Enoxaparin Use in Hospitalized SARS-CoV-2-Positive Patients with Elevated D-Dimer: A Pilot Study

Introduction The SARS-CoV-2 is a human pathogenic coronavirus that causes a respiratory tract infection, which may lead to systemic hyper-inflammation that is associated with a hypercoagulable state. Anticoagulation as an adjunct may decrease thrombi formation. Objectives This study aims to evaluate the efficacy and safety of enoxaparin for the prevention of thrombotic events in hospitalized SARS-CoV-2 patients with elevated D-dimer. Methods A single-center retrospective cohort study was conducted to evaluate three enoxaparin dosing regimens: full treatment (1 mg/kg SC Q12H or 1.5 mg/kg SC Q24H), intermediate (.5 mg/kg SC Q12H or 1 mg/kg SC Q24H), and prophylaxis (40 mg SC Q24H). The primary endpoint evaluated the percentage of patients who developed a venous thromboembolism (VTE). The secondary endpoints evaluated the development of a major bleed, mechanical ventilation need, and death. Results Forty-five patients were included with 27, 8, and 10 participants in the full treatment, intermediate, and prophylaxis arms, respectively. Six patients developed a VTE: 3, 1, and 2 in the listed above groups, respectively ( P = .83). Twenty patients died: 11, 3, and 6, respectively ( P = .64). Four patients developed a major bleed: 1, 1, and 2, respectively ( P = .17). Six patients required intubation: 1, 2, and 3 in the arms, respectively ( P = .043). Conclusion The study did not find a difference in respect to the development of a VTE between the three investigated doses of anticoagulation. However, our findings suggest that treatment dose of enoxaparin might be associated with lower risk for mechanical ventilation in hospitalized COVID-19-positive patients with elevated D-dimer.

Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study

Objective: Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing medical multimorbidity (MMB) are effective, particularly given that this patient population faces more treatment resistance. Therefore, there is a need for initial preliminary research to examine whether DMH interventions are associated with reductions on depressive and anxiety symptoms in the context of MMB.Methods: This preregistered retrospective cohort intent-to-treat study with 2,819 patients enrolled in a therapist-supported DMH (TS-DMH) intervention examined the associations between MMB and mental health. Results: Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Conclusions: The MHP showed preliminary effectiveness as an evidence-based treatment for patients experiencing depression and anxiety in the context of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

The Effect of Computerized Cognitive Training for Adults Over 40 with Dementia-Related Anxiety

Dementia-related anxiety (DRA) may occur when cognitive lapses are appraised as threatening. Individuals with DRA may seek activities to improve cognitive function, including popular computerized cognitive training programs like Lumosity©. We evaluated if DRA changed after eight weeks of Lumosity© use and whether changes were maintained over time. Participants aged 40 and older with pre-existing DRA participated via Amazon’s Mechanical Turk (T1 N = 395; age M = 52.49, SD = 8.71) and were randomly assigned to the experimental (Lumosity© software), active control (Lumosity© crossword puzzles), or no treatment group. Participants completed measures of DRA at T1 and at four follow-up points (T2 = 8 weeks; T3 = 12 weeks; T4 = 16 weeks; T5 = 20 weeks). Repeated measures ANOVAs were used to evaluate the change in DRA. A significant T1-T2 reduction in DRA occurred for the Lumosity© group only (p = .01, partial-eta2 = .03). Longitudinal changes were observed for the Lumosity© group only: DRA scores at T1 were significantly greater than at T2, T4, and T5 (ps < .05). A step-up test procedure was conducted to determine minimum treatment dose effects. A greater reduction in DRA occurred between the Lumosity© and crossword puzzle groups between 25.00 and 29.99 hours of software use (p = .05, partial-eta2 = .19). Lumosity© software outperformed crossword puzzles in DRA reduction from T1 to T2, which was maintained for 12 weeks post-software use. Independent of Lumosity’s intended purpose of supporting cognitive functioning, participants subjectively believe it helps and experience associated benefits.

The Ketogenic Effect of Medium-Chain Triacylglycerides

Medium-chain triacylglycerides (MCTs) are dietary supplements that can induce ketosis without the need for a traditional ketogenic diet or prolonged fasting. They have the potential to marginally delay the progression of neurodegenerative diseases, such as Alzheimer's disease. However, there have been inconsistencies in reports of the MCT dose–response relationship, which may be due to differences in MCT composition, participant characteristics, and other factors that can influence ketone generation. To resolve these discrepancies, we reviewed studies that investigated the ketogenic effect of MCTs in healthy adults. Aside from the treatment dose, other factors that can influence the ketogenic response, such as accompanying meals, fasting duration, and caffeine intake, were assessed. Based on the available literature, four practical recommendations are made to optimize the ketogenic effect of MCTs and reduce unwanted side effects (primarily gastrointestinal discomfort and diarrhea). First, the starting dose should be either 5 g of octanoic acid [caprylic acid (C8); a component of MCTs] or 5 g of a combination of C8 and decanoic or capric acid (C10; another component of MCTs), and the dose should be progressively increased to 15–20 g of C8. Second, MCTs should be consumed after an overnight fast, without an accompanying meal if tolerable, or with a low-carbohydrate meal. Third, the addition of caffeine may slightly increase the ketogenic response. Fourth, emulsifying the MCTs might increase their ketogenic effect and alleviate side effects.

Microwave treatment for improved quality and safety of dehydrated pitted apricots

Dehydrated pitted apricots are widely used as a ready meal ingredient, which renders control of their quality and safety a relevant issue. Pitted apricots are rich in sugars, moisture and organic acids that serve a good medium for microorganisms. Therefore, these products require presale processing. Microwave treatment proved effective for the processing of raw and finished food products. Its impact on microorganisms depends on variant criteria, including taxonomic affiliation, total counts, dielectric cell properties and the treatment dose. The research aimed to study death kinetics in the native dried apricot surface microflora and its growth during subsequent storage. In this respect, we have studied the microwave treatment impact on dried apricot surface microflora depending on treatment dose and determined the residual microflora growth rate during subsequent storage. The doses of 120, 180 and 240 kJ at a 200 W radiation power have been shown to reduce baseline contamination of dehydrated pitted apricots by three orders of magnitude. Statistical kinetics analyses demonstrated a retarded surface microflora growth during subsequent storage. Microwave doses of 120–240 kJ (accounting for ±0.4 lg CFU/g error) exhibited a similar microflora dynamics in subsequent storage. The exposure of dried apricots to a lowest microwave field of 120 kJ ensured stability of the product microbiological dynamics.