Innovations in clinical neuroscience最新文献

Prevention of sexual assault in intellectual disability (ID) begins with defining the problem. There are identified risk factors and barriers faced by adults with ID who experience sexual assault. Research shows that individuals with ID are victimized by sexual assault at rates substantially higher than the general population. The perpetrators are usually trusted individuals in their environment, such as peers, caregivers, or family members. Effective prevention efforts require identifying risk factors and employing public health strategies. Finally, widespread adoption of evidence-based educational programs and proven strategies are necessities.

Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is one of the most widely prescribed antidepressant drugs in the United States due to its safety and efficacy. SSRIs are the first-line treatment for major depressive disorder and are also indicated for anxiety disorders, eating disorders, bipolar disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. Common side effects of SSRIs include insomnia, nausea, anxiety, headache, weight change, sexual dysfunction, and suicide risk. Seizures are a less common side effect of fluoxetine. This article presents the case of 19-year-old transgender male patient who developed seizures as a side effect of an intentional overdose of fluoxetine. Although marketed frequently as a safe medication, providers should be aware of the adverse effects of fluoxetine.

Background: Prognostic markers can optimize the management of acute ischemic stroke (AIS). Neuroglobin (Ngb), which plays a role in intraneuronal oxygen transport and hypoxia resistance, is a potential prognostic marker in AIS. Methods: A cohort study was conducted on patients with AIS treated at Dr. Cipto Mangunkusumo National Referral Hospital from March to April 2023. Serum samples for Ngb examination were collected three days after the onset of the stroke, while a modified Rankin Scale (mRS) was obtained after seven days and again after six months. National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), and Montreal Cognitive Assessment (MoCA-Ina) scores were obtained on the seventh day. Significance analysis and receiver operating characteristic (ROC) curve were used to determine the relationship between Ngb and AIS outcomes. Results: A total of 42 subjects underwent analysis. Serum Ngb levels were higher in subjects with mRS score of 3 to 6, compared to those with scores of 0 to 2 (median [range]: 12.42ng/mL [3.57-50.43] vs. 4.79ng/mL [2.25-37.32], p=0.005). The association with mRS persisted until six months post-AIS (p=0.004). The area under the ROC curve (AUC) was 0.75. Ngb levels were also higher in groups with higher NIHSS at discharge (p=0.03), lower BI (p=0.01), and lower MoCA-Ina scores (p=0.002). Clinical assessments (BI and NIHSS), along with evaluations of cognitive function and Ngb markers, can be employed to monitor patient progress and predict stroke outcomes up to six-months post-AIS. Conclusion: Higher serum Ngb levels in AIS are associated with poorer functional outcomes. Further research is needed before clinical application.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other health care professionals so "clinician" is used to indicate all treatment team members.

Background: Methadone is commonly utilized to treat opioid use disorder (OUD). Requirements to visit an opioid treatment provider (OTP) clinic for methadone treatment limits access to treatment, impacts quality of life, and reduces OUD treatment program retention. The Computerized Oral Prescription Administration (COPA) system is a dual-biometric dispensing device for take-home dosing that could reduce the impacts of methadone administration on patients and clinic staff.

Objective: To identify challenges for patients treated with methadone for OUD and gain their perspectives on COPA.

Methods: Adult patients treated with methadone at a single-site OTP clinic were recruited to complete a qualitative interview regarding their experience with methadone and the impact that expansion of take-home doses would have on their life. Participants were provided printed resources describing COPA and handled a COPA device before being asked for their perspectives.

Results: Participants (n=12) were 58.33 percent male and 41.67 percent female, and had no take-home doses (n=5), 2 to 5 days of take-home doses (n=4), or six or more days of take-home doses (n=3). Most (91.67%) participants desired more take-home doses, and 66.7 percent stated more take-home doses would reduce the negative impact of OUD treatment on their ability to work. Average time and cost per trip to obtain their methadone dose at the clinic was 75 minutes and $36.58, respectively. Participants responded positively toward COPA. Participants with no take-home privileges would pay $126.88 per month to obtain take-home privileges by using COPA, and those with take-home privileges would pay $30.31 per month to keep the same level of take-home doses and $117.50 per month to expand their take-home doses using COPA.

Conclusion: Participants endured a monetary and time burden to access their methadone treatment, and wished to have more take-home doses to reduce the frequency of their visits to the OTP clinic. Participants viewed take-home doses as having a positive impact on their ability to care for family members, hold a job, and travel, and they appreciated the key attributes of COPA and were willing to invest their own funds to gain access to the device. COPA is a potential solution to expand take-home methadone access to patients while ensuring safety, adherence, retention, and appropriate use.

Introduction: The demographics of the United States (US) are evolving as time progresses. The geriatric population is growing, with many elderly people dealing with mental health issues. Major depressive episodes affect 1 to 5 percent of those aged 65 years or older, which emphasizes the importance of addressing mental health concerns in this populace. This article explores how antidepressant use can lead to bleeding problems in geriatric patients, as the prevalence of treatment-resistant depression in these patients is increasing, along with the identification of the potentially life-threatening bleeding risks associated with these medications.

Methods: We did a comprehensive literature search using PubMed, EBSCOhost, and Google Scholar to find the articles pertinent to our subject. Reference lists of relevant articles were also reviewed.

Conclusion: These findings highlight the heightened risk of severe bleeding events linked to use of selective serotonin reuptake inhibitors (SSRIs) in the elderly. This was most notable among octogenarians and those with a history of upper gastrointestinal (GI) bleeding. This risk is accentuated when SSRIs are combined with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), the highest risk being observed with use of a combination of aspirin, clopidogrel, and SSRIs. Our review concludes that while the relative risk is high, the absolute risk remains low. However, caution is advised when prescribing SSRIs to individuals aged 80 years or older. These findings emphasize the need for tailored medication management, vigilant monitoring, and a patient-centered approach in prescribing antidepressants to geriatric patients. Balancing mental healthcare with potential bleeding risks is paramount in the evolving landscape of geriatric mental health.

Objective: Arab populations have a long tradition of consanguinity. In Morocco, consanguineous marriages are culturally favored. In this study, we assessed the effect of consanguinity on the occurrence of intellectual disability (ID) and investigated its association to education level and professional status in a series of Moroccan families.

Design: In total, 186 patients with ID were included in this study. Data were processed and analyzed with the IBM SPSS.

Results: The rate of consanguinity among the parents of children with ID was 34.95 percent. Marriages between first cousins accounted for 24.19 percent of consanguineous unions (FI=0.02). In the general population (n=300), 27.3 percent of marriages were consanguineous, with 22.66 percent being marriages between first cousins. Marriage between first cousins was the most common type of consanguineous marriage. The illiteracy rate was greater among women, compared to men (56.9% vs. 37.87%). The majority of mothers (81.11%) were housewives. A predominance of low professional status was observed among the men (62.22% of population, 22.7%). There was a high correlation between consanguinity and ID. The association between education level, professional status, and consanguinity rate in ID was not statistically significant (p>0.05).

Conclusion: The consanguinity rate in Moroccan families remains important. More strategies and efforts must be taken and reinforced for a better understanding and awareness of consanguinity risks to significantly reduce this practice.

Objective: Cognitive impairment is a recurrent complication in people with chronic kidney disease (CKD), which includes those undergoing hemodialysis (HD). Researchers aimed to analyze vitamin D levels, beta-amyloid 42, indoxyl sulfate, and serum parathyroid hormone (PTH) in patients with cognitive impairment who underwent HD.

Design: This comparative, cross-sectional study was conducted at the HD unit of Dr. M Djamil Padang Hospital. This study enrolled 60 patients with CKD who underwent routine HD and 20 normal subjects as controls. In both groups, serum levels of vitamin D, beta-amyloid 42, indoxyl sulfate, and PTH were measured using the enzyme-linked immunosorbent assay method, and cognitive function was assessed using the Indonesian version of the Montreal Cognitive Assessment neuropsychological test.

Results: The mean±standard deviation age of the study subjects was 51.48±11.44 years, with 53.4 percent being male. Vitamin D levels were higher in the control group, compared to the case group (p<0.05). The case group had higher levels of beta-amyloid, indoxyl sulfate, and PTH, compared to the control group (p<0.05). Significant differences were found in vitamin D and indoxyl sulfate levels between the groups with and without cognitive impairment (p<0.05).

Conclusion: Lower levels of vitamin D and higher levels of indoxyl sulfate were observed in the group with cognitive impairment when compared to the group without cognitive impairment.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other health care professionals so "clinician" is used to indicate all treatment team members.