Gitelman syndrome is an autosomal recessive disorder characterised by hypokalaemia, metabolic alkalosis, hypomagnesaemia, hypocalciuria and hypertension [1]. We report the case of a female patient presenting with significant rhabdomyolysis and motor deficiency associated to Gitelman’s syndrome.

Purpose: To investigate the compliance and acceptance of first time using nasal spray OC-01 (Tyrvaya) for dry eye in order to study the potential strategy to improve the usage. Method: Twenty patients with DED either having resistance to eye drops therapy or having difficulty applying eye drops were included from January 2023 to July 4, 2023. A sample of one bottle of Varenicline was given to patients to spray both nasal cavities two times a day for two weeks. Detailed instructions and possible side effects were given according to the pharmaceutical pamphlets. The second bottle was given to those patients who stopped for the first bottle for the second chance to try. Questionnaire consisted of the following questions: 1) In two weeks did you stop the treatment? If you did stop and cannot continue, what was the reason? 2) were your dry eye symptoms being less and you can accept this treatment and continue? 3) How did the second bottle work? Result: Out of 20 patients, 18 responded (90%). 56% had good response with either mild side effect or can tolerate well and experience improvement in dry eye. 44% had poor response with sneezing, cough, nasal irritation resulting in abandoning the nasal spray. The second bottle improved the discontinue rate to 17%and good response rate to 83%. There was 1.1% lost follow up. Conclusion: The first-time successful rate of using nasal spray of Tyrvaya is about 56%. The discontinuation rate was about 44%. Second bottle with further education had better successful rate. The discontinuation rate improved to 17% and the successful rate to 83%. Education and reinforcement may increase the acceptance and compliance for patients who are indicated for the medication.

Hyponatremia due to risperidone is a rare complication that can be associated with drowsiness, confusion to coma and seizures. We report a case of a 92-year-old female with delirium combined with pulmonary infection who developed severe hyponatremia after 30 days of risperidone treatment, and the patient’s blood sodium gradually increased to normal after administration of concentrated sodium chloride, tolvaptan and gradual reduction of risperidone dosage until discontinuation. Through clinical observation, the mechanism of hyponatremia caused by risperidone is related to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

Antipsychotic drugs (APs) are widely used drugs for schizophrenia. For decades, these agents are frequently associated with some side-effects, including increased the risk of Venous Thromboembolism (VTE). A case of a man (53 years old) with schizophrenia was reported in this study. The man with no identified risk factor for thromboembolism, and developed Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) after treatment with risperidone 2 years. The current case indicates that use of risperidone for long time can be associated with the risk of PTE and DVT. Risperidone is a Second-Generation Antipsychotic medication (SGA), as a mixed serotonin 5HT2 and dopamine D2 receptor antagonist possibly implicated in this adverse event. As suggested by this observation, VTE and PTE risk not just appears to new users, so they should be vigilant monitored to ensure early detection and prompt treatment of VET and PTE during medication.

The title of this brief discussion is inspired by the poem by Christina Georgina Rossetti ‘Where shall I find a white rose blowing?’ White roses are considered to symbolise honour, respect, dignity and peace, and are particularly relevant to loss, death, grief, and hope. The idea of hope when a person is dying is nonetheless complex, and can confuse and distress family members. While hope for curing a serious illness may not be possible, it is often helpful to review life, loves and relationships, in order to progress through the experience, and die with some sense of peace and equanimity - this is realistic hope. The brief account that follows is disguised, yet illustrates ways in which normal communication between family members became difficult, throughout episodes of serious ill-health. The usual ways that family members communicated were no longer helpful or could be tolerated by the family as a whole. Brief psychotherapy helped, and although confined to a single assessment consultation, all involved recognised the need for an immediate change in circumstances, in order to achieve and provide some level of emotional and relational comfort to one another, at a time of extreme crisis.

Objective: To explore the predictive value of white blood cell (WBC), monocyte (M), neutrophil-to-lymphocyte ratio (NLR), fibrinogen (FIB), free prostate-specific antigen (fPSA) and free prostate-specific antigen/prostate-specific antigen (f/tPSA) in prostate cancer (PCa).

COVID‐19 is an ongoing pandemic and alarming public health issue throughout the globe. Nursing staff encounter patient deaths many times throughout their careers. The death of a patient is one of the most common stressors associated with their clinical duties. Failing to address these issues mystifies the experience and leads to nurses suppressing their emotions out of fear and discomfort. These barriers hold nurses back from reflecting and prevent them from effectively coping with patient deaths, which negatively impacts their physical and mental health .A qualitative evidence synthesis was conducted to assess the experience of nursing staff with patient deaths and during postmortem care. The databases were searched for qualitative studies published after 2009. The search resulted in a total of 802 articles that were screened for eligibility. Duplicate studies were excluded. After eligibility screening, four qualitative studies on nurses’ experience of patient deaths and postmortem care were identified and included in the analysis. An integrated analysis was conducted on the four qualitative studies. The studies were based in the United States, South Africa, Taiwan, and the United Kingdom. A total of 30 nursing staff reported their experiences of postmortem care. Three themes were identified: concerns associated with postmortem care, anxiety associated with death, and emotional alienation.

Point of care ultrasound has a very good application prospect in perioperative period because of its dynamic, real-time and repeatable advantages. At the same time, it has high accuracy and can quickly find the common causes of hypoxemia, such as pulmonary edema, atelectasis and pleural effusion. It is a good visualization tool. Perioperative combined use of cardiopulmonary ultrasound, on the basis of excluding cardiac dysfunction, rapid diagnosis of pulmonary edema. The author conducted a study on two cases of acute lung injury induced by a relatively large amount of blood transfusion. The patients had no prior cardiopulmonary disease, no abnormal findings were found on cardiac ultrasound, hypoxemia, and signs of lung injury were found on bedside pulmonary ultrasound.

The use of Radiation Therapy (RT) in lung cancer has shown some exciting and sometimes disappointing advances in recent years. Protons compared with photons interact differently with human tissues, and can be used to improve patient care suffering lung cancer. A new strategy is the simultaneous injection of Nanoparticles (NPs) with proton radiation to the tumor which has been given over a decade to improve conventional RT. In this work, Proton Beam Therapy (PBT) with Gold Nanoparticles (GNPs) is used as part of a combination program for the treatment of advanced localized lung cancers. The purpose of this paper is developing the complex GEANT4 (G4) model on the human lung and predict the distribution of absorbed dose in lung tumors during proton therapy without and with high-Z injection of GNPs. Thus, the distribution of the absorbed dose in lung tumor for four modes of Bethe-Bloch’s relativistic quantum theory, G4 simulation model, hartree-fock-roothaan wave functions and the bortfeld theoretical model without and with the injection of GNPs in predicted phantom of the lung are compared.

Introduction: Skin involvement is less common in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) than that of aggressive lymphoma such as diffuse large B cell lymphoma and T cell lymphoma. Cutaneous lesion as an initial presentation of CLL/SLL is even more rarely. While CLL/SLL presenting in the skin has been reported, to our knowledge it has never been described in the context of such as earlobes.