An in vivo microdialysis assessment of concurrent MDMA and cocaine administration in Sprague–Dawley rats

Background and rationale  

Despite the popularity of polysubstance abuse among recreational methylendioxymethamphetamine (MDMA) users, relatively few controlled experimental studies have documented the neurobehavioral effects of MDMA in combination with other abused substances.     

Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment

Patients with idiopathic pulmonary fibrosis (IPF) inevitably experience declines in functional status that are most frequently due to progressive pulmonary fibrosis. However, the cause of the clinical deterioration is often uncertain, and disease progression is difficult to distinguish from disease-associated complications or adverse effects of therapy. In studies of the clinical course of IPF, mortality is most frequently due to respiratory failure (38.7%); other causes of death include heart failure (14.4%), bronchogenic carcinoma (10.4%), ischemic heart disease (9.5%), infection (6.5%), and pulmonary embolism (3.4%). Other, usually nonfatal, disease-associated complications include pneumothorax, corticosteroid-induced metabolic side effects and myopathy, and therapy-related immunosuppression. In evaluating clinical deterioration in patients with IPF, disease-associated complications and adverse effects of therapy should be distinguished from progressive pulmonary fibrosis. The cause of clinical deterioration will alter the therapeutic intervention required and will influence patient prognosis and duration of survival. This article examines the causes of clinical deterioration in patients with IPF and the diagnostic procedures for assessing disease-associated complications and staging IPF progression.     

Single, total paracentesis for tense ascites: sequential hemodynamic changes and right atrial size

Hemodynamic changes induced by a single, total paracentesis were evaluated in 21 patients with tense ascites from whom 4 to 16 L of ascites were drained over 2 to 8 hr with no serious complications. At 60 min, compared to baseline, there was an increase in cardiac output (7.7 +/- 0.5 to 8.5 +/- 0.6 L/min, p less than 0.02) and a tendency for right atrial pressure to decrease (9.3 +/- 0.8 to 7.50 +/- 0.8 mm Hg, NS), with no change in pulmonary capillary wedge pressure (10.9 +/- 0.9 to 10.7 +/- 0.9 mm Hg). Between 3 and 12 hr later, there was a drop in right atrial pressure, pulmonary capillary wedge pressure and cardiac output to 5.6 +/- 0.6 (p less than 0.02), 7.2 +/- 0.8 mm Hg (p less than 0.002) and 7.2 +/- 0.6 L/min (NS) respectively, indicative of the development of relative hypovolemia and suggesting that therapeutic plasma expansion is appropriate at this time. Two-dimensional echocardiography before paracentesis (n = 8) showed a reduction in the right to left atrium area ratio as compared with values in patients with minimal ascites (0.54 +/- 0.04 vs 0.82 +/- 0.02, p less than 0.0001). This technique may help in identifying patients with right atrial compression caused by tense ascites.     

Digital Social and Emotional Literacy Intervention for Vulnerable Children in Brazil: Participants’ Experiences

Social emotional literacy (SEL) interventions are widely implemented through schools, with growing evidence for a range of positive child outcomes. Increasingly, such interventions are delivered on online platforms. To date, there is limited evidence about digital SEL interventions in low- and middle-income countries (LMIC). The aim of this study was to explore the perceptions and experiences of children, parents and facilitator of the potential value of addressing SEL via tailored digital intervention. The intervention was designed to help children, in Brazil, to cope during the first COVID-19 pandemic lockdown. The intervention was delivered via a digital platform to groups of three children for 45 min per week for nine. Thirteen children, nine parents and nine facilitators were interviewed following the completion of the intervention. The data was analysed through a codebook thematic approach, which led to three themes: empowerment, participatory aspects of the intervention and digital adaptation. Overall, children’s SEL development was reported to be supported during the COVID-19 pandemic, by the application of new skills outside the sessions. Children reported a number of empowering factors such as being heard and belonging. A range of useful participatory tools were identified including storytelling, games, drawings and videos. Blended SEL interventions involving both face-to-face and web-based facilitation could be developed within a tiered model of universal mental health promotion and targeted prevention. Access to online platforms would increase reach to large numbers of children in LMIC, especially in contexts of disadvantage.     

Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures

Sixteen patients, with a fracture of the upper humerus treated with hemiarthroplasty, were followed-up for 45.7 +/- 15.1 (20-72) months after surgery. The results were assessed using the Constant-Murley scale. The mean score was 75.8 +/- 15.7 (54-96) points out of a possible maximum of 100. At the time of their last follow-up they underwent CT of the fractured and contralateral humerus. Humeral length and retroversion were measured and evaluated. A very good final outcome (Constant score more than 71) was achieved in patients with a difference in retroversion less than 10 degrees and a difference in length less than 14 mm, between fractured and sound humerus. The mean difference in retroversion was 8.7 degrees and the mean difference in length was 0.65 cm, between fractured and sound humerus. We attribute the very good clinical outcome in our series to the quality of the anatomical reconstruction that was performed.     

Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis

BACKGROUND: Rheolytic mechanical thrombectomy using the AngioJet catheter (Possis Medical, Minneapolis, MN) has been shown to be effective in the treatment of deep venous thrombosis (DVT). Additional infusion of thrombolytic agents via the device creates a novel treatment strategy of pharmacomechanical thrombectomy (PMT), which further enhances thrombectomy efficacy. The purpose of the current study was to compare the treatment outcome in patients with symptomatic DVT who underwent either catheter-directed thrombolysis (CDT) or PMT intervention. METHODS: During a recent 8-year period, clinical records of all patients with symptomatic lower leg DVT undergoing catheter-directed interventions were evaluated. Patients were divided into 2 treatment groups: CDT or PMT. Comparisons were made with regards to the treatment outcome between the 2 groups. RESULTS: A total of 93 patients who underwent 98 catheter-directed interventions for DVT were included in the study. Among them, CDT or PMT was performed in 46 (47%) and 52 (53%) procedures, respectively. In the CDT group, complete or partial thrombus removal was accomplished in 32 (70%) and 14 (30%) cases, respectively. In the PMT cohort, complete or partial thrombus removal was accomplished in 39 (75%) and 13 (25%) cases, respectively. Venous balloon angioplasty and/or stenting in the CDT or PMT groups was necessary in 36 (78%) and 43 (82%), respectively (difference not significant [NS]). Patients in the CDT groups underwent a mean of 2.5 venograms during the hospital course, in contrast to 0.4 venograms per patient in PMT cohorts (P < .001). Immediate (<24 hours) improvement in clinical symptoms in CDT and PMT groups was achieved in 33 (72%) and 42 (81%) cases, respectively (NS). Significant reductions in the intensive care unit (ICU) and hospital lengths of stay was noted in the PMT group (0.6 and 4.6 days) when compared to the CDT group (2.4 and 8.4 days). During follow-up visits, the primary patency rates at 1 year of CDT and PMT groups were 64% and 68%, respectively (NS). Hospital cost analysis showed significant cost reduction in the PMT group compared to the CDT group (P < .01). CONCLUSIONS: PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. When compared to CDT, this treatment provides similar treatment success with reduced ICU, total hospital length of stay, and hospital costs.     

T2 relaxation time analysis in patients with multiple sclerosis: correlation with magnetization transfer ratio

The aim of the current study was to perform T2 relaxation time measurements in multiple sclerosis (MS) patients and correlate them with magnetization transfer ratio (MTR) measurements, in order to investigate in more detail the various histopathological changes that occur in lesions and normal-appearing white matter (NAWM). A total number of 291 measurements of MTR and T2 relaxation times were performed in 13 MS patients and 10 age-matched healthy volunteers. Measurements concerned MS plaques (105), NAWM (80), and dirty white matter (DWM; 30), evenly divided between the MS patients, and normal white matter (NWM; 76) in the healthy volunteers. Biexponential T2 relaxation-time analysis was performed, and also possible linearity between MTR and mean T2 relaxation times was evaluated using linear regression analysis in all subgroups. Biexponential relaxation was more pronounced in black-hole lesions (16.6%) and homogeneous enhancing plaques (10%), whereas DWM, NAWM, and mildly hypointense lesions presented biexponential behavior with a lower frequency(6.6, 5, and 3.1%, respectively). Non-enhancing isointense lesions and normal white matter did not reveal any biexponentional behavior. Linear regression analysis between monoexponential T2 relaxation time and MTR measurements demonstrated excellent correlation for DWM(r=–0.78, p<0.0001), very good correlation for black-hole lesions(r=-0.71, p=0.002), good correlation for isointense lesions(r=–0.60, p=0.005), moderate correlation for mildly hypointense lesions(r=–0.34, p=0.007), and non-significant correlation for homogeneous enhancing plaques, NAWM, and NWM. Biexponential T2 relaxation-time behavior is seen in only very few lesions (mainly on plaques with high degree of demyelination and axonal loss). A strong correlation between MTR and monoexponential T2 values was found in regions where either inflammation or demyelination predominates; however, when both pathological conditions coexist, this linear relationship is lost.