Plos One
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Therapeutic drug monitoring (TDM) is recommended during valproic acid (VPA) use, and total serum concentration has been widely adopted. However, the free form of VPA is responsible for its pharmacologic and toxic effects, and the total and free concentrations are highly discordant because of VPA's highly protein bound and saturable binding characteristics. Therefore, free VPA monitoring is increasingly advocated. Nevertheless, the correlation between free VPA concentration and associated adverse effects remains unknown. ⋯ A free VPA serum concentration of 14.67 mcg/mL had the optimal discriminating power for the occurrence of thrombocytopenia. Ammonemia should be monitored even if free VPA concentration is within the safety range.
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Tonsillectomy is a commonly performed surgical procedure worldwide; however, the possible long-term consequences have not been fully explored. The tonsils are secondary lymphoid tissue providing a defensive barrier against pathogens. There are few data in the literature on the relationship between prior tonsillectomy and the risk of irritable bowel syndrome (IBS). ⋯ Stratified analysis revealed that a higher adjusted HR of 3.79 (95% CI, 1.35-10.64) in patients ≥50 years old, and there was a marginally significantly higher adjusted HR of 1.98 (95% CI, 0.99-3.95) of developing IBS when the follow-up period was longer than 3 years. Tonsillectomy was associated with a higher risk of developing IBS. Physicians should provide appropriate monitoring of IBS in patients undergoing tonsillectomy.
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A false-negative case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is defined as a person with suspected infection and an initial negative result by reverse transcription-polymerase chain reaction (RT-PCR) test, with a positive result on a subsequent test. False-negative cases have important implications for isolation and risk of transmission of infected people and for the management of coronavirus disease 2019 (COVID-19). We aimed to review and critically appraise evidence about the rate of RT-PCR false-negatives at initial testing for COVID-19. ⋯ Protocol available on the OSF website: https://tinyurl.com/vvbgqya.
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Considering its pandemicity and absence of effective treatment, authorities across the globe have designed various mitigation strategies to combat the spread of COVID-19. Although adherence towards preventive measures is the only means to tackle the virus, reluctance to do so has been reported to be a major problem everywhere. Thus, this study aimed to assess the community's adherence towards COVID-19 mitigation strategies and its associated factors among Gondar City residents, Northwest Ethiopia. ⋯ The findings have indicated that nearly half of the study participants had poor adherence towards COVID-19 mitigation measures. Sex, level of information exposure, attitude towards COVID-19 preventive measures, and risk perception of COVID-19 were factors which significantly influenced the adherence of the community towards COVID-19 mitigation measures. Therefore, it is crucial to track adherence responses towards the COVID-19 preventive measures, scale up the community's awareness of COVID-19 prevention and mitigation strategies through appropriate information outlets, mainstream media, and rely on updating information from TV, radio, and health care workers about COVID-19.
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In pre-hospital emergency care, video laryngoscopes (VLs) with disposable blades are preferably used due to hygienic reasons. However, there is limited existing data on the use of VLs with disposable blades by emergency medical staff. Therefore, the aim of this study was to compare the efficacy of four different VLs with disposable blades and the conventional standard Macintosh laryngoscope, when used by anesthetists with extensive previous experience and paramedics with little previous experience in endotracheal intubation (ETI) in a simulated difficult airway. ⋯ VLs with hyperangulated blades facilitated ETI in both groups and decreased the failure rate by an absolute 11.1% when used by paramedics with little previous experience in ETI. Our results therefore suggest that hyperangulated VLs could be beneficial and might be the method of choice in comparable settings, especially for emergency medical staff with less experience in ETI.