Geertsennorth6398

On April 13, 2017, a bill to legalize cannabis was introduced to the Canadian Parliament and presented to the public. On October 17, 2018, Canada legalized recreational cannabis use. We assessed intoxication severity, reflected by ICU admission rates, risk factors and other characteristics in children who presented to the emergency department (ED) with cannabis intoxication, before and after legalization.

A retrospective cohort study of children 0-18 years who presented to a pediatric ED between January 1, 2008 and December 31, 2019 with cannabis intoxication. The pre-legalization period was defined from January 1, 2008 to April 12, 2017 and the peri-post legalization period from April 13, 2017 to December 31, 2019.

We identified 298 patients; 232 (77.8%) presented in the pre legalization period and 66 (22.1%) in the peri-post legalization period; median age 15.9 years (range 11 months-17.99 years). A higher proportion of children were admitted to the ICU in the peri-post legalization period (13.6% vs. al cannabis legalization in Canada is associated with increased rates of severe intoxications in children. Edible ingestion is a strong predictor of ICU admission in the pediatric population.

Inpatient rehabilitation therapy (IRT) is commonly offered to cancer patients during or after cancer treatment in Germany. However, little is known about utilization and long-term effects of this offer in colorectal cancer (CRC) patients. We aimed to assess IRT utilization, determinants of utilization and the association between IRT and survival in CRC patients.

CRC patients diagnosed in 2005-2014 recruited in the population-based DACHS study in South West Germany were included. Determinants of IRT utilization were assessed by multivariable logistic regression. Hazard ratios (HRs) of the association of IRT with overall and disease-specific survival were estimated by adjusted Cox proportional hazards models. Modified landmark approach was applied to avoid immortal time biased results.

Among the included CRC patients (

 = 3704), 43.6% underwent IRT. Patients who did not live in a relationship with a partner, worked as employee and who reported higher levels of physical activity were more likely to undergo IRT. Patients were less likely to undergo IRT if they had private health insurance, were diagnosed with cancer stage IV, received no or laparoscopic cancer surgery or were treated in a hospital with medium vs. high surgical volume. The median follow-up time was 4.4 years (post-landmark). Utilization of IRT was associated with better overall (HR 0.81, 95% confidence interval 0.72-0.92) and disease-specific survival (HR 0.72, 95% confidence interval 0.61-0.85).

Almost every other CRC patient underwent IRT. Next to clinical characteristics, identified social and lifestyle characteristics seemed to play an essential role in the decision-making. Use of IRT was associated with better overall and disease-specific survival.

Almost every other CRC patient underwent IRT. Next to clinical characteristics, identified social and lifestyle characteristics seemed to play an essential role in the decision-making. Use of IRT was associated with better overall and disease-specific survival.

Immunocompromised patients shed SARS-CoV-2 for extended periods, but to our knowledge person-to-person transmission from late shedding has not been reported.

We present a case in which a COVID-19 patient infected another over 28 days after the patient's initial symptoms, past current guideline recommendations of 20 days for length of isolation in immunocompromised patients. Whole genome sequencing of their viruses was performed to ascertain the transmission.

Severely immunocompromised patients, whose clearance of the virus is impaired, may remain infectious for extended periods. Caution should be taken particularly in hospital settings where lapses in isolation procedures might pose increased risk, especially to other immunocompromised patients.

Severely immunocompromised patients, whose clearance of the virus is impaired, may remain infectious for extended periods. Caution should be taken particularly in hospital settings where lapses in isolation procedures might pose increased risk, especially to other immunocompromised patients.

Sepsis represents a life-threatening syndrome characterized by a cytokine storm. Whether cytokine levels are related to the susceptibility pattern of invasive micro-organism remains a matter of debate. The purpose of this study is to investigate the immune response in multidrug resistant (MDR) and non-MDR sepsis patients by measuring cytokine levels, compare the outcome and determine predictors of mortality.

A total of 128 septic patients, treated in intensive care unit (ICU) were enrolled in the study. Epidemiological and ICU data were recorded. Plasma concentrations of angiopoietin-2 (Ang-2), interleukin (IL)-6, IL-10, tumour necrosis factor-α (TNF-α) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) were measured on admission.

A total of 90 patients suffered from non-MDR and 38 from MDR gram-negative sepsis. Levels of TNF-α were significantly higher (

 = .017) in non-MDR sepsis patients. All pro-inflammatory cytokines were significantly increased in severely ill patients comparecarbapenem resistance are important factors associated with higher mortality.Introduction Waldenström's macroglobulinemia (WM), an orphan disease, is a rare low-grade B-cell lymphoplasmacytic lymphoma with unique clinical features and monoclonal IgM production. Rituximab remains to this date the backbone of most commonly used treatment combinations. The FDA/EMA approval of Ibrutinib, the first-in-class BTK inhibitor, either as monotherapy or in combination with rituximab, changed the treatment landscape of the disease.Areas covered Clinical trial data that demonstrate mode of action, efficacy, and the safety profile of each agent will be covered. A safety analysis of the combination treatment will also be performed to point out its high efficacy and overall favorable toxicity profile. The disadvantages and treatment gaps that still exist in the treatment of WM which relate to the need for long-term ibrutinib administration and the lack of deep remissions and subsequent disease relapse, will also be reviewed.Expert opinion The ibrutinib-rituximab combination is both effective and safe, in the newly-diagnosed and relapsed-refractory disease setting. The optimal therapeutic approach for WM patients remains however to be established. The question of which combinatory (or synergistic) regimen can allow for a fixed-treatment duration, deep and durable responses with a safe toxicity profile is being addressed in ongoing clinical trials.Victims of commercial sexual exploitation (CSE) are in need of multiple community services to aid in their recovery. Service providers are critical to ensuring these victims receive needed treatment. Given the complex trauma of these victims and the necessity of long-term treatment, these service professionals may experience vicarious trauma (VT) and burnout. This qualitative study interviewed 12 professionals who have provided direct services to victims of CSE about their experiences. They had on average about 8 years of experience and three were survivors of CSE. Almost all reported instances of burnout and VT but also had strategies for the prevention of such experiences. Most participants reported experiences of VT and burnout are inevitable when working with this population, but self-care strategies and peer support are essential to combatting these negative experiences. These results can inform agencies that provide services to victims of CSE so as to ensure their staff stay healthy and avoid burnout.

Pure Leydig cell tumors (LCTs) represent 0.1% of ovarian masses. Postmenopausal patients typically present with virilization. Although LCTs can be challenging to locate on conventional imaging, positron emission tomography (PET) has been demonstrated to be effective.

A 64-year-old postmenopausal woman presented with alopecia, facial hirsutism, and clitoromegaly. Laboratory findings included elevated testosterone and androstenedione. Ultrasound, computed tomography, and magnetic resonance imaging showed no adnexal masses. PET did not demonstrate ovarian fludeoxyglucose-avidity. Histopathology after bilateral salpingo-oophorectomy revealed bilateral Leydig cell tumors. Her testosterone normalized 2 weeks postoperatively.

We describe the occult, symptomatic, bilateral ovarian Leydig cell tumors, an occurrence that has not been described in the literature. Virilizing tumors must be considered in patients with evidence of hyperandrogenism, even without pelvic masses on imaging.

We describe the occult, symptomatic, bilateral ovarian Leydig cell tumors, an occurrence that has not been described in the literature. Virilizing tumors must be considered in patients with evidence of hyperandrogenism, even without pelvic masses on imaging.Despite historic existence of campus ministries at universities, little is known about the roles of campus ministry leaders. This research explored campus ministry leaders' engagement with students through interviews (n = 19). Analysis indicated interviewees' work includes building relationships with students, navigating the secular context of a public university, and tensions with others in campus ministry. selleck Interviewees reported emotional strain resulting from extensive caring labor. Focused support for campus ministers would benefit both leaders and students.Dealing with painful suffering is discussed in a passage featuring an interchange between several rabbis in the Babylonian Talmud. As part of that discussion someone says, "Give me your hand." Who speaks that phrase, and what is the purpose behind this request? What practical lessons can this passage teach us today? The explanations offered here propose an alternative understanding to the conventional explanation of who initiates the action. I suggest that it is the sufferer who speaks, thereby achieving self-empowerment.Chaplaincy is a spoke in the wheel of interdisciplinary care that uses its disciplines to better the patient's medical condition. Therefore, chaplains ought to consider how their emotional and spiritual support helps interdisciplinary teams treat patients' illnesses/injuries. This essay explores how chaplains can contribute more effectively to interdisciplinary care by keeping their patients' condition in focus throughout their spiritual assessments and using models that are familiar to the medical team.This clinical report describes some rather unusual procedures used in a chaplain's ministry to a seriously disturbed mother in her struggle to grieve for members of her family who had died in a fire.In this article, the author describes how spirituality affect the lives of people during COVID-19 pandemic. The author reflects on the meaning of religiosity and spirituality (R/S) from a practical, theological and pastoral point of view. This article presents new insights on the ongoing search for meaning and purpose of life amidst the COVID-19 pandemic.This study used quasi-experimental design with repeated measures (pre-test, post-test, and follow-up). Based on the post-test and the follow-up comparison, active music therapy was effective in reducing academic anxiety after two weeks of the treatment. Active music therapy which are integrated in CBT group counseling not only can overcome individual problems, but the therapies can also help individuals analyze their own thoughts and behavior.