Citations

Salicylate is a potent pharmacologic agent, and the rational therapy of salicylate intoxication must be based on an understanding of its pharmacologic actions and consequent pathophysiologic effects.l Because it acts to uncouple oxidative phosphorylation in a manner analogous to that of 2,4-dinitrophenol, salicylate is, first of all, a general metabolic stimulant.2 Oxygen consumption, carbon dioxide formation, and heat production are increased by its action; consequently, oxygen requirement, blood CO2 concentration, and the need to eliminate heat are also increased. Respiration, heart rate, and cardiac output must increase to satisfy the demands imposed by the acceleration of metabolic processes. Second, saiicylate interferes in a complex manner with the normal metabolism of carbohydrate.3 Many factors seem to be involved, some tending to decrease and others to increase the blood glucose concentralion, and, clinically, either hyperglycemia or hypoglycemia may be observed. Hyperglycemia may be partially explained by the release of epinephrmne due to activation of hypothalamic sympathetic centers. However, large doses of salicyiate also decrease aerobic metabolism and increase glucose-6-phosphatase activity, effects which tend to increase the blood glucose level. Hypoglycemia, on the other hand, may be caused by an increased utilization of glucose by peripheral tissues or by interference with gluconeogenesis by salicylates. Recent studies suggest that brain glucose concentration may be decreased despite minimal alterations in blood glucose level.4 As a result of these salicylate-mnduced alterations in carbohydrate metabolism, organic acids, particularly lactic, pyruvic, and acetoacetic, accumuiate.5 Infants appear to be particularly susceptible to the toxic effects of salicylate on carbohydrate metabolism and are more likely to have disturbances in blood glucose concentration and metabolic acidosis than are older children.

Abstract Introduction: This case illustrates the feasibility, benefit, and putative enhanced ecological validity of performing internet-parent–child interaction therapy (I-PCIT) in the parent–child dyad's home for the treatment of behavior problems in medically ill children in the context of a global pandemic. Patient concerns: Parents of a 5-year-old girl initially presented with concerns regarding inattentiveness, physical and verbal fighting with her siblings, and getting kicked out of daycare for hitting another child. Patient also had difficulties sleeping at night. Diagnoses: Patient was diagnosed with electrical status epilepticus in sleep, frontal lobe executive function deficit, and attention deficit hyperactivity disorder. Interventions: Patient received a course of I-PCIT. Equipment included a cell phone with video capabilities connected to a videotelephony software program and set-up in the child's home by the parents. The treatment course included 8, 1-hour, weekly teaching/coaching sessions (7 of which were performed using I-PCIT) plus 1 follow-up booster session 6 months later. Outcomes: Home-based I-PCIT implementation greatly improved disruptive behaviors in a young child with electrical status epilepticus in sleep and attention deficit hyperactivity disorder. Conclusion: A combination of I-PCIT and methylphenidate allowed her to be successful at home and in a school setting. More research is needed on PCIT adaptations, such as home-based and internet-based PCIT, for medically ill children as well as treatment protocols for combined therapies.

INTRODUCTION Our educational report discusses a unique card game that provides an engaging, and competitive strategy for teaching psychopharmacology in the medically ill. It engages the players and helps them learn how to justify medical decisions in the context of complicated medical comorbidity. METHODS We describe a problem-based learning approach where learners are presented with randomized diagnoses and complications and are then forced to make prescription decisions for treatment from a limited and randomized supply of medication cards. Each round is facilitated by the teacher, who engages the teams and/or individual players in discussions regarding the rationale and justification of the medication decisions. These treatment plans are scored according to the appropriateness of the medication choice and the process is repeated. DISCUSSION The game is flexible regarding players’ levels of education and has been played by medical students, psychiatry residents, and fellows throughout their years of training. Overall feedback has been positive from facilitators and trainees and the game has been a valuable source of engaging learners in the process of making complex medication decisions in the medically ill.

AbstractBackgroundIntracardiac electrogram data remain one of the primary diagnostic inputs guiding complex ablation procedures. However, the technology to collect, process, and display intracardiac signals has known shortcomings and has not advanced in several decades.ObjectiveThe purpose of this study was to evaluate a new signal processing platform, the PURE EP™ system (PURE), in a multi‐center, prospective study.MethodsIntracardiac signal data of clinical interest were collected from 51 patients undergoing ablation procedures with PURE, the signal recording system, and the 3D mapping system at the same time stamps. The samples were randomized and subjected to blinded, controlled evaluation by three independent electrophysiologists to determine the overall quality and clinical utility of PURE signals when compared to conventional sources. Each reviewer assessed the same (92) signal sample sets and responded to (235) questions using a 10‐point rating scale. If two or more reviewers rated the PURE signal higher than the control, it was deemed superior.ResultsA total of 93% of question responses showed consensus amongst the blinded reviewers. Based on the ratings for each pair of signals, a cumulative total of 164 PURE signals out of 218 (75.2%) were statistically rated as Superior for this data set (p < .001). Only 14 PURE signals out of 218 were rated as Inferior (6.4%).ConclusionThe PURE intracardiac signals were statistically rated as superior when compared to conventional systems.