Background: and PurposeAcute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients. Methods: This retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated. Results: This study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p<0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment (p<0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine. Conclusions Neostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.

Background: and PurposeAcute colonic pseudo-obstruction (ACPO) is a common but understudied complication in neurocritically ill patients. The acetylcholinesterase inhibitor neostigmine can be used to treat ACPO in patients who do not respond to conventional treatment. This study investigated the effectiveness and adverse events when using neostigmine to manage ACPO in neurocritically ill patients. Methods: This retrospective study investigated patients with ACPO who were treated using neostigmine in the neurological intensive-care units at two centers between March 2017 and August 2020. Neostigmine was administered intravenously or subcutaneously (at doses ranging from 0.25 mg to 2 mg) according to the protocols at the two centers. The outcomes were bowel movements and the changes in colon diameters on abdominal radiographs. Safety events such as bradycardia, vomiting, salivation, and sweating were evaluated. Results: This study included 31 subjects with a mean age of 46.8 years (65.4% males). All patients had a bowel movement at a median of 120 minutes after administering neostigmine. The colon diameter decreased by a median of 17.5 mm (paired t-test: p<0.001) regardless of the dose and treatment protocols. Multilevel analysis confirmed that the mean colon diameter decreased from 66 mm pretreatment to 47.5 mm posttreatment (p<0.001), with an intraclass correlation coefficient of 13%. Three patients (9.7%) exhibited hypersalivation, sweating, bradycardia, and vomiting. Bradycardia (heart rate, 42 beats/minute) occurred in one patient (3.2%), and was successfully managed by injecting atropine. Conclusions Neostigmine injection is a safe and effective treatment option for ACPO in neurocritically ill patients who fail to respond to conservative management.

This paper aims to discuss the sequential use of rituximab and 90Yttrium-ibritumomab tiuxetan, a novel treatment approach in the management of refractory follicular non-Hodgkin's lymphoma. Radioimmunotherapy (RIT), which combines the benefits of targeted radiation therapy and monoclonal antibody, has significantly increased the response rate well in excess of 50%. This is explained by the inherent radiosensitive nature of lymphoma cells. We present a case of a 56-year-old male with refractory follicular lymphoma. The patient was referred for RIT, the first case in the Philippines. The patient was pretreated with two doses of rituximab followed by an intravenous infusion of 90Y-ibritumomab tiuxetan (Zevalin). Hematologic nadir was reached six weeks following administration of the radioimmunotherapy. During this time, the patient developed melena. Hematologic recovery was noted after three weeks. Re-evaluation with computed tomography three months after treatment showed significant reduction in the tumor bulk and resolution of lymphadenopathies. This report underscores the importance and evolving role of radioimmunotherapy in the management of refractory non-Hodgkin's lymphoma.

Human ; Male ; Middle Aged ; Antibodies, Monoclonal ; Infusions, Intravenous ; Lymphadenopathy ; Lymphoma, Follicular ; Lymphoma, Non-hodgkin ; Melena ; Philippines ; Radioimmunotherapy ; Rituximab ; Tomography ; Yttrium Radioisotopes

INTRODUCTION:Radioactive iodine(I131) therapy is an established definitive treatment for Graves' hyperthyroidism.However,the optimal method of determining the radioiodine treatment dose remains controversial.
OBJECTIVE: To compare the efficacy of fixed dose versus  calculated  dose  regimen  in  the  treatment  of  Graves'  hyperthyroidism  among  Filipinos 
METHODOLOGY: Diagnosed   Graves'   disease   patients underwent  thyroid  ultrasound  to  estimate  thyroid  size. Patients  were  randomized  to  either  fixed  or  calculated dose  of  radioiodine  treatment.  For  fixed  dose  group,the  WHO  goiter  grading  was  utilized:  Grade   0   (5mCi),  Grade   1  (7mCi),  Grade2  (10mCi),  Grade  3  (15mCi).  For calculated  dose  group  the  following  formula  was  used:
                    Dose(mCi)= 160uCi/g thyroid x thyroid gland weight in grams x 100  /  24-hour RAIU(%)
Thyroid function test (TSH,FT4)  was monitored every  three  months  for  one  year. 
RESULTS: Of  the  60  patients  enrolled,  45  (fixed  dose;  n= 27,  calculated  dose;  n=  18)  completed  the  six  months follow-up  study.  Analysis  was  done  by  application  of  the  intention-to-treat  principle.  The  percentage  failure  rate  at  third  month  in  the  fixed  vs.  calculated  dose  group  was:  26  v.  28%  with  a  relative  risk  (RR)  value  of  0.93.  At  six  months  post-therapy,  there  was  a  noted  reduction  in  the  failure  rates  for  both  study  groups  (11  vs.  22%,  respectively),  with   a   further   reduction   in   the   relative   risk   value (0.67),  favoring  the  fixed  dose  group.
CONCLUSION: Fixed   dose   radioiodine   therapy   for Graves'   disease   is   observed   to   have   a   lower   risk   of   treatment   failure   (persistent   hyperthyroidism)   at   three  and  six  months  post-therapy  compared  to  the calculated  dose.

Human ; Male ; Female ; Middle Aged ; Adult ; Iodine Radioisotopes ; Iodine ; Intention To Treat Analysis ; Graves Disease ; Hyperthyroidism ; Goiter ; Thyroid Function Tests ; Treatment Failure

Background: It is acknowledged that legislation acts as a motivator for organizational action on psychosocial risks. Our study aims to provide evidence on the relationship between key occupational safety and health (OSH) policy principles and organizational action on work-related stress, and, in turn, with reported employee job demands and resources and their experience of work-related stress. We focus on Italy where specific legislation and practices on work-related stress were introduced in 2008 which are underpinned by these key OSH policy principles. Methods: Secondary analysis of the Italian samples from the employer ESENER-2 and employee 6th EWCS surveys was conducted, using path analysis in structural equation modeling (SEM) linking the two datasets. Results: We found a strong statistically significant relationship between OSH policy principles and organizational action on work-related stress (C.I. = .62-.78 p < .001). The existence of an organizational action plan on work-related stress was found to be significantly associated with more reported job resources (C.I. = .02-.24, p < .05) but these were not found to be significantly associated with less work-related stress. No significant association was found between having an organizational action plan for work-related stress and reported job demands. However, job demands were significantly related to reported work-related stress (C.I. = .27-.47, p < .001). Conclusions Findings add support to the call for specific legislation on work-related psychosocial risks and highlight how an organizational OSH culture underpinned by key OSH principles, and awareness/competence development on psychosocial risk management can have a positive effect on organizational action. However, further support needs to be provided to organizations around developing primary prevention interventions at the organizational level with the aim of reducing job demands.

Background: and Purpose Ischemic stroke is a common cause of death worldwide. In clinical practice it is observed that many individuals who have experienced an ischemic stroke also suffer from simultaneous comorbidities such as heart failure, which could be directly associated with a worse clinical prognosis. Therefore, this study analyzed outcomes in terms of the severity of the event, inhospital mortality, duration of hospital stay, and inhospital recurrence of the episode, in order to determine the implications resulting from the presentation of both pathologies. Methods: This was a retrospective-cohort, hospital-based study. Results: The study included 110 subjects with heart failure (exposed) and 109 subjects without heart failure (nonexposed). The incidence of inhospital mortality was 27.27% in exposed patients and 9.17% in nonexposed patients (p<0.001), and the presence of heart failure increased the risk of death by 92% (p=0.027). According to scores on the National Institutes of Health Stroke Scale, the median severity was worse in exposed than nonexposed patients (16.1 vs. 9.2, p=0.001). The median hospital stay was 9 days in subjects with heart failure and 7 days in nonexposed patients (p=0.011). The rate of inhospital stroke did not differ significantly between exposed and nonexposed patients (1.82% vs. 0.92%, p=0.566). Conclusions Individuals with heart failure who suffer from an acute ischemic stroke show worse clinical outcomes in terms of mortality, event severity, and duration of hospital stay.

Background: and Purpose Ischemic stroke is a common cause of death worldwide. In clinical practice it is observed that many individuals who have experienced an ischemic stroke also suffer from simultaneous comorbidities such as heart failure, which could be directly associated with a worse clinical prognosis. Therefore, this study analyzed outcomes in terms of the severity of the event, inhospital mortality, duration of hospital stay, and inhospital recurrence of the episode, in order to determine the implications resulting from the presentation of both pathologies. Methods: This was a retrospective-cohort, hospital-based study. Results: The study included 110 subjects with heart failure (exposed) and 109 subjects without heart failure (nonexposed). The incidence of inhospital mortality was 27.27% in exposed patients and 9.17% in nonexposed patients (p<0.001), and the presence of heart failure increased the risk of death by 92% (p=0.027). According to scores on the National Institutes of Health Stroke Scale, the median severity was worse in exposed than nonexposed patients (16.1 vs. 9.2, p=0.001). The median hospital stay was 9 days in subjects with heart failure and 7 days in nonexposed patients (p=0.011). The rate of inhospital stroke did not differ significantly between exposed and nonexposed patients (1.82% vs. 0.92%, p=0.566). Conclusions Individuals with heart failure who suffer from an acute ischemic stroke show worse clinical outcomes in terms of mortality, event severity, and duration of hospital stay.

OBJECTIVE: To compare adolescents with non-suicidal self-injury behavior and tattoos [NSSI (T+)] with another group with non-suicidal self-injury behavior without tattoos [NSSI (T−)]. METHODS: Adolescents (n=438) 42.6% males from the community (M=12.3, SD=1.3), completed the Self-Injury Schedule. RESULTS: The lifetime prevalence of tattoos performed with the purpose to feel pain was 1.8%. Compared to the NSSI (T−) group, the NSSI (T+) group was significantly more likely to meet the DSM-5 frequency criteria of 5 self-injury events in 1 year, practice more than one method of self-injury, and topography, more suicidal intentionality, more negative thoughts and affective emotions before, during, and after self-injury and more academic and social dysfunction. CONCLUSION: Adolescents from the community who practice tattooing to feel pain, show a distinct phenotype of NSSI. Health professionals and pediatricians should assess tattooing characteristics such as intention (to feel pain), frequency, and presence of non-suicidal self-injury behavior and suicide intentionality.
Adolescent ; Appointments and Schedules ; Health Occupations ; Humans ; Intention ; Male ; Methods ; Phenotype ; Prevalence ; Suicide ; Tattooing