occlusion of the right middle cerebral artery. DISCUSSION AND CONCLUSION: The mechanism causing the transient anosmia may have resulted in a transient loss of hippocampal function, resulting in amnesia. This rare case is consistent with recent research showing that olfaction has developed as a navigation system.

Factors associated with the frequency of respiratory rate measurement by hospital nurses: a multicentre cross-sectional study.

BACKGROUND: Although the respiratory rate (RR) is a sensitive predictor of patient deterioration, it is often neglected. Moreover, only a few studies have investigated the factors that cause health professionals to disregard RR. AIMS: This cross-sectional study aimed to elucidate the factors affecting the frequency of RR measurement by the nurses. METHODS: An original questionnaire, comprising 18 factors extracted from previous studies, was administered to nurses from nine hospitals. FINDINGS: Of the 644 eligible nurses, 592 (92%) completed the questionnaire. The adjusted odds ratios and 95% confidence intervals of the factors of importance, educational experiences, shortened-count method use, negative experiences, and inconvenience were 2.24 (1.13-4.45), 2.26 (1.20-4.26), 0.61 (0.42-0.91), 0.45 (0.29-0.70), and 0.41 (0.26-0.65), respectively. CONCLUSION: Education, feedback systems, and automation are the primary issues that need attention. Prioritising these factors could provide a practical guide for optimising the frequency of RR measurement.