Notes

Structural Foundation and Method involving Actions for two main Generally Neutralizing Antibodies Against SARS-CoV-2 Emerging Variants of interest.
Electroconvulsive therapy (ECT) may be considered for treatment of severe, treatment-resistant, and emergent depression associated with MDD or bipolar disorder. Patients with epilepsy usually take medications that raise the seizure threshold, which poses challenges during ECT. We report a 66-year-old male with epilepsy taking levetiracetam extended-release (XR), lorazepam, and zonisamide requiring ECT for severe MDD. After literature review, the XR form of levetiracetam was changed to higher doses of the immediate-release (IR) formulation, and zonisamide was discontinued 2 days prior to ECT in the hospital and was resumed when the patient underwent outpatient continuation ECT. The patient was treated to remission after receiving 8 acute bilateral ECT treatments before being transitioned to continuation ECT. We provide a brief review of medication management of antiepileptic drugs and other medications that increase the seizure threshold during ECT. To our knowledge, this is the first reported case describing the management of levetiracetam, lorazepam, and zonisamide concomitantly during ECT. Our case suggests that utilizing the IR formulation of levetiracetam, administering the evening dose early the day prior to the procedure, and temporarily discontinuing zonisamide prior to bilateral ECT is effective for the treatment of severe MDD while maintaining seizure prophylaxis.The divalproex (DVP) package insert states that rifampin may increase the oral clearance of valproate by 40% and that valproic acid derivative dose adjustments may be required when starting or stopping rifampin. However, the overall clinical significance of this drug-drug interaction remains unclear given that limited clinical outcome data has been published. This case describes a 52-year-old female with bipolar disorder, borderline personality disorder, and PTSD who was previously stable on a medication regimen consisting of DVP delayed-release 500 mg every morning and 1500 mg every evening (baseline steady-state trough 99.8 mcg/mL). Throughout rifampin therapy for latent tuberculosis treatment, she required an increase in both the frequency of DVP administration, from 2 to 3 times daily, and DVP dose by 75% to maintain clinical stability. Valproic acid trough concentrations ranged from 56.4 to 75.9 mcg/mL during the 4-month course of rifampin. This report supports that the DVP-rifampin interaction may be clinically significant and of a greater magnitude than suggested by the package insert.
Dosing recommendations for paliperidone long-acting injectable antipsychotic (LAIA) do not include oral antipsychotic (OAP) overlap; however, OAPs are often given concurrently despite limited evidence describing both the risks and benefits of this practice.

A retrospective chart review was conducted in patients initiated on paliperidone palmitate (PP) during a psychiatric hospitalization to compare patients who received OAP overlap versus those who did not. The primary outcome is the proportion of patients who receive prescription claims for benztropine, a medication commonly prescribed for extrapyramidal symptoms, at the time of LAIA discontinuation and 6 months postdischarge. Secondary outcomes include prescription claims for beta blockers and diphenhydramine, number of psychiatric emergency visits and hospitalizations, length of stay of the index hospitalization, frequency of LAIA discontinuation and the time to LAIA discontinuation.

There is a significant difference in the proportion of benztropine prescription claims in the OAP overlap group versus the no-overlap group at the time of LAIA discontinuation (30% vs 0%,
 = .046) but not at 6 months postdischarge. There are also significant differences in the number of psychiatric emergency visits (0.7 vs 0.1,
 = .02) and psychiatric hospitalizations (0.6 vs 0.1,
 = .029) at the time of LAIA discontinuation. No other differences are observed in defined secondary outcomes.

Patients who receive OAP overlap while receiving PP receive more benztropine and have more psychiatric emergency visits and hospitalizations than those treated without OAP. Larger studies with better control for confounding variables are needed to confirm these results.
Patients who receive OAP overlap while receiving PP receive more benztropine and have more psychiatric emergency visits and hospitalizations than those treated without OAP. Larger studies with better control for confounding variables are needed to confirm these results.
Despite the paucity of studies evaluating short-acting parenteral second-generation antipsychotics in the medically ill, their use in this population has increased. The purpose of this study was to characterize the use of IM olanzapine and ziprasidone in the medically ill at an academic medical center.

This is a retrospective medical record review of all patients who received IM olanzapine or ziprasidone on nonpsychiatric inpatient units at a large academic medical center from August 1, 2015 to July 31, 2017. The primary endpoint characterized the indication for use. Secondary endpoints included safety, effectiveness, and prescribing patterns.

After exclusion criteria, a total of 100 patients were included in this study, predominantly white males with a mean age of 56 years. Seventy-four percent of patients received IM ziprasidone and 26% received IM olanzapine. The most common indications for use were agitation of nonpsychotic origin (40%) and delirium (33%). Patients received IM olanzapine and ziprasino patient developed Torsades de Pointes even when combined with other agents that putatively increase QTc. Given the retrospective, single-center, nonrandomized design of this study, the safety and effectiveness of these parenteral second-generation antipsychotics in common causes of acute agitation should continue to be further evaluated.
Patients who are transgender have unique population-specific needs and risk factors. Nationwide surveys of health profession school administrators indicate a gap in coverage of lesbian, gay, bisexual, and transgender health content in their curricula. To address this gap, a pharmacist-developed transgender-health care focused seminar was presented to medical professionals, trainees, and students accompanied by a novel education assessment scale.

The seminar was presented by a psychiatric pharmacy resident to health care professionals and trainees in various settings. Subjects covered during the seminar included terminology, diagnostic criteria and prevalence of gender dysphoria, nonhormonal treatment, gender-affirming hormone therapy, and other considerations. The Trans* Health Education Evaluation Scale (THEES) was developed to assess participants' self-perceived proficiency regarding care of patients who are transgender immediately before and after attending a seminar. Total scale scores were compared prsonnel as measured by THEES.Contact dermatitis is an increasingly common dermatologic condition, and it is generally associated with exposure to an irritant or allergen that causes pruritic skin lesions of varying size and severity. Formaldehyde, frequently found in household products, preservatives, and fabrics, is a common trigger for allergic contact dermatitis (ACD). We report the unique case of an ACD flare in a patient, which was caused by contact with a backpack while he was traveling abroad. Necrostatin 2 The patient's right arm was in contact with the backpack's shoulder straps every time he would put on the backpack. As a consequence, he developed a pruritic erythematous rash on his right arm. The patient had undergone patch testing prior to the trip, which had shown a positive reaction to formaldehyde, among other compounds. The patient started noticing the resolution of the rash once he stopped using this specific backpack.Transcarotid artery revascularization (TCAR) procedure is a novel hybrid surgical modality in treating carotid stenosis. Understanding the various steps of the TCAR and the unique challenges involved in the anesthetic management is essential for the successful conduct of anesthesia. In this article, we discuss the overview of the key issues relevant to the anesthetic management and strategies from our experience. We present the data on anesthetic management and outcomes of 40 patients who underwent TCAR procedure at our institute between June 2018 and February 2020. Electronic medical records were retrospectively reviewed and relevant demographic, clinical, and laboratory data were collected. All our patients had general anesthesia with an endotracheal tube utilizing standard American Society of Anesthesiology (ASA) monitoring along with intra-arterial blood pressure monitoring and cerebral oximetry. The mean age of our patients was 73.6 ± 7.58 years. Fifteen (37.5 %) patients had significant co-morbidities, anesthesia to mitigate hemodynamic response during extubation. The mean blood loss was 74 ml ± 33.19 ml, and none of our patients received blood transfusion during the perioperative period. The mean duration of anesthesia was 202.6 ± 27.85 minutes, and the mean length of hospital stay was 1.5 ± 0.97 days. A thorough preoperative examination with specific attention to the preoperative neurological deficits and cardiopulmonary reserve is important for the meticulous management of intraoperative hemodynamics. Intraoperative administration of glycopyrrolate and the use of vasopressors to maintain optimal hemodynamics to ensure cerebral perfusion during the perioperative period should be considered. The anesthetic goals of carotid revascularization (TCAR) are perioperative hemodynamic stability and early evaluation of neurological status in the immediate postoperative period.Mooren's ulcer, a rare ophthalmic disease, presents clinically as a painful, chronic, peripheral corneal ulceration of unknown etiology with some autoimmune origin evidence. It begins with an intense limbal inflammation, leaving behind an opaque cornea. If left untreated, progressive damage and corneal degeneration can lead to permanent loss of vision. Herein, we present a classic case of Mooren's ulcer in the right eye of a 60-year-old male patient with no known comorbid condition. No underlying systemic disorder being the rarity in our case, the cause remains idiopathic. The patient was previously diagnosed with having Mooren's ulcer in his left eye 10 years ago. Despite multiple topical treatments and surgical interventions, there was a complete loss of vision. He presented exaggerated manifestations, including pain, redeye, watery eye, photophobia, and the progressive decline of vision. A combination of multiple pharmacological and surgical interventions, including lateral tarsorrhaphy, amniotic membrane grafting, conjunctival flap, and scleral patch graft, was tried to ameliorate the affected eye but failed to salvage the eye permanently.The ability to communicate enables people to share information, thoughts, and concerns with others in a certain time and place. Communication plays a fundamental role across a variety of institutions. However, the stakes are exceptionally high in primary health care (PHC). Poor communication in PHC increases the patient's risk of medication errors, patient injury, delay in treatment, and/or death. Effective communication is especially critical when health providers communicate with seniors because aging is partly responsible for physical, mental, and social/emotional changes. Studies have suggested that simulations are an effective means to train health providers in the development/enhanced communication skills; however, current educational programs focus on physical and cognitive aspects of aging. This editorial highlights possible contributions from the communication accommodation theory (CAT) to structure a communication training strategy that may help to improve healthcare providers' ability to converse and connect with the vulnerable older population and address their social and emotional well-being.
Website: https://www.selleckchem.com/products/nec-1s-7-cl-o-nec1.html