Lower Serum Testosterone Associated with Elevated Polychlorinated Biphenyl Concentrations in Native American Men

Background: Polychlorinated biphenyls (PCBs) and chlorinated pesticides are endocrine disruptors, altering both thyroid and estrogen hormonal systems. Less is known of action on androgenic systems. Objective: We studied the relationship between serum concentrations of testosterone in relation to levels of PCBs and three chlorinated pesticides in an adult Native American (Mohawk) population. Methods: We collected fasting serum samples from 703 adult Mohawks (257 men and 436 women) and analyzed samples for 101 PCB congeners, hexachlorobenzene (HCB), dichlorodiphenyldichloroethylene (DDE), and mirex, as well as testosterone, cholesterol, and triglycerides. The associations between testosterone and tertiles of serum organochlorine levels (both wet weight and lipid adjusted) were assessed using a logistic regression model while controlling for age, body mass index (BMI), and other analytes, with the lowest tertile being considered the referent. Males and females were considered separately. Results: Testosterone concentrations in males were inversely correlated with total PCB concentration, whether using wet-weight or lipid-adjusted values. The odds ratio (OR) of having a testosterone concentration above the median was 0.17 [95% confidence interval (CI), 0.05–0.69] for total wet-weight PCBs (highest vs. lowest tertile) after adjustment for age, BMI, total serum lipids, and three pesticides. The OR for lipid-adjusted total PCB concentration was 0.23 (95% CI, 0.06–0.78) after adjustment for other analytes. Testosterone levels were significantly and inversely related to concentrations of PCBs 74, 99, 153, and 206, but not PCBs 52, 105, 118, 138, 170, 180, 201, or 203. Testosterone concentrations in females are much lower than in males, and not significantly related to serum PCBs. HCB, DDE, and mirex were not associated with testosterone concentration in either men or women. Conclusions: Elevation in serum PCB levels is associated with a lower concentration of serum testosterone in Native American men

THE ISSUE OF AGGRESSION IN PATIENTS WITH VENTRICULAR TACHYCARDIA WITH PULSE AND A SHORT EPISODE OF CARDIAC ARREST — A CASE OF A 68-YEAR-OLD MALE

   INTRODUCTION: Ventricular tachycardia (VT) is a life-threatening event. The role of the medical rescue team is to diagnose this disorder on the basis of resuscitation guidelines and general recommendations concern­ing ECG diagnoses. Patients with ventricular tachycardia, as a result of cerebral hypoxia, may react with aggression. In such situations, taking one’s medical history, conducting a physical examination or attempting emergency rescue operations may become difficult, or even impossible. OBJECTIVE: The objective of the paper is to demonstrate the issue of unintentional aggression that may occur in patients with ventricular tachycardia (VT) with a high heart rate and a short episode of cardiac arrest (CA), and the impact of such a disorder on attempted medical rescue operations. MATERIAL AND METHODS: The analysis of the case study was performed on the basis of medical documen­tation, i.e. an emergency dispatch order and an emergency medical services form. CASE DESCRIPTION: A medical emergency unit stationed at one of the substations in Łódź Province, 27 km away from a multi-disciplinary hospital, received a call from a medical dispatcher. The person calling emer­gency services requested the urgent arrival of an ambulance for her husband, who had suddenly passed out and was now lying on the kitchen floor showing no signs of life. In the course of the ambulance’s arrival at the location, the patient’s wife urged the ambulance to arrive soon, on account of her husband’s aggres­sive behaviour. CONCLUSIONS: Cardiac dysrhythmia and particularly ventricular tachycardia (VT) may constitute a serious health issue for the patient. The clinical picture may also vary across patients. An analysis of the case study demonstrates that medical personnel must be prepared to handle unconventional scenarios. The article shows that the procedure of cardioversion may be the only right choice when handling a patient with an unstable tachycardia

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered, Web-Based Clinical Decision Support System for the Treatment of Depression in Adults: Longitudinal Feasibility Study.

BACKGROUND: Approximately two-thirds of patients with major depressive disorder do not achieve remission during their first treatment. There has been increasing interest in the use of digital, artificial intelligence-powered clinical decision support systems (CDSSs) to assist physicians in their treatment selection and management, improving the personalization and use of best practices such as measurement-based care. Previous literature shows that for digital mental health tools to be successful, the tool must be easy for patients and physicians to use and feasible within existing clinical workflows. OBJECTIVE: This study aims to examine the feasibility of an artificial intelligence-powered CDSS, which combines the operationalized 2016 Canadian Network for Mood and Anxiety Treatments guidelines with a neural network-based individualized treatment remission prediction. METHODS: Owing to the COVID-19 pandemic, the study was adapted to be completed entirely remotely. A total of 7 physicians recruited outpatients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Patients completed a minimum of one visit without the CDSS (baseline) and 2 subsequent visits where the CDSS was used by the physician (visits 1 and 2). The primary outcome of interest was change in appointment length after the introduction of the CDSS as a proxy for feasibility. Feasibility and acceptability data were collected through self-report questionnaires and semistructured interviews. RESULTS: Data were collected between January and November 2020. A total of 17 patients were enrolled in the study; of the 17 patients, 14 (82%) completed the study. There was no significant difference in appointment length between visits (introduction of the tool did not increase appointment length; F2,24=0.805; mean squared error 58.08; P=.46). In total, 92% (12/13) of patients and 71% (5/7) of physicians felt that the tool was easy to use; 62% (8/13) of patients and 71% (5/7) of physicians rated that they trusted the CDSS. Of the 13 patients, 6 (46%) felt that the patient-clinician relationship significantly or somewhat improved, whereas 7 (54%) felt that it did not change. CONCLUSIONS: Our findings confirm that the integration of the tool does not significantly increase appointment length and suggest that the CDSS is easy to use and may have positive effects on the patient-physician relationship for some patients. The CDSS is feasible and ready for effectiveness studies. TRIAL REGISTRATION: ClinicalTrials.gov NCT04061642; http://clinicaltrials.gov/ct2/show/NCT04061642

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142934/1/bdi12609.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142934/2/bdi12609_am.pd

Proteomic analysis of urinary exosomes from patients with lithium-induced nephrogenic diabetes insipidus

: Lithium (Li)-induced Nephrogenic Diabetes Insipidus (NDI) is a large healthcare problem, which affect around 40% of patients with bipolar disorder undergoing Li treatment. NDI is characterized by the inability in the kidney to concentrate urine in response to vasopressin in the kidney collecting duct (CD). In animals, Li causes a downregulation of aquaporin-2 and a cellular remodeling of the CD in rats resulting in a reduced fraction of principal cells relative to intercalated cells. Whether Li has similar effects in the human kidney is, however, not known. Urinary exosomes are extracellular nanovesicles derived from intracellular multivesicular bodies fused with the plasma membrane of epithelial cells lining the kidney tubular system and the urinary tract. The purpose of the first part of this study is to analyze whether the urinary rat proteome reflects the Li-induced changes in the kidney. This is followed by proteomic analyses of urinary exosomes isolated from Li-NDI patients. Rats were divided in three groups; controls (n=8), 2-week Li treatment (40 mmol/kg/food, n=8) and 4-week Li treatment (40 mmol/kg/food, n=8). Treatment with Li showed a significant increase in urine output after 2-weeks (P<0.01) and 4-weeks (P<0.05). Additionally, the rats developed severe polydipsia, with water intake significantly increased after 2-weeks Li treatment (P<0.001) and 4-weeks Li treatment (P<0.0001). Early morning urine samples from the placebo group in a previous published 12-week placebo-controlled pilot trial (Fotso Soh et al, 2021. A double-blind, randomized, placebo-controlled pilot trial of atorvastatin for nephrogenic diabetes insipidus in lithium users. Bipolar Disorders 23, 66-75) involving Li-NDI patients (n=9) were collected. The Li-NDI participants have been on a stable dose of Li (˃2 months) and determined to have a urinary osmolality <600 mOsm/kg at baseline. In addition, urine from random healthy controls (n=6) were collected. Urine samples from the rodent study and human study were subjected to ultracentrifugation for exosome isolation and will be further processed for mass spectrometry analysis (MS/MS)