Hospital Can Misses

BackgroundMultiple international studies report on the use of diaries in intensive care units focusing on benefits for patients, families, and occasionally professionals. Most studies use quantitative methods and have limitations such as small sample sizes and short follow-ups. Therefore, further research with larger samples and a longer follow-up period, employing a mixed-methods approach is suggested. This protocol aims to assess the efficacy of the use of intensive care unit diaries for patients and families and explore professionals’ experiences and satisfaction.Method/DesignMixed-method study: a quantitative phase followed by a qualitative phase. Phase 1: Randomised, parallel, non-blinded, multicentre clinical trial, with an experimental group (diary) and a control group (no diary), to identify the efficacy of the diary in improving quality of life and preventing post-traumatic stress and anxiety/depression in patients and family. Measurement tools include the SF-36 Health Questionnaire, EIE-R scale, and HADS scale, administered 2-, 6- and 12-months post-discharge. Each group comprises 120 cases. Data analysis will use IBM-SPSS (v.24) To evaluate the satisfaction of professionals a survey will be carried out. Phase 2: Hermeneutic phenomenological study with theoretical sampling. Size of 38–72 patients/family members until theoretical data saturation is reached. Data collection from in-depth interviews and field diary 6 months after discharge. Phenomenological analysis according to Smith. Guba and Lincoln’s rigour criteria.DiscussionThis research will provide knowledge regarding the benefits and limitations of the use of diaries, based on quantitative and qualitative data, and will promote reflection on their implementation, considering patients, family, and professionals. This study will provide new knowledge about the satisfaction of professionals with diary implementation. This multicentre study will provide valuable information on the contribution of diaries in clinical practice and their impact on patient recovery and the experiences of families and professionals. If the efficacy of the diary is confirmed, it will mark a significant advancement in the care of critically ill patients, contributing to the expansion of their use.Trial registrationClinicalTrials.gov Identifier NCT05288140. First Published March 21, 2022. Version 1.

ObjectivesUrinary acidification plays a crucial role in acid-base homeostasis, its evaluation being necessary in the differential diagnosis of metabolic acidosis. The practical limitations of the functional tests required to confirm an acidification disorder point out the need for a simple screening method for urinary acidification assessment in spot urine. The best candidates are urine pH and ammonium (NH4+), but there are few data on their reference values in spot urine in children.MethodsOur study measured urine pH and NH4+/creatinine ratio in the first morning fasting urine of 135 healthy children aged between 5 and 14 years. pH was measured by dipstick and potentiometry, concluding that only potentiometric measures were appropriated for assessing urinary acidification in acid-base diseases.ResultsMedian urine pH was 5.67 (interquartile range 5.44–6.01), ranging from 4.90 to 7.60. Median NH4+/creatinine ratio was 4,869 μmol/mmol (interquartile range 3,528–5,918). The reference interval for urine pH ranged from 5.01 to 6.88 and the reference interval for NH4+/creatinine ratio ranged from 1,646 μmol/mmol to 9,799 μmol/mmol.ConclusionsThese results supply, for the first time, paediatric reference values for both parameters simultaneously, standardizing the sample and method of choice and providing a clinically useful tool for a preliminary evaluation of urinary acidification.

Ménière’s Disease (MD) is a chronic inner ear disorder defined by recurring episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and/or fullness in the ear. Its prevalence varies by region and ethnicity, with scarce epidemiological data in the Brazilian population. Although most MD cases are sporadic, familial MD (FMD) is observed in 5% to 20% of European cases. Through exome sequencing, we have found a rare missense variant in the OTOG gene in a Brazilian individual with MD with probable European ancestry (chr11:17599671C>T), which was previously reported in a Spanish cohort. Two additional rare missense heterozygous OTOG variants were found in the same proband. Splice Site analysis showed that chr11:17599671C>T may lead to substantial changes generating exonic cis regulatory elements, and protein modelling revealed structural changes in the presence of chr11:17599671C>T, chr11:17576581G>C, and chr11:17594108C>T, predicted to highly destabilize the protein structure. The manuscript aims to replicate genes previously reported in a Spanish cohort, and the main finding is that a Brazilian patient with MD also has variants previously reported in familial MD, supporting OTOG as the most frequently mutated gene in MD.

Introduction Perampanel is a selective antagonist of the AMPA receptor for glutamate, primarily approved for the treatment of certain types of epilepsy. With the evolving understanding of psychiatric disorders’ neurobiology, it’s hypothesized that targeting the glutamatergic system could offer substantial therapeutic benefits (Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, et al. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol [Internet]. 2023 [cited 2024 Sep 2] ;14:1182304).ObjectivesThe purpose of this study is to evaluate the effectiveness of perampanel in managing psychiatric symptoms such as sleep disturbances, depression, anxiety, and irritability.MethodsA comprehensive review of scientific studies was carried out, centering on clinical trials and observational research that explored the application of perampanel in individuals exhibiting psychiatric symptoms. The review included articles published between 2013 and 2024, utilizing databases like PubMed, Scopus, and PsycINFO for sourcing. The inclusion criteria covered studies that assessed the impact of perampanel on psychiatric conditions, detailing both the clinical results and any side effects.ResultsFindings indicate that perampanel may have beneficial effects in reducing symptoms of insomnia (Abenza-Abildúa MJ, Suárez-Gisbert E, Thuissard-Vasallo IJ, Andreu-Vazquez C. Perampanel in chronic insomnia. Clin Neurol Neurosurg. 2020 May 1;192), depression and anxiety (Scorrano G, Lattanzi S, Salpietro V, Giannini C, Chiarelli F, Matricardi S. The Cognitive and Behavioural Effects of Perampanel in Children with Neurodevelopmental Disorders: A Systematic Review. J Clin Med [Internet]. 2024 Jan 10 [cited 2024 Sep 3];13(2)) in certain patient groups. However, significant adverse effects were also reported, including behavioural changes and increased aggression in some cases, necessitating careful monitoring during treatment.ConclusionsNumerous antiepileptic medications have been effectively utilized in treating psychiatric conditions. Perampanel, in particular, has demonstrated effectiveness in managing nocturnal seizures, preserving sleep architecture, and treating restless legs syndrome. A study conducted in Spain revealed that combining perampanel with either an antidepressant or an anxiolytic significantly enhances sleep quality after three months in patients without epilepsy (Abenza-Abildúa MJ, Suárez-Gisbert E, Thuissard-Vasallo IJ, Andreu-Vazquez C. Perampanel in chronic insomnia. Clin Neurol Neurosurg. 2020 May 1;192).While there are no large-scale clinical trials specifically targeting mood disorders, some ongoing research is exploring the broader psychiatric effects of Perampanel, including its impact on anxiety disorders.Disclosure of InterestNone Declared

To describe the pharmacokinetics (PK) of linezolid in plasma and pleural fluid (PF) in critically ill patients with proven or suspected Gram-positive bacterial infections. Observational PK study in 14 critically ill patients treated with linezolid at standard doses. Blood and PF samples were collected and analysed by HPLC. The ratio between PF and plasma concentrations was calculated. The PK/pharmacodynamic (PD) target of linezolid in plasma was defined as 100% of the duration of the dosing interval in which concentrations were above the MIC (%100 T > MIC). The median (5th and 95th percentiles) linezolid concentration values for plasma pre-dose at steady state (Cmin,ss) and at the end of the 1-h infusion at steady state (Cmax,ss) were 1.1 (0.02-28.3) and 13.8 mg/L (2.9-38.1), respectively, and the PF pre-dose concentration (PF0 h) and PF concentration at the end of the 1-h intravenous infusion (PF1 h) were 2.8 (0.1-31.6) and 4.2 mg/L (0.1-45.2), respectively. At both times (pre-dose and post-infusion), a strong positive correlation was observed between PF and plasma linezolid concentrations (Spearman's rho coefficients = 0.8 and 0.9, with P < 0.001 for both). The defined PK/PD target in plasma was achieved in 8 (57.1%), 4 (28.6%) and 3 (21.4%) patients assuming an MIC of 1, 2 and 4 mg/L, respectively. Linezolid seems to penetrate well into the PF, with concentrations exceeding those in plasma. However, high inter-individual variability, both in plasma and PF concentrations, was observed. A high proportion of patients did not achieve the PK/PD target in plasma, especially in the presence of high MIC strains.

Plain Language SummaryThere is a need for an alternative treatment to significantly improve NPS in AD and decrease the caregiver’s stress as well as the financial burden resulting from polypharmacy and institutionalization. Any promising treatment should be safe and reduce the risk of adverse effects. This study evaluated the efficacy of a CBD-rich oil in treating NPS in a cohort of 59 patients with AD over a follow-up of more than 1 year, with a specific focus on its impact on caregiver burden. The study showed a significant reduction in the NPI-Q severity and caregiver’s distress scores after 3 months of intervention, and sustained for up to 24 months of follow-up. Notably, the effectiveness was independent of age, sex, years with AD, type of acetylcholinesterase inhibitors, and NPI-Q severity score before CBD treatment. A low CBD dose and a slow dose titration improve tolerance. These results may indicate that alleviating NPS in people with AD facilitates daily caregiving and improves caregivers’ emotional and physical distress.