Helbozacho1583

INTRODUCTION Tetra-hydro-cannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. AZD-5153 6-hydroxy-2-naphthoic in vitro However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of pre-injury marijuana exposure on thromboembolic complications in trauma patients. METHODS We performed a 2-year (2015-2016) analysis of ACS-TQIP database and included all adult (≥18y) trauma patients. Patients were stratified based on pre-injury exposure to Marijuana THC +ve and THC -ve groups. We performed propensity score matching to control for confounding variables demographics, comorbidities, injury parameters, hospital course, and thromboprophylaxis use. Outcomes were thromboembolic complications (TEC) [deep venous thrombosis (DVT), pulmonary embolism (PE), stroke, myocardial infarction (MI)] and mortality. RESULTS Of 593,818 trauma patients, 678 patients were matched (THC +ve 226 vs THC -ve 452). Mean age was 34±15 years, ISS was 14[10-21]. There was no difference between the two groups regarding age (p=0.75), gender (p=0.99), ISS (p=0.54), spine-AIS (p=0.61), head-AIS (p=0.32), extremities-AIS (p=0.38), use of unfractionated heparin (p=0.54), use of low molecular weight heparin (p=0.54), and hospital length of stay (p=0.87). Overall, the rate of TEC was 4.3% and mortality was 4%. Patients in THC +ve group had higher rates of TEC compared to those in THC -ve group (3.5% vs 1.1%, p=0.03). The rate of DVT (6.6% vs 1.8%, p=0.02) and PE (2.2% vs 0.2%, p=0.04) was higher in THC +ve group. However, there was no difference regarding the rate of stroke (p=0.24), MI (p=0.35) and mortality (p=0.28). CONCLUSION THC exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients. LEVEL OF EVIDENCE Level III PrognosticPrognostic.OBJECTIVE This study explored the role of emotion regulation (ER) as a moderator in the stressor - adjustment outcome relationship, while identifying the relevant stressors. METHODS In 214 adolescents (10-18y; 51.4% boys), stressors (parent- and peer relations, negative events), psychological outcomes (adolescent perceived stress, psychopathology symptoms, negative affect) and biological measures related to the stress response (hair cortisol (HC), heart rate variability (HRV)) as well as ER strategies maladaptive (MalER), adaptive (AdER), and their ratio (Mal/AdER), were measured and analysed via linear regression, adjusted for age, sex and socioeconomic status. RESULTS Parental rejection and bullying turned out as the strongest stressors towards psychological outcomes (β in the range of |.217-.352|, p less then .05). Additionally, parental rejection was associated with HC (β=.242, p=.035), while none of the stressors with HRV. MalER was linked to all, and AdER to most psychological outcomes (range of β |.21-.49|, p less then 0.05). MalER, but not AdER, was associated with HC (β=.25, p=.009), whereas none of the ER strategy types were associated with HRV. Moreover, several associations between stressors and psychological outcomes were moderated by MalER and Mal/AdER, while AdER's role as a moderator was not confirmed. CONCLUSIONS The study confirmed that adolescents' stressors are associated with both psychological and physiological outcomes and moderated by MalER or Mal/AdER. The lack of moderation by AdER directs towards the maladaptive shift theory. Investigations through a longitudinal, rather than a cross-sectional design, could further elucidate the current observations. Moreover, training in how to use ER effectively has a potential of increasing adolescents' stress resilience.OBJECTIVE Psychiatric illness complicates the assessment of alcohol and sedative withdrawal (ASW). This study measured the diagnostic characteristics of the Revised Clinical Institute Withdrawal Alcohol Assessment (CIWA-Ar) and the Brief Alcohol Withdrawal Scale (BAWS) compared with a reference standard in patients with psychiatric illness and evaluated their administration time. METHODS This prospective quality improvement (QI) project conducted in November, 2016 evaluated 35 consecutive unique patients in psychiatric settings. Each patient was evaluated on 1 occasion, sequentially by 2 independent examiners with the CIWA-Ar and BAWS. A Diagnostic Statistical Manual of Mental Disorders, Fifth Edition diagnosis of ASW derived after medical record review by 2 psychiatrists blind to the screening results served as a reference standard. Psychometric properties of the CIWA-Ar and BAWS were measured against the reference. RESULTS Nineteen (54%) patients had ASW diagnosis by the reference standard. The sensitivity (95% confidence interval [CI]) of the CIWA-Ar was 47% (25%-71%) at a cut-off score ≥8; sensitivity of the BAWS was 79% (54%-94%) at a cut-off score ≥3. Specificity (95% CI) for CIWA-Ar and BAWS was 88% (62%-98%) and 88% (62%-98%), respectively. Administration times (interquartile range) for the CIWA-Ar and BAWS were 120 (60-180) and 65 (50-75) seconds, respectively. Receiver operator characteristic area under the curve for CIWA-Ar was 0.77 and for BAWS was 0.76 (P = 0.86). CONCLUSION Both instruments performed similarly in assessing for mild to moderate ASW in a sample of patients with psychiatric illness. The BAWS took 65 seconds to administer-almost half as much time as the CIWA-Ar.We examined whether the implementation of the CDC's recommended screening of CT/NG with proactive follow-up among high-risk youth recruited from community and clinic settings reduced future CT/NG diagnoses. Following the CDC recommendations demonstrated a 41% decline in STIs; three tests in one year resulted in a 10% decline.The Fragile X syndrome is the leading hereditary cause of intellectual disability and Autism Spectrum Disorders. There is paucity of information about psychoses in such patients with little follow up. We report a case of schizophrenia in a male patient diagnosed with Fragile X syndrome. The patient has been followed up for a period of 3 years. The diagnostic and management challenges are discussed. This is a unique case of schizophrenia in Fragile X syndrome. We discuss the common molecular pathways to the expression of both schizophrenia and Fragile X syndrome. This is the first case report of schizophrenia in a patient with diagnosis of Fragile X syndrome in Australia.