Transient increased immunoglobulin levels in a hyper-IgM syndrome patient with COVID-19 infection

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected millions of people around the world. This zoonotic-enveloped virus is primarily transmitted through inhalation. Infected people are commonly asymptomatic or manifest mild symptoms, including fever, cough, diarrhea, and fatigue. However, it may lead to severe patterns associated with multiple organ failure in individuals with an impaired immune system. Objective: Here we report a 7-year-old girl with hyper-immunoglobulin M (IgM) (HIgM) phenotype, admitted to the hospital emergency department with fever, cough, and pneumonia symptoms because of the COVID-19 infection. Coronavirus infection was confirmed by a positive real-time polymerase chain reaction test. Surprisingly, serum levels of both IgG and IgA of the patient were transiently normalized during the COVID-19 infection when tested prior to the monthly injection of intravenous immunoglobulin. After she recovered from the COVID infection, her immunoglobulin levels returned to the primary stage and she demonstrated HIgM phenotype. Conclusion: Since this transient increase in the levels of immunoglobulins was solely observed during the COVID-19 infection, and no other infectious episodes were diagnosed in the patient, clarifying the exact cause would help to understand in a better manner the implications and specification of humoral immunity in patients with primary antibody deficiencies.

Perception of a New Prolonged-Release Buprenorphine Formulation in Patients with Opioid Use Disorder: The PREDEPO Study

<b><i>Aim:</i></b> The aim of the study was to assess the acceptance of patients with opioid use disorder (OUD) to switching their opioid dependence treatment (ODT) for a prolonged-release buprenorphine (PRB) injection according to their prior ODT (buprenorphine/naloxone [B/N] or methadone). <b><i>Methods:</i></b> This was an observational, retrospective/cross-sectional, multicentre study of adult patients diagnosed with OUD on ODT. Data collected from diaries were analysed to know their interest and opinion on PRB. Questions with fixed response options were included, and several Likert scales were used. <b><i>Results:</i></b> A total of 98 patients were enrolled (B/N: 50.0%, methadone: 50.0%). The mean age was 46.9 ± 8.43 years and 79.6% were males. PRB was similarly perceived by both groups in most variables analysed, receiving a mean score of 7.2/10 (B/N: 7.4, methadone: 7.0; <i>p</i> = 0.520), and approximately 65% of patients said they were willing to switch to PRB (B/N: 63.3%, methadone: 65.3%; <i>p</i> = 0.833). Of these, a higher percentage in the B/N group considered that switching would be easy/very easy (B/N: 90.3%, methadone: 46.9%; <i>p</i> &#x3c; 0.001) and that they would start PRB when available (B/N: 64.5%, methadone: 34.3%; <i>p</i> = 0.005). More than 90% would prefer the monthly injection (B/N: 93.6%, methadone: 100%; <i>p</i> = 0.514). One-third of patients in both groups were unsure/would not switch their ODT to PRB (B/N: 36.7%, methadone: 34.7%; <i>p</i> = 0.833). The main reason was administration by injection. <b><i>Conclusion:</i></b> Two-thirds of patients would switch their treatment for PRB, and most patients on B/N considered that switching would be easy. PRB could be a suitable alternative for OUD management.

Ulipristal Acetate Versus Leuprolide Acetate in Medical Management of Uterine Fibroids

BACKGROUND We wanted to compare the effectiveness of the treatment and the adverse effects of ulipristal acetate and leuprolide acetate in the medical management of symptomatic uterine fibroids. METHODS This is a randomised controlled study conducted in the the Department of Obstetrics and Gynaecology in Chalmeda Anand Rao Institute of Medical Sciences from January 2019 to January 2020. 60 patients with symptomatic fibroids and excessive uterine bleeding were randomly divided. They were given daily therapy of ulipristal acetate 10 mg orally for 3 months or monthly injection leuprolide acetate 3.75 mg intramuscularly for 3 months. RESULTS Controlled uterine bleeding was observed in 98 % of patients who received oral therapy of ulipristal acetate of 10 mg, and 89 % of patients who received injections of leuprolide acetate, for differences in comparison with leuprolide acetate of 8.8 % points (95 % CI, 0.4 to 18.3) for ulipristal acetate of 10 mg. Median time of amenorrhea for those taking ulipristal acetate of 10 mg was 5 days, and 21 days for leuprolide acetate. 10 % of patients receiving ulipristal acetate reported moderateto-severe hot flashes and 40 % of patients receiving leuprolide acetate reported moderate to severe hot flashes (P < 0.0010 for each dose of leuprolide acetate vs. ulipristal acetate). CONCLUSIONS Daily therapy of 10-mg ulipristal acetate was considered non inferior when compared to monthly injections of leuprolide acetate in control of uterine bleeding, moreover ulipristal acetate therapy was also significantly less likely to cause hot flashes. KEY WORDS Ulipristal Acetate; Leuprolide acetate; Abnormal Uterine Bleeding; Leiomyoma

Pengabdian Kepada Masyarakat Dengan Asuhan Kebidanan Pada Pasien Retensio Placentadi Puskesmas Pembantu Golodukal, Kecamatan Langke Rembong, Kabupaten Manggarai

ABSTRAK Setiap wanita akan melalui proses kehamilan, persalinan, nifas hal tersebut merupakan proses yang fisiologis. Selama menjalani proses tersebut kemungkinan terjadi masalah kesehatan yang dapat menimbulkan kesakitan bahkan kematian baik pada ibu dan bayi. Tujuan kegiatan ini untuk mempelajari dan memahami asuhan kebidanan pada ibu hamil, bersalin, nifas, neonates dan KB secara komprehensif. Metode yang digunakan adalah metode penelitian kualitatif deskriptif dengan pendekatan studi kasus tujuh langkah varney. Tehnik pengambilan data melalui wawancara, observasi langsung dan studi dokumen rekam medic. Analisa data dilakukan secara deskriptif berdasarkan tujuh langkah varney. Hasil kegiatan ini adalah Ny. M.G.L umur 26 tahun, G2P1A0, ibu bersalin dengan retensio placenta dan penatalaksanaan manual placenta sesuai standar SOP di tingkat pelayanan primer, nifas normal, BBL normal dan ibu menggunakan KB suntik 3 bulanan. Kata kunci : Asuhan kehamilan, bersalin, Retensio Placenta. ABSTRACT Every woman will go through a process of pregnancy, childbirth, childbirth, this is a physiological process. During this process, there may be health problems that can cause pain and even death to both mother and baby. The purpose of this activity is to learn and understand midwifery care for pregnant women, childbirth, postpartum, neonates, and family planning in a comprehensive manner. The method used is the descriptive qualitative research method with a seven-step Varney case study approach. Data collection techniques through interviews, direct observation, and study of medic record documents. The data analysis was done descriptively based on the seven Varney steps. The result of this activity is Mrs. M.G.L, 26 years old, G2P1A0, a mother giving birth with retained placenta and manual management of the placenta according to SOP standards at the primary care level, normal postpartum, normal LBW, and the mother uses 3-monthly injection contraceptives. Key words: Pregnancy care, childbirth, Retensio Placenta

Interest in long-acting injectable buprenorphine among syringe services program participants

Objective: To examine syringe services program (SSP) participants’ interest in long-acting injectable buprenorphine.Design: SSP participants completed a 136-item questionnaire by phone. Items assessed quantitative ratings of interest in sublingual and injectable buprenorphine, preference for sublingual versus injectable buprenorphine, and reasons for preferences.Setting: Two large urban SSPs.Participants: SSP participants ≥18 years of age with current or lifetime opioid use disorder (OUD).Main outcome measure(s): (1) Interest in sublingual and injectable buprenorphine, respectively, on a scale from 0 to 10 (0 = no interest and 10 = high interest); and (2) preference for sublingual buprenorphine versus injectable buprenorphine. Participants were also asked whether they agreed with statements that presented potential reasons for preferring each formulation.Results: A total of 104 unique participants were interviewed, of which 72 (69 percent) were currently receiving or considering buprenorphine treatment. Among these 72 participants, the median level of interest in starting or continuing sublingual buprenorphine was 8 out of 10 (interquartile range [IQR]: 6-10) and in starting injectable buprenorphine was 5 out of 10 (IQR: 1-9). Thirty-six (50 percent) preferred sublingual, 27 (38 percent) preferred injectable, and 9 (13 percent) preferred neither or declined to answer. Participants who preferred injectable buprenorphine most commonly agreed that the convenience of the monthly injection was the reason for their preference.Conclusions: Among SSP participants with OUD, we found moderate interest in injectable buprenorphine. Introducing this new form of buprenorphine treatment at SSPs could help meet the needs of individuals who are not well-served by standard OUD treatment models.

Examining long-acting injectable antipsychotic (depot) medication in the elderly: a 5-year retrospective cross-sectional study evaluating depot use in an Australian psychogeriatric service

Objective: The primary aim was to examine the use of long-acting injectable (LAI) antipsychotic (depot) medication in a cohort of older patients in a community psychogeriatric service. Method: From 2014 to 2018, all patients who were on LAIs each year were analysed for various characteristics including their profile, type of LAI used, dose and relapse rates related to switching, ceasing and community treatment order (CTO) use. Results: A total of 880 patients were managed by the service with 142 recorded cases of LAI use in total over the 5 years (16.1%). Second-generation antipsychotics (SGAs) outnumbered first-generation antipsychotics (FGAs) by 2:1, with a trend of increasing use of SGA LAIs. The most commonly used LAI was Paliperidone monthly injection (PP1M) (50.7%). Lower than usual adult chlorpromazine equivalent daily doses of LAIs were used. The relapse rate while on a LAI was 13.4%. Moreover, 54.9% of the patients on LAIs were on a CTO. Relapse rates were lower on LAIs in combination with a CTO (7.7%). Conclusions: LAIs, especially the SGAs, are increasingly used in our service. In combination with a CTO, LAIs are an effective treatment in reducing relapse rates in the elderly.