Serotonin syndrome caused by a CYP2C19-mediated interaction between low-dose escitalopram and clopidogrel: a case report

BackgroundSerotonin syndrome has been recognized as a serious adverse reaction to antidepressants and is characterized by sudden or severe autonomic nerve dysfunction and neuromuscular symptoms. Without an accurate diagnosis and prompt treatment, serotonin syndrome progresses rapidly and can be life-threatening. It is usually related to the dose of 5-hydroxytryptamine drugs, and the dose is the basis for diagnosis. Therefore, serotonin syndrome induced by low-dose antidepressants rarely occurs, and clinicians are more likely to misdiagnose patients who take low-dose antidepressants with similar symptoms. Here, we present a case study of serotonin syndrome caused by a relatively low dose of escitalopram, which is not common in past references.Case summaryThe patient was a 74-year-old Asian woman with a 42-year history of schizophrenia. After 6 weeks of antidepressant treatment, our patient presented with characteristic myoclonus in the lower limbs and closed eyes with fluttering. Initially, she was misdiagnosed with neuroleptic malignant syndrome (NMS) due to antipsychotic medication and was treated accordingly, even with discontinuation of clozapine. However, her symptoms persisted, and then therapeutic drug monitoring was initiated with the involvement of a clinical pharmacist. Eventually, she was diagnosed with serotonin syndrome due to escitalopram levels reaching the warning level. Subsequently, the patient’s treatment was modified, and her clinical outcome was satisfactory without any other serious adverse reactions. Gene detection was also performed, and a cytochrome P450 enzyme (CYP) 2C19-mediated interaction between low-dose escitalopram and clopidogrel seems to be a possible mechanism.ConclusionData on this is extremely scarce, and to the best of our knowledge, serotonin syndrome caused by low-dose antidepressants has not yet been discussed to any great extent in the literature. Our case provides more clinical experience in the treatment of serotonin syndrome

An Interferon-Related Signature in the Transcriptional Core Response of Human Macrophages to Mycobacterium tuberculosis Infection

The W-Beijing family of Mycobacterium tuberculosis (Mtb) strains is known for its high-prevalence and -virulence, as well as for its genetic diversity, as recently reported by our laboratories and others. However, little is known about how the immune system responds to these strains. To explore this issue, here we used reverse engineering and genome-wide expression profiling of human macrophage-like THP-1 cells infected by different Mtb strains of the W-Beijing family, as well as by the reference laboratory strain H37Rv. Detailed data mining revealed that host cell transcriptome responses to H37Rv and to different strains of the W-Beijing family are similar and overwhelmingly induced during Mtb infections, collectively typifying a robust gene expression signature (“THP1r2Mtb-induced signature”). Analysis of the putative transcription factor binding sites in promoter regions of genes in this signature identified several key regulators, namely STATs, IRF-1, IRF-7, and Oct-1, commonly involved in interferon-related immune responses. The THP1r2Mtb-induced signature appeared to be highly relevant to the interferon-inducible signature recently reported in active pulmonary tuberculosis patients, as revealed by cross-signature and cross-module comparisons. Further analysis of the publicly available transcriptome data from human patients showed that the signature appears to be relevant to active pulmonary tuberculosis patients and their clinical therapy, and be tuberculosis specific. Thus, our results provide an additional layer of information at the transcriptome level on mechanisms involved in host macrophage response to Mtb, which may also implicate the robustness of the cellular defense system that can effectively fight against genetic heterogeneity in this pathogen

Timely mental health services contribute to the containment of COVID-19 pandemic in China

AbstractThe COVID-19 pandemic?is the most severe public health crisis in the 21st century. The?pandemic not only posed great challenges to people's physical health but also?induced wide-ranging impacts on mental health of infected and suspected patients, frontline healthcare workers, and the general public whose normal life was disrupted by the pandemic. In this commentary, we outline the initiatives and coordinated efforts on providing timely mental health services after the pandemic outbreak in China, including understanding the mental health impact of COVID-19, prioritizing and coordinating mental health services along with medical services in the efforts to contain the pandemic, initiating and implementing specific measures to improve mental wellbeing of frontline healthcare workers, and increasing the accessibility of mental health services to the general public. Theses services, along with other coordinated efforts, contribute to the containment of COVID-19 pandemic in China?and could be valuable for other countries to take proactive measures to mitigate the mental health impacts of the pandemic now and in the future

Factor structure of the Children's Revised Impact of Event Scale among children and adolescents who survived the 2008 Sichuan earthquake in China

To evaluate the psychometric properties of the Chinese version of Children's Revised Impact of Event Scale (CRIES) and its applicability among Chinese children and adolescents, a study was conducted on two samples, the first, 1 month after the 2008 Sichuan earthquake, the second, 7 months after the earthquake. High levels of posttraumatic stress symptoms were found among both groups of children. The results also showed a decline of intrusion and arousal symptoms in accordance with the different periods of time elapsed since the earthquake; however, no difference was found in the avoidance symptoms between the two samples. Both the subscales and the CRIES total showed moderate to good reliability. Confirmatory factor analysis (CFA) of CRIES supported the presumed three inter-correlated factors model. However, the results of the second sample (with more than 6 months elapsed subsequent to the earthquake) are more likely to support this model than those of the first sample. This study generally justifies the use of CRIES as a screening instrument for probable PTSD victims among children and adolescents exposed to horrible natural disasters in China. Limitations of the present study and directions for future research are also discussed

Applying a Set of Potential Methods for the Integrated Assessment of the Marine Eco-Environmental Carrying Capacity in Coastal Areas

The accelerated socioeconomic development has placed the coastal ecosystems under stress, which influences the sustainable development of coastal areas. Marine eco-environmental carrying capacity assessment (MECCA) can provide a scientific basis for coordinating coastal socioeconomic development and eco-environmental protection, ensuring a more effective marine ecosystem-based management approach toward sustainability. However, accurate assessment methods are still in the exploratory stage, as there has been a lack of systematic research and applications combining integrated MECCA with a unified method to underpin coastal management processes. In light of this issue, this study applied the marine eco-environmental carrying capacity in coastal waters (MECCCW) conceptual framework to support the establishment of an assessment indicator system for MECCA and used the regularization method and entropy method to determine weights. This study also applied the simplified state space model to comprehensively evaluate and analyze the marine eco-environmental carrying capacity (MECC) of coastal areas. Focusing on the coastal area of Sanya Bay, southern China, as the study area, we assessed the MECC for the period from 2015 to 2020. The state of the MECC was divided into three grades: load capacity, full-load capacity, and overload capacity. The results showed that (1) the MECCA indicator system in Sanya Bay included a total of three criteria and eight assessment indicators and (2) the weights of the environmental carrying capacity (ECC) and human activities (HA) were both relatively higher than that of ecological resilience (ER). The latter result indicates that either ECC or HA could play a more predominant role in the changes of the MECC state in Sanya Bay. The results also indicated that (3) for each criterion, ECC, ER, and HA were at load capacity from 2015 to 2020. In this instance, ECC and HA presented similar change trends in relation to the MECC state of Sanya Bay. Finally, (4) the overall Sanya Bay’s MECC was also at load capacity and weakened, fluctuating between 2015 and 2020. These findings indicate that the coastal area of Sanya Bay is capable of sustainable development, but that there is a need for further eco-environmental improvement. The results of this study can serve as a reference when decisions have to be made about coastal management from an environmental and ecological perspective. Furthermore, this method may provide a feasible approach for integrated MECCA in other coastal areas

Psychological predictors of posttraumatic growth among adult survivors of Wenchuan earthquake in China

The current research investigates the applicability of the posttraumatic growth inventory and psychological predictors of posttraumatic growth among adult survivors of the Wenchuan earthquake in China. The results indicated that although the survivors reported a high degree of posttraumatic stress symptoms, they also experienced a moderate to high level of posttraumatic growth two years after the earthquake. The simplified Chinese version of the Posttraumatic Growth Inventory had good reliability in the current study. Confirmatory factor analysis of the simplified Chinese version of the Posttraumatic Growth Inventory verified that the original five-factor model fit the data better than the four-factor model documented by Ho et al. (2004, 2011) among Chinese cancer patients. The current study also demonstrates that positive changes in outlook, positive affect, and perceived social support are significant predictors of posttraumatic growth among adult survivors of the Wenchuan earthquake. Directions for future research on posttraumatic growth among survivors of natural disasters and implications for developing psychological interventions to help people recover from traumatic events are discussed

Mental health in frontline medical workers during the 2019 novel coronavirus disease epidemic in China: A comparison with the general population

Background: Since December 2019, China has been affected by a severe outbreak of coronavirus disease 2019 (COVID-19). Frontline medical workers experienced difficulty due to the high risk of being infected and long and distressing work shifts. The current study aims to evaluate psychological symptoms in frontline medical workers during the COVID-19 epidemic in China and to perform a comparison with the general population. Methods: An online survey was conducted from 14 February 2020 to 29 March 2020. A total of 899 frontline medical workers and 1104 respondents in the general population participated. Depression, anxiety, insomnia, and resilience were assessed via the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Insomnia Severity Index (ISI), and abbreviated Connor&ndash;Davidson Resilience Scale (CD-RISC-10), respectively. Results: Overall, 30.43%, 20.29%, and 14.49% of frontline medical workers in Hubei Province and 23.13%, 13.14%, and 10.64% of frontline medical workers in other regions reported symptoms of depression, anxiety, and insomnia, respectively. In addition, 23.33%, 16.67%, and 6.67% of the general population in Hubei Province and 18.25%, 9.22%, and 7.17% of the general population in other regions reported symptoms of depression, anxiety, and insomnia, respectively. The resilience of frontline medical staff outside Hubei Province was higher than that of the general population outside Hubei Province. Conclusion: A large proportion of frontline medical workers and the general public experienced psychological symptoms during the COVID-19 outbreak. Psychological services for frontline medical workers and the general public are needed.</p

Prevalence and associated factors of post-traumatic stress disorder in burned patients and their family members

Background: Post-traumatic stress disorder (PTSD) is common among burn patients and their family members. The objective of this study was to document the prevalence of PTSD and explore the sociodemographic and burn-specific associated factors of PTSD among Chinese burn survivors and their family members. Methods: A total of 131 adult patients with unintentional burns and 194 family members of burn patients were recruited from two burn units. All participants completed a general information form and the PTSD Checklist for the DSM-5 (PCL-5). Results: Fifty-five (42.0%) burn victims and ninety-nine (51.0%) family members of burn victims met the criteria for PTSD; the average score of the sample was 31.21 +/- 21.56 and 33.16 +/- 19.30. Logistic regression analysis revealed that middle age (45-55 years), poor economic status, greater total body surface area (TBSA) and longer time since the burn incident positively predicted the PTSD of patients and that female family members had a higher risk of PTSD. Conclusions: Burn patients and their family members are susceptible to PTSD. Suitable and long-term psychological intervention programmes should be executed for burn patients and their family members. (c) 2020 Published by Elsevier Ltd