Innovations in clinical neuroscience最新文献

Background: Acute pain (AP) is a prevalent symptom in hospital settings, affecting up to 84 percent of the patients seeking healthcare services. It significantly impacts an individual's quality of life, with inadequate management resulting in slower recovery, increased cost of care, and a greater risk of developing chronic pain. While pharmacological approaches are effective, they are associated with numerous side effects, including nausea, addiction, and the possibility of fatal overdoses. Given this, virtual reality (VR) offers an innovative avenue to manage AP effectively while minimizing the effects of drugs.

Objectives: This study aims to map the extent of literature on utilizing VR as a tool for the nonpharmacological management of AP. Specifically, this review attempts to understand the characteristics of the populations using VR for AP management, the technical specifications and mechanisms used to alleviate AP, and the overall effectiveness of VR in managing AP.

Methods: A scoping review was conducted to identify literature from the following electronic databases: PubMed, ScienceDirect, ERIC, and Google Scholar. To be included in this review, articles had to focus on AP in both adult and pediatric populations and address AP using VR in any clinical or care setting. The search was limited to peer-reviewed, English-language, quantitative research articles published between 2000 and 2024.

Results: A total of 97 studies were identified. Sixty-six percent of studies demonstrated the efficacy of VR as an analgesic, outperforming traditional nonpharmacological approaches (eg, standard of care, mobile phones). Distraction was the most effective VR mechanism for pain management, showing efficacy in 86.9 percent of studies. The most common focus was on needle-related pain (30.9%), followed by dental and perioperative pain (15.5% each). VR was most effective in wound care (87.5%), followed by labor-related (83.33%) and dental (80%) pain.

Conclusion: VR is a promising tool for managing AP, offering considerable benefits in terms of patient care, patient experience, and reduction in drug-related side effects. The high efficacy rates for wound care, labor-related pain, and dental pain highlight the potential for VR to be integrated into standard pain management protocols. However, further research, with rigorous research design, is required to standardize VR interventions and optimize their effectiveness across different patient populations and pain contexts.

The presence of patent foramen ovale (PFO) has been associated with migraine. Several retrospective, nonrandomized studies support reduction of migraine frequency and severity after PFO closure. However, three randomized, controlled trials (RCTs) have not met their primary efficacy endpoints, and their reporting quality has not been assessed. The present study aims to determine the reporting quality of RCTs focusing on the PFO closure for the treatment of migraine according to the revised Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. Systematic searches of two databases (MEDLINE/PubMed and Cochrane Library) were conducted. The primary objective was to establish the mean CONSORT adherence of RCTs of PFO closure for the migraine treatment, and secondary objectives were the calculation of adherence per CONSORT item and the effect of CONSORT statement in high-ranked medical journals. A 37-item questionnaire based on the CONSORT 2010 checklist was used to assess the reporting quality. Adequate adherence to the CONSORT statement was defined as reporting over 70 percent of the items. The search identified three eligible articles for analysis. The mean adherence was 69.66±4.49 percent. Only one of the studies achieved a good reporting quality (≥75%). Twenty-six of the 37 items of the CONSORT checklist (70.3%) were reported in more than half of the studies. Quality of reporting in RCTs focusing on the PFO closure for the treatment of migraine remains unsatisfactory. Further improvement of reporting quality is essential to assess the validity of clinical research.

Introduction: Premarketing clinical trials of azithromycin (AZT) computed a 0.8-percent incidence rate of neurological symptoms, such as headaches and vertigo. Postmarket surveillance reported on psychiatric reactions to AZT that included aggression, agitation, anxiety, delirium, and hallucinations. Nonetheless, these observations do not provide further insight on patient characteristics, disease course, and medical intervention.

Methods: We report the case of an 18-year-old male patient with no prior medical or psychiatric history who developed profound religious delusions and unusual behavior hours after taking a one-time AZT dose of 1,000mg for a confirmed sexually transmitted Chlamydia trachomatis infection.

Results: The patient presentation and clinical history satisfied criteria for a manic episode with psychotic features lasting for at least one week. As per The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, the patient was diagnosed with medication-induced manic episode with psychotic features. At presentation, the patient received an intramuscular injection consisting of haloperidol 10mg and diphenhydramine 50mg, followed by olanzapine 10mg, diazepam 20mg, and lorazepam 5mg orally on account of his severe agitation. The patient was then maintained on olanzapine 30mg and lorazepam 5mg for six days. Lorazepam was then titrated down to 4mg for two days, then to 3mg in the outpatient setting. The patient demonstrated relative improvement in both the inpatient and outpatient settings, with no relapse despite eventual discontinuation of psychotropic medication.

Conclusion: We report, to our knowledge for the first time, that AZT monotherapy might induce a manic episode with psychotic features in adolescent patients with no psychiatric medical history.

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.

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.