Orexin receptor antagonists versus antipsychotics for the management of delirium in intensive care unit patients with cardiovascular disease: A retrospective observational study.

OBJECTIVE: Although antipsychotics are often used in the pharmacological treatment of delirium, recent reports suggest the efficacy of orexin receptor antagonists. This study investigated whether orexin receptor antagonists could be a possible treatment option for delirium. METHOD: A nonblinded nonrandomized routine clinical treatment was performed. Patients treated in intensive care units (ICU) for cardiovascular disease and receiving psychiatric intervention were studied retrospectively. The scores from the Intensive Care Delirium Screening Checklist (ICDSC) were compared between patients treated with orexin receptor antagonists and those treated with antipsychotics. RESULTS: The mean (standard deviation) ICDSC scores were 4.5 (1.8) at day -1 and 2.6 (2.6) at day 7 for orexin receptor antagonist group (n = 25) and 4.6 (2.4) at day -1 and 4.1 (2.2) at day 7 for antipsychotic group (n = 28). The orexin receptor antagonist group showed significantly lower ICDSC scores than the antipsychotic group (p = 0.021). CONCLUSION: While precise efficacy cannot be determined from our retrospective, observational, and uncontrolled pilot study, this analysis encourages a future double-blind randomized placebo-controlled trial of orexin-antagonists for delirium treatment.

Improvement of catatonia-induced rapid respiratory failure with electroconvulsive therapy: A case report.

We encountered a case of sudden respiratory failure during treatment of catatonia that required intensive care. Electroconvulsive therapy (ECT) was administered in the intensive care unit while the patient was under systemic control. The catatonia symptom was relieved, and respiratory failure improved. Although a proximal venous thrombus was observed, anticoagulation therapy was continued during ECT, and the patient was successfully treated without causing a pulmonary embolism. It is crucial to monitor the patient's physical and psychological symptoms because respiratory status may deteriorate rapidly in a catatonic state.

Prevention of end-stage renal disease with percutaneous endoscopic gastrojejunostomy tubes in a patient with recurrent episodes of binge eating and purging.

Background: Bulimia nervosa (BN) and the binge-eating/purging subtype of anorexia nervosa (b/p AN) are characterized by binge eating and unsafe compensatory behaviors, such as laxatives or diuretic abuse, self-induced vomiting, and excessive exercise. BN often causes miscellaneous physical complications that can lead to death. However, there have been very few prior reports on the physical complications of chronic BN. Case Presentation: We report a case of chronic BN of over 10 years. Her compensatory behaviors caused dehydration more easily than before. Repeated dehydration may result in end-stage renal disease (ESRD). Therefore, we had to prevent dehydration by placing a percutaneous endoscopic gastrojejunostomy (PEG-J) tube. After PEG-J placement, dehydration did not reoccur, thereby protecting her renal involvement from progressing to ESRD. Conclusion: Chronic BN exposure may cause repeated dehydration with time. Therefore, the PEG-J tube would be effective in preventing dehydration, which leads to ESRD.

Characterisation of QoI-resistant field isolates of Botrytis cinerea from citrus and strawberry.

BACKGROUND: In 2004, field isolates of Botrytis cinerea Pers. ex Fr., resistant to strobilurin fungicides (QoIs), were first found in commercial citrus orchards in Wakayama Prefecture, Japan. Subsequently, QoI-resistant isolates of this fungus were also detected in plastic strawberry greenhouses in Saga, Ibaraki and Chiba prefectures, Japan. Biological and molecular characterisation of resistant isolates was conducted in this study. RESULTS: QoI-resistant isolates of B. cinerea grew well on PDA plates containing kresoxim-methyl or azoxystrobin at 1 mg L(-1), supplemented with 1 mM of n-propyl gallate, an inhibitor of alternative oxidase, whereas the growth of sensitive isolates was strongly suppressed. Results from this in vitro test were in good agreement with those of fungus inoculation tests in vivo. In resistant isolates, the mutation at amino acid position 143 of the cytochrome b gene, known to be the cause of high QoI resistance in various fungal pathogens, was found, but only occasionally. The heteroplasmy of cytochrome b gene was confirmed, and the wild-type sequence often present in the majority of resistant isolates, indicating that the proportion of mutated cytochrome b gene was very low. CONCLUSION: The conventional RFLP and sequence analyses of PCR-amplified cytochrome b gene are insufficient for molecular identification of QoI resistance in B. cinerea.