Sustained Low-Efficiency Daily Diafiltration with Hemoperfusion as a Therapy for Severe Star Fruit Intoxication: A Report of Two Cases

Abstract

Over the past decade, star fruit (Averrhoa carambola) intoxication decreased in the Taiwanese society due to improved public education on chronic kidney disease (CKD). Various complications including hiccups, altered levels of consciousness, coma, and seizures have been reported in individuals with renal failure who ingested fresh star fruit or star fruit juice. A high mortality rate (from 33 to 80%) was observed in patients with altered levels of consciousness, despite prompt dialysis and supportive care. According to previous case reports, the proposed treatment of choice for severe star fruit intoxication may be continuous renal replacement therapy with or without hemoperfusion. We report two cases of star fruit intoxication with stage V CKD (one case is predialysis) presenting with coma and generalized tonic-clonic seizures. The two patients were treated with sustained low-efficiency daily diafiltration (SLEDD-f) and charcoal hemoperfusion. Status epilepticus was controlled fairly quickly after treatment with SLEDD-f and hemoperfusion. However, the outcomes in this report are still poor (both remained comatose; one of two patients died). Currently, there are no data for the use of SLEDD-f with hemoperfusion for severe star fruit intoxication. SLEDD-f with charcoal hemoperfusion may play a role in managing refractory status epilepticus in patients with severe star fruit poisoning.     

Medication Use in Alzheimer's Disease and Healthy Aging

Abstract

The purpose of this research was to determine if decreased utilization of specific medication in individuals with Alzheimer's disease (AD) reflects a global process of decreased medication usage. Participants were 1103 individuals (461 controls; 437 probable AD; 161 possible AD, and 44 Mixed Dementia), drawn from our Alzheimer's Disease Research Registry. Medication usage at entry into the registry did not differ between controls and probable AD cases. Possible AD and the mixed dementia cases took significantly more medications than controls or probable AD cases. Longitudinal analysis showed no significant changes in controls and mixed dementia cases up to 2 years, and use increased in possible and probable AD cases over time. Stratification of subjects by MMSE scores at entry showed no significant difference between groups. Medication use in probable AD patients does not differ from controls, and does not seem to be subject to systematic bias based on disease progression (as measured by MMSE scores). The presence of co-morbidity adds to medication utilization. Cognitive impairment does not appear to affect total medication use, suggesting that specific medication utilization patterns are unlikely to be the result of larger usage patterns.     

Adaptive Sliding Transfer for Toileting

No abstract available for this article.     

Contributing to an integrated profession: a model-based examination of the A-ONE

Yerxa’s [1] model of an integrated profession depicts a circular scholarly process whereby ideas formed in practice are subjected to research and then returned to practice through education. This knowledge-generating cycle supports occupational science and the development of our professional identity. The aim of this article is to demonstrate how Yerxa’s model was used to evaluate if three developmental cycles of the ADL-Focused Occupation-Based Neurobehavioral Evaluation (A-ONE) sufficiently represented all necessary model components required for implementation into practice. The three cycles were historical, educational and measurement. The necessary components included: (a) dilemmas in practice, (b) new ideas that emerged from those practice issues, (c) research to test those ideas and (d) education designed to integrate new knowledge into practice. The results of this analysis of the A-ONE supported adequate research related to ideas from practice being implemented back into practice. Through using the model of an integrated profession to reflect on ideas ignited within practice, and then implementing research to explore the potential contribution of those ideas to knowledge generation, we gain the power to influence the future development of occupational science and the profession.     

中医药不同时机介入治疗脑梗死急性期

目的探讨中医药对脑梗死急性期患者不同时机介入治疗的疗效。方法在脑梗死急性期患者常规治疗的基础上,采用中医药介入疗法,时间点选择在治疗的第1、3、5、7天,利用美国国立卫生研究院卒中量表及日常生活活动量表(Brathel指数)等方法分析其临床疗效。结果Ⅲ组(第3天)介入中医药治疗总有效率为95.0%,优于其他各组。结论第3天介入中医药治疗效果最为明显,是相对平衡的介入时间点。     

Evidence of favorable sleep-EEG patterns in adolescent male vigorous football players compared to controls

Sleep is crucial for psychological functioning and daily performance. Both lay and scientific opinion hold that physical activity encourages restorative sleep. However, research on this in adolescence is limited. The aim of the present study was to compare sleep-EEG patterns of vigorous exercisers and controls. Twelve adolescent male football players (14 h of vigorous exercise per week) and 12 controls (1.5 h of vigorous exercise per week) matched for gender, age (about 16 years), and educational level, took part in the study. Sleep-EEG registration was performed following a day without exercise. Sleep-EEG analyses revealed that, compared to controls, the football players showed greater sleep efficiency, shortened sleep onset latency, less awakenings after sleep onset, more stage 4, and less REM sleep. Importantly, this pattern of results emerged following a day without exercise. Moreover, vigorous football players reported better daily performance and displayed less weeknight (Sunday to Thursday) to weekend night (Friday and Saturday nights) variation. Findings suggest that for the football players, vigorous exercise seemed to lead to longer-lasting electrophysiological change in brain activity irrespective of acute bouts of exercise.