Optimization of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances with Amiodarone-associated thyrotoxicosis

Introduction: The effectiveness of premedication of patients with arterial hypertension and severe ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis, high anxiety and cyclothymiae disorders should be based on the pharmacological positions of the need to reduce the risk of dangerous adverse cardiovascular reactions. Materials and methods: During the research, a clinical group of 114 patients with arterial hypertension, severe ventricular arrhythmias and Amiodarone-associated type I thyrotoxicosis was formed: four subgroups were identified. In Subgroup 1 (n=22), no premedication was given. In Subgroup 2 (n=32), premedication was given with Diazepam and magnesium sulfate in a prolonged mode. In Subgroup 3 (n=30), the patients received Diazepam the day before surgery. In Subgroup 4 (n=30), premedication was given with Midazolam. A dynamic assessment of the severity of anxiety, depression, sedation and daily monitoring of blood pressure and ECG were carried out. Results and discussion: After surgery, in Subgroup 1, the level of anxiety and depression increased. In all other Subgroups, regardless of the type of premedication, the use of benzodiazepines was accompanied by a decrease in the level of anxiety after surgery. A decrease in pressure load and an increase in the stability of the parameters of systemic hemodynamics were registered in Subgroup 2 of patients, whereas in Subgroup 4 of patients, the pressure load increased while limiting the differences in blood pressure values during the day. After surgery, in Subgroup 2, cardiac rhythm disturbances were less common; in Subgroup 3, the structure of rhythmogenesis disturbances in the heart almost did not change, and in Subgroup 4, there was an unfavorable trend of an increase in the frequency of supraventricular, single and group ventricular extrasystoles. Conclusion: The prolonged premedication with long-acting benzodiazepines and magnesium preparations in patients with arterial hypertension, ventricular rhythm disturbances against the background of Amiodarone-associated thyrotoxicosis reduces the level of anxiety, as well as the risk of developing cardiovascular complications and instability of systemic hemodynamics.

Multi-Process Action Control in Physical Activity: A Primer

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control (M-PAC) framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes (reflective, regulatory, reflexive) build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit (differences in outcome vs. behavioral goals; balancing multiple behavioral goals) and automatic tendencies (approach-avoidance, conservation of energy expenditure). Regulatory processes (prospective and reactive tactics) are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes (habit, identity) begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms (e.g., mobile health), and at different levels of scale (clinical, group, population).

Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques. Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic Novgorod Regional Clinical Hospital based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearsons 2-test with Yatess correction. Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 20102014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020. Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

The Relationship between Mental Health with the Level of Empathy Among Medical Students in Southern Thailand: A University-Based Cross- Sectional Study

Objective: To determine the level of and factors associated with empathy among medical students.Materials and Methods: This cross-sectional study surveyed all first- to sixth-year medical students at the Facultyof Medicines, Prince of Songkla University, at the end of the 2020 academic year. The questionnaires consisted of:1) The personal and demographic information questionnaire, 2) The Toronto Empathy Questionnaire, and 3) ThaiMental Health Indicator-15. Data were analyzed using descriptive statistics, and factors associated with empathylevel were assessed via chi-square and logistic regression analyses.Results: There were 1010 participants with response rate of 94%. Most of them were female (59%). More than half(54.9%) reported a high level of empathy. There was a statistically significant difference in empathy levels betweenpre-clinical and clinical medical students; in regards to empathy subgroups (P-value < 0.001). The assessment ofemotional states in others by demonstrating appropriate sensitivity behavior, altruism, and empathic respondingscores among the pre-clinical group were higher than those of the clinical group. Multivariate analysis indicatedthat female gender, pre-clinical training level, and minor specialty preference were factors associated with empathylevel. The protective factor that significantly improved the level of empathy was having fair to good mental health.Conclusion: More than half of the surveyed medical students reported a high level of empathy. The protective factorthat improved the level of empathy was good mental health. However, future qualitative methods, longitudinalsurveillance, or long-term follow-up designs are required to ensure the trustworthiness of these findings.

The Implications of the Diving Response in Reducing Panic Symptoms

Increased CO2 sensitivity is common in panic disorder (PD) patients. Free divers who are known for their exceptional breathing control have lower CO2 sensitivity due to training effects. This study aimed to investigate the immediate effects of cold facial immersion (CFI), breath holding and CO2 challenges on panic symptoms. Healthy participants and patients with PD were subjected to four experimental conditions in a randomly assigned order. The four conditions were (a) breath-holding (BH), (b) CFI for 30 s, (c) CO2 challenge, and (d) CO2 challenge followed by CFI. Participants completed a battery of psychological measures, and physiological data (heart rate and respiration rate) were collected following each experimental condition. Participants with PD were unable to hold their breath for as long as normal controls; however, this finding was not significant, potentially due to a small sample size. Significant reductions in both physiological and cognitive symptoms of panic were noted in the clinical group following the CFI task. As hypothesized, the CFI task exerted demonstrable anxiolytic effects in the clinical group in this study by reducing heart rate significantly and lessening self-reported symptoms of anxiety and panic. This outcome demonstrates the promise of the CFI task for clinical applications.

Features of atopic reactivity in children with bronchial asthma

Bronchial asthma is a chronic disease characterized by reversible airway obstruction with clinical manifestations of recurrent wheezing episodes, airway inflammation, and their hyperreactivity. Timely diagnosis of bronchial asthma in early childhood will allow adequate prescribing therapy and controlled management of patients, which in the future will reduce the risk of serious complications and improve the quality of life of patients.The aim of the study – to identify the influencing factors on the manifestations of atopic reactivity in children with bronchial asthma, depending on the content of IgE specific to house dust antigens in the blood serum, in order to optimize the management of the disease.Material and methods. A comprehensive clinical and paraclinical examination of 79 school-age children with atopic bronchial asthma was carried out in the Regional Children's Clinical Hospital and the City Children's Polyclinic in Chernivtsi. According to the concentration of specific IgE to the house dust allergen, the patients were divided into two clinical groups. The first (I) clinical group included 55 children in whom the concentration of these antibodies in the blood exceeded 3.5 kU / l, the second group (II) consisted of 24 patients in which the level of specific IgE was below this value. According to the main clinical signs, the comparison groups were compared.Results. It was found that the proportion of patients in the first group who had contact with tobacco smoking of their parents was higher than in the comparison group. Constant contact with tobacco smoke, when both parents have this bad habit in the family, increases the likelihood of developing hypersensitivity to house dust in children with asthma by almost 9 times. At the same time, bronchial asthma was more often combined with atopic dermatitis in these patients, while low concentration of specific IgE to house dust was associated with comorbidity of asthma with allergic rhinitis. The risk of moderate to severe bronchial asthma in patients with low IgE levels increases significantly. The probability of developing the phenotypes of late-onset asthma and exercise-induced asthma in children with low concentrations of specific IgE to house dust increases by 3 and 2 times, respectively. The number of schoolchildren with an extremely high concentration of IgE (more than 100 kU/l) to D. Pteronyssinus antigens was twice as high as in the comparison group, and every second patient also had very high levels of antibodies to D. Farinae tick.Conclusion. Children with atopic hypersensitivity to house dust allergens have an increased chance of comorbid bronchial asthma and atopic dermatitis, late-onset asthma and physical exertion, asthma is much more severe, which must be taken into account when personalizing specific therapy.

Studying the strength of the tibia during the replacement of a post-resection defect with a segmental allograft using locked intramedullary nailing (experimental clinical study)

Background. To achieve success in the incorporation of allografts and bone of the recipient, many factors are taken into account, which can be divided into two main groups: those related to sterilization and processing of the bone allograft and factors affecting the reliability of implant fixation in the bone of the recipient. The second important factor is the method for fixing the allografts and the bone of the recipient. The purpose was to determine the mechanical properties of bone after segmental bone alloplasty. Materials and methods. Female patient Sh., 30 years old, diagnosed with osteosarcoma of the left distal tibia T2N0M0 GIII, degree II, clinical group II, underwent polychemotherapy courses, surgical intervention according to the developed method. The tumor was removed en block, a post-resection defect was replaced with an articulating segmental bone allograft, fixed to the recipient’s bone through a stepped osteotomy and an intramedullary locked nail. Bone autografts were additionally placed into the area of the allograft contact with the recipient’s bone. After 2 years, the patient underwent surgery: amputation at the left third of the thigh. Radiographically, fusion of the allograft and the recipient’s bone was noted. An experimental study of the tensile strength of the tibia after segmental alloplasty of a post-resection defect was carried out using the developed surgical technique and a segmental allograft. Results. To compare the results of an experimental study of the tibia preparation after segmental bone alloplasty, data about the values of the ultimate strength of the bone tissue under compression and bending loads were selected. As shown by the experiment, the ultimate strength of the tibia preparation after its bone alloplasty was 51.82 MPa. This value corresponds to the minimum ultimate strength of a compact bone in bending — 51 MPa. Although this is twice as low as the maximum value of the ultimate strength of a compact bone in bending (133 MPa), it should be borne in mind that all the given reference values were obtained when testing intact preparations of a compact bone. Conclusions. The use of a segmental bone allograft to replace a post-resection defect in a long bone with its fixation to the recipient’s bone through a stepped osteotomy and locked intramedullary nailing with additional bone autoplasty in the area of the allograft contact with the recipient’s bone makes it possible to obtain in the osteotomy zone the bone, the ultimate strength of which corresponds to that of the intact tissue.

Consonantal Landmarks as Predictors of Dysarthria among English-Speaking Adults with Cerebral Palsy

The current study explored the possibility that the consonantal landmarks served as predictors of dysarthric speech produced by English-speaking adults with cerebral palsy (CP). Additionally, the relationship between the perceptual severity of dysarthric speech and the consonantal landmarks was explored. The analyses included 210 sentences from the TORGO database produced by seven English-speaking CP speakers with dysarthria and seven typically developing controls matched in age and gender. The results indicated that the clinical group produced more total landmark features than did the control group. A binominal regression analysis revealed that the improper control of laryngeal vibration and the inability to tactically control the energy in a voiced segment would lead to the higher likelihood of dysarthric speech. A multinominal regression analysis revealed that producing too many +v and −v landmark features would lead to higher perceptual severity levels among the CP speakers. Together with literature, the current study proposed that the landmark-based acoustic analysis could quantify the differences in consonantal productions between dysarthric and non-dysarthric speech and reflect the underlying speech motor deficits of the population in concern.

Voice-hearing across the continuum: a phenomenology of spiritual voices

Voice-hearing in clinical and non-clinical groups has previously been compared using standardized assessments of psychotic experiences. Findings from several studies suggest that non-clinical voice-hearing (NCVH) is distinguished by reduced distress and increased control. However, symptom-rating scales developed for clinical populations may be limited in their ability to elucidate subtle and unique aspects of non-clinical voices. Moreover, such experiences often occur within specific contexts and systems of belief, such as spiritualism. This makes direct comparisons difficult to interpret. Here we present findings from a comparative interdisciplinary study which administered a semi-structured interview to NCVH individuals and psychosis patients. The non-clinical group were specifically recruited from spiritualist communities. The findings were consistent with previous results regarding distress and control, but also documented multiple modalities that were often integrated into a single entity, high levels of associated visual imagery, and subtle differences in the location of voices relating to perceptual boundaries. Most spiritual voice-hearers reported voices before encountering spiritualism, suggesting that their onset was not solely due to deliberate practice. Future research should aim to understand how spiritual voice-hearers cultivate and control voice-hearing after its onset, which may inform interventions for people with distressing voices.

Oral and Verbal Praxis in Impaired Language Learners

In the context of language descriptions, the terms oral and verbal praxis refer to volitional movements for performing oral gestures and movements for speech. These movements involve programming articulators and rapid sequences of muscle firings that are required for speech sound productions. A growing body of research has highlighted the links between oral motor kinematics and language production skills in both typically developing (TD) children and children with developmental language disorders, including Specific Language Impairment (SLI). Yet, there have been limited attempts to assess the link between non-linguistic and linguistic development. In the present study, we investigated oral and verbal praxis behaviors in children with SLI. Fifteen children with SLI formed a clinical group and 15 children with typical development who were matched to the clinical group for chronological age, gender, and socio-economic status formed the TD group. We assessed participants in both groups for their language abilities with age-appropriate standardized language tests. To investigate oral and verbal praxis behaviors, we administered the Assessment Protocol for Oral Motor, Oral Praxis and Verbal Praxis Skills to the two groups. We used the non-parametric Mann–Whitney U test to compare the two groups with respect to oral and verbal praxis measures; and we found a significant difference between isolated and sequential movements in the oral praxis section in two age subgroups of these groups ( p ≤ .05). Spearman’s correlations revealed a strong correlation between core language scores and sequential movements in the younger children with SLI and in TD children. These results showed co-morbidity between SLI and poor oral motor skills, suggesting that SLI is not just a language disorder, but a group of co-morbid conditions that include oral motor and verbal praxis difficulties.