Selective serotonin reuptakeinhibitors (SSRIs) are the gold standard treatment for major depressive disorder (MDD). However, the use of phosphodiesterase (PDE) inhibitors in the treatment of MDD remains unclear.Our study aims to compare the effect of PDE inhibitor combination therapy to SSRI monotherapy for the treatment of MDD. We performed a comprehensive literature search using PubMed, EMBASE, and Web of Science databases, for studies that assess the impact of PDE inhibitor therapy on MDD patients. The primary outcome of our study was treatment response rate at the end of study time. Pooled odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated using the random-effects model. A P-value <0.05 was considered statistically significant. A total of four randomized control trials (RCTs), including 270 patients with MDD, were included in the analysis. Follow-up periods ranged from 6 to 12 weeks. The PDE inhibitor group was associated with a significantly higher treatment response rate (OR, 4.77; 95% CI, 2.05-11.12; P = 0.0003). Our meta-analysis demonstrated that MDD patients receiving PDE inhibitor combination therapy had a higher treatment response rate than MDD patients receiving SSRI monotherapy. Further large-scale RCTs with long-term follow-ups are necessary to validate our findings.

No abstract

Takotsubo cardiomyopathy causes transient left ventricular dysfunction. It typically has a favorable prognosis but rarely leads to complications such as cardiogenic shock. Also known as stress-induced cardiomyopathy, it is precipitated by emotional or physical stress. Serotonin syndrome can cause severe stress due to excessive serotonergic activity in the central nervous system. We report a case of cardiogenic shock precipitated by serotonin syndrome-induced takotsubo cardiomyopathy. Only one other documented case has exhibited cardiogenic shock in this setting.

OBJECTIVES Cadaver dissection has become the gold-standard for anatomical education in US medical schools. Ethical issues regarding cadavers may not be as obvious as in living patients, which can lead to their potential neglect in medical school curricula. In this study, we assessed the different ethical concerns (ECs) of medical students regarding cadavers in the gross anatomy lab (GAL), gathered student information, including self-reported academic performance (AP) in the GAL, and determined the best predictors for a student's EC. METHODS All second-year medical students at the University of Toledo were invited to complete an anonymous, online-survey. Participants were presented with 10 hypothetical but realistic lab scenarios and asked to rate their EC for each on a 5-point Likert scale. Gender, age, and scores received in the GAL course were also collected. A multiple linear regression model was used to find the best predictors of the total EC score. RESULTS A total of 112 (63%) responses to the online-survey were recorded. The highest EC was for Q7: Taking pictures of the cadaver. The lowest EC was for Q10: The dissection of cadavers itself is an EC. Gender was the best predictor of total EC, followed by age. Female total EC was significantly higher than that for males (35.8 ± 5.5 vs 33.1 ± 7.9). Female scores for Q1 and Q2 were significantly higher than those for males. Total EC for students in the age group 25 to 34 was significantly higher than those in the age group 18 to 24 (35.9 ± 6.1 vs 33.9 ± 7.2). No significant difference was found for individual scenarios. AP was not significantly related to the total score or the scores of the individual scenarios. CONCLUSION The significant differences in ECs of medical students found in our study indicate that not all students have the same outlook towards the GAL specifically and ECs generally.