Zobrazení zdroje stránky Thompsondohn1970

A negative work situation can trigger the development of serious mental disorders such as psychotic, neurotic, or cognitive disorders, as well as those derived from work-related stress and psychoactive substance abuse, and self-injurious behaviours. For early detection, treatment, reintegration, and/or rehabilitation, coordination between the public health system and occupational health or occupational risk prevention services is necessary.BACKGROUND BRASH syndrome is a newly recognized clinical entity characterized by bradycardia, renal failure, atrioventricular blockade, shock, and hyperkalemia. Patients with BRASH syndrome often have severe bradycardia that is refractory to antidotes and chronotropic medications. In these situations, transvenous pacemaker and renal replacement therapy may be necessary. Therefore, rapid diagnosis and correct management of this entity are crucial to reduce mortality. We report a case and the management of BRASH syndrome in the Emergency Department. CASE REPORT A 76-year-old man with chronic kidney disease stage 3, essential hypertension and psoriasis, and receiving atenolol presented to the Emergency Department with lethargy and weakness that started 3 days ago, with rapid deterioration into shock. His initial laboratory tests revealed hyperkalemia, metabolic acidosis, and acute kidney injury. His initial electrocardiogram was remarkable for sinus bradycardia with junctional escape rhythm with ventricular rate of 26 bpm. A chest X-ray was normal. Transthoracic echocardiogram showed normal systolic and diastolic function. Atenolol was immediately held. He was treated with potassium-lowering agents and vasoactive drugs. Due to the persistence of bradycardia, even after reversal of hyperkalemia, a temporary transvenous pacemaker was placed. Renal replacement therapy was not required. Renal function improved and heart rate stabilized at 80 bpm. The patient was discharged and advised to avoid atrioventricular-blocking agents, with Cardiology follow-up. CONCLUSIONS BRASH syndrome is a serious complication due to a combination of hyperkalemia, hypotension, and bradycardia in the setting of kidney dysfunction and medications that block the atrioventricular node. Hemodynamic support and temporary pacemaker use may be needed to manage this entity.BACKGROUND This study aimed to investigate frontoparietal network (FPN) dysfunction in participants with migraine without aura (MwoA). MATERIAL AND METHODS We selected 48 age-, sex-, and education level-matched graduate students (24 participants with MwoA [MwoA group] and 24 healthy controls). [https://www.selleckchem.com/ selleck screening library] RS-fMRI and independent component analysis were used to examine the FPN and to compare abnormal encephalic regional homogeneity values. The Mindful Attention Awareness Scale (MAAS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Self-Rating Scale of Sleep (SRSS) were used to evaluate attention, anxiety, depression, and sleep, respectively. Pearson's correlation was applied to evaluate the association between abnormal brain areas and the scores for each scale. RESULTS Neural function activity in encephalic regions of FPN showed abnormal changes in the MwoA group. The MwoA group had significantly lower MAAS scores (P less then 0.001), higher SAS scores (P less then 0.001), and higher SDS (P=0.06) and SRSS scores (P=0.26). In the MwoA group, functional activity of the right parietal lobule in the left FPN was positively correlated with MAAS scores (P=0.01) and negatively correlated with SAS (P=0.02). The orbital part of left inferior frontal gyrus activity in the right FPN was positively correlated with SDS (P=0.04) and SRSS (P less then 0.001). Right superior marginal gyrus activity in the right FPN was positively correlated with SDS (P=0.02). CONCLUSIONS Abnormal FPN function was correlated with attention, anxiety, depression, and sleep status in the MwoA group. These results offer further insights into the evaluation and treatment of MwoA.<br /><br /> To report on the use of scleral lens therapy for a patient with lipid keratopathy secondary to rigid gas permeable contact lens wear and ocular surface disease.<br /><br /> Case report and literature review.<br /><br /> A 40-year-old man with a history of keratoconus and rigid gas permeable contact lens wear, resulting in corneal neovascularization and lipid keratopathy. The patient reported to our clinic with central lipid keratopathy secondary to rigid gas permeable lens wear and ocular surface disease. Given the density, central location, and subsequent visual limitations induced by lipid deposition and topographical irregularity, penetrating keratoplasty and scleral contact lens wear were discussed as possible treatment options. In this case, scleral lens wear provided both visual improvement and resolution of lipid keratopathy. After 3 years, the patient has remained stable, with significant visual improvement and near-complete resolution of lipid keratopathy.<br /><br /> This case illustrates the use of scleral lens wear in the therapeutic management of lipid keratopathy secondary to rigid gas permeable lens wear and ocular surface disease. For patients limited by lipid keratopathy and topographical irregularity, scleral lens wear may be used to achieve both visual and therapeutic outcomes.<br /><br />This case illustrates the use of scleral lens wear in the therapeutic management of lipid keratopathy secondary to rigid gas permeable lens wear and ocular surface disease. For patients limited by lipid keratopathy and topographical irregularity, scleral lens wear may be used to achieve both visual and therapeutic outcomes.<br /><br /> To evaluate the lubricating effect of hyaluronic acid (HA) on soft contact lenses (SCLs) measured using a pendulum-type friction tester.<br /><br /> We measured the coefficient of friction (CoF) of narafilcon A, delefilcon A, and etafilcon A with polyvinylpyrrolidone (PVP), daily disposable SCL material, using a modified pendulum-type friction tester. Sample SCLs were set on an acrylic plastic half-ball and placed into the polyethylene terephthalate hemisphere cup filled with 0.4 mL of test lubricants that included saline and 0.05%, 0.1%, 0.2%, 0.3%, 0.4%, and 0.5% (wt/vol) HA (molecular weight, 850 kDa). The viscosities of saline and HA were measured using an Ubbelohde viscometer.<br /><br /> The CoF of the SCL under a low concentration (0.05%) of HA was the lowest and significantly lower than saline in narafilcon A and delefilcon A (P&lt;0.05, Steel multiple comparison test). Under higher HA concentrations (0.3%, 0.4%, and 0.5%), the CoF was significantly higher than that of saline (P&lt;0.01, Steel' multiple comparison test) in all three SCLs. There were no significant differences of CoF among three SCLs in saline and all concentrations of HA. The HA viscosities increased exponentially with the concentration (Y=1.2829e9.286X).<br /><br /> The viscosity of a high concentration of HA may increase the friction of SCLs, which may have a deleterious effect on the ocular surface.<br /><br />The viscosity of a high concentration of HA may increase the friction of SCLs, which may have a deleterious effect on the ocular surface.<br /><br /> To evaluate a novel sagittal height fitting algorithm for estimation of alignment curve (AC) radius during Euclid orthokeratology lens trial.<br /><br /> Chinese myopic children were recruited in this study and were randomly divided into two groups. The AC radius of one group was calculated by the novel fitting algorithm. The AC radius of the other group was decided by the optometrist using flat K readings and eccentricity values. The number of lens trials was recorded for each patient, and the consistencies of AC radius between the first trial lenses and the final ordered lenses were tested by Pearson correlations and Bland-Altman plots.<br /><br /> One hundred three adolescent patients (103 eyes) were enrolled, including 57 boys and 46 girls. The numbers of trials for the novel algorithm and traditional method were 1.2±0.4 times versus 1.4±0.5 times, respectively, and the difference between the two methods was significant (t=2.404, P=0.018). The difference of AC value between the first trial lens and the lens to be produced for the novel algorithm and traditional method 0.000±0.020 mm and 0.003±0.028 mm separately. There was no statistical difference between the two methods (t=0.748, P=0.456).<br /><br /> The new sagittal height simulation software can accurately calculate the AC value of the orthokeratology lens suitable for the Chinese patients.<br /><br />The new sagittal height simulation software can accurately calculate the AC value of the orthokeratology lens suitable for the Chinese patients.<br /><br /> To compare the effect of the use of different lubrication eye drops and nonpreserved saline for the application of miniscleral contact lenses (CLs) on subjective experience during 6 hr of lens wear.<br /><br /> Experienced soft CL wearers aged 18 to 45 years (inclusive) were enrolled in this prospective, randomized, double-masked, three arm comparison cross-over study. Subjects were custom fitted with KATT 16.5 mm diameter miniscleral lenses, ordered to their prescription. Subjects attended visits on three separate days and were randomized to receive instillation of an HP-guar/nanoemulsion drop or an HP-guar/sodium hyaluronate (HA) eye drop into the miniscleral lens before filling with saline or filling with saline alone (control). Subjective responses were collected up to 6 hr postapplication. Generalized linear mixed models with multinomial distribution and cumulative logit link were used to compare the rate at which responses improved post-CL application for the different treatments.<br /><br /> Twenty-four participants completed the study. Dryness symptoms were more likely to improve at a slower rate postlens application with saline alone compared with the addition of HP-guar/nanoemulsion (P=0.005) or HP-guar/HA (P=0.049) before lens application. Furthermore, the addition of HP-guar/nanoemulsion was more effective than saline alone in improving symptoms of fluctuating vision (P=0.011), grittiness/burning/stinging (P=0.001), and foreign body sensation (P=0.006) more quickly.<br /><br /> The use of postlens lubrication may be useful in enhancing adaptation to miniscleral lenses.<br /><br />The use of postlens lubrication may be useful in enhancing adaptation to miniscleral lenses.<br /><br /> To describe contact lens prescription trends for patients with keratoconus.<br /><br /> Demographics, corneal curvature, visual acuity, and type of contact lens prescribed were reviewed for all patients with keratoconus evaluated in the contact lens service in 2010 and 2020.<br /><br /> There were 292 patients in 2010 and 217 in 2020. In 2010, 69% were using corneal gas-permeable lenses (GP), 16% soft toric, 13% hybrid, and 2% soft sphere with no scleral lens (SL). In 2020, 60% were using corneal GP, 22% SL, 12% soft toric, 5% hybrid, and 1% soft sphere. Mean log of minimum angle of resolution visual acuities with manifest refraction were (represented in mean [SD, range]) 0.42 (0.33, 0-1.3) in 2010 and 0.35 (0.33, 0-1.6) in 2020 improving to 0.19 (0.18, 0-1.3; P≤0.01) and 0.13 (0.14, 0-0.60; P&lt;0.01) with contact lenses. Mean keratometry measurement in patients using SLs was 53.0 diopters (D) (9.9, 42.1-84.5), which was steeper than 46.6 D in patient's using all other lens types in 2010 and 2020 (3.9, 40.9-57.9; P&lt;0.01).<br /><br /> Scleral lens prescription increased during the past decade; however, corneal GP lenses remain the most frequent lens prescribed for patients with keratoconus in this cohort.