Transitioning From In-Person to Telehealth Cognitive-Behavioral Therapy for Social Anxiety Disorder During the COVID-19 Pandemic: A Case Study in Flexibility in an Adverse Context.

Social anxiety disorder (SAD) is a condition in which people consistently and persistently experience significant fear and/or anxiety about one or more social situations in which they may be scrutinized and negatively evaluated. SAD has historically been found to respond well to cognitive-behavioral therapy (CBT) delivered both in-person and via telehealth; however, comparatively little information is available regarding response to treatment in the context of Coronavirus Disease 2019 (COVID-19) pandemic social and physical distancing guidelines, which have affected the way in which behavioral health services are delivered, as well as opportunities for interpersonal interactions which are either spontaneous or assigned as exposures. The current case study describes "Jennifer" (a pseudonym), a college student with a primary diagnosis of SAD, who was treated with primarily CBT interventions for 18 individual sessions over the course of approximately 6 months, which included treatment with a psychologist and a graduate student, implemented both in-person and via telehealth, both before and during the COVID-19 pandemic.

Cocaine and cardiovascular complications.

Thirty-six million Americans older than 12 years of age have used cocaine in their lifetime. Cocaine abuse is on the rise and it brings the challenges to treat the complication associated with it, particularly cardiovascular complications. As the understanding of pathophysiology of cocaine-associated cardiovascular complications is advancing, the treatment modalities are also modifying.

Combination therapy in hypertension: A focus on angiotensin receptor blockers and calcium channel blockers.

Every third adult in the United States has hypertension. Hypertension is a continuous, independent, potent risk factor for cardiovascular events like stroke, myocardial infarction, and heart failure. The blood pressure control achieved with most hypertensives is way below the recommended goal.

Activation of caspase-3 may not contribute to postresuscitation myocardial dysfunction.

We have previously reported that postresuscitation myocardial dysfunction is accompanied by the release of cytochrome c and caspase-3 activation. We now investigated the role of caspase-3 activation by examining whether such process prompts apoptotic DNA fragmentation, whether caspase-3 inhibition attenuates myocardial dysfunction, and whether myocardial protective effects of sodium-hydrogen exchanger isoform-1 (NHE-1) inhibition involve caspase-3 inhibition using a rat model of ventricular fibrillation (VF) of closed-chest resuscitation. Resuscitation after 4 or 8 min of untreated VF caused significant reductions in left ventricular stroke work index averaging 23% of sham control rats at 4 h postresuscitation.

[Trends in cardiopulmonary resuscitation].

Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends that have the greatest potential for improving outcome can be recognized in cardiopulmonary resuscitation (CPR): (1) systems to prevent cardiac arrests through recognition of early warning signs and timely intervention, (2) a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation, (3) the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and (4) the use of hypothermia.

Tissue angiotensin-converting enzyme inhibitors for the prevention of cardiovascular disease in patients with diabetes mellitus without left ventricular systolic dysfunction or clinical evidence of heart failure: a pooled meta-analysis of randomized placebo-controlled clinical trials.

Aim: The aim of this study was to determine the role of tissue angiotensin-converting enzyme (ACE) inhibitors in the prevention of cardiovascular disease in patients with diabetes mellitus without left ventricular systolic dysfunction or clinical evidence of heart failure in randomized placebo-controlled clinical trials using pooled meta-analysis techniques.

Methods: Randomized placebo-controlled clinical trials of at least 12 months duration in patients with diabetes mellitus without left ventricular systolic dysfunction or heart failure who had experienced a prior cardiovascular event or were at high cardiovascular risk were selected. A total of 10 328 patients (43 517 patient-years) from four selected trials were used for meta-analysis.

Zoniporide preserves left ventricular compliance during ventricular fibrillation and minimizes postresuscitation myocardial dysfunction through benefits on energy metabolism.

Objective: To investigate whether sodium-hydrogen exchanger isoform-1 (NHE-1) inhibition attenuates myocardial injury during resuscitation from ventricular fibrillation through effects on energy metabolism, using an open-chest pig model in which coronary perfusion was controlled by extracorporeal circulation.

Design: Randomized controlled animal study.

Setting: University research laboratory.

Methemoglobinemia-induced cardio-respiratory failure secondary to topical anesthesia.

Acute toxic methemoglobinemia is an infrequent complication of the use of topical anesthetics, most notably benzocaine. The clinical picture is characterized by sudden development of tissue hypoxia without underlying cardiac or respiratory dysfunction, and deceptively normal oxygen saturation on conventional arterial blood gas analysis. This condition may be rapidly fatal and management depends upon prompt recognition, confirmation of clinical suspicion using cooximetry of arterial blood, and quick institution of therapy.

Cariporide potentiates the effects of epinephrine and vasopressin by nonvascular mechanisms during closed-chest resuscitation.

Background: The efficacy of vasopressor therapy during closed-chest resuscitation is limited and decreases over time. We previously reported that sodium-hydrogen exchanger isoform-1 inhibition during ventricular fibrillation (VF) using cariporide ameliorates ischemic contracture and enhances the efficacy of chest compression. We currently investigated whether cariporide could potentiate pressor responses to epinephrine and vasopressin.

Cariporide enables hemodynamically more effective chest compression by leftward shift of its flow-depth relationship.

When given during closed-chest resuscitation, cariporide (4-isopropyl-methylsulfonylbenzoyl-guanidine methanesulfonate; a selective inhibitor of the Na(+)/H(+) exchanger isoform-1) enables generation of viable perfusion pressures with less depth of compression. We hypothesized that this effect results from greater blood flows generated for a given depth of compression. Two series of 14 rats each underwent 10 min of untreated ventricular fibrillation followed by 8 min of chest compression before defibrillation was attempted.

Capnography during cardiac resuscitation: a clue on mechanisms and a guide to interventions.

Measurement of the end-tidal partial pressure of carbon dioxide (PCO) during cardiac arrest has been shown to reflect the blood flow being generated by external means and to prognosticate outcome. In the present issue of , Grmec and colleagues compared the initial and subsequent PCOin patients who had cardiac arrest precipitated by either asphyxia or ventricular arrhythmia. A much higher PCOwas found immediately after intubation in instances of asphyxial arrest.

Optimal timing for electrical defibrillation after prolonged untreated ventricular fibrillation.

Objective: It currently is recommended that electrical shocks be delivered immediately on recognition of ventricular fibrillation. However, decreased effectiveness of this approach has been reported after prolonged intervals of untreated ventricular fibrillation. We investigated the optimal strategy for successful defibrillation after prolonged untreated ventricular fibrillation by using a rat model of ventricular fibrillation and closed-chest resuscitation.

Sodium-hydrogen exchange inhibition during ventricular fibrillation: Beneficial effects on ischemic contracture, action potential duration, reperfusion arrhythmias, myocardial function, and resuscitability.

Background: Inhibition of the sarcolemmal sodium-hydrogen exchanger isoform-1 (NHE-1) is emerging as a promising novel strategy for ameliorating myocardial injury associated with ischemia and reperfusion. We investigated whether NHE-1 inhibition (with cariporide) could minimize mechanical and electrical myocardial abnormalities that develop during ventricular fibrillation (VF) and improve outcome using a porcine model of closed-chest resuscitation.

Methods And Results: Two groups of 8 pigs each were subjected to 8 minutes of untreated VF and randomized to receive either a 3-mg/kg bolus of cariporide or 0.

Myocardial protection during ventricular fibrillation by inhibition of the sodium-hydrogen exchanger isoform-1.

Activation of the sarcolemmal sodium-hydrogen exchanger isoform-1 (NHE-1) in response to the intense intracellular acidosis that develops during ischemia has been identified as an important mechanism of myocardial cell injury. NHE-1 inhibition in the quiescent (nonfibrillating) heart ameliorates functional manifestation of ischemia and reperfusion injury. We investigated in isolated heart and intact rat models of ventricular fibrillation whether NHE-1 inhibition, by using the selective inhibitor cariporide, could ameliorate myocardial abnormalities that develop during ventricular fibrillation and limit resuscitability and survival.

Transtracheal oxygenation : an alternative to endotracheal intubation during cardiac arrest.

Study Objectives: Because efforts to secure adequate arterial oxygenation during cardiac resuscitation are more important than efforts to promote CO(2) elimination, we investigated whether continuous transtracheal oxygenation (TTO) could represent a potentially simpler alternative to conventional positive-pressure ventilation with 100% O(2) through an endotracheal tube.

Design: Controlled and randomized.

Setting: Animal laboratory.

Successful ventricular defibrillation by the selective sodium-hydrogen exchanger isoform-1 inhibitor cariporide.

Background: Sodium-hydrogen exchanger isoform-1 (NHE-1) activation worsens functional myocardial abnormalities associated with ischemia and reperfusion. We hypothesize that these abnormalities may limit cardiac resuscitation from ventricular fibrillation (VF) and investigated whether NHE-1 inhibition with the benzoylguanidine derivative cariporide could improve resuscitability, postresuscitation myocardial function, and short-term survival in isolated heart and intact rat models of VF. Methods and Results-- In the isolated rat heart, VF was induced for 25 minutes.

Epidemiology of ciprofloxacin-resistant Pseudomonas aeruginosa in a veterans affairs hospital.

This study was performed to identify risk factors for the nosocomial acquisition of ciprofloxacin-resistant Pseudomonas aeruginosa (CRPA) in a Veterans Administration hospital between January 1994, and March 1995. The study was a retrospective comparison of host factors and in-hospital exposures of patients who acquired nosocomially CRPA and ciprofloxacin-sensitive P. aeruginosa (CSPA).

Myocardial effects of repeated electrical defibrillations in the isolated fibrillating rat heart.

Objective: Although substantial myocardial cell injury has been reported after high-energy electrical defibrillation, only minimal injury with transient functional defects seems to develop at energy levels not exceeding those required to reverse ventricular fibrillation. Because multiple electrical shocks are often delivered in clinical settings during attempts to reverse ventricular fibrillation, we investigated the effects of repetitive shocks on postresuscitation myocardial dysfunction by using an isolated rat heart model of ventricular fibrillation.

Design: Prospective and randomized.

Myocardial effects of ventricular fibrillation in the isolated rat heart.

Objective: Ventricular fibrillation (VF) is known to increase myocardial oxygen requirements and to alter coronary vascular physiology. However, the significance of these effects during cardiac arrest and resuscitation is not well understood. A model was developed in the isolated rat heart to investigate the myocardial effects of VF during a simulated episode of cardiac arrest and resuscitation.

Metabolic implications of low-dose triiodothyronine administration in rats: relevance to the adjunctive use of triiodothyronine in the treatment of depression.

The adjunctive use of triiodothyronine (T3) with tricyclic antidepressants is generally believed to augment the efficacy of the tricyclic medications in unipolar, bipolar, and treatment-resistant depression. In the small subset of depressed patients with evidence for overt or subclinical hypothyroidism, the efficacy of supplementary T3 is logically presumed to derive from the amelioration of the hypothyroidism. It is, however, uncertain why adjunctive T3 therapy is often effective in the initially euthyroid depressed patient and if such therapy induces subclinical hyperthyroidism.

The appearance, distribution, and longevity of receptor-[125I]T3 complexes within the nuclei of isolated rat hepatocytes.

The nuclei of isolated rat hepatocytes were separable into three receptor compartments based upon their differential salt extractabilities: nucleoplasmic receptors (NP) extractable with 0.15 M KCl, high-salt extractable receptors (HSE) extractable with 0.4 M KCl, and salt-resistant receptors (SR) extractable with 0.

The hepatocellular thyroid status of uremic rats estimated from the abundances of thyroid hormone-dependent nucleoplasmic proteins.

Although the serum thyroxine (T4) and triiodothyronine (T3) concentrations of uremic rats are commensurate with moderate hypothyroidism, their thyroid status at the tissue level remains controversial. To help establish the hepatocellular thyroid status of uremic rats, a novel tissue marker (nuclear protein abundances) was evaluated in uremic rats (U), hypothyroid rats (H), and hypothyroid uremic rats (HU). Uremia was established by five-sixths nephrectomy.