Transcanal endoscopic carbon dioxide laser resection of early-stage (A1-B1) glomus tympanicum tumours: single-centre case series

OBJECTIVE

To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours.

METHODS

A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery.

RESULTS

Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence.

CONCLUSION

The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.

Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout in primary care and healthcare professionals: development, feasibility, and potential effectiveness studies

BACKGROUND

A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem and digital tools have been proposed as a solution.

OBJECTIVE

We present the development, feasibility, and potential effectiveness studies of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers.

METHODS

User-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. Healthy controls (HCs) tested Vickybot for reliability. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different clinical situations. (2) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined from both subjective and objective user-engagement Indicators (UEIs). Potential effectiveness was measured using paired t-tests or the Wilcoxon signed-rank test for the change in self-assessment scores.

RESULTS

40 HCs tested Vickybot simultaneously, and data was transmitted and registered reliably. (1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) received 98.8% of the expected modules according to each simulation. Suicidal alerts were correctly received. (2) Feasibility and potential effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after two weeks of use. No significant differences were found between the scores of the first and second self-assessments for anxiety [t(8) = 1.000, P = .34] or depressive [t(8) = .40, P = .70] symptoms. However, work-related burnout scores were moderately reduced (Z = -2.07, P = 0.038, r = .32). There was a non-significant trend towards higher reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Three patients (8.8%) activated the suicide alert, and the research team intervened promptly with successful outcomes. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement). Feasibility was moderate.

CONCLUSIONS

The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and detecting suicidal risk. Potential effectiveness was shown in reducing work-related burnout, but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required.

CLINICALTRIAL

PCP analogues in samples of Barcelona from 2009 to 2015

Introduction

Novel psychoactive substances (NPS) use is progressively increasing year on year. The new analogues of phencyclidine are frequently sold as legal dissociative anesthetic drug with hallucinogenic and sedative effects, a legal alternative to ketamine, acting as a high affinity and selective ligand of NMDA receptor antagonists.

Objectives

To describe the presence of 3- and 4-MeO-PCP in samples delivered to Energy Control from 2009 to 2015 in Spain.

Methods

A total of 21,198 samples were analyzed from august 2009 to august 2015. Only those samples containing 4-MeO-PCP or 3-MeO-PCP were studied. They were analyzed by Energy Control, a Spanish harm reduction NGO that offers the possibility of analyzing the substances that users report. Analysis was done by gas chromatography–mass spectrometry.

Results

All the samples resulted to be the acquired drug of the consumer. Three samples were adulterated with substances as tramadol, cocaine, acetone among others.

Conclusions

Three and 4-MeO-PCP consumption is not found to be an emerging issue according to the results of our samples. Even the potential harmful effects of these dissociative drugs, our indirect indicator seems to show that consumption has not increased. A more precise monitoring would make a better approach to the real consumption and the impact of these substances in our society.

Disclosure of interest

The authors declare that they have no competing interest.

25I-NBOMe: The legal LSD

Introduction

Novel psychoactive substances (NPS) use is progressively increasing year on year. A new group of phenethylamines sold as legal stimulants and hallucinogens is being reported increasingly since 2012. Within this group, 25I-NBOMe is an outstanding substance with powerful effects and high affinity with the serotonin 2a (5HT2a) receptor. Several toxicity cases have been reported so far.

Objectives

To describe the presence of 25I-NBOMe and its characteristics in samples delivered to Energy Control from 2009 to 2015 in Spain.

Methods

Among the samples, 21,198 analyzed from august 2009 to august 2015 and only those samples containing 25I-NBOMe were studied (n = 56). Samples were analyzed by Energy Control, a Spanish harm-reduction NGO that offers users the possibility of analyzing the substances they intend to consume. Analysis was done by Gas Chromatography–Mass Spectrometry.

Results

From 56 samples were 25I-NBOMe was found, 24 were bought as LSD (42.8%), 12 as 25I-NBOMe (21.4%), 4 as 25C-NBOMe (7.1%), 4 as 25I-NBOH (7.1%) and 12 as other substances (21.4%), gummy bears included. All samples were received from 2012 on, having the highest peak on 2013 (19 samples).

Conclusions

25I-NBOMe consumption represents an emerging issue with potential harmful effects, especially when the substance used is not the expected. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological researches should be conducted to deepen knowledge about 25I-NBOMe and the management of its possible toxic effects. Physicians should be aware of NPS, their increasing use and the clinical differences between them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Is there a relationship between morbid obesity and depression?

Introduction

A considerable proportion of patients with morbid obesity require treatment with antidepressants.

Objectives

The aim of this study is to determine the incidence of patients who are in antidepressant treatment and identify risk factors for the need of this treatment in patients with morbid obesity.

Materials and methods

Retrospective cohort study of 292 patients with morbid obesity who underwent bariatric surgery at Hospital del Mar from January 2010 to November 2015. The incidence of antidepressant treatment was analyzed, and also its possible relationship with the following variables: age, sex, BMI, tobacco smoking, alcohol consumption and age of onset of obesity. Chi2 test for categorical variables and Student t-test for quantitative variables were applied. Afterwards, a multivariate analysis was performed using logistic regression.

Results

The mean age is 43.1 years. Most of the patients (76.4%) are women. Seventy-seven patients (26.4%) are receiving treatment with antidepressants. There is a statistically significant relationship between age and the need of treatment with antidepressants (P < 0.001). This relationship is still present when the variables are analyzed using logistic regression (P < 0.005, OR 1.049). We have not found any significant relationship with the rest of the variables.

Conclusions

Despite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. From all the variables that have been analyzed we have found that as the age of the patients increase, there is a higher number of patients that receive treatment with antidepressants.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Use of tritium to predict soluble pollutants transport in Ebro River waters (Spain)

The Ebro River, in Northeast Spain, discharges into the Mediterranean Sea after flowing through several large cities and agricultural, mining and industrial areas. The Ascó nuclear power plant (NPP) is located in its lower section and comprises two pressurised water reactor units, from which low-level liquid radioactive waste is released to river waters under authority control. Tritium routinely released by the NPP was used as a radiotracer to determine the longitudinal dispersion coefficient and velocity of the river waters. Several field experiments, in co-ordination with the NPP, were carried out during 1991 and 1992. During each field experiment, the flow rate was kept constant by dams located upstream from the NPP. After each tritium release, water was sampled downstream at periodic intervals over several hours and tritium was measured with a low-background liquid scintillation counter. Velocity and dispersion coefficient were determined in river waters for several river discharges using an analytical, box-type and numerical approach to solve the one-dimensional advection-diffusion equation. The set of calibrated parameters was used to predict the displacement and dispersion of soluble pollutants in river waters. Velocity was determined as a function of river discharge and river slope, and dispersion coefficient was determined as a function of distance. Finally, sensitivity of the model predictions was studied and uncertainties of the fitted parameters were estimated.

A rapid method for the simultaneous determination of gross alpha and beta activities in water samples using a low background liquid scintillation counter

The radiological examination of water requires a rapid screening technique that permits the determination of the gross alpha and beta activities of each sample in order to decide if further radiological analyses are necessary. In this work, the use of a low background liquid scintillation system (Quantulus 1220) is proposed to simultaneously determine the gross activities in water samples. Liquid scintillation is compared to more conventional techniques used in most monitoring laboratories. In order to determine the best counting configuration of the system, pulse shape discrimination was optimized for 6 scintillant/vial combinations. It was concluded that the best counting configuration was obtained with the scintillation cocktail Optiphase Hisafe 3 in Zinsser low diffusion vials. The detection limits achieved were 0.012 Bq L-1 and 0.14 Bq L-1 for gross alpha and beta activity respectively, after a 1:10 concentration process by simple evaporation and for a counting time of only 360 min. The proposed technique is rapid, gives spectral information, and is adequate to determine gross activities according to the World Health Organization (WHO) guideline values.

Datura stramonium poisoning. Identification of tropane alkaloids in urine by gas chromatography-mass spectrometry

A case of acute poisoning by ingestion of Datura stramonium infusion is reported. The patient presented with a typical anticholinergic syndrome (dryness of mouth, mydriasis, flushing, tachycardia, agitation, hallucinations) and was treated with symptomatic and supportive measures. The presence of tropane belladona alkaloids in a urine sample was demonstrated by gas chromatography-mass spectrometry.