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Sample records for depot neuroleptic medication

  1. Cure or curse? Ambivalent attitudes towards neuroleptic medication in schizophrenia and non-schizophrenia patients

    Directory of Open Access Journals (Sweden)

    Dieter Naber

    2009-10-01

    Full Text Available Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis patients. As direct questioning is notoriously prone to social desirability biases, we conducted an anonymous survey. After a strict selection process blind to results, 95 psychiatric patients were retained for the final analyses (69 participants with a presumed diagnosis of schizophrenia psychosis, 26 without psychosis. Self-reported neuroleptic non-compliance was more prevalent in psychosis patients than non-psychosis patients. Apart from side effects and illness insight, main reasons for non-compliance in both groups were forgetfulness, distrust in therapist, and no subjective need for treatment. Other notable reasons were stigma and advice of relatives/acquaintances against neuroleptic medication. Gain from illness was a reason for non-compliance in 11-18% of the psychosis patients. Only 9% of all patients reported no side effects and full compliance and at the same time acknowledged that neuroleptics worked well for them. While pills were preferred over depot injections by the majority of patients, depot was judged as an alternative by a substantial subgroup. Although many patients acknowledge the need and benefits of neuroleptic medication, non-compliance was the norm rather than the exception in our samples.

  2. Ritanserin as add-on medication to neuroleptic therapy for patients with chronic or subchronic schizophrenia

    NARCIS (Netherlands)

    Den Boer, JA; Vahlne, JO; Post, P; Heck, AH; Daubenton, F; Olbrich, R

    2000-01-01

    The effect of ritanserin, a potent 5HT(2A/2C) receptor antagonist, used as an add-on medication to neuroleptic treatmentin patients with schizophrenia, was compared with that of placebo, in an international, double-blind, parallel-group study. Previously established neuroleptic therapy was maintaine

  3. A Fatal Case of Neuroleptic Malignant Syndrome After Paralytic Bowel in a Patient Taking Antiparkinson Medication

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    Domenico Campa

    2016-06-01

    Full Text Available Objectives: We report a fatal case of neuroleptic malignant-like syndrome, which occurred as a consequence of paralytic bowel in a 72-year-old woman on treatment with antiparkinson medication. Case description: Contrast enhanced computerized tomography of the chest and abdomen demonstrated the presence of paralytic bowel. Results: The patient died. Conclusions: Physicians involved in the treatment of patients affected by Parkinson’s disease should take into consideration the possibility of dopaminergic drug malabsorption due to paralytic bowel as a possible cause of neuroleptic malignant-like syndrome.

  4. A systematic review of service-user reasons for adherence and nonadherence to neuroleptic medication in psychosis.

    Science.gov (United States)

    Wade, Miriam; Tai, Sara; Awenat, Yvonne; Haddock, Gillian

    2017-02-01

    People diagnosed with psychosis, such as those with schizophrenia-related disorders, are routinely prescribed neuroleptic medication as a primary treatment. Despite reported benefits of neuroleptic treatment for symptom remission and relapse prevention, discontinuation rates are high. Research examining factors associated with neuroleptic non-adherence report inconsistent findings. Reasons for adherence to neuroleptic medication are under-researched. The current review aimed to synthesise evidence exploring service-user self-reported reasons for adherence and non-adherence to neuroleptic medication. A systematic literature search of databases and reference list searching identified 21 studies investigating service-user accounts of reasons for adherence and/or non-adherence to neuroleptic medication. Qualitative, quantitative and mixed-method studies were included in the review. Several themes of reasons were identified. Reasons for both adherence and non-adherence were largely similar; medication efficacy, compatibility with personal medication or religious beliefs, side-effects and the influence of relationships with other people. Experiences of stigma and economic difficulties were generally identified as reasons for non-adherence only while experiences of fear and coercion were identified as reasons for adherence only. The review identified crucial factors which may aid service providers in bettering treatment for people with psychosis and will provide evidence which could contribute to future prescribing guidelines. Copyright © 2016 Elsevier Ltd. All rights reserved.

  5. Neuroleptic malignant syndrome in clinical practices

    Directory of Open Access Journals (Sweden)

    Bugarinović Snežana M.

    2016-01-01

    Full Text Available Topic: Neuroleptic Malignant Syndrome is a rare but specific lethal reaction to neuroleptics / antipsychotics.It occurs in 0.02% to 3.3% of patients in the treatment applying conventional neuroleptic drugs. Neuroleptic malignant syndrome is associated with highly potent antipsychotic drugs. However, it can occur more frequently in patients treated with atypical antipsychotics such as clozapine. Topic position in medical public: Neuroleptic malignant syndrome is critical medical condition, potentially threatening complication associated with side effects of neuroleptic drugs. High levels of creatine kinase (CK and leukocytosis are associated with neuroleptic malignant syndrome. Future action: Neuroleptic malignant syndrome as a psychiatric entity requires permanent research, early diagnosis, adequate therapy, exchange of clinical experiences, and what's of particular importance, rational antipsychotic administration.

  6. Dosage of conventional neuroleptic medication and subjective cognitive functioning in schizophrenia.

    Science.gov (United States)

    Krausz, M; Moritz, S; Lambert, M; Naber, D

    2000-03-01

    Subjective cognitive and perceptual disturbances as assessed with the Frankfurt Complaint Questionnaire (FCQ) were correlated with chlorpromazine equivalents in 40 schizophrenic inpatients, who were treated with conventional neuroleptics. In line with previous research using 'objective' neuropsychological tests, both correlations and partial correlations (controlling for the effects of psychopathology, extrapyramidal symptoms and length of illness) confirmed that higher neuroleptic doses significantly worsen several cognitive and perceptual domains (r = 0.44 -0.54; P < or = 0.005 -0.05) with the possible exception of mnestic functions (r = 0.21 -0.24, n.s.) and language (r = 0.37 -0.38, P < 0.1). The clinical importance of self-report scales for evaluating both the risks and benefits of neuroleptic treatment is discussed.

  7. Adherence to depot versus oral antipsychotic medication in schizophrenic patients during the long-term therapy

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    Stanković Žana

    2013-01-01

    Full Text Available Background/Aim. There is a high rate of schizophrenic patients who do not adhere to their prescribed therapy, despite the implementation of antipsychotic long-acting injections and the introduction of atypical antipsychotics. The aim of this study was to investigate the differences in sociodemographic, clinical and medication adherence variables between the two groups of schizophrenic patients on maintenance therapy with depot antipsychotic fluphenazine decanoate and oral antipsychotics only as well as a correlation between the medication adherence and other examined variables. Methods. A total of 56 patients of both genders, aged < 60 years, with the diagnosis of schizophrenia (F20 (ICD-10, 1992 clinically stable for at least 6 months were introduced in this cross-sectional study. The patients from the depot group (n = 19 were on classical depot antipsychotic fluphenazine decanoate administering intramuscularly every 4 weeks (with or without oral antipsychotic augmentation and the patients from the oral group (n = 37 were on oral therapy alone with classical or atypical antipsychotics, either as monotherapy or combined. The Positive and Negative Syndrome Scale (PANSS was used to assess symptom severity. Item G12 of the PANSS was used to assess insight into the illness. The patients completed the Medical Adherence Rating Scale (MARS was used to assess adherence to the therapy. A higher MARS score indicates behavior [Medical Adherence Questionnaire (MAQ subscale] and attitudes toward medication [Drug Attitude Inventory (DAI subscale] that are more consistent with treatment adherence. The exclusion criteria were determined. The Pearson's χ2 test was used to compare categorical variables, Student's t-test to compare continuous variables and Pearson's correlation to test the correlation significance; p = 0.05. Results. Significant betweengroup differences in age, illness duration, chlorpromazine equivalents, PANSS score and DAI subscore were found

  8. Medical Cosmopolitanism in Global Dubai: A Twenty-first-century Transnational Intracytoplasmic Sperm Injection (ICSI) Depot.

    Science.gov (United States)

    Inhorn, Marcia C

    2017-03-01

    Dubai-one of the seven United Arab Emirates and the Middle East's only "global city"-is gaining a reputation as a transnational medical tourism hub. Characterized by its "medical cosmopolitanism," Dubai is now attracting medical travelers from around the world, some of whom are seeking assisted conception. Dubai is fast becoming known as a new transnational "reprohub" for intracytoplasmic sperm injection (ICSI), the variant of in vitro fertilization designed to overcome male infertility. Based on ethnographic research conducted in one of the country's most cosmopolitan clinics, this article explores the ICSI treatment quests of infertile men coming to Dubai from scores of other nations. The case of an infertile British-Moroccan man is highlighted to demonstrate why ICSI is a particularly compelling "masculine hope technology" for infertile Muslim men. Thus, Muslim men who face barriers to ICSI access in their home countries may become "reprotravelers" to Dubai, an emergent ICSI depot.

  9. Neuroleptic malignant syndrome: a preventive program.

    Science.gov (United States)

    Fernando, M L; Manchanda, R; Kirk, C

    1992-03-01

    Neuroleptic Malignant Syndrome is a very serious side effect of antipsychotic medications. The paper describes a preventative program which was instituted in an inpatient unit of a provincial psychiatric hospital. There have been no mortalities from Neuroleptic Malignant Syndrome (NMS) during this program. A suspicion of NMS by clinical evaluation and laboratory tests resulted in prompt management. The recommended management plan is described.

  10. Administration of depot medroxyprogesterone acetate on the day of mifepristone for medical abortion: a pilot study.

    Science.gov (United States)

    Sonalkar, Sarita; McClusky, Jessica; Hou, Melody Y; Borgatta, Lynn

    2015-02-01

    We sought to evaluate satisfaction with timing of administration and continuation rates of depot medroxyprogesterone (DMPA) when given on the initial visit for first-trimester medical abortion. In this pilot study, we administered DMPA within 15 min of mifepristone administration. Participants were followed up in the clinic 7 days after enrollment and were contacted at 14 days, 28 days and 3, 6, 9 and 12 months by telephone. We assessed satisfaction with contraception timing, DMPA continuation, bleeding patterns and abortion completion. Twenty women were enrolled. At 7-day follow-up, 18 of 19 contacted participants (94.7%) were satisfied with timing of DMPA administration. Ten of 19 participants (52.6%) discontinued DMPA after the first injection. At 1 year, 3 participants out of 19 were continuing DMPA (15.7%). The median number of bleeding days after abortion was 19. Three participants had medical abortion failure. In the first year after abortion, there were four known repeat pregnancies. The timing of initiation of DMPA on the initial visit for medical abortion is satisfactory to women, but its influence on medical abortion efficacy requires further study. Continuation rates for DMPA were low in our sample. This pilot study provides groundwork for future larger studies to assess initiation of the injectable contraceptive DMPA on the day of mifepristone for medical abortion, but low continuation rates of DMPA in our sample emphasize the importance of access to intrauterine devices and implants after abortion. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Recurrence of neuroleptic malignant syndrome.

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    González-Blanco, Leticia; García-Prada, Hilario; Santamarina, Susana; Jiménez-Treviño, Luis; Bobes, Julio

    2013-01-01

    Neuroleptic malignant syndrome (NMS) is a rare idiosyncratic reaction associated with the use of neuroleptics that has an incidence of 0.02 to 3% among patients taking these drugs. This is a very serious complication with a mortality rate that reaches 10-20%. It is therefore very important to have high clinical suspicion and use appropriate criteria to objectify this clinical picture early, stopping the medication causing the picture and to avoid the subsequent complications as much as possible that would be responsible for both its mortality and sequels. We present that case of an 81-year old woman who was admitted to the Psychiatric Hospitalization Unit (PHU) for a depressive episode with psychotic symptoms who developed a neuroleptic malignant syndrome (NMS) when Haloperidol was introduced. After its suspension and subsequent clinical recovery, antipsychotic treatment with Risperidone was reintroduced and she suffered a recurrence of NMS. Finally, significant improvement was achieved with several sessions of electroshock therapy (EST).

  12. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

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    Oruch, Ramadhan; Pryme, Ian F; Engelsen, Bernt A; Lund, Anders

    2017-01-01

    Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment. PMID:28144147

  13. Neuroleptic malignant syndrome: an easily overlooked neurologic emergency

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    Oruch R

    2017-01-01

    Full Text Available Ramadhan Oruch,1 Ian F Pryme,2 Bernt A Engelsen,3 Anders Lund4 1Department of Pharmacology and Toxicology, School of Pharmacy, Benghazi University, Benghazi, Libya; 2Department of Biomedicine, 3Department of Clinical Medicine, Section of Neurology, 4Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway Abstract: Neuroleptic malignant syndrome is an unpredictable iatrogenic neurologic emergency condition, mainly arising as an idiosyncratic reaction to antipsychotic agent use. It is characterized by distinctive clinical features including a change in mental status, generalized rigidity, hyperpyrexia, and dysautonomia. It can be lethal if not diagnosed and treated properly. Mortality and morbidity attributed to this syndrome have recently declined markedly due to greater awareness, earlier diagnosis, and intensive care intervention. In most cases, the syndrome occurs as a result of a rapid increase in a dose of neuroleptic, especially one of the long-acting ones. Pathophysiology behind this syndrome is attributed to a dopamine receptor blockade inside the neurons rendered by the offending drug and excessive calcium release from the sarcoplasmic reticulum of skeletal myocytes. Laboratory tests, although not diagnostic, may assist in assessing the severity of the syndrome and also the consequent complications. The syndrome has been described in all age groups and occurs more in males than in females. Genetics appears to be central regarding the etiology of the syndrome. Stopping the use of the offending agent, cold intravenous fluids, and removal of the causative agent and its possible active metabolites is the cornerstone of treatment. Periodic observation of psychotic patients recently started on antipsychotic medications, especially those being treated with depot preparations, may aid to an early diagnosis of the syndrome and lead to early treatment. Keywords: neuroleptic malignant syndrome, dopamine

  14. An uncommon adverse effect of levodopa withdrawal in a patient taking antipsychotic medication: neuroleptic malignant-like syndrome.

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    Man, S P

    2011-02-01

    A patient with symptoms suggestive of neuroleptic malignant syndrome after levodopa withdrawal is described. The patient presented with persistent high fever, stupor, autonomic dysfunction, rigidity, and rhabdomyolysis. He was successfully treated with intravenous dantrolene, resumption of levodopa, and forced alkaline diuresis. Doctors should be aware of the risk of abrupt cessation of dopamine agonists.

  15. Genetic studies of DRD4 and clinical response to neuroleptic medications

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    Kennedy, J.L.; Petronis, A.; Gao, J. [Univ. of Toronto, Ontario (Canada)] [and others

    1994-09-01

    Clozapine is an atypical antipsychotic drug that, like most other medications, is effective for some people and not for others. This variable response across individuals is likely significantly determined by genetic factors. An important candidate gene to investigate in clozapine response is the dopamine D4 receptor gene (DRD4). The D4 receptor has a higher affinity for clozapine than any of the other dopamine receptors. Furthermore, recent work by our consortium has shown a remarkable level of variability in the part of the gene coding for the third cytoplasmic loop. We have also identified polymorphisms in the upstream 5{prime} putative regulatory region and at two other sites. These polymorphisms were typed in a group of treatment-resistant schizophrenia subjects who were subsequently placed on clozapine (n = 60). In a logistic regression analysis, we compared genotype at the DRD4 polymorphism to response versus non-response to clozapine. Neither the exon-III nor any of the 5{prime} polymorphisms alone significantly predicted response; however, when the information from these polymorphisms was combined, more predictive power was obtained. In a correspondence analysis of the four DRD4 polymorphisms vs. response, we were able to predict 76% of the variance in response. Refinement of the analyses will include assessment of subfactors involved in clinical response phenotype and incorporation of the debrisoquine metabolizing locus (CYP2D6) into the prediction algorithm.

  16. The neuroleptic malignant syndrome.

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    Caroff, S N

    1980-03-01

    The neuroleptic malignant syndrome (NMS) is an evidently underdiagnosed but potentially lethal consequence of treatment with potent neuroleptics. The author presents a detailed review of the clinical characteristics and differential diagnosis of the NMS as described in the world literature. Further studies of the incidence, etiology and pathogenesis of the NMS may enhance knowledge of neuroleptic pharmacology and produce more effective means of prevention and treatment.

  17. An unrecognised case of withdrawal neuroleptic malignant syndrome: a case report.

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    Ball, Hadrian; de Waal, Hugo; Craig, Ken

    2009-10-01

    Withdrawal neuroleptic malignant syndrome is a not widely recognised variant of the rare adverse consequence of neuroleptic medication, neuroleptic malignant syndrome (NMS). We present a case to bring the disorder to the attention of clinicians responsible for treating serious mental illness and medical and judicial officers who may be involved in investigating serious untoward incidents occurring within a mental health care setting.

  18. Effects of Depot Medroxyprogesterone Acetate Injection Timing on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial.

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    Raymond, Elizabeth G; Weaver, Mark A; Louie, Karmen S; Tan, Yi-Ling; Bousiéguez, Manuel; Aranguré-Peraza, Ana Gabriela; Lugo-Hernández, Elba M; Sanhueza, Patricio; Goldberg, Alisa B; Culwell, Kelly R; Kaplan, Clair; Memmel, Lisa; Sonalkar, Sarita; Jamshidi, Roxanne; Winikoff, Beverly

    2016-10-01

    To evaluate the effects of timing of depot medroxyprogesterone acetate injection on medical abortion outcome and risk of repeat pregnancy within the subsequent 6 months. In a multinational randomized trial, we assigned women undergoing medical abortion who wanted depot medroxyprogesterone acetate to administration either with mifepristone (Quickstart group) or after the abortion (Afterstart group). We ascertained abortion outcome, pregnancies, and contraception use over 7 months. From August 2013 to March 2015, we enrolled 461 participants with pregnancy durations of 75 days or less. Of participants included in the abortion outcome analyses, 14 of 220 (6.4%) and 12 of 226 (5.3%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the upper 90% confidence limit on this difference was 4.9%, within our prestipulated 5% noninferiority margin. Ongoing pregnancy after initial abortion treatment was significantly more common in the Quickstart group (8/220 [3.6%]) than in the Afterstart group (2/226 [0.9%]); the difference was 2.7% (90% confidence interval 0.4-5.6%). By 6 months, 5 of 213 (2.3%) and 7 of 217 (3.2%) in the Quickstart and Afterstart groups, respectively, became pregnant (exact log-rank test, P=.64). Use of highly effective contraceptives was significantly more common in the Quickstart group at 31 days (P<.001), but no difference was apparent at 6 months. The Quickstart group was significantly more satisfied with group assignment. Depot medroxyprogesterone acetate administration with mifepristone did not appreciably increase the risk of surgery after medical abortion but did increase the risk of ongoing pregnancy. It enhanced patient satisfaction, but we found no evidence that it decreased 6-month risk of repeat pregnancy. ClinicalTrials.gov, https://clinicaltrials.gov, NCT01902485.

  19. Neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Mariana Moscovich

    2011-10-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a potentially fatal adverse event associated with the use of antipsychotics (AP. The objective of this study was to investigate the profile of cases of NMS and to compare our findings with those published in similar settings. A series of 18 consecutive patients with an established diagnosis of NMS was analyzed, gathering data on demography, symptoms and signs. Two thirds of all cases involved woman with a past medical history of psychiatric disorder receiving relatively high doses of AP. The signs and symptoms of NMS episodes were similar to those reported in other series and only one case had a fatal outcome, the remaining presenting complete recovery. As expected, more than two thirds of our cases were using classic AP (68%, however the clinical profile of these in comparison with those taking newer agent was similar. Newer AP also carry the potential for NMS.

  20. Use of neuroleptics in a general hospital

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    Castellanos Virgilio

    2002-05-01

    Full Text Available Abstract Background This study investigates the clinical use of neuroleptics within a general hospital in acutely ill medical or surgical patients and its relation with dementia three months after admission compared with control subjects. Methods Cases were defined as every adult patient to whom a neuroleptic medication was prescribed during their hospitalization in our Hospital from February 1st, to June 30th, 1998. A control matched by age and sex was randomly selected among patients who had been admitted in the same period, in the same department, and had not received neuroleptics drugs (205 cases and 200 controls. Demographic, clinical and complementary data were compared between cases and controls. Crude odds ratios estimating the risk of dementia in non previously demented subjects compared with the risk in non-demented control subjects were calculated. Results 205 of 2665 patients (7.7% received a neuroleptic drug. The mean age was 80.0 ± 13.6 years and 52% were females. They were older and stayed longer than the rest of the population. Only 11% received a psychological evaluation before the prescription. Fifty two percent were agitated while 40% had no reason justifying the use of neuroleptic drug. Three months after neuroleptic use 27% of the surviving cases and 2.6% of the surviving controls who were judged non-demented at admission were identified as demented. Conclusions The most common reason for neuroleptic treatment was to manage agitation symptomatically in hospitalised patients. Organic mental syndromes were rarely investigated, and mental status exams were generally absent. Most of neuroleptic recipients had either recognised or unrecognised dementia.

  1. On the early recognition of neuroleptic malignant syndrome.

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    Clark, T; Ananth, J; Dubin, S

    Neuroleptic Malignant Syndrome, a serious and sometimes fatal complication, has been reported to occur in some patients with the administration of neuroleptic medications. Clinically it is manifested by four groups of symptoms which include muscular hypertonicity, autonomic instability, altered consciousness, and hyperthermia. Laboratory findings such as elevated creatinine phosphokinase and leukocytosis are also seen. While it is true that the incidence of the full blown clinical picture of this syndrome is rare, the authors report that only muscular hypertonicity and autonomic instability have occurred frequently in their setting leading to discontinuation of neuroleptics. Such abortive cases may go undetected. If properly diagnosed, the occurrence of this syndrome is not as rare as the published reports indicate. Second, it is reported that rechallenge with neuroleptics may not induce Neuroleptic Malignant Syndrome again. The authors noted recurrence of fever after rechallenge with a different neuroleptic drug. This article describes the method of early recognition and prevention of morbidity as well as mortality.

  2. Nicotine binding in human striatum: elevation in schizophrenia and reductions in dementia with Lewy bodies, Parkinson's disease and Alzheimer's disease and in relation to neuroleptic medication.

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    Court, J A; Piggott, M A; Lloyd, S; Cookson, N; Ballard, C G; McKeith, I G; Perry, R H; Perry, E K

    2000-01-01

    Striatal nicotinic acetylcholine receptors with high affinity for nicotinic agonists are involved with the release of a number of neurotransmitters, including dopamine. Previous findings as to whether these receptors are changed in Parkinson's disease and Alzheimer's disease are inconsistent and no previous investigations have focused on these receptors in dementia with Lewy bodies and schizophrenia, which are also associated with disorders of movement. The present autoradiographic study of striatal [3H]nicotine binding in Alzheimer's and Parkinson's diseases, dementia with Lewy bodies and schizophrenia was conducted with particular reference to the potentially confounding variables of tobacco use and neuroleptic medication. [3H]Nicotine binding in both dorsal and ventral caudate and putamen was significantly reduced in Parkinson's disease (43-67%, n=13), Alzheimer's disease (29-37%, n=13) and dementia with Lewy bodies (50-61%, n=20) compared to age-matched controls (n=42). Although tobacco use in the control group was associated with increased [3H]nicotine binding (21-38%), and neuroleptic treatment in dementia with Lewy bodies and Alzheimer's disease was associated with reduced [3H]nicotine binding (up to 29%), differences between neurodegenerative disease groups and controls persisted in subgroups of Alzheimer's disease cases (26-33%, n=6, in the ventral striatum) and dementia with Lewy body cases (30-49%, n=7, in both dorsal and ventral striatum) who had received no neuroleptic medication compared to controls who had not smoked (n=10). In contrast, striatal [3H]nicotine binding in a group of elderly (56-85 years) chronically medicated individuals with schizophrenia (n=6) was elevated compared with the entire control group (48-78%, n=42) and with a subgroup that had smoked (24-49%, n=8). The changes observed in [3H]nicotine binding are likely to reflect the presence of these receptors on multiple sites within the striatum, which may be differentially modulated

  3. [Acute renal failure in neuroleptic malignant syndrome].

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    Wagner, G; Rónai, L

    1995-10-01

    The neuroleptic malignant syndrome is characterized by hyperpyrexia, muscle rigidity, extrapyramidal motion disorder, vegetative symptoms and mental disorientation. This group of symptoms develops abruptly and may lead to serious complications. One of these complications is the acute renal failure. Permanent muscle rigidity causes the damage of muscle cells which result in myoglobinaemia, myoglobinuria and elevations in muscle related creatine phosphokinase. The authors report the case of a young man who underwent neuroleptic medication because of hebephrenia. During the medication the following symptoms were developed: extrapyramidal symptoms, restlessness, muscle rigidity, high fever. These symptoms eventually lead to acute renal failure caused by rhabdomyolysis (characteristic urine finding, significant elevations in serum creatine phosphokinase). With regards to the neuroleptic malignant syndrome dantrolenum and bromocriptin treatment were applied with the discontinuation of neuroleptic medication. As a part of the complex therapy a massive volumen-supplementing and alkalizing treatment was used but haemodialysis had also become necessary. During the above mentioned treatment symptoms referring to the neuroleptic malignant syndrome resolved and the acute renal failure was cured. The case report calls attention to a specific group of symptoms and the possibilities for prevention and treatment. The above case report is the first observation in Hungary.

  4. Neuroleptic malignant syndrome: the diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Ivana Stasevic Karlicic

    2016-07-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a life-threatening, often fatal idiosyncratic reaction to neuroleptic or other drug therapies that antagonise the central dopaminergic neurotransmission. The clinical presentation of NMS is very heterogeneous. The lack of specific levels of symptom severity in currently used diagnostic criteria dims the diagnosis of NMS. Therefore differential diagnosis is of priority, because NMS is a diagnosis of exclusion. The aim of this paper is to present a complex clinical picture in a patient that after a differential diagnostic exclusion of other medical conditions and intoxications is diagnosed as NMS. Case reports such as these help raise awareness of this clinical issue.

  5. Neuroleptic malignant syndrome: A diagnostic challenge

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    Reshma P Ambulkar

    2012-01-01

    Full Text Available We report the case of a 7-year-old girl operated for craniopharyngioma who developed hyperkalemic cardiac arrest in the post-operative period. She was diagnosed as Neuroleptic malignant syndrome (NMS and the causative drug was carbamazepine. It was essentially a diagnosis of exclusion, and treatment was mainly supportive in form of withdrawal of the neuroleptic medication (carbamazepine and administration of dantrolene and bromocriptine. Although, relatively uncommon, NMS can be fatal. NMS presents a clinical challenge as the patient outcome depends on its prompt recognition and treatment.

  6. [Neuroleptic malignant syndrome : Rare cause of fever of unknown origin].

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    Chackupurakal, R; Wild, U; Kamm, M; Wappler, F; Reske, D; Sakka, S G

    2015-07-01

    Neuroleptic malignant syndrome (NMS) is a possible cause of fever of unknown origin (FUO) and is a potentially fatal adverse effect of various drugs, especially of neuroleptics. First generation antipsychotics, such as received by the patient described in this article, are more likely to cause NMS than second generation antipsychotics. The key symptoms are the development of severe muscle rigidity and elevated temperature associated with the use of neuroleptic medication. Malignant catatonia (MC) is an important differential diagnosis of NMS. While neuroleptics can trigger NMS and must be immediately discontinued if NMS occurs, neuroleptic therapy represents the first line treatment for MC. This article describes the case of a patient with schizoaffective disorder where initially the diagnosis of NMS was not clear. Eventually, fever and a markedly elevated serum creatine kinase (CK) led to the correct diagnosis and the appropriate therapy with dantrolene, bromocriptine and amantadine. Furthermore, a thorough review of the currently available literature on NMS is provided.

  7. Potentiating effect of fluphenazine decanoate and risperidone on development of neuroleptic malignant syndrome.

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    Liu, Pang-Yen; Wu, Pei-Chuan; Chen, Chun-Yen; Chen, Yi-Chyan

    2011-01-01

    We present the case of a woman with paranoid schizophrenia who was receiving oral risperidone. She developed neuroleptic malignant syndrome (NMS) following the addition of depot fluphenazine for the treatment of refractory delusions. NMS subsided and psychotic features were controlled after both antipsychotics were discontinued and the patient was treated instead with olanzapine.

  8. Discontinuing financial incentives for adherence to antipsychotic depot medication: long-term outcomes of a cluster randomised controlled trial

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    Priebe, Stefan; Bremner, Stephen A; Pavlickova, Hana

    2016-01-01

    Objectives In a cluster randomised controlled trial, offering financial incentives improved adherence to antipsychotic depot medication over a 1-year period. Yet, it is unknown whether this positive effect is sustained once the incentives stop. Methods and analyses Patients in the intervention and control group were followed up for 2 years after the intervention. Primary and secondary outcomes were assessed at 6 months and 24 months post intervention. Assessments were conducted between September 2011 and November 2014. Results After the intervention period, intervention and control groups did not show any statistically significant differences in adherence, neither in the first 6 months (71% and 77%, respectively) nor in the following 18 months (68%, 74%). There were no statistically significant differences in secondary outcomes, that is, adherence ≥95% and untoward incidents either. Conclusions It may be concluded that incentives to improve adherence to antipsychotic maintenance medication are effective only for as long as they are provided. Once they are stopped, adherence returns to approximately baseline level with no sustained benefit. Trial registration number ISRCTN77769281; Results. PMID:27655261

  9. Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients' and clinicians' perspectives after a 12-month randomized controlled trial.

    Science.gov (United States)

    Noordraven, Ernst L; Schermer, Maartje H N; Blanken, Peter; Mulder, Cornelis L; Wierdsma, André I

    2017-08-29

    A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in this trial. Three mental healthcare institutions in secondary psychiatric care in the Netherlands participated in this study. Patients (n = 169), 18-65 years, diagnosed with schizophrenia, schizoaffective disorder or another psychotic disorder who had been prescribed antipsychotic depot medication, were randomly assigned to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (intervention group) or treatment as usual alone (control group). Structured questionnaires were administered after the 12-month intervention period. Data were available for 133 patients (69 control and 64 intervention) and for 97 clinicians. Patients (88%) and clinicians (81%) indicated that financial incentives were a good approach to improve medication adherence. Ethical concerns were categorized according to the four-principles approach (autonomy, beneficence, non-maleficence, and justice). Patients and clinicians alike mentioned various advantages of M4M in clinical practice, such as increased medication adherence and improved illness insight; but also disadvantages such as reduced intrinsic motivation, loss of autonomy and feelings of dependence. Overall, patients evaluated financial incentives as an effective method of improving medication adherence and were willing to accept this reward during clinical treatment. Clinicians were also positive about the use of this intervention in daily practice. Ethical concerns are discussed in terms of patient autonomy, beneficence, non-maleficence and justice. We conclude that this intervention is ethically acceptable under certain conditions, and that further research is necessary to clarify issues of benefit

  10. Low dosage of aripiprazole induced neuroleptic malignant syndrome after interaction with other neuroleptic drugs

    Directory of Open Access Journals (Sweden)

    Albino Petrone

    2013-09-01

    Full Text Available Aripiprazole is a 2nd generation antipsychotic medication, atypical neuroleptic used for treatment of schizophrenia improving symptoms such as hallucinations, delusions, and disorganized thinking. A potentially fatal symptom complex sometimes referred to as neuroleptic malignant syndrome (NMS has been reported in association with administration of antipsychotic drugs, including aripiprazole. Rare cases of NMS occurred during aripiprazole treatment in the worldwide clinical database. The disease is characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. We report on a 63-year old woman with depression syndrome who developed neuroleptic malignant syndrome after twelve days of aripripazole 5 mg per day. Our case is added to the small number already described and suggests the need for caution when aripripazole is added to increase the effect of other antipsychotics.

  11. Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service.

    LENUS (Irish Health Repository)

    Cleary, A

    2012-01-01

    The aim of this audit was to review current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. Following a review of the literature on best practice internationally, an evidence based audit tool was adapted. A sample of 60 case files, care plans and prescriptions were audited between January and May 2010. This represented 31% of the total number of service users receiving depot injections in the mental health service region (n=181). The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only 5 (8%) case notes examined had documentation recorded describing the condition of the injection site and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded, and only 3 (5%) of case notes had documented that information on the depot injection and side effects was given. In 57 (95%) of case notes no documentation of recorded information on the depot and on side effects was given. Documentation of physical observations and tests revealed that 58% of cases had full blood count, liver function tests, thyroid function tests and fasting lipids recorded. All other tests (i.e. temperature, pulse, respirations, blood pressure, ECG) were recorded in less than 50% of cases. Prolactin levels were not recorded in any case. The lack of written consent was partly attributed to lack of recording of consent. The failure to monitor and record some\\r\

  12. Amantadine in the treatment of neuroendocrine side effects of neuroleptics.

    Science.gov (United States)

    Correa, N; Opler, L A; Kay, S R; Birmaher, B

    1987-04-01

    An open-label reversal drug study was undertaken on 10 neuroleptic-treated schizophrenic inpatients to assess the impact of amantadine hydrochloride on presumed prolactin-mediated neuroendocrine side effects. Measures were conducted across 7 weeks, including a 2-week neuroleptic baseline, a 3-week neuroleptic-plus-amantadine phase, and a 2-week return to the baseline regimen. Significant reduction with amantadine was observed on all six indices of neuroendocrine side effects: serum prolactin levels, body weight, gynecomastia/galactorrhea, breast tenderness, decreased libido, and amenorrhea. Improvement on these parameters was noted for as many as nine or all 10 patients, while in no cases was there worsening. In terms of motor and clinical effects, significant diminution of extrapyramidal and psycho-pathological symptoms was also achieved during this phase. The results suggested that amantadine may be beneficial for the treatment of neuro-endocrine side effects of antipsychotic medication owing to its ability to reverse neuroleptic-induced hyperprolactinemia.

  13. A case of recurrent neuroleptic malignant syndrome

    Institute of Scientific and Technical Information of China (English)

    Zexiang OUYANG; Li CHU

    2013-01-01

    Summary:Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic complication associated with the use of neuroleptic agents and characterized by a distinctive clinical syndrome of fever, rigidity, autonomic nervous system dysfunction and mental status change. This report discusses the clinical presentation, possible etiology, pathogenesis and treatment of one case of recurrent NMS in a middle-aged woman with schizophrenia. NMS occurred after combined treatment with haloperidol and aripiprazole (the first episode) and, four years later, after combined treatment with haloperidol and clozapine (the second episode). This case highlights the need to be particularly cautious in the use of antipsychotic medications in patients with a history of NMS and, whenever possible, to avoid combined treatment with multiple antipsychotic medications in these patients.

  14. Immobilization of Russian VX skin depots by localized cooling: implications for decontamination and medical countermeasures.

    Science.gov (United States)

    Mikler, J; Tenn, C; Worek, F; Reiter, G; Thiermann, H; Garrett, M; Bohnert, S; Sawyer, T W

    2011-09-25

    The chemical weapon nerve agent known as Russian VX (VR) is a potent organophosphorus (OP) compound that is much less studied than its VX analogue with respect to toxicity, as well as to the effectiveness of several known countermeasures against it. An anaesthetized domestic swine model was utilized to assess several approaches in mitigating its toxicity, including the utility of cooling VR treated skin to increase the therapeutic window for treatment. The 6h LD₅₀ for VR topically applied on the ear was 100 μg/kg. Treatment of VR exposed animals (5 × LD₅₀) with pralidoxime (2PAM) very poorly regenerated inhibited blood cholinesterase activity, but was partially effective in preventing signs of OP poisoning and increasing survival. In contrast, treatment with the Hagedorn oxime HI-6 reactivated cholinesterase, eliminated all signs of poisoning and prevented death. Decontamination with the Reactive Skin Decontaminant Lotion (RSDL) 15 min after VR exposure was completely effective in preventing death. Cooling of the VR exposure sites for 2 or 6h prevented signs of OP poisoning and death during the cooling period. However, these animals died very quickly after the cessation of cooling, unless they were treated with oxime or decontaminated with RSDL. Blood analyses showed that cooling of agent exposure sites delayed the entry of VR into the bloodstream. Medical treatment with HI-6 and to a lesser extent 2PAM, or decontamination with RSDL are effective in protecting against the toxic effects of cutaneous exposure to VR. Immobilizing this agent (and related compounds) within the dermal reservoir by cooling the exposure sites, dramatically increases the therapeutic window in which these medical countermeasures are effective.

  15. Clozapine Induced Neuroleptic Malignant Syndrome

    Directory of Open Access Journals (Sweden)

    Yong Suk Jo

    2017-08-01

    Full Text Available Neuroleptic malignant syndrome is a rare, but potentially life-threatening adverse event associated with the use of neuroleptic agents. We describe the case of a 47-year-old schizophrenic woman who was treated with clozapine for years. The patient developed acute renal failure with pulmonary edema, and underwent mechanical ventilation and hemodialysis.

  16. Neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Bino Rajamani

    2016-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a life-threatening emergency that is often seen as a complication of antipsychotic agents. It is characterized by a tetrad of motor, behavioral, autonomic, and laboratory abnormalities. We report a case of a 34-year-old man with a history of newly diagnosed Type 2 diabetes mellitus, mental retardation, and behavioral abnormalities who developed NMS after starting on antipsychotic agents. He presented with high temperature, muscle rigidity, tachycardia, and elevated blood pressure. After a week of hospital treatment in the general ward of a secondary care unit, he was discharged in a hemodynamically and mentally stable state.

  17. Neuroleptic Malignant Syndrome Requiring Neurological Intensive Care Unit Follow-up: Review with Nine Cases

    Directory of Open Access Journals (Sweden)

    Nazlı Gamze Bülbül

    2014-12-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but life-threatening clinical manifestation induced by neuroleptic medication. Although NMS is regarded as a psychiatric diagnosis, its treatment requires a systematic approach and thus intensive care follow-up. In this paper, we report nine cases with NMS followed up in our Neurology Intensive Care Unit over the last three years.

  18. Drug resistant neuroleptic malignant syndrome and the role of electroconvulsive therapy.

    Science.gov (United States)

    Hashim, Husnain; Zeb-un-Nisa; Alrukn, Suhail Abdulla Mohammad; Al Madani, Abubaker Abdul Rahman Shaffi

    2014-04-01

    Neuroleptic malignant syndrome is considered as a rare but potentially fatal complication of neuroleptic medications e.g.,antipsychotics, sedatives and anti emetics. It is characterized by hyperthermia, muscle rigidity, an elevated creatine kinase level and autonomic instability. The syndrome often develops after the start of antipsychotic or a sudden increase in dosage of the neuroleptic medication or in states of dehydration. Treatment is mainly supportive and includes withdrawal of the neuroleptic medication and, possibly, administration of drugs such as dantrolene and bromocriptine. In rare cases where drugs treatment remains ineffective a trial of electroconvulsive therapy is being given. The case presented is a drug resistant case of Neuroleptic Malignant Syndrome where finally electroconvulsive therapy was effective.

  19. Neuroleptic malignant syndrome: critical factors.

    Science.gov (United States)

    Staab, W L

    1994-12-01

    Although NMS is a rare complication of neuroleptic drug use, it is potentially fatal. Nursing care is directed at careful assessment, accurate treatment, and reduction of complications. Further studies should focus on prevention and treatment.

  20. Atypical Neuroleptic Malignant Syndrome Associated with Use of Clozapine

    Directory of Open Access Journals (Sweden)

    Quevedo-Florez Leonardo

    2017-01-01

    Full Text Available The Neuroleptic Malignant Syndrome (NMS is a medical emergency of infrequent presentation in the emergency department, which is associated with the use of psychiatric drugs, such as typical and atypical antipsychotics. Our case addresses a 55-year-old patient diagnosed with undifferentiated schizophrenia for 10 years, who had been receiving clozapine and clonazepam as part of their treatment. This patient presents the symptoms of Neuroleptic Malignant Syndrome without fever, which improves with treatment especially with the withdrawal of clozapine. In the absence of fever and clinical improvement, the patient is considered to have an atypical presentation of this disease.

  1. Neuroleptic malignant syndrome in cycloserine-induced psychosis

    Science.gov (United States)

    Sawant, Neena S.; Kate, Natasha S.; Bhatankar, Swaroop S.; Kulkarni, Prathamesh S.

    2015-01-01

    A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months. Patient's antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness. PMID:26069374

  2. Simultaneous occurrence of toxic epidermal necrolysis and neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Muhammed K

    2005-01-01

    Full Text Available Toxic epidermal necrolysis (TEN is an acute life-threatening blistering disease characterized by involvement of the skin, multiple mucous membranes and internal organs. It is most commonly precipitated by the administration of medications like anticonvulsants. Neuroleptic malignant syndrome (NMS is a rare complication of neuroleptic therapy characterized by catatonic behavior, generalized muscular rigidity, hyperthermia and autonomic dysfunction. An 18-year-old girl presenting with simultaneous appearance of TEN and NMS following anti-psychotic drugs given for bipolar mood disorder, is reported for the rare association and her complete recovery.

  3. Neuroleptic malignant syndrome in cycloserine-induced psychosis

    Directory of Open Access Journals (Sweden)

    Neena S Sawant

    2015-01-01

    Full Text Available A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months . Patient′s antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness.

  4. Neuroleptic malignant syndrome in cycloserine-induced psychosis.

    Science.gov (United States)

    Sawant, Neena S; Kate, Natasha S; Bhatankar, Swaroop S; Kulkarni, Prathamesh S

    2015-01-01

    A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months. Patient's antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness.

  5. Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus

    Directory of Open Access Journals (Sweden)

    Ali Ertug Arslankoylu

    2011-06-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked.

  6. Typical neuroleptic malignant syndrome presented in patient on maintenance quetiapine

    Directory of Open Access Journals (Sweden)

    Chintan Madhusudan Raval

    2014-01-01

    Full Text Available Neuroleptic malignant syndrome is an acute, life-threatening medical complication caused by antipsychotics. It is commonly seen with typical antipsychotics and very rare with atypicals. Cases have been reported with quetiapine also, but this case is of special interest because it occurred in patient who was stable on maintenance quetiapine 200 mg/day for last 5 years.

  7. Neuroleptic Malignant Syndrome: Diagnostic and Therapeutic Dilemmas

    Directory of Open Access Journals (Sweden)

    Abebaw Fekadu

    2005-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a life threatening medical state complicating the use of antipsychotic medications and other drugs that affect the dopaminergic system on administration or withdrawal. The condition was recognised nearly half a century ago, shortly after the discovery of antipsychotic medications. However, there are still no systematic studies about NMS. There are no definitive guidelines on its treatment. Although early recognition is emphasised and usually possible, delayed diagnosis is not rare. We here report on a case of NMS complicated by renal failure, and possibly respiratory failure. The report underscores the seriousness of delayed diagnosis and puts forward a comprehensive management recommendation based on our experience and the existing literature.

  8. Olanzapine-Induced Neuroleptic Malignant Syndrome

    Directory of Open Access Journals (Sweden)

    Seyedhamze Hosseini

    2017-05-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but life-threatening idiosyncratic side effect resulting from neuroleptic drugs. NMS mainly occurs in patients treated with high-potency typical antipsychotics, but rarely caused by atypical antipsychotics. Although NMS is less common with atypical antipsychotic, but it seems that its incidence is rising due to increased administration of such drugs. We present the case of a 27-year-old man with a history of paranoid schizophrenia that showed signs consistent with NMS that occurred after treatment with olanzapine. The patient was adherent to treatment. He had decreased level of consciousness, muscle rigidity, diaphoresis, fever, drooling, urinary incontinence, and high blood pressure. This patient illustrates that NMS can occur due to treatment with atypical antipsychotic drugs like olanzapine, particularly in the presence of risk factors. This phenomenon is often unrecognized, underdiagnosed, or not treated properly. Physicians should be aware that NMS with extrapyramidal syndrome could occur with olanzapine at steady state doses without recent dosage adjustments or titration. It is essential that adequate and safe dose of medication is chosen and the patient is monitored by the signs and symptoms of this lethal syndrome.

  9. Neuroleptic Malignant Syndrome Associated with Lithium Toxicity

    Science.gov (United States)

    Patil, Vaibhav; Gupta, Rishab; Verma, Rohit; Balhara, Yatan Pal Singh

    2016-01-01

    Neuroleptic Malignant Syndrome (NMS) is an idiosyncratic and potentially life-threatening reaction to neuroleptic drugs. Lithium is a first-line mood stabilizer used in the treatment and prophylaxis of bipolar disorder. There are several case reports of lithium-associated NMS, but only when it was given in combination with antipsychotics. Therefore, the possibility of NMS being secondary to the antipsychotics could not be ruled out in those cases. Here we present a case of lithium-induced NMS in a patient who was not being treated concomitantly with any other agent known to cause NMS. The patient, a 74-year-old female with a 30-year history of bipolar affective disorder, was admitted to the emergency room of the All India Institute of Medical Sciences, New Delhi, with history of high fever and generalized weakness for 10 days before the admission. NMS was established based the presence of three cardinal symptoms. She was started on intravenous fluids to correct her sodium levels slowly and requested to follow-up at the psychiatry clinic. PMID:27403245

  10. Neuroleptic Malignant Syndrome Associated with Lithium Toxicity

    Directory of Open Access Journals (Sweden)

    Vaibhav Patil

    2016-07-01

    Full Text Available Neuroleptic Malignant Syndrome (NMS is an idiosyncratic and potentially life-threatening reaction to neuroleptic drugs. Lithium is a first-line mood stabilizer used in the treatment and prophylaxis of bipolar disorder. There are several case reports of lithium-associated NMS, but only when it was given in combination with antipsychotics. Therefore, the possibility of NMS being secondary to the antipsychotics could not be ruled out in those cases. Here we present a case of lithium-induced NMS in a patient who was not being treated concomitantly with any other agent known to cause NMS. The patient, a 74-year-old female with a 30-year history of bipolar affective disorder, was admitted to the emergency room of the All India Institute of Medical Sciences, New Delhi, with history of high fever and generalized weakness for 10 days before the admission. NMS was established based the presence of three cardinal symptoms. She was started on intravenous fluids to correct her sodium levels slowly and requested to follow-up at the psychiatry clinic.

  11. The impact of neuroleptic dosage and extrapyramidal side effects on schizophrenic basic symptoms.

    Science.gov (United States)

    Moritz, S; Krausz, M; Gottwalz, E; Andresen, B

    2000-01-01

    The impact of neuroleptic medication and extrapyramidal symptoms on abnormal subjective experiences in schizophrenia, also termed basic symptoms, as assessed with the Frankfurt Complaint Questionnaire (FCQ) was investigated in 40 schizophrenic patients medicated with conventional neuroleptics. Basic symptoms are thought to reflect the subjective side of schizophrenic vulnerability and to underlie schizophrenic symptomatology. It was expected that basic symptoms would inversely correlate with chlorpromazine equivalents, since neuroleptics not only improve acute schizophrenic symptoms but also have prophylactic properties. However, a significant positive correlation with neuroleptic dosage and extrapyramidal symptoms emerged, suggesting that basic symptoms as operationalized in the FCQ partly reflect neuroleptic-induced deficits. The results remained unchanged when global psychopathology was controlled for. In line with previous research, basic symptoms correlated with thought disorder but not with positive symptoms. However, when the effects of neuroleptic-induced disturbances were controlled for, thought disorder also insignificantly correlated with basic symptoms. Our findings confirm previous results that question the construct validity of the FCQ. Moreover, the need to control for confounding variables (such as medication) is emphasized by comparing different psychiatric groups.

  12. Olanzapine induced neuroleptic malignant syndrome.

    Science.gov (United States)

    Patra, Bichitra Nanda; Khandelwal, Sudhir K; Sood, Mamta

    2013-01-01

    An 18 year old male diagnosed as a case of bipolar affective disorder (BPAD), developed neuroleptic malignant syndrome (NMS) following treatment with olanzapine (20 mg per day), an atypical antipsychotic drug. NMS is usually seen with typical antipsychotic drugs. The patient was diagnosed as a case of NMS, offending agent was immediately withdrawn and prompt treatment with bromocriptine and levodopa produced a good recovery. The various features of the case are discussed in view of the potential mortality of the syndrome.

  13. Neuroleptic-induced deficit syndrome in bipolar disorder with psychosis

    Directory of Open Access Journals (Sweden)

    Ueda S

    2016-02-01

    Full Text Available Satoshi Ueda,1 Takeshi Sakayori,1 Ataru Omori,2 Hajime Fukuta,3 Takashi Kobayashi,3 Kousuke Ishizaka,1 Tomoyuki Saijo,4 Yoshiro Okubo1 1Department of Neuropsychiatry, Nippon Medical School, Tokyo, Japan; 2Tamachuo Hospital, Tokyo, Japan; 3Kurumegaoka Hospital, Tokyo, Japan; 4Saijo Clinic, Tokyo, Japan Abstract: Neuroleptics can induce not only physical adverse effects but also mental effects that produce deficit status in thought, affect, cognition, and behavior. This condition is known as neuroleptic-induced deficit syndrome (NIDS, which includes apathy, lack of initiative, anhedonia, indifference, blunted affect, and reduced insight into disease. Although this old concept now appears almost forgotten, neuroleptics, whether typical or atypical, can make depression or bipolar disorder resemble other more refractory conditions, readily leading to mistaken diagnosis and inappropriate treatment. The authors describe three cases of NIDS superimposed on depressive phase in bipolar disorder with psychosis, where the attending psychiatrist’s failure to recognize NIDS prevented patients from receiving effective treatment and achieving remission. All cases achieved remission after reduction of neuroleptics and intensive therapy, including electroconvulsive therapy, for bipolar depression. The concept of NIDS was originally introduced for schizophrenia, and it has rarely been highlighted in other diseases. In recent years, however, atypical antipsychotics are being more often administered to patients with bipolar disorder. Psychiatrists, therefore, should also remember and exercise caution regarding NIDS in the pharmacotherapy of bipolar disorder with and without psychosis. The authors believe that the concept of NIDS needs to be reappraised in current psychiatry. Keywords: neuroleptic-induced deficit syndrome (NIDS, bipolar disorder, psychosis, atypical antipsychotics, electroconvulsive therapy

  14. Neuroleptic malignant syndrome in elderly patients.

    Science.gov (United States)

    Caroff, Stanley N; Campbell, E Cabrina; Sullivan, Kenneth A

    2007-04-01

    Antipsychotic drugs are widely and increasingly prescribed for neurobehavioral disorders in elderly patients. However, the efficacy of these drugs has not been consistently demonstrated in geriatric populations and there are continuing concerns regarding adverse effects. Among the latter are severe neurological disorders, including neuroleptic malignant syndrome. Although the incidence and mortality of neuroleptic malignant syndrome may have declined with heightened awareness of this disorder and the development of newer drugs, neuroleptic malignant syndrome still occurs in association with the use of antipsychotics. To enhance patient safety and clinical vigilance among practitioners, the authors present a clinical overview of neuroleptic malignant syndrome.

  15. Neuroleptic malignant syndrome induced by atypical antipsychotics.

    Science.gov (United States)

    Farver, Debra K

    2003-01-01

    A review of the English literature confirms that neuroleptic malignant syndrome (NMS) occurs with both traditional and atypical antipsychotic medications. Published reports of NMS induced by the traditional antipsychotics have given the practitioner valuable information on the prevention and treatment of this adverse effect. Case reports have also been published concerning NMS and clozapine, risperidone, olanzapine and quetiapine. By evaluating the case reports of atypical antipsychotic-induced NMS, valuable information may be obtained concerning similarities or differences from that induced by the traditional antipsychotics. The case reports of NMS with atypical antipsychotics were evaluated for diagnosis, age/sex of patient, risk factors, antipsychotic doses and duration of use, symptoms of NMS, and clinical course.

  16. [Neuroleptic malignant syndrome after aortic valve replacement; report of a case].

    Science.gov (United States)

    Ichiba, T; Takemoto, N

    2003-09-01

    A 64-year-old male with treated Parkinson's disease underwent mechanical valve replacement for aortic valve regurgitation. The antiparkinsonian drugs for internal use were interrupted on the morning of the operative day. After the operation, the patient developed fervescence, muscle rigidity, hidropoiesis and a rise in creatine kinase. The patient was diagnosed as neuroleptic malignant syndrome and given medication dantrolene sodium and antiparkinsonian drugs on the 5th postoperative day. The symptom of neuroleptic malignant syndrome disappeared on 12 postoperative days. As the stress of open heart surgery with extracorporeal circulation trigger off neuroleptic malignant syndrome, the patient with Parkinson's disease need early beginning of antiparkinsonian drugs on account of prevention of neuroleptic malignant syndrome after operation.

  17. A case of neuroleptic malignant syndrome induced by perospirone

    Institute of Scientific and Technical Information of China (English)

    Jing CHEN; Shengli ZHI

    2013-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition induced by neuroleptic medications. Its main symptoms include the rapid onset of fever, severe extrapyramidal symptoms, autonomic nervous system dysfunction, and impaired consciousness. In severe cases, acute renal failure and circulatory failure can develop, which can rapidly lead to death. In this case report, we discuss the etiology, pathophysiology and management of this condition in a female patient with NMS induced by perospirone. The case highlights the need for clinicians to be vigilant:rapid identification of NMS and vigorous symptomatic treatment of NMS symptoms is the key to decreasing the case-fatality of this rare but serious adverse reaction to antipsychotic medications.

  18. Elevated creatine kinase does not necessarily correspond temporally with onset of muscle rigidity in neuroleptic malignant syndrome: a report of two cases

    Directory of Open Access Journals (Sweden)

    Nisijima K

    2012-12-01

    Full Text Available Koichi NisijimaDepartment of Psychiatry, Jichi Medical University, Tochigi, JapanAbstract: Neuroleptic malignant syndrome is an uncommon but dangerous complication of antipsychotic drugs, characterized by clinical symptoms that include hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental state. Serum creatine kinase (CK elevation occurs in over 90% of cases. Many diagnostic criteria sets for neuroleptic malignant syndrome have been proposed, all of which include hyperthermia and muscle rigidity as major symptoms, and serum CK elevation as either a major or minor symptom. In general, elevated CK occurs in the initial stage of neuroleptic malignant syndrome and corresponds temporally with the onset of muscle rigidity. However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult. Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome. An elevated CK level is common in the early stage of neuroleptic malignant syndrome, suggesting that serum CK elevation is a useful indicator for early detection of neuroleptic malignant syndrome. However, a definitive diagnosis of neuroleptic malignant syndrome must be determined from the presence of specific clinical symptoms.Keywords: neuroleptic malignant syndrome, creatine kinase, muscle rigidity

  19. Evidences of possible side effects of neuroleptic drugs:A systematic review

    Institute of Scientific and Technical Information of China (English)

    Prashant Tiwari; Rajnikant Panik; Arin Bhattacharya; Dheeraj Ahirwar; Anish Chandy

    2012-01-01

    The premise that chronic neuroleptic treatment may induce decline in some schizophrenic patients has received considerable attention. This effect, typically called super sensitivity psychosis, has been accredited to neuroleptic induced changes in mesolimbic or mesocortical dopaminergic receptors. Both typical and atypical antipsychotics generations of medication tend to block receptors in the brain's dopamine pathways which offers a number of harmful and undesired (adverse) effects including lowered life expectancy, extrapyramidal effects on motor control including akathisia (an inability to sit still), trembling, and muscle weakness weight gain, decrease in brain volume, enlarged breasts e.g. gynecomastia in men and milk discharge in men and women (galactorrhea due to hyperprolactinaemia), lowered white blood cell count (agranulocytosis), involuntary repetitive body movements (tardive dyskinesia), diabetes, and sexual dysfunction. In evaluating the risk of neuroleptic medication, the occurrence of its common side effects and uneasiness connected with these side effects should be determined. However, research has not established that neuroleptics cause the projected effect, and considerations of mechanism have not been alienated from those of causation. The focus of research in this area should be the concern or repudiation of a causal relationship between chronic neuroleptic use and psychotic relapse, even though at hand article would eradicate to researchers to find out a compiled revision on probable side effects of neuroleptic drugs.

  20. Neuroleptic malignant syndrome: mechanisms, interactions, and causality.

    Science.gov (United States)

    Gillman, P Ken

    2010-09-15

    This review focuses on new data from recent publications concerning how compounding interactions between different thermoregulatory pathways influence the development of hyperthermia and/or neuroleptic malignant syndrome (NMS), and the fundamental issue of the presumed causal role of antipsychotic drugs. The formal criteria for substantiating cause-effect relationships in medical science, established by Hill, are applied to NMS and, for comparison, also to malignant hyperthermia and serotonin toxicity. The risk of morbidities related to hyperthermia is reviewed from human and experimental data: temperatures in excess of 39.5°C cause physiological and cellular dysfunction and high mortality. The most temperature-sensitive elements of neural cells are mitochondrial and plasma membranes, in which irreversible changes occur around 40°C. Temperatures of up to 39°C are "normal" in mammals, so, the term hyperthermia should be reserved for temperatures of 39.5°C or greater. The implicitly accepted presumption that NMS is a hypermetabolic and hyperthermic syndrome is questionable and does not explain the extensive morbidity in the majority of cases, where the temperature is less than 39°C. The thermoregulatory effects of dopamine and acetylcholine are outlined, especially because they are probably the main pathways by which neuroleptic drugs might affect thermoregulation. It is notable that even potent antagonism of these mechanisms rarely causes temperature elevation and that multiple mechanisms, including the acute phase response, stress-induced hyperthermia, drugs effects, etc., involving compounding interactions, are required to precipitate hyperthermia. The application of the Hill criteria clearly supports causality for drugs inducing both MH and ST but do not support causality for NMS.

  1. Acute psychosis followed by fever: Malignant neuroleptic syndrome or viral encephalitis?

    Directory of Open Access Journals (Sweden)

    Stojanović Zvezdana

    2014-01-01

    Full Text Available Introduction. Neuroleptic malignant syndrome is rare, but potentially fatal idiosyncratic reaction to antipsychotic medications. It is sometimes difficult to diagnose some clinical cases as neuroleptic malignant syndrome and differentiate it from the acute viral encephalitis. Case report. We reported a patient diagnosed with acute psychotic reaction which appeared for the first time. The treatment started with typical antipsychotic, which led to febrility. The clinical presentation of the patient was characterised by the signs and symptoms that might have indicated the neuroleptic malignant syndrome as well as central nervous system viral disease. In order to make a detailed diagnosis additional procedures were performed: electroencephalogram, magnetic resonance imaging of the head, lumbar puncture and a serological test of the cerebrospinal fluid. Considering that after the tests viral encephalitis was ruled out and the diagnosis of neuroleptic malignant syndrome made, antipsychotic therapy was immediately stopped. The patient was initially treated with symptomatic therapy and after that with atypical antipsychotic and electroconvulsive therapy, which led to complete recovery. Conclusion. We present the difficulties of early diagnosis at the first episode of acute psychotic disorder associated with acute febrile condition. Concerning the differential diagnosis it is necessary to consider both neuroleptic malignant syndrome and viral encephalitis, i.e. it is necessary to make the neuroradiological diagnosis and conduct cerebrospinal fluid analysis and blood test. In neuroleptic malignant syndrome treatment a combined use of electroconvulsive therapy and low doses of atypical antipsychotic are confirmed to be successful.

  2. Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary.

    Science.gov (United States)

    Dosi, Rupal; Ambaliya, Annirudh; Joshi, Harshal; Patell, Rushad

    2014-06-23

    Serotonin syndrome and neuroleptic malignant syndrome are two drug toxidromes that have often overlapping and confusing clinical pictures. We report a case of a young man who presented with alteration of mental status, autonomic instability and neuromuscular hyperexcitability following ingestion of multiple psychiatric and antiepileptic medications. The patient satisfied criteria for serotonin syndrome and neuroleptic malignant syndrome, and based on the characteristic clinical features, laboratory findings and clinical course it was concluded that the patient had both toxidromes. The patient was managed with cyproheptadine and supportive measures, and recovered over the course of 3 weeks. A brief review of literature highlighting the diagnostic clues as well as the importance of recognising and distinguishing the often missed and confounding diagnoses follows.

  3. Neuroleptic malignant syndrome associated with metoclopramide in a child.

    Science.gov (United States)

    Yaman, Ayhan; Kendirli, Tanıl; Ödek, Çağlar; Yıldız, Caner; Beğde, Fırat; Erkol, Hatice; İnce, Erdal

    2014-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal complication of treatment with antipsychotic medication. NMS has also been associated with non-neuroleptic agents that block central dopamine pathways, such as metoclopramide, amoxapine and lithium. Metoclopromide has antidopaminergic properties and is a rare but well-recognized perpetrator in the development of NMS. NMS has a constellation of signs and symptoms, including hyperthermia, muscle rigidity, autonomic instability, tachycardia, tachypnea, diaphoresis, hypertension and altered mental status. We present a 2-year-old girl who developed neuroleptic malignant syndrome after metoclopromide therapy. High-dose metoclopromide was given to our patient, and it is very likely that she was dehydrated while using metoclopromide, as she developed NMS two hours after treatment. The patient was discharged on the sixth day after admission to our hospital, having been cured. In summary, NMS developed in this patient very soon after metoclopromide treatment. NMS is a life-threatening emergency; if not recognized, or left untreated, it may be fatal. Therefore, early recognition of the developing signs and symptoms, along with a thorough medical history, is of great importance.

  4. Olanzapine induced neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Bichitra Nanda Patra

    2013-01-01

    Full Text Available An 18 year old male diagnosed as a case of bipolar affective disorder (BPAD, developed neuroleptic malignant syndrome (NMS following treatment with olanzapine (20 mg per day, an atypical antipsychotic drug. NMS is usually seen with typical antipsychotic drugs. The patient was diagnosed as a case of NMS, offending agent was immediately withdrawn and prompt treatment with bromocriptine and levodopa produced a good recovery. The various features of the case are discussed in view of the potential mortality of the syndrome.

  5. Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission

    Directory of Open Access Journals (Sweden)

    Faizan Mazhar

    2016-01-01

    Full Text Available Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with drugs given during the course of hospital treatment which leads to the development of serotonin syndrome overlapped with neuroleptic malignant syndrome. The physician should be aware that both NMS and SS can appear as overlapping syndrome especially when patients use a combination of both antidepressants and antipsychotics.

  6. Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission

    Science.gov (United States)

    Akram, Shahzad; Haider, Nafis; Ahmed, Rafeeque

    2016-01-01

    Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with drugs given during the course of hospital treatment which leads to the development of serotonin syndrome overlapped with neuroleptic malignant syndrome. The physician should be aware that both NMS and SS can appear as overlapping syndrome especially when patients use a combination of both antidepressants and antipsychotics. PMID:27433163

  7. Infections as complications of neuroleptic malignant syndrome.

    Science.gov (United States)

    Bilanakis, Nikolaos; Peritogiannis, Vaios; Kalampokis, Georgios

    2009-01-01

    Neuroleptic malignant syndrome is an uncommon but potentially fatal side effect of antipsychotic drug treatment. Several serious complications have been associated with neuroleptic malignant syndrome, such as acute renal failure, deep venous thrombosis, pulmonary embolism and aspiration pneumonia. Reports on infections other than aspiration pneumonia appear, from the literature, to be uncommon. Four cases of infection (three cases of upper respiratory tract infection and one case of urinary tract infection) which developed during the course of neuroleptic malignant syndrome are reported and pathophysiological mechanisms underlying their presentation are suggested.

  8. Neuroleptic Malignant Syndrome in a Patient with Corticobasal Degeneration

    Directory of Open Access Journals (Sweden)

    Myung Jun Lee

    2011-10-01

    Full Text Available Parkinson’s disease is a principal underlying disease of neuroleptic malignant syndrome (NMS occurring in parkinsonian disorders, but NMS may occur in patients with progressive supranuclear palsy and multiple system atrophy. We report first patient with corticobasal degeneration (CBD who developed NMS after abrupt reduction of antiparkinsonian medication and concurrent infection. It should be kept in mind that the prevention of infectious illness, which is common complication in parkinson-plus syndrome, is important, and dose reduction or withdrawal of anti-parkinsonian medications should be carefully performed even in the patients with CBD who are expected to be unresponsive to levodopa treatment.

  9. Anesthetic management of a pediatric patient with neuroleptic malignant syndrome.

    Science.gov (United States)

    Bhalla, Tarun; Maxey, Douglas; Sawardekar, Amod; Tobias, Joseph D

    2012-04-01

    Neuroleptic malignant syndrome (NMS) is a rare disorder which is clinically similar to malignant hyperthermia (MH). It is characterized by hyperthermia, autonomic instability, muscle rigidity, coma, rhabdomyolysis, and acidosis. Without immediate and appropriate therapy, mortality may result. NMS is associated with administration of antipsychotic medications, anti-emetic medications, and changes in the dosage of anti-parkinsonian drugs. As several similarities exist between NMS and MH, differentiating between them can be a challenge for the clinician. We report anesthetic care during magnetic resonance imaging of the brain of a 14-year-old female with bipolar and schizoaffective disorders and the recent onset of NMS.

  10. Neuroleptic malignant syndrome in a patient with corticobasal degeneration.

    Science.gov (United States)

    Lee, Myung Jun; Lyoo, Chul Hyoung; Lee, Myung Sik

    2011-10-01

    Parkinson's disease is a principal underlying disease of neuroleptic malignant syndrome (NMS) occurring in parkinsonian disorders, but NMS may occur in patients with progressive supranuclear palsy and multiple system atrophy. We report first patient with corticobasal degeneration (CBD) who developed NMS after abrupt reduction of antiparkinsonian medication and concurrent infection. It should be kept in mind that the prevention of infectious illness, which is common complication in parkinson-plus syndrome, is important, and dose reduction or withdrawal of anti-parkinsonian medications should be carefully performed even in the patients with CBD who are expected to be unresponsive to levodopa treatment.

  11. Neuroleptic malignant syndrome: Possible relationship between neuroleptic treatment and smoking cessation

    Directory of Open Access Journals (Sweden)

    Mª José Martín Vázquez

    2007-12-01

    Full Text Available We report the case of M., a schizophrenic patient who was treated with high doses of antipsychotics for a long time allowing him to be stable for years. He then decided to give up smoking and two weeks later he suffered a syndrome diagnosed as Neuroleptic Malignant Syndrome with somatic complications. This caused his death two months after the start of the symptoms. We discuss the implications of smoking cessation in the origin of the syndrome due to a lower metabolism of psychotropic medications, which previously had been well tolerated. We conclude that it is important to take into account the smoking and caffeine intake of these patients, as well as other metabolic inductor or inhibitor drugs.

  12. Neuroleptic malignant syndrome. Recognition, prevention and management.

    Science.gov (United States)

    Velamoor, V R

    1998-07-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal form of drug-induced hyperthermia characterised by mental status changes, muscle rigidity, hyperthermia and autonomic dysfunction. Increased awareness and early recognition will lead to prompt management. The diagnosis of NMS presents a challenge because several medical conditions generate similar symptoms. The presentation and course of NMS can be quite variable ranging from a stormy and potentially fatal course to a relatively benign and self-limiting course. The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of suspected cases and prompt discontinuation of the offending agent. All patients with psychosis should be monitored daily for dehydration and elevated temperature, have vital signs checked and agitation should be watched for. Antipsychotics should be used conservatively with gradual titration of doses. The management of NMS should be based on a hierarchy of symptom severity. Following an episode of NMS, the patient should be reassessed for further treatment with antipsychotics and rechallenge should not be attempted at least 2 weeks following resolution of symptoms of NMS. The patient and family should be educated about the episode and consent for further medication use obtained after a clear explanation of the risk-benefit analysis.

  13. Neuroleptic Malignant Syndrome: A Case Aimed at Raising Clinical Awareness

    Directory of Open Access Journals (Sweden)

    Jad Al Danaf

    2015-01-01

    Full Text Available A 60-year-old man with a history of bipolar disorder on risperidone, bupropion, and escitalopram was admitted for community acquired streptococcal pneumonia. Four days later, he developed persistent hyperthermia, dysautonomia, rigidity, hyporeflexia, and marked elevation of serum creatine phosphokinase. He was diagnosed with neuroleptic malignant syndrome (NMS and improved with dantrolene, bromocriptine, and supportive therapy. This case emphasizes the importance of considering a broad differential diagnosis for fever in the ICU, carefully reviewing the medication list for all patients, and considering NMS in patients with fever and rigidity.

  14. Atypicality in presentation of neuroleptic malignant syndrome caused by olanzapine

    Directory of Open Access Journals (Sweden)

    Mishra Biswaranjan

    2007-10-01

    Full Text Available Neuroleptic malignant syndrome (NMS is the most serious of acute neurological side effects produced by antipsychotic medication, characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction, the prevalence of which varies from 0.4-1.4%. NMS is usually seen in treatment with high potency typical antipsychotics and very rarely with atypical antipsychotics. However, NMS cases have been reported with risperidone, clozapine, olanzapine and quetiapine. The presentations of NMS have often varied, and we report another atypicality in presentation of NMS due to olanzapine use.

  15. Neuroleptic malignant syndrome following catatonia: Vigilance is the price of antipsychotic prescription

    Directory of Open Access Journals (Sweden)

    Thomas J Reilly

    2017-03-01

    Full Text Available Objectives: To describe a case of neuroleptic malignant syndrome following antipsychotic treatment of catatonia, highlighting the potentially serious complications of this rare adverse drug reaction. Methods: We present a case report of a patient who developed this syndrome with various sequelae. Results: The patient developed neuroleptic after being treated with lorazepam and olanzapine for catatonia. He subsequently developed the complications of rhabdomyolysis, acute kidney injury, pulmonary embolism, urinary retention and ileus. He received high-dose lorazepam, anticoagulation and intravenous fluids. Antipsychotic medication in the form of haloperidol was reinstated with no adverse effect, and he went on to make a full recovery. Conclusions: This case illustrates the potential life-threatening complications of neuroleptic malignant syndrome and the need for a low index of clinical suspicion. It also highlights the lack of evidence for treatment of catatonia, including the use of antipsychotics.

  16. Side effects of antipsychotic agents--neuroleptic malignant syndrome.

    Science.gov (United States)

    Cvjetković-Bosnjak, Mina; Soldatović-Stajić, Branislava

    2010-01-01

    Summary - Neuroleptic malignant syndrome is a rare, potentially life-threatening complication which is an unpredictable, idiosyncratic reaction to antipsychotics. In patients receiving traditional antipsychotics, neuroleptic malignant syndrome occurs with an incidence of 0.2-3.3%. However, neuroleptic malignant syndrome also appears in patients treated with atypical antipsychotics, especially Clozapine. A possible cause of neuroleptic malignant syndrome is blockade of dopamine receptors in the nigrostriatal tracts or hypothalamic nuclei. If signs and symptoms of the Neuroleptic malignant syndrome are identified in time, full recovery is possible. This is a report of a female patient with neuroleptic malignant syndrome treated by traditional antipsychotics. As soon as neuroleptic malignant syndrome symptoms were recognized, the antipsychotic drugs were discontinued, symptomatic therapy was initiated and symptoms of neuroleptic malignant syndrome disappeared. However, the patient's psychotic symptoms persisted and an atypical antipsychotic was administered. During the next few days the psychotic symptoms gradually disappeared and the patient accomplished good recovery.

  17. Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

    NARCIS (Netherlands)

    van Maldegem, Bianca T; Smit, Leo M E; Touw, Daan J; Gemke, Reinoud J B J

    UNLABELLED: Neuroleptic malignant syndrome (NMS) is a rare but serious disorder caused by antipsychotic medication including phenothiazines. For sedative purposes, increasing doses of alimemazine were administered to a 4-year-old multiple handicapped girl, with cerebral damage of the basal ganglia.

  18. Neuroleptic malignant syndrome during zuclopenthixol therapy in X-linked cerebral adrenoleukodystrophy

    NARCIS (Netherlands)

    Rubio-Gozalbo, ME; van Waardenburg, DA; Forget, PP; Spaapen, LJM; Verrips, A; Vroomen, PCAJ

    2001-01-01

    An 8 year-old boy with X-ALD under treatment with sinavastatin developed a severe adverse reaction when the dose of his other medication, zuclopenthixol was increased. Both drugs were withdrawn after a diagnosis of neuroleptic malignant syndrome was made.

  19. Neuroleptic Malignant Syndrome and Mental Retardation: Review and Analysis of 29 Cases.

    Science.gov (United States)

    Boyd, Richard D.

    1993-01-01

    Neuroleptic malignant syndrome, an uncommon but potentially lethal complication of antipsychotic medication, is reviewed, including analysis of 29 cases in which the condition appeared in individuals with mental retardation. Recommendations about reducing morbidity and mortality in this population are offered. (Author/DB)

  20. Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

    NARCIS (Netherlands)

    van Maldegem, Bianca T; Smit, Leo M E; Touw, Daan J; Gemke, Reinoud J B J

    2002-01-01

    UNLABELLED: Neuroleptic malignant syndrome (NMS) is a rare but serious disorder caused by antipsychotic medication including phenothiazines. For sedative purposes, increasing doses of alimemazine were administered to a 4-year-old multiple handicapped girl, with cerebral damage of the basal ganglia.

  1. Neuroleptic malignant syndrome during zuclopenthixol therapy in X-linked cerebral adrenoleukodystrophy

    NARCIS (Netherlands)

    Rubio-Gozalbo, ME; van Waardenburg, DA; Forget, PP; Spaapen, LJM; Verrips, A; Vroomen, PCAJ

    2001-01-01

    An 8 year-old boy with X-ALD under treatment with sinavastatin developed a severe adverse reaction when the dose of his other medication, zuclopenthixol was increased. Both drugs were withdrawn after a diagnosis of neuroleptic malignant syndrome was made.

  2. Neuroleptic Malignant Syndrome and Mental Retardation: Review and Analysis of 29 Cases.

    Science.gov (United States)

    Boyd, Richard D.

    1993-01-01

    Neuroleptic malignant syndrome, an uncommon but potentially lethal complication of antipsychotic medication, is reviewed, including analysis of 29 cases in which the condition appeared in individuals with mental retardation. Recommendations about reducing morbidity and mortality in this population are offered. (Author/DB)

  3. Neuroleptic-induced acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Francisco Garcia Soriano

    Full Text Available CONTEXT: A case of neuroleptic malignant syndrome and acute respiratory distress syndrome is presented and discussed with emphasis on the role of muscle relaxation, creatine kinase, and respiratory function tests. CASE REPORT: A 41-year-old man presented right otalgia and peripheral facial paralysis. A computed tomography scan of the skull showed a hyperdense area, 2 cm in diameter, in the pathway of the anterior intercommunicating cerebral artery. Preoperative examination revealed: pH 7.4, PaCO2 40 torr, PaO2 80 torr (room air, Hb 13.8 g/dl, blood urea nitrogen 3.2 mmol/l, and creatinine 90 mmol/l. The chest x-ray was normal. The patient had not eaten during the 12-hour period prior to anesthesia induction. Intravenous halothane, fentanyl 0.5 mg and droperidol 25 mg were used for anesthesia. After the first six hours, the PaO2 was 65 torr (normal PaCO2 with FiO2 50% (PaO2/FiO2 130, and remained at this level until the end of the operation 4 hours later, maintaining PaCO2 at 35 torr. A thrombosed aneurysm was detected and resected, and the ends of the artery were closed with clips. No vasospasm was present. This case illustrates that neuroleptic drugs can cause neuroleptic malignant syndrome associated with acute respiratory distress syndrome. Neuroleptic malignant syndrome is a disease that is difficult to diagnose. Acute respiratory distress syndrome is another manifestation of neuroleptic malignant syndrome that has not been recognized in previous reports: it may be produced by neuroleptic drugs independent of the manifestation of neuroleptic malignant syndrome. Some considerations regarding the cause and effect relationship between acute respiratory distress syndrome and neuroleptic drugs are discussed. Intensive care unit physicians should consider the possibility that patients receiving neuroleptic drugs could develop respiratory failure in the absence of other factors that might explain the syndrome.

  4. Neuroleptic malignant syndrome induced by lamotrigine.

    Science.gov (United States)

    Ishioka, Masamichi; Yasui-Furukori, Norio; Hashimoto, Kojiro; Sugawara, Norio

    2013-01-01

    This case report describes a 54-year-old man with bipolar I disorder who was treated with aripiprazole (ARP) and lithium. The patient was admitted to our hospital because of aggravation of depressive symptoms, and treatment with lamotrigine (LTG) was initiated. Two weeks after admission, we discontinued administration of ARP after the appearance of a tremor. Three weeks after discontinuing ARP, the patient developed a high fever, rigidity of the arms, diarrhea, dysphagia, and diaphoresis. We suspected these symptoms were consistent with neuroleptic malignant syndrome and therefore removed the application of LTG. After 2 days, most of the patient's symptoms and blood results had improved, leading us to conclude that the LTG treatment had induced neuroleptic malignant syndrome. Thus, the purpose of this case report was to warn psychiatrists against therapy with LTG, as it may be conducive to neuroleptic malignant syndrome.

  5. Makahiki+WattDepot

    DEFF Research Database (Denmark)

    Johnson, Philip M.; Xu, Yongwen; Brewer, Robert S.;

    2013-01-01

    Satisfying the radically different requirements and operating assumptions of the next generation smart grid requires new kinds of software that enable research and experimentation into the ways that electrical energy production and consumption can be collected, analyzed, visualized, and provided...... to consumers. Since 2009, we have been designing, implementing, and evaluating an open source software "stack" to facilitate this research. This software stack consists of two custom systems called WattDepot and Makahiki, along with the open source components they rely upon (Java, Restlet, Postgres, Python...

  6. [Intensive care treatment for neuroleptic malignant syndrome].

    Science.gov (United States)

    Hensel, Mario; Böhler, Klaus; Marnitz, Rudolf; Binder, Christian; von Brevern, Michael

    2010-07-01

    We report a case of severe neuroleptic malignant syndrome developing in a 28-year-old female patient following deliberate self-poisoning with atypical antipsychotic drugs and serotonin reuptake inhibitors. Because of an increasing loss of consciousness she was rapidly transferred to an Intensive Care Unit. Following this, she became progressively febrile associated with rhabdomyolysis and life-threatening organ dysfunctions. Due to fast diagnosis and immediate therapy the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of neuroleptic malignant syndrome. In addition therapeutic options are discussed.

  7. [Malignant neuroleptic syndrome--a possibility for early diagnosis].

    Science.gov (United States)

    Rasmussen, K T; Scherling, A

    1991-10-21

    A 17-year-old man developed the malignant neuroleptic syndrome and recovered after the neuroleptic drug was discontinued. When the treatment with the neuroleptic was resumed four weeks later, an elevated serum creatine kinase level was found without any other symptoms of the malignant neuroleptic syndrome. The neuroleptic was discontinued and the serum creatine kinase level was normalized. In both episodes, serum creatine kinase level was followed daily. The elimination of creatine kinase followed a first order kinetic, indicating that release of the enzyme to the blood stopped as soon the neuroleptic was discontinued. In the second episode, the increase in serum creatine kinase level was found before the symptoms of malignant neuroleptic syndrome appeared. This opens a possible way to early diagnosis and in that way prevention of severe symptoms.

  8. Neuroleptic malignant syndrome in the trauma intensive care unit: Diagnosis and management of a rare disease in a challenging population.

    Science.gov (United States)

    Drews, Joseph David; Christopher, Andrew; Evans, David Clay

    2017-01-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening neurological disorder associated with the use of antipsychotic medications. Many of its classic signs, such as fever and altered mental status, are nonspecific in trauma intensive care unit (ICU) patients, and its rarity makes it a difficult diagnosis in this population. However, delays in treatment can be costly both in terms of hospital resources and patient outcomes. We herein report a case of a 54-year-old trauma patient with NMS precipitated by a combination of cocaine withdrawal and neuroleptic medications. Few cases of NMS in the intubated polytrauma patient have been described in the literature previously. Given the poor outcomes associated with this disorder, ICU patients would benefit from risk stratification and avoidance of neuroleptic medications in those at highest risk for NMS, particularly patients who are withdrawing from dopaminergic agents.

  9. Neuroleptic malignant syndrome (a case report.

    Directory of Open Access Journals (Sweden)

    Patkar A

    1991-07-01

    Full Text Available An adult schizophrenic patient developed neuroleptic malignant syndrome following treatment with parenteral haloperidol. An early recognition of the syndrome, immediate discontinuation of the offending agent and prompt treatment with bromocriptine and lorazepam produced a good recovery. The various features of the case are discussed in view of the potential lethality of the syndrome.

  10. Neuroleptic malignant syndrome : Successful treatment with bromocriptine

    NARCIS (Netherlands)

    Verhoeven, W.M.A.; Elderson, Arthur; Westenberg, H.G.M.

    1985-01-01

    The neuroleptic malignant syndrome (NMS) is a potentially fatal complication of antipsychotic drugs and is characterized by severe muscle rigidity, hyperpyrexia, and autonomic dysfunctions. The pathogenesis of NMS is considered to be related to dopamine-receptor blockade in the basal

  11. Neuroleptic malignant syndrome : Successful treatment with bromocriptine

    NARCIS (Netherlands)

    Verhoeven, W.M.A.; Elderson, Arthur; Westenberg, H.G.M.

    1985-01-01

    The neuroleptic malignant syndrome (NMS) is a potentially fatal complication of antipsychotic drugs and is characterized by severe muscle rigidity, hyperpyrexia, and autonomic dysfunctions. The pathogenesis of NMS is considered to be related to dopamine-receptor blockade in the basal ganglia and hyp

  12. [Electroconvulsion therapy for neuroleptic malignant syndrome].

    Science.gov (United States)

    Buggenhout, S; Vandenberghe, J; Sienaert, P

    2014-01-01

    A 64-year-old man, diagnosed with recurrent depression, developed a neuroleptic malignant syndrome (nms) during treatment with olanzapine and mirtazapine. Psychotropic drugs were discontinued. Supportive therapy in an intensive care setting was initiated and electroconvulsive therapy (ect) was administered, after which the patient recovered. This case report discusses the place of ect in the treatment of nms.

  13. Acute cardiac failure in neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Sparrow, Patrick

    2012-02-03

    We present a case of rapid onset acute cardiac failure developing as part of neuroleptic malignant syndrome in a 35-year-old woman following treatment with thioridazine and lithium. Post mortem histology of cardiac and skeletal muscle showed similar changes of focal cellular necrosis and vacuolation suggesting a common disease process.

  14. Quetiapine and clarithromycin-induced neuroleptic malignant syndrome.

    Science.gov (United States)

    Christodoulou, Christos; Margaritis, Dimitris; Makris, Gerasimos; Kavatha, Dimitra; Efstathiou, Vasiliki; Papageorgiou, Charalabos; Douzenis, Athanasios

    2015-01-01

    We report a case of neuroleptic malignant syndrome possibly caused by the combined administration of quetiapine and clarithromycin in a 75-year-old male patient. He was receiving quetiapine regularly. Two days before his admission to the hospital, he had been feverish and started receiving clarithromycin without consulting a doctor. Clarithromycin administration was interrupted 3 days after his admission because it was ineffective and because his clinical state was deteriorating. The patient presented altered level of consciousness and excessive muscular rigidity on his limbs, while he remained feverish (38.7 °C). Laboratory abnormalities included elevated serum creatine phosphokinase level (5.387 U/L), leukocytosis, and low serum iron. The patient was diagnosed with neuroleptic malignant syndrome, and quetiapine was immediately discontinued. After the following days, his muscle rigidity and mental status ameliorated, his fever withdrew, and his laboratory findings improved. The various features of the case are discussed in view of the fact that the concomitant administration of cytochrome 3A4 inhibitors, such as clarithromycin, is suggested to cause an increase of plasma concentrations of quetiapine. Thus, physicians should have a high index of suspicion of the interactions of commonly administered medications.

  15. Depot Maintenance: Executed Workload and Maintenance Operations at DOD Depots

    Science.gov (United States)

    2017-02-03

    capital investments, process improvements, and public-private partnerships in enclosure I. To perform our work, we reviewed 10 U.S.C. § 2464 and DOD... capital investments.7 This non-generalizable sample was selected to ensure a mix of military services (at least one per type of site—Army depot, Navy...analyzed data on workload, personnel, and capital investment for each military depot for fiscal years 2012 through 2015. We chose this time frame

  16. Afebrile Neuroleptic Malignant Syndrome associated with Fluphenazine decanoate: A case report

    Directory of Open Access Journals (Sweden)

    Marzieh Assareh

    2010-06-01

    Full Text Available "nNeuroleptic Malignant Syndrome (NMS is unusual but could be a lethal reaction associated with neuroleptic drugs. It occurs in almost 0.07-2.2% of patients under treatment with neuroleptics. There are some medical treatments that may also be helpful for its treatment, including dopamine agonists, muscle relaxants, and electroconvulsive therapy (ECT. We present this case to alert the clinicians to the potential for inducing afebrile NMS. Our case is a 41-year-old man with a history of schizophrenia showing signs and symptoms in accordance with NMS, 2 weeks after receiving one dose of 12.5 mg fluphenazine decanoate, abruptly following the 3rdsession of ECT. The patient presented with decreased level of consciousness, muscular rigidity, waxy flexibility, mutism ,generalized tremor, sever diaphoresis and tachycardia which progressed during the previous 24 h. Laboratory data indicated primarily leukocytosis, an increasing level of creatinine phosphokinase and hypokalemia during the next 72h. In patients receiving antipsychotics, any feature of NMS should carefully be evaluated whether it is usual or unusual particularly in patients receiving long acting neuroleptics.

  17. Malignant neuroleptic syndrome following deep brain stimulation surgery: a case report

    Directory of Open Access Journals (Sweden)

    Stavrinou Lampis C

    2011-06-01

    Full Text Available Abstract Background The neuroleptic malignant syndrome is an uncommon but dangerous complication characterized by hyperthermia, autonomic dysfunction, altered mental state, hemodynamic dysregulation, elevated serum creatine kinase, and rigor. It is most often caused by an adverse reaction to anti-psychotic drugs or abrupt discontinuation of neuroleptic or anti-parkinsonian agents. To the best of our knowledge, it has never been reported following the common practice of discontinuation of anti-parkinsonian drugs during the pre-operative preparation for deep brain stimulation surgery for Parkinson's disease. Case presentation We present the first case of neuroleptic malignant syndrome associated with discontinuation of anti-parkinsonian medication prior to deep brain stimulation surgery in a 54-year-old Caucasian man. Conclusion The characteristic neuroleptic malignant syndrome symptoms can be attributed to other, more common causes associated with deep brain stimulation treatment for Parkinson's disease, thus requiring a high index of clinical suspicion to timely establish the correct diagnosis. As more centers become eligible to perform deep brain stimulation, neurologists and neurosurgeons alike should be aware of this potentially fatal complication. Timely activation of the deep brain stimulation system may be important in accelerating the patient's recovery.

  18. Gastric Dilation due to a Neuroleptic Agent in an Elderly Patient: A Case Report

    Science.gov (United States)

    Parent, V.; Popitean, L.; Loctin, A.; Camus, A.; Manckoundia, P.

    2014-01-01

    Neuroleptics may cause side effects, some of which are little known. We describe here a case of gastric dilation related to treatment with a neuroleptic in an elderly man. To our knowledge, such a case has never been reported in the literature. A 76-year-old man, living in a nursing home, was hospitalized for general weakness and abdominal pain. He had dementia with behavioral disorders treated with cyamemazine, a sedative and anxiolytic neuroleptic. Given a clinical suspicion of intestinal occlusion, an abdominopelvic computerized tomography scan was performed before the patient was admitted to our hospital. This computerized tomography scan did not show intestinal occlusion and there was no mention of gastric dilation in the computerized tomography scan report. Thus, acute gastroenteritis was suspected. The usual medications were stopped and symptomatic treatment for gastroenteritis was started. Quickly, his clinical state and biological parameters returned to normal and his usual treatment, including cyamemazine, was started again. The next day, the digestive symptoms, except for obstipation, reappeared. The abdominal X-ray showed gastric dilation without intestinal occlusion. The neuroleptic was stopped again and symptoms vanished the next day. This report underlines all of the necessary precautions and surveillance around drug prescription, especially in elderly persons. PMID:25161671

  19. Gastric Dilation due to a Neuroleptic Agent in an Elderly Patient: A Case Report

    Directory of Open Access Journals (Sweden)

    V. Parent

    2014-01-01

    Full Text Available Neuroleptics may cause side effects, some of which are little known. We describe here a case of gastric dilation related to treatment with a neuroleptic in an elderly man. To our knowledge, such a case has never been reported in the literature. A 76-year-old man, living in a nursing home, was hospitalized for general weakness and abdominal pain. He had dementia with behavioral disorders treated with cyamemazine, a sedative and anxiolytic neuroleptic. Given a clinical suspicion of intestinal occlusion, an abdominopelvic computerized tomography scan was performed before the patient was admitted to our hospital. This computerized tomography scan did not show intestinal occlusion and there was no mention of gastric dilation in the computerized tomography scan report. Thus, acute gastroenteritis was suspected. The usual medications were stopped and symptomatic treatment for gastroenteritis was started. Quickly, his clinical state and biological parameters returned to normal and his usual treatment, including cyamemazine, was started again. The next day, the digestive symptoms, except for obstipation, reappeared. The abdominal X-ray showed gastric dilation without intestinal occlusion. The neuroleptic was stopped again and symptoms vanished the next day. This report underlines all of the necessary precautions and surveillance around drug prescription, especially in elderly persons.

  20. Benzamide neuroleptics in the practice of a psychiatrist, a neurologist, and an internist at the present development stage of psychopharmacology (by the example of sulpiride)

    OpenAIRE

    2012-01-01

    The paper reviews the literature on the use of benzamide neuroleptics (by the example of sulpiride) to treat mental disorders and psychosomatic diseases. It characterizes medications, such as benzamide derivatives. The mechanism of action of sulpiride and its differences from other neuroleptics are discussed. The efficacy of sulpiride (as monotherapy or combined therapy) in the treatment of different mental disorders, psychosomatic diseases, alcohol and drug additions, etc. is critically anal...

  1. Lanreotide Depot: An Antineoplastic Treatment of Carcinoid or Neuroendocrine Tumors.

    Science.gov (United States)

    Wolin, Edward M; Manon, Amandine; Chassaing, Christophe; Lewis, Andy; Bertocchi, Laurent; Richard, Joel; Phan, Alexandria T

    2016-12-01

    Peptide drugs for antineoplastic therapies usually have low oral bioavailability and short in vivo half-lives, requiring less preferred delivery methods. Lanreotide depot is a sustained-release somatostatin analog (SSA) formulation produced via an innovative peptide self-assembly method. Lanreotide is approved in the USA and Europe to improve progression-free survival (PFS) in patients with unresectable gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and also approved in Europe for symptom control in carcinoid syndrome associated with GEP-NETs. This review discusses how the distinct molecule and formulation of lanreotide depot provide advantages to patients and health care providers, as well as the most recent clinical evidence demonstrating the safety and efficacy of lanreotide depot in inhibiting tumor growth and controlling hormonal symptoms in GEP-NETs. The lanreotide depot formulation confers a remarkable pharmacokinetic profile with no excipients, comprised only of lanreotide acetate and water. Of note, lanreotide depot constitutes an example for peptide self-assembly based formulations, providing insights that could help future development of sustained-release formulations of other antineoplastic peptides. Most patients with GEP-NETs will present with inoperable or incurable disease; thus, medical management for symptoms and tumor control plays a crucial role. Recent long-term clinical studies have demonstrated that lanreotide depot is well tolerated, prolongs PFS in GEP-NET patients, and significantly reduces symptoms related to carcinoid syndrome. The unique depot formulation and delivery method of lanreotide confer advantages in the treatment of metastatic GEP-NETs, contributing to improvements in NET-related symptoms and PFS without reducing quality of life in this patient population.

  2. Rechallenging clozapine after neuroleptic malignant syndrome.

    Science.gov (United States)

    Anbalagan, Emaya; Ithman, Muaid; Lauriello, John

    2014-09-01

    Neuroleptic malignant syndrome (NMS) is a potentially fatal manifestation of antipsychotic use associated with symptoms that include mental status changes, muscle rigidity, fever and autonomic dysfunction. An occurrence of NMS with clozapine has been reported in the past but there are very few reports of successfully rechallenging the drug in individuals who have developed the syndrome. This case report discusses one of the few instances in literature where clozapine has been re-administered successfully to a patient without a reoccurrence of NMS. In conclusion, a rechallenge of clozapine after neuroleptic malignant syndrome can be done if care is taken to avoid concurrent use of lithium and other psychotropics, monitoring for NMS symptoms and titrating the dose upward slowly after a reasonable period of time.

  3. Treatment of neurolept-induced tardive dyskinesia

    Directory of Open Access Journals (Sweden)

    Jankelowitz SK

    2013-09-01

    Full Text Available Stacey K Jankelowitz Central Clinical School, University of Sydney, Sydney, NSW, Australia Abstract: Tardive dyskinesia (TDK includes orobuccolingual movements and “piano-playing” movements of the limbs. It is a movement disorder of delayed onset that can occur in the setting of neuroleptic treatment as well as in other diseases and following treatment with other drugs. The specific pathophysiology resulting in TDK is still not completely understood but possible mechanisms include postsynaptic dopamine receptor hypersensitivity, abnormalities of striatal gamma-aminobutyric acid (GABA neurons, and degeneration of striatal cholinergic interneurons. More recently, the theory of synaptic plasticity has been proposed. Considering these proposed mechanisms of disease, therapeutic interventions have attempted to manipulate dopamine, GABA, acetylcholine, norepinephrine and serotonin pathways and receptors. The data for the effectiveness of each class of drugs and the side effects were considered in turn. Keywords: tardive dyskinesia, treatment, neuroleptic agents

  4. Acute renal failure in neuroleptic malignant syndrome.

    Science.gov (United States)

    Nishioka, Yoshiaki; Miyazaki, Masanobu; Kubo, Susumu; Ozono, Yoshiyuki; Harada, Takashi; Kohno, Shigeru

    2002-07-01

    We report a patient with neuroleptic malignant syndrome (NMS) who developed acute renal failure and was successfully treated by hemodialysis. A 60-year-old man with a 26-year history of schizophrenia had been treated with thioridazine and sulpiride. He was admitted to our hospital for muscular rigidity and oliguria. After the diagnosis of NMS with acute renal failure was established, thioridazine and sulpiride were discontinued and hemodialysis was instituted. Renal function gradually improved and hemodialysis was discontinued after 17th treatment. We also reviewed 57 cases of NMS with acute renal failure reported in the literature. To our knowledge, 26 years is the longest latency between initiation of neuroleptic drug treatment and onset of NMS. Our review of reported NMS cases with acute renal failure identified those risks for poor prognosis as high level of BUN, age and female gender.

  5. FPA Depot - Web Application

    Science.gov (United States)

    Avila, Edwin M. Martinez; Muniz, Ricardo; Szafran, Jamie; Dalton, Adam

    2011-01-01

    Lines of code (LOC) analysis is one of the methods used to measure programmer productivity and estimate schedules of programming projects. The Launch Control System (LCS) had previously used this method to estimate the amount of work and to plan development efforts. The disadvantage of using LOC as a measure of effort is that one can only measure 30% to 35% of the total effort of software projects involves coding [8]. In the application, instead of using the LOC we are using function point for a better estimation of hours in each software to develop. Because of these disadvantages, Jamie Szafran of the System Software Branch of Control And Data Systems (NE-C3) at Kennedy Space Canter developed a web application called Function Point Analysis (FPA) Depot. The objective of this web application is that the LCS software architecture team can use the data to more accurately estimate the effort required to implement customer requirements. This paper describes the evolution of the domain model used for function point analysis as project managers continually strive to generate more accurate estimates.

  6. [Increase of serum procalcitonin levels during a neuroleptic malignant syndrome].

    Science.gov (United States)

    Cabot, B; Pautas, E; Gatey, M; Perivier, S; Mahieux, F; Pinquier, C; Hausfater, P

    2009-01-01

    When fever occurs in a patient treated with a neuroleptic, the diagnosis of a neuroleptic malignant syndrome is difficult to differentiate to that of an infectious event. Among inflammation biomarkers of inflammation, serum procalcitonin levels increase both quickly and specifically during a bacterial infection. We report the first case of a neuroleptic malignant syndrome associated with a significant increase of serum procalcitonin levels, without concomitant septic syndrome. The neuroleptic malignant syndrome might be a non-infectious clinical situation associated with an increased serum procalcitonin concentration.

  7. Neuroleptic malignant syndrome in trauma patient.

    Science.gov (United States)

    Gragnani, Alfredo; Cezillo, Marcus Vinicius Boaretto; Oliveira, Andrea Fernandes; Ferreira, Lydia Masako

    2015-09-01

    In recent years, there has been an increased use of neuroleptic agents in the unit care in trauma patients. There is a lack of prospective data, and most of the information is obtained from related cases. It is needed to have a high index of suspicion with regard to excluding neuroleptic malignant syndrome (NMS) in patients taking neuroleptics and presenting with hyperthermia, because of the potentially fatal consequences. It is a rare syndrome in the burn patient with a lack of proven treatments, and high morbidity and mortality are related. In the actual literature there are few related cases of NMS in the polytrauma patient, particularly in association with psychiatric conditions. In burn NMS is a rare complication with difficult diagnosis, because of the similar symptoms that can occur either in patients in the Burn Unit Care with other fatal conditions that are present in the acute phase response. Actually, there is no marker for the NMS, which difficult the early diagnosis and prognosis. The treatment still is based on case reports, with lack of clinical trials, but remain as standard and universally accepted. Besides that, the neural signaling of the NMS indicates possibilities for better understanding of the pathophysiology treatment protocol.

  8. Neuroleptic Malignant syndrome (NMS): a rare presentation induced by an antiemetic - case report.

    Science.gov (United States)

    Kashyap, Gursharan Lal; Patel, Ashok G

    2011-09-01

    Neuroleptic Malignant Syndrome is one of the life threatening complications of antipsychotic psychotropic medication. We here report a case of a 39 years old male who has had a diagnosis of paranoid schizophrenia since the age of 18. He had been on antipsychotic therapy since then. He was stable on a combination of antipsychotics. He had mild hyper-salivation for a long time but was not very concerned about it. He requested and was prescribed Hyoscine Hydrobromide 300 mcg BD for hyper-salivation. There was no other medication change. After 5 days of starting Kwells, the patient presented with Neuroleptic Malignant syndrome. One has to watch for NMS while starting Hyoscine Hydrbromide for someone on antispychotics.

  9. Neuroleptic Malignant Syndrome: A Rare Cause of Fever 1 in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hayriye Gonullu

    2013-10-01

    Full Text Available    Neuroleptic malignant syndrome (NMS is a rare and life threatening complication of antipsychotic therapy. It presents with fever, altered mental status, autonomic instability and muscle rigidity. Differential diagnosis consist many conditions. NMS is a diagnosis of exclusion. NMS is in the differential diagnosis of patients presenting with fever to emergency department, where careful history and previous medication use is essential for diagnosing and treating this phenomenon.

  10. Effects of sulpiride on persistent neuroleptic-induced dyskinesia in monkeys.

    Science.gov (United States)

    Häggström, J E

    1984-01-01

    Five Cebus apella monkeys with persistent neuroleptic-induced dyskinesia were given a single dose of sulpiride (20 mg/kg i.m.). The dyskinesia was reduced in all five although four developed attacks of acute dystonia which had to be reversed by anticholinergic medication in three animals. In one monkey the administration of classic neuroleptics had earlier been shown to induce a typical sequence of events. First there was a similar reduction of dyskinesia as seen in the other monkeys, 1-2 days later there was noticed a rebound deterioration lasting for several days. Metoclopramide 0.5 mg/kg, caused such a rebound effect (for 2 days), whereas sulpiride did not.

  11. Two unusual complications of neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    A Ahmad

    2013-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but well described complication of the administration of antipsychotic agents. Compartment syndrome, with increased pressures within the confined space of fascial sheaths leading to compression damage of the contained tissue, similarly is well described. Brachial plexus injuries caused by patient malposition are also very rare but a few cases have been reported. We report a case where these three complications occurred together. This was attributable to the patient developing NMS whilst asleep in the prone position overnight.

  12. Electroconvulsive in a Schizophrenic Patient With Neuroleptic Malignant Syndrome and Rhabdomyolysis.

    Science.gov (United States)

    San Gabriel, Maria Chona P; Eddula-Changala, Bharathi; Tan, Yonghong; Longshore, Carrol T

    2015-09-01

    We present the case of a middle-aged man with a chronic history of schizoaffective disorder, depressed type, stable on a second-generation antipsychotic. Psychotic symptoms recurred contingent to medication noncompliance necessitating hospitalization. Treatment was complicated by the development of neuroleptic malignant syndrome (NMS). In addition, subsequent medication rechallenges failed because of recurrent rhabdomyolysis and atypical NMS. Electroconvulsive therapy (ECT) treatment was initiated, affording remission of psychotic symptoms and nonrecurrence of NMS and rhabdomyolysis. Our experience confirmed the efficacy of ECT treatment in providing symptom relief of psychosis complicated by recurrent episodes of NMS and atypical NMS. Likewise, it illustrated the efficacy of ECT treatment for rhabdomyolysis.

  13. Neuroleptic-induced catatonia: clinical presentation, response to benzodiazepines, and relationship to neuroleptic malignant syndrome.

    Science.gov (United States)

    Lee, Joseph W Y

    2010-02-01

    Neuroleptic-induced catatonia (NIC), manifested in an extrapyramidal-catatonic syndrome, has been sporadically reported in the literature. Confusion surrounds its relationship to neuroleptic malignant syndrome (NMS) and extrapyramidal reactions to neuroleptics. This study examined (a) its clinical presentation and response to benzodiazepines, (b) the hypothesis that NIC and NMS are on the same spectrum with a continuum of symptom progression, and (c) its possible relationship to extrapyramidal reactions. Of 127 episodes of acute catatonia prospectively identified, 18 were diagnosed with NIC. All catatonia episodes received benzodiazepines. The NIC episodes were analyzed noting their clinical presentations, laboratory findings, and responses to treatments. Their responses to benzodiazepines were compared, with retrospective rating on a 7-point scale, to that for catatonia episodes associated with mania and schizophrenia. The progression of symptoms in each NIC episode was reviewed. The NIC episodes presented predominantly in the stuporous form associated with parkinsonism. Delirium, autonomic abnormality, and elevated serum creatine phosphokinase were all common. Neuroleptic malignant syndrome was diagnosed in 3 episodes (17%). The 3 catatonia groups did not differ significantly in their benzodiazepines responses: 78% (14/18) of NIC, 75% (12/16) of manic catatonia, and 67% (34/51) of schizophrenic catatonia episodes showed full responses. A spectrum of presentation across episodes was noted with simple NIC without delirium, autonomic disturbances, or fever at one end and NMS or malignant NIC at the other end. Symptoms in individual episodes showed a similar continuum progression. No extrapyramidal reactions immediately preceded the NIC episodes. Findings of this study support the hypothesis that NIC and NMS are disorders on the same spectrum and reveal no indication that extrapyramidal reactions progress to NIC.

  14. Prevalence of neuroleptic-induced movement disorders: an 8-year follow-up study in chronic schizophrenia inpatients.

    Science.gov (United States)

    Parksepp, Madis; Ljubajev, Ülle; Täht, Karin; Janno, Sven

    2016-10-01

    Atypical antipsychotic drug use by schizophrenia patients in Estonia increased from 32% in 2004 to 61% in 2009. To assess the prevalence of neuroleptic-induced movement disorders in the Estonian institutionalized population of schizophrenia patients twice over a period of eight years, before and after introduction of atypical antipsychotic drugs using DSM-IV criteria. DSM-IV criteria and specific rating scales were used to evaluate the prevalence of neuroleptic-induced movement disorders among 72 patients who participated in the study in 2009 compared to 99 patients who participated in 2001. Despite increased use of atypical antipsychotics in the study population (up to 30% from 20%), the proportion of movement disorder-free population remained the same over 8 years - 38.9% in 2001 versus 38.4% in 2009. There were significant intra-individual fluctuations. Use of a typical antipsychotic resulted in an almost seven times higher risk of tardive dyskinesia after 8 years. Doses of antipsychotic drugs had no effect on the severity of neuroleptic-induced movement disorders. Unfortunately, in 18% of patients the switch of medication from typical to atypical did not change the overall prevalence of neuroleptic-induced movement disorders in the group. The long-term benefit of atypical antipsychotics requires further research in patients who are treated with antipsychotics for years.

  15. Lethal neuroleptic malignant syndrome due to amisulpride.

    Science.gov (United States)

    Musshoff, Frank; Doberentz, Elke; Madea, Burkhard

    2013-06-01

    A 42-year old-man was found lying in his bed having seizures. Later he became unconscious and hypotonic developing mydriasis as well as rigidity. The body core temperature (rectal temperature) was above 42 °C. Blood pH was decreased during treatment, and his general condition deteriorated. The patient developed gasping respiration, ventricular fibrillation, and died. During autopsy and histological investigation cerebral and pulmonary edema were noted together with general congestion of the internal organs. Further observations included contraction bands of myocytes, a contracted spleen, fibrosis of the liver, and gall stones. Toxicological analyses of peripheral blood revealed the following results: amisulpride 4.65 mg/l, biperiden 0.12 mg/l, imipramine 0.33 mg/l, and desipramine 0.68 mg/l. An amisulpride-induced neuroleptic malignant syndrome was therefore diagnosed as the patho-physiological mechanism leading to death.

  16. Neuroleptic malignant syndrome masked by cerebral malaria.

    Science.gov (United States)

    Rajesh, Kumar Muniandy; Sinnathamby, Vellan; Sakthi, Arul N

    2013-05-22

    A 38-year-old man with an underlying psychiatric illness presented with altered sensorium and abnormal behaviour. He was febrile at 38°C and weak looking; otherwise no other abnormalities were detected. A blood film conducted for malarial parasite (BFMP) revealed Plasmodium falciparum; hence a diagnosis of cerebral malaria was made. He was treated with antimalarial drugs for 2 days prior to being transferred out to the ward following clinical improvement. He subsequently developed episodes of stupor and refusal of feeding. Following an evaluation by the psychiatrist, a diagnosis of catatonic schizophrenia was made and he was started on oral sulpiride and benhexol. Unfortunately, he developed high-grade fever at 40°C with muscle rigidity and fasciculation. The diagnosis of neuroleptic malignant syndrome (NMS) was clinched and the antipsychotics were discontinued. However he succumbed to NMS several days later due to multiorgan failure.

  17. Treatment of neurolept-induced tardive dyskinesia.

    Science.gov (United States)

    Jankelowitz, Stacey K

    2013-01-01

    Tardive dyskinesia (TDK) includes orobuccolingual movements and "piano-playing" movements of the limbs. It is a movement disorder of delayed onset that can occur in the setting of neuroleptic treatment as well as in other diseases and following treatment with other drugs. The specific pathophysiology resulting in TDK is still not completely understood but possible mechanisms include postsynaptic dopamine receptor hypersensitivity, abnormalities of striatal gamma-aminobutyric acid (GABA) neurons, and degeneration of striatal cholinergic interneurons. More recently, the theory of synaptic plasticity has been proposed. Considering these proposed mechanisms of disease, therapeutic interventions have attempted to manipulate dopamine, GABA, acetylcholine, norepinephrine and serotonin pathways and receptors. The data for the effectiveness of each class of drugs and the side effects were considered in turn.

  18. [Pathomorphology of myocardium in the neuroleptic malignant syndrome].

    Science.gov (United States)

    Volkov, V P

    2012-01-01

    It was performed morphometric analysis of 55 cases which formed 4 groups: 1 - control group - 10 patients without neuroleptic treatment and heart diseases; 2 - 12 patients without heart disease treated with antipsychotic drugs; 3 - 17 - without cardiaс pathology who died from neuroleptic malignant syndrome (NMS); 4 - 16 patients with neuroleptic cardiomyopathy (NCMP) who died from NMS. The damage of myocardium in NMS is a relatively acute process involving disturbances of microcirculation, interstitial edema and dystrophic-degenerative changes of cardiomyocytes (CMC). These changes worsen the previous abnormal state of the heart muscle (microfibrosis, CMC atrophy) caused by cardiotoxic side-effects of neuroleptics. The severity of the total myocardium damage in NMS is directly depended on the absence or presence of NCMP.

  19. Neuroleptic malignant syndrome presenting as pulmonary edema and severe bronchorrhea.

    Science.gov (United States)

    Patel, U; Agrawal, M; Krishnan, P; Niranjan, S

    2002-04-01

    Neuroleptic malignant syndrome is a rare (incidence, 0.02%-3.2%) but dangerous complication following the use of neuroleptic drugs. When not promptly recognized, this disease carries a high mortality (10%-20%) and morbidity rate. We report an unusual case of neuroleptic malignant syndrome that presented predominantly with autonomic instability in the form of recurrent episodes of respiratory distress. The respiratory distress was initially caused by pulmonary edema and later was caused by severe bronchorrhea. We propose that aspiration pneumonia resulting in respiratory failure, the leading cause of death in neuroleptic malignant syndrome, may be a result of a combination of altered mental status and bronchorrhea. This has therapeutic implications because early institution of bromocriptine/dantrolene can prevent aspiration pneumonia and, hence, mortality from respiratory failure.

  20. [Neuroleptic malignant syndrome: presentation of a case treated with sulpiride].

    Science.gov (United States)

    Brescia, A; Zocchi, M

    1991-01-01

    The authors, in this case, stress the importance that cases of N.M.S. can arise as possible complication of sulpiride treatment, a drug of large use and with less unwished extrapyramidal effects that other neuroleptics.

  1. [3-D ultrasound-assisted gait analysis of schizophrenic patients. Comparison between conventional neuroleptics and olanzapine].

    Science.gov (United States)

    Putzhammer, Albert; Heindl, Bernhard; Müller, Jürgen; Broll, Karin; Pfeiff, Liane; Perfahl, Maria; Hess, Linda; Koch, Horst

    2003-05-01

    Schizophrenic disorders as well as neuroleptic treatment can affect locomotion. The study assessed the influence of neuroleptic treatment on human gait via ultrasonic topometric gait analysis. In a control sample the test system proved high test-retest-reliability. Spatial and temporal gait parameters were assessed in schizophrenic patients without neuroleptic treatment (n = 12) and under treatment with conventional neuroleptics (n = 14) and re-assessed after treatment change to the atypical neuroleptic olanzapine in a repeated measures design. After switch from conventional neuroleptics to olanzapine patients showed an increase of gait velocity (p step length (p gait analysis.

  2. Network technology for depot modernization

    Energy Technology Data Exchange (ETDEWEB)

    Hostick, C.J.

    1990-12-01

    This report was prepared by the Pacific Northwest Laboratory to summarize existing and emerging information system technology and standards applicable to Depot System Command (DESCOM) modernization efforts. The intent of this summarization is to provide the Revitalization of Army Depots for the Year 2000 (READY 2000) team a clear understanding of the enabling information system technologies required to support effective modernization activities. Much of the information contained in this report was acquired during the last year in support of the US Army Armament, Munitions, and Chemical Command (AMCCOM) Facility Integrated Manufacturing Management System (FIMMS) project at PNL, which is targeting the modernization of plant-wide information systems at Army Ammunition Plants. The objective of information system modernization is to improve the effectiveness of an organization in performing its mission. Information system modernization strives to meet this objective by creating an environment where data is electronically captured near the source and readily available to all areas of the organization. Advanced networks, together with related information system technology, are the enabling mechanisms that make modern information system infrastructures possible. The intent of this paper is to present an overview of advanced information system network technology to support depot modernization planners in making technology management decisions. Existing and emerging Open System Interconnection (OSI) and Government Open System Interconnection Profile (GOSIP) standards are explained, as well as a brief assessment of existing products compliant with these standards. Finally, recommendations for achieving plant-wide integration using existing products are presented, and migration strategies for full OSI compliance are introduced. 5 refs., 16 figs. (JF)

  3. Two cases of neuroleptic malignant syndrome in elderly patients taking atypical antipsychotics

    Institute of Scientific and Technical Information of China (English)

    Yuhui FENG; Xianhong YANG; Yanyan HUANG

    2013-01-01

    Summary: Neuroleptic malignant syndrome (NMS) is a rare, life-threatening adverse reaction to antipsychotic medication that typically includes high-fever, extrapyramidal symptoms, autonomic nervous system dysfunction and disturbances in consciousness. Though reported to be more common following use of the older, first generation antipsychotic medications, it can also occur in patients taking the newer, second generation antipsychotic medications. This report discusses the clinical presentation, possible etiology, pathogenesis and treatment of two cases of NMS that occurred in elderly patients after taking atypical antipsychotics. With the increasing use of atypical antipsychotic medication in elderly patients - who may be more susceptible to this adverse reaction - there is a need to increase clinical vigilance about this condition, particularly among internists and gerontologists who may be unfamiliar with this rare complication to antipsychotic medication.

  4. Precautionary measures reduce risk of definite neuroleptic malignant syndrome in newly typical neuroleptic-treated schizophrenia inpatients.

    Science.gov (United States)

    Shiloh, Roni; Valevski, Avi; Bodinger, Liron; Misgav, Sagit; Aizenberg, Dov; Dorfman-Etrog, Pnina; Weizman, Abraham; Munitz, Hanan

    2003-05-01

    Neuroleptic malignant syndrome (NMS) is a potentially lethal antipsychotic drug (APD)-induced thermoregulatory disturbance. We hypothesized that several precautionary measures taken after administeration of APDs might prevent progression to definite NMS. The study group included 657 consecutively admitted drug-free schizophrenia inpatients who received various typical APDs for 28 days. Specific predefined precautionary measures were employed for this group. The comparison group (n=192) consisted of typical APD-treated schizophrenia inpatients in whom such precautionary measures were not imposed. The study group exhibited a significantly lower incidence of definite NMS (1/657=0.2% versus 4/192=2.1%; P=0.01, odds ratio=13.96; 95% confidence interval 1.55-125.63). Antipsychotics were discontinued in 28 patients (28/657=4.3%) from the study group due to NMS (n=1) or early detection of potential NMS-related signs (probable abortive NMS) (n=27). Our findings suggest that specific precautionary measures can effectively reduce the incidence of definite NMS by approximately one order in newly medicated schizophrenia inpatients.

  5. Benzamide neuroleptics in the practice of a psychiatrist, a neurologist, and an internist at the present development stage of psychopharmacology (by the example of sulpiride

    Directory of Open Access Journals (Sweden)

    Dmitry Sergeyevich Danilov

    2012-01-01

    Full Text Available The paper reviews the literature on the use of benzamide neuroleptics (by the example of sulpiride to treat mental disorders and psychosomatic diseases. It characterizes medications, such as benzamide derivatives. The mechanism of action of sulpiride and its differences from other neuroleptics are discussed. The efficacy of sulpiride (as monotherapy or combined therapy in the treatment of different mental disorders, psychosomatic diseases, alcohol and drug additions, etc. is critically analyzed. By taking into account the currently adopted multidisciplinary approach to managing patients with the above conditions, the presented data are certain to provoke interest among physicians of different specialties.

  6. Space Transportation Infrastructure Supported By Propellant Depots

    Science.gov (United States)

    Smitherman, David; Woodcock, Gordon

    2012-01-01

    A space transportation infrastructure is described that utilizes propellant depot servicing platforms to support all foreseeable missions in the Earth-Moon vicinity and deep space out to Mars. The infrastructure utilizes current expendable launch vehicle (ELV) systems such as the Delta IV Heavy, Atlas V, and Falcon 9, for all crew, cargo, and propellant launches to orbit. Propellant launches are made to Low-Earth-Orbit (LEO) Depot and an Earth-Moon Lagrange Point 1 (L1) Depot to support a new reusable in-space transportation vehicles. The LEO Depot supports missions to Geosynchronous Earth Orbit (GEO) for satellite servicing and to L1 for L1 Depot missions. The L1 Depot supports Lunar, Earth-Sun L2 (ESL2), Asteroid and Mars Missions. New vehicle design concepts are presented that can be launched on current 5 meter diameter ELV systems. These new reusable vehicle concepts include a Crew Transfer Vehicle (CTV) for crew transportation between the LEO Depot, L1 Depot and missions beyond L1; a new reusable lunar lander for crew transportation between the L1 Depot and the lunar surface; and Mars orbital Depot are based on International Space Station (ISS) heritage hardware. Data provided includes the number of launches required for each mission utilizing current ELV systems (Delta IV Heavy or equivalent) and the approximate vehicle masses and propellant requirements. Also included is a discussion on affordability with ideas on technologies that could reduce the number of launches required and thoughts on how this infrastructure include competitive bidding for ELV flights and propellant services, developments of new reusable in-space vehicles and development of a multiuse infrastructure that can support many government and commercial missions simultaneously.

  7. A rare case of neuroleptic malignant syndrome presenting with serious hyperthermia treated with a non-invasive cooling device: a case report

    Directory of Open Access Journals (Sweden)

    Storm Christian

    2009-02-01

    Full Text Available Abstract Introduction A rare side effect of antipsychotic medication is neuroleptic malignant syndrome, mainly characterized by hyperthermia, altered mental state, haemodynamic dysregulation, elevated serum creatine kinase and rigor. There may be multi-organ dysfunction including renal and hepatic failure as well as serious rhabdomyolysis, acute respiratory distress syndrome and disseminated intravascular coagulation. The prevalence of neuroleptic malignant syndrome is between 0.02% and 2.44% for patients taking neuroleptics and it is not necessary to fulfil all cardinal features characterizing the syndrome to be diagnosed with neuroleptic malignant syndrome. Because of other different life-threatening diseases matching the various clinical findings, the correct diagnosis can sometimes be hard to make. A special problem of intensive care treatment is the management of severe hyperthermia. Lowering of body temperature, however, may be a major clinical problem because hyperthermia in neuroleptic malignant syndrome is typically unresponsive to antipyretic agents while manual cooling proves difficult due to peripheral vasoconstriction. Case presentation A 22-year-old Caucasian man was admitted unconscious with a body temperature of 42°C, elevated serum creatine phosphokinase, tachycardia and hypotonic blood pressure. In addition to intensive care standard therapy for coma and shock, a non-invasive cooling device (Arctic Sun 2000®, Medivance Inc., USA, originally designed to induce mild therapeutic hypothermia in patients after cardiopulmonary resuscitation, was used to lower body temperature. After successful treatment it became possible to obtain information from the patient about his recent ambulant treatment with Olanzapin (Zyprexa® for schizophrenia. Conclusion Numerous case reports have been published about patients who developed neuroleptic malignant syndrome due to Olanzapin (Zyprexa® medication. Frequently hyperthermia has been observed

  8. Neuropsychiatric sequelae of neuroleptic malignant syndrome.

    Science.gov (United States)

    Adityanjee; Sajatovic, Martha; Munshi, Kaizad R

    2005-01-01

    The authors review the literature on persistent sequelae of neuroleptic malignant syndrome (NMS). They highlight the clinical presentations, assessment, and management of persistent sequelae and stress the need to take preventive steps to minimize their occurrence. The authors conducted a Medline and PubMed search for papers on residual sequelae of NMS. They cross-referenced the available papers and "operationalized" the diagnostic criteria for persistent neuropsychiatric sequelae. A total of 31 cases of neuropsychiatric sequelae of NMS were identified. With reduction in mortality from NMS, persistent sequelae of NMS have assumed clinical importance. Long-term sequelae persist for weeks to months after amelioration of an acute episode. Individuals with a preexisting CNS insult are more predisposed to develop persistent sequelae. A high index of awareness for persistent sequelae is warranted because antipsychotics are widely used for psychiatric disorders besides schizophrenia. Awareness of such outcomes and the use of evidence-based strategies to minimize risk factors will help clinicians in reducing the persistent sequelae of NMS.

  9. Prescription of neuroleptics for children and adolescents in Italy.

    Science.gov (United States)

    Traversa, G; Spila-Alegiani, S; Arpino, C; Ferrara, M

    1998-01-01

    The objective of this study was to describe the use of neuroleptics among children and adolescents in the province of Rome. Subjects 5 to 19 years of age who received neuroleptic prescriptions within the National Health Service between 1986 and 1991 were identified. Prevalence and incidence of use were estimated. The yearly prevalence of use during the study period ranged from 1.3 to 1.7 per 1000 inhabitants. The incidence during 1989 was 1.1 per 1000, with a marked increase with age. Haloperidol was the drug most frequently prescribed; 59.2% of the subjects received only one prescription during the year. Among subjects with more than one prescription, 42.3% received neuroleptics in combination. The observed pattern of use suggests that in current practice neuroleptics are also used for the treatment of nonpsychotic conditions. The analysis of data derived from a prescription monitoring system may provide an important contribution to the description of neuroleptic use among children and adolescents.

  10. Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Jae Meen Lee

    2016-02-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS surgery in a cerebral palsy (CP patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

  11. Case reports of neuroleptic malignant syndrome in context of quetiapine use.

    Science.gov (United States)

    Detweiler, Mark B; Sullivan, Kelly; Sharma, Taral R; Kim, Kye Y; Detweiler, Jonna G

    2013-12-01

    A retrospective analysis was followed on 20 case reports covering the possible correlation between the atypical antipsychotic, quetiapine, and neuroleptic malignant syndrome (NMS), determined by the study of 7 different NMS criteria guidelines. A great majority (19) of the case studies did not meet the requirements of all 7 guidelines, frequently due to unreported information. Nor was quetiapine proven to be the sole cause of the possible NMS in the two age groups investigated. Only one case was found to have no other medication or medical conditions confounding the relationship of quetiapine and NMS symptoms, and that case was in the context of a significant quetiapine overdose. The other 19 cases demonstrated the difficulty of identifying the cause of NMS when polypharmacy and other medical conditions are involved. The authors note the need for caution in deciding both the presence of NMS and the causal factors of the symptoms.

  12. Depot Maintenance: Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements

    Science.gov (United States)

    2009-09-01

    of Representatives DEPOT MAINTENANCE Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future...Depot Maintenance. Improved Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements 5a... Strategic Planning Needed to Ensure That Army and Marine Corps Depots Can Meet Future Maintenance Requirements Highlights of GAO-09-865, a report to

  13. Defense Depot Tracy Total Quality Management Plan

    Science.gov (United States)

    1989-07-01

    PAGES TQM ( Total Quality Management ), Depot Operations, Continuous Process Improvement 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...make up our pcrceptions of Total Quality Management . Our goal is to improve those proven management processes that have brought us success while being...MANIAGEMENT F. QUALITY AUDITS OF PRODUCTS AND OPERATIONS ASSETS MANAGEMENT 00 i .......... / ~899 29 03 1 EFENSE DEPOT TACY TOTAL QUALITY MANAGEMENT PLAN

  14. Forecasting Wartime Depot-Level Component Workloads.

    Science.gov (United States)

    1985-01-01

    Baseline Study the NALC assumed that all failures sent to the depot must be repaired, despite the fact that ASO plans to buy war reserve stock to...be bought to fill these demands. Note, however, that the stock buy for the 0 exponential pipeline case is somewhat less than that required for the...daily demands on depot supply to BCN rates Minimum workload 200 - Baseline- 23 month scenario -Low BCM 175 - .. . High BCM7i. -- Hgh BCM half sortie 150

  15. Sustained attention and planning deficits but intact attentional set-shifting in neuroleptic-naïve first-episode schizophrenia patients.

    Science.gov (United States)

    Hilti, Caroline C; Delko, Tarik; Orosz, Ariane T; Thomann, Kathrin; Ludewig, Stephan; Geyer, Mark A; Vollenweider, Franz X; Feldon, Joram; Cattapan-Ludewig, Katja

    2010-01-01

    The nature of deficits in tests of sustained attention, planning and attentional set-shifting has not been investigated in neuroleptic-naïve first-episode (FE) schizophrenia patients. Based on previous literature of chronic and medicated FE schizophrenia patients, we predicted that the neuroleptic-naïve patients would show deficits in these cognitive processes. Twenty-nine neuroleptic-naïve FE schizophrenia patients and 33 healthy controls - matched by age, gender, and nicotine consumption - performed 3 tests from the Cambridge Automated Neuropsychological Test Battery (CANTAB) thought to measure these cognitive processes: the Rapid Visual Information Processing task (RVIP, sustained attention), the Stockings of Cambridge task (SOC, planning), and the Intradimensional/Extradimensional set-shifting task (IDED, attention shifting). The patients were significantly impaired in the sensitivity index (A') of the RVIP, and in the number of problems solved with minimum moves on the SOC. Nevertheless, the groups did not differ regarding the number of participants who failed at the crucial extradimensional shift stage of the IDED. Sustained attention and planning abilities are already impaired in neuroleptic-naïve FE schizophrenia patients, whereas set-shifting abilities as measured with the IDED task seem to be intact at illness onset. Since chronic schizophrenia patients have been shown to have impaired IDED performance, we tentatively propose that IDED performance deteriorates over time with illness chronicity and/or medication.

  16. Further studies on the neuroleptic profile of manassantin A.

    Science.gov (United States)

    Rao, K V; Puri, V N; el-Sawaf, H A

    1990-04-25

    In an earlier preliminary study, manassantin A, a neolignoid from Saururus cernuus was found to show neuroleptic type activity in mice when given by the i.p. route. It blocked the stereotypy and hyperactivity caused by amphetamine at doses comparable to those of haloperidol, but unlike the latter, did not show catalepsy or ptosis at atoxic doses. In the present study, a more detailed comparison of manassantin A with haloperidol and in some cases with chlorpromazine and reserpine using a variety of neuroleptic parameters and by various routes of administration is described. Results of the present study clearly show that the drug is readily absorbed from various routes of administration and shows many of the patterns of neuroleptic activity. Manassantin A was comparable to haloperidol in many of the tests but unlike the latter, did not produce antiadrenergic or anticholinergic effects. Manassantin A was found to bind weakly to calf caudate membranes (IC50 3500 nM) while haloperidol (IC50 5 nM) and chlorpromazine (IC50 50 nM) inhibited [3H]haloperidol binding. Manassantin A also did not affect the dopamine-induced adenylate cyclase activity in rat caudate nuclei (IC50 greater than 10,000 nM) while haloperidol (IC50 700 nM) and chlorpromazine (IC50 350 nM) inhibited the enzyme synthesis. These biochemical and behavioral tests suggest that manassantin A exhibits a selective neuroleptic profile and may be considered to behave as an atypical agent.

  17. Electroencephalographic sleep in clinically stable schizophrenic patients: two-weeks versus six-weeks neuroleptic-free.

    Science.gov (United States)

    Nofzinger, E A; van Kammen, D P; Gilbertson, M W; Gurklis, J A; Peters, J L

    EEG sleep studies in schizophrenic patients are influenced by alterations in clinical state and medication status. The current study defines longitudinal alterations in electroencephalographic (EEG) sleep for 10 healthy men who were schizophrenic patients who remained relatively clinically stable during a double-blind neuroleptic withdrawal study. Clinical assessments and EEG sleep studies were performed at baseline on haloperidol, and then at 2-week and 6-week drug-free periods. Sleep continuity and rapid eye movement (REM) sleep measures declined not only between the haloperidol baseline and 2-week drug-free conditions, but continued to decline from 2-week to 6-weeks neuroleptic-free. Alterations in EEG sleep from the 2-week to 6-week haloperidol-free assessments did not correlate with changes in clinical symptoms suggesting effects related to drug-withdrawal or subclinical state changes. These results show that despite relative clinical stability over time, the EEG sleep of schizophrenic patients continues to change following withdrawal of a neuroleptic and is dependent on the duration of the drug-free interval.

  18. Happy birthday neuroleptics! 50 years later: la folie du doute.

    Science.gov (United States)

    Stip, Emmanuel

    2002-05-01

    Given that we are celebrating the 50th birthday of neuroleptics introduction in psychiatry, the author proposes to take a look at certain results related to therapeutic practice. After a brief chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia, the author presents a critical review of four meta-analyses. Since Delay, Deniker and Harl's initial report, the story of neuroleptics comprises several periods. In 1963, the hyper-dopaminergic theory of psychoses was proposed. Another period began with models mainly based on the serotonin/dopamine relative blockade receptor hypothesis. More recently, a new framework to understand the differential effect of antipsychotics is related to the appropriate modulation (e.g., fast dissociation) of the D2 receptor alone. The concept of atypicality has become a new vista for research and to market new compounds. However, after 50 years of neuroleptic drugs, are we able to answer the following simple questions: Are neuroleptics effective in treating schizophrenia? Is there a difference between atypical and conventional neuroleptics? How do the efficacy and safety of newer antipsychotic drugs compare with those of clozapine? Actually, the answers yielded by these simple questions by meta-analysis should elicit in us a good deal of humility. If we wish to base psychiatry on evidence-based medicine, we run a genuine risk in taking a closer look at what has long been considered fact. Each psychiatrist must continue to be critical, sceptical, optimistic (not overoptimistic) and to learn in order to integrate the positive aspects of our growing knowledge base.

  19. Catatonia versus neuroleptic malignant syndrome: the diagnostic dilemma and treatment

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sahoo

    2014-01-01

    Full Text Available Catatonia is a syndrome, comprised of symptoms such as motor immobility, excessive motor activity, extreme negativism, and stereotyped movements. Neuroleptic is able to induce catatonia like symptoms, that is, the neuroleptic malignant syndrome (NMS. In NMS, patients typically show symptoms such as an altered mental state, muscle rigidity, tremor, tachycardia, hyperpyrexia, leukocytosis, and elevated serum creatine phosphorous kinase. Several researchers have reported studies on catatonia and the association between catatonia and NMS, but none were from this part of the eastern India. In our case, we observed overlapping symptoms of catatonia and NMS; we wish to present a case of this diagnostic dilemma in a patient with catatonia, where a detailed history, investigation, and symptom management added as a great contribution to the patient′s rapid improvement.

  20. Hyperosmolar hyperglycemic state secondary to neuroleptic malignant syndrome.

    Science.gov (United States)

    Takanobu, Keisuke; Okazaki, Daisuke; Ogawa, Tomoo; Watanabe, Shinya; Oka, Matsuhiko; Murakami, Shinichi; Ura, Hideki

    2015-01-01

    Neuroleptic malignant syndrome (NMS) is often considered to be a precipitating factor for diabetic coma, such as a hyperosmolar hyperglycemic state (HHS). The combination of NMS and a systemic illness such as HHS can be difficult to diagnose because NMS may mask the coexisting condition. Although this coexistence is rare, it may be fatal if not detected early. We report a case of HHS in a 47-year-old male patient that developed after the distinguishing features of NMS had subsided. After the diagnosis of HHS, his recovery was a result of intravenous administration of soluble human insulin and fluid supplementation. Physicians caring for patients with diabetes who are also treated with neuroleptic agents should be aware that NMS may precipitate the development of secondary hyperglycemia despite a history of well-controlled blood glucose levels.

  1. Neuroleptic malignant syndrome and clozapine withdrawal at the same time?

    Science.gov (United States)

    Margetić, Branimir; Aukst-Margetić, Branka

    2005-01-01

    The authors report a case of a patient, who in a few days after an abrupt discontinuation of clozapine and haloperidol developed agitated and confused state resembling neuroleptic malignant syndrome (NMS) and clozapine withdrawal symptoms at the same time. Data obtained from family members led to gradual reintroduction of clozapine and to subsequent recovery. The case illustrates the importance for clinicians to be familiar with the variety of discontinuation symptoms, so they can recognize them and offer effective treatment.

  2. A Rare Case of Myxedema Coma with Neuroleptic Malignant Syndrome (NMS).

    Science.gov (United States)

    Dixit, Siddharth; Dutta, Manoj Kumar; Namdeo, Mayank

    2015-05-01

    Myxedema coma or hypothyroid crisis is an endocrine emergency and needs ICU management. Neuroleptic malignant syndrome (NMS) is another medical emergency which needs high degree of clinical suspicion else mortality can be high. There is a paradox in co existence of myxedema coma and NMS. While one is hypometabolic state another is hypermetabolic state and both can be precipitated by antipsychotics use. Hypothermia and flaccidity commonly expected in myxedema coma may mask fever and rigidity of classical NMS contributing to diagnostic problem and treatment delay. Scientific literature on coexistance of myxedema coma and NMS is sparse. We hereby report first case with coexisting myxedema coma and NMS in a patient of schizophrenia treated with antipsychotic, where classical symptoms of NMS were masked by myxedema coma. Prompt diagnosis and effective management by a team resulted in favourable outcome in our patient. This case is reported to alert intensive care physicians to atypical manifestations of NMS in presence of hypothyroidism.

  3. Extensive Deep Venous Thrombosis in a Patient with Neurolept Malignant Syndrome despite Being on Prophylaxis

    Directory of Open Access Journals (Sweden)

    Jerrin C. Mathew

    2011-01-01

    Full Text Available The risk of venous thromboembolism (VTE in patients with Neuroleptic malignant syndrome (NMS and those on antipsychotic medications is well established. We present here a case whereby the patient had NMS and developed extensive deep venous thrombosis (DVT despite being on standard DVT Prophylaxis. Our case illustrates that empiric intravenous heparin for the initial few days after the onset of NMS may be considered in those with high risk of VTE, as in such patients standard DVT prophylaxis may not be sufficient. To standardize as to which patients with NMS would be at the highest risk of VTE while on standard DVT prophylaxis, the role of a standardized scoring system and a double-blind randomized trial in the future would probably be beneficial.

  4. Fever development in neuroleptic malignant syndrome during treatment with olanzapine and clozapine.

    Science.gov (United States)

    Szota, Anna; Ogłodek, Ewa; Araszkiewicz, Aleksander

    2013-01-01

    Neuroleptic malignant syndrome (NMS) is the most dangerous life-threatening complication of antipsychotic medication. It's development is connected with the blockade of dopaminergic transmission (D2 receptors) in the nigrostriatal system of the brain. Fever is one of the main symptoms of this syndrome and it's elevation is due to the activation of the immune system. Numerous studies report that treatment with clozapine (doses 37.5-600 mg) or olanzapine (doses 10-25 mg) or the use of these drugs in polytherapy cause pyrexia between 37.8-40.6 °C. Additionally, levels of proinflammatory interleukins such as IL-6, IL-1,TNF-α were increased. The aim of this article is to describe how olanzapine and clozapine influence fever development in NMS, in relation to the dose of the drug taken by schizophrenic patients including changes in immunological system.

  5. Techno-economic analysis of decentralized biomass processing depots.

    Science.gov (United States)

    Lamers, Patrick; Roni, Mohammad S; Tumuluru, Jaya S; Jacobson, Jacob J; Cafferty, Kara G; Hansen, Jason K; Kenney, Kevin; Teymouri, Farzaneh; Bals, Bryan

    2015-10-01

    Decentralized biomass processing facilities, known as biomass depots, may be necessary to achieve feedstock cost, quantity, and quality required to grow the future U.S. bioeconomy. In this paper, we assess three distinct depot configurations for technical difference and economic performance. The depot designs were chosen to compare and contrast a suite of capabilities that a depot could perform ranging from conventional pelleting to sophisticated pretreatment technologies. Our economic analyses indicate that depot processing costs are likely to range from ∼US$30 to US$63 per dry metric tonne (Mg), depending upon the specific technology implemented and the energy consumption for processing equipment such as grinders and dryers. We conclude that the benefits of integrating depots into the overall biomass feedstock supply chain will outweigh depot processing costs and that incorporation of this technology should be aggressively pursued.

  6. [French Society for Biological Psychiatry and Neuropsychopharmacology task force: Formal Consensus for the prescription of depot antipsychotics].

    Science.gov (United States)

    Samalin, L; Abbar, M; Courtet, P; Guillaume, S; Lancrenon, S; Llorca, P-M

    2013-12-01

    Compliance is often partial with oral antipsychotics and underestimated for patients with serious mental illness. Despite their demonstrated advantages in terms of relapse prevention, depot formulations are still poorly used in routine. As part of a process to improve the quality of care, French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) Task Force elaborated a Formal Consensus for the prescription of depot antipsychotics in clinical practice. The Task Force recommends as first-line choice, the use of long-acting injectable (LAI) second-generation antipsychotics in patients with schizophrenia, schizoaffective disorder and delusional disorder. They can be considered as a second-line option as a monotherapy to prevent manic recurrence or in combination with mood stabilizer to prevent depressive recurrence in the maintenance treatment of bipolar disorder. LAI second-generation antipsychotics can also be used after a first episode of schizophrenia. Depot neuroleptics are not recommended during the early course of schizophrenia and are not appropriate in bipolar disorder. They are considered as a second-line option for maintenance treatment in schizophrenia. LAI formulations should be systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated. LAI antipsychotics can be used preferentially for non-compliant patients with frequent relapses or aggressive behaviors. A specific information concerning the advantages and inconveniences of the LAI formulations, in the framework of shared-decision making must be delivered to each patient. Recommendations for switching from one oral/LAI form to another LAI and for using LAI antipsychotics in specific populations (pregnant women, elderly patients, subjects in a precarious situation, and subjects having to be treated in a prison establishment) are also proposed. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  7. Propofol-Remifentanil Combination for Management of Electroconvulsive Therapy in a Patient with Neuroleptic Malignant Syndrome

    Directory of Open Access Journals (Sweden)

    Modabber Arasteh

    2012-01-01

    Full Text Available Electroconvulsive therapy can be effective in severe or treatment resistant neuroleptic malignant syndrome patients. Anesthesia and use of muscle relaxant agents for electroconvulsive therapy in such patients may encounter anesthesiologists with specific challenges. This case report describes successful management of anesthesia in 28-year-old male patient undergoing eight electroconvulsive therapy sessions for treatment of neuroleptic malignant syndrome.

  8. Current trend in drug delivery considerations for subcutaneous insulin depots to treat diabetes.

    Science.gov (United States)

    P V, Jayakrishnapillai; Nair, Shantikumar V; Kamalasanan, Kaladhar

    2017-05-01

    Diabetes mellitus (DM) is a metabolic disorder due to irregularities in glucose metabolism, as a result of insulin disregulation. Chronic DM (Type 1) is treated by daily insulin injections by subcutaneous route. Daily injections cause serious patient non-compliance and medication non-adherence. Insulin Depots (ID) are parenteral formulations designed to release the insulin over a specified period of time, to control the plasma blood glucose level for intended duration. Physiologically, pancreas produces and secretes insulin in basal and pulsatile mode into the blood. Delivery systems mimicking basal release profiles are known as open-loop systems and current marketed products are open-loop systems. Future trend in open-loop systems is to reduce the number of injections per week by enhancing duration of action, by modifying the depot properties. The next generation technologies are closed-loop systems that mimic the pulsatile mode of delivery by pancreas. In closed-loop systems insulin will be released in response to plasma glucose. This review focuses on future trend in open-loop systems; by understanding (a) the secretion of insulin from pancreas, (b) the insulin regulation normal and in DM, (c) insulin depots and (d) the recent progress in open-loop depot technology particularly with respect to nanosystems. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Neuroleptic malignant syndrome or a statin drug reaction? A case report.

    Science.gov (United States)

    Cooper, Joyce M; Jones, Alison L

    2009-01-01

    A 60-year-old woman with a long psychiatric history presented with delirium and mutism. She was febrile, with marked limb rigidity and elevated creatinine kinase (CK) level. Current medications included pericyazine. Current or recent use of dopamine-blocking agents, such as pericyazine, together with a disturbance in conscious state, autonomic dysfunction, and an elevated CK level may be suggestive of neuroleptic malignant syndrome (NMS). The diagnosis was confirmed as NMS, and she was successfully treated with bromocriptine. Eight years later, she represents with symptoms suggesting recurrence of NMS including elevated CK level and myalgia, however, without limb rigidity. Current medications include quetiapine, lithium, simvastatin, and a recent course of clarithromycin. Macrolide antibiotics such as clarithromycin inhibit the metabolic pathway of statins via the cytochrome CYP450 3A4 hepatic enzyme system and may result in elevated CK level, myopathy, or rhabdomyolysis producing symptoms that may be confused with NMS. Simvastatin was ceased with rapid decrease in CK level and resolution of symptoms. This case highlights the importance of considering other diagnoses in any patient presenting with a disturbance in conscious state, autonomic dysfunction, and an elevated CK level. Particularly in a patient with a history of NMS, a thorough medication history is essential to aid diagnosis and avoid confusion with presenting symptoms and medical history.

  10. Glutamate-based magnetic resonance spectroscopy in neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Atri Chatterjee

    2014-01-01

    Full Text Available Glutamate neurotoxicity is implicated in a number of neurological diseases, including Neuroleptic Malignant syndrome. Therefore, functional magnetic resonance imaging can help in diagnosis and monitoring such conditions. However, reports of this application are scarce in the literature. In this manuscript, glutamate based imaging of the basal ganglia showed increased levels of the neurotransmitter bilaterally. In addition, a radon transform of the functional image was performed to look for any asymmetry in cerebral activation. Although no asymmetry was detected in this case, this novel analysis can be applied in physiological and pathological scenarios to visualize contribution of different brain structures.

  11. Carisoprodol withdrawal syndrome resembling neuroleptic malignant syndrome: Diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Gunchan Paul

    2016-01-01

    Full Text Available Soma (Carisoprodol is N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; a commonly prescribed, centrally acting skeletal muscle relaxant. Neuroleptic malignant syndrome (NMS is a potentially life-threatening adverse effect of antipsychotic agents. Although diagnostic criteria for NMS have been established, it should be recognized that atypical presentations occur and more flexible diagnostic criteria than currently mandated, may be warranted. We wish to report a postoperative case of bilateral knee replacement who presented with carisoprodol (Soma withdrawal resembling NMS that was a diagnostic dilemma. Subsequently, it was successfully treated with oral baclofen in absence of sodium dantrolene.

  12. Carisoprodol withdrawal syndrome resembling neuroleptic malignant syndrome: Diagnostic dilemma

    Science.gov (United States)

    Paul, Gunchan; Parshotam, Gautam L; Garg, Rajneesh

    2016-01-01

    Soma (Carisoprodol) is N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; a commonly prescribed, centrally acting skeletal muscle relaxant. Neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. Although diagnostic criteria for NMS have been established, it should be recognized that atypical presentations occur and more flexible diagnostic criteria than currently mandated, may be warranted. We wish to report a postoperative case of bilateral knee replacement who presented with carisoprodol (Soma) withdrawal resembling NMS that was a diagnostic dilemma. Subsequently, it was successfully treated with oral baclofen in absence of sodium dantrolene. PMID:27625493

  13. Antipsychotic-Induced Neuroleptic Malignant Syndrome After Cardiac Surgery.

    Science.gov (United States)

    Moll, Vanessa; Ward, Ceressa T; Zivot, Joel B

    2016-07-01

    We report a case of neuroleptic malignant syndrome (NMS) in a postoperative cardiac surgery patient after the administration of typical and atypical antipsychotics for the treatment of delirium. On postoperative day 8, the patient's temperature peaked at 40.6°C. Agitation, rigidity, elevation in creatine kinase, and leukocytosis were associated findings. NMS was suspected on postoperative day 10. All antipsychotics were discontinued; dantrolene infusions and fluid therapy were initiated. After 2 days of NMS treatment, the patient's symptoms resolved. The temporal relationship between discontinuation of all antipsychotics, initiation of dantrolene, and clinical improvement supports the diagnosis of antipsychotic-induced NMS.

  14. Atypical neuroleptic malignant syndrome with long-term clozapine.

    Science.gov (United States)

    Corallo, Carmela E; Ernest, David

    2007-12-01

    Clozapine-induced neuroleptic malignant syndrome (NMS) may present differently from NMS associated with traditional antipsychotic agents, with fewer clinical features, particularly fewer extrapyramidal manifestations. The risk of developing NMS with clozapine does not appear dose-related. In half of cases, it occurs within 2 weeks of beginning clozapine therapy, but it can develop at any stage, especially with long-term use. We describe a patient who presented with atypical NMS after more than 10 years of clozapine treatment, and who was safely re-challenged with the same drug.

  15. SODIUM THIOPANTAL AND MIDAZOLAM USE IN NEUROLEPTIC ANESTHESIA

    Directory of Open Access Journals (Sweden)

    P SAJEDI

    2001-12-01

    Full Text Available Introduction: In this study amnesic and anesthetic effects of Midazolam used to reduce awarness and recall of neurolept Anesthesia. Methods: The study was clinical trial with simple random sampling. Patients were studied in four groups of 30 numbers. Each preparation and induction of anesthesia was identical in all groups. Bolous Thiopental (BT group received 0.3mg/kg NaThiopental during induction of Anesthesia. Infusion thiopental group (IT 0.3mg/kg Na thiopental was given during induction plus 100mg/kg/min for Maintaince of anesthesia. Bolous Midazolam (BM group recieved 0.1 mg/kg Midazolam during induction and Infusion Midazolam (lM groug 0.1 mg/kg during Induction plus 0.1mg/kg/h for maintainance of Anesthesia. All groups were observed for signs of awareness and recall. Also hemodynamic variables and duration of recovery were measured and compared between groups with analysis of variance and Chi square tests. Result: Signs of Awareness (tachycardia and Lacrimation in IM group was significantly less than other groups. (P<0.05 Percent of patients reported recall were significantly lower in IM group. (P<0.05 Discussion: Infusion of Midazolam can reduce signs of awareness and recall during neurolept anesthesia without increase in complications or duration of recovery period

  16. Haloperidol-induced neuroleptic malignant syndrome complicated by hyperosmolar hyperglycemic state.

    Science.gov (United States)

    Rock, Wasseem; Elias, Mazen; Lev, Ami; Saliba, Walid R

    2009-10-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency that may be caused by neuroleptic agents of any class. The association with hyperosmolar hyperglycemic state (HHS) is rare and carries a grave prognosis. We describe the case of a 25-year-old male patient with haloperidol-induced NMS complicated by HHS that culminated in the patient's death despite all treatment efforts. Physicians caring for diabetic psychiatric patients who are treated with neuroleptic agents should be aware of this association that may be prevented by tight glycemic control.

  17. Temporal changes in serum creatine kinase concentration and degree of muscle rigidity in 24 patients with neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Nisijima K

    2013-06-01

    Full Text Available Koichi Nisijima, Katutoshi ShiodaDepartment of Psychiatry, Jichi Medical University, Tochigi, JapanAbstract: Neuroleptic malignant syndrome (NMS is a dangerous adverse response to antipsychotic drugs. It is characterized by the four major clinical symptoms of hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental state. Serum creatine kinase (CK elevation occurs in over 90% of NMS cases. In the present study, the detailed temporal changes in serum CK and degree of muscle rigidity, and the relationship between CK concentration and degree of muscle rigidity over the time course from fever onset, were evaluated in 24 affected patients. The results showed that serum CK peaked on day 2 after onset of fever and returned to within normal limits at day 12. Mild muscle rigidity was observed before the onset of fever in 17 of 24 cases (71%. Muscle rigidity was gradually exacerbated and worsened until day 4 after onset of fever. These findings confirm physicians' empirical understanding of serum CK concentrations and muscle rigidity in NMS based on data accumulated from numerous patients with the syndrome, and they indicate that serum CK may contribute to the early detection of NMS.Keywords: neuroleptic malignant syndrome, creatine kinase, muscle rigidity

  18. Altered functional connectivity links in neuroleptic-naïve and neuroleptic-treated patients with schizophrenia, and their relation to symptoms including volition

    Directory of Open Access Journals (Sweden)

    Weidan Pu

    2014-01-01

    Full Text Available In order to analyze functional connectivity in untreated and treated patients with schizophrenia, resting-state fMRI data were obtained for whole-brain functional connectivity analysis from 22 first-episode neuroleptic-naïve schizophrenia (NNS, 61 first-episode neuroleptic-treated schizophrenia (NTS patients, and 60 healthy controls (HC. Reductions were found in untreated and treated patients in the functional connectivity between the posterior cingulate gyrus and precuneus, and this was correlated with the reduction in volition from the Positive and Negative Symptoms Scale (PANSS, that is in the willful initiation, sustenance, and control of thoughts, behavior, movements, and speech, and with the general and negative symptoms. In addition in both patient groups interhemispheric functional connectivity was weaker between the orbitofrontal cortex, amygdala and temporal pole. These functional connectivity changes and the related symptoms were not treated by the neuroleptics. Differences between the patient groups were that there were more strong functional connectivity links in the NNS patients (including in hippocampal, frontal, and striatal circuits than in the NTS patients. These findings with a whole brain analysis in untreated and treated patients with schizophrenia provide evidence on some of the brain regions implicated in the volitional, other general, and negative symptoms, of schizophrenia that are not treated by neuroleptics so have implications for the development of other treatments; and provide evidence on some brain systems in which neuroleptics do alter the functional connectivity.

  19. Fatty acid composition of fat depots in wintering Canada geese

    Science.gov (United States)

    Austin, J.E.

    1993-01-01

    I determined the fatty acid composition of subcutaneous, abdominal, visceral, and leg saddle depots in adult female Canada Geese (Branta canadensis) wintering in north-central Missouri during October 1984-March 1985. Mean levels of C14:0, C16:0, C16:1, C18:0, C18:1, C18:2, and C18:3 generally were highest in the subcutaneous and abdominal depots. The ratio of saturated to unsaturated fats was highest in the leg saddle depot and lowest in the abdominal depot. I also assessed the differences among sexes, seasons, and years in fatty acid composition of abdominal fat depots in adult geese collected during October-March, 1985-1987. Adult females had consistently higher levels of C14:0 in abdominal depots than males. Fatty acid composition of the abdominal depot differed among years but not by season. In the abdominal depot, C14:0, C16:0, C16:1, and C18:1 were higher in 1986-1987 compared with the previous two years, whereas C18:3 was highest in 1984-1985. Differences among years reflected changes in winter diet. Fatty acids of wintering geese were similar to those previously found in breeding Canada Geese.

  20. Neuroleptic Malignant Syndrome Associated with Refractory Acute Disseminated Encephalomyelitis

    Directory of Open Access Journals (Sweden)

    Silvia R. Delgado

    2016-04-01

    Full Text Available We present the case of a young man who was transferred to our hospital with worsening acute disseminated encephalomyelitis (ADEM despite treatment with intravenous methylprednisolone, intravenous immunoglobulin and plasma exchange. He developed neuroleptic malignant syndrome (NMS without the use of dopamine-modulating drugs. His progressive clinical improvement started after treatment with intravenous cyclophosphamide and methylprednisolone. In our patient, acute demyelination with severe bilateral inflammation of the basal ganglia could have caused a state of central dopamine depletion, creating proper conditions for the development of NMS. Significant clinical improvement of our case after treatment with intravenous cyclophosphamide and steroids provides further evidence for a possible role of the inflammatory lesions in the pathogenesis of NMS in association with ADEM.

  1. A case of neuroleptic malignant syndrome following cardiac surgery

    Directory of Open Access Journals (Sweden)

    Atsushi Tamura

    2017-06-01

    Full Text Available Neuroleptic malignant syndrome (NMS is rare but sometimes causes life-threatening conditions. We report the case of a 53-year-old male patient who developed NMS following cardiac surgery. He was diagnosed with schizophrenia and pre- scribed blonanserin, chlorpromazine, and biperiden. From postoperative day 3, hyperthermia, disturbed consciousness, and involuntary movement were observed. Subsequently, his serum creatine phosphokinase (CPK levels increased. After NMS was suspected, chlorpromazine and biperiden were stopped. From postoperative day 7, intravenous administration of dant- rolene was initiated. Following this treatment, his serum CPK levels gradually decreased, and the other symptoms improved. The treatment of NMS remains controversial. There is no evidence that dantrolene is effective for treating NMS; however, it may be one of the important options for treating NMS. We present the case and discuss the diagnosis and management of NMS following cardiac surgery. [Arch Clin Exp Surg 2017; 6(2.000: 117-119

  2. An atypical case of neuroleptic malignant syndrome precipitated by valproate.

    Science.gov (United States)

    Verma, Rajesh; Junewar, Vivek; Rathaur, Bhanu Pratap Singh

    2014-03-06

    Neuroleptic malignant syndrome (NMS) can be caused by various drugs. We report a case of a 60-year-old woman who presented with high-grade fever, muscular rigidity, tachycardia, tachypnoea and altered sensorium along with seizures. She had been taking olanzapine for the past 2 years for psychosis. For the last month valproate was added to her treatment. Her blood investigations revealed hyponatraemia and raised serum ammonia and creatinine phosphokinase (CPK) levels. In view of hyperthermia, muscular rigidity, autonomic disturbances, altered mental status and raised CPK, a diagnosis of NMS was made. Valproate could have probably precipitated NMS; although the patient was taking antipsychotics for a long time, it was only with the addition of valproate that she developed these symptoms. Raised serum ammonia levels also indicated the presence of valproate toxicity. Seizures were probably due to electrolyte disturbances. Offending drugs were withdrawn. The patient improved with treatment by dopamine agonist and other supportive treatments.

  3. Neuroleptic Malignant Syndrome After the Use of Venlafaxine in a Patient with Generalized Anxiety Disorder

    Directory of Open Access Journals (Sweden)

    Tsung-Chien Lu

    2006-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a potentially lethal adverse reaction to neuroleptics, which is characterized by hyperthermia, extrapyramidal symptoms, altered consciousness and autonomic dysfunction. Although NMS is most commonly induced by the high-potency neuroleptics, its development has also been associated with the use of non-neuroleptic agents that block central dopamine pathways. A 68-year-old man with generalized anxiety disorder and depressive symptoms presented at the emergency department (ED with high fever, tremor, muscle rigidity, rhabdomyolysis and altered mental status. NMS was considered to have been caused by the recent addition and subsequent dose increase in his treatment regimen of venlafaxine, a serotonin norepinephrine reuptake inhibitor. He was successfully treated with bromocriptine, lorazepam, and fluid hydration in the ED and intensive care unit.

  4. A case study: neuroleptic malignant syndrome with risperidone and CYP2D6 gene variation.

    Science.gov (United States)

    Ochi, Shinichiro; Kawasoe, Koichiro; Abe, Masao; Fukuhara, Ryuji; Sonobe, Kantaro; Kawabe, Kentaro; Ueno, Shu-ichi

    2011-01-01

    We present a schizophrenic patient who experienced neuroleptic malignant syndrome with risperidone treatment due to variants of the CYP2D6 gene with reduced function. Clinicians need to be aware of this potential complication.

  5. Emergency anaesthetic management of a severely anaemic, chronic schizophrenic patient with history of neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Shrividya Chellam

    2011-01-01

    Full Text Available Administering anaesthesia to a patient with chronic schizophrenia is a challenge due to the increased risk of various perioperative complications. Neuroleptic agents are highly effective drugs used for the treatment of psychiatric disorders, but are rarely associated with neuroleptic malignant syndrome (NMS. Here, we describe the successful anaesthetic management of a patient of chronic schizophrenia with past history of NMS who presented in emergency with active bleeding per rectum and haemoglobin of 3 gm%.

  6. Antidepressant versus neuroleptic activities of sulpiride isomers on four animal models of depression.

    Science.gov (United States)

    Vaccheri, A; Dall'Olio, R; Gaggi, R; Gandolfi, O; Montanaro, N

    1984-01-01

    The atypical neuroleptic sulpiride is also prescribed for depression because of its activating effect. However, such an effect does not necessarily imply an action identical to that of classical antidepressants, and a laboratory comparison of the neuroleptic and antidepressant activities of sulpiride may contribute to a better definition of its psychotherapeutic profile. Sulpiride isomers were studied in the rat in four behavioural models of depression which are thought to be influenced by neuroleptics in different ways. Desipramine (imipramine) and haloperidol were employed in each test as a standard antidepressant and neuroleptic, respectively. The four tests were: 1) prevention of apomorphine-induced sedation: 2) antagonism of apomorphine-induced hypothermia; 3) behavioural despair (swim test); 4) learned helplessness ( FR2 lever pressing escape). Desipramine ameliorated behaviour in all tests; haloperidol ameliorated the response to test 1, influenced that to test 2 in a neuroleptic-like way and worsened the responses to tests 3 and 4. (-)-Sulpiride worked in a similar way to haloperidol in all tests. (+)-Sulpiride significantly and dose-dependently ameliorated the responses to test 3 and was inactive in the others. No conclusion was drawn from test 1 owing to its lack of specificity; the results of the remaining tests indicated a neuroleptic profile of (-)-sulpiride and suggested a potential "antidepressant" activity of (+)-sulpiride which merits further investigation.

  7. The effects of neuroleptics on the GABA-induced Cl- current in rat dorsal root ganglion neurons: differences between some neuroleptics.

    Science.gov (United States)

    Yokota, Kenjiro; Tatebayashi, Hideharu; Matsuo, Tadashi; Shoge, Takashi; Motomura, Haruhiko; Matsuno, Toshiyuki; Fukuda, Akira; Tashiro, Nobutada

    2002-03-01

    1. Several neuroleptics inhibited the 3 microM gamma-aminobutyric acid induced-chloride current (GABA-current) on dissociated rat dorsal root ganglion neurons in whole-cell patch-clamp investigations. 2. The IC(50) for clozapine, zotepine, olanzapine, risperidone and chlorpromazine were 6.95, 18.26, 20.30, 106.01 and 114.56 microM, respectively. The values for the inhibitory effects of neuroleptics on the GABA (3 microM)-current, which were calculated by the fitting Hill's equations where the concentrations represent the mean therapeutic blood concentrations, were ranked clozapine>zotepine>chlorpromazine>olanzapine>risperidone. These inhibitory effects, weighted with the therapeutic concentrations of neuroleptics, were correlated with the clinical incidences of seizure during treatment with neuroleptics. 3. Clozapine reduced the picrotoxin-inhibiton, and may compete with a ligand of the t-butylbicyclophosphorothionate (TBPS) binding site. 4. Haloperidol and quetiapine did not affect the peak amplitude of the GABA (3 microM)-current. However, haloperidol reduced the clozapine-inhibition, and may antagonize ligand binding to TBPS binding site. 5. Neuroleptics including haloperidol and quetiapine enhanced the desensitization of the GABA (3 microM)-current. However, haloperidol and quetiapine at 100 microM inhibited the desensitization at the beginning of application. 6. Blonanserin (AD-5423) at 30 and 50 microM potentiated the GABA (3 microM)-current to 170.1+/-6.9 and 192.0+/-10.6% of the control current, respectively. Blonanserin shifted GABA concentration-response curve leftward. Blonanserin only partly negatively interacted with diazepam. The blonanserin-potentiation was not reversed by flumazenil. Blonanserin is not a benzodiazepine receptor agonist. 7. The various effects of neuroleptics on the GABA-current may be related to the clinical effects including modifying the seizure threshold.

  8. The effects of neuroleptics on the GABA-induced Cl− current in rat dorsal root ganglion neurons: differences between some neuroleptics

    Science.gov (United States)

    Yokota, Kenjiro; Tatebayashi, Hideharu; Matsuo, Tadashi; Shoge, Takashi; Motomura, Haruhiko; Matsuno, Toshiyuki; Fukuda, Akira; Tashiro, Nobutada

    2002-01-01

    Several neuroleptics inhibited the 3 μM γ-aminobutyric acid induced-chloride current (GABA-current) on dissociated rat dorsal root ganglion neurons in whole-cell patch-clamp investigations. The IC50 for clozapine, zotepine, olanzapine, risperidone and chlorpromazine were 6.95, 18.26, 20.30, 106.01 and 114.56 μM, respectively. The values for the inhibitory effects of neuroleptics on the GABA (3 μM)-current, which were calculated by the fitting Hill's equations where the concentrations represent the mean therapeutic blood concentrations, were ranked clozapine>zotepine>chlorpromazine>olanzapine>risperidone. These inhibitory effects, weighted with the therapeutic concentrations of neuroleptics, were correlated with the clinical incidences of seizure during treatment with neuroleptics. Clozapine reduced the picrotoxin-inhibiton, and may compete with a ligand of the t-butylbicyclophosphorothionate (TBPS) binding site. Haloperidol and quetiapine did not affect the peak amplitude of the GABA (3 μM)-current. However, haloperidol reduced the clozapine-inhibition, and may antagonize ligand binding to TBPS binding site. Neuroleptics including haloperidol and quetiapine enhanced the desensitization of the GABA (3 μM)-current. However, haloperidol and quetiapine at 100 μM inhibited the desensitization at the beginning of application. Blonanserin (AD-5423) at 30 and 50 μM potentiated the GABA (3 μM)-current to 170.1±6.9 and 192.0±10.6% of the control current, respectively. Blonanserin shifted GABA concentration-response curve leftward. Blonanserin only partly negatively interacted with diazepam. The blonanserin-potentiation was not reversed by flumazenil. Blonanserin is not a benzodiazepine receptor agonist. The various effects of neuroleptics on the GABA-current may be related to the clinical effects including modifying the seizure threshold. PMID:11906969

  9. Pharmacokinetics, safety, and tolerability of a depot formulation of naltrexone in alcoholics: an open-label trial

    Directory of Open Access Journals (Sweden)

    Koch Monika

    2005-04-01

    Full Text Available Abstract Background Naltrexone is an effective medication for treatment of alcohol dependence, but its efficacy is limited by lack of adherence to the oral dosage form. A long-acting depot formulation of naltrexone may increase adherence. Methods A single site, 6-week open label study was conducted with 16 alcohol dependent subjects each receiving 300 mg of Naltrexone Depot by intramuscular injection. The main outcomes were safety and tolerability of the Naltrexone Depot formulation, blood levels of naltrexone and its main metabolite 6-beta naltrexol, and self-reported alcohol use. All subjects received weekly individual counseling sessions. Results The medication was well tolerated with 88% of subjects completing the 6-week trial. The most common side effect experienced was injection site complications. There were no serious adverse events. Subjects had naltrexone and 6-beta-naltrexol concentrations throughout the trial with mean values ranging from 0.58 ng/mL to 2.04 ng/mL and 1.51 ng/mL to 5.52 ng/mL, respectively, at each sampling time following administration. Compared to baseline, subjects had significantly reduced number of drinks per day, heavy drinking days and proportion of drinking days. Conclusion Naltrexone Depot is safe and well tolerated in alcoholics and these findings support the further investigation of its utility in larger double-blind placebo controlled trials.

  10. Severe neuroleptic malignant syndrome: successful treatment with high-dose lorazepam and diazepam: a case report.

    Science.gov (United States)

    Tsai, Meng-Chang; Huang, Tiao-Lai

    2010-01-01

    Neuroleptic malignant syndrome (NMS) is an idiosyncratic and potentially fatal adverse complication of antipsychotic medications and other dopamine-modulating agents. It is characterized by hyperthermia, muscle rigidity, autonomic dysfunction and alteration in mental status. Here, we report a patient with severe NMS who was successfully treated with highdose lorazepam and diazepam. A 61-year-old man with bipolar I disorder was admitted to the hospital because of manic episodes. Fever, muscle rigidity, tachycardia, diaphoresis, elevated blood pressure and delirium occurred following intramuscular injection of haloperidol and NMS was diagnosed. Supportive treatment included hydration, alkalinized fluids and correction of abnormal electrolytes without the use of dantrolene, dopaminergic agents or electroconvulsive therapy. The Francis-Yacoub NMS rating scale was employed for evaluation of clinical improvement, and scores were 55 on the first day and 0 at discharge. The patient was followed up for 6 months and was free of NMS. In conclusion, this is the first report of rapid relief of NMS with high-dose lorazepam and diazepam in a Taiwanese patient.

  11. Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report

    Directory of Open Access Journals (Sweden)

    Young Kyoung Sa

    2013-03-01

    Full Text Available Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS. However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA. In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

  12. A rare case of neuroleptic malignant syndrome without elevated serum creatine kinase

    Directory of Open Access Journals (Sweden)

    Nisijima K

    2014-02-01

    Full Text Available Koichi Nisijima, Katutoshi Shioda Department of Psychiatry, Jichi Medical University, Tochigi, Japan Abstract: Neuroleptic malignant syndrome (NMS is a life-threatening adverse reaction to antipsychotic drugs. Although there is no specific examination able to diagnose NMS, serum creatine kinase (CK elevation has been reported in over 90% of NMS patients. In this report, we describe a patient who developed NMS but had normal CK levels. The patient presented with hyperthermia of over 38°C, severe muscle rigidity, autonomic dysfunction, and altered mental status. Although serum CK levels were measured three times during the course of NMS, the levels were within the normal range. The patient died of respiratory failure 13 days after the onset of NMS symptoms. As patients without elevated serum CK levels are rarely reported, we discuss potential reasons why the serum CK was not elevated in our patient. This case shows clinicians that although serum CK elevation is a useful indicator for the early detection of NMS, the diagnosis of NMS must be determined by clinical symptoms as otherwise, the appropriate treatment procedures for NMS may be delayed. Keywords: malnutrition, NMS, CK, hyperthermia

  13. Rice bran oil prevents neuroleptic-induced extrapyramidal symptoms in rats: Possible antioxidant mechanisms

    Directory of Open Access Journals (Sweden)

    Noreen Samad

    2015-09-01

    Full Text Available Tardive dyskinesia (TD is one of the serious side effects of long-term antipsychotic treatment. Chronic treatment with neuroleptic leads to the development of abnormal oral movements called vacuous chewing movements (VCMs. The oxidative stress hypothesis of TD is one of the possible pathophysiologic models for TD. Preclinical and clinical studies of this hypothesis indicate that neurotoxic free radical production is likely to be a consequence of antipsychotic medication and is related to occurrence of TD. Oxidative stress is implicated in the pathophysiology of TD. Rats chronically treated with haloperidol orally at a dose of 0.2 mg/kg/day for a period of 5 weeks developed VCMs, which increased in a time-dependent manner as the treatment continued for 5 weeks. Motor coordination impairment started after the 1st week and was maximally impaired after 3 weeks and gradually returned to the 1st week value. Motor activity in an open field or home cage (activity box not altered. Administration of rice bran oil (antioxidant by oral tubes at a dose of 0.4 mL/day prevented the induction of haloperidol-elicited VCMs as well impairment of motor coordination. The results are discussed in the context of a protective role of antioxidant of rice bran oil in the prevention of haloperidol-induced extrapyramidal symptoms.

  14. Olanzapine-induced neuroleptic malignant syndrome in a patient with bipolar affective disorder: Does quetiapine holds the solution?

    Directory of Open Access Journals (Sweden)

    Praveen Tripathi

    2013-01-01

    Full Text Available Neuroleptic Malignant Syndrome (NMS is a rare, severe and life threatening condition induced by antipsychotic medications. It is commonly encountered with the use of first generation antipsychotics, however cases of NMS have been reported with the use of second generation antipsychotics like Olanzapine, Risperidone, Paliperidone, Aripiprazole, Ziprasidone, Amisulpride, Quetiapine and Clozapine, though the incidence of such reports is rare. Due to decreased use of first generation antipsychotics, NMS is reported less frequently now a days. In this case report- we highlight the management issues of a patient suffering from bipolar affective disorder, who had developed NMS following intramuscular injection of haloperidol, which was withdrawn and olanzapine was given later on. The patient had again developed NMS with olanzapine. Finally the patient was managed with modified electroconvulsive therapy and discharged on Lithium carbonate and Quetiapine.

  15. Monotherapy with lanreotide depot for acromegaly: long-term clinical experience in a pituitary center.

    Science.gov (United States)

    Sagvand, Babak Torabi; Khairi, Shafaq; Haghshenas, Arezoo; Swearingen, Brooke; Tritos, Nicholas A; Miller, Karen K; Klibanski, Anne; Nachtigall, Lisa B

    2016-08-01

    Long-acting somatostatin analogs are one of the main classes of medical therapy used for acromegaly and most patients require ongoing treatment. Few studies have evaluated the long-term efficacy and safety of lanreotide depot beyond 2 years. The goal of this study was to provide a long-term longitudinal assessment of efficacy and safety of lanreotide depot in lanreotide responders compared to a surgically cured control group. In this retrospective longitudinal case-control study, patients with acromegaly receiving lanreotide depot monotherapy continuously for at least 24 months (N = 24) and surgically cured patients (N = 39) were compared. Serum IGF-1, pituitary MRIs, lanreotide dose, co-morbidities and adverse effects were assessed longitudinally. In the lanreotide group, IGF-1 remained normal and unchanged over 6 years; comparable to the surgery only group. There was no difference in prevalence of normal IGF-1 between the lanreotide and surgery only groups at 6 months (100 vs. 97 %), 6 years (89 vs. 90 %) and at last follow-up (96 vs. 92 %). Tumor size remained stable (79 %) or decreased (21 %) in the lanreotide group. In the surgery only group, tumor size remained unchanged in all patients. Hemoglobin A1C did not differ between lanreotide and surgery only groups (baseline 5.8 vs. 6.1 %; last follow-up 6.0 vs. 5.7 %). Two (8 %) of the lanreotide and none of the surgery only group developed new diabetes mellitus. Lanreotide depot maintains normalization of IGF-1 in 89 % of responders after 6 years, comparable to surgically cured controls, and controlled tumor size in all without significant adverse effects.

  16. DEPOT database: Reference manual and user's guide

    Energy Technology Data Exchange (ETDEWEB)

    Clancey, P.; Logg, C.

    1991-03-01

    DEPOT has been developed to provide tracking for the Stanford Linear Collider (SLC) control system equipment. For each piece of equipment entered into the database, complete location, service, maintenance, modification, certification, and radiation exposure histories can be maintained. To facilitate data entry accuracy, efficiency, and consistency, barcoding technology has been used extensively. DEPOT has been an important tool in improving the reliability of the microsystems controlling SLC. This document describes the components of the DEPOT database, the elements in the database records, and the use of the supporting programs for entering data, searching the database, and producing reports from the information.

  17. Locating Depots for Capacitated Vehicle Routing

    DEFF Research Database (Denmark)

    Gørtz, Inge Li; Nagarajan, Viswanath

    2016-01-01

    We study a location-routing problem in the context of capacitated vehicle routing. The input to the k-location capacitated vehicle routing problem (k-LocVRP) consists of a set of demand locations in a metric space and a fleet of k identical vehicles, each of capacity Q. The objective is to locate k...... depots, one for each vehicle, and compute routes for the vehicles so that all demands are satisfied and the total cost is minimized. Our main result is a constant-factor approximation algorithm for k-LocVRP. In obtaining this result, we introduce a common generalization of the k-median and minimum...... spanning tree problems (called k median forest), which might be of independent interest. We give a local-search based (3+ε)-approximation algorithm for k median forest, which leads to a (12+ε)-approximation algorithm for k-LocVRP, for any constant ε>0....

  18. Abarelix: abarelix-depot-F, abarelix-depot-M, abarelix-L, PPI 149, R 3827.

    Science.gov (United States)

    2003-01-01

    Abarelix [Abarelix-Depot-F, Abarelix-Depot-M, Abarelix-L, PPI 149, R 3827, Plenaxis] is a peptide consisting of natural and artificial amino acids. In females, abarelix is an estrogen production antagonist with potential for the treatment of breast cancer, endometriosis and other reproductive hormone diseases. In males it is a testosterone production antagonist and has potential as hormonal therapy of prostate cancer. Depot formulations of abarelix (abarelix-depot-M and abarelix-depot-F) are being developed for hormonally responsive prostate cancer and endometriosis, respectively. Clinical development of the depot formulations is currently being conducted by Praecis Pharmaceuticals, the originators of the agent. A non-depot formulation, abarelix-L, was also being conducted for prostate gland volume reduction. Praecis Pharmaceuticals has entered into a number of licensing agreements covering abarelix. However, all agreements have since been terminated leaving Praecis to develop and commercialise the agent on its own. The terminated agreements include an agreement between Praecis and Roche for the commercialisation of abarelix in the US. This agreement was terminated in November 1998. Praecis Pharmaceuticals also entered into a collaborative agreement with Amgen in March 1999, whereby the companies would develop abarelix and Amgen would commercialise the drug in the US, Canada, Australia, Asia and several secondary markets. However, in September 2001, Praecis and Amgen announced that they were terminating the agreement for all indications. Praecis stated at the time that it remained committed to developing abarelix for both prostate cancer and endometriosis. Amgen had submitted 'Lotestrol' to the US Patent and Trademarks Office as a possible tradename for abarelix-depot-M. Lotestrol may also have been under consideration as a tradename for abarelix-depot-F. Praecis had also sold European, African, Latin American and Middle Eastern rights to abarelix to Sanofi

  19. Expandable Cryogenic Tankage for On Orbit Depot Storage Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The proposed expandable depot storage tanks would make it possible to have an on-orbit tank larger in volume than any existing or planned launch vehicles. The size...

  20. Radiological Final Status Survey of the Hammond Depot, Hammond, Indiana

    Energy Technology Data Exchange (ETDEWEB)

    T.J. Vitkus

    2008-04-07

    ORISE conducted extensive scoping, characterization, and final status surveys of land areas and structures at the DNSC’s Hammond Depot located in Hammond, Indiana in multiple phases during 2005, 2006 and 2007.

  1. Hypothermic response produced by manassantin A, a novel neuroleptic agent.

    Science.gov (United States)

    Rao, K V; Puri, V N

    1988-01-01

    Manassantin A (MNS-A), a novel neolignoid, neutral compound shown to possess neuroleptic properties, causes hypothermic response in male and female mice of CD-1 strain when administered by the intra-cerebroventricular (icv), (0.1, 1.0, 3.2, 10 micrograms/mouse), intraperitoneal (ip), (0.1, 0.32, 1.0, 3.2 mg/kg) and oral (0.5, 1.6, 5.0, 16 mg/kg) routes. The hypothermia was found to be dose and time dependent, the maximum decrease of temperature being observed by the icv route (P less than 0.001) after 2 hours. However, ip and oral administration of lower and middle order doses were not very effective but higher doses caused significant (P less than 0.001) reduction of body temperature. The centrally-induced hypothermic response by MNS-A may give future leads as a screening model for antidepressant drugs and can be a useful tool for manipulating physiological and pharmacological processes to understand the central thermoregulatory functions.

  2. Neuroleptic Malignant Syndrome: A Review from a Clinically Oriented Perspective.

    Science.gov (United States)

    Tse, Lurdes; Barr, Alasdair M; Scarapicchia, Vanessa; Vila-Rodriguez, Fidel

    2015-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side-effect that can occur in response to treatment with antipsychotic drugs. Symptoms commonly include hyperpyrexia, muscle rigidity, autonomic dysfunction and altered mental status. In the current review we provide an overview on past and current developments in understanding the causes and treatment of NMS. Studies on the epidemiological incidence of NMS are evaluated, and we provide new data from the Canada Vigilance Adverse Reaction Online database to elaborate on drug-specific and antipsychotic drug polypharmacy instances of NMS reported between 1965 and 2012. Established risk factors are summarized with an emphasis on pharmacological and environmental causes. Leading theories about the etiopathology of NMS are discussed, including the potential contribution of the impact of dopamine receptor blockade and musculoskeletal fiber toxicity. A clinical perspective is provided whereby the clinical presentation and phenomenology of NMS is detailed, while the diagnosis of NMS and its differential is expounded. Current therapeutic strategies are outlined and the role for both pharmacological and non-pharmacological treatment strategies in alleviating the symptoms of NMS are discussed.

  3. Venous Thromboembolism Following Dantrolene Treatment for Neuroleptic Malignant Syndrome

    Science.gov (United States)

    Chen, Po-Hao; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2016-01-01

    Neuroleptic malignant syndrome (NMS) is one of the most severe iatrogenic emergencies in clinical service. The symptoms including sudden consciousness change, critical temperature elevation and electrolytes imbalance followed by mutli-organ system failure were common in NMS. In addition to aggressive interventions with intravenous fluid resuscitation and antipyretics, several antidotes have been suggested to prevent further progression of the muscle damage. Dantrolene has been reported to be one of the most effective treatments for NMS. However, the adverse effects of dantrolene treatment for NMS have not yet been evaluated thoroughly. Here we report a young male patient with bipolar I disorder who developed NMS after rapid tranquilization with haloperidol. Dantrolene was given intravenously for the treatment of NMS. However, fever accompanied with local tenderness, hardness with clear border and swelling with heat over the patient’s left forearm occurred on the sixth day of dantrolene treatment. Venous thromboembolism (VTE) over intravenous indwelling site at the patient’s forearm was noted and confirmed by Doppler ultrasound. The patient’s VTE recovered after heparin and warfarin thrombolytic therapy. To our knowledge, this is the first case report demonstrating the possible relationship between dantrolene use and VTE in a patient with antipsychotic treatment. Although the causal relationship and the underlying pathogenesis require further studies, dantrolene should be used with caution for patients with NMS. PMID:27776396

  4. CASE REPORT OF NEUROLEPTIC MALIGNANT SYNDROME WITH RISING BLOOD SUGAR

    Institute of Scientific and Technical Information of China (English)

    WANG Hong-xing; LV Qiu-lin; WANG Zu-cheng; HUANG Ji-zhong; XU He-ding; WEN Hui; CHEN Jun; QIAO Song; NI Xiao-dong

    2007-01-01

    Objective To report one case of neuroleptic malignant syndrome (NMS) with raising blood sugar. Methods The patient was studied clinically with biochemistry, white blood cells, psychiatric symptoms,and creatine phosphokinase (CPK) observations. Results The male patient with a history of taking antipsychotics more 30 years and his age of onset was about 20 years. He had severe muscular rigidity, altered consciousness and autonomic disturbance associated with elevation of serum CPK levels ( max 3755 U/L) and leucocytosis ( max 13.3 × 109/L ) , especially granular leukocytosis( max 90% ) and lymphocytopenia (min 8% ). In addition, high blood sugar emerged along with the variation of white blood cells ( max 9. 0 mmol/L). Conclusion The manifestations of the patient was in conformity with those of the NMS. The patient had catatonic signs such as mutism,drinking difficulty, etc. and excess of saliva. Developmental observation with CPK and white blood cells is able to reveal the severity level of NMS. Raising blood sugar should be also monitoring item.

  5. Neuroleptic malignant syndrome associated with atypical antipsychotic drugs.

    Science.gov (United States)

    Trollor, Julian N; Chen, Xiaohua; Sachdev, Perminder S

    2009-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially severe idiosyncratic adverse reaction usually seen in the context of treatment with antipsychotic drugs. Although NMS is historically associated with the classic or 'typical' antipsychotic drugs, it is also a potential adverse effect of atypical antipsychotic drugs. The widespread use of atypical antipsychotic drugs highlights the need to examine the data relating to the symptomatology, diagnosis, classification and management of NMS with these newer agents. We used MEDLINE and EMBASE to identify NMS case reports and systematic reviews published to June 2008 related to the atypical antipsychotic drugs clozapine, olanzapine, risperidone, paliperidone, aripiprazole, ziprasidone, amisulpride and quetiapine. Case reports and reviews were systematically examined. Our review suggests that, in general, NMS associated with atypical antipsychotic drugs manifests in a typical manner. One notable exception is clozapine-induced NMS, which appears less likely to manifest with extrapyramidal features, including rigidity and tremor. The available literature highlights the divergence of opinion relating to the core diagnostic features of NMS and its conceptualization as a categorical versus dimensional disorder. Both these issues have relevance for the identification of atypical or milder forms of NMS, which are sometimes seen with atypical antipsychotic drugs.

  6. Neuroleptic Malignant Syndrome Associated with Valproate in an Adolescent

    Science.gov (United States)

    Yıldırım, Veli; Direk, Meltem Çobanogulları; Güneş, Serkan; Okuyaz, Çetin; Toros, Fevziye

    2017-01-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction that usually occurs after the administration of antipsychotic drugs. Antidepressants, benzodiazepines, and antiepileptic drugs are also suggested to be associated with NMS. It is believed to result from a dopaminergic blockade in the central nervous system. NMS is manifested by hyperthermia, muscle rigidity, autonomic dysfunction, altered mental status, leukocytosis, and elevated serum creatinine phosphokinase. Valproate is commonly used in the treatment of many psychiatric and neurologic disorders. Valproate can precipitate NMS, especially when used with antipsychotic drugs concurrently. A 17-year-old male patient, who presented with fever, muscular rigidity, confusion, sweating, and tachycardia was admitted to the emergency room. He had been taking only valproate for the last two months for bipolar disorder. His laboratory analyses revealed raised serum hepatic enzymes, creatinine phosphokinase, and myoglobin levels. Considering fever, rigidity, autonomic dysfunction, cognitive alteration, and high creatinine phosphokinase levels, the patient was diagnosed with NMS. In this paper, we aim to discuss the association between valproate and NMS. PMID:28138117

  7. Total Quality Management Implementation Plan: Defense Depot, Ogden

    Science.gov (United States)

    1989-07-01

    NUMBERS Total Quality Management Implementation Plan Defense Depot Ogden 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...PAGES TQM ( Total Quality Management ), Continuous Process Improvement, Depot Operations, Process Action Teams 16. PRICE CODE 17. SECURITY...034 A Message From The Commander On Total Quality Management i fully support the DLA aoproacii to Total Quality Management . As stated by General

  8. SERDP-ESTCP Depot Cd/Chromate Replacement Initiative

    Science.gov (United States)

    2014-11-18

    ESTCP SERDP Environmental Technology Development Process Office of the Deputy Under Secretary of Defense - Installations and Environment 4...SERDP-ESTCP Depot Cd/ Chromate Replacement Initiative Robin Nissan Weapons Systems and Platforms Program Manager ASETSDefense 18 November 2014...NOV 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE SERDP-ESTCP Depot Cd/ Chromate Replacement Initiative 5a

  9. Rocuronium-sugammadex for electroconvulsive therapy management in neuroleptic malignant syndrome: A case report.

    Science.gov (United States)

    Casas Reza, P; Gestal Vázquez, M; Outeiro Rosato, Á; López Álvarez, S; Diéguez García, P

    2017-02-01

    Neuroleptics are a group of drugs widely used in the treatment of psychotic symptoms. Among their adverse effects is the ability to trigger a neuroleptic malignant syndrome (NMS). The diagnosis of NMS is determined by exclusion, and its initial therapeutic management should be the withdrawal of neuroleptics, the administration of benzodiazepines, and electroconvulsive therapy (ECT). ECT is an effective treatment in these patients, and in those cases with a poor response to treatment with antipsychotic drugs. A review is presented on the treatment options and anaesthetic implications of ECT used to handle a patient diagnosed with paranoid schizophrenia in the context of NMS. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Skin-conductance orienting response in chronic schizophrenics: the role of neuroleptics.

    Science.gov (United States)

    Spohn, H E; Coyne, L; Wilson, J K; Hayes, K

    1989-11-01

    The primary aim of this study was to determine whether there is an association between neuroleptic treatment and skin-conductance orienting response (SCOR) nonresponding in chronic schizophrenics. In a design adapted to this purpose, we were unable to demonstrate a relationship between neuroleptics and nonresponding. Although inability to prove the null hypothesis precludes a claim that neuroleptic treatment and SCOR nonresponding are unrelated, internal evidence and prior studies strongly suggest that such a dissociation exists in most chronic schizophrenic nonresponders. We also found stable nonspecific and toxic skin conductance activity differences between SCOR "responders" and "nonresponders" on three occasions of testing. We interpret our results as bearing on state and trait issues in chronic schizophrenics.

  11. Locating Depots for Capacitated Vehicle Routing

    CERN Document Server

    Goertz, Inge Li

    2011-01-01

    We study a location-routing problem in the context of capacitated vehicle routing. The input is a set of demand locations in a metric space and a fleet of k vehicles each of capacity Q. The objective is to locate k depots, one for each vehicle, and compute routes for the vehicles so that all demands are satisfied and the total cost is minimized. Our main result is a constant-factor approximation algorithm for this problem. To achieve this result, we reduce to the k-median-forest problem, which generalizes both k-median and minimum spanning tree, and which might be of independent interest. We give a (3+c)-approximation algorithm for k-median-forest, which leads to a (12+c)-approximation algorithm for the above location-routing problem, for any constant c>0. The algorithm for k-median-forest is just t-swap local search, and we prove that it has locality gap 3+2/t; this generalizes the corresponding result known for k-median. Finally we consider the "non-uniform" k-median-forest problem which has different cost ...

  12. Locating Depots for Capacitated Vehicle Routing

    DEFF Research Database (Denmark)

    Gørtz, Inge Li; Nagarajan, Viswanath

    2011-01-01

    We study a location-routing problem in the context of capacitated vehicle routing. The input to k-LocVRP is a set of demand locations in a metric space and a fleet of k vehicles each of capacity Q. The objective is to locate k depots, one for each vehicle, and compute routes for the vehicles so...... that all demands are satisfied and the total cost is minimized. Our main result is a constant-factor approximation algorithm for k-LocVRP. To achieve this result, we reduce k-LocVRP to the following generalization of k median, which might be of independent interest. Given a metric (V, d), bound k...... median forest, which leads to a (12+E)-approximation algorithm for k-LocVRP, for any constant E > 0. The algorithm for k median forest is t-swap local search, and we prove that it has locality gap 3 + 2 t ; this generalizes the corresponding result for k median [3]. Finally we consider the k median...

  13. Neuroleptic malignant syndrome and serotonin syndrome in a female patient: a clinicopathologic case.

    Science.gov (United States)

    Gómez-Esteban, Juan Carlos; Barcena, Joseba; Forcadas, Maribel; Somme, Johanne; Agundez, Marta; Tijero, Beatriz; Zarranz, Juan J

    2009-01-01

    We report the case of a 24-year-old female patient who initially developed a neuroleptic malignant syndrome after haloperidol exposure and experienced 6 years later a serotonin syndrome after repeated fluoxetine exposure. The patient did not respond to symptomatic treatment and died in this latter episode. At necropsy, no gross or microscopic changes were seen with conventional histological stains, and immunohistochemical stains were negative. This is the first clinicopathologic case of a patient who experienced both neuroleptic malignant and serotonin syndromes. We speculate that this case argue in favor that both syndromes share some fundamental pathogenetic mechanisms.

  14. Neuroleptic malignant syndrome and subsequent clozapine-withdrawal effects in a patient with refractory schizophrenia

    Directory of Open Access Journals (Sweden)

    Cheng MF

    2016-03-01

    Full Text Available Minfeng Cheng,* Huaying Gu,* Liangrong Zheng, Houliang Wang, Zhiyong Zhong, Shenglin Wen Department of Psychiatry, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China *These authors contributed equally to this work Abstract: Here, we report a female patient developing neuroleptic malignant syndrome following the use of a combination of clozapine and haloperidol. Subsequently, the patient presented withdrawal effects after an abrupt discontinuation of clozapine. Psychiatrists not aware of possible clozapine-withdrawal effects may misdiagnose as a part of the primary mental illness or as the initial symptoms worsening, if unrecognized. Keywords: clozapine, neuroleptic malignant syndrome, withdrawal effect, schizophrenia

  15. Neuroleptic Malignant Syndrome Caused by a Combination of Carbamazepine and Amitriptyline

    Directory of Open Access Journals (Sweden)

    A. Bruce Janati

    2012-01-01

    Full Text Available A 32-year-old female, with a history of secondarily-generalized convulsive epilepsy, mental retardation, and a psychiatric illness, developed neuroleptic malignant syndrome while receiving carbamazepine and amitriptyline concurrently. We hypothesize that the addition of amitriptyline to carbamazepine caused a decrease in the serum level of carbamazepine, resulting in NMS. We conclude that combination therapy with carbamazepine and amitriptyline should be avoided in patients who are predisposed to NMS. The purpose of this paper is to warn physicians against combination therapy with carbamazepine and tricyclic antidepressants which may be conducive to neuroleptic malignant syndrome in susceptible patients.

  16. Porcine stress syndrome: an animal model for the neuroleptic malignant syndrome?

    Science.gov (United States)

    Keck, P E; Seeler, D C; Pope, H G; McElroy, S L

    1990-07-01

    The porcine stress syndrome is a genetic disorder of swine which, like neuroleptic malignant syndrome, is characterized by hyperthermia, muscle rigidity, and autonomic dysfunction. We investigated the porcine stress syndrome as a possible animal model for neuroleptic malignant syndrome in two ways. First, we administered haloperidol and lithium carbonate, alone and in combination, to susceptible and resistant swine. Second, we attempted to prevent the syndrome by pretreating animals with bromocriptine. Porcine stress syndrome was induced in 2 of 3 susceptible and 1 of 3 resistant swine by combined treatment with lithium and haloperidol, but was not triggered by treatment with lithium or haloperidol alone. Pretreatment with bromocriptine conferred no protection against the syndrome.

  17. [Sulpiride: the best known atypical, safe neuroleptic drug. Review of literature].

    Science.gov (United States)

    Rzewuska, M

    1998-01-01

    This is a review of literature data on a neuroleptic drug--sulpiride. Sulpiride, a benzamide derivative displays selective affinity for mesolimbic and mesocortical dopamine receptors. For this reason it is classified as an atypical antipsychotic drug. In clinical use, it causes undesirable side effects (particularly extrapyramidal, cholinolytical) less often than classical neuroleptics, does not cause sedation, and has activating and antidepressive properties. These characteristics caused that it is considered a drug of first choice in delusional psychoses with inhibition, depression, lowered activity, intensified negative or deterioration symptoms. The most serious drawback of the drug is the risk of symptoms caused by increased prolactine excretion, and increase in body weight.

  18. Neuroleptic malignant syndrome in an AIDS patient: clinical and pathological findings.

    Science.gov (United States)

    Gabellini, A S; Pezzoli, A; De Massis, P; Casadei, G; Grillo, A; Sacquegna, T

    1994-09-01

    Neuroleptic malignant syndrome (NMS) has been recently described following therapy with non strictly neuroleptic drugs that alter dopaminergic function, such as sulpiride and metoclopramide, and might occur more easily in patients with functional or organic brain disorders. We observed an AIDS patient who suffered from NMS following treatment with clotiapine for insomnia and agitation. Two months later, he presented with a similar syndrome following antiemetic treatment with alizapride. On both occasions, the symptoms completely regressed after the administration of dopaminergic and muscle relaxant drugs. The patient died of pneumonia one month after the last episode. The present paper describes the clinical and pathological findings.

  19. Architecture Study for a Fuel Depot Supplied from Lunar Assets

    Science.gov (United States)

    Perrin, Thomas M.; Casler, James G.

    2016-01-01

    This architecture study sought to determine the optimum architecture for a fuel depot supplied from lunar assets. Four factors - the location of propellant processing (on the Moon or on the depot), the depot location (on the Moon, L1, GEO, or LEO), the propellant transfer location (L1, GEO, or LEO), and the propellant transfer method (bulk fuel or canister exchange) were combined to identify 18 candidate architectures. Two design reference missions (DRMs) - a commercial satellite servicing mission and a Government cargo mission to Mars - created demand for propellants, while a propellant delivery DRM examined supply issues. The study concluded Earth-Moon L1 is the best location for an orbiting depot. For all architectures, propellant boiloff was less than anticipated, and was far overshadowed by delta-v requirements and resulting fuel consumption. Bulk transfer is the most flexible for both the supplier and customer. However, since canister exchange bypasses the transfer of bulk cryogens and necessary chilldown losses, canister exchange shows promise and merits further investigation. Overall, this work indicates propellant consumption and loss is an essential factor in assessing fuel depot architectures.

  20. EPA and Home Depot Offer Tips to Conserve Water, Save Money

    Science.gov (United States)

    (PHILADELPHIA - March 16, 2015) Officials from the U.S. Environmental Protection Agency and The Home Depot kicked off Fix a Leak Week today at The Home Depot store in South Philadelphia by demonstrating several simple, inexpensive improvement

  1. DEPOT: A Database of Environmental Parameters, Organizations and Tools

    Energy Technology Data Exchange (ETDEWEB)

    CARSON,SUSAN D.; HUNTER,REGINA LEE; MALCZYNSKI,LEONARD A.; POHL,PHILLIP I.; QUINTANA,ENRICO; SOUZA,CAROLINE A.; HIGLEY,KATHRYN; MURPHIE,WILLIAM

    2000-12-19

    The Database of Environmental Parameters, Organizations, and Tools (DEPOT) has been developed by the Department of Energy (DOE) as a central warehouse for access to data essential for environmental risk assessment analyses. Initial efforts have concentrated on groundwater and vadose zone transport data and bioaccumulation factors. DEPOT seeks to provide a source of referenced data that, wherever possible, includes the level of uncertainty associated with these parameters. Based on the amount of data available for a particular parameter, uncertainty is expressed as a standard deviation or a distribution function. DEPOT also provides DOE site-specific performance assessment data, pathway-specific transport data, and links to environmental regulations, disposal site waste acceptance criteria, other environmental parameter databases, and environmental risk assessment models.

  2. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    Science.gov (United States)

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  3. Causal ACTH-Depot Therapy during Pregnancies following Infertility Treatment

    Directory of Open Access Journals (Sweden)

    Rudolf Klimek

    2012-01-01

    Full Text Available The aim of this paper was to confirm the efficacy of adrenocorticotropin depot (ACTH-depot therapy in pregnancies with threatened miscarriage and preterm delivery through the desired stimulation of the adrenal glands controlled by the rest of organism. The activity of hypothalamic-pituitary-adrenal axis plays a key role in pregnancy. Such naturally stimulated endogenous corticosteroid hormones are free from unwanted side effects of their synthetics analogs. Low level of maternal blood ACTH and insufficient increase of induced by hypothalamic hormones oxytocinases (cystine-β-aminopeptidases were indication to ACTH-depot therapy (0.5 mg/week in our consecutive prospective studies. Contrary to antenatal use of synthetic corticosteroids, there are no temporal limits of this therapy, which has to be more often recommended into clinical prevention of fetal morbidity, treatment of premature delivery, and finally elimination of the newborn's mortality caused by the neuroendocrinological gestoses.

  4. Hydrotherapy as a possible neuroleptic and sedative treatment.

    Science.gov (United States)

    Shevchuk, Nikolai A

    2008-01-01

    Psychotic symptoms such as delusions and hallucinations can have a devastating effect on a patient's social functioning. Since psychosis is rarely congenital, it is possible that lifestyle factors play a role in its etiology. This paper offers a hypothesis that some of these factors could be: (a) A lifestyle lacking evolutionarily conserved stressors such as frequent exposure to heat and/or cold, resulting in a lack of "thermal exercise" which could lead to malfunctioning of the brain. (b) Partial retention and absorption of toxic waste in the colon, as described in more detail below. (c) Genetic makeup that makes a person vulnerable to the above conditions. To test the hypothesis, three types of hydrotherapy are proposed (to be tested separately) as a putative neuroleptic treatment: head-out hot showers, adapted cold showers (twice daily each), and colon hydrotherapy (every 3-12 weeks, which also includes a dietary change according to Harvard's Healthy Eating Pyramid). The following is supporting evidence: Dopaminergic transmission in the mesolimbic pathway is involved in central processing of pain and negative stimuli (e.g. stress-induced analgesia) in addition to its role in the pathophysiology of psychosis. It is also known that if a neural pathway can perform two different functions, then the execution of one function will often suppress the other (e.g. gate control theory of pain). Thus, a pain-based therapy, such as a moderately hot shower, could have a "crowding out" effect on pathological processes within the mesolimbic system. In addition, hyperthermia is known to induce fatigue and depress activity of the frontal cortex (the sedative effect). As described previously, an adapted cold shower could work as a mild electroshock applied to the sensory cortex and, therefore, it might have an antipsychotic effect similar to that of electroconvulsive therapy. Additionally, a cold shower is a vivid example of stress-induced analgesia and would also be expected to

  5. The neuroleptic malignant syndrome: A report of 14 cases from North India

    Directory of Open Access Journals (Sweden)

    Panagariya A

    2007-01-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare, life-threatening but potentially treatable condition. This study was performed to investigate the clinical spectrum, antecedent events and outcome of NMS patients admitted in the Neurology department of a large teaching hospital of North India. Fourteen cases of NMS were taken after a thorough search during a three-year period (May 2000 to April 2003. The Incidence of NMS was 1.40/ 1000 patients treated with neuroleptics and mortality rate was 14.28%. Amongst the neuroleptics Haloperidol (parenteral was implicated as a most common drug for NMS in 57% of patients. An association with coexisting precipitating illness was clearly recorded in 71.4% patients. All the recorded patients of NMS received 500-700 mg CPZ equivalent/day of neuroleptics. NMS as an indiosyncratic phenomenon was noticed in 28% patients. 85.7% responded to dopaminergic drugs along with supportive treatment and showed partial or complete recovery within 7-14 days. In those with partial recovery residual deficits included Parkinsonian features, depression and diaphoresis in a small percentage of patients.

  6. [Case of neuroleptic malignant syndrome following open heart surgery for thoracic aortic aneurysm with parkinson's disease].

    Science.gov (United States)

    Shinoda, Maiko; Sakamoto, Mik; Shindo, Yuki; Ando, Yumi; Tateda, Takeshi

    2013-12-01

    An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.

  7. Adesão ao tratamento e hospitalizações entre pacientes que realizam aplicações de Flufenazina Depot Adhesión al tratamiento y hospitalización entre pacientes que realizan aplicaciones de Flufenazina Depot Compliance with treatment and hospitalization among patients using Flufenazine Depot

    Directory of Open Access Journals (Sweden)

    José Menna Oliveira

    2003-08-01

    analizados los informes de pacientes incluidos en el régimen depot antes de mayo de 2001 y que realizaron por lo menos una aplicación entre mayo de 2001 y junio de 2002, con respecto a la adhesión al tratamiento y eventuales hospitalizaciones. RESULTADOS: De un total de 100 pacientes, 66 permanecían en régimen depot al final del período estudiado. De estos, 40 (61% respondieron bien al tratamiento, mientras que 26 (39% no respondieron adecuadamente. Hubo un total de 25 pacientes que sufrió hospitalizaciones, de los cuales, la mayoría no estaba en tratamiento a la finalización del estudio o no respondieron bien al tratamiento. Entre los pacientes que procedían del mismo barrio en que se encuentra el hospital, 10 (67% respondieron bien al tratamiento, mientras que 30 pacientes (59% procedentes de otros barrios no respondieron bien al tratamiento. DISCUSIÓN: El número de hospitalizaciones varió visiblemente de acuerdo con la permanencia o no en tratamiento y la respuesta al mismo. Pacientes provenientes de barrios distantes del hospital tendieron a presentar peor adhesión al tratamiento. CONCLUSIONES: Es posible que pacientes en régimen de aplicación depot residentes en las cercanías al local de aplicación se beneficien mas del tratamiento que aquellos residentes en locales distantes. Son necesarios mas estudios comparando administraciones depot con VO en términos de adhesión e investigando factores predecibles de buena respuesta al tratamiento.OBJECTIVES: The authors review literature on depot medication and present data referring to compliance with treatment and hospitalizations of patients who are medicated with flufenazine enantate as outpatients at Hospital Espírita de Pelotas. Methods: The patients in the study were included in the depot regime before May 2001 and had at least one application between May 2001 and June 2002. They were analyzed for the variables compliance with treatment and possible hospitalizations RESULTS: Out of a total of 100

  8. NASA Shuttle Logistics Depot (NSLD) - The application of ATE

    Science.gov (United States)

    Simpkins, Lorenz G.; Jenkins, Henry C.; Mauceri, A. Jack

    1990-01-01

    The concept of the NASA Shuttle Logistics Depot (NSLD) developed for the Space Shuttle Orbiter Program is described. The function of the NSLD at Cape Canaveral is to perform the acceptance and diagnostic testing of the Shuttle's space-rated line-replaceable units and shop-replaceable units (SRUs). The NSLD includes a comprehensive electronic automatic test station, program development stations, and assorted manufacturing support equipment (including thermal and vibration test equipment, special test equipment, and a card SRU test system). The depot activities also include the establishment of the functions for manufacturing of mechanical parts, soldering, welding, painting, clean room operation, procurement, and subcontract management.

  9. Guidelines for establishing a donor human milk depot.

    Science.gov (United States)

    Geraghty, Sheela R; List, Betsy A; Morrow, Georgia B

    2010-02-01

    Human milk is the preferred choice for infant feeding. When a sick or premature infant's own mother's milk is unavailable, donor human milk is becoming more widely used. Many potential milk donors do not live within close proximity to the 10 North American not-for-profit milk banks. Transporting milk via commercial carriers can be inconvenient and costly for recipient banks. A network of donor human milk depots is one practical way to increase the quantity of available donor human milk. This article provides guidelines and practical suggestions for establishing a donor human milk depot.

  10. Electroconvulsive therapy in drug resistant neuroleptic malignant syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Yousefi A

    2010-02-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Neuroleptic malignant syndrome is an idiosyncratic and potentially fatal reaction to neuroleptic drugs and is characterized by fever, muscular rigidity, altered mental status, autonomic dysfunction, elevated serum CPK and leucocytosis Neuroleptic malignant syndrome is treated with dantrolene, bromocriptin, amantadin and electroconvulsive therapy."n"nCase: A 22 years old, schizophrenic female was refered to the Emergency ward of Roozbeh hospital in Tehran, Iran in December 2008 with aggression, impulsivity, and reduced sleep. After injection of haloperidol, the patient developed a high grade fever, diaphoresis and muscular stiffness. She was diagnosed as neuroleptic malignant syndrome and the treatment with dantrolen, bromocriptin and amantadin initiated. Although fever subsided, other signs continued, therefore we applied electroconvulsive therapy to this case."n"nConclusion: Due to excellent response of the patient to electroconvulsive therapy and the rare reports of electroconvulsive therapy in neuroleptic malignant syndrome in the Iranian population, this case may lead to develop studies for further investigations of this issue.

  11. Depo-Provera (depot medroxyprogesterone acetate use after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lam C

    2016-09-01

    Full Text Available Clarissa Lam,1 Amitasrigowri S Murthy2,3 1New York University School of Medicine, 2Department of Obstetrics and Gynecology, Bellevue Hospital Center, New York University School of Medicine, 3New York University Langone Medical Center, New York, NY, USA Abstract: In the US, obesity rates are increasing greatly. The Centers for Disease Control and Prevention estimates that 68.5% of Americans, including 63.9% of adult women older than 20 years, are overweight (body mass index between 25 kg/m2 and 29.9 kg/m2 or obese (body mass index >30 kg/m2. In light of this, it is not surprising that the rates of bariatric surgery have also been increasing. When considering the metabolic changes associated with both bariatric surgery and contraceptive use, in combination with the unique medical considerations of obese women, it is indisputable that clear guidelines are needed when counseling obese patients of reproductive age after bariatric surgery. In this literature review, we focus on depot medroxyprogesterone acetate (DMPA and the implications of its use in obese women, preweight and postweight loss following bariatric surgery. Both DMPA use and bariatric surgery are known to cause bone loss, but it is still unclear whether there is an additive effect of the two factors on bone loss and whether either of these factors directly leads to an increased risk of bone fracture. The current consensus guidelines do not impose a restriction on the use of DMPA after bariatric surgery. DMPA use is associated with weight gain, and it is unclear whether weight loss blunting occurs with the use of DMPA after bariatric surgery. Prior studies had demonstrated an association with weight gain in adolescents, and therefore, those prescribing DMPA use after bariatric surgery in adolescents should proceed with caution. Adult women do not have a similar response to the use of DMPA. DMPA use has rarely been associated with increased risk of venous thromboembolism (VTE. The

  12. Computer-aided acquisition and logistics support (CALS): Concept of Operations for Depot Maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Bourgeois, N.C.; Greer, D.K.

    1993-04-01

    This CALS Concept of Operations for Depot Maintenance provides the foundation strategy and the near term tactical plan for CALS implementation in the depot maintenance environment. The user requirements enumerated and the overarching architecture outlined serve as the primary framework for implementation planning. The seamless integration of depot maintenance business processes and supporting information systems with the emerging global CALS environment will be critical to the efficient realization of depot user's information requirements, and as, such will be a fundamental theme in depot implementations.

  13. Technology requirements for an orbiting fuel depot: A necessary element of a space infrastructure

    Science.gov (United States)

    Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

    1988-01-01

    Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect on criticality ratings. Over 70 depot-related technology areas are addressed.

  14. Technology requirements for an orbiting fuel depot - A necessary element of a space infrastructure

    Science.gov (United States)

    Stubbs, R. M.; Corban, R. R.; Willoughby, A. J.

    1988-01-01

    Advanced planning within NASA has identified several bold space exploration initiatives. The successful implementation of these missions will require a supporting space infrastructure which would include a fuel depot, an orbiting facility to store, transfer and process large quantities of cryogenic fluids. In order to adequately plan the technology development programs required to enable the construction and operation of a fuel depot, a multidisciplinary workshop was convened to assess critical technologies and their state of maturity. Since technology requirements depend strongly on the depot design assumptions, several depot concepts are presented with their effect of criticality ratings. Over 70 depot-related technology areas are addressed.

  15. Locoregional cancer therapy using polymer-based drug depots

    NARCIS (Netherlands)

    Ramazani, Farshad; van Nostrum, Cornelis F.; Storm, G; Kiessling, Fabian; Lammers, Twan; Hennink, Wim E.; Kok, Robbert J.

    2016-01-01

    Locoregional delivery of anticancer drugs is an attractive approach to minimize adverse effects associated with intravenous chemotherapy. Polymer-based drug depots injected or implanted intratumorally or adjacent to the tumor can provide long-term local drug exposure. This review highlights studies

  16. Radiological Scoping Survey of the Scotia Depot Scotia, New York

    Energy Technology Data Exchange (ETDEWEB)

    E. N. Bailey

    2005-02-05

    At the request of the Defense Logistics Agency, the Oak Ridge Institute for Science and Education conducted radiological scoping surveys of the Scotia Depot during the period of September 24 through 27, 2007. The scoping survey included visual inspections and limited radiological surveys performed in accordance with area classification that included surface scans, total and removable activity measurements, and soil sampling.

  17. Total Quality Management Implementation Plan Defense Depot Memphis

    Science.gov (United States)

    1989-07-01

    Total Quality Management Implementation...improvement goals, implementation strategy and milestones. 6’ SEP 291989 /; ELECTE i= E 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM ( Total Quality Management ), Depot...changing work environment where change is the norm. We are talking about changes in attitudes and habits. Total Quality Management is not a

  18. Locoregional cancer therapy using polymer-based drug depots

    NARCIS (Netherlands)

    Ramazani, Farshad; van Nostrum, Cornelis F.; Storm, G; Kiessling, Fabian; Lammers, Twan; Hennink, Wim E.; Kok, Robbert J.

    2016-01-01

    Locoregional delivery of anticancer drugs is an attractive approach to minimize adverse effects associated with intravenous chemotherapy. Polymer-based drug depots injected or implanted intratumorally or adjacent to the tumor can provide long-term local drug exposure. This review highlights studies

  19. Fatty acid composition of subcutaneous and kidney fat depots of ...

    African Journals Online (AJOL)

    which had been kept for 90 days on one of five different diets. The diets were ..... A comparison of the fatty acid content of fat depots in the Boer goat as reported ... owing to the influencethat nutrition, notably the carbohydrate source, has on the ...

  20. Redistributing Stock in Library Systems with a Depot

    NARCIS (Netherlands)

    van der Heide, Gerlach; Roodbergen, Kees Jan; van Foreest, Nicky

    Public library organizations often utilize depots for carrying out shipments to libraries in case of stock-outs and for storing low demand rental items at low cost. Similar systems may be employed by rental companies for other rental products such as tools, DVDs, and jewelry. Since shipments deplete

  1. Orbiting Depot and Reusable Lander for Lunar Transportation

    Science.gov (United States)

    Petro, Andrew

    2009-01-01

    A document describes a conceptual transportation system that would support exploratory visits by humans to locations dispersed across the surface of the Moon and provide transport of humans and cargo to sustain one or more permanent Lunar outpost. The system architecture reflects requirements to (1) minimize the amount of vehicle hardware that must be expended while maintaining high performance margins and (2) take advantage of emerging capabilities to produce propellants on the Moon while also enabling efficient operation using propellants transported from Earth. The system would include reusable single- stage lander spacecraft and a depot in a low orbit around the Moon. Each lander would have descent, landing, and ascent capabilities. A crew-taxi version of the lander would carry a pressurized crew module; a cargo version could carry a variety of cargo containers. The depot would serve as a facility for storage and for refueling with propellants delivered from Earth or propellants produced on the Moon. The depot could receive propellants and cargo sent from Earth on a variety of spacecraft. The depot could provide power and orbit maintenance for crew vehicles from Earth and could serve as a safe haven for lunar crews pending transport back to Earth.

  2. Oral and depot progestin therapy for endometriosis: towards a personalized medicine.

    Science.gov (United States)

    Buggio, Laura; Somigliana, Edgardo; Barbara, Giussy; Frattaruolo, Maria Pina; Vercellini, Paolo

    2017-09-24

    Endometriosis is an estrogen-dependent chronic inflammatory disorder that requires a life-long management plan. Long-term adherence to treatment is pivotal to ensure an effective clinical management. In this optic, one of the cornerstone of endometriosis medical treatment is represented by progestins. Areas covered: This narrative review examines the clinical efficacy, safety and tolerability of oral and depot progestins used in the treatment of endometriosis. The material included in the current manuscript was obtained with a MEDLINE search through PubMed from inception until February 2017. Expert opinion: Progestins are effective in controlling pain symptoms in the majority of women with endometriosis, and their effect seems not inferior to that achieved with other compounds used to treat the disease, such as gonadotropin-releasing hormone agonist. Available progestins include a broad range of both oral and depot compounds, and represent, in most cases, an inexpensive treatment option. In addition, progestins do not increase significantly thrombotic risk and could be adopted in those women with metabolic or cardiovascular contraindication to estrogen-progestins. The choice between the different available compounds should be tailored for every woman with preference to the most cost-effective treatment, depending on the most complained symptom and disease location.

  3. Naltrexone depot formulations for opioid and alcohol dependence: a systematic review.

    Science.gov (United States)

    Lobmaier, Philipp P; Kunøe, Nikolaj; Gossop, Michael; Waal, Helge

    2011-12-01

    Naltrexone is an opioid receptor antagonist that blocks the reinforcing effects of opioids and reduces alcohol consumption and craving. It has no abuse potential, mild and transient side effects, and thus appears an ideal pharmacotherapy for opioid dependence. Its effectiveness in alcohol dependence is less evident, but compliance with naltrexone combined with psychosocial support has been repeatedly shown to improve drinking outcomes. Limited compliance with oral naltrexone treatment is a known drawback. Several naltrexone implant and injectable depot formulations are being investigated and provide naltrexone release for at least 1 month. Studies among opioid-dependent patients indicate significant reductions in heroin use, but sample sizes are usually small. In alcohol dependence, two large multicenter trials report alcohol and craving reductions for naltrexone and placebo groups, indicating a significant but moderate effect. The pharmacokinetic profile of the injectable formulation indicates reliable naltrexone release over 1 month at therapeutic levels. Implant formulations releasing naltrexone up to 7 months are reported. Findings on safety and tolerability confirm the generally mild adverse effects described for naltrexone tablets. However, further research on therapeutic levels (i.e., opioid blocking) is warranted. The majority of naltrexone implants lacks approval for regular clinical use and larger longitudinal studies are needed. The available naltrexone depot formulations have the potential to significantly improve medication compliance in opioid and alcohol dependence. In certain circumstances, they may constitute a promising new treatment option. © 2010 Blackwell Publishing Ltd.

  4. Behavioural interactions between 5-hydroxytryptophan, neuroleptic agents and 5-HT receptor antagonists in modifying rodent responding to aversive situations.

    OpenAIRE

    1995-01-01

    1. The ability of 5-hydroxytryptophan, 5-HT2 receptor antagonists and typical and atypical neuroleptic agents to modify behavioural responding to aversive situations was investigated in the mouse light/dark test and rat social interaction. 2. The administration of 5-hydroxytryptophan inhibited rat social interaction and the exploratory behaviour of mice in the light/dark test. 3. The 5-HT2 receptor antagonists, ketanserin, ritanserin, MDL11939, methysergide and RP62203, the neuroleptic agents...

  5. Homeostatic imbalance of purine catabolism in first-episode neuroleptic-naive patients with schizophrenia.

    Directory of Open Access Journals (Sweden)

    Jeffrey K Yao

    Full Text Available BACKGROUND: Purine catabolism may be an unappreciated, but important component of the homeostatic response of mitochondria to oxidant stress. Accumulating evidence suggests a pivotal role of oxidative stress in schizophrenia pathology. METHODOLOGY/PRINCIPAL FINDINGS: Using high-pressure liquid chromatography coupled with a coulometric multi-electrode array system, we compared 6 purine metabolites simultaneously in plasma between first-episode neuroleptic-naïve patients with schizophrenia (FENNS, n = 25 and healthy controls (HC, n = 30, as well as between FENNS at baseline (BL and 4 weeks (4w after antipsychotic treatment. Significantly higher levels of xanthosine (Xant and lower levels of guanine (G were seen in both patient groups compared to HC subjects. Moreover, the ratios of G/guanosine (Gr, uric acid (UA/Gr, and UA/Xant were significantly lower, whereas the ratio of Xant/G was significantly higher in FENNS-BL than in HC. Such changes remained in FENNS-4w with exception that the ratio of UA/Gr was normalized. All 3 groups had significant correlations between G and UA, and Xan and hypoxanthine (Hx. By contrast, correlations of UA with each of Xan and Hx, and the correlation of Xan with Gr were all quite significant for the HC but not for the FENNS. Finally, correlations of Gr with each of UA and G were significant for both HC and FENNS-BL but not for the FENNS-4w. CONCLUSIONS/SIGNIFICANCE: During purine catabolism, both conversions of Gr to G and of Xant to Xan are reversible. Decreased ratios of product to precursor suggested a shift favorable to Xant production from Xan, resulting in decreased UA levels in the FENNS. Specifically, the reduced UA/Gr ratio was nearly normalized after 4 weeks of antipsychotic treatment. In addition, there are tightly correlated precursor and product relationships within purine pathways; although some of these correlations persist across disease or medication status, others appear to be lost among FENNS

  6. Neuroleptic Malignant Syndrome in a Patient with Tongue Cancer: A Report of a Rare Case

    Directory of Open Access Journals (Sweden)

    Osamu Baba

    2013-01-01

    Full Text Available Background. Neuroleptic malignant syndrome (NMS is a rare but life-threatening complication of neuroleptic drugs, which are used widely in head and neck cancer (HANC patients who develop delirium. Methods and Results. Postoperative delirium in a 39-year-old man with tongue cancer was treated with haloperidol and chlorpromazine. Three days after the first administration of antipsychotics, the patient exhibited elevated body temperature, autonomic and extrapyramidal symptoms, and impaired consciousness. A definitive diagnosis was made using the research diagnostic criteria for NMS in the DSM-IV, and the antipsychotics were immediately discontinued. The patient was given dantrolene and bromocriptine to treat the NMS. The patient’s hyperthermia, elevated creatinin kinase (CK, and muscle rigidity improved gradually, with all symptoms of NMS resolving completely by 13 days after the diagnosis. Conclusions. HANC surgeons must be alert for early signs of NMS and use antipsychotics conservatively to avoid NMS and its potentially fatal outcome.

  7. Neurotoxic syndrome induced by clomipramine plus risperidone in a patient with autistic spectrum disorder: serotonin or neuroleptic malignant syndrome?

    Science.gov (United States)

    Nikolaou, Kalliopi N; Gournellis, Rossetos; Michopoulos, Ioannis; Dervenoulas, Georgios; Christodoulou, Christos; Douzenis, Athanasios

    2015-01-01

    To the best of our knowledge, there are no case studies of serotonin syndrome (SS) in patients with autism spectrum disorder. We report the case of a 33-year-old male who presented SS under the combined use of clomipramine and risperidone. More specifically, within 2 days after clomipramine (10 mg/BID-two times a day) was added to risperidone (4 mg/OD-once a day), mirtazapine 45 mg/OD and alprazolam (0,5 mg/TID-three times a day) he began to present mental, neurological and autonomic symptoms. All his psychopathological manifestations and laboratory findings normalized after the above-mentioned drugs' discontinuation, and the administration of supportive medical care and lorazepam 2,5 mg/TID. The diagnosis of serotonin syndrome was challenging due to the relatively low dose of clomipramine, an increase of risperidone which had taken place before clomipramine administration and clinical symptoms which could be attributed to both serotonin and neuroleptic malignant syndrome.

  8. Development of neuroleptic agents: pharmacogenetics and current safety issues of regulatory concern.

    Science.gov (United States)

    Shah, Rashmi

    2002-12-01

    The development of safe and effective new drug treatments for schizophrenia poses a challenging task. This class of drugs is known to be associated with a wide range of serious and troublesome safety problems that include neurological, cardiac, endocrine, and metabolic side effects. Many of these drugs have a narrow therapeutic index and generate metabolites that often have their own unique pharmacological profile different from the parent compound. These features make it imperative that the optimal dose schedules for neuroleptic drugs are carefully characterized. Many of these drugs are metabolized by cytochrome P450 enzymes, which show genetic polymorphism and a bi modal distribution within the population, A significant subset of the population cannot eliminate these drugs as effectively as the majority. This brings an added dimension of complexity in characterizing the dose and individualizing therapy. Many neuroleptic agents are proarrhythmic with an adverse effect on cardiac repolarization. They are prone to prolonging the QT interval and inducing torsade de pointes. Given the potentially fatal outcome of this ventricular tachyarrhythmia, drug development programs need to ensure that the proarrhythmic potential of any new neuroleptic agent is thoroughly explored and its proarrhythmic risk characterized. The clinical use of many of these drugs is further troubled by their high potential for drug-drug interactions. These too need to be adequately investigated during development The approval and the labeling of a new neuroleptic agent require a careful regulatory assessment of its risk/benefit ratio in comparison with the available alternatives. Their safe and effective use in routine clinical practice depends on careful attention to prescribing information, especially the contraindications, precautions, and patient-monitoring requirements.

  9. Death due to fulminant neuroleptic malignant syndrome induced by low doses of haloperidol: a rare case.

    Science.gov (United States)

    Zou, Donghua; Shao, Yu; Qin, Zhiqiang; Zhang, Jianhua; Liu, Ningguo; Li, Zhengdong; Huang, Ping; Chen, Yijiu

    2014-05-01

    The paper reports on a rare case of fulminant neuroleptic malignant syndrome (NMS) with several risk factors, typical manifestation and rapid death induced by low doses of haloperidol. The pathological findings, pathogenesis, clinical manifestations, diagnostic criteria, risk factors and other features of NMS are discussed. The importance of forensic pathologists being aware of the possibility of NMS as the cause of death in people taking antipsychotic drugs is stressed.

  10. Effects of neuroleptics administration on adult neurogenesis in the rat hypothalamus.

    Science.gov (United States)

    Rojczyk, Ewa; Pałasz, Artur; Wiaderkiewicz, Ryszard

    2015-12-01

    Among many factors influencing adult neurogenesis, pharmacological modulation has been broadly studied. It is proven that neuroleptics positively affect new neuron formation in canonical neurogenic sites - subgranular zone of the hippocampal dentate gyrus and subventricular zone of the lateral ventricles. Latest findings suggest that adult neurogenesis also occurs in several additional regions like the hypothalamus, amygdala, neocortex and striatum. As the hypothalamus is considered an important target of neuroleptics, a hypothesis can be made that these substances are able to modulate local neural proliferation. Experiments were performed on adult male rats injected for 28 days or 1 day by three neuroleptics: olanzapine, chlorpromazine and haloperidol. Immunohistochemistry was used to determine expression of proliferation marker (Ki-67) and the marker of neuroblasts - doublecortin (DCX) - which may inform about drug influence on adult neurogenesis at the level of the hypothalamus. It was shown that a single injection of antipsychotics causes significant decrease in hypothalamic DCX expression, but after chronic treatment with chlorpromazine, but not olanzapine, there is an increase in the number of newly formed neuroblasts. Haloperidol has the opposite effect - its long-term administration decreases the number of DCX-positive cells. Cell proliferation levels (Ki-67 expression) increase after long-term drug administration, whereas their single doses do not have any modulatory effect on proliferation potential. Our results throw a new light on the neuroleptics mechanism of action. They also support the potential role of antipsychotics as a factor that can modulate hypothalamic neurogenesis with putative clinical applications. Copyright © 2015 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  11. [Clinical-chemical studies in schizophrenic out-patients under neuroleptic long-term treatment with particular consideration of the hepatic metabolism (author's transl)].

    Science.gov (United States)

    Gonçalves, N; Grüneberg, F

    1977-01-01

    A series of clinical-chemical tests was conducted in 68 schizophrenic out-patients under long-term neuroleptic medication, with particular consideration of the hepatic metabolism, i.e.: Erythrocyte sedimentation rate, alpha 1-glycoprotein, ceruloplasmin, fibrinogen, GPT, GOT, gamma-GT, total protein and serum-protein-electrophoresis. Furthermore, the glucose tolerance tests was carried out. In 44% of the patients an increased erythrocyte sedimentation rate and positive correlations with increased fibrinogen values were found. Increased gamma-GT-values were proven in 33% of the patients; they correlated positively with the increased GPT-and/or GOT-values as well as with pathological glucose tolerance values. Overweight of more than 10 kilos was found in 46% of the patients. A significant correlation between overweight and pathological glucose tolerance values existed. The results were interpreted as consequence of a light fatty liver.

  12. Pargyline reduces/prevents neuroleptic-induced acute dystonia in monkeys.

    Science.gov (United States)

    Heintz, R; Casey, D E

    1987-01-01

    The neuropharmacologic mechanisms underlying neuroleptic-induced extrapyramidal syndromes (EPS) were studied using a nonhuman primate model. Twenty-six Cebus albifrons monkeys were given weekly challenges of haloperidol (0.025 mg/kg IM), and half of the animals received the monoamine oxidase (MAO) inhibitor pargyline (5 mg/kg PO) daily for 17 consecutive days during the protocol. Pargyline caused no changes in baseline behaviors, but significantly reduced haloperidol-induced acute dystonia (AD) (-67%, P less than 0.002) and parkinsonism (-56%, P less than 0.005). The majority (8 of 13) of the experimental group had complete prevention of neuroleptic-induced EPS during cotreatment with pargyline. Behavioral scores returned to baseline levels after stopping pargyline, and did not show the further sensitization to haloperidol-induced AD that occurred in the control group. The possible mechanisms by which an MAO inhibitor might influence neuroleptic-induced AD were considered. The most likely explanation would appear to involve facilitation of striatal dopamine (DA) neurotransmission by inhibition of intra- and extraneuronal MAO, thus supporting the hypothesis that AD is due to decreased striatal DA function with secondary cholinergic hyperfunction.

  13. Neuroleptic-induced movement disorders in a naturalistic schizophrenia population: diagnostic value of actometric movement patterns

    Directory of Open Access Journals (Sweden)

    Tuisku Katinka

    2008-04-01

    Full Text Available Abstract Background Neuroleptic-induced movement disorders (NIMDs have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry. Methods A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV. Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD. Results The patterns of neuroleptic-induced akathisia (NIA and pseudoakathisia (PsA were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia. Conclusion The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.

  14. The common marmoset (Callithrix jacchus) as a model for neuroleptic-induced acute dystonia.

    Science.gov (United States)

    Fukuoka, T; Nakano, M; Kohda, A; Okuno, Y; Matsuo, M

    1997-12-01

    To examine whether acute dystonia is induced by neuroleptic treatment, common marmosets were treated with haloperidol orally twice a week over 25 weeks until dystonic behavior was elicited. Movement disorders such as acute dystonia were observed 6 weeks after the initial treatment, and had appeared in all treated animals by 25 weeks. Once these movement disorders were induced, they consistently reappeared after further treatment with haloperidol, and once haloperidol dosing was discontinued, the episodes vanished. Then, various neuroleptic drugs (bromperidol, chlorpromazine, risperidone thioridazine, sulpiride, tiapride, and clozapine) or a nonneuroleptic drug (diazepam) were administered orally instead of haloperidol in the above animals. All the neuroleptic drugs except for clozapine elicited similar abnormal behavior, while diazepam failed to induce any dystonia. An anticholinergic drug, trihexyphenidyl, which is known to reduce acute dystonia in patients, was also given orally to the above haloperidol-sensitized animals, followed by further treatment with haloperidol 30 min later. This clearly suppressed the induction of dystonia by haloperidol. The similarity between these findings for haloperidol-pretreated common marmosets and clinical findings suggests that the present model is useful for predicting the potential of antipsychotics to induce acute dystonia in humans.

  15. [Catatonia and neuroleptic malignant syndrome in view of a psychopathological and pathophysiological overlap: a brief review].

    Science.gov (United States)

    Asztalos, Zoltán; Egervári, Luca; Andrássy, Gábor; Faludi, Gábor; Frecska, Ede

    2014-03-01

    Catatonia was first described in the 19th century as a syndrome with motor, affective and behavioral symptoms. During the 20th century it was rather regarded as a rare motoric manifestation of schizophrenia and that classification has almost resulted in the disappearance of catatonia among patients outside of the schizophrenia spectrum. With the introduction of neuroleptics, the incidence of catatonic schizophrenia also declined which was attributed to effective treatment. Simultaneously, neuroleptic malignant syndrome was described, which shows many similarities with catatonia. Recently, several researchers suggested a common origin of the two disorders. In this paper we review case reports of the last five years, in which both neuroleptic malignant syndrome and catatonia had emerged as a diagnosis. Additionally, based on the relevant literature, we propose a common hypothetical pathomechanism with therapeutic implications for the two syndromes. Besides underlining the difficulties of differential diagnosis, the reviewed cases demonstrate a transition between the two illnesses. The similarities and the possible shifts may suggest a neuropathological and pathophysiological overlap in the background of the two syndromes. Electroconvulsive therapy and benzodiazepines seem to be an effective treatment in both syndromes. These two treatment approaches can be highly valuable in clinical practice, especially if one considers the difficulties of differential diagnosis.

  16. [The initial dysphoric reaction (IDR) to the first dose of neuroleptics].

    Science.gov (United States)

    Schimmelmann, B Graf; Schacht, M; Perro, C; Lambert, M

    2004-01-01

    Initial dysphoric response (IDR) is characterized by a negative affective reaction within 48 h after a neuroleptic test dose. Currently, there are three scales for measuring the IDR (Neuroleptic Dysphoria Scale, Dysphoric Response Index, Drug Attitude Inventory). The debate continues about the definition, measurement, and underlying aetiology of IDR. Nevertheless, with a prevalence of 30%, the response is a clinically relevant phenomenon. Empirical data give some evidence of an association between IDR and short-term outcome. No correlation of IDR with pretreatment variables has been found yet (e.g. age, gender, and psychopathology at baseline, especially depression and hostility). With respect to aetiology, a negative subjective reaction to concurrent extrapyramidal side effects and direct dysaffective effects of some neuroleptics have been discussed. Other studies found that IDR might not be a specifically antipsychotic effect. Our first results give some evidence that patients treated with atypical antipsychotics experience IDR less often and less severely than those treated with conventional antipsychotics described in the literature. Further research should include placebo-controlled studies and the evaluation of specific pretreatment variables. To assess the aetiology of IDR, further basic research is needed.

  17. Inflammatory characteristics of distinct abdominal adipose tissue depots relate differently to metabolic risk factors for cardiovascular disease Distinct fat depots and vascular risk factors

    NARCIS (Netherlands)

    Kranendonk, Mariette E. G.; van Herwaarden, Joost A.; Stupkova, Tereza; de Jager, Wilco; Vink, Aryan; Moll, Frans L.; Kalkhoven, Eric; Visseren, Frank L. J.

    2015-01-01

    Objective: Abdominal obesity is associated with insulin resistance and metabolic syndrome. However, specific contributions of distinct adipose tissue (AT) depots to metabolic complications of obesity are still unclear. In this study, the inflammatory profile of four distinct abdominal AT-depots and

  18. Master Environmental Plan: Fort Wingate Depot Activity, Gallup, New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Biang, C.A.; Yuen, C.R.; Biang, R.P.; Antonopoulos, A.A.; Ditmars, J.D.

    1990-12-01

    The master environmental plan is based on an environmental assessment of the areas requiring environmental evaluation (AREEs) at Fort Wingate Depot Activity near Gallup, New Mexico. The Fort Wingate Depot Activity is slated for closure under the Base Closure and Realignment Act, Public Law 100--526. The MEP assesses the current status, describes additional data requirements, recommends actions for the sites, and establishes a priority order for actions. The plan was developed so that actions comply with hazardous waste and water quality regulations of the State of New Mexico and applicable federal regulations. It contains a brief history of the site, relevant geological and hydrological information, and a description of the current status for each AREE along with a discussion of the available site-specific data that pertain to existing or potential contamination and the impact on the environment. 35 refs., 27 figs., 23 tabs.

  19. [Treatment of Adult Schizophrenic Patients With Depot Antipsychotics].

    Science.gov (United States)

    Jaramillo González, Luis Eduardo; Gómez Restrepo, Carlos; García Valencia, Jenny; de la Hoz Bradford, Ana María; Ávila-Guerra, Mauricio; Bohórquez Peñaranda, Adriana

    2014-01-01

    To determine the indications of long-acting antipsychotic injection and what its effectiveness and safety in adult patients with schizophrenia during the treatment maintenance phase. A clinical practice guideline was elaborated under the parameters of the Methodological Guide of the Ministerio de Salud y Protección Social to identify, synthesize and evaluate the evidence and make recommendations about the treatment and follow-up of adult patients with schizophrenia. The evidence of NICE guide 82 was adopted and updated. The evidence was presented to the Guideline Developing Group and recommendations, employing the GRADE system, were produced. The literature review shows that the evidence has moderate to low quality. 8 articles were used. The risk of relapse was lower with depot risperidone and paliperidone palmitate when compared with placebo. For the risk of hospitalizations comparing depot antipsychotics (APD) versus oral AP, the result is inconclusive. Globally the second-generation APD had a lower risk of discontinuation when compared with placebo. The second generation AP had higher risk of extrapyramidal syndromes than placebo, as in the use of antiparkinsonian. The comparison of second-generation AP injections versus placebo showed an increased risk of early weight gain. The use of depot antipsychotics in the maintenance phase of adult patients diagnosed with schizophrenia is recommended if there is no adherence to oral antipsychotics as the patient's preference. It is not recommended depot antipsychotics in the acute phase of schizophrenia in adults. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  20. Buserelin-depot in the treatment of prostate cancer

    Directory of Open Access Journals (Sweden)

    G. P. Kolesnikov

    2015-01-01

    Full Text Available The high incidence of prostate cancer (PC and the considerably wide use of hormone therapy for its treatment as an individual modalityfor its advanced forms (Т3–Т4, N1, M1, recurrences, and progression after local treatments (radical prostatectomy, radiation therapy and for combined treatment as neoadjuvant and adjuvant therapies determine the importance of a sufficient range of hormonal drugs at an urologic oncologist’s disposal. Among the luteinizing hormone-releasing hormone (LHRH agonists, there is rather long-known Buserelin made in Russia, the clinical efficacy of which is highly competitive with foreign analogs. The paper presents the results of a 3-month trial of the efficiency and safety of Buserelin depot treatment in 20 patients aged 53 to 87 years with morphologically verified PC. The patients with PC showed a gradual decrease in the mean values of prostate-specific antigen (PCA from81.2 to 27.8 and 23.0 ng / ml at 2 and 3 months of Buserelin depot therapy, respectively. The performed therapy could achieve reductions in testosterone levels from 168 ng / dl at baseline to 21 and 19.8 ng / dl postcastration at 1 and 3 months of the therapy.All the patients tolerated Buserelin depot therapy without having clinically significant adverse reactions. The most common complaints were hyperhidrosis and hot flushes, which are typical of all LHRH agonists and which are not marked in the treatment with other drugs of this group.Conclusion. Buserelin depot 3.75 mg is a highly effective Russian drug to treat hormone-dependent PC. Its administration causes a reduction in PSA levels and ensures a steady decline in serum testosterone concentrations to the postcastration level without causing serious side effects. The findings do not differ from those when foreign LHRH analogues are used.

  1. An Organizational Analysis of Marine Corps Recruit Depot, San Diego

    Science.gov (United States)

    2003-03-01

    generations, e.g., Gen-X and millennials . e. Process/Subsystems This design factor addresses: 1. Financial Management, Measurement and Controls...As the RTR CO says, “the beauty of this place is just basic Marine Corps leadership. MOS regardless.”70 More specifically, it’s “leadership...The fact that we can question what we are doing is beautiful .”74 He has begun a planning culture within Depot staff offices. Such thinking in

  2. Occupational Exposure of Petroleum Depot Workers to BTEX Compounds

    Directory of Open Access Journals (Sweden)

    M Rezazadeh Azari

    2011-12-01

    Full Text Available Background: Benzene, toluene, ethylbenzene and xylene (BTEX are the most important toxic volatile compounds in the air and could be easily absorbed through the respiratory tract. In recent years, the risk of exposure to BTEX compounds, especially benzene as a carcinogen, has been considered in petroleum depot stations. Objective: To assess the occupational exposure of petroleum depot workers in Iran to BTEX compounds. Methods: After completing a questionnaire and assessing occupational exposure to BTEX compounds, 78 (46 exposed and 32 non-exposed depot workers were randomly selected to participate in this study. Air sampling and analysis of BTEX was conducted according to the NIOSH method No. 1501. Analysis of urinary hippuric acid, as an indicator of toluene exposure, was carried out according to NIOSH method No. 8300. Personal monitoring of the high exposure group to BTEX compounds was repeated to verify the results obtained in the first phase of the monitoring. Results: Among the 9 operating groups studied, occupational exposure to benzene and toluene was higher in quality control and gasoline loading operators—the median exposure ranged from 0.16 to 1.63 ppm for benzene and 0.2 to 2.72 ppm for toluene. Median exposure of other group members to BTEX compounds was below the detection limit of analytical method (0.07, 0.06, 0.05, and 0.05 ppm, respectively. The level of toluene exposure measured showed correlation with neither post-shift urinary hippuric acid (Spearman's rho=0.128, p=0.982 nor with the difference between post- and pre-shift urinary hippuric acid (Spearman's rho=0.089, p=0.847 in depot operational workers. Conclusion: Gasoline loading operators are exposed to a relatively high level of benzene.

  3. The Home Depot Upgrades its Corporate Building Prototype

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2013-03-01

    The Home Depot partnered with the Department of Energy (DOE) to develop and implement solutions to build new, low-energy buildings that are at least 50% below Standard 90.1-2007 of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), the American National Standards Institute (ANSI), and the Illuminating Engineering Society of North America (IESNA) as part of DOE’s Commercial Building Partnerships (CBP) Program.

  4. Lanreotide Depot: An Antineoplastic Treatment of Carcinoid or Neuroendocrine Tumors

    OpenAIRE

    Wolin, Edward M.; Manon, Amandine; Chassaing, Christophe; Lewis, Andy; Bertocchi, Laurent; Richard,Joel; Phan,Alexandria T

    2016-01-01

    Purpose Peptide drugs for antineoplastic therapies usually have low oral bioavailability and short in vivo half-lives, requiring less preferred delivery methods. Lanreotide depot is a sustained-release somatostatin analog (SSA) formulation produced via an innovative peptide self-assembly method. Lanreotide is approved in the USA and Europe to improve progression-free survival (PFS) in patients with unresectable gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and also approved in Europ...

  5. Depot Maintenance: Improvements to DODs Biennial Core Report Could Better Inform Oversight and Funding Decisions

    Science.gov (United States)

    2016-11-01

    many complex weapon systems and equipment. Recognizing the key role of the depots and the risk of overreliance on contractors, Section 2464 of...Office of the Secretary of Defense This is a work of the U.S. government and is not subject to copyright protection in the United States. The published...military depots2—public-sector facilities that are government-owned and government-operated—and private-sector contractors. Depots have a key role

  6. Population pharmacokinetic modeling of a subcutaneous depot for GnRH antagonist degarelix

    DEFF Research Database (Denmark)

    Tornøe, Christoffer Wenzel; Agersø, Henrik; Nielsen, Henrik Aalborg;

    Purpose. The objective of this study is to develop a population pharmacokinetic (PK) model that describes the subcutaneous (SC) depot formation of gonadotropin-releasing hormone (GnRH) antagonist degarelix, which is being developed for treatment of prostate cancer, exhibiting dose-volume and dose...... depot model describes the PK profile of GnRH antagonist degarelix. This modeling approach might also be applicable for other depot-formulated drugs exhibiting complex PK profiles....

  7. Population Pharmacokinetic Modeling of a Subcutaneous Depot for GnRH Antagonist Degarelix

    DEFF Research Database (Denmark)

    Tornøe, Christoffer Wenzel; Agersø, Henrik; Nielsen, Henrik Aalborg;

    2004-01-01

    Purpose. The objective of this study is to develop a population pharmacokinetic (PK) model that describes the subcutaneous (SC) depot formation of gonadotropin-releasing hormone ( GnRH) antagonist degarelix, which is being developed for treatment of prostate cancer, exhibiting dose-volume and dose...... depot model describes the PK profile of GnRH antagonist degarelix. This modeling approach might also be applicable for other depot-formulated drugs exhibiting complex PK profiles....

  8. Population Pharmacokinetic Modeling of a Subcutaneous Depot for GnRH Antagonist Degarelix

    DEFF Research Database (Denmark)

    Tornøe, Christoffer Wenzel; Agersø, Henrik; Nielsen, Henrik Aalborg

    2004-01-01

    Purpose. The objective of this study is to develop a population pharmacokinetic (PK) model that describes the subcutaneous (SC) depot formation of gonadotropin-releasing hormone ( GnRH) antagonist degarelix, which is being developed for treatment of prostate cancer, exhibiting dose-volume and dose...... depot model describes the PK profile of GnRH antagonist degarelix. This modeling approach might also be applicable for other depot-formulated drugs exhibiting complex PK profiles....

  9. 氯氮平所致恶性综合征1例%Case report on clozapine-associated neuroleptic malignant syndrome

    Institute of Scientific and Technical Information of China (English)

    王艳琼; 何睿哲; 张辉

    2012-01-01

    This article summarizes the clinical manifestations of one case of clozapine-associated neuroleptic malignant syndrome and discusses its diagnosis, predisposing factors and treatment based on a literature review. Early identification and treatment is critical to lower the mortality of clozapine-associated neuroleptic malignant syndrome.

  10. Neuroleptic malignant-like syndrome with a slight elevation of creatine-kinase levels and respiratory failure in a patient with Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Wei L

    2014-02-01

    Full Text Available Li Wei,1,2 Yinghui Chen1,2 1Department of Neurology, Jinshan Hospital, 2Department of Neurology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China Abstract: Neuroleptic malignant-like syndrome (NMLS is a rare but catastrophic complication of drug treatment for Parkinson's disease (PD. Sudden withdrawal and abrupt reduction of antiparkinsonian drugs are major risk factors. Just as its name suggests, the clinical features of NMLS are similar to neuroleptic malignant syndrome, which is a dangerous adverse response to antipsychotic drugs. Both of these conditions can present with hyperthermia, marked muscle rigidity, altered consciousness, autonomic dysfunction, and elevated serum creatine-kinase (CK levels. However, we describe a special NMLS case with a slight elevation of CK levels and respiratory failure in the full course of her treatment. The patient, a 68-year-old woman with a 4-years history of Parkinson's disease, presented with hyperthermia and severe muscular rigidity. During the course of her treatment, her maximum temperature was extremely high (above 41°C. At the beginning, the diagnosis of NMLS secondary to dopamine decrease was difficult to make, because her initial blood examination revealed that her serum CK levels were mildly elevated and decreased to normal range rapidly. Although antiparkinsonian drugs and supportive treatment were applied, the patient developed an acute respiratory failure in the early course of treatment. This case report highlights that when confronted with Parkinson's patients with high body temperature and muscle rigidity, NMLS should be taken into consideration even if there is no CK elevation. Likewise, the need for supportive care is essential, because its complications are severe, even such as respiratory failure. Keywords: antiparkinsonian drugs, creatine kinase, parkinsonism–hyperpyrexia syndrome, respiratory failure

  11. Neuroleptic intolerance in patients with anti-NMDAR encephalitis

    Science.gov (United States)

    Lejuste, Florian; Thomas, Laure; Picard, Géraldine; Desestret, Virginie; Ducray, François; Rogemond, Veronique; Psimaras, Dimitri; Antoine, Jean-Christophe; Delattre, Jean-Yves; Groc, Laurent; Leboyer, Marion

    2016-01-01

    Objective: To precisely describe the initial psychiatric presentation of patients with anti-NMDA receptor (NMDAR) antibodies encephalitis (anti-NMDAR encephalitis) to identify potential clues enhancing its early diagnosis. Methods: We retrospectively studied the French Reference Centre medical records of every adult patient with anti-NMDAR encephalitis to specify the patients' initial psychiatric symptoms leading to hospitalization in a psychiatric department and the reasons underlying the diagnosis of anti-NMDAR encephalitis. Results: The medical records of 111 adult patients were reviewed. Psychiatric features were the initial presentation in 65 patients (59%). Among them, several psychiatric manifestations were observed, including visual and auditory hallucinations (n = 26, 40%), depression (n = 15, 23%), mania (n = 5, 8%), acute schizoaffective episode (n = 15, 23%), and eating disorder or addiction (n = 4; 6%). Forty-five patients (40% of total cohort) were first hospitalized in a psychiatric institution (91% women), with a median duration of stay of 9 days (range 0.25–239 days). Among them, 24 patients (53%) had associated discreet neurologic signs at the first evaluation, while 17 additional patients (38%) developed neurologic signs within a few days. Twenty-one patients (47%) were transferred to a medical unit for a suspicion of antipsychotic intolerance characterized by high temperature, muscle rigidity, mutism or coma, and biological results suggesting rhabdomyolysis. Conclusions: Several psychiatric presentations were observed in patients with anti-NMDAR encephalitis, although none was specific; however, patients, mostly women, also had discreet neurologic signs that should be carefully assessed as well as signs of antipsychotic intolerance that should raise suspicion for anti-NMDAR encephalitis. PMID:27606355

  12. N-Palmitoylethanolamine depot injection increased its tissue levels and those of other acylethanolamide lipids

    Directory of Open Access Journals (Sweden)

    Grillo SL

    2013-08-01

    Full Text Available Stephanie L Grillo,1,* Jantana Keereetaweep,2,* Michael A Grillo,1 Kent D Chapman,2 Peter Koulen1–3 1Vision Research Center, Department of Ophthalmology, School of Medicine, University of Missouri – Kansas City, Kansas City, MO, USA; 2University of North Texas, Center for Plant Lipid Research, Department of Biological Sciences, Denton, TX, USA; 3Department of Basic Medical Science, School of Medicine, University of Missouri – Kansas City, Kansas City, MO, USA *These authors contributed equally to this work Abstract: N-Palmitoylethanolamine (NAE 16:0 is an endogenous lipid signaling molecule that has limited water solubility, and its action is short-lived due to its rapid metabolism. This poses a problem for use in vivo as oral administration requires a high concentration for significant levels to reach target tissues, and injection of the compound in a dimethyl sulfoxide- or ethanol-based vehicle is usually not desirable during long-term treatment. A depot injection of NAE 16:0 was successfully emulsified in sterile corn oil (10 mg/kg and administered in young DBA/2 mice in order to elevate baseline levels of NAE 16:0 in target tissues. NAE 16:0 levels were increased in various tissues, particularly in the retina, 24 and 48 hours following injections. Increases ranged between 22% and 215% (above basal levels in blood serum, heart, brain, and retina and induced an entourage effect by increasing levels of other 18 carbon N-Acylethanolamines (NAEs, which ranged between 31% and 117% above baseline. These results indicate that NAE 16:0 can be used as a depot preparation, avoiding the use of inadequate vehicles, and can provide the basis for designing tissue-specific dosing regimens for therapies involving NAEs and related compounds. Keywords: cannabinoid receptor, vanilloid receptor, DBA/2 mice, lipid extraction, gas chromatography, mass spectrometry

  13. [A new LH-RH agonist for treatment of prostate cancer, 3-month controlled-release formulation of goserelin acetate (Zoladex LA 10.8 mg depot)--outline of pre-clinical and clinical studies].

    Science.gov (United States)

    Tsukagoshi, Shigeru

    2002-09-01

    Goserelin acetate is a LH-RH agonist developed by AstraZeneca (formerly ICI, UK), and has been used clinically for the treatment of prostate cancer as a 4-week controlled-release formulation (Zoladex 3.6 mg depot). Recently, a new drug (Zoladex LA 10.8 mg depot) with 3-month controlled-release formulation was developed and became commercially available in Japan. In the randomized comparative phase III studies carried out with global bases, single administration of the new drug yielded almost equivalent anti-testosterone effect and the same serum level of the previous 3.6 mg depot formulation in 3-times continuous administration. In these studies, adverse drug reactions, which were mainly due to pharmacological effects of the new drug and minimal, were found in 52.6% (41/78) compared with 54.8% (46/84) with the previous 3.6 mg depot formulation. In the phase III studies, there were no significant differences in average serum testosterone levels between the two formulations at 12 and 13 weeks after administration. In the Japanese late phase II study with untreated patients, castration effect was observed in all 20 cases entered in the trial. In 20 cases in which treatment was switched from 3.6 mg depot to the new formulation, there were no significant changes in serum testosterone levels at castration level of the untreated patients, 90% (18/20) responded to the treatment, and normalization of PSA level was found in 75.0% (15/20). The adverse drug reactions were mainly increased triglyceride level and hot flushes. In the retrospective evaluation of untreated patients in this trial and the post-marketing clinical trial data for 3.6 mg depot, it was concluded that the new drug had almost the same efficacy and safety profile as 3.6 mg depot in Japanese people. These results indicate that Zoladex LA 10.8 mg depot has the same efficacy and safety as 3.6 mg depot with administration every three months, the burden of injection of LH-RH agonist can be reduced. This new

  14. Progressive Encephalomyelitis with Rigidity and Myoclonus in an Intellectually Disabled Patient Mimicking Neuroleptic Malignant Syndrome

    Directory of Open Access Journals (Sweden)

    Zheyu Xu

    2017-05-01

    Full Text Available We present a case of 32-year-old male with profound mental retardation and autism spectrum disorder who had presented with seizures, rigidity and elevated creatine kinase and was initially diagnosed as neuroleptic malignant syndrome (NMS. The patient subsequently had a complicated clinical course, developing refractory status epilepticus, which lead to the eventual diagnosis of progressive encephalomyelitis with rigidity and myoclonus (PERM. We discuss the clinical similarities and differences between NMS and PERM, and highlight the need to consider alternative diagnoses when the clinical picture of NMS is atypical, particularly in this patient group where the history and clinical examination may be challenging.

  15. [Psychotropic drugs - The special importance of anticonvulsants and neuroleptics in treatment of patients with chronic pain].

    Science.gov (United States)

    Brinkers, Michael; Petz, Tobias; Hoffmeyer, Dieter

    2011-01-01

    Therapy by psychotropic drugs is bound to limited indications, which are partially changing. By an extent literary research in pubmed and Cochrane especially corresponding articles of the past 10 years were proofed. So antidepressants were continually seldom given to nociceptor pain. While on the other side anticonvulsants are to be given in the case of neuropathic pain of defined quality, it will be looked for new applications for these drugs. Particularly hitherto existing difficult indications as fibromyalgia were investigated as possible indication for anticonvulsants. At least neuroleptics can be used for very difficult, resistant and bizarre pains such as cenesthesias.

  16. Malignant catatonia and neuroleptic malignant syndrome in relation to disulfiram overdose

    Directory of Open Access Journals (Sweden)

    Kiran K Kumar

    2016-01-01

    Full Text Available Disulfiram is a widely used drug in the management of alcohol dependence syndrome as an aversive agent. Although a drug of high efficacy, it has a large number of side effects. Disulfiram-induced catatonia is a known rare side effect of the drug and herein we report a case of what appeared to be the sequential development of malignant catatonia and neuroleptic malignant syndrome in a patient with a diagnosis of alcohol dependence syndrome and co-morbid paranoid schizophrenia following disulfiram overdose. Clinicians need to be vigilant on the emergence of such rare side effects.

  17. Malignant Catatonia and Neuroleptic Malignant Syndrome in Relation to Disulfiram Overdose

    Science.gov (United States)

    Kumar, Kiran K.; Bondade, Swapna; Sattar, Fiaz Ahmed; Singh, Niharika

    2016-01-01

    Disulfiram is a widely used drug in the management of alcohol dependence syndrome as an aversive agent. Although a drug of high efficacy, it has a large number of side effects. Disulfiram-induced catatonia is a known rare side effect of the drug and herein we report a case of what appeared to be the sequential development of malignant catatonia and neuroleptic malignant syndrome in a patient with a diagnosis of alcohol dependence syndrome and co-morbid paranoid schizophrenia following disulfiram overdose. Clinicians need to be vigilant on the emergence of such rare side effects. PMID:27570348

  18. Antipsychotic Drugs Rechallenge in Multi-antipsychotic Drug Induced Atypical Neuroleptic Malignant Syndrome: A Case of Cotard’s Syndrome

    Directory of Open Access Journals (Sweden)

    Helin Yılmaz

    2017-03-01

    Full Text Available Neuroleptic malignant syndrome (NMS is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Cotard’s syndrome is characterized by the appearance of nihilistic delusions concerning one’s own body or life. By presenting this case, we aim to discuss the differential diagnosis and treatment plan of a patient with catatonia and Cotard’s syndrome, which were noted after NMS, in light of the literature.

  19. Cortical and subcortical 5-HT2A receptor binding in neuroleptic-naive first-episode schizophrenic patients

    DEFF Research Database (Denmark)

    Erritzoe, David; Rasmussen, Hans; Kristiansen, Klaus Nyegaard

    2008-01-01

    of this disease. The aim of this study is to investigate cortical and subcortical 5-HT(2A) binding in neuroleptic-naive schizophrenic patients. Fifteen neuroleptic-naive patients diagnosed with schizophrenia (age 27.5+/-4.5 years), 11 men and 4 women, and 15 healthy control subjects matched for age (28.......5+/-5.7 years) and gender underwent a 40 min positron emission tomography (PET) study using the 5-HT(2A) antagonist, [(18)F]altanserin, as a radioligand. PET images were co-registered to 3 T magnetic resonance images (MRIs) for each individual subject, and ROIs were applied automatically onto the individual...

  20. Neuroleptic malignant syndrome-like reaction precipitated by antipsychotics in a patient with gamma-butyrolactone withdrawal.

    Science.gov (United States)

    Eiden, Céline; Capdevielle, Delphine; Deddouche, Charlotte; Boulenger, Jean-Philippe; Blayac, Jean-Pierre; Peyrière, Hélène

    2011-12-01

    We report the case of a patient with chronic abuse of gamma-butyrolactone (GBL, 3 bottles per week for 4 months), who in the course of the management of acute agitation and hallucinations developed symptoms compatible with both neuroleptic malignant syndrome and GBL withdrawal symptoms.Some GHB withdrawal symptoms are similar to those of neuroleptic malignant syndrome, and the administration of antipsychotics might worsen the neurological condition of patients. So, it seems important to rapidly detect drugs taken by patients with mental agitation, to optimize management and minimize complications related to drugs.

  1. A case of neuroleptic malignant syndrome with acute renal failure after the discontinuation of sulpiride and maprotiline.

    Science.gov (United States)

    Kiyatake, I; Yamaji, K; Shirato, I; Kubota, M; Nakayama, S; Tomino, Y; Koide, H

    1991-01-01

    A 46-year-old man developed neuroleptic malignant syndrome with acute myoglobinuric renal failure after the discontinuation of sulpiride and maprotiline treatment. He showed the characteristic features of hyperpyrexia, altered consciousness, muscle rigidity, and autonomic dysfunction. Laboratory data showed lysis of skeletal muscle cells and renal impairment. Muscle biopsy revealed necrosis and regenerative changes in muscle fibers. Renal biopsy showed focal tubulitis and interstitial infiltration of small inflammatory cells. The combination of sulpiride and maprotiline has not previously been reported to be the cause of neuroleptic malignant syndrome and acute myoglobinuric renal failure.

  2. Gas production and transport in artificial sludge depots.

    Science.gov (United States)

    van Kessel, T; van Kesteren, W G M

    2002-01-01

    This paper presents a study to determine the impact of gas production in dredging sludge on the storage capacity of artificial sludge depots. Gas is produced as a result of the decomposition of organic material present in dredging spoil. This process, in which methane and carbon dioxide are formed, may lead to expansion of sludge layers, partly or even completely counterbalancing consolidation. The study shows that, even with a very conservative estimation of the rate of gas production, accumulation of gas occurs as convective and diffusive transport proceed very slowly. Nucleation of gas bubbles occurs already at a limited oversaturation of pore water. During their growth, bubbles push aside the surrounding grain matrix. Resulting stresses may initiate cracks around bubbles. If these cracks join, they may form channels stretching out to the depot surface and along which gas may escape. However, channels are only stable to a limited depth below which bubble accumulation may continue. The gas content at which sufficient cracks and channels are formed to balance the rate of gas production with the rate of outflow strongly depends on the constitutive properties of the dredging sludge considered. In sludge with a high shear strength (> 10 kPa), stable channels are created already at low deformations. However, a large expansion may occur in sludge with a low strength. The present study shows that accumulation of gas may continue until a bulk density less than that of water is attained. This is equivalent to a gas fraction of about 25-37%, depending on the initial water content of the sludge. Only then can gas escape as a result of instabilities in the sediment matrix. This should be well taken into account during the design and management of artificial depots.

  3. Depot effect of bioactive components in experimental membrane filtrations

    Science.gov (United States)

    Mitev, D.; Peshev, D.; Peev, G.; Peeva, L.

    2017-01-01

    Depot effects were found to be accompanying phenomena of membrane separation processes. Accumulation of target species in the membrane matrix during feasibility tests can hamper proper conclusions or compromise the filtration results. Therefore, we investigated the effects of delayed membrane release of chlorogenic acid and caffeine, considered as key compounds of interest in spent coffee products’ recovery treatment. Permeate fluxes and key components release were studied in course of 24 hours via nanofiltration of pure solvent, both immediately after the mock solution filtration and after idle stay. Conclusions are drawn and recommendations advised for proper analysis of experimental data on membrane screening.

  4. Invasive cervical cancer and depot-medroxyprogesterone acetate

    OpenAIRE

    1985-01-01

    Preliminary results of a study of the possible relationship of depot-medroxy-progesterone acetate (DMPA) to invasive cervical cancer are presented. The findings are based on data from three participating centres in Thailand and one in Mexico. A relative risk for cervical cancer of 1.2 was observed in women who had ever used DMPA; this was not statistically significant. No consistent increase in risk with duration of use was observed, although a relative risk of 2 was found in women who had us...

  5. Comparison of heuristic approaches for the multiple depot vehicle scheduling problem

    NARCIS (Netherlands)

    A.S. Pepin; G. Desaulniers (Guy); A. Hertz (Alain); D. Huisman (Dennis)

    2006-01-01

    textabstractGiven a set of timetabled tasks, the multi-depot vehicle scheduling problem is a well-known problem that consists of determining least-cost schedules for vehicles assigned to several depots such that each task is accomplished exactly once by a vehicle. In this paper, we propose to compar

  6. Treating allergic rhinitis with depot-steroid injections increase risk of osteoporosis and diabetes

    DEFF Research Database (Denmark)

    Aasbjerg, Kristian; Torp-Pedersen, Christian; Vaag, Allan

    2013-01-01

    In Denmark, 23% of the adult population have allergic rhinitis. We have previously demonstrated that a majority of hay fever patients are treated with depot-steroid injections in violation of the guidelines. It has been hypothesised that 1-2 annual depot-steroid injections are not harmful...

  7. Pharmacokinetics in Elderly Women of Benzyl Alcohol From an Oil Depot

    NARCIS (Netherlands)

    Kalicharan, Raween; El Amrani, Mohsin; Schot, Peter; Vromans, Herman|info:eu-repo/dai/nl/073088803

    2016-01-01

    Pharmaceutical oil depots are meant to release active substances at a sustained rate. Most of these depots contain benzyl alcohol (BOH) to facilitate the production and administration. Because BOH changes the solubility of components in both the body fluid and the oil formulation, it is relevant to

  8. Antipsychotic dose escalation as a trigger for Neuroleptic Malignant Syndrome (NMS: literature review and case series report

    Directory of Open Access Journals (Sweden)

    Langan Julie

    2012-11-01

    Full Text Available Abstract Background “Neuroleptic malignant syndrome” (NMS is a potentially fatal idiosyncratic reaction to any medication which affects the central dopaminergic system. Between 0.5% and 1% of patients exposed to antipsychotics develop the condition. Mortality rates may be as high as 55% and many risk factors have been reported. Although rapid escalation of antipsychotic dose is thought to be an important risk factor, to date it has not been the focus of a published case series or scientifically defined. Description We aimed to identify cases of NMS and review risk factors for its development with a particular focus on rapid dose escalation in the 30 days prior to onset. A review of the literature on rapid dose escalation was undertaken and a pragmatic definition of “rapid dose escalation” was made. NMS cases were defined using DSM-IV criteria and systematically identified within a secondary care mental health service. A ratio of titration rate was calculated for each NMS patient and “rapid escalators” and “non rapid escalators” were compared. 13 cases of NMS were identified. A progressive mean dose increase 15 days prior to the confirmed episode of NMS was observed (241.7 mg/day during days 1–15 to 346.9 mg/day during days 16–30 and the mean ratio of dose escalation for NMS patients was 1.4. Rapid dose escalation was seen in 5/13 cases and non rapid escalators had markedly higher daily cumulative antipsychotic dose compared to rapid escalators. Conclusions Rapid dose escalation occurred in less than half of this case series (n = 5, 38.5%, although there is currently no consensus on the precise definition of rapid dose escalation. Cumulative antipsychotic dose – alongside other known risk factors - may also be important in the development of NMS.

  9. Policies for Positioning Empty Containers in an Inland Multi-depot System

    DEFF Research Database (Denmark)

    Dang, Vinh Quang; Nielsen, Izabela Ewa; Yun, Won-Young

    2011-01-01

    This research focuses on the problem of positioning empty containers in a port area with multiple depots. Three options are considered to prepare the required extent of positioning: positioning from other overseas ports, inland positioning between depots, and leasing. The policies for empty......-container management are as follows: a coordinated (s, S) inventory policy for overseas positioning, (ri, Ri) policy at each depot for inland positioning; and a simple leasing policy with zero lead-time. For inland positioning policy, four different methods are proposed to reposition empty containers between depots....... Customer demands and returning containers in depots and lead-time for positioning from overseas are considered as uncertain factors. The objective is to obtain the optimal policy in order to minimize the expected total cost including inventory holding, overseas positioning, inland positioning and leasing...

  10. Reshaping chronicity: neuroleptics and changing meanings of therapy in French psychiatry, 1950-1975.

    Science.gov (United States)

    Henckes, Nicolas

    2011-12-01

    This article explores the transformations in the regime of practice and discourse concerning chronic mental illness in French psychiatry in the post-war period and the role played by chemotherapy in these transformations. From the 1950s and 60s on, chronicity was reconstructed as a new experience, involving a new set of expectations, of dilemmas and negotiations, and involving new types of actors giving a new meaning to what they were doing with patients. While some psychiatrists thought that neuroleptics could open the way to active treatment of these pathologies, in effect this project faced a series of obstacles: some came from psychiatric ideologies, others from the conditions of psychiatric work. As a result chronicity acquired a new uncertain and elusive shape. Based on an examination of the interplay of meaning and action in psychiatrists' recourse to neuroleptics in the treatment of their chronic patients, this article seeks to highlight the difficult construction of the idea of chemotherapy in post-war French psychiatry and, more generally, the transformations in its notion of therapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Lithium Toxicity and Neurologic Effects: Probable Neuroleptic Malignant Syndrome Resulting from Lithium Toxicity

    Directory of Open Access Journals (Sweden)

    Osamede Edokpolo

    2012-01-01

    Full Text Available Introduction. We present the case of a patient who developed lithium toxicity with normal therapeutic levels, as a result of pharmacokinetic interaction with Valsartan, and probable Neuroleptic Malignant Syndrome from the ensuing lithium toxicity. Case Presentation. A 59-year old black male with bipolar disorder maintained on lithium and fluphenazine therapy presented with a 2 week history of worsening confusion, tremor, and gait abnormality. He recently had his dose of Valsartan increased. At presentation, patient had signs of autonomic instability, he was confused, dehydrated, and had rigidity of upper extremities. Significant labs on admission were lithium level-1.2, elevated CK-6008, leukocytosis WBC-22, and renal impairment; Creatinine-4.1, BUN-35, HCO3-20.1, and blood glucose 145. CT/MRI brain showed old cerebral infarcts, and there was no evidence of an infective process. Lithium and fluphenazine were discontinued, his lithium levels gradually decreased, and he improved with supportive treatment including rehydration and correction of electrolyte imbalance. Conclusions. This case illustrates that lithium toxicity can occur within therapeutic levels, and the neurotoxic effect of lithium can include Neuroleptic Malignant Syndrome. Clinicians should be aware of the risk associated with drug interactions with lithium.

  12. From neutrophils to macrophages: differences in regional adipose tissue depots.

    Science.gov (United States)

    Dam, V; Sikder, T; Santosa, S

    2016-01-01

    Currently, we do not fully understand the underlying mechanisms of how regional adiposity promotes metabolic dysregulation. As adipose tissue expands, there is an increase in chronic systemic low-grade inflammation due to greater infiltration of immune cells and production of cytokines. This chronic inflammation is thought to play a major role in the development of metabolic complications and disease such as insulin resistance and diabetes. We know that different adipose tissue depots contribute differently to the risk of metabolic disease. People who have an upper body fat distribution around the abdomen are at greater risk of disease than those who tend to store fat in their lower body around the hips and thighs. Thus, it is conceivable that adipose tissue depots contribute differently to the inflammatory milieu as a result of varied infiltration of immune cell types. In this review, we describe the role and function of major resident immune cells in the development of adipose tissue inflammation and discuss their regional differences in the context of metabolic disease risk. We find that although initial studies have found regional differences, a more comprehensive understanding of how immune cells interrupt adipose tissue homeostasis is needed.

  13. Artificial immune algorithm for multi-depot vehicle scheduling problems

    Science.gov (United States)

    Wu, Zhongyi; Wang, Donggen; Xia, Linyuan; Chen, Xiaoling

    2008-10-01

    In the fast-developing logistics and supply chain management fields, one of the key problems in the decision support system is that how to arrange, for a lot of customers and suppliers, the supplier-to-customer assignment and produce a detailed supply schedule under a set of constraints. Solutions to the multi-depot vehicle scheduling problems (MDVRP) help in solving this problem in case of transportation applications. The objective of the MDVSP is to minimize the total distance covered by all vehicles, which can be considered as delivery costs or time consumption. The MDVSP is one of nondeterministic polynomial-time hard (NP-hard) problem which cannot be solved to optimality within polynomial bounded computational time. Many different approaches have been developed to tackle MDVSP, such as exact algorithm (EA), one-stage approach (OSA), two-phase heuristic method (TPHM), tabu search algorithm (TSA), genetic algorithm (GA) and hierarchical multiplex structure (HIMS). Most of the methods mentioned above are time consuming and have high risk to result in local optimum. In this paper, a new search algorithm is proposed to solve MDVSP based on Artificial Immune Systems (AIS), which are inspirited by vertebrate immune systems. The proposed AIS algorithm is tested with 30 customers and 6 vehicles located in 3 depots. Experimental results show that the artificial immune system algorithm is an effective and efficient method for solving MDVSP problems.

  14. Psychotropic Medication Use among Children with Autism Spectrum Disorders Enrolled in a National Registry, 2007-2008

    Science.gov (United States)

    Rosenberg, Rebecca E.; Mandell, David S.; Farmer, Janet E.; Law, J. Kiely; Marvin, Alison R.; Law, Paul A.

    2010-01-01

    Patterns of current psychotropic medication use among 5,181 children with autism spectrum disorders (ASD) enrolled in a Web-based registry were examined. Overall, 35% used at least one psychotropic medication, most commonly stimulants, neuroleptics, and/or antidepressants. Those who were uninsured or exclusively privately insured were less likely…

  15. Síndrome neuroléptica maligna de paciente em uso de olanzapina Neuroleptic malignant syndrome in patient using olanzapine

    Directory of Open Access Journals (Sweden)

    Fabrício Lins de Medeiros

    2008-01-01

    Full Text Available A síndrome neuroléptica maligna (SNM é uma reação idiossincrásica rara, extremamente grave e potencialmente fatal ao uso de antipsicóticos, tanto típicos quanto atípicos, bem como drogas de ação dopaminérgica. O diagnóstico fundamenta-se em critérios clínicos e laboratoriais e exclusão de outras condições médicas gerais ou psiquiátricas que melhor expliquem os sintomas. Segundo o DSM-IV, os principais critérios são rigidez muscular grave e temperatura elevada, associadas ao uso de medicação antipsicótica. Foi relatado um caso de paciente com 30 anos manifestando história de transtorno afetivo bipolar, que apresentou sinais e sintomas consistentes com SNM, após três semanas de tratamento com olanzapina. Esse relato visa a discutir o risco da SNM ao uso de antipsicóticos atípicos, bem como a importância de diagnóstico precoce e intervenção imediata.Neuroleptic malignant syndrome (NMS is an idiosyncratic, serious and potentially fatal disorder observed in patients who receive treatment with neuroleptics, typical and atypical, as well as medications with dopaminergic effects. The diagnosis is based on clinical and laboratory criteria and the exclusion of other general medical or psychiatric conditions that could best explain the symptoms. The main criteria according to DSM-IV are severe rigidity and fever associated with the use of antipsychotic medication. We present a case of a 30-year-old female with history of bipolar affective disorder that developed signs and symptoms consistent with NMS after three weeks of treatment with Olanzapine. This case aims to address the risk of NMS associated atypical antipsychotic, as well as the importance of an early diagnosis and immediate intervention.

  16. Costs and effects of long-acting risperidone compared with oral atypical and conventional depot formulations in Germany.

    Science.gov (United States)

    Laux, Gerd; Heeg, Bart; van Hout, Ben A; Mehnert, Angelika

    2005-01-01

    Schizophrenia is one of the most expensive psychiatric conditions because of high direct and indirect costs associated with the nature of the illness, its resistance to treatment and the consequences of relapse. Long-acting risperidone is a new formulation of an atypical antipsychotic drug that also offers the improvements in compliance associated with haloperidol depot. The aim of this simulation study was to compare the benefits and costs of three pharmacological treatment strategies comprising first-line treatment with long-acting risperidone injection, a haloperidol depot or an oral atypical antipsychotic agent, over a 5-year period in Germany. A discrete event simulation model was developed to compare three treatment scenarios from the perspective of major third-party payers (sickness funds and social security 'Sozialversicherung'). The scenarios comprised first-line treatment with haloperidol depot (scenario 1), long-acting risperidone (scenario 2) and oral olanzapine (scenario 3). Switches to second or third-line options were allowed when side-effects occurred or a patient suffered more than a fixed number of relapses. The model accounted for fixed patient characteristics, and on the basis of these, simulated patient histories according to several time-dependent variables. The time horizon for this model was limited to 5 years, and in accordance with German guidelines, costs and effects were discounted by between 3 and 10%. Direct costs included medication, type of physician visits and treatment location. Indirect costs were not included. Information on treatment alternatives, transition probabilities, model structure and healthcare utilization were derived from the literature and an expert panel. Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted life-years (QALY). Univariate sensitivity analyses were carried out, as were subgroup analyses based on disease severity and

  17. Rocuronium and sugammadex: An alternative to succinylcholine for electro convulsive therapy in patients with suspected neuroleptic malignant syndrome.

    LENUS (Irish Health Repository)

    Ramamoorthy, Karthik G

    2012-01-31

    We report a case of presumptive neuroleptic malignant syndrome requiring muscle relaxation for electro-convulsive therapy. short acting muscle relaxation without the use of succinylcholine was achieved using rocvronivm reversed with the novel reversal agent sugammadex. We suggest that this combination is a safe and effective alternative to succinylcholine in such cases.

  18. Rocuronium and sugammadex: An alternative to succinylcholine for electro convulsive therapy in patients with suspected neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Karthik G Ramamoorthy

    2011-01-01

    Full Text Available We report a case of presumptive neuroleptic malignant syndrome requiring muscle relaxation for electro-convulsive therapy. short acting muscle relaxation without the use of succinylcholine was achieved using rocvronivm reversed with the novel reversal agent sugammadex. We suggest that this combination is a safe and effective alternative to succinylcholine in such cases.

  19. Anti-NMDA-receptor encephalitis presenting with catatonia and neuroleptic malignant syndrome in patients with intellectual disability and autism.

    Science.gov (United States)

    Kiani, Reza; Lawden, Mark; Eames, Penelope; Critchley, Peter; Bhaumik, Sabyasachi; Odedra, Sunita; Gumber, Rohit

    2015-02-01

    We report anti-N-methyl-d-aspartate (NMDA) receptor encephalitis in two patients with autism and intellectual disability presenting with neuropsychiatric symptoms of catatonia and neuroleptic malignant syndrome. Case reports such as these help raise awareness of this clinical issue. By paving the way for earlier diagnoses they ultimately maximise the potential for curative treatments and prevention of long-term complications.

  20. Absence of a difference in the neurosecretory activity of supraoptic nucleus vasopressin neurons of neuroleptic-treated schizophrenic patients.

    NARCIS (Netherlands)

    Malidelis, Y.I.; Panayotacopoulou, M.T.; Heerikhuize, J.J. van; Unmehopa, U.A.; Kontostavlaki, D.P.; Swaab, D.F.

    2005-01-01

    Dysfunction in water intake and metabolism has frequently been reported in schizophrenia. The general population of schizophrenics under neuroleptic treatment secretes lower amounts of vasopressin than controls at comparable values of plasma osmolality. The purpose of the present study was to

  1. The effects of psychoactive drugs and neuroleptics on language in normal subjects and schizophrenic patients: a review.

    Science.gov (United States)

    Salomé, F; Boyer, P; Fayol, M

    2000-12-01

    The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.

  2. Subjective well-being in schizophrenia as measured with the Subjective Well-Being under Neuroleptic Treatment scale : a review

    NARCIS (Netherlands)

    Vothknecht, Sylke; Schoevers, Robert A.; de Haan, Lieuwe

    2011-01-01

    Objective: The Subjective Well-being under Neuroleptic Treatment scale (SWN) is the most widely used self-rating scale in recent research of subjective well-being in schizophrenia. We reviewed all available publications on relevant research of subjective well-being using the SWN, in order to evaluat

  3. Intrinsic differences in adipocyte precursor cells from different white fat depots

    DEFF Research Database (Denmark)

    Macotela, Yazmín; Emanuelli, Brice; Mori, Marcelo A;

    2012-01-01

    Obesity and body fat distribution are important risk factors for the development of type 2 diabetes and metabolic syndrome. Evidence has accumulated that this risk is related to intrinsic differences in behavior of adipocytes in different fat depots. In the current study, we demonstrate...... is higher in obesity-prone C57BL/6 mice than obesity-resistant 129 mice, and the number in both depots is increased by up to 270% by exposure of mice to high-fat diet. Thus, APCs from visceral and subcutaneous depots are dynamic populations, which have intrinsic differences in gene expression...

  4. The Linehaul-Feeder Vehicle Routing Problem with Virtual Depots and Time Windows

    Directory of Open Access Journals (Sweden)

    Huey-Kuo Chen

    2011-01-01

    Full Text Available This paper addresses the linehaul-feeder vehicle routing problem with virtual depots and time windows (LFVRPTW. Small and large vehicles deliver services to customers within time constraints; small vehicles en route may reload commodities from either the physical depot or from the larger vehicle at a virtual depot before continuing onward. A two-stage solution heuristic involving Tabu search is proposed to solve this problem. The test results show that the LFVRPTW performs better than the vehicle routing problem with time windows in terms of both objective value and the number of small vehicles dispatched.

  5. Invasive cervical cancer and depot-medroxyprogesterone acetate

    Science.gov (United States)

    1985-01-01

    Preliminary results of a study of the possible relationship of depot-medroxy-progesterone acetate (DMPA) to invasive cervical cancer are presented. The findings are based on data from three participating centres in Thailand and one in Mexico. A relative risk for cervical cancer of 1.2 was observed in women who had ever used DMPA; this was not statistically significant. No consistent increase in risk with duration of use was observed, although a relative risk of 2 was found in women who had used DMPA for more than 5 years. This observed increase in risk was confined to women who were aged under 46 years or who had first been exposed to DMPA before 30 years of age. These findings are based on small numbers of subjects, and may not represent a causal relationship. PMID:2931205

  6. MODELING OF HIGH STORAGE SHEET DEPOT WITH PLANT SIMULATION

    Directory of Open Access Journals (Sweden)

    Andrzej Jardzioch

    2013-03-01

    Full Text Available Manufacturing processes are becoming increasingly automated. Introduction of innovative solutions often necessitate processing very large number of signals from various devices. Correctness tests of the components configuration becomes a compiled operation requiring vast expenditure of time and knowledge. The models may be a mathematical reflection of the actual object. Many actions can be computer-assisted to varying degree. One example is construction of simulation models. These can also be simulation models developed in advanced software. The stages of creating a model may be purely random. This paper aims at a closer analysis of the simulation model based on the high storage sheet depot modeling using Plant Simulation software. The results of analysis can be used for optimization, but this stage is a separate issue.

  7. The case for a centralized repair depot for Space Shuttle

    Science.gov (United States)

    Enlow, R. D.

    1985-01-01

    The first priority of the NSTS program is to make the Space Shuttle system fully operational and cost effective in providing routine access to space. In support of this priority an integrated logistics support system was planned, structured and is being implemented to support a launch-on-time goal of 95 percent. In achieving a 95 percent spares 'fill rate' in an environment of small fleet size, highly unique and high cost assets, significant spares cost can be incurred. A major portion of these costs are for the additional spares required when repair or acquisition times are lengthy. This paper provides a fundamental analysis of the costs and other factors involved in the spare and repair process and provides an optimized cost and process solution for the Space Shuttle program - a centralized repair depot located at KSC.

  8. Sex dimorphism and depot differences in adipose tissue function.

    Science.gov (United States)

    White, Ursula A; Tchoukalova, Yourka D

    2014-03-01

    Obesity, characterized by excessive adiposity, is a risk factor for many metabolic pathologies, such as type 2 diabetes mellitus (T2DM). Numerous studies have shown that adipose tissue distribution may be a greater predictor of metabolic health. Upper-body fat (visceral and subcutaneous abdominal) is commonly associated with the unfavorable complications of obesity, while lower-body fat (gluteal-femoral) may be protective. Current research investigations are focused on analyzing the metabolic properties of adipose tissue, in order to better understand the mechanisms that regulate fat distribution in both men and women. This review will highlight the adipose tissue depot- and sex-dependent differences in white adipose tissue function, including adipogenesis, adipose tissue developmental patterning, the storage and release of fatty acids, and secretory function. This article is part of a Special Issue entitled: Modulation of Adipose Tissue in Health and Disease.

  9. Olanzepine-induced neuroleptic malignant syndrome in a case of multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Deepak Hanumanthaiah

    2014-01-01

    Full Text Available Suspicion of neuroleptic malignant syndrome (NMS is a frequent cause of emergent psychiatric consultation. Despite early recognition, NMS has remained a syndrome that causes high rates of morbidity and mortality. A 25-year-old male with multiple sclerosis presented to the accident and emergency department and E with ataxia. He was started on steroids. On the third day, he became tearful and anxious. A diagnosis of multiple sclerosis-induced psychosis was made and he was started on olanzepine 2.5 mg BD. On the sixth day the patient was tachypneic and had tachycardia. Temperature recorded in the axilla was 45°C. Patient was intubated and electively ventilated. A diagnosis of NMS was made and treated accordingly. This case report highlights the importance of recognizing and treating NMS in a patient on anti-psychotics.

  10. Reversible magnetic resonance imaging changes in a case of neuroleptic malignant syndrome.

    Science.gov (United States)

    Jain, Rajendra Singh; Gupta, Pankaj Kumar; Gupta, Ishwar Dayal; Agrawal, Rakesh; Kumar, Sunil; Tejwani, Shankar

    2015-08-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of mainly typical antipsychotic drugs. It is characterized by fever, altered mental status, generalized rigidity, autonomic instability, myoclonus, raised creatine phosphokinase, rhabdomyolysis, and leukocytosis. Neuroimaging (brain computed tomography/magnetic resonance imaging [MRI]) is usually normal in most of the cases of NMS. Magnetic resonance imaging findings have not been well elucidated in NMS as yet. Very few cases have been reported worldwide. We herein, report a case of a 42-year-old patient of NMS, who presented to us with reversible changes in MRI brain. This case report highlights the possible MRI changes in NMS and their plausible mechanism.

  11. Delirium followed by neuroleptic malignant syndrome in rehabilitation setting. Is it anger reaction before discharge?

    Science.gov (United States)

    Al Owesie, Rafat M; Robert, Asirvatham Alwin

    2013-01-01

    Delirium and neuroleptic malignant syndrome (NMS) are two uncommon syndromes that are often unrecognized or misdiagnosed by the primary physicians as functional psychiatric disorders. The infrequency and the heterogeneity of clinical manifestation, progression and outcome with which those diagnoses are encountered (particularly in chronic rehabilitation settings) make them formidable diagnostic challenge. In this report, we present a case in which there was a misdiagnosis of delirium and NMS as functional psychiatric disorders. This report demonstrates the fact that early recognition and intervention in such cases are essential to prevent the grave outcome and potential fatality. The authors believe that there is a key role for the consulting psychiatrist in this area in providing diagnostic clarity and advice regarding management and ongoing staff education.

  12. Atypical neuroleptic malignant syndrome. “Doing more harm than gain”

    Directory of Open Access Journals (Sweden)

    Khalid Javid Bhat

    2013-08-01

    Full Text Available Neuroleptic malignant syndrome (NMS a rare, idiosyncratic, and potentially fatal adverse reaction can be deceptive especially when the hallmark features are lacking. Most diagnostic criteria include fever and muscle rigidity, although NMS may present without either. Delirium, agitation and catatonia can be the earliest features of NMS and in acute care settings, concomitant use of sedatives and anti-psychotics by the attending clinicians may even obscure the sentinel signs of NMS and further aggravate the underlying insult. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment and the strict adherence to the classical criteria of NMS may lead to a diagnostic delay and dire consequences for these patients and sometimes this delay can procure death. [Int J Res Med Sci 2013; 1(4.000: 601-603

  13. Catatonic Symptoms Appearing before Autonomic Symptoms Help Distinguish Neuroleptic Malignant Syndrome from Malignant Catatonia.

    Science.gov (United States)

    Komatsu, Takayuki; Nomura, Tomohisa; Takami, Hiroki; Sakamoto, So; Mizuno, Keiko; Sekii, Hajime; Hatta, Kotaro; Sugita, Manabu

    A 42-year-old Japanese woman with a 10-year history of schizophrenia was admitted due to a disturbance in consciousness that met the diagnostic criteria for both neuroleptic malignant syndrome (NMS) and malignant catatonia. Despite systemic supportive treatments, the catatonic symptoms preceding autonomic symptoms persisted. The symptoms improved after lorazepam administration, leading to a retrospective diagnosis of malignant catatonia. Catatonia is thought to be caused by a dysfunction of ganmma-aminobutyric acid type A receptors in the cortico-cortical networks of the frontal lobes, which causes hypoactivity of the dopaminergic transmission in the subcortical areas. Identifying the catatonic symptoms preceding autonomic symptoms could aid in distinguishing malignant catatonia from NMS.

  14. Catatonia and neuroleptic malignant syndrome: two disorders on a same spectrum? Four case reports.

    Science.gov (United States)

    Luchini, Federica; Lattanzi, Lorenzo; Bartolommei, Natalia; Cosentino, Luca; Litta, Antonella; Kansky, Christine; Mauri, Mauro; Cassano, Giovanni Battista; Fagiolini, Andrea; Casamassima, Francesco

    2013-01-01

    We present the history of four bipolar patients who developed neuroleptic malignant syndrome (NMS) after antipsychotic treatment, focusing on the relationship between NMS and catatonia. In all cases, the administration of antipsychotics has been suspended as soon as fever and autonomic disturbances occurred. A supportive therapy was initiated to stabilize general conditions, then every patient started electroconvulsive therapy (ECT) in combination with benzodiazepines (BDZ). The risk of complications was reduced by the quick adoption of supportive care, whereas the combination of ECT and BDZ was effective in resolving the clinical picture. These cases may provide further support to the hypothesis that catatonia and NMS are disorders pertaining to the same spectrum of illness because the onset or exacerbation of catatonic symptoms coincided with the administration of antipsychotics. Our experience confirms the efficacy and safety of ECT in combination with BDZ as treatment of NMS and residual catatonia.

  15. Single photon emission computed tomography with [sup 123]I-N-isopropyl-p-iodoamphetamine in three cases of neuroleptic malignant syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Nishijima, Koichi; Matoba, Masaki; Takano, Kenji; Ishiguro, Takeo (Jichi Medical School, Minamikawachi, Tochigi (Japan)); Nakamura, Megumi; Nagano, Mitsuru

    1992-11-01

    Three patients with neuroleptic malignant syndrome underwent single photon emission computd tomography (SPECT) with I-123-N-isopropyl-p-iodoamphetamine (I-123 IMP). In two patients, there was bilateral difference in tracer uptake on early images: decreased uptake in the right basal ganglion and increased uptake in the left basal ganglion. In the third patient, similar findings were seen on early images; however, in contrast to early images, delayed images showed more noticeable tracer uptake in the right basal ganglion than the left basal ganglion. These findings were not associated with the recovery from neuroleptic malignant syndrome. This suggested that some abnormality in the basal ganglion may be involved in the occurrence of neuroleptic malignant syndrome. SPECT with I-123 IMP was considered useful in searching for pathophysiology of neuroleptic malignant syndrome. (N.K.).

  16. Síndrome neuroléptico maligno Neuroleptic malignant syndrome

    Directory of Open Access Journals (Sweden)

    Ricardo J. Toro

    1989-02-01

    Full Text Available

    El síndrome neuroléptico maligno (SNM es una complicación rara, idiosincrática y potencialmente fatal, relacionada con el uso de drogas que afectan el sistema dopaminérgico; su cuadro clínico consiste en síntomas extrapiramidales, signos de disfunción autonómica y trastornos en el estado de conciencia, asociados a leucocitosis ya cifras muy elevadas de creatina fosfoquinasa. Reportamos el caso de un hombre de 32 años que presentó un síndrome catatónico severo después del uso intrahospitalario de antipsicóticos potentes a altas dosis para el control de una depresión psicótica. Se discuten las características clínicas del paciente y los hallazgos comunes en el SNM.

    The Neuroleptic Malignant Syndrome (NMS Is a rare, idiosyncratic and potentially fatal complication of therapy with many drugs affecting the dopaminergic system; It Includes extrapyramidal symptoms, signs of autonomic dysfunction, disorders of consciousness, leucocytosis and an increase in serum creatine phosphokinase .We report the case of a 32 years old man, who developed a severe catatonic syndrome after receiving high doses of potent neuroleptics to control a psychotic depression. Clinical features of this case and common findings of NMS are discussed.

  17. Selective action of an atypical neuroleptic on the mechanisms related to the development of cocaine addiction: a pre-clinical behavioural study

    OpenAIRE

    Marinho, Eduardo Ary Villela; Oliveira-Lima, Alexandre Justo de [UNIFESP; Wuo-Silva, Raphael; Santos, Renan [UNIFESP; Baldaia, Marilia Araujo [UNIFESP; Hollais, André Willian [UNIFESP; Longo, Beatriz Monteiro; Berro, Laís Fernanda; Frussa-Filho, Roberto

    2014-01-01

    An increased function in the mesolimbic dopaminergic system has been extensively associated with the rewarding effects of both natural stimuli and drugs of abuse. Thus, dopamine receptor blockers, such as neuroleptic drugs, can be proposed as candidates for potential therapeutic approaches to treat drug dependence. Notwithstanding, this therapeutic potential of neuroleptics critically depends on a selective action on the specific mechanisms related to the development of addiction. We compared...

  18. Replenishment policies for Empty Containers in an Inland Multi-depot System

    DEFF Research Database (Denmark)

    Dang, Quang-Vinh; Nielsen, Izabela Ewa; Yun, W. Y.

    2013-01-01

    This research focuses on the problem of positioning empty containers in a port area with multiple depots. Three options are considered: positioning from other overseas ports, inland positioning between depots and leasing. The policies for empty-container management are as follows: a coordinated (s......, S) inventory policy for overseas positioning, a (ri, Ri) policy at each depot for inland positioning, and a simple leasing policy with zero lead-time and infinite capacity. For the inland positioning policy, four different methods are proposed to reposition empty containers between depots....... The objective is to obtain the optimal policy in order to minimize the expected total cost consisting of: inventory holding, overseas positioning, inland positioning and leasing costs. A simulation-based genetic algorithm is developed to find near-optimal policies. Numerical examples are given to demonstrate...

  19. The Numerical Investigation of Temperature and Velocity Distribution in the High-Bay Depot

    Directory of Open Access Journals (Sweden)

    Xuehong Wu

    2014-07-01

    Full Text Available High-bay depot plays an important role in the storage industry. Due to large and high space of high-bay depot, it is difficult to make temperature distribution uniform, which will influence the storage time of raw materials. In this paper, the aim is to find the reasonable air supply and energy-saving method; a supply-air method of high-bay depot is investigated as an example. The results show the radius and spacing of the supply-air inlet have great influence on temperature distribution. The temperature nonuniformity coefficient of summer is smaller than that of winter. The investigated results can provide a theoretical reference for the high-bay depot design and economic operation.

  20. A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial.

    Directory of Open Access Journals (Sweden)

    Clive Ballard

    2008-04-01

    Full Text Available BACKGROUND: There have been increasing concerns regarding the safety and efficacy of neuroleptics in people with dementia, but there are very few long-term trials to inform clinical practice. The aim of this study was to determine the impact of long-term treatment with neuroleptic agents upon global cognitive decline and neuropsychiatric symptoms in patients with Alzheimer disease. METHODS AND FINDINGS: DESIGN: Randomised, blinded, placebo-controlled parallel two-group treatment discontinuation trial. SETTING: Oxfordshire, Newcastle and Gateshead, London and Edinburgh, United Kingdom. PARTICIPANTS: Patients currently prescribed the neuroleptics thioridazine, chlorpromazine, haloperidol trifluoperazine or risperidone for behavioural or psychiatric disturbance in dementia for at least 3 mo. INTERVENTIONS: Continue neuroleptic treatment for 12 mo or switch to an identical placebo. OUTCOME MEASURES: Primary outcome was total Severe Impairment Battery (SIB score. Neuropsychiatric symptoms were evaluated with the Neuropsychiatric Inventory (NPI. RESULTS: 165 patients were randomised (83 to continue treatment and 82 to placebo, i.e., discontinue treatment, of whom 128 (78% commenced treatment (64 continue/64 placebo. Of those, 26 were lost to follow-up (13 per arm, resulting in 51 patients per arm analysed for the primary outcome. There was no significant difference between the continue treatment and placebo groups in the estimated mean change in SIB scores between baseline and 6 mo; estimated mean difference in deterioration (favouring placebo -0.4 (95% confidence interval [CI] -6.4 to 5.5, adjusted for baseline value (p = 0.9. For neuropsychiatric symptoms, there was no significant difference between the continue treatment and placebo groups (n = 56 and 53, respectively in the estimated mean change in NPI scores between baseline and 6 mo; estimated mean difference in deterioration (favouring continue treatment -2.4 (95% CI -8.2 to 3.5, adjusted for

  1. Incidence of galactorrhea in young women using Depot-Medroxyprogesterone Acetate.

    Science.gov (United States)

    Omar, Hatim A; Zakharia, Rana M; Kanungo, Shibani; Huff, Marlene; McClanahan, Kimberly

    2006-05-05

    Galactorrhea is rarely mentioned as a possible side effect of the use of Depot-Medroxyprogesterone Acetate (DMPA). Over the last few years, we have noticed an increased number of patients complaining of galactorrhea. A review of clinical data showed that between 1999 and 2005, 360 adolescents in our clinic used DMPA for at least 6 months. After medical follow-up, 13 (3.6%) of these patients were found to have developed galactorrhea. The mean age of the patients was 19.4 years with a range from 13-24. Prolactin levels in these patients were normal, and in all subjects, the galactorrhea resolved spontaneously within the next year in both patients who continued use and those who discontinued use of DMPA. It appears that galactorrhea is a benign side effect and as previous reports have suggested, it did not seem to be related to changes in Prolactin levels in our patients. It is thought that this is a progesterone-mediated effect. We believe that reassurance and education of patients is sufficient and there is no evidence of need for further intervention. Since the sample size is small in this study, additional research is recommended as to validate the presence of progesterone-mediated effects secondary to the use of DMPA.

  2. Incidence of Galactorrhea in Young Women Using Depot-Medroxyprogesterone Acetate

    Directory of Open Access Journals (Sweden)

    Hatim A. Omar

    2006-01-01

    Full Text Available Galactorrhea is rarely mentioned as a possible side effect of the use of Depot-Medroxyprogesterone Acetate (DMPA. Over the last few years, we have noticed an increased number of patients complaining of galactorrhea. A review of clinical data showed that between 1999 and 2005, 360 adolescents in our clinic used DMPA for at least 6 months. After medical follow-up, 13 (3.6% of these patients were found to have developed galactorrhea. The mean age of the patients was 19.4 years with a range from 13—24. Prolactin levels in these patients were normal, and in all subjects, the galactorrhea resolved spontaneously within the next year in both patients who continued use and those who discontinued use of DMPA. It appears that galactorrhea is a benign side effect and as previous reports have suggested, it did not seem to be related to changes in Prolactin levels in our patients. It is thought that this is a progesterone-mediated effect. We believe that reassurance and education of patients is sufficient and there is no evidence of need for further intervention. Since the sample size is small in this study, additional research is recommended as to validate the presence of progesterone-mediated effects secondary to the use of DMPA.

  3. An Assessment of External Organizational Marketing at Naval Aviation Depot (NADEP) North Island

    Science.gov (United States)

    2005-12-01

    Logistics Command (ALC) at McClellan Air Force Base ( AFB ) in Sacramento , California. The second facility identified was the San Antonio ALC at Kelly...appointed BRAC Commission recommended the closure of 2 out of 5 of the United States Air Force’s aviation depots. The first was the Sacramento Aviation... AFB in San Antonio, Texas. To the commission, these two depots represented redundant production capacity that was already available at the

  4. A Variable Neighborhood Search-Based Heuristic for the Multi-Depot Vehicle Routing Problem

    Directory of Open Access Journals (Sweden)

    Arif Imran

    2013-01-01

    Full Text Available The multi-depot vehicle routing problem (MDVRP is addressed using an adaptation of the variable neighborhood search (VNS. The proposed VNS algorithm besides using several neighborhoods and a number of local searches has a number of additional features. These include a scheme for identifying borderline customers, a diversivication procedure and a mechanism that aggregates and disaggregates routes between depots. The proposed algorithm is tested on the data instances from the literature and produces competitive results.

  5. Defense Inventory: Further Analysis and Enhanced Metrics Could Improve Service Supply and Depot Operations

    Science.gov (United States)

    2016-06-01

    to be used up beyond recovery or repair—and provides these items to the services when requisitioned in support of approximately 2,400 weapon...distribution functions for depot maintenance operations varies across the services . For example, the Air Force and DLA have agreed to a local recovery ...DEFENSE INVENTORY Further Analysis and Enhanced Metrics Could Improve Service Supply and Depot Operations Report

  6. Differential screening identifies transcripts with depot-dependent expression in white adipose tissues

    Directory of Open Access Journals (Sweden)

    Zhou Shengli

    2008-08-01

    Full Text Available Abstract Background The co-morbidities of obesity are tied to location of excess fat in the intra-abdominal as compared to subcutaneous white adipose tissue (WAT depot. Genes distinctly expressed in WAT depots may impart depot-dependent physiological functions. To identify such genes, we prepared subtractive cDNA libraries from murine subcutaneous (SC or intra-abdominal epididymal (EP white adipocytes. Results Differential screening and qPCR validation identified 7 transcripts with 2.5-fold or greater enrichment in EP vs. SC adipocytes. Boc, a component of the hedgehog signaling pathway demonstrated highest enrichment (~12-fold in EP adipocytes. We also identified a dramatic enrichment in SC adipocytes vs. EP adipocytes and in SC WAT vs. EP WAT for transcript(s for the major urinary proteins (Mups, small secreted proteins with pheromone functions that are members of the lipocalin family. Expression of Boc and Mup transcript was further assessed in murine tissues, adipogenesis models, and obesity. qPCR analysis reveals that EP WAT is a major site of expression of Boc transcript. Furthermore, Boc transcript expression decreased in obese EP WAT with a concomitant upregulation of Boc transcript in the obese SC WAT depot. Assessment of the Boc binding partner Cdon in adipose tissue and cell fractions thereof, revealed transcript expression similar to Boc; suggestive of a role for the Boc-Cdon axis in WAT depot function. Mup transcripts were predominantly expressed in liver and in the SC and RP WAT depots and increased several thousand-fold during differentiation of primary murine preadipocytes to adipocytes. Mup transcripts were also markedly reduced in SC WAT and liver of ob/ob genetically obese mice compared to wild type. Conclusion Further assessment of WAT depot-enriched transcripts may uncover distinctions in WAT depot gene expression that illuminate the physiological impact of regional adiposity.

  7. Homeostatic imbalance of purine catabolism in first-episode neuroleptic-naïve patients with schizophrenia.

    Science.gov (United States)

    Yao, Jeffrey K; Dougherty, George G; Reddy, Ravinder D; Keshavan, Matcheri S; Montrose, Debra M; Matson, Wayne R; McEvoy, Joseph; Kaddurah-Daouk, Rima

    2010-03-03

    Purine catabolism may be an unappreciated, but important component of the homeostatic response of mitochondria to oxidant stress. Accumulating evidence suggests a pivotal role of oxidative stress in schizophrenia pathology. Using high-pressure liquid chromatography coupled with a coulometric multi-electrode array system, we compared 6 purine metabolites simultaneously in plasma between first-episode neuroleptic-naïve patients with schizophrenia (FENNS, n = 25) and healthy controls (HC, n = 30), as well as between FENNS at baseline (BL) and 4 weeks (4w) after antipsychotic treatment. Significantly higher levels of xanthosine (Xant) and lower levels of guanine (G) were seen in both patient groups compared to HC subjects. Moreover, the ratios of G/guanosine (Gr), uric acid (UA)/Gr, and UA/Xant were significantly lower, whereas the ratio of Xant/G was significantly higher in FENNS-BL than in HC. Such changes remained in FENNS-4w with exception that the ratio of UA/Gr was normalized. All 3 groups had significant correlations between G and UA, and Xan and hypoxanthine (Hx). By contrast, correlations of UA with each of Xan and Hx, and the correlation of Xan with Gr were all quite significant for the HC but not for the FENNS. Finally, correlations of Gr with each of UA and G were significant for both HC and FENNS-BL but not for the FENNS-4w. During purine catabolism, both conversions of Gr to G and of Xant to Xan are reversible. Decreased ratios of product to precursor suggested a shift favorable to Xant production from Xan, resulting in decreased UA levels in the FENNS. Specifically, the reduced UA/Gr ratio was nearly normalized after 4 weeks of antipsychotic treatment. In addition, there are tightly correlated precursor and product relationships within purine pathways; although some of these correlations persist across disease or medication status, others appear to be lost among FENNS. Taken together, these results suggest that the potential for steady formation of

  8. Preliminary data concerning the reliability and psychometric properties of the Greek translation of the 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20

    Directory of Open Access Journals (Sweden)

    Arapidis Konstantinos

    2009-01-01

    Full Text Available Abstract Background The 20-item Subjective Well-Being Under Neuroleptic Treatment Scale (SWN-20 is a self-report scale developed in order to assess the well-being of patients receiving antipsychotic medication independent of the improvement in their psychotic symptoms. The current study reports on the reliability and the psychometric properties of the Greek translation of the SWN-20. Methods A total of 100 inpatients or outpatients with schizophrenia (79 males and 21 females, aged 42.6 ± 11.35 years old from 3 different facilities were assessed with the Positive and Negative Symptoms Scale (PANSS, the Calgary Depression Scale and the Simpson-Angus Scale, and completed the SWN-20. The statistical analysis included the calculation of Pearson product moment correlation coefficient, the Cronbach α and factor analysis with Varimax normalised rotation. Results The SWN-20 had an α value equal to 0.79 and all the items were equal. The factor analysis revealed the presence of seven factors explaining 66% of total variance. The correlation matrix revealed a moderate relationship of the SWN-20 and its factors with the PANSS-Negative (PANSS-N, PANSS-General Psychopathology (PANSS-G, the Simpson-Angus and the Calgary scales, and no relationship to age, education and income class. Discussion The Greek translation of the SWN-20 is reliable, with psychometric properties close to the original scale.

  9. Treatment resistant non-catatonic mutism in schizophrenia responding to a combination of continuation electroconvulsive therapy and neuroleptics

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2012-01-01

    Full Text Available Non-catatonic mutism in schizophrenia has been described less frequently in literature. We describe the case of a young male who presented with non-catatonic mutism, secondary to first rank symptoms, which was refractory to adequate antipsychotic trials (quetiapine, risperidone, aripiprazole, ziprasidone, and trifluperazine and responded to a combination of electroconvulsive therapy (ECT and neuroleptics partially. However, when the ECT was continued in the continuation phase, the patient started speaking.

  10. Making Sense of the 'Chemical Revolution'. Patients' Voices on the Introduction of Neuroleptics in the 1950s.

    Science.gov (United States)

    Majerus, Benoît

    2016-01-01

    The so-called chemical revolution has produced a vast historiographical corpus. Yet the patient's voice remains surprisingly absent from these stories. Based on the archives of the Institut de Psychiatrie (Brussels), this paper traces the introduction of Largactil as recounted in patient letters, physician records and nurse notes. The paper thus contributes to the history of therapies from below, but also participates in the historiographical debate about whether the introduction of neuroleptics can indeed be considered a revolution.

  11. An autopsy case of neuroleptic malignant syndrome (NMS) and its immunohistochemical findings of muscle-associated proteins and mitochondria.

    Science.gov (United States)

    Kubo, S; Orihara, Y; Kitamura, O; Ikematsu, K; Tsuda, R; Nakasono, I

    2001-01-01

    Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disorder. In forensic cases, post-mortem diagnosis of NMS is sometimes difficult if ante-mortem information, such as neuroleptic ingestion or signs and symptoms, cannot be obtained. A 39-year-old Japanese male on a neuroleptic treatment regimen suddenly became agitated and died. Autopsy revealed muscle rigidity and hyperthermia. Post-mortem examination of blood revealed elevation of creatine phosphokinase-MM (CK-MM) and lactate dehydrogenase-4 and dehydrogenase-5 (LDH-4 and LDH-5). In renal glomeruli and tubules, myoglobin was stained immunohistochemically. From these findings, the cause of death was considered to be NMS. To support the diagnosis of NMS, both skeletal and cardiac muscles were stained with actin, myoglobin, desmin and mitochondria antibodies immunohistochemically. Actin, myoglobin, desmin, and mitochondria had been lost from skeletal, but not from the cardiac muscle, which suggested that only the skeletal muscle was damaged. Moreover, because mitochondria had disappeared only from the skeletal muscle, it was considered that skeletal muscle degeneration was caused by mitochondrial damage. Therefore, it is suggested that immunostaining of skeletal muscle by antibodies for muscle-associated proteins and mitochondria is useful to corroborate a diagnosis of NMS.

  12. The effects by neuroleptics, antimycotics and antibiotics on disulfide reducing enzymes from the human pathogens Acanthamoeba polyphaga and Naegleria fowleri.

    Science.gov (United States)

    Ondarza, Raúl N; Iturbe, Angélica; Hernández, Eva

    2007-01-01

    This paper discusses the effects of two neuroleptic agents, chlorpromazine and trifluoperazine; three antimycotics, amphotericin B, ketoconazole and miconazole and four antibiotics, pentamidine, rifampicin, mepacrine and metronidazole on the NADPH-dependent disulfide reducing enzymes cystine reductase (CysR), glutathione reductase (GR) trypanothione reductase (TR) and a putative disulfide reductase for compound X in Acanthamoeba polyphaga from the human pathogens A. polyphaga and Naegleria fowleri. Against A. polyphaga, all nine drugs studied had the capacity to inhibit the putative disulfide reductase from the trophozoites at a concentration of 32microg/ml during a 24h incubation and they were: the neuroleptics trifluoperazine (100%) and chlorpromazine (96%), the antimycotics miconazole (89%) ketoconazole (81%) and amphotericin B, (53%) and the antibiotics pentamidine (89%), rifampicin (64%), mepacrine (57%) and metronidazole (14%). Only six of the nine drugs simultaneously inhibited CysR, GR and the putative disulfide reductase. In N. fowleri, the most potent inhibitors of trypanothione reductase were amphotericin B and miconazole which inhibited 100% at a concentration of 32microg/ml during the 24h incubation followed by the neuroleptics trifluoperazine (92%) and chlorpromazine (80%) and the antibiotic mepacrine (70%). All these also inhibited CysR and GR from the trophozoites other than mepacrine which inhibited only CysR and TR. Ketoconazole, rifampicin (which did not affect CysR), pentamidine and metronidazole had opposite effects since they did not inhibit but increased the amount of the three thiols.

  13. Depot medroxyprogesterone (Depo-Provera) and risk of breast cancer.

    Science.gov (United States)

    Paul, C.; Skegg, D. C.; Spears, G. F.

    1989-01-01

    OBJECTIVE--To determine whether use of the injectable contraceptive depot medroxyprogesterone acetate (Depo-Provera) affects the risk of breast cancer in women. DESIGN--A population based case-control study. SETTING--Nationwide community study. SUBJECTS--891 Women aged 25-54 with newly diagnosed breast cancer were compared with 1864 women selected at random from the electoral rolls. INTERVENTION--Women were interviewed by telephone about past use of contraceptives and about possible risk factors for breast cancer. MAIN OUTCOME MEASURE--Relative risk of breast cancer in women who had used medroxyprogesterone. RESULTS--Medroxyprogesterone had been used by 110 patients and 252 controls. Overall, the relative risk of breast cancer associated with any duration of use was 1.0 (95% confidence interval 0.80 to 1.3). In women aged 25-34 the relative risk was 2.0 (1.0 to 3.8). The relative risk was highest in women aged 25-34 who had used the drug for six years or longer, although there were few women in this category. Women who had used it for two years or longer before age 25 had an increased risk of breast cancer (relative risk 4.6; 1.4 to 15.1). CONCLUSION--Despite the lack of an overall association these findings suggest that medroxyprogesterone may increase the risk of breast cancer in young women. PMID:2529939

  14. Performance Gains of Propellant Management Devices for Liquid Hydrogen Depots

    Science.gov (United States)

    Hartwig, Jason W.; McQuillen, John B.; Chato, David J.

    2013-01-01

    This paper presents background, experimental design, and preliminary experimental results for the liquid hydrogen bubble point tests conducted at the Cryogenic Components Cell 7 facility at the NASA Glenn Research Center in Cleveland, Ohio. The purpose of the test series was to investigate the parameters that affect liquid acquisition device (LAD) performance in a liquid hydrogen (LH2) propellant tank, to mitigate risk in the final design of the LAD for the Cryogenic Propellant Storage and Transfer Technology Demonstration Mission, and to provide insight into optimal LAD operation for future LH2 depots. Preliminary test results show an increase in performance and screen retention over the low reference LH2 bubble point value for a 325 2300 screen in three separate ways, thus improving fundamental LH2 LAD performance. By using a finer mesh screen, operating at a colder liquid temperature, and pressurizing with a noncondensible pressurant gas, a significant increase in margin is achieved in bubble point pressure for LH2 screen channel LADs.

  15. Depot-specific Regulation of the Conversion of Cortisone to Cortisol in Human Adipose Tissue

    Science.gov (United States)

    Lee, Mi-Jeong; Fried, Susan K.; Mundt, Steven S.; Wang, Yanxin; Sullivan, Sean; Stefanni, Alice; Daugherty, Bruce L.; Hermanowski-Vosatka, Anne

    2015-01-01

    Objective Our main objective was to compare the regulation of cortisol production within omental (Om) and abdominal subcutaneous (Abd sc) human adipose tissue. Methods and Procedures Om and Abd sc adipose tissue were obtained at surgery from subjects with a wide range of BMI. Hydroxysteroid dehydrogenase (HSD) activity (3H-cortisone and 3H-cortisol interconversion) and expression were measured before and after organ culture with insulin and/or dexamethasone. Results Type 1 HSD (HSD1) mRNA and reductase activity were mainly expressed within adipocytes and tightly correlated with adipocyte size within both depots. There was no depot difference in HSD1 expression or reductase activity, while cortisol inactivation and HSD2 mRNA expression (expressed in stromal cells) were higher in Om suggesting higher cortisol turnover in this depot. Culture with insulin decreased HSD reductase activity in both depots. Culture with dexamethasone plus insulin compared to insulin alone increased HSD reductase activity only in the Om depot. This depot-specific increase in reductase activity could not be explained by an alteration in HSD1 mRNA or protein, which was paradoxically decreased. However, in Om only, hexose-6-phosphate dehydrogenase (H6PDH) mRNA levels were increased by culture with dexamethasone plus insulin compared to insulin alone, suggesting that higher nicotinamide adenine dinucleotide phosphate-oxidase (NADPH) production within the endoplasmic reticulum (ER) contributed to the higher HSD reductase activity. Discussion We conclude that in the presence of insulin, glucocorticoids cause a depot-specific increase in the activation of cortisone within Om adipose tissue, and that this mechanism may contribute to adipocyte hypertrophy and visceral obesity. PMID:18388900

  16. Measurement of ground and nearby building vibration and noise induced by trains in a metro depot.

    Science.gov (United States)

    Zou, Chao; Wang, Yimin; Wang, Peng; Guo, Jixing

    2015-12-01

    Metro depots are where subway trains are parked and where maintenance is carried out. They usually occupy the largest ground areas in metro projects. Due to land utilization problems, Chinese cities have begun to develop over-track buildings above metro depots for people's life and work. The frequently moving trains, when going into and out of metro depots, can cause excessive vibration and noise to over-track buildings and adversely affect the living quality of the building occupants. Considering the current need of reliable experimental data for the construction of metro depots, field measurements of vibration and noise on the ground and inside a nearby 3-story building subjected to moving subway trains were conducted in a metro depot at Guangzhou, China. The amplitudes and frequency contents of velocity levels were quantified and compared. The composite A-weighted equivalent sound levels and maximum sound levels were captured. The predicted models for vibration and noise of metro depot were proposed based on existing models and verified. It was found that the vertical vibrations were significantly greater than the horizontal vibrations on the ground and inside the building near the testing line. While at the throat area, the horizontal vibrations near the curved track were remarkably greater than the vertical vibrations. The attenuation of the vibrations with frequencies above 50 Hz was larger than the ones below 50 Hz, and the frequencies of vibration transmitting to adjacent buildings were mainly within 10-50 Hz. The largest equivalent sound level generated in the throat area was smaller than the testing line one, but the instantaneous maximum sound level induced by wheels squeal, contact between wheels and rail joints as well as turnout was close to or even greater than the testing line one. The predicted models gave a first estimation for design and assessment of newly built metro depots.

  17. Effectiveness of paliperidone depot injection in seriously violent men with comorbid schizophrenia and dissocial personality disorder in a UK high-security hospital.

    Science.gov (United States)

    Mortlock, Anna-Marie; Larkin, Fintan; Ross, Callum C; Gupta, Nitin; Sengupta, Samrat; Das, Mrigendra

    2017-05-01

    High-security hospital patients are often complex in presentation and are characterized by treatment resistance, medication nonadherence and history of violence. Paliperidone is licensed both as an oral and depot antipsychotic medication in the treatment of schizophrenia. Clinical trials have shown that paliperidone depot is well tolerated with similar efficacy to risperidone depot but with additional practical advantages. Whilst data exist for the effectiveness of paliperidone palmitate (PP), there are no studies involving patients in forensic settings or those with comorbid personality disorder. Our aim was to evaluate the effectiveness of PP on violence, aggression and personality disorder symptoms. This project was a retrospective service evaluation involving 11 patients, carried out in a high-security hospital. A combination of patient records and interviews with the treating consultant psychiatrist were used to ascertain a Clinical Global Impression (CGI) score, the effect of PP on specific personality disorder symptom domains (cognitive-perceptual, impulsive-behavioural dyscontrol and affective dysregulation) and incidents of violence and aggression. Engagement with occupational and psychological therapies was also evaluated. Metabolic parameters were reviewed. A total of 6 out of 11 patients continued on PP, most of whom had schizophrenia and dissocial personality disorder with histories of violence. All showed improvement in the CGI score with associated benefits in the three personality symptom domains. Overall, two patients demonstrated a reduction in the risk of violence. There was improvement in engagement with occupational therapy and psychological work. No significant effects on metabolic parameters were noted although hyperprolactinaemia, albeit asymptomatic, was consistently recorded. This pragmatic service evaluation of a small but complex patient group demonstrated, for the first time, that PP was effective in reducing violence as well as

  18. Space Resource Requirements for Future In-Space Propellant Production Depots

    Science.gov (United States)

    Smitherman, David; Fikes, John; Roy, Stephanie; Henley, Mark W.; Potter, Seth D.; Howell, Joe T. (Technical Monitor)

    2001-01-01

    In 2000 and 2001 studies were conducted at the NASA Marshall Space Flight Center on the technical requirements and commercial potential for propellant production depots in low Earth orbit (LEO) to support future commercial, NASA, and other Agency missions. Results indicate that propellant production depots appear to be technically feasible given continued technology development, and there is a substantial growing market that depots could support. Systems studies showed that the most expensive part of transferring payloads to geosynchronous orbit (GEO) is the fuel. A cryogenic propellant production and storage depot stationed in LEO could lower the cost of missions to GEO and beyond. Propellant production separates water into hydrogen and oxygen through electrolysis. This process utilizes large amounts of power, therefore a depot derived from advanced space solar power technology was defined. Results indicate that in the coming decades there could be a significant demand for water-based propellants from Earth, moon, or asteroid resources if in-space transfer vehicles (upper stages) transitioned to reusable systems using water based propellants. This type of strategic planning move could create a substantial commercial market for space resources development, and ultimately lead toward significant commercial infrastructure development within the Earth-Moon system.

  19. Neuroendocrine Tumors and Lanreotide Depot: Clinical Considerations and Nurse and Patient Preferences.

    Science.gov (United States)

    Ryan, Pamela; Phan, Alexandria T; Adelman, Daphne T; Iwasaki, Michiko

    2016-12-01

    Somatostatin analogs (SSAs) are a mainstay therapy for the treatment of carcinoid syndrome associated with neuroendocrine tumors (NETs). They are effective for a range of gastroenteropancreatic NETs (GEP-NETs). Lanreotide depot (Somatuline®) is an SSA that is approved for the treatment of GEP-NETs to improve progression-free survival (PFS). The article reviews the efficacy, safety, and administration of lanreotide depot and relates those attributes to considerations and preferences of oncology nurses and their patients. A review of the literature on the use of lanreotide for the treatment of NETs and carcinoid syndrome was conducted. In addition, the literature on drug delivery and routes of administration was surveyed to provide context for comparative studies related to clinical and patient preferences. Lanreotide depot prolongs PFS and is well tolerated by patients who expressed satisfaction in the ability to control symptoms related to carcinoid syndrome. Nurses cited several benefits to using lanreotide depot in the clinical setting, including more time saved to address other patient care issues. Attributes of lanreotide depot-including its efficacy, safety and tolerability, dosing and administration, and cost-may contribute to healthcare decisions regarding the treatment and management of NETs.

  20. Depot specific differences during adipogenesis of porcine stromal-vascular cells.

    Science.gov (United States)

    Samulin, Johanna; Lien, Sigbjørn; Grindflek, Eli; Berget, Ingunn; Ruyter, Bente; Sundvold, Hilde

    2008-05-01

    Recently a role of adipose tissue as an endocrine organ secreting factors involved in the regulation of whole-body energy homeostasis has emerged. Preadipocytes in different fat depots have distinct adipogenic potential and the metabolic activity differs between mature adipocytes of different depot origins. Here we describe the proliferation and differentiation of stromal-vascular cells derived from subcutaneous and visceral fat depots of adult pigs. We demonstrate that subcutaneous porcine preadipocytes proliferate more actively and that individual subcutaneous adipocytes have a more rapid accumulation of triacylglycerols than visceral cells. During differentiation, subcutaneous and visceral preadipocytes showed similar gene expression patterns with increased expression of adiponectin (APM1), adipocyte-specific fatty acid binding protein (FABP4), catalase (CAT), and peroxisome proliferator-activated receptor gamma 2 (PPARG2). Furthermore, initial data showing depot-originated effects on the expression of CAT, carnitine palmitoyl transferase 1B (CPT1B) and FABP4 suggest possible depot specific differences in the function and metabolism of mature porcine adipocytes.

  1. A rare case of neuroleptic malignant syndrome without elevated serum creatine kinase.

    Science.gov (United States)

    Nisijima, Koichi; Shioda, Katutoshi

    2014-01-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction to antipsychotic drugs. Although there is no specific examination able to diagnose NMS, serum creatine kinase (CK) elevation has been reported in over 90% of NMS patients. In this report, we describe a patient who developed NMS but had normal CK levels. The patient presented with hyperthermia of over 38°C, severe muscle rigidity, autonomic dysfunction, and altered mental status. Although serum CK levels were measured three times during the course of NMS, the levels were within the normal range. The patient died of respiratory failure 13 days after the onset of NMS symptoms. As patients without elevated serum CK levels are rarely reported, we discuss potential reasons why the serum CK was not elevated in our patient. This case shows clinicians that although serum CK elevation is a useful indicator for the early detection of NMS, the diagnosis of NMS must be determined by clinical symptoms as otherwise, the appropriate treatment procedures for NMS may be delayed.

  2. Skeletal effects of central nervous system active drugs: anxiolytics, sedatives, antidepressants, lithium and neuroleptics.

    Science.gov (United States)

    Vestergaard, Peter

    2008-09-01

    Many central nervous system active drugs can alter postural balance, increasing the risk of fractures. Anxiolytics and sedatives include the benzodiazepines, and these have been associated with a limited increase in the risk of fractures, even at low doses, probably from an increased risk of falls. No systematic differences have been shown between benzodiazepines with long and short half-lives. Although the increase in risk of fractures was limited, care must still be taken when prescribing for older fall-prone subjects at risk of osteoporosis. Neuroleptics may be associated with a decrease in bone mineral density and a very limited increase in fracture risk. Antidepressants are associated with a dose-dependent increase in the risk of fractures. The increase in relative risk of fractures seems to be larger with selective serotonin reuptake inhibitors (SSRIs) than with tricyclic antidepressants. The reason for this is not known but may be linked to serotonin effects on bone cells and the risk of falls. With the wide use of SSRIs, more research is needed. Lithium is associated with a decrease in the risk of fractures. This may be linked to its effects on the Wnt glycoprotein family, which is a specialised signalling system for certain cell types.

  3. Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Jaspinder Kaur

    2016-01-01

    Full Text Available Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH, neuroleptic malignant syndrome (NMS, and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

  4. Preliminary evaluation of manassantin A, a potential neuroleptic agent from Saururus cernuus.

    Science.gov (United States)

    Rao, K V; Puri, V N; Diwan, P K; Alvarez, F M

    1987-09-01

    Manassantin A (MNS-A), a novel dineolignan isolated from Saururus cernuus was evaluated for its central depressant effects. Intraperitoneal (IP) administration of MNS-A to mice at nontoxic doses caused a decrease in spontaneous motor activity and inhibition of amphetamine-induced stereotypy, with an ED50 of 0.21 +/- 0.02 mg/kg for its antiamphetamine activity. Doses of MNS-A up to the LD50 did not produce catalepsy and ptosis as were observed with haloperidol used as a reference drug. The compound caused a dose-dependent hypothermia, while haloperidol was not very effective in this test. Potentiation of pentobarbital-sleeping time was observed to be of comparable degree with both drugs. In spite of the higher toxicity (acute LD50 5.4 +/- 0.2 mg/kg, IP) than that shown by haloperidol, the somewhat selective neuroleptic profile of MNS-A makes it an interesting candidate for more detailed studies.

  5. Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

    Science.gov (United States)

    Lopez, Ricardo

    2016-01-01

    Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH), neuroleptic malignant syndrome (NMS), and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK) and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone. PMID:27721999

  6. [Applying Neuman's Systems Model to a neuroleptic malignant syndrome psychiatric patient and his caregiver].

    Science.gov (United States)

    Wang, Shu-Mi; Lai, Chien-Yu

    2010-04-01

    This article describes a nurse's experience using Neuman's Systems Model to care for a chronic psychiatric patient and his caregiver. The patient was diagnosed as suffering from neuroleptic malignant syndrome (NMS). Nursing care described in this article was administered from October 23 to December 4, 2007. The patient developed NMS in the third month of a three-month period of hospitalization, which endangered his life as well as the health of his caregiver. Nursing care was provided to the patient and his caregiver based on Neuman's Systems Model, which included assessments of intrapersonal, interpersonal, and extra-personal forces as well as of environmental factors affecting the health of the patient and his caregiver. The four nursing care issues identified included: existing self-care deficit, sensory/perceptual alteration, sleep pattern disturbance, and caregiver role strain. Following Neuman's systems model, primary, secondary, and tertiary prevention were used to strengthen the flexible lines of defense, internal lines of resistance, and supporting existing strengths of both patient and caregiver, as well as to conserve client system energy. Significant improvements in patient and caregiver abilities were apparent in nursing intervention outcomes. This experience shows the Neuman's systems model to be an efficient model in psychiatric nursing care.

  7. [Studies of risk factors and preventive care for neuroleptic malignant syndrome].

    Science.gov (United States)

    Tanii, Hisashi

    2006-11-01

    Neuroleptic malignant syndrome (NMS) is a life-threatening complication of anti-psychotic treatment and can occur any time during the course of treatment. Since NMS can occur in any subject treated with anti-psychotic drugs, causing senously adverse side effects, prevention of NMS is one of the most important issues in clinical psychiatry. Although therapeutic guidelines for NMS have been proposed and gradually put in place, the pathogenesis has not been fully elucidated. Prevention of NMS consists of three approaches: removal of pathogenetic factors, understanding of initial symptoms and consideration of the administration of preventive drugs. Risk factors for NMS are inherited factors, individual factors and environmental factors. The overlapping of these factors might lead to fulminant NMS. These risk factors such as environmental factors are enumerated in DSM-IV. We meta-analyzed the case-control studies of the risk factors for NMS, because the evaluation of each risk factor has not been studied yet. The results were as follows: mental retardation, psychiatric manifestations such as agitation and excitement as individual factors. High dosage administration, rapid increase and parenteral administration of antipsychotic drugs are the drug factors. It is hopeful to give preventive care, such as precautionary measurement of autonomic dysfunction, and treatment to these groups at high risk for NMS.

  8. The skin conductance orienting response in neuroleptic-free schizophrenics: replication of the scoring criteria effect.

    Science.gov (United States)

    Levinson, D F; Edelberg, R; Maricq, H R

    1985-06-01

    It has been suggested that the use of invalid scoring criteria might be responsible for the finding of excessive nonhabituation of the skin conductance orienting response (SCOR) in schizophrenia. Certain criteria may confuse SCOR and spontaneous SC activity in subjects with high rates of the latter (Levinson et al. 1984). To replicate this finding, data were reanalyzed from a study of 25 neuroleptic-free schizophrenic patients and 23 normal male subjects. Analysis of response latency and amplitude during a habituation paradigm of 11 78.5-dB tones confirmed the predictions. Broad scoring criteria (SCOR onset 1-5 sec poststimulus, and a three-no-response-trials habituation criterion) produced significantly different habituation scores than more restrictive criteria (1.6-3.0 sec latency window and a two-trials habituation criterion). Nonhabituation was scored in five patients and six normals by the former criteria, but in no patient and one normal by the latter. Nonhabituators, defined by using the broad criteria, had higher rates of spontaneous activity. The narrow latency window contained significantly more responses than could be explained by the spontaneous activity rate, but this was not true for the added time permitted by the broad window. It is concluded that the use of more restrictive scoring criteria may help to clarify the validity of SCOR nonresponse or hyporesponse as a marker for a type of schizophrenic illness.

  9. Depot medroxyprogesterone in the management of benign prostatic hyperplasia.

    Science.gov (United States)

    Onu, P E

    1995-01-01

    The effects of depot medroxyprogesterone (DMPA), a 5 alpha-reductase, luteinizing-hormone release and human androgen receptor adhesion inhibitor, were assessed in 80 patients with benign prostatic hyperplasia (BPH) in a double-blind, placebo-controlled study. Patients were randomized to DMPA 150 mg single-dose intramuscular injection or placebo in a similar fashion. The following changes were seen with DMPA after 3 months (duration of DMPA effect): (1) serum testosterone reached castration levels within 3 days as compared to no changes in the placebo group; (2) the prostate volume was reduced by 25% compared to a 3% decrease with placebo (p < 0.001); (3) maximum urinary-flow rates increased by 3.7 ml/s compared to placebo (p < 0.001); (4) total urinary symptom scores decreased by 4.9 points compared to a nonsignificant decrease with placebo (p < 0.005). There was a 2.5-point decrease in irritative symptoms (urinary frequency, nocturia and urgency) as compared to a nonsignificant decrease with placebo (p < 0.005). After 3 months, the urinary symptoms and urodynamic changes were reversed but significantly greater than the baseline values (p < 0.001). The prostates showed regrowth to the initial sizes within 18-36 weeks. DMPA was better tolerated, except for a higher incidence of impotence, decreased libido and ejaculatory disorders, than in the placebo group. The quality of life is improved with DMPA since it did not produce hot flashes. It was concluded that single-dose DMPA 150 mg is a safe and effective treatment for prostatic obstruction where potency is a secondary consideration.

  10. Bone density in women receiving depot medroxyprogesterone acetate for contraception.

    Science.gov (United States)

    Cundy, T; Evans, M; Roberts, H; Wattie, D; Ames, R; Reid, I R

    1991-01-01

    OBJECTIVE--To determine if the use of the injectable contraceptive depot medroxyprogesterone (DMPA), which reduces ovarian oestrogen production, is associated with changes in bone density. DESIGN--Population study. DMPA users were compared with two control groups selected from larger population studies and individually matched for several putative determinants of bone density (age, race, body mass index, and years of oestrogen deficiency). Controls and DMPA users were matched without prior knowledge of their bone density measurements. SETTING--Teaching hospital and community family planning clinics. SUBJECTS--30 current users of DMPA with a minimum five years' previous use, 30 premenopausal controls, and 30 postmenopausal controls. MAIN OUTCOME MEASURE--Lumbar spine and femoral neck bone mineral density assessed by dual energy x ray absorptiometry. RESULTS--Compared with premenopausal controls matched for age, race, and body mass index, DMPA users had significantly reduced bone density in the lumbar spine (mean difference 7.5% (95% confidence interval 1.9% to 13.1%), p = 0.002) and in the femoral neck (6.6%, (0.8% to 12.3%), p = 0.007). Compared with postmenopausal controls matched for body mass index and duration of oestrogen deficiency, DMPA users had greater bone density in the lumbar spine (8.9% (4.3% to 13.5%), p = 0.001), but in the femoral neck the difference in bone density was less (4.0% (-0.4% to 8.5%), p = 0.04). CONCLUSIONS--Women using DMPA have bone density values intermediate between those of normal premenopausal and postmenopausal controls; thus, the degree of oestrogen deficiency induced by DMPA may have an adverse effect on bone density. PMID:1830502

  11. Association of Postpartum Predischarge Depot-Medroxyprogesterone Acetate with In-Hospital Breastfeeding Initiation.

    Science.gov (United States)

    Chen, Dinah; Fuell Wysong, Elena; Li, Hong; Perriera, Lisa; Furman, Lydia

    2016-12-01

    The primary aim of this study was to examine the association between postpartum predischarge depot-medroxyprogesterone acetate (ppDMPA) and in-hospital breastfeeding initiation, and the secondary exploratory aim was to determine if any racial disparities are associated with ppDMPA receipt or its relationship to breastfeeding initiation. We conducted a cross-sectional retrospective chart review of maternal and newborn records at a large urban academic medical center. Variables extracted included in-hospital feeding choice, obstetrical and sociodemographic variables, infant characteristics, and ppDMPA receipt. The association of ppDMPA and maternal-child characteristics with breastfeeding initiation was examined using logistic regression analysis. Among singleton live births of 919 mother-infant pairs (76.5% African American [AA]), 67% initiated breastfeeding (34% exclusive and 33% mixed) and 31.4% received ppDMPA. Breastfeeding rates differed significantly between AA (60.7%) and non-AA mothers (86.6%), and ppDMPA also differed significantly between AA (37.6%) and non-AA mothers (11.6%). Adjusting for other independent predictors, mothers who received ppDMPA were 1.5 times more likely not to initiate breastfeeding if AA, and 5.2 times more likely not to initiate breastfeeding if non-AA. ppDMPA receipt was independently associated with decreased rates of breastfeeding initiation. Although more AA mothers received ppDMPA than non-AA, the association of ppDMPA with breastfeeding noninitiation was stronger in non-AA than in AA mothers. Future research should examine this question prospectively to ascertain if there is a cause-effect relationship and should address both physiological effects and social perceptions.

  12. Artificial intelligence technology assessment for the US Army Depot System Command

    Energy Technology Data Exchange (ETDEWEB)

    Pennock, K A

    1991-07-01

    This assessment of artificial intelligence (AI) has been prepared for the US Army's Depot System Command (DESCOM) by Pacific Northwest Laboratory. The report describes several of the more promising AI technologies, focusing primarily on knowledge-based systems because they have been more successful in commercial applications than any other AI technique. The report also identifies potential Depot applications in the areas of procedural support, scheduling and planning, automated inspection, training, diagnostics, and robotic systems. One of the principal objectives of the report is to help decisionmakers within DESCOM to evaluate AI as a possible tool for solving individual depot problems. The report identifies a number of factors that should be considered in such evaluations. 22 refs.

  13. Multi-depot Vehicle Routing Problem with Pickup and Delivery Requests

    Science.gov (United States)

    Sombuntham, Pandhapon; Kachitvichyanukul, Voratas

    2010-10-01

    This paper considers a multi-depot vehicle routing problem with pickup and delivery requests. In the problem of interest, each location may have goods for both pickup and delivery with multiple delivery locations that may not be the depots. These characteristics are quite common in industrial practice. A particle swarm optimization algorithm with multiple social learning structures is proposed for solving the practical case of multi-depot vehicle routing problem with simultaneous pickup and delivery and time window. A new decoding procedure is implemented using the PSO class provided in the ETLib object library. Computational experiments are carried out using the test instances for the pickup and delivery problem with time windows (PDPTW) as well as a newly generated instance. The preliminary results show that the proposed algorithm is able to provide good solutions to most of the test problems.

  14. A 3/2-Approximation Algorithm for Multiple Depot Multiple Traveling Salesman Problem

    Science.gov (United States)

    Xu, Zhou; Rodrigues, Brian

    As an important extension of the classical traveling salesman problem (TSP), the multiple depot multiple traveling salesman problem (MDMTSP) is to minimize the total length of a collection of tours for multiple vehicles to serve all the customers, where each vehicle must start or stay at its distinct depot. Due to the gap between the existing best approximation ratios for the TSP and for the MDMTSP in literature, which are 3/2 and 2, respectively, it is an open question whether or not a 3/2-approximation algorithm exists for the MDMTSP. We have partially addressed this question by developing a 3/2-approximation algorithm, which runs in polynomial time when the number of depots is a constant.

  15. Non-opiate [beta]-endorphin fragments and dopamine--III [gamma]-type endorphins and various neuroleptics counteract the hypoactivity elicited by injection of apomorphine into the nucleus accumbens

    NARCIS (Netherlands)

    Ree, J.M. van; Caffe, A.R.; Wolterink, G.

    1982-01-01

    The hypoactivity in rats induced by small doses of apomorphine, injected bilaterally into the nucleus accumbens area of the brain, could be antagonized by pretreatment with the neuroleptic-like neuropeptide des-enkephalin-γ-endorphin (DEγE, β-endorphin 6–17) as well as with the neuroleptic drugs hal

  16. Examining a Paradigm Shift in Organic Depot-Level Software Maintenance for Army Communications and Electronics Equipment

    Science.gov (United States)

    2015-05-30

    Examining a Paradigm Shift in Organic Depot-Level Software Maintenance for Army Communications and Electronics Equipment Randolph L...functional realignment of maintenance responsibilities. The results indicate that this paradigm shift in software maintenance responsibilities is...of communications and electronics equipment, can CECOM continue to operate under a paradigm of two distinct depots for software and hardware

  17. Are depot as effective as oral antipsychotics on first-episode psychosis?

    Science.gov (United States)

    Orus, Cristián; Aceituno, David

    2016-05-23

    Depot antipsychotics have been generally used in patients with chronic schizophrenia with adherence problems to oral therapy. However, it has been suggested they can be a good alternative in earlier stages too. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including two pertinent randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is not clear whether there are differences between depot and oral antipsychotics in first-episode psychosis because the certainty of the available evidence is very low.

  18. Neuroleptic malignant syndrome induced by combination therapy with tetrabenazine and tiapride in a Japanese patient with Huntington's disease at the terminal stage of recurrent breast cancer.

    Science.gov (United States)

    Nozaki, Ichiro; Furukawa, Yutaka; Kato-Motozaki, Yuko; Ikeda, Tokuhei; Tagami, Atsuro; Takahashi, Kazuya; Ishida, Chiho; Komai, Kiyonobu

    2014-01-01

    We herein describe the case of an 81-year-old Japanese woman with neuroleptic malignant syndrome that occurred 36 days after the initiation of combination therapy with tiapride (75 mg/day) and tetrabenazine (12.5 mg/day) for Huntington's disease. The patient had been treated with tiapride or tetrabenazine alone without any adverse effects before the administration of the combination therapy. She also had advanced breast cancer when the combination therapy was initiated. To the best of our knowledge, the occurrence of neuroleptic malignant syndrome due to combination therapy with tetrabenazine and tiapride has not been previously reported. Tetrabenazine should be administered very carefully in combination with other neuroleptic drugs, particularly in patients with a worsening general condition.

  19. Effects of acute and long-term typical or atypical neuroleptics on morphine-induced behavioural effects in mice.

    Science.gov (United States)

    Hollais, André W; Patti, Camilla L; Zanin, Karina A; Fukushiro, Daniela F; Berro, Laís F; Carvalho, Rita C; Kameda, Sonia R; Frussa-Filho, Roberto

    2014-03-01

    1. It has been suggested that the high prevalence of drug abuse in schizophrenics is related to chronic treatment with typical neuroleptics and dopaminergic supersensitivity that develops as a consequence. Within this context, atypical neuroleptics do not seem to induce this phenomenon. In the present study, we investigated the effects of acute administration or withdrawal from long-term administration of haloperidol and/or ziprasidone on morphine-induced open-field behaviour in mice. 2. In the first experiment, mice were given a single injection of haloperidol (1 mg/kg, i.p.) or several doses of ziprasidone (2, 4 or 6 mg/kg, i.p.) and motor activity was quantified by the open-field test. The aim of the second experiment was to verify the effects of an acute injection of haloperidol (1 mg/kg) or ziprasidone (6 mg/kg) on 20 mg/kg morphine-induced behaviours in the open-field test. In the third experiment, mice were treated with 1 mg/kg haloperidol and/or 2, 4 or 6 mg/kg ziprasidone for 20 days. Seventy-two hours after the last injection, mice were injected with 20 mg/kg, i.p., morphine and then subjected to the open-field test. Acute haloperidol or ziprasidone decreased spontaneous general activity and abolished morphine-induced locomotor stimulation. 3. Withdrawal from haloperidol or ziprasidone did not modify morphine-elicited behaviours in the open-field test. The results suggest that withdrawal from neuroleptic treatments does not contribute to the acute effect of morphine in schizophrenic patients.

  20. The consolidation of neuroleptic therapy: Janssen, the discovery of haloperidol and its introduction into clinical practice.

    Science.gov (United States)

    López-Muñoz, Francisco; Alamo, Cecilio

    2009-04-29

    The discovery of haloperidol at the end of the 1950s constitutes one of the greatest advances of 20th century psychiatry. This antipsychotic drug has their origin in the research process of central analgesic molecules derived from pethidine and methadone, carried out by the Belgian company Janssen Phamaceutica. After the synthesis of phenoperidine, numerous analogues of this compound were studied, and chemists at Janssen took the decision to substitute the propiophenone group for a butyrophenone group. One of these compounds went the R-1625, a stronger agent with specifically neuroleptic properties but lacking morphine-like activity. This substance was synthesized on the 11th February 1958 and received the generic name of haloperidol because of the two halogenated substitutes incorporated into the molecule. Clinical development of haloperidol was conducted, primarily, by psychiatric research team at the University of Liège that confirmed its efficacy in the treatment of various psychiatric disorders such as acute and chronic paranoid psychosis, mania, or chronic treatment-resistant schizophrenia. Under the brand name Haldol((R)), haloperidol was licensed and marketed in Belgium in October 1959. The direct and differed consequences of its introduction into the psychiatric practice have been multiple, involving different areas of socio-sanitary reality. Moreover, haloperidol has contributed substantially to the development of biological psychiatry and currently neuroscience, because it made possible the development of new experimental models for predicting the effects of antipsychotics, and allowed the postulate of the firsts biological hypotheses about the schizophrenia etiology. Haloperidol has been included in the World Health Organisation's list of essential medicines.

  1. CB1 cannabinoid receptors are involved in neuroleptic-induced enhancement of brain neurotensin

    Directory of Open Access Journals (Sweden)

    Parichehr Hassanzadeh

    2014-03-01

    Full Text Available Objective(s: Targeting the neuropeptide systems has been shown to be useful for the development of more effective antipsychotic drugs. Neurotensin, an endogenous neuropeptide, appears to be involved in the mechanism of action of antipsychotics. However, the available data provide conflicting results and the mechanism(s by which antipsychotics affect brain neurotensin neurotransmission have not been identified. Therefore, we aimed to investigate the effects of fluphenazine and amisulpride on brain regional contents of neurotensin considering the role of cannabinoid CB1 receptors which interact with neurotensin neurotransmission. Materials and Methods:Fluphenazine (0.5, 1, and 3 mg/kg or amisulpride (3, 5, and 10 mg/kg were administered intraperitoneally to male Wistar rats either for one day or 28 consecutive days.Twenty four hours after the last injection of drug or vehicle, neurotensin contents were determined in the mesocorticolimbic and nigrostriatal dopamine regions by radioimmunoassay. In the case of any significant change, the effect of pre-treatment with CB1 receptor antagonist, AM251 was investigated. Results:Chronic, but not acute, treatment with the highest dose of fluphenazine or amisulpride resulted in significant enhancement of neurotensin contents in the prefronatal cortex and nucleus accumbens. Fluphenazine also elevated neurotensin levels in the anterior and posterior caudate nuclei and substantia nigra. Neither amisulpride nor fluphenazine affected neurotensin contents in the amygdala or hippocampus. Pre-treatment with AM251 (3 mg/kg prevented the neuroleptic-induced elevation of neurotensin. AM251 showed no effect by itself. Conclusion:The brain neurotensin under the regulatory action of CB1 receptors is involved in[T1]  the effects of amisulpride and fluphenazine.

  2. [Neuroleptic malignant syndrome associated with the syndrome of inappropriate secretion of antidiuretic hormone].

    Science.gov (United States)

    Yamaguchi, K; Takamoto, K; Yagi, K; Tanabe, H

    1995-02-01

    We reported a case of neuroleptic malignant syndrome (NMS) associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). A 71-year-old woman, who had been diagnosed as hypertension and multiple cerebral infarction, was given sulpiride 150 mg daily for depressive state. Three days after started sulpiride, she developed fever, sweating, difficulty of movement and was admitted to the hospital. The white blood cell count rose to 16,300/mm3 and serum creatine kinase (CK) to 3,063 IU/L. Two days later CK rose to 20,050 IU/L regardless of stopping the drug, so she was transferred to our hospital for further investigation. On admission, it was the 6th day from the onset, she was mute and akinetic accompanied by muscle pain and rigidity in extremities. Serum CK was 1,831 IU/L, Na 122 mEq/L, osmolality 244 mOsm/kg, plasma antidiuretic hormone (ADH) level 6.5 pg/ml and urine Na was 101 mEq/L, osmolality 467 mOsm/kg. Renal and adrenal functions, plasma renin activity were normal. From the history, course and these data, diagnosis of NMS associated with SIADH was made. Intravenous sodium (130-200 mEq/day) and fluids (1,000-1,200 ml/day) were carefully infused. She became active, muscle pain disappeared and rigidity, akinesia decreased. CK, serum Na and osmolality gradually improved to normal. About the transient increase in ADH secretion, we considered that hypothalamic disturbance in NMS might induce leakage of stored ADH from neuroendocrine neurons in it.

  3. Clinical outcome of one-third-dose depot triptorelin is the same as half-dose depot triptorelin in the long protocol of controlled ovarian stimulation

    Directory of Open Access Journals (Sweden)

    Yu Li

    2012-01-01

    Full Text Available Objective: Appropriate dosage of the long-acting depot gonadotrophin releasing hormone (GnRH agonist has not been determined in long protocol for IVF, and one-third-dose depot triptorelin was compared with half-dose in a luteal long protocol of in-vitro fertilization/ intra cytoplasmic sperm injection (IVF/ICSI treatment in this study. Materials and Methods: This is a prospective, randomized, open clinical trial. 100 patients were randomized into two groups. Group I received one-third-dose (1.25 mg depot triptorelin. Group II received half-dose (1.87 mg. The clinical and experimental parameters were compared between the two groups. Results: There was no premature luteinizing hormone (LH surge in both groups. On Day 3-5 of menstrual cycle after down-regulation, fewer patients showed low-level LH (<1.0 IU/L and estradiol (<30 pg/mL in group I (P <0.05. There were fewer oocytes retrieved (P =0.086, fewer total embryos and available embryos for cryopreservation in Group I (P <0.05, while good-quality embryo rate was higher in group I (P <0.05. The length and dose of ovarian stimulation was lower in Group I, but not significantly. The clinical pregnancy (52% versus 40%, implantation (48% versus 37.5%, delivery (46% versus 32%, or live birth (42% versus 32% rates and the abortion (8% versus 20% rates showed no significant differences. Conclusion: Depot triptorelin 1.25 mg can be successfully used with reduced pituitary suppression and lower cost in a long protocol for in-vitro fertilization.

  4. Repeated treatment with (-)-sulpiride plus a low dose of SCH 23390 displays wider neuroleptic activity without inducing dopaminergic supersensitivity.

    Science.gov (United States)

    Dall'Olio, R; Gandolfi, O; Roncada, P; Vaccheri, A; Montanaro, N

    1990-01-01

    Combined treatment with (-)-sulpiride plus a low dose of the D1 receptor antagonist SCH 23390, unlike (-)-sulpiride given alone, blocked rat striatal dopaminergic transmission. Five days after the withdrawal of 21-day repeated administration of the combined treatment, no increase in apomorphine-induced stereotyped behaviour was observed. The results suggest that the combination of a D2 blocker and a low dose of a D1 blocker produces a wider spectrum of neuroleptic activity without an overt risk of inducing dopaminergic behavioural supersensitivity.

  5. Recurrent neuroleptic malignant syndrome due to tiapride and haloperidol: the possible role of D-2 dopamine receptors.

    Science.gov (United States)

    Hermesh, H; Huberman, M; Radvan, H; Kott, E

    1984-11-01

    Two typical recurrent episodes of neuroleptic malignant syndrome (NMS) in the same patient are described. The first episode was caused by a sulpiride derivative, tiapride. This is the first case in which a drug of the benzamide group has been reported to have caused such adverse drug reaction. In the second episode, NMS occurred due to haloperidol in the lowest dose ever reported and was accompanied by highly excessive levels of various muscle enzymes. Involvement of hypothalamic and striatal dopamine system, and particularly of D-2 subtype receptors, is suggested by this case.

  6. [Anesthetic management of a patient with mental disabilities as well as the past history of heat stroke and neuroleptic malignant syndrome].

    Science.gov (United States)

    Takaishi, Kazumi; Nakajo, Nobuyoshi

    2007-09-01

    A 22-year-old man with mental disabilities with the history of neuroleptic malignant syndrome and heat stroke was scheduled for dental treatment under general anesthesia. Heat stroke and neuroleptic malignant syndrome are related to malignant hyperthermia. We suggested the patient and family to undergo preoperative screening tests for malignant hyperthermia susceptibility, but they rejected. We selected slow induction using nitrous oxide, oxygen and sevoflurane to prevent excitement and anxiety for placing a catheter in a peripheral vein. We were very cautious in primary symptoms of malignant hyperthermia, i.e., tachycardia, increased end-tidal carbon dioxide, and rigidity of masseter. In the perioperative period, no complications occurred.

  7. Nanosized sustained-release drug depots fabricated using modified tri-axial electrospinning.

    Science.gov (United States)

    Yang, Guang-Zhi; Li, Jiao-Jiao; Yu, Deng-Guang; He, Mei-Feng; Yang, Jun-He; Williams, Gareth R

    2017-01-27

    Nanoscale drug depots, comprising a drug reservoir surrounded by a carrier membrane, are much sought after in contemporary pharmaceutical research. Using cellulose acetate (CA) as a filament-forming polymeric matrix and ferulic acid (FA) as a model drug, nanoscale drug depots in the form of core-shell fibers were designed and fabricated using a modified tri-axial electrospinning process. This employed a solvent mixture as the outer working fluid, as a result of which a robust and continuous preparation process could be achieved. The fiber-based depots had a linear morphology, smooth surfaces, and an average diameter of 0.62±0.07μm. Electron microscopy data showed them to have clear core-shell structures, with the FA encapsulated inside a CA shell. X-ray diffraction and IR spectroscopy results verified that FA was present in the crystalline physical form. In vitro dissolution tests revealed that the fibers were able to provide close to zero-order release over 36h, with no initial burst release and minimal tailing-off. The release properties of the depot systems were much improved over monolithic CA/FA fibers, which exhibited a significant burst release and also considerable tailing-off at the end of the release experiment. Here we thus demonstrate the concept of using modified tri-axial electrospinning to design and develop new types of heterogeneous nanoscale biomaterials.

  8. A framework for measuring efficiency levels :The case of express depots

    NARCIS (Netherlands)

    Banaszewska, A.; Cruijssen, F.C.A.M.; Dullaert, W.; Lemmen-Gerdessen, van J.C.

    2012-01-01

    The efficiency and effectiveness in any distribution network is largely determined by the performance of depots in such a network. The purpose of this study is to develop a methodological framework to evaluate the performance of distribution centers of express companies. The framework is based on Da

  9. Pharmacodynamic effects of depot-medroxyprogesterone acetate (DMPA) administered to lactating women on their male infants

    NARCIS (Netherlands)

    Virutamasen, P; Leepipatpaiboon, S; Kriengsinyot, R; Vichaidith, P; Muia, PN; SekaddeKigondu, CB; Mati, JKG; Forest, MG; Dikkeschei, LD; Wolthers, BG; dArcangues, C

    Normal postpartum women, who had a spontaneous vaginal delivery of one full-term male infant, free of congenital abnormalities and other diseases, were recruited for this study. Thirteen women received 150 mg depot-medroxyprogesterone acetate (DMPA), intramuscularly on days 42 + 1 and 126 + 1

  10. Terbutaline depot tablets in childhood asthma. A double-blind controlled study

    DEFF Research Database (Denmark)

    Foged, N; Høst, A; Ljungholm, K

    1985-01-01

    . The design of the study was double-blind, cross-over, with a randomized allocation of the drugs. Both drugs improved the lung function significantly. The children had significantly less coughing during the night when they took depot tablets than when they took ordinary tablets. The side effects were few...

  11. Depot-specific differences in perilipin and hormone-sensitive lipase expression in lean and obese

    Directory of Open Access Journals (Sweden)

    Beylot Michel

    2009-12-01

    Full Text Available Abstract Background Mainly dependent on hormone-sensitive lipase, lipolysis is differently impaired between fat depots in human obesity. Perilipin A expression is a critical element in adipocyte lipolysis. The present study aimed at comparing expression and subcellular distribution of perilipin and hormone-sensitive lipase in two abdominal adipose tissues of lean and obese women. We examined whether regional differences in perilipin expression contribute to impaired lipolytic rates. Methods Abdominal subcutaneous and omental adipose tissues were obtained from six lean and ten obese women. We measured total protein content and relative distribution of hormone-sensitive lipase and perilipin proteins between lipid and non-lipid fractions in tissue homogenates. Hormone-sensitive lipase and perilipin mRNA levels, adipocyte size, basal (non-stimulated and noradrenaline-stimulated lipolysis in isolated adipocytes were determined. Results Adipocytes were significantly larger in the obese versus the lean women and in subcutaneous versus omental fat. Expressed as a function of cell number, basal lipolysis and noradrenaline responsiveness were higher in subcutaneous versus omental adipocytes from the obese women (P Conclusion In both fat depots, a reduced perilipin protein expression was observed in women obesity. Perilipin protein level may contribute to differences in basal lipolysis and in adipocyte size between fat depots and may regulate lipid accumulation in adipocytes. Differences in hormone-sensitive lipase subcellular distribution were reported between fat depots in the obese women.

  12. Tests of the higher order turbulence model for atmospheric circulations (HOTMAC) at Deseret Chemical Depot

    Energy Technology Data Exchange (ETDEWEB)

    Costigan, K.R.

    1998-11-01

    Deseret Chemical Depot is one of the US Army`s storage facilities for its stockpile of chemical weapon agents. Congress has directed the Department of Defense to eliminate the aging stockpiles, which have existed since the end of World War II, and the US Army is destroying these lethal chemical munitions. Although the danger is slight, accurate predictions of the wind field in the valley are necessary for dispersion calculations in the event of an accident involving toxic chemicals at the depot. There are several small communities in Rush and Tooele valleys, including the town of Tooele, and Salt Lake City is located 65 km to the Northeast of Deseret Chemical Depot South area, at 1,300 m MSL and beyond the Oquirrh Mountains. The purpose of this report is to carry out three-dimensional numerical simulations of the atmospheric circulations in the region around Deseret Chemical Depot with the Higher Order Turbulence Model for Atmospheric Circulations (HOTMAC) and to evaluate the performance of the model. The code had been modified to assimilate local meteorological observations through the use of Newtonian nudging. The nudging scheme takes advantage of the extensive network of local observations in the valley.

  13. Pharmacodynamic effects of depot-medroxyprogesterone acetate (DMPA) administered to lactating women on their male infants

    NARCIS (Netherlands)

    Virutamasen, P; Leepipatpaiboon, S; Kriengsinyot, R; Vichaidith, P; Muia, PN; SekaddeKigondu, CB; Mati, JKG; Forest, MG; Dikkeschei, LD; Wolthers, BG; dArcangues, C

    1996-01-01

    Normal postpartum women, who had a spontaneous vaginal delivery of one full-term male infant, free of congenital abnormalities and other diseases, were recruited for this study. Thirteen women received 150 mg depot-medroxyprogesterone acetate (DMPA), intramuscularly on days 42 + 1 and 126 + 1 postpa

  14. Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long-acting intramuscular injections: a qualitative study.

    Science.gov (United States)

    Smith, James Paul; Herber, Oliver Rudolf

    2015-06-01

    The ethical issues experienced by mental health nurses in administering antipsychotic depot and long-acting intramuscular injections (LAI) were explored in the present study. Mental health nurses face ethically-difficult situations when administering these medications. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical issues involved in performing the procedure. Purposive and snowball sampling was used to select eight participants from two mental health hospitals. Semistructured interviews were carried out to collect data. A thematic analysis was conducted on the data. The four main themes that emerged from the analyses were: (i) lack of alternatives; (ii) safety; (iii) feeling uncomfortable; and (iv) difficulty maintaining the therapeutic relationship. The findings suggest that mental health nurses face ethical challenges in administering LAI. The findings raise much needed awareness of the need for mental health nurses and nurse educators to consider the ethical issues experienced while performing the procedure. There is a need for nurse education providers and organizations to provide opportunities for mental health nurses to address their 'lived experiences'. Educational courses are needed to equip mental health nurses with the technical and critical thinking skills to administer safe and effective antipsychotic depot and LAI.

  15. Intermediate affinity and potency of clozapine and low affinity of other neuroleptics and of antidepressants at H3 receptors.

    Science.gov (United States)

    Kathmann, M; Schlicker, E; Göthert, M

    1994-12-01

    It was the aim of the present study to determine the affinities of four neuroleptics and five antidepressants for histamine H3 receptors. In rat brain cortex membranes, the specifically bound [3H]-N alpha-methylhistamine was monophasically displaced by clozapine (pKi 6.15). The other drugs did not completely displace the radioligand even at 100 microM; the pKi values were: haloperidol (4.91); sulpiride (4.73); amitriptyline (4.56); desipramine (4.15); levomepromazine (4.14); fluovoxamine (4.13); maprotiline (4.09); moclobemide (H3 receptor model, i.e., in superfused mouse brain cortex slices preincubated with [3H]-noradrenaline. The electrically evoked tritium overflow was not affected by clozapine 0.5-32 microM. However, clozapine shifted the concentration-response curve of histamine for its inhibitory effect on the evoked overflow to the right, but did not affect the maximum effect of histamine. The Schild plot yielded a pA2 value of 6.33. In conclusion, clozapine shows an intermediate affinity and potency (as a competitive antagonist) at H3 receptors. The Ki value of clozapine at H3 receptors resembles its Ki value at D2 receptors (the target of the classical neuroleptics), but is higher than its Ki values at D4, 5-HT2 or muscarinic acetylcholine receptors, which according to current hypotheses, might be involved in the atypical profile of clozapine.

  16. (*) Central Growth Factor Loaded Depots in Bone Tissue Engineering Scaffolds for Enhanced Cell Attraction.

    Science.gov (United States)

    Quade, Mandy; Knaack, Sven; Akkineni, Ashwini Rahul; Gabrielyan, Anastasia; Lode, Anja; Rösen-Wolff, Angela; Gelinsky, Michael

    2017-08-01

    Tissue engineering, the application of stem and progenitor cells in combination with an engineered extracellular matrix, is a promising strategy for bone regeneration. However, its success is limited by the lack of vascularization after implantation. The concept of in situ tissue engineering envisages the recruitment of cells necessary for tissue regeneration from the host environment foregoing ex vivo cell seeding of the scaffold. In this study, we developed a novel scaffold system for enhanced cell attraction, which is based on biomimetic mineralized collagen scaffolds equipped with a central biopolymer depot loaded with chemotactic agents. In humid milieu, as after implantation, the signaling factors are expected to slowly diffuse out of the central depot forming a gradient that stimulates directed cell migration toward the scaffold center. Heparin, hyaluronic acid, and alginate have been shown to be capable of depot formation. By using vascular endothelial growth factor (VEGF) as model factor, it was demonstrated that the release kinetics can be adjusted by varying the depot composition. While alginate and hyaluronic acid are able to reduce the initial burst and prolong the release of VEGF, the addition of heparin led to a much stronger retention that resulted in an almost linear release over 28 days. The biological activity of released VEGF was proven for all variants using an endothelial cell proliferation assay. Furthermore, migration experiments with endothelial cells revealed a relationship between the degree of VEGF retention and migration distance: cells invaded deepest in scaffolds containing a heparin-based depot indicating that the formation of a steep gradient is crucial for cell attraction. In conclusion, this novel in situ tissue engineering approach, specifically designed to recruit and accommodate endogenous cells upon implantation, appeared highly promising to stimulate cell invasion, which in turn would promote vascularization and finally new

  17. Heat shock proteins: in vivo heat treatments reveal adipose tissue depot-specific effects.

    Science.gov (United States)

    Rogers, Robert S; Beaudoin, Marie-Soleil; Wheatley, Joshua L; Wright, David C; Geiger, Paige C

    2015-01-01

    Heat treatments (HT) and the induction of heat shock proteins (HSPs) improve whole body and skeletal muscle insulin sensitivity while decreasing white adipose tissue (WAT) mass. However, HSPs in WAT have been understudied. The purpose of the present study was to examine patterns of HSP expression in WAT depots, and to examine the effects of a single in vivo HT on WAT metabolism. Male Wistar rats received HT (41°C, 20 min) or sham treatment (37°C), and 24 h later subcutaneous, epididymal, and retroperitoneal WAT depots (SCAT, eWAT, and rpWAT, respectively) were removed for ex vivo experiments and Western blotting. SCAT, eWAT, and rpWAT from a subset of rats were also cultured separately and received a single in vitro HT or sham treatment. HSP72 and HSP25 expression was greatest in more metabolically active WAT depots (i.e., eWAT and rpWAT) compared with the SCAT. Following HT, HSP72 increased in all depots with the greatest induction occurring in the SCAT. In addition, HSP25 increased in the rpWAT and eWAT, while HSP60 increased in the rpWAT only in vivo. Free fatty acid (FFA) release from WAT explants was increased following HT in the rpWAT only, and fatty acid reesterification was decreased in the rpWAT but increased in the SCAT following HT. HT increased insulin responsiveness in eWAT, but not in SCAT or rpWAT. Differences in HSP expression and induction patterns following HT further support the growing body of literature differentiating distinct WAT depots in health and disease.

  18. Validation of the Algorithm for Depot TCTO Labor Costs for the Component Support Cost System (D160B).

    Science.gov (United States)

    2014-09-26

    AD-AI5? 461 VALIDATION OF THE ALGORITHM FOR DEPOT TCTO LABOR COSTS / FOR THE COMPONENT.. (U) INFORMATION SPECTRUM INC ARLINGTON VA S J EINHORN 12 APR...U VALIDATION OF THE ALGORITHM FOR DEPOT TCTO LABOR COSTS I FOR C THE COMPONENT SUPPORT COST SYSTEM (D160B) Contract No. F33600-82-C-0543 12 April 1984...tasks," including a user survey. This report provides the verification and validation of the algorithm called "Depot TCTO Labor Costs." The costs of

  19. Brain dysfunction in psychiatric patients during music perception measured by EEG mapping: relation to motor dysfunction and influence of neuroleptic drugs.

    Science.gov (United States)

    Günther, W; Steinberg, R; Streck, P; Banquet, J P; Bscheid, I; Raith, L; Riedel, R; Klages, U; Stiltz, I

    1991-05-01

    reduced to nearly normal by neuroleptic medication. The latter finding may contribute to possible clinical applications of EEG mapping, considering the EEG's unique suitability for long-term brain function monitoring. Other neuroimaging methods like SPECT and PET should be used for additional "external validation".

  20. The effect of financial incentives on adherence to antipsychotic depot medication: does it change over time?

    Science.gov (United States)

    Pavlickova, Hana; Bremner, Stephen A; Priebe, Stefan

    2015-08-01

    A recent cluster-randomized controlled trial found that offering financial incentives improves adherence to long-acting injectable antipsychotics (LAIs). The present study investigates whether the impact of incentives diminishes over time and whether the improvement in adherence is linked to the amount of incentives offered. Seventy-three teams with 141 patients with psychotic disorders (using ICD-10) were randomized to the intervention or control group. Over 1 year, patients in the intervention group received £15 (US $23) for each LAI, while control patients received treatment as usual. Adherence levels, ie, the percentage of prescribed LAIs that were received, were calculated for quarterly intervals. The amount of incentives offered was calculated from the treatment cycle at baseline. Multilevel models were used to examine the time course of the effect of incentives and the effect of the amount of incentives offered on adherence. Adherence increased in both the intervention and the control group over time by an average of 4.2% per quarterly interval (95% CI, 2.8%-5.6%; P time and treatment group. Further, a higher total amount of incentives was associated with poorer adherence (βbootstrapped = -0.11; 95% CIbootstrapped, -0.20 to -0.01; P = .023). A substantial effect of financial incentives on adherence to LAIs occurs within the first 3 months of the intervention and is sustained over 1 year. A higher total amount of incentives does not increase the effect. ISRCTN.com identifier: ISRCTN77769281 and UKCRN.org identifier: 7033. © Copyright 2015 Physicians Postgraduate Press, Inc.

  1. Sexual Dysfunction in Two Types of Hormonal Contraception: Combined Oral Contraceptives versus Depot Medroxyprogesterone Acetate

    Directory of Open Access Journals (Sweden)

    Nourossadat Kariman

    2017-01-01

    Full Text Available Background & aim: Sexual health is an essential element of quality of life, affecting both physical and psychological domains. Hormones used in contraceptive methods have contradictory effects on sexual function. In this study, we aimed to compare sexual function in women using combined oral contraceptives (COC and depot medroxyprogesterone acetate (DMPA, referred to healthcare centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2013. Methods: This descriptive, comparative study was performed on 240 women (n=120 per group, selected through multistage sampling in Tehran, Iran. A questionnaire consisting of three parts, General Health Questionnaire (GHQ-28, demographic characteristics, and Female Sexual Function Index (FSFI, was completed through interviews. For data analysis, descriptive statistics were calculated, and independent t-test, Mann-Whitney test, Chi-square, and Fisher's exact test were performed, using SPPS version 16. P-value less than 0.05 was considered statistically significant. Results: The mean age at marriage in women using DMPA was lower than those using COC (18.55±3.61 vs. 19.92±3.98 years. Based on the findings, the menstrual status in the majority of DMPA users was irregular (46.7% in DMPA group vs. 8.3% in COC group. The difference in sexual function between the COC and DMPA groups was significant. Sexual arousal and lubrication were more favorable in the COC group in comparison with the DMPA group; also, pain in this group was lower than the DMPA group. Scores of total sexual function (27.35±5.22 in DMPA group vs. 29.15±6.13 in COC group, sexual arousal (4.11±0.90 in DMPA group vs. 4.51±1.39 in COC group, and vaginal lubrication (4.82±1.30 in DMPA group vs. 5.26±1.35 in COC group were lower in the DMPA group, compared to the COC group. Pain scores (4.91±1.25 in DMPA group vs. 5.28±1.19 in COC group were higher in the DMPA group in comparison with the COC group (P

  2. In vivo determination of subcutaneous and abdominal adipose tissue depots in German Holstein dairy cattle.

    Science.gov (United States)

    Raschka, C; Ruda, L; Wenning, P; von Stemm, C-I; Pfarrer, C; Huber, K; Meyer, U; Dänicke, S; Rehage, J

    2016-07-01

    Ultrasonography was used as a noninvasive method for quantitative estimation of the subcutaneous and abdominal adipose tissue depots in dairy cattle. The prediction model was created and validated with a total of 29 German Holstein cows; 6 were in early lactation (≤100 d in milk [DIM]) and 16 were in advanced lactation (101 to 292 DIM). Seven cows were nonpregnant and nonlactating and had been off milk for 350 to 450 d. Transcutaneous assessment of the thickness of subcutaneous and retroperitoneal adipose tissue was done at 16 sites on the body surface of all cows. After completion of the ultrasonographic measurements, the cows were slaughtered and the adipose depots were separately weighed. A stepwise multivariate regression analysis of the ultrasonographic variables was performed to estimate the slaughter weights of the different fat depots. Slaughter weights of the fat depots ranged from 5.0 to 43.0 kg for subcutaneous adipose tissue (SCAT), from 13.7 to 98.8 kg for abdominal adipose tissue (AAT), from 3.4 to 30.3 kg for retroperitoneal adipose tissue (RPAT), from 5.2 to 39.6 kg for omental adipose tissue (OMAT), and from 4.0 to 35.8 kg for mesenteric adipose tissue (MAT). The relationship between calculated amount of fat and slaughter weight of fat had coefficients of determination () and root mean square errors (kg) of 0.88 and 3.4, respectively, for SCAT; 0.94 and 6.1, respectively, for AAT; 0.94 and 1.7, respectively, for RPAT; 0.83 and 3.2, respectively, for OMAT; and 0.95 and 1.6, respectively, for MAT. The accuracy of ultrasonographic measurement of the different fat depots appears sufficient for the quantitative assessment of internal and subcutaneous fat stores in cows. This method is noninvasive and therefore allows safe and repeated monitoring of the amount of stored fat in different adipose tissue depots of German Holsteins cows.

  3. Maternal obesity programs increased leptin gene expression in rat male offspring via epigenetic modifications in a depot-specific manner

    Directory of Open Access Journals (Sweden)

    Simon Lecoutre

    2017-08-01

    Conclusions: Consistent with the DOHaD hypothesis, persistent epigenetic remodeling occurs at regulatory regions especially within intergenic sequences, linked to higher leptin gene expression in adult HF offspring in a depot-specific manner.

  4. Effects of ovariectomy and resistance training on lipid content in skeletal muscle, liver, and heart; fat depots; and lipid profile

    National Research Council Canada - National Science Library

    Baldissera, Vilmar; de Andrade Perez, Sérgio Eduardo; Prestes, Jonato; Domingos, Mateus Moraes; Shiguemoto, Gilberto Eiji; Pereira, Guilherme Borges; Bernardes, Celene Fernandes; Duarte, Josiane Oliveira; Leite, Richard Diego

    2009-01-01

    The aim of the present study was to investigate the effects of resistance training on skeletal muscle lipid content, liver lipid content, heart lipid content, fat depots, and lipid profile in ovariectomized rats...

  5. To Ensure the Integrity of the Cryogenic Propellant Depot Tank Within the Expected Radiation and Space Debris Environment Project

    Data.gov (United States)

    National Aeronautics and Space Administration — We intend to develop the technology for lightweight composite structure suitable for both cryogenic fuel depot storage as well as human in-space habitat. These will...

  6. Contraception Insurance Coverage and Receipt of Long-Acting Reversible Contraception or Depot Medroxyprogesterone Acetate on the Day of Abortion.

    Science.gov (United States)

    Krashin, Jamie W; Stuart, Gretchen S; Garrett, Joanne; Spector, Hannah; Bryant, Amy G; Charm, Samantha; Morse, Jessica E

    2017-07-01

    To evaluate whether contraceptive insurance coverage for women who present for an abortion is associated with obtaining long-acting reversible contraception or depot medroxyprogesterone acetate (DMPA) on the day the abortion is completed. We conducted a prospective cohort study of women presenting for medical or surgical abortion at a single health center in North Carolina. Eligible women were 18 years or older and fluent in English or Spanish. Data were from participant questionnaires, medical charts, and financial records. Our main exposure was whether the woman had insurance coverage for contraception at clinic intake. Our primary outcome was receiving DMPA, an intrauterine device, or a contraceptive subdermal implant on the same day of their surgical abortion or at the visit that determined their medication abortion was complete. We used univariable, bivariable, and multivariable analysis to report our findings. Five hundred seventy-five women enrolled in our cohort between September 2015 and April 2016. One hundred twenty-eight (22%) had insurance coverage and 447 (78%) did not. In the group with insurance coverage for contraception, 38% (49/128) received a long-acting reversible contraception method or DMPA compared with 7% (33/447) in the group without insurance coverage for contraception. After adjusting for confounding, women with contraceptive coverage were more than five times as likely to receive immediate postabortion contraception with one of these methods compared with women without coverage (relative risk 5.6, 95% confidence interval 3.8-8.3). Women with contraceptive insurance coverage on the day of their abortion were more likely to leave the abortion clinic with an intrauterine device or implant in place or receive DMPA injection compared with women without coverage.

  7. New contraceptive eligibility checklists for provision of combined oral contraceptives and depot-medroxyprogesterone acetate in community-based programmes.

    Science.gov (United States)

    Stang, A.; Schwingl, P.; Rivera, R.

    2000-01-01

    Community-based services (CBS) have long used checklists to determine eligibility for contraceptive method use, in particular for combined oral contraceptives (COCs) and the 3-month injectable contraceptive depot-medroxyprogesterone acetate (DMPA). As safety information changes, however, checklists can quickly become outdated. Inconsistent checklists and eligibility criteria often cause uneven access to contraceptives. In 1996, WHO produced updated eligibility criteria for the use of all contraceptive methods. Based on these criteria, new checklists for COCs and DMPA were developed. This article describes the new checklists and their development. Several rounds of expert review produced checklists that were correct, comprehensible and consistent with the eligibility requirements. Nevertheless, field-testing of the checklists revealed that approximately half (48%) of the respondents felt that one or more questions still needed greater comprehensibility. These findings indicated the need for a checklist guide. In March 2000, WHO convened a meeting of experts to review the medical eligibility criteria for contraceptive use. The article reflects also the resulting updated checklist. PMID:10994285

  8. Indication of metal homeostasis disturbance in earthworm Eisenia fetida after exposure to semi-solid depot sludge.

    Science.gov (United States)

    Babić, Sanja; Dragun, Zrinka; Sauerborn Klobučar, Roberta; Ivanković, Dušica; Bačić, Niko; Fiket, Željka; Barišić, Josip; Krasnići, Nesrete; Strunjak-Perović, Ivančica; Topić Popović, Natalija; Čož-Rakovac, Rozelindra

    2015-09-01

    Treated sewage sludge is commonly used in agriculture as fertilizer. It is, therefore, necessary to determine possible detrimental influences of sludge application on soil contamination and accumulation of contaminants in tissues of terrestrial animals, which in the long run could also have undesirable effects on humans. With that aim, the study was performed using earthworm Eisenia fetida as test organism and semi-solid depot sludge from a wastewater treatment plant as exposure media. The concentrations of 26 metals/metalloids were determined in depot sludge, and their bioaccumulation was estimated in whole tissue of E. fetida, and for the first time in the soluble tissue fraction, which represents metal fraction available for metabolic requirements and toxic effects. Obtained results have revealed acceptable levels of several elements (Cd, Cr, Cu, Ni, Pb, Zn) in depot sludge, when compared to currently valid regulations, and only moderate accumulation of some elements (e.g. As, Ba, Cd, Co, Fe, Tl, V, and Zn) in earthworms, as a consequence of exposure to depot sludge. However, a concentration increase after exposure to depot sludge was observed in E. fetida for several elements (Cd, Mo, and Zn), which were present in lower concentrations in the exposure mixtures than in soil. Contrary, a concentration decrease was observed for Cs, Mn, and Rb, although they were present in higher concentrations in depot sludge than in soil. It was an indication of disturbance in metal homeostasis in earthworms, possibly caused by exposure to complex mixture of contaminants present in depot sludge. The cumulative effect of exposure to a number of various contaminants (inorganic, organic, microbiological and pharmaceutical), even if each of them was not present in very high concentrations, could have caused distress in earthworms exposed to depot sludge. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. 恶性综合征10例临床分析%Clinical analysis of 10 cases of neuroleptic malignant syndrome

    Institute of Scientific and Technical Information of China (English)

    尹变利; 任向阳; 马聪敏

    2014-01-01

    目的:分析恶性综合征的临床特点,以提高对本病的认识,减少误诊率。方法回顾性分析确诊的10例恶性综合征患者的临床资料,并复习相关文献。结果10例患者中,8例有抗精神病药物服用史,2例不规律服用美多芭,临床表现为发热、肌强直、肌酶增高、意识障碍及自主神经功能障碍,影像学等检查排除其他疾病,综合治疗有效。结论恶性综合征临床少见,多有抗精神病药物服药史,主要与药物影响脑内递质有关,临床表现及肌酶增高为主要的诊断依据,及时治疗大多预后良好。%Objective To analyze the clinical characteristics of neuroleptic malignant syndrome (NMS) in order to improve the cognition of this disease and to reduce misdiagnosis rate.Methods The clinical data of 10 patients diagnosed with NMS were retrospectively analyzed, and the relevant literature was reviewed.Results In the 10 cases, 8 of them had long term of taking antipsychotic medication and 2 of them irregularly took the madopar tablet. Their clinical manifestations were fever, myotonia, increased muscle enzymes, disturbance of consciousness and autonomic nerve dysfunction. Other diseases were ruled out by imaging tests, and the comprehensive treatment was effective. Conclusion NMS is rare in clinic. Patients with NMS usually have a history of taking antipsychotic medication, and the drugs mainly influence the neurotransmitter in brain. Clinical manifestations and increased creatase are the main diagnostic basis for NMS. Prognosis can be good if patient is treated timely.

  10. 不同药物致神经阻滞剂恶性综合征的护理%Nursing of malignant syndrome neuroleptic induced by antipsychotic drugs

    Institute of Scientific and Technical Information of China (English)

    李素琴; 邵志梅; 孙长艳

    2015-01-01

    Objective:To explore the nursing of malignant syndrome neuroleptic induced by antipsychotic drugs. Methods:Clinical features of 44 cases with mental disease were analyzed retrospectively with the Levenson malignant syndrome diagnostic criteria and received supportive nursing. Results:44 cases of patients in the use of high potency antipsychotics appeared with the manifestations of fever,muscle tension,disturbance of consciousness,elevated serum cre-atine kinase and the plant nerve function disorder,obviously,with supportive care in early recognition and stop the medicine promptly and effectively,the dis-ease has been effictively controlled and mitigation. Conclusion:Require medication in patients with nursing staff to understand,especially in the process of the doctor treatment, medicine should focus on monitoring,strengthen the observation after medication. The early detection of abnormal situation timely with-drawal and supportive care,avoid to cause serious adverse reaction.%目的::探讨不同抗精神病药物致神经阻滞剂恶性综合征的护理方法。方法:采用Levenson的恶性综合征诊断标准,对44例精神病患者的临床特征进行回顾性分析,在早期识别和及时停药后进行支持性护理。结果:44例患者在使用高效价抗精神病药物时出现以发热、肌张力增高、意识障碍、血清肌酸磷酸激酶升高以及植物神经功能紊乱等明显的临床表现,在治疗1~4周内,临床症状逐渐消失,病情得到有效控制和缓解。结论:要求护理人员了解患者用药情况,尤其在医师换药、调药的过程中应重点监护,加强患者服药后的观察。早期发现异常情况及时停药并给予支持性护理,避免造成严重不良反应的发生。

  11. An Injectable, Click-Cross-Linked Small Intestinal Submucosa Drug Depot for the Treatment of Rheumatoid Arthritis.

    Science.gov (United States)

    Kim, Kyungsook; Park, Ji Hoon; Park, Seung Hun; Lee, Hye Yun; Kim, Jae Ho; Kim, Moon Suk

    2016-12-01

    Here, a click-cross-linked small intestine submucosa (SIS) drug depot is described for the treatment of rheumatoid arthritis (RA). To the best of the knowledge, there have been no studies related to the intra-articular injection of methotrexate (Met)-loaded click-cross-linkable SIS (Met-loaded Cx-SIS) for RA treatment. As the key objective of this work, injectable formulations of tetrazine-modified SIS (TE-SIS) and transcyclooctene-modified SIS (TC-SIS) are employed as drug depots. Within a few seconds, the simple mixing of equal amounts of TE-SIS and TC-SIS suspensions forms a gelatinous click-cross-linked SIS (Cx-SIS) drug depot in vitro and in vivo. The formed Cx-SIS depot is maintained in the articular joint over an extended period, while SIS alone rapidly disappears. Injectable formulations of Met-loaded Cx-SIS and Met-loaded SIS are prepared and then injected into articular joints to form drug depots. Compared to animals treated with Met-loaded SIS, RA animals treated with Met-loaded Cx-SIS show effective RA repair, as well as extensive regeneration of chondrocytes and glycosaminoglycan deposits. Collectively, these results indicate that the Met-loaded Cx-SIS depot is successfully formed after intra-articular injection of click-cross-linkable SIS, and that this formulation induces long-lasting Met release and allows Met to act effectively in the articular joint, resulting in RA repair.

  12. Effect of Depot Medroxyprogesterone Acetate (DMPA) on Bone Mineral Density in Women of Reproductive Age

    Institute of Scientific and Technical Information of China (English)

    Ling GAI; Jing-lu ZHANG; Hui-zhen ZHANG; Ping GAI; Yong-hong LIU

    2009-01-01

    Objective To compare bone mineral density (BMD) between users of intramuscular depot medroxyprogesterone acetate(DMPA) and nonhormonal control subjects. Methods The study included 68 women aged between 25 and 40 years using depot medroxyprogesterone acetate for 24 months and 59 women aged between 25 and 40 years using nonhormonal contraception as control subjects. BMD of the lumbar spine and femoral neck were obtained using dual energy X-ray absorptiometry. Results At 24 months of treatment, as compared with baseline, the mean BMD in lumbar spine and femoral neck was decreased by 5.5% and 5.9%, respectively. Lumbar spine and femoral neck BMD in women who used DMPA were significantly decreased compared with the subjects in nonuser (P<0.001). Conclusion These results show BMD declined during using DMPA in women aged 25 -40 years old.

  13. Understanding of empty container movement: A study on a bottleneck at an off-dock depot

    Science.gov (United States)

    Zain, Rosmaizura Mohd; Rahman, Mohd Nizam Ab; Nopiah, Zulkifli Mohd; Saibani, Nizaroyani

    2014-09-01

    Port not only function as connections between marine and land transportation but also as core business areas. In a port terminal, available space is limited, but the influx of container is growing. The off-dock depot is one of the key supply chain players that hold empty containers in the inventory. Therefore, this paper aims to identify the main factors of bottlenecks or congestion that hinder the rapid movement of empty containers from the off-dock depot to the customers. Thirty interviews were conducted with individuals who are key players in the container supply chain. The data were analyzed using Atlas.ti software and the analytic hierarchy process to rank the priority factors of bottlenecks. Findings show that several pertinent factors act as barriers to the key players in the container movement in the day-to-day operations. In future studies, strategies to overcome fragmentation in the container supply chain and logistics must be determined.

  14. Optimizing the Shunting Schedule of Electric Multiple Units Depot Using an Enhanced Particle Swarm Optimization Algorithm

    Science.gov (United States)

    Jin, Junchen

    2016-01-01

    The shunting schedule of electric multiple units depot (SSED) is one of the essential plans for high-speed train maintenance activities. This paper presents a 0-1 programming model to address the problem of determining an optimal SSED through automatic computing. The objective of the model is to minimize the number of shunting movements and the constraints include track occupation conflicts, shunting routes conflicts, time durations of maintenance processes, and shunting running time. An enhanced particle swarm optimization (EPSO) algorithm is proposed to solve the optimization problem. Finally, an empirical study from Shanghai South EMU Depot is carried out to illustrate the model and EPSO algorithm. The optimization results indicate that the proposed method is valid for the SSED problem and that the EPSO algorithm outperforms the traditional PSO algorithm on the aspect of optimality. PMID:27436998

  15. Different adipose tissue depots: Metabolic implications and effects of surgical removal.

    Science.gov (United States)

    Marcadenti, Aline; de Abreu-Silva, Erlon Oliveira

    2015-11-01

    Increased adiposity has been associated to worse metabolic profile, cardiovascular disease, and mortality. There are two main adipose tissue depots in the body, subcutaneous and visceral adipose tissue, which differ in anatomical location. A large body of evidence has shown the metabolic activity of adipose tissue; lipectomy and/or liposuction therefore appear to be alternatives for improving metabolic profile through rapid loss of adipose tissue. However, surgical removal of adipose tissue may be detrimental for metabolism, because subcutaneous adipose tissue has not been associated to metabolic disorders such as insulin resistance and type 2 diabetes mellitus. In addition, animal studies have shown a compensatory growth of adipose tissue in response to lipectomy. This review summarizes the implications of obesity-induced metabolic dysfunction, its relationship with the different adipose tissue depots, and the effects of lipectomy on cardiometabolic risk factors. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  16. The contribution of different adipose tissue depots to plasma plasminogen activator inhibitor-1 (PAI-1) levels.

    Science.gov (United States)

    Barnard, Sunelle A; Pieters, Marlien; De Lange, Zelda

    2016-11-01

    Increased plasma plasminogen activator inhibitor-1 (PAI-1) level is considered a mechanistic pathway through which obesity contributes to increased cardiovascular disease risk. Abdominal adipose tissue specifically, is a major PAI-1 source with visceral adipose tissue (VAT), an ectopic fat depot, generally considered to produce more PAI-1 than subcutaneous adipose tissue. However, this does not necessarily lead to increased plasma PAI-1 levels. This review provides an overview of studies investigating the association between body fat distribution and plasma PAI-1 levels. It discusses factors that influence this relationship and also considers the contribution of other tissue to plasma PAI-1 levels, placing the relative contribution of adipose tissue into perspective. In conclusion, the relationship between VAT and plasma PAI-1 levels is not fixed but can be modulated by a number of factors such as the size of the subcutaneous adipose tissue depot, ethnicity, possibly genetics and other obesity-related metabolic abnormalities.

  17. EMERGENCY SUPPLY FOR MULTI-DEPOT PROBLEM IN CERTAIN AND UNCERTAIN CIRCUMSTANCES

    Institute of Scientific and Technical Information of China (English)

    刘春林; 施建军

    2001-01-01

    It is well known that the most prominent characteristic of emergency systems is the limit of time. A scheme must be made in much shorter time, and the retrieval vehicle should be able to reach the emergency site in the earliest time according to the proposed scheme so that the emergency event is dealt with as early as possible. This paper deals with multi-depot problems in two cases: (1) When the duration or time needed by the retrieval vehicle arriving at the emergency site from each depot is a non-negative real number, a single-objective (or min-max) and a two-phase problems on the earliest-emergency-activity-start-time (EEAST) are considered. (2) When the duration is regarded as an interval number, we consider the problem of finding an optimal scheme meeting a given deadline t with maximum possibility (or truth value).

  18. [Preauricular injection of betamethasone depot and acyclovir for the treatment of acute herpes zoster ophthalmicus].

    Science.gov (United States)

    Arenas-Archila, E; Alvizu, F; Muñoz-Sarmiento, D

    2015-04-01

    Several treatments have been described for the management of patients with herpes zoster ophthalmicus (HZO). However, the progress of these patients is usually slow, and many of them develop postherpetic neuritis (PHN). In the present paper, three clinical cases are presented, in which a significant symptomatic improvement was obtained by using a preauricular injection of a mixture of betamethasone depot combined with acyclovir. PHN did not develop in any of them. The preauricular injection of betamethasone depot and acyclovir could be a good alternative for the management of HZO. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Structural change in dopamine D{sub 2} receptor gene in a patient with neuroleptic malignant syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ram, A.; Cao, Q.; Gershon, E.S. [National Institutes of Health, Bethesda, MD (United States)] [and others

    1995-06-19

    Dysfunction of the dopaminergic system has been suggested as a pathogenic mechanism in neuroleptic malignant syndrome. Therefore, we examined the complete coding sequences of the dopamine D{sub 2} receptor (DRD2) gene for structural abnormalities in 12 patients with a history of NMS, including two cases of familial NMS. Mutational analysis was performed by denaturing gradient gel electrophoresis (DGGE), a highly sensitive technique for detecting sequence differences. We found in one patient with a history of NMS a nucleotide substitution at codon 310 (CCG{r_arrow}TCG) of exon 7 of the DRD2 gene which predicts the replacement of proline to serine in the third cytoplasmic loop of the receptor, a part of the receptor that interacts with G-proteins. A larger series of patients with NMS needs to be investigated to establish whether this allele is associated with an increased susceptibility to NMS. 25 refs., 1 fig.

  20. Single photon emission computed tomography with [sup 123]I-IMP in three cases of the neuroleptic malignant syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Nisijima, K. (Dept. of Psychiatry, Jichi Medical School, Tochigi-Ken (Japan)); Matoba, M. (Dept. of Psychiatry, Jichi Medical School, Tochigi-Ken (Japan)); Ishiguro, T. (Dept. of Psychiatry, Jichi Medical School, Tochigi-Ken (Japan))

    1994-05-01

    Single photon emission computed tomography (SPECT) perfusion brain scans using [sup 123]I-N-isopropyl-p-iodoamphetamine ([sup 123]I-IMP) were performed in three patients with the neuroleptic malignant syndrome (NMS). In two accumulation was increased in the left basal ganglia and decreased in the right on the early images during the active phase of NMS; this asymmetry was not seen after recovery. In the third patient two examinations were performed during the active phase; on the first, increased accumulation of [sup 123]I-IMP in the left basal ganglia was found on the early images, but on the second, increased accumulation of tracer was found in the right basal ganglia on the delayed images. These abnormalities disappeared after improvement of the NMS. These results suggest that a disturbance in the basal ganglia is related to the development of NMS. (orig.)

  1. A neuroleptic malignant-like syndrome (NMLS) in a patient with Parkinson's disease resolved with rotigotine: a case report.

    Science.gov (United States)

    Fiore, Stefania; Persichino, Lidia; Anticoli, Sabrina; De Pandis, Maria Francesca

    2014-12-17

    Neuroleptic Malignant-Like Syndrome (NMLS) is a rare, but potentially fatal complication of dopaminergic therapy in Parkinson's disease due to a sudden withdrawal of dopaminergic therapy. Here, we describe the case of a 79 years old woman, with 19 years history of Parkinson disease treated with L-dopa, dopamine agonists and MAO inhibitors, whose sudden withdrawal due to lack of therapeutic compliance, led to sudden onset of high fever, muscle rigidity, akinesia, autonomic dysfunction, impaired level of consciousness, respiratory distress and dysphagia with inability to take oral dopaminergic therapy. High blood levels of CPK and myoglobinaemia were found. The patient was treated with transdermal Rotigotine starting from a dose of 2 mg/24 hours, that was rapidly increased to 6 mg/24 hours, leading to resolution of the acute disturbances.

  2. An Archeological Overview and Management Plan for Tooele Army Depot North and South

    Science.gov (United States)

    1984-03-29

    is located in the northeast corner of the Depot.- Aside from CAMUS , this is the major activity area on the South Post. The developed portion, located... Albert Sidney Johnston, the officer in charge of an 1857 expedition to Utah, was instructed to find a suitable location for a permanent post near Salt...City: State of Utah. Department of Natural resources, Technical Publication No. 69.* Reagan, Albert B. 1934a. The Shoshone-Gosiute (Goshute), or

  3. Control of Adipocyte Differentiation in Different Fat Depots; Implications for Pathophysiology or Therapy

    Directory of Open Access Journals (Sweden)

    Xiuquan eMa

    2015-01-01

    Full Text Available Adipocyte differentiation and its impact on restriction or expansion of particular adipose tissue depots has physiological and pathophysiological significance in view of the different functions of these depots. Brown or beige fat [BAT] expansion can enhance thermogenesis, lipid oxidation, insulin sensitivity and glucose tolerance; conversely expanded visceral fat [VAT] is associated with insulin resistance, low grade inflammation, dyslipidaemia and cardiometabolic risk. The largest depot, subcutaneous white fat [WAT], has important beneficial characteristics including storage of lipid out of harms way and secretion of adipokines, especially leptin and adiponectin, with positive metabolic effects including lipid oxidation, energy utilisation, enhanced insulin action and an anti-inflammatory role. The absence of these functions in lipodystrophies leads to major metabolic disturbances. An ability to expand WAT adipocyte differentiation would seem an important defence mechanism against the detrimental effects of energy excess and limit harmful accumulation of lipid in ectopic sites, such as liver and muscle.Adipocyte differentiation involves a transcriptional cascade with PPARg being most important in WAT but less so in VAT, with increased angiogenesis also critical. The transcription factor, Islet1, is fairly specific to VAT and in vitro inhibits adipocyte differentiation. The physiological importance of Islet1 requires further study. Basic control of differentiation is similar in BAT but important differences include the effect of PGC-1a on mitochondrial biosynthesis and upregulation of UCP1; also PRDM16 plays a pivotal role in expression of the BAT phenotype.Modulation of the capacity or function of these different adipose tissue depots, by altering adipocyte differentiation or other means, holds promise for interventions that can be helpful in human disease, particularly cardiometabolic disorders associated with the world wide explosion of

  4. Hybrid tabu search for the multi-depot vehicle routing problem

    Science.gov (United States)

    Hu, Shan-Liang

    2010-07-01

    A hybrid tabu search for the multi-depot vehicle routing problem is considered in this paper. The purpose of the proposed approach is to decrease the number of used vehicles and the total travel cost. An extensive numerical experiment was performed on benchmark problem instances available in literature, the computational results are presented to show the high effectiveness and performance of the proposed approaches.

  5. Base Closure and Realignment Act (BRAC) Cleanup Plan, Sacramento Army Depot, Sacramento, California

    Science.gov (United States)

    1995-10-01

    Washington, D.C. Farquhar, F.P. 1965. History of the Sierra Nevada. University of California Press, Berkeley . FEMA (Federal Emergency Management Agency...during Earthquakes. Earthquake Engineering Research Institute: Berkeley , California. 7-6 Sacramento Army Depot California -BRAC Cleanup Plan - Version...SwaffmateAmy Depei Cal~ onda - PAC Cleanu PMan *Versio 2 QO~be 195 Gtognd Suttae Q 0 G S Silty SAND -Light Brown, Moist, Soft. I Fine with Small Pebbles

  6. Vaginal Atrophy following Long-Term Depot Medroxyprogesterone Acetate Use: A Case Report

    Directory of Open Access Journals (Sweden)

    Christie Walker

    2013-01-01

    Full Text Available Depot medroxyprogesterone acetate (DMPA is a commonly used form of contraception, with noncontraceptive benefits for the user. The mode of action is through the suppression of ovulation. It leads to hypoestrogenism which causes dryness of the vagina and dyspareunia. We present in this paper a patient that was very symptomatic with regard to vaginal atrophic changes determined by vaginal cytology. This side effect may become increasingly more common as we see more long-term use of DMPA.

  7. Counting the costs: Comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa

    Directory of Open Access Journals (Sweden)

    Gray Andrew

    2001-06-01

    Full Text Available Abstract Background In South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate (DMPA and norethisterone oenanthate (NET-EN as injectable progestagen-only contraceptives (IPCs, and both products are extensively used. Objectives and Methods Utilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents. Utilisation patterns were analysed by means of a Pareto (ABC analysis of IPCs issued from 4 South African provincial pharmaceutical depots over 3 financial years. A case study from rural KwaZulu-Natal, South Africa, is used to examine utilisation patterns and self-reported side effects experienced by 187 women using IPCs. Results IPCs accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from 2 depots increased over the 3-year period. Since DMPA was cheaper, if all NET-EN clients in the 1999/2000 financial year (annualised had used DMPA, the 4 depots could have saved 4.95 million South African Rands on product acquisition costs alone. The KZN case study showed slightly more NET-EN (54% than DMPA (46% use; no significant differences in self-reported side effects; and that younger women were more likely to use NET-EN than DMPA (p = 0.0001. Conclusions Providing IPCs on the basis of age is not appropriate or cost effective. Rational use of these products should include consideration of the cost of prescribing one over another.

  8. HALF-DOSE DEPOT TRIPTORELIN COMPARABLE TO REDUCED DAILY BUSERELIN: A RANDOMIZED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    L. Safdarian

    2007-09-01

    Full Text Available Pituitary suppression by depot GnRH agonist may be excessive for ovarian stimulation. This study compares the efficacy of a single half-dose depot triptorelin and reduced-dose daily buserelin in a long protocol ICSI/ET. METHODS: A total of 182 patients were randomized into two groups using sealed envelopes. Pituitary desensitization was obtained in group 1 (91 patients with half-dose (1.87 mg depot triptorelin in the mid-luteal phase of their menstrual cycle, and in group 2 (91 patients with standard daily dose (0.5 mg buserelin, which was then reduced to 0.25 mg at the start of human menopausal gonadotropin (HMG stimulation. RESULTS: No significant differences were found among those who received HCG in terms of clinical pregnancy rate (34.4% in both groups, implantation rate (14.8% in group 1 versus 11.1% in group 2, fertilization rate (93.3 versus 95.6%, poor response rate (11.1 versus 6.7%, and miscarriage rate (11.1 versus 7.8%. No significant differences were seen in number of HMG ampoules used, follicles at HCG administration, and oocytes retrieved. The number of days of stimulation was significantly reduced in group 2 (11.2 +/- 1.8 in group 1 versus 10.6 +/- 1.9, p = 0.030. CONCLUSION: A half-dose of depot triptorelin can be successfully used in ovarian stimulation instead of reduced-dose daily buserelin, with more patient comfort and reduced stress and cost of injections.

  9. Preliminary Assessment/Site Investigation: Tooele Army Depot, Utah. Volume 2. South Area

    Science.gov (United States)

    1988-12-29

    Classification) Preliminary Assessment/Site Investigation, Toefle Army Depot., Utah; Volume ’fl-South Area Q2 PERSONAL AUTHOR(S) Andris Lapins CPG, Li 3a...Regulations CERCLA Comprehensive Environmental Response, Compensation and Liability Act CES Civil Engineering Squadron CGW Chemistry Groundwater File CRL...area around s rEAD . 2-12 Low humidity is a characteristic of the valley climate and visibility is generally good. During winter months, however, storm

  10. Extending Depot Length and Intervals for DDG 51 Class Ships: Examining the 72 Month Operational Cycle

    Science.gov (United States)

    2016-01-01

    model that was used in examining the effect of a 72-month cycle on the Arleigh Burke– class destroyer fleet. Chap- ter Seven presents our findings...in improving ship class maintenance management through work package documentation development. They also recognized SURFMEPP’s role in tracking work...Extending Depot Length and Intervals for DDG-51- Class Ships Examining the 72-Month Operational Cycle Roland J. Yardley, Daniel Tremblay, Brian

  11. Using Depot Inventory Position to Determine Transportation Mode of Retrograde Reparable Assets

    Science.gov (United States)

    2005-03-01

    could be used as a factor and shows the serviceable inventory could prove useful as well. 46 In his book The Goal, Eli Goldratt (1992) suggests...process, as this will just waste resources and not speed up the system ( Goldratt , 1992). If the depot is considered the bottleneck based on its... Goldratt , Eliyahu M. The Goa (Second Edition). Great Barrington MA. The North River Press, 1992. Hall, Patricia K. and Paul R. Murphy. “The

  12. Evidence for Environmental Contamination in Residential Neighborhoods Surrounding the Defense Depot of Memphis, Tennessee

    Directory of Open Access Journals (Sweden)

    Cynthia Warrick

    2006-09-01

    Full Text Available An interdisciplinary environmental assessment team from the Howard University Environmental Justice Partnership (HUEJP conducted a site visit and assessment of the Defense Depot of Memphis, Tennessee in February of 2000. This depot was built in the late 1940’s for storage of numerous chemicals and munitions. As the years progressed, many Memphis citizens have grown to believe that the activities and chemical stockpile located at this site have negatively affected the health environment of their residents. There is anecdotal evidence and documentation of numerous cancers and other illnesses in those local territories, and specifically, at the Memphis Depot site. Currently, this depot is closed and in remediation by the local government. Particularly, citizens of the Rozelle community have started a campaign to investigate any signs of exposure pathways to noted health risks. The HUEJP was contacted and asked to investigate the community concerns. Obliging to the request, we aimed to sample at three drainage sites and a residential site, talk to local citizens, and gain any additional information that would be helpful in relieving anxiety in the Rozelle community. Soil, sediment, and water samples were collected and analyzed for total organic carbon, inorganic anions, and heavy metals. These data show that for the four sites sampled, the highest concentrations of organic compounds and heavy metals were located either within a residential area or in an area with a direct transport pathway to the community. Atomic absorption analysis revealed detectable amounts of cadmium, lead and chromium metals at all sites with direct transport pathways into the residential community, with chromium concentrations being far in excess of the EPA standard limits.

  13. Field Demonstration/Validation of Electrolytic Barriers for Energetic Compounds at Pueblo Chemical Depot

    Science.gov (United States)

    2010-01-01

    quantification limit PCD Pueblo Chemical Depot PID photoionization detector PI Principal Investigator PRB permeable reactive barrier PVC Polyvinyl...substrate (lactate) immediately downgradient of the former ponds • Injection of additional emulsified vegetable oil in a series of 10-20 transects...Sale (Wyoming PG-1954). Monitoring wells were constructed of 1-inch PVC pipe and 10-slot well screens. A 20-40 quartz filter sand was installed

  14. DoD Depot-Level Reparable Supply Chain Management: Process Effectiveness and Opportunities for Improvement

    Science.gov (United States)

    2014-01-01

    and reducing the time horizons of firm orders passed to the depots. It could start by shifting all production planning to six-month intervals. After...degree on repair process flow time, and, in some services, retrograde time. This reduces the amount of inventory the closed-loop system needs to meet...We should also note that a disruption in the retrograde pipeline from Iraq to Kuwait and then back to the United States also hampered Figure 4.5

  15. Long-acting neuroleptics used in wildlife management do not impair thermoregulation or physical activity in goats (Capra hircus).

    Science.gov (United States)

    Fick, Linda; Mitchell, Duncan; Fuller, Andrea

    2007-06-01

    Long-acting neuroleptics commonly are used in wildlife management to decrease stress-related mortality in wild animals, but with possible effects on thermoregulation, which may contribute to residual morbidity and mortality. We investigated the effects of haloperidol (0.01, 0.1, 1 mg kg(-1), n=4), zuclopenthixol (0.1, 1, 10 mg kg(-1), n=4) and perphenazine (0.1, 1, 10 mg kg(-1), n=8), as well as control injections of sunflower oil, on body temperature and physical activity of laboratory goats under hot, cold and thermoneutral ambient temperatures. Implanted data loggers continuously recorded abdominal temperature, and data loggers attached externally on the foreleg recorded movement of unrestrained goats, in a climatic chamber at 35 degrees C, 10 degrees C and 22 degrees C. Cycling ambient temperature between 35 degrees C in daytime and 10 degrees C at night time caused a significant increase in amplitude of the circadian rhythm of body temperature in goats given sunflower oil (P=0.0012, unpaired t-test, n=8), but the administration of zuclopenthixol or perphenazine did not affect this change in amplitude (P>0.05, two-way ANOVA, n=4). Mean daily body temperature after administration of zuclopenthixol or perphenazine, and mean daily activity after zuclopenthixol administration, were not significantly different to those after control injections, at any ambient temperature, for the expected duration of drug activity (all P>0.05, two-way ANOVA, n=4). Thermal response indices, and mean activity, during heat, cold or thermoneutral exposure, of goats for 7 h after haloperidol injection, were not significantly different, at any dose or any ambient temperature, to those following control injections (all P>0.05, repeated measures ANOVA, n=4). Long-acting neuroleptics did not impair activity or thermoregulation of goats subjected to inescapable thermal challenges.

  16. A genetically engineered thermally responsive sustained release curcumin depot to treat neuroinflammation.

    Science.gov (United States)

    Sinclair, S Michael; Bhattacharyya, Jayanta; McDaniel, Jonathan R; Gooden, David M; Gopalaswamy, Ramesh; Chilkoti, Ashutosh; Setton, Lori A

    2013-10-10

    Radiculopathy, a painful neuroinflammation that can accompany intervertebral disc herniation, is associated with locally increased levels of the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα). Systemic administration of TNF antagonists for radiculopathy in the clinic has shown mixed results, and there is growing interest in the local delivery of anti-inflammatory drugs to treat this pathology as well as similar inflammatory events of peripheral nerve injury. Curcumin, a known antagonist of TNFα in multiple cell types and tissues, was chemically modified and conjugated to a thermally responsive elastin-like polypeptide (ELP) to create an injectable depot for sustained, local delivery of curcumin to treat neuroinflammation. ELPs are biopolymers capable of thermally-triggered in situ depot formation that have been successfully employed as drug carriers and biomaterials in several applications. ELP-curcumin conjugates were shown to display high drug loading, rapidly release curcumin in vitro via degradable carbamate bonds, and retain in vitro bioactivity against TNFα-induced cytotoxicity and monocyte activation with IC50 only two-fold higher than curcumin. When injected proximal to the sciatic nerve in mice via intramuscular (i.m.) injection, ELP-curcumin conjugates underwent a thermally triggered soluble-insoluble phase transition, leading to in situ formation of a depot that released curcumin over 4days post-injection and decreased plasma AUC 7-fold. © 2013.

  17. A Genetically Engineered Thermally Responsive Sustained Release Curcumin Depot to Treat Neuroinflammation

    Science.gov (United States)

    Sinclair, S. Michael; Bhattacharyya, Jayanta; McDaniel, Jonathan R.; Gooden, David M.; Gopalaswamy, Ramesh; Chilkoti, Ashutosh; Setton, Lori A.

    2014-01-01

    Radiculopathy, a painful neuroinflammation that can accompany intervertebral disc herniation, is associated with locally increased levels of the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα). Systemic administration of TNF antagonists for radiculopathy in the clinic has shown mixed results, and there is growing interest in the local delivery of anti-inflammatory drugs to treat this pathology as well as similar inflammatory events of peripheral nerve injury. Curcumin, a known antagonist of TNFα in multiple cell types and tissues, was chemically modified and conjugated to a thermally responsive elastin-like polypeptide (ELP) to create an injectable depot for sustained, local delivery of curcumin to treat neuroinflammation. ELPs are biopolymers capable of thermally-triggered in situ depot formation that have been successfully employed as drug carriers and biomaterials in several applications. ELP-curcumin conjugates were shown to display high drug loading, rapidly release curcumin in vitro via degradable carbamate bonds, and retain in vitro bioactivity against TNFα-induced cytotoxicity and monocyte activation with IC50 only two-fold higher than curcumin. When injected proximal to the sciatic nerve in mice via intramuscular (i.m.) injection, ELP-curcumin conjugates underwent a thermally triggered soluble-insoluble phase transition, leading to in situ formation of a depot that released curcumin over 4 days post-injection and decreased plasma AUC 7-fold. PMID:23830979

  18. EVALUATION OF LANREOTIDE DEPOT/AUTOGEL EFFICACY AND SAFETY AS A CARCINOID SYNDROME TREATMENT (ELECT): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL.

    Science.gov (United States)

    Vinik, Aaron I; Wolin, Edward M; Liyanage, Nilani; Gomez-Panzani, Edda; Fisher, George A

    2016-09-01

    To evaluate the efficacy and safety of lanreotide depot/autogel 120 mg for the control of carcinoid syndrome (CS) symptoms in patients with neuroendocrine tumors (NETs). This was a 16-week, randomized, double-blind, phase 3 trial (Clinicaltrials.gov: NCT00774930). Patients with/without prior somatostatin analog (SSA) use were randomized to lanreotide depot/autogel 120 mg or placebo every 4 weeks, with access to short-acting octreotide as rescue medication. The primary endpoint was the percentage of days in which short-acting octreotide was used, which was assessed from daily diaries using an analysis of covariance including the stratification variables baseline short-acting octreotide use and frequency of diarrhea/flushing. The proportions of patients experiencing treatment success was a supportive analysis. Adverse events were recorded at all visits. A total of 115 patients were enrolled (lanreotide, n = 59; placebo, n = 56). The adjusted mean (95% confidence interval [CI]) percentage of days with rescue octreotide use (primary endpoint) was significantly lower in the lanreotide (33.7%; 95% CI, 25.0%-42.4%) versus the placebo group (48.5%; 95% CI, 39.6%-57.4%), representing an absolute difference of -14.8% (95% CI, -26.8% to -2.8%; P = .017). The odds ratio of full/partial treatment success (≤3 days short-acting octreotide use weeks 12 to 15) was significantly greater with lanreotide than placebo (2.4; 95% CI, 1.1-5.3; P = .036). No new safety concerns were identified, and lanreotide was well tolerated. Lanreotide depot/autogel is effective for the control of CS symptoms in patients (SSA-naïve or experienced) with NETs. AE = adverse event BMI = body mass index CS = carcinoid syndrome ELECT = Evaluating Lanreotide Efficacy and safety as a Carcinoid-syndrome Treatment HRQoL = health-related quality of life LTOLE = long-term open-label extension NET = neuroendocrine tumor OL = open label SSA = somatostatin analog.

  19. CYP1A2 and CYP2D6 Gene Polymorphisms in Schizophrenic Patients with Neuroleptic Drug-Induced Side Effects.

    Science.gov (United States)

    Ivanova, S A; Filipenko, M L; Vyalova, N M; Voronina, E N; Pozhidaev, I V; Osmanova, D Z; Ivanov, M V; Fedorenko, O Yu; Semke, A V; Bokhan, N A

    2016-03-01

    Polymorphic variants of CYP1A2 and CYP2D6 genes of the cytochrome P450 system were studied in patients with schizophrenia with drug-induced motor disorders and hyperprolactinemia against the background of long-term neuroleptic therapy. We revealed an association of polymorphic variant C-163A CYP1A2*1F of CYP1A2 gene with tardive dyskinesia and association of polymorphic variant 1846G>A CY2D6*4 and genotype A/A of CYP2D6 gene (responsible for debrisoquin-4-hydroxylase synthesis) with limbotruncal tardive dyskinesia in patients with schizophrenia receiving neuroleptics for a long time.

  20. [Circulatory pattern under electro-stimulation-analgesia and neurolept-anaesthesia in the same patient. A comparative study during retinal and vitreous body operations (author's transl)].

    Science.gov (United States)

    Abdulla, W; Sostegno, C; Gärtner, J; Frey, R

    1981-05-01

    The present paper reports a comparative study on circulatory conditions of patients who underwent both electro-stimulation- and neurolept anaesthesia. Investigations were carried out in 20 patients who had operations on the retina or vitreous body, either under neurolept or electro-stimulation anaesthesia, and who had to undergo a second of those, so that both types of anaesthesia were administered in each patient. 50% of the patients were showing polymorbidity which is often observed in elderly persons; 5 of the cases were patients suffering from hypertonia which had previously been treated unsatisfactory. As measure for judging the circulatory conditions under either anaesthetic method, the plain measurable values of systolic and diastolic pressure and heart rate were registered. A statistical evaluation of the anaesthetic records was carried out with special consideration of circulatory stability and each method of anaesthesia in the individual group of patients. Concerning circulatory changes, significant variations on 1%- level were found.

  1. Neuroleptic malignant syndrome associated with haloperidol use in critical care setting: should haloperidol still be considered the drug of choice for the management of delirium in the critical care setting?

    Science.gov (United States)

    Dixit, Deepali; Shrestha, Pranabh; Adelman, Marc

    2013-07-12

    A 48-year-old man was brought to the emergency department because of intoxication. The patient was in respiratory distress, subsequently intubated for airway protection. On hospital day 5, he was diagnosed with delirium. Haloperidol was initiated at 5 mg intravenous every 6 h and titrated up to a dose of 60 mg /day over 5 days. On hospital day 18, his temperature peaked to 107.1°F. Other symptoms included mental status change, muscular rigidity and autonomic dysfunction. Neuroleptic malignant syndrome (NMS) associated with haloperidol was suspected. No other causes for these symptoms were present. Concurrent medications were reviewed and ruled out for possible drug-induced fever. Haloperidol was discontinued and dantrolene and bromocriptine was initiated. The temperature decreased to 102.2°F within 3 h and other symptoms resolved overtime. The temporal relationship between the patient's fever decline with the discontinuation of haloperidol, and improvement with dantrolene and bromocriptine, the diagnosis was believed to be haloperidol-induced NMS.

  2. Prediction of Neurocognitive Deficits by Parkinsonian Motor Impairment in Schizophrenia: A Study in Neuroleptic-Naïve Subjects, Unaffected First-Degree Relatives and Healthy Controls From an Indigenous Population.

    Science.gov (United States)

    Molina, Juan L; González Alemán, Gabriela; Florenzano, Néstor; Padilla, Eduardo; Calvó, María; Guerrero, Gonzalo; Kamis, Danielle; Stratton, Lee; Toranzo, Juan; Molina Rangeon, Beatriz; Hernández Cuervo, Helena; Bourdieu, Mercedes; Sedó, Manuel; Strejilevich, Sergio; Cloninger, Claude Robert; Escobar, Javier I; de Erausquin, Gabriel A

    2016-11-01

    Neurocognitive deficits are among the most debilitating and pervasive symptoms of schizophrenia, and are present also in unaffected first-degree relatives. Also, multiple reports reveal parkisonian motor deficits in untreated subjects with schizophrenia and in first-degree relatives of affected subjects. Yet, the relation between motor and cognitive impairment and its value as a classifier of endophenotypes has not been studied. To test the efficacy of midbrain hyperechogenicity (MHE) and parkinsonian motor impairment (PKM) as predictors of neurocognitive impairment in subjects with or at risk for schizophrenia, that could be used to segregate them from first-degree relatives and healthy controls. Seventy-six subjects with chronic schizophrenia never exposed to antipsychotic medication, 106 unaffected first-degree relatives, and 62 healthy controls were blindly assessed for cognitive and motor function, and transcranial ultrasound. Executive function, fluid intelligence, motor planning, and hand coordination showed group differences. PKM and MHE were significantly higher in untreated schizophrenia and unaffected relatives. Unaffected relatives showed milder impairment, but were different from controls. PKM and MHE predict cognitive impairment in neuroleptic-naive patients with schizophrenia and their unaffected first-degree relatives and may be used to segregate them from first-degree relatives and healthy controls. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  3. Selective action of an atypical neuroleptic on the mechanisms related to the development of cocaine addiction: a pre-clinical behavioural study.

    Science.gov (United States)

    Marinho, Eduardo A V; Oliveira-Lima, Alexandre J; Wuo-Silva, Raphael; Santos, Renan; Baldaia, Marilia A; Hollais, André W; Longo, Beatriz M; Berro, Laís F; Frussa-Filho, Roberto

    2014-04-01

    An increased function in the mesolimbic dopaminergic system has been extensively associated with the rewarding effects of both natural stimuli and drugs of abuse. Thus, dopamine receptor blockers, such as neuroleptic drugs, can be proposed as candidates for potential therapeutic approaches to treat drug dependence. Notwithstanding, this therapeutic potential of neuroleptics critically depends on a selective action on the specific mechanisms related to the development of addiction. We compared the effects of different doses of haloperidol, ziprasidone and aripiprazole (first-, second- and third-generation neuroleptics, respectively) on spontaneous locomotor activity of mice in a novel environment, hyperlocomotion induced by acute cocaine administration and cocaine-induced locomotor sensitization by a two-injection protocol. Whereas high doses of haloperidol abolished the three behavioural paradigms without selectivity, low doses of ziprasidone selectively abolished the development of the behavioural sensitization phenomenon. Finally, low doses of aripiprazole inhibited acute cocaine-induced hyperlocomotion and behavioural sensitization without modifying spontaneous locomotor activity. Thus, aripiprazole at lower doses was the most selective antipsychotic drug concerning the inhibition of the development of behavioural sensitization to cocaine. Because locomotor sensitization in rodents has been proposed to share plastic mechanisms with drug addiction in humans, our data provide relevant suggestions to the clinical practice.

  4. Age-related and depot-specific changes in white adipose tissue of growth hormone receptor-null mice.

    Science.gov (United States)

    Sackmann-Sala, Lucila; Berryman, Darlene E; Lubbers, Ellen R; Zhang, Han; Vesel, Clare B; Troike, Katie M; Gosney, Elahu S; List, Edward O; Kopchick, John J

    2014-01-01

    Growth hormone receptor-null (GHR(-/-)) mice are dwarf, insulin sensitive, and long-lived in spite of increased adiposity. However, their adiposity is not uniform, with select white adipose tissue (WAT) depots enlarged. To study WAT depot-specific effects on insulin sensitivity and life span, we analyzed individual WAT depots of 12- and 24-month-old GHR(-) (/-) and wild-type (WT) mice, as well as their plasma levels of selected hormones. Adipocyte sizes and plasma insulin, leptin, and adiponectin levels decreased with age in both GHR(-) (/-) and WT mice. Two-dimensional gel electrophoresis proteomes of WAT depots were similar among groups, but several proteins involved in endocytosis and/or cytoskeletal organization (Ehd2, S100A10, actin), anticoagulation (S100A10, annexin A5), and age-related conditions (alpha2-macroglobulin, apolipoprotein A-I, transthyretin) showed significant differences between genotypes. Because Ehd2 may regulate endocytosis of Glut4, we measured Glut4 levels in the WAT depots of GHR(-) (/-) and WT mice. Inguinal WAT of 12-month-old GHR(-) (/-) mice displayed lower levels of Glut4 than WT. Overall, the protein changes detected in this study offer new insights into possible mechanisms contributing to enhanced insulin sensitivity and extended life span in GHR(-) (/-) mice.

  5. The Combination of Expert Judgment and GIS-MAIRCA Analysis for the Selection of Sites for Ammunition Depots

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    Ljubomir Gigović

    2016-04-01

    Full Text Available This paper suggests spatial multi-criteria model in order to assist decision makers in the selection of sites which are suitable for ammunition depots (AD. They represent military facilities which have more criteria that need to be matched than civil structures. The proposed model is based on combined use of Geographic information systems (GIS and multi-criteria techniques. The model application is presented in the case study of Carpathian region, the Eastern part of Serbia. The model deals with nine restrictions and six evaluation criteria. Decision Making Trial and Evaluation Laboratory—Analytic Network Process (DEMATEL-ANP multi-criteria techniques are used to determine weight coefficients of evaluation criteria. Along with the above mentioned methods, this paper introduces a new technique for the multi-criteria decision making—MAIRCA (MultiAttributive Ideal-Real Comparative Analysis method. The MAIRCA method is used for the ranking and selection of suitable locations. The results have shown that 45 km2 of the Carpathian region is very suitable for ammunition depot construction. The MAIRCA method chose location L1 as the most appropriate. Sensitivity analysis shows that the model is capable of identifying a suitable ammunition depot location. This approach can be helpful in determining suitable ammunition depot locations in other regions with similar geographic conditions and can also be successfully used for the suitability assessment of existing ammunition depots.

  6. Effects of depot-medroxyprogesterone acetate on the immune microenvironment of the human cervix and endometrium: implications for HIV susceptibility.

    Science.gov (United States)

    Smith-McCune, K K; Hilton, J F; Shanmugasundaram, U; Critchfield, J W; Greenblatt, R M; Seidman, D; Averbach, S; Giudice, L C; Shacklett, B L

    2017-09-01

    Depot-medroxyprogesterone acetate is a commonly used injectable contraceptive that has been associated with an increased risk of HIV acquisition. This study compares effects of depot-medroxyprogesterone acetate on immune parameters from several upper reproductive tract compartments relevant to HIV-1 susceptibility in repetitive samples from 15 depot-medroxyprogesterone acetate users and 27 women not on hormonal contraceptives. Compared with samples from unexposed women in the mid-luteal phase, depot-medroxyprogesterone acetate use was associated with: increased endocervical concentrations of MCP1 and IFNalpha2; decreased endocervical concentrations of IL1beta and IL6; increased proportions of endometrial CD4+ and CD8+ cells expressing the activation marker HLADR; increased density of endometrial macrophages; and decreased density of endometrial regulatory T cells. Unlike previous reports with samples from the vagina, we did not observe increased expression of the HIV co-receptor CCR5 on CD4+ T cells in the endocervix or endometrium. Our results indicate important differences in anatomic compartments regarding mechanisms by which depot-medroxyprogesterone acetate could be associated with increased risk of HIV acquisition, including increased recruitment of macrophages to the endometrium, decreased levels of pro-inflammatory cytokines in the endocervix possibly leading to enhanced susceptibility to viral infection, and activation of endometrial T cells.

  7. 关于抗精神病药致恶性综合征的2例病例讨论及分析%Analysis of two cases of neuroleptic malignant syndrome induced by antipsychotics

    Institute of Scientific and Technical Information of China (English)

    沈学谦

    2015-01-01

    Objective: Cases with Neuroleptic malignant syndrome (NMS) caused by antipsychotics were collected - and the adverse reactions were analyzed. To explore the predisposing factors and clinical features of NMS and provide reference for clinical rational drug use.Method: By tracking patients medical records in our psychiatric department, two cases of NMS were enrolled and treated, . We analyzed the causes, pathogenesis, dosing regimens.Results: With proper treatment, two patients can discharged.Conclusion:Malignant syndrome is a rare, life-threatening adverse reaction to antipsychotic medication.The key of the treatment for NMS lies on early detection, immediately discontinuing antipsychotics medication, timely symptomatic treatment, supportive therapy, and intensive care.%目的:笔者主要是通过收集抗精神病药物使用后出现恶性综合征的病历,并对该不良反应做出处理和分析。探讨恶性综合征的诱发因素及发病特征,为临床合理用药提供参考。方法:跟踪我院精神科住院患者出现恶性综合征的2例病历,分析恶性综合征的发病原因,发病过程,制定给药方案。结果:通过合理治疗,两例患者均能康复出院。结论:恶性综合征是一种与抗精神病药物治疗有关的严重并发症,治疗的关键就在于早期发现、立即停用抗精神病药物,及时对症治疗,支持治疗,加强护理。

  8. Tratamento farmacológico de acatisia induzida por antipsicóticos Pharmacological treatment of neuroleptic-induced akathisia

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    Adriano Resende Lima

    2001-06-01

    Full Text Available INTRODUÇÃO: A acatisia induzida por antipsicóticos é um transtorno de movimento relacionado ao sistema motor e caracterizado por sensação subjetiva de inquietude interna, irritabilidade ou disforia que podem ser intensas. Associa-se à sensação física e objetiva de desassossego e a movimentos não discinéticos. Esse efeito adverso pode predispor à pobre adesão ao tratamento e, conseqüentemente, favorecer recaídas. Assim, a escolha do melhor tratamento contribui para o alívio do sofrimento dos pacientes e favorece o melhor prognóstico. OBJETIVOS: Avaliar a eficácia e a tolerabilidade dos betabloqueadores, benzodiazepínicos e anticolinérgicos, comparados ao placebo e entre si, no tratamento de acatisia induzida por antipsicóticos, independente de idade ou diagnóstico psiquiátrico. MÉTODOS: Todos os estudos controlados, obtidos a partir das estratégias de busca que compararam betabloqueadores de ação central, benzodiazepínicos ou anticolinérgicos ao placebo e entre si, independente de sexo, idade ou diagnóstico psiquiátrico, foram considerados para esta atualização. Até março de 1999, foram consultadas sete bases de dados eletrônicos, sendo também examinadas as referências bibliográficas dos artigos selecionados. RESULTADOS: São apresentados 22 estudos controlados, sendo 13 comparando betabloqueadores, benzodiazepínicos e anticolinérgicos ao placebo e nove comparando diretamente as intervenções entre si. CONCLUSÕES: As três intervenções farmacológicas demonstraram eficácia superior comparadas ao placebo. Betabloqueadores de ação central mostraram-se mais eficazes, quando comparados a betabloqueadores de ação periférica, benzodiazepínicos e anticolinérgicos.INTRODUCTION: Neuroleptic-induced akathisia is a movement disorder related to the motor system characterized by complaints of inner restlessness, mental uneasiness, or dysphoria, all of which can be intense. Restlessness and non

  9. Testosterone depot injection in male hypogonadism: a critical appraisal

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    Aksam A Yassin

    2008-01-01

    Full Text Available Aksam A Yassin1, Mohamed Haffejee21Clinic of Urology/Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany and Department of Urology, Gulf Medical College School of Medicine, Ajman-UAE 2Urology Division at the University of Witwaterstrand & Johannesburg Hospital, Johannesburg, South AfricaAbstract: Testosterone compounds have been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable testosterone esters have been used for treatment, but they generate supranormal testosterone levels shortly after the 2- to 3-weekly injection interval and then testosterone levels decline very rapidly, becoming subnormal in the days before the next injection. The rapid fluctuations in plasma testosterone are subjectively experienced as disagreeable. Testosterone undecanoate is a new injectable testosterone preparation with a considerably better pharmacokinetic profile. After 2 initial injections with a 6-week interval, the following intervals between two injections are almost always 12-weeks, amounting eventually to a total of 4 injections per year. Plasma testosterone levels with this preparation are nearly always in the range of normal men, so are its metabolic products estradiol and dihydrotestosterone. The “roller coaster” effects of traditional parenteral testosterone injections are not apparent. It reverses the effects of hypogonadism on bone and muscle and metabolic parameters and on sexual functions. Its safety profile is excellent due to the continuous normalcy of plasma testosterone levels. No polycythemia has been observed, and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. There was no impairment of uroflow. Testosterone undecanoate is a valuable contribution to the treatment options of androgen deficiency.Keywords: testosterone treatment, testosterone undecanoate, pharmacokinetic profile, clinical efficacy, side effects

  10. Association between 5-HT2A, TPH1 and GNB3 genotypes and response to typical neuroleptics: a serotonergic approach

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    Kampman Olli

    2007-05-01

    Full Text Available Abstract Background Schizophrenia is a common psychiatric disease affecting about 1% of population. One major problem in the treatment is finding the right the drug for the right patients. However, pharmacogenetic results in psychiatry can seldom be replicated. Methods We selected three candidate genes associated with serotonergic neurotransmission for the study: serotonin 2A (5-HT2A receptor gene, tryptophan hydroxylase 1 (TPH1 gene, and G-protein beta-3 subunit (GNB3 gene. We recruited 94 schizophrenia patients representing extremes in treatment response to typical neuroleptics: 43 were good responders and 51 were poor responders. The control group consisted of 392 healthy blood donors. Results We do, in part, replicate the association between 5-HT2A T102C polymorphism and response to typical neuroleptics. In female patients, C/C genotype was significantly more common in non-responders than in responders [OR = 6.04 (95% Cl 1.67–21.93, p = 0.005] or in the control population [OR = 4.16 (95% CI 1.46–11.84, p = 0.005]. TPH1 A779C C/A genotype was inversely associated with good treatment response when compared with non-responders [OR = 0.59 (95% Cl 0.36–0.98, p = 0.030] or with the controls [OR = 0.44 (95% CI 0.23–0.86, p = 0.016], and GNB3 C825T C/T genotype showed a trend-like positive association among the male patients with a good response compared with non-responders [OR = 3.48 (95% Cl 0.92–13.25, p = 0.061], and a clearer association when compared with the controls [OR = 4.95 (95% CI 1.56–15.70, p = 0.004]. Conclusion More findings on the consequences of functional polymorphisms for the role of serotonin in the development of brain and serotonergic neurotransmission are needed before more detailed hypotheses regarding susceptibility and outcome in schizophrenia can be formulated. The present results may highlight some of the biological mechanisms in different courses of schizophrenia between men and women.

  11. Revisiting the 'self-medication' hypothesis in light of the new data linking low striatal dopamine to comorbid addictive behavior.

    Science.gov (United States)

    Awad, A George; Voruganti, Lakshmi L N P

    2015-06-01

    Persons with schizophrenia are at a high risk, almost 4.6 times more likely, of having drug abuse problems than persons without psychiatric illness. Among the influential proposals to explain such a high comorbidity rate, the 'self-medication hypothesis' proposed that persons with schizophrenia take to drugs in an effort to cope with the illness and medication side effects. In support of the self-medication hypothesis, data from our earlier clinical study confirmed the strong association between neuroleptic dysphoria and negative subjective responses and comorbid drug abuse. Though dopamine has been consistently suspected as one of the major culprits for the development of neuroleptic dysphoria, it is only recently our neuroimaging studies correlated the emergence of neuroleptic dysphoria to the low level of striatal dopamine functioning. Similarly, more evidence has recently emerged linking low striatal dopamine with the development of vulnerability for drug addictive states in schizophrenia. The convergence of evidence from both the dysphoria and comorbidity research, implicating the role of low striatal dopamine in both conditions, has led us to propose that the person with schizophrenia who develops dysphoria and comorbid addictive disorder is likely to be one and the same.

  12. Eradicating hepatitis C virus ameliorates insulin resistance without change in adipose depots.

    Science.gov (United States)

    Milner, K-L; Jenkins, A B; Trenell, M; Tid-Ang, J; Samocha-Bonet, D; Weltman, M; Xu, A; George, J; Chisholm, D J

    2014-05-01

    Chronic hepatitis C (CHC) is associated with lipid-related changes and insulin resistance; the latter predicts response to antiviral therapy, liver disease progression and the risk of diabetes. We sought to determine whether insulin sensitivity improves following CHC viral eradication after antiviral therapy and whether this is accompanied by changes in fat depots or adipokine levels. We compared 8 normoglycaemic men with CHC (genotype 1 or 3) before and at least 6 months post viral eradication and 15 hepatitis C antibody negative controls using an intravenous glucose tolerance test and two-step hyperinsulinaemic-euglycaemic clamp with [6,6-(2) H2 ] glucose to assess peripheral and hepatic insulin sensitivity. Magnetic resonance imaging and spectroscopy quantified abdominal fat compartments, liver and intramyocellular lipid. Peripheral insulin sensitivity improved (glucose infusion rate during high-dose insulin increased from 10.1 ± 1.6 to 12 ± 2.1 mg/kg/min/, P = 0.025), with no change in hepatic insulin response following successful viral eradication, without any accompanying change in muscle, liver or abdominal fat depots. There was corresponding improvement in incremental glycaemic response to intravenous glucose (pretreatment: 62.1 ± 8.3 vs post-treatment: 56.1 ± 8.5 mm, P = 0.008). Insulin sensitivity after viral clearance was comparable to matched controls without CHC. Post therapy, liver enzyme levels decreased but, interestingly, levels of glucagon, fatty acid-binding protein and lipocalin-2 remained elevated. Eradication of the hepatitis C virus improves insulin sensitivity without alteration in fat depots, adipokine or glucagon levels, consistent with a direct link of the virus with insulin resistance. © 2013 John Wiley & Sons Ltd.

  13. Depot- and sex-specific effects of maternal obesity in offspring's adipose tissue.

    Science.gov (United States)

    Lecoutre, Simon; Deracinois, Barbara; Laborie, Christine; Eberlé, Delphine; Guinez, Céline; Panchenko, Polina E; Lesage, Jean; Vieau, Didier; Junien, Claudine; Gabory, Anne; Breton, Christophe

    2016-07-01

    According to the Developmental Origin of Health and Disease (DOHaD) concept, alterations of nutrient supply in the fetus or neonate result in long-term programming of individual body weight (BW) setpoint. In particular, maternal obesity, excessive nutrition, and accelerated growth in neonates have been shown to sensitize offspring to obesity. The white adipose tissue may represent a prime target of metabolic programming induced by maternal obesity. In order to unravel the underlying mechanisms, we have developed a rat model of maternal obesity using a high-fat (HF) diet (containing 60% lipids) before and during gestation and lactation. At birth, newborns from obese dams (called HF) were normotrophs. However, HF neonates exhibited a rapid weight gain during lactation, a key period of adipose tissue development in rodents. In males, increased BW at weaning (+30%) persists until 3months of age. Nine-month-old HF male offspring was normoglycemic but showed mild glucose intolerance, hyperinsulinemia, and hypercorticosteronemia. Despite no difference in BW and energy intake, HF adult male offspring was predisposed to fat accumulation showing increased visceral (gonadal and perirenal) depots weights and hyperleptinemia. However, only perirenal adipose tissue depot exhibited marked adipocyte hypertrophy and hyperplasia with elevated lipogenic (i.e. sterol-regulated element binding protein 1 (Srebp1), fatty acid synthase (Fas), and leptin) and diminished adipogenic (i.e. peroxisome proliferator-activated receptor gamma (Pparγ), 11β-hydroxysteroid dehydrogenase type 1 (11β-Hds1)) mRNA levels. By contrast, very few metabolic variations were observed in HF female offspring. Thus, maternal obesity and accelerated growth during lactation program offspring for higher adiposity via transcriptional alterations of visceral adipose tissue in a depot- and sex-specific manner. © 2016 Society for Endocrinology.

  14. [Computer-assisted management of depots for blood products in health establishments].

    Science.gov (United States)

    Carré, J

    2008-11-01

    To manage the filing of blood components at the hospital of the city of Bayeux, the laboratory uses Cursus, a dedicated software for haemovigilance. Benefits for using this software at different steps of the blood bank management are: simplification, security and harmonization of practices during receipt and issurance of blood components, securing recordings with the use of bar codes for patient identification and blood components listing, implementation of a computerized tracking system for transfusion, traceability, limitation of written documents and availability of statistics on the management of the depot.

  15. Using Genetic Algorithm For Winter Maintenance Operations: Multi Depot K-Chinese Postman Problem

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    İbrahim Zeki Akyurt

    2015-02-01

    Full Text Available In this study, the assignment and routing problem of one of Istanbul’s winter maintenance activities, salt pouring, was scrutinized. The starting point of the study considers the high cost of winter maintenance work, a shrinking assigned budget, high numbers of vehicles and streets to service that the increase in difficulty to solve the problem due to their high numbers. In this respect, the problem was modeled as multi depot k-Chinese postman problem, a type of arc routing problem. This mathematical model was solved by genetic algorithm. For comparison, the current solution, Clarke and Wright Algorithm and Sweep Algorithm were used.

  16. Dot Enumeration Perceptual Organization Task (DEPOT): evidence for a short-term visual memory deficit in schizophrenia.

    Science.gov (United States)

    Rabinowicz, E F; Opler, L A; Owen, D R; Knight, R A

    1996-08-01

    The Dot Enumeration Perceptual Organization Task (DEPOT) evaluates the validity of 2 specific competing cognitive models of early input dysfunction in schizophrenic individuals: a primary Stage 1, sensory store, perceptual organization deficit vs. a Stage 2, short-term visual memory (STVM) deficit. DEPOT was also designed to assess the hypothesis that schizophrenic individuals tend to perform poorly on all cognitive tasks. In DEPOT both number and form judgments are made about the same dot patterns. A response delay manipulation assesses the persistence and operation of STVM. The study included 41 psychotic inpatients (8 with acute and 16 with chronic schizophrenia and 7 with bipolar and 10 with nonbipolar affective disorder) and 38 controls (22 college students and 16 hospital personnel). Although the pattern of results was consistent with neither the Stage 1 deficit nor the general deficit hypotheses, a Stage 2, STVM deficit hypothesis could account parsimoniously for the data.

  17. Humans and Mice Display Opposing Patterns of “Browning” Gene Expression in Visceral and Subcutaneous White Adipose Tissue Depots

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    Maria A. Zuriaga

    2017-05-01

    Full Text Available Visceral adiposity is much more strongly associated with cardiometabolic disease in humans than subcutaneous adiposity. Browning, the appearance of brown-like adipocytes in the white adipose tissue (WAT, has been shown to protect mice against metabolic dysfunction, suggesting the possibility of new therapeutic approaches to treat obesity and type 2 diabetes. In mice, subcutaneous WAT depots express higher levels of browning genes when compared with visceral WAT, further suggesting that differences in WAT browning could contribute to the differences in the pathogenicity of the two depots. However, the expression of browning genes in different WAT depots of human has not been characterized. Here, it is shown that the expression of browning genes is higher in visceral than in subcutaneous WAT in humans, a pattern that is opposite to what is observed in mice. These results suggest that caution should be applied in extrapolating the results of murine browning gene expression studies to human pathophysiology.

  18. Co-methylated Genes in Different Adipose Depots of Pig are Associated with Metabolic, Inflammatory and Immune Processes

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    Mingzhou Li, Honglong Wu, Tao Wang, Yudong Xia, Long Jin, Anan Jiang, Li Zhu, Lei Chen, Ruiqiang Li, Xuewei Li

    2012-01-01

    Full Text Available It is well established that the metabolic risk factors of obesity and its comorbidities are more attributed to adipose tissue distribution rather than total adipose mass. Since emerging evidence suggests that epigenetic regulation plays an important role in the aetiology of obesity, we conducted a genome-wide methylation analysis on eight different adipose depots of three pig breeds living within comparable environments but displaying distinct fat level using methylated DNA immunoprecipitation sequencing. We aimed to investigate the systematic association between anatomical location-specific DNA methylation status of different adipose depots and obesity-related phenotypes. We show here that compared to subcutaneous adipose tissues which primarily modulate metabolic indicators, visceral adipose tissues and intermuscular adipose tissue, which are the metabolic risk factors of obesity, are primarily associated with impaired inflammatory and immune responses. This study presents epigenetic evidence for functionally relevant methylation differences between different adipose depots.

  19. 33 CFR 334.480 - Archers Creek, Ribbon Creek and Broad River, S.C.; U.S. Marine Corps Recruit Depot rifle and...

    Science.gov (United States)

    2010-07-01

    ... Broad River, S.C.; U.S. Marine Corps Recruit Depot rifle and pistol ranges, Parris Island. 334.480..., S.C.; U.S. Marine Corps Recruit Depot rifle and pistol ranges, Parris Island. (a) During periods when the rifle and pistol ranges on Parris Island are in use, the following areas will be restricted to...

  20. Elucidation of molecular mechanisms of physiological variations between bovine subcutaneous and visceral fat depots under different nutritional regimes.

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    Josue Moura Romao

    Full Text Available Adipose tissue plays a critical role in energy homeostasis and metabolism. There is sparse understanding of the molecular regulation at the protein level of bovine adipose tissues, especially within different fat depots under different nutritional regimes. The objective of this study was to analyze the differences in protein expression between bovine subcutaneous and visceral fat depots in steers fed different diets and to identify the potential regulatory molecular mechanisms of protein expression. Subcutaneous and visceral fat tissues were collected from 16 British-continental steers (15.5 month old fed a high-fat diet (7.1% fat, n=8 or a control diet (2.7% fat, n=8. Protein expression was profiled using label free quantification LC-MS/MS and expression of selected transcripts was evaluated using qRT-PCR. A total of 682 proteins were characterized and quantified with fat depot having more impact on protein expression, altering the level of 51.0% of the detected proteins, whereas diet affected only 5.3%. Functional analysis revealed that energy production and lipid metabolism were among the main functions associated with differentially expressed proteins between fat depots, with visceral fat being more metabolically active than subcutaneous fat as proteins associated with lipid and energy metabolism were upregulated. The expression of several proteins was significantly correlated to subcutaneous fat thickness and adipocyte size, indicating their potential as adiposity markers. A poor correlation (r=0.245 was observed between mRNA and protein levels for 9 genes, indicating that many proteins may be subjected to post-transcriptional regulation. A total of 8 miRNAs were predicted to regulate more than 20% of lipid metabolism proteins differentially expressed between fat depots, suggesting that miRNAs play a role in adipose tissue regulation. Our results show that proteomic changes support the distinct metabolic and physiological characteristics

  1. Tenofovir disoproxil fumarate intravaginal ring protects high-dose depot medroxyprogesterone acetate-treated macaques from multiple SHIV exposures.

    Science.gov (United States)

    Smith, James M; Srinivasan, Priya; Teller, Ryan S; Lo, Yungtai; Dinh, Chuong T; Kiser, Patrick F; Herold, Betsy C

    2015-01-01

    Preclinical HIV prevention models use either a single high-dose viral challenge in depot medroxyprogesterone acetate-treated macaques or repeated viral challenges in cycling macaques. We tested the efficacy of an intravaginal tenofovir disoproxil fumarate (TDF) ring in a model combining repeated 30-mg injections of depot medroxyprogesterone acetate every 6 weeks with vaginal viral challenges weekly for 12 weeks. Twelve macaques were randomized to TDF or placebo rings. All placebo macaques became infected after a median of 2 exposures, whereas only 1 TDF macaque became infected at the eighth exposure (P = 0.0012). The TDF ring provides durable protection in a stringent challenge model.

  2. A constructive heuristic for time-dependent multi-depot vehicle routing problem with time-windows and heterogeneous fleet

    Directory of Open Access Journals (Sweden)

    Behrouz Afshar-Nadjafi

    2017-01-01

    Full Text Available In this paper, we consider the time-dependent multi-depot vehicle routing problem. The objective is to minimize the total heterogeneous fleet cost assuming that the travel time between locations depends on the departure time. Also, hard time window constraints for the customers and limitation on maximum number of the vehicles in depots must be satisfied. The problem is formulated as a mixed integer programming model. A constructive heuristic procedure is proposed for the problem. Also, the efficiency of the proposed algorithm is evaluated on 180 test problems. The obtained computational results indicate that the procedure is capable to obtain a satisfying solution.

  3. Dopamine transporter single-photon emission computerized tomography supports diagnosis of akinetic crisis of parkinsonism and of neuroleptic malignant syndrome.

    Science.gov (United States)

    Martino, G; Capasso, M; Nasuti, M; Bonanni, L; Onofrj, M; Thomas, A

    2015-04-01

    Akinetic crisis (AC) is akin to neuroleptic malignant syndrome (NMS) and is the most severe and possibly lethal complication of parkinsonism. Diagnosis is today based only on clinical assessments yet is often marred by concomitant precipitating factors. Our purpose is to evidence that AC and NMS can be reliably evidenced by FP/CIT single-photon emission computerized tomography (SPECT) performed during the crisis. Prospective cohort evaluation in 6 patients. In 5 patients, affected by Parkinson disease or Lewy body dementia, the crisis was categorized as AC. One was diagnosed as having NMS because of exposure to risperidone. In all FP/CIT, SPECT was performed in the acute phase. SPECT was repeated 3 to 6 months after the acute event in 5 patients. Visual assessments and semiquantitative evaluations of binding potentials (BPs) were used. To exclude the interference of emergency treatments, FP/CIT BP was also evaluated in 4 patients currently treated with apomorphine. During AC or NMS, BP values in caudate and putamen were reduced by 95% to 80%, to noise level with a nearly complete loss of striatum dopamine transporter-binding, corresponding to the "burst striatum" pattern. The follow-up re-evaluation in surviving patients showed a recovery of values to the range expected for Parkinsonisms of same disease duration. No binding effects of apomorphine were observed. By showing the outstanding binding reduction, presynaptic dopamine transporter ligand can provide instrumental evidence of AC in Parkinsonism and NMS.

  4. Catatonia, Neuroleptic Malignant Syndrome, and Cotard Syndrome in a 22-Year-Old Woman: A Case Report

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    C. Weiss

    2013-01-01

    Full Text Available The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as “I do not have a heart,” “my heart is not beating,” “I can not breathe,” “I am breaking apart,” “I have no head” (ideas of negation and statements about the patient being responsible for the “death of the whole world” (ideas of enormity. Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.

  5. [Diazepam-responsive malignant catatonia in a patient with an initial clinical diagnosis of neuroleptic malignant syndrome: a case report].

    Science.gov (United States)

    Mishima, Takayasu; Tsuboi, Yoshio; Higuchi, Masa-Aki; Tsugawa, Jun; Obata, Toyoshi; Yamada, Tatsuo

    2011-05-01

    We report a case of malignant catatonia initially diagnosed as neuroleptic malignant syndrome (NMS) that responded successfully to diazepam administration. A 29-year-old man with mental retardation was admitted to our hospital because of high fever, muscle pain, and consciousness disturbance. Fifteen days before admission, he had developed muscle pain and weakness in his legs. He presented with fever, tachycardia, tachypnea, elevated blood pressure, excessive sweating, and neurological findings of lethargy and severe muscle rigidity in the neck and extremities. Laboratory findings included elevated serum creatine phosphokinase (CPK) level. His clinical features and the laboratory test results fulfilled the diagnostic criteria for NMS. He was treated for NMS with dantrolene sodium and bromocriptine mesylate for 2 weeks; however, there was no improvement. Therefore, treatment was changed to diazepam administration because of suspected malignant catatonia. One week after initiation of diazepam administration, his symptoms gradually improved, and the serum CPK level normalized. The diagnosis of malignant catatonia was confirmed because treatment with diazepam was dramatically effective, whereas the initial treatment for NMS was not beneficial. The clinical presentation of malignant catatonia is similar to that of NMS. Indeed, some authors have described NMS as a variant of malignant catatonia. If treatment is refractory in cases of NMS, malignant catatonia may be suspected, and changing treatment to diazepam administration may be useful.

  6. Persistent neuroleptic-induced rigidity and dystonia in AIDS dementia complex: a clinico-pathological case report.

    Science.gov (United States)

    Factor, S A; Podskalny, G D; Barron, K D

    1994-12-01

    Patients with AIDS dementia complex (ADC) appear to have an increased likelihood of developing acute onset parkinsonism and dystonia when treated with dopamine antagonists. It has been hypothesized, based on clinical evidence, that hypersensitivity to these drugs in ADC is probably related to direct invasion of the basal ganglia by the HIV virus and a secondary alteration in dopaminergic mechanisms. We report the first pathological description of a patient with ADC who developed acute onset, generalized rigidity and dystonia after a brief trial of low dose neuroleptic therapy administered for psychotic symptoms. An unusual clinical feature of this case was the persistence of his movement disorder. Pathological examination revealed a generalized encephalitic process with substantial neuronal loss observed primarily in the medial and lateral globus pallidus. Correlation with a current model of basal ganglia pathophysiology and other disorders with pallidal lesions is discussed. Clinical and pathological features of this case confirm the previous contention and indicate that dopamine antagonists should be utilized with extreme caution in patients with ADC.

  7. A Fuzzy Goal Programming for a Multi-Depot Distribution Problem

    Science.gov (United States)

    Nunkaew, Wuttinan; Phruksaphanrat, Busaba

    2010-10-01

    A fuzzy goal programming model for solving a Multi-Depot Distribution Problem (MDDP) is proposed in this research. This effective proposed model is applied for solving in the first step of Assignment First-Routing Second (AFRS) approach. Practically, a basic transportation model is firstly chosen to solve this kind of problem in the assignment step. After that the Vehicle Routing Problem (VRP) model is used to compute the delivery cost in the routing step. However, in the basic transportation model, only depot to customer relationship is concerned. In addition, the consideration of customer to customer relationship should also be considered since this relationship exists in the routing step. Both considerations of relationships are solved using Preemptive Fuzzy Goal Programming (P-FGP). The first fuzzy goal is set by a total transportation cost and the second fuzzy goal is set by a satisfactory level of the overall independence value. A case study is used for describing the effectiveness of the proposed model. Results from the proposed model are compared with the basic transportation model that has previously been used in this company. The proposed model can reduce the actual delivery cost in the routing step owing to the better result in the assignment step. Defining fuzzy goals by membership functions are more realistic than crisps. Furthermore, flexibility to adjust goals and an acceptable satisfactory level for decision maker can also be increased and the optimal solution can be obtained.

  8. Genital Injury Signatures and Microbiome Alterations Associated With Depot Medroxyprogesterone Acetate Usage and Intravaginal Drying Practices.

    Science.gov (United States)

    Birse, Kenzie D; Romas, Laura M; Guthrie, Brandon L; Nilsson, Peter; Bosire, Rose; Kiarie, James; Farquhar, Carey; Broliden, Kristina; Burgener, Adam D

    2017-02-15

    Increasing evidence suggests depot medroxyprogesterone acetate (DMPA) and intravaginal practices may be associated with human immunodeficiency virus (HIV-1) infection risk; however, the mechanisms are not fully understood. This study evaluated the effect of DMPA and intravaginal practices on the genital proteome and microbiome to gain mechanistic insights. Cervicovaginal secretions from 86 Kenyan women, including self-reported DMPA users (n = 23), nonhormonal contraceptive users (n = 63), and women who practice vaginal drying (n = 46), were analyzed using tandem-mass spectrometry. We identified 473 human and 486 bacterial proteins from 18 different genera. Depot medroxyprogesterone acetate use associated with increased hemoglobin and immune activation (HBD, HBB, IL36G), and decreased epithelial repair proteins (TFF3, F11R). Vaginal drying associated with increased hemoglobin and decreased phagocytosis factors (AZU1, MYH9, PLAUR). Injury signatures were exacerbated in DMPA users who also practiced vaginal drying. More diverse (H index: 0.71 vs 0.45; P = .009) bacterial communities containing Gardnerella vaginalis associated with vaginal drying, whereas DMPA showed no significant association with community composition or diversity. These findings provide new insights into the impact of DMPA and vaginal drying on mucosal barriers. Future investigations are needed to confirm their relationship with HIV risk in women.

  9. SeqDepot: streamlined database of biological sequences and precomputed features.

    Science.gov (United States)

    Ulrich, Luke E; Zhulin, Igor B

    2014-01-15

    Assembling and/or producing integrated knowledge of sequence features continues to be an onerous and redundant task despite a large number of existing resources. We have developed SeqDepot-a novel database that focuses solely on two primary goals: (i) assimilating known primary sequences with predicted feature data and (ii) providing the most simple and straightforward means to procure and readily use this information. Access to >28.5 million sequences and 300 million features is provided through a well-documented and flexible RESTful interface that supports fetching specific data subsets, bulk queries, visualization and searching by MD5 digests or external database identifiers. We have also developed an HTML5/JavaScript web application exemplifying how to interact with SeqDepot and Perl/Python scripts for use with local processing pipelines. Freely available on the web at http://seqdepot.net/. RESTaccess via http://seqdepot.net/api/v1. Database files and scripts maybe downloaded from http://seqdepot.net/download.

  10. Experience with octreotide depot in the treatment of castration-resistant prostate cancer

    Directory of Open Access Journals (Sweden)

    G. P. Kolesnikov

    2015-01-01

    Full Text Available Castration-resistant prostate cancer (CRPC is one of the most complex and unsolved problems in urologic oncology. The somatostatin analogue octreotide depot made in Russia may be used for its treatment. The paper gives the results of a trial of the efficiency and safety of treatment with octreotide depot 30 mg and dexamethasone in 20 patients aged 58 to 89 years with CRPC during continued androgen deprivation therapy. The duration of the trial was 3 months. A response was assessed from the serum levels of prostate-specific antigen (PCA, the time course of changes in general and biochemical blood test values, the degree of pain syndrome, and improvement in quality of life in a patient. A total response in reducing PSA was obtained in 70 % of the patents; overall, the best results were achieved in the group receiving octreotide before chemotherapy with docetaxel. The tolerability of octreotide deport with dexamethasone was good in all cases; no obvious adverse hematological and clinical reactions were noted.

  11. A two-stage approach to the depot shunting driver assignment problem with workload balance considerations

    Science.gov (United States)

    Gronalt, Manfred; Sun, Yan

    2017-01-01

    Due to its environmentally sustainable and energy-saving characteristics, railway transportation nowadays plays a fundamental role in delivering passengers and goods. Emerged in the area of transportation planning, the crew (workforce) sizing problem and the crew scheduling problem have been attached great importance by the railway industry and the scientific community. In this paper, we aim to solve the two problems by proposing a novel two-stage optimization approach in the context of the electric multiple units (EMU) depot shunting driver assignment problem. Given a predefined depot shunting schedule, the first stage of the approach focuses on determining an optimal size of shunting drivers. While the second stage is formulated as a bi-objective optimization model, in which we comprehensively consider the objectives of minimizing the total walking distance and maximizing the workload balance. Then we combine the normalized normal constraint method with a modified Pareto filter algorithm to obtain Pareto solutions for the bi-objective optimization problem. Furthermore, we conduct a series of numerical experiments to demonstrate the proposed approach. Based on the computational results, the regression analysis yield a driver size predictor and the sensitivity analysis give some interesting insights that are useful for decision makers. PMID:28704489

  12. Relationships between rodent white adipose fat pads and human white adipose fat depots

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    Daniella E. Chusyd

    2016-04-01

    Full Text Available The objective of this review was to compare and contrast the physiological and metabolic profiles of rodent white adipose fat pads with white adipose fat depots in humans. Human fat distribution and its metabolic consequences have received extensive attention, but much of what has been tested in translational research has relied heavily on rodents. Unfortunately, the validity of using rodent fat pads as a model of human adiposity has received less attention. There is a surprisingly lack of studies demonstrating an analogous relationship between rodent and human adiposity on obesity-related comorbidities. Therefore, we aimed to compare known similarities and disparities in terms of white adipose tissue development and distribution, sexual dimorphism, weight loss, adipokine secretion, and aging. While the literature supports the notion that many similarities exist between rodents and humans, notable differences emerge related to fat deposition and function of white adipose tissue. Thus, further research is warranted to more carefully define the strengths and limitations of rodent white adipose tissue as a model for humans, with a particular emphasis on comparable fat depots, such as mesenteric fat.

  13. The multi-depot electric vehicle location routing problem with time windows

    Directory of Open Access Journals (Sweden)

    Juan Camilo Paz

    2018-01-01

    Full Text Available In this paper, the Multi-Depot Electric Vehicle Location Routing Problem with Time Windows (MDVLRP is addressed. This problem is an extension of the MDVLRP, where electric vehicles are used instead of internal combustion engine vehicles. The recent development of this model is explained by the advantages of this technology, such as the diminution of carbon dioxide emissions, and the support that they can provide to the design of the logistic and energy-support structure of electric vehicle fleets. There are many models that extend the classical VRP model to take electric vehicles into consideration, but the multi-depot case for location-routing models has not been worked out yet. Moreover, we consider the availability of two energy supply technologies: the “Plug-in” Conventional Charge technology, and Battery Swapping Stations; options in which the recharging time is a function of the amount of energy to charge and a fixed time, respectively. Three models are proposed: one for each of the technologies mentioned above, and another in which both options are taken in consideration. The models were solved for small scale instances using C++ and Cplex 12.5. The results show that the models can be used to design logistic and energy-support structures, and compare the performance of the different options of energy supply, as well as measure the impact of these decisions on the overall distance traveled or other optimization objectives that could be worked on in the future.

  14. A tabu-search heuristic for solving the multi-depot vehicle scheduling problem

    Directory of Open Access Journals (Sweden)

    Gilmar D'Agostini Oliveira Casalinho

    2014-08-01

    Full Text Available Currently the logistical problems are relying quite significantly on Operational Research in order to achieve greater efficiency in their operations. Among the problems related to the vehicles scheduling in a logistics system, the Multiple Depot Vehicle Scheduling Problem (MDVSP has been addressed in several studies. The MDVSP presupposes the existence of depots that affect the planning of sequences to which travel must be performed. Often, exact methods cannot solve large instances encountered in practice and in order to take them into account, several heuristic approaches are being developed. The aim of this study was thus to solve the MDVSP using a meta-heuristic based on tabu-search method. The main motivation for this work came from the indication that only recently the use of meta-heuristics is being applied to MDVSP context (Pepin et al. 2008 and, also, the limitations listed by Rohde (2008 in his study, which used the branch-and-bound in one of the steps of the heuristic presented to solve the problem, which has increased the time resolution. The research method for solving this problem was based on adaptations of traditional techniques of Operational Research, and provided resolutions presenting very competitive results for the MDVSP such as the cost of the objective function, number of vehicles used and computational time.

  15. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

    Directory of Open Access Journals (Sweden)

    Daniel Martinez-Ramirez

    Full Text Available Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.A significant effect for dopaminergic administration (p<0.01 on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4. Contraindicated dopamine blocking agents were administered in 23% (71/339 of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4, p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1 compared to those who did not (M=5.9 days, SD=6.8. Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

  16. Mycobacterium tuberculosis persistence in various adipose depots of infected mice and the effect of anti-tubercular therapy.

    Science.gov (United States)

    Agarwal, Pooja; Khan, Shaheb R; Verma, Subash C; Beg, Muheeb; Singh, Kavita; Mitra, Kalyan; Gaikwad, Anil N; Akhtar, Md Sohail; Krishnan, Manju Y

    2014-07-01

    The adipocytes are one of the non-professional phagocytes postulated to be a haven for Mycobacterium tuberculosis during persistence in the human host. The adipocyte - M. tuberculosis interaction data available to date are ex vivo. The present study was primarily aimed to investigate M. tuberculosis infection of adipocytes in course of infection of mouse model. Using primary murine adipocytes, the study first confirmed the infection and immunomodulation of natural adipocytes by M. tuberculosis. The bacilli could be isolated form visceral, subcutaneous, peri renal and mesenteric adipose depots of immunocompetent mice infected with M. tuberculosis intravenously. The bacilli could be isolated from adipocytes and the stromal vascular fraction, even though the numbers were significantly higher in the latter. The bacterial burden in the adipose depots was comparable to those in lungs in the early phase of infection. But with time, the burden in the adipose depots was either decreased or kept under control, despite the increasing burden in the lungs. Infected mice treated with standard anti tubercular drugs, despite effective elimination of bacterial loads in the lungs, continued to harbour M. tuberculosis in adipose depots at loads similar to untreated mice in the late infection phase.

  17. Receptor imaging of schizophrenic patients under treatment with typical and atypical neuroleptics; Nuklearmedizinische Rezeptordiagnostik bei schizophrenen Patienten unter Therapie mit typischen und atypischen Neuroleptika

    Energy Technology Data Exchange (ETDEWEB)

    Dresel, S.; Tatsch, K. [Klinik und Poliklinik fuer Nuklearmedizin der Ludwig-Maximilians-Univ. Muenchen (Germany); Meisenzahl, E. [Psychiatrische Klinik der Ludwig-Maximilians-Univ. Muenchen (Germany); Scherer, J. [Bezirkskrankenhaus Haar (Germany)

    2002-09-01

    Schizophrenic psychosis is typically treated by typical and atypical neuroleptics. Both groups of drugs differ with regard to induction of extrapyramidal side effects. The occupancy of postsynaptic dopaminergic D2 receptors is considered to be an essential aspect of their antipsychotic properties. The dopamine D2 receptor status can be assessed by means of [I-123]IBZM SPECT. Studies on the typical neuroleptic haloperidol revealed an exponential dose response relationship measured by IBZM. Extrapyramidal side effects were presented by all patients below a threshold of the specific binding of IBZM below 0.4 (with one exception, norm value: >0.95). Also under treatment with the atypical neuroleptic clozapine an exponential dose response relationship was found. However, none of these patients showed extrapyramidal side effects. Recently introduced, new atypical neuroleptics such as risperidone and olanzapine again presented with an exponential relationship between daily dose and IBZM binding. The curves of the latter were in between the curves of haloperidol and clozapine. Extrapyramidal side effects were documented in a less number of patients treated with risperidone as compared to haloperidol, for olanzapine only one patient revealed these findings in our own patient group. The pharmacological profile of atypical neuroleptics shows - in addition to their binding to dopamine receptors - also high affinities to the receptors of other neurotransmitter systems, particularly the serotonergic system. Therefore, the lower incidence of extrapyramidal side effects seen by atypical in comparison to typical neuroleptics is at least in part most likely due to a complex interaction on a variety of neurotransmitter systems. (orig.) [German] Die pharmakologische Therapie von Erkrankungen aus dem schizophrenen Formenkreis erfolgt durch typische und atypische Neuroleptika. Beide Gruppen unterscheiden sich klinsich im Wesentlichen durch die Eigenschaft, extrapyramidal

  18. Development and validation of a multi-analyte LC-MS/MS approach for quantification of neuroleptics in whole blood, plasma, and serum.

    Science.gov (United States)

    Montenarh, Deborah; Hopf, Markus; Maurer, Hans H; Schmidt, Peter; Ewald, Andreas H

    2016-10-01

    Based on a similar approach for quantification of antidepressants, benzodiazepines, and z-drugs, a liquid chromatography-tandem mass spectrometry (LC-MS/MS) multi-analyte approach with simple liquid-liquid extraction was extended for fast target screening and quantification of neuroleptics in whole blood, plasma, and serum. As this method is part of a multi-analyte procedure for over 100 analytes from different drug classes and as the extracts were additionally used in the authors' laboratory for gas chromatography-mass spectrometry (GC-MS) analysis, one universal stable-isotope-labelled internal standard (SIL-IS) was used to save time and resource. The method was validated with respect to international guidelines. For accuracy and precision, full calibration was performed with ranges from subtherapeutic to toxic concentrations. Selectivity problems could not be observed, but matrix effects ranged from 68 to 211% in all samples. For the low quality control (QC), recovery ranged from 32 to 112%, process efficiency from 31 to 165% and for the high QC recovery from 42 to 141%, process efficiency from 29 to 154%. In addition statistical data evaluation of the variances of the recovery, matrix effects, and process efficiency data between whole blood vs. plasma, whole blood vs. serum, and plasma vs. serum were done. The presented LC-MS/MS approach was applicable for selective detection of 33 neuroleptics as well as accurate and precise quantification of 25 neuroleptics in whole blood, 19 in plasma, and 17 in serum. More significant matrix effects (ME) for neuropletic drugs overall in plasma and serum as compared with whole blood were detected. Copyright © 2015 John Wiley & Sons, Ltd.

  19. A Case Report of Catatonia and Neuroleptic Malignant Syndrome With Multiple Treatment Modalities: Short Communication and Literature Review.

    Science.gov (United States)

    Chiou, Yu-Jie; Lee, Yu; Lin, Chin-Chuen; Huang, Tiao-Lai

    2015-10-01

    We describe a case with complicated clinical presentations who was difficult to treat. We described the possible etiologies and differential diagnosis of neuroleptic malignant syndrome (NMS), catatonia, and infection, in details. This patient was also referred to neuro-intensive care unit for extensive workup and treatments by neurologist guidelines. In addition, we also used lorazepam-diazepam protocol and antipsychotics, but both failed to completely relieve her symptoms. She eventually responded to electroconvulsive therapy (ECT).A 60-year-old female patient with schizophrenia was diagnosed to suspected pneumonia, urinary tract infection, and retarded catatonia at first. The brain computed tomography revealed no significant finding. She developed NMS caused by the administration of low-dose quetiapine (200 mg) after carbamazepine was discontinued. The Francis-Yacoub NMS rating scale (F-Y scale) total score was 90. We utilized lorazepam-diazepam protocol and prescribed bromocriptine and amantadine, but NMS was not improved. Meanwhile, we arranged the brain magnetic resonance imaging to survey the physical problem, which revealed agenesis of septum pellucidum and dilated lateral ventricles. She was then transferred to the neuro-intensive care unit on the 15th hospital day for complete study. The results of cerebrospinal fluid study and electroencephalography were unremarkable. She was transferred back to psychiatric ward on the 21st hospital day with residual catatonic and parkinsonian symptoms of NMS, and the F-Y scale total score was 63. Finally, her residual catatonic condition that followed NMS got improved after 11 sessions of ECT. On the 47th hospital day, the F-Y scale total score was 9.This report underscores that the ECT is an effective treatment for a patient of NMS when other treatments have failed.

  20. Ecstacy-induced delayed rhabdomyolysis and neuroleptic malignant syndrome in a patient with a novel variant in the ryanodine receptor type 1 gene.

    Science.gov (United States)

    Russell, T; Riazi, S; Kraeva, N; Steel, A C; Hawryluck, L A

    2012-09-01

    We present the case of a 20-year-old woman who developed rhabdomyolysis, disseminated intravascular coagulopathy and multi-organ failure induced by ecstasy. Following initial improvement, she developed delayed rhabdomyolysis then haloperidol-induced neuroleptic malignant syndrome, which was treated with a total of 50 mg.kg(-1) dantrolene. Subsequent genetic testing revealed a novel potentially pathogenic variant in the ryanodine receptor type 1 gene. However, caffeine-halothane contracture testing of the patient's mother who carried the same gene variant was negative for malignant hyperthermia.

  1. 多次利培酮治疗致抗精神病药恶性综合征%Neuroleptic malignant syndrome after repeated treatment with risperidone

    Institute of Scientific and Technical Information of China (English)

    丁跃庆; 李华; 谢振强; 张伟娟; 代俊; 孔君; 吴洪军

    2012-01-01

    1例31岁女性患者因精神分裂症给予利培酮1 mg,2次/d口服,1周后剂量增至2 mg,2次/d.此前患者曾3次间断应用利培酮治疗.本次治疗规律服药49 d,患者精神症状缓解.第50~52天未遵医嘱规律服药.第54天患者出现大汗淋漓,体温达38.5 ℃.第55天出现意识障碍、心动过速、双上肢肌强直、肌张力增高.心电图示窦性心动过速.实验室检查示:白细胞计数12.3×109/L,胆碱酯酶 13 268 U /L,肌酸激酶 1447 U/L,利培酮血液浓度70.5 μg/L.诊断为抗精神病药恶性综合征(NMS).立即停用利培酮,进行物理降温、补液、抗心律失常、抗感染、纠正酸碱平衡、护肝等治疗.6 d后患者体温恢复正常,NMS症状消失.换用奥氮平治疗后,未再出现类似症状.%A 31-year-old woman with schizophrenia received risperidone 1 mg twice daily. One week later, the dose was increased to 2 mg twice daily. The patient had previously received risperidone intermittent treatment for three times. After a 49-day regular treatment, the psychiatric symptoms relieved. On days 50 to 52, she did not adhere to the instructions of the physician for regular use of the drug. On day 54, the patient experienced profuse sweating with a temperature of 38. 5 ℃. On day 55, she developed disturbance of consciousness, tachycardia, muscle rigidity of the upper limbs, and hypermyotonia. Her electrocardiograph showed sinus tachycardia. Laboratory tests showed the following findings: white blood cell count 12. 3 × 109/L, cholinesterase 13 268 U/L, creatine kinase 1447 U/L. The blood concentrations of risperidone was 70. 5 μg/L. Neuroleptic malignant syndrome ( NMS ) was diagnosed. The medication was stopped immediately. Physical methods for lowering body temperature, fluid supplement, antiarrhythmics, anti-infective therapy, correction of the acid-base imbalance, and liver-protective treatment were given. Six days later, the temperature returned to normal, the NMS symptoms

  2. Intramuscular depot formulations of leuprolide acetate suppress testosterone levels below a 20 ng/dL threshold: a retrospective analysis of two Phase III studies

    Directory of Open Access Journals (Sweden)

    Spitz A

    2016-08-01

    Full Text Available Aaron Spitz,1 Marc Gittelman,2 Lawrence I Karsh,3 Sanja Dragnic,4 Ahmed M Soliman,5 Aditya Lele,6 Damian Gruca,7 Michael Norton4 1Orange County Urology Associates, Laguna Beach, CA, 221st Century Oncology/UroMedix-Aventura Division, Aventura, FL, 3The Urology Center of Colorado, Denver, CO, 4US Medical Affairs, 5Health Economics and Outcomes Research, 6Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA; 7Global Medical Affairs, AbbVie Deutschland, Ludwigshafen, Germany Introduction: Androgen deprivation therapy (ADT with gonadotropin-releasing hormone (GnRH analogs is a standard treatment for advanced prostate cancer. GnRH analog therapy can reduce testosterone to “castrate” levels, historically defined as <50 ng/dL. With the advent of newer assays, a lower threshold of <20 ng/dL has recently been proposed. We report the results of a retrospective analysis of two Phase III trials of 4- and 6-month depot microsphere formulations of leuprolide acetate (LA, a GnRH agonist that has previously demonstrated efficacy in testosterone suppression to <50 ng/dL in patients on ADT. This analysis investigates the ability of these LA formulations to suppress to ≤20 ng/dL levels.Methods: In two of five AbbVie/Abbott clinical trials of microsphere formulations of LA for ADT, analytic technology permitting testosterone detection as low as 3 ng/dL was used and thus was selected for this analysis. Both trials were open-label, fixed-dose studies in prostate cancer patients, naïve to ADT. Patients received either 30 mg (4-month formulation; n=49 or 45 mg (6-month formulation; n=151 depot injections of LA microspheres. Treatment duration was up to 32 weeks for the 4-month formulation and 48 weeks for the 6-month formulation. The proportion of patients achieving the 20 ng/dL threshold was determined every 4 weeks.Results: Pooled analysis showed that 152 of 193 (79% of patients achieved serum testosterone levels of ≤20 ng/dL at 4 weeks, and

  3. 抗精神病药物所致恶性综合征10例临床分析%Clinical Analysis of 10 Cases of Neuroleptic Malignant Syndrome Caused by Antipsychotics

    Institute of Scientific and Technical Information of China (English)

    孙振晓; 于相芬

    2014-01-01

    目的:探讨抗精神病药物所致恶性综合征(NMS)的临床表现及诊治方法。方法:对我院2007年1月至2012年3月收治的10例抗精神病药物所致NMS病例进行临床分析。结果:NMS发病前表现精神运动性兴奋7例(70%),进食差9例(90%);60%的患者发病于夏季;合并用药8例(80%),且多合并高效价药物,其中4例为长效药物;发生于用药后1周内4例(40%),1月内9例(90%)。临床表现意识障碍、肌强直、发热、心动过速、呼吸急促、血压不稳、多汗等。实验室检查表现白细胞增高、肌酸磷酸激酶升高等。经停用致病药物、提供支持和对症治疗、应用多巴胺受体激动剂、苯二氮类药物等治疗,均获痊愈。结论:恶性综合征是与抗精神病药物治疗有关的严重并发症,应及时发现,合理治疗。%Objective: To explore the clinical manifestation and the way of diagnosis of neuroleptic malignant syn-drome (NMS)caused by antipsychotics. Methods: The clinical data of 10 patients with neuroleptic malignant syndrome caused by antipsychotics,who were enrolled and treated in our hospital from Jan. 2007 to Mar. 2012,was retrospectively analyzed. Results: Before the onset of NMS,7 cases (70%) had the expression of psychomotor agitation and 9 cases (90%) had poor oral intake. Most cases began to sicken in summer. Combined medication was given to 8 cases (80%) with high potency antipsychotics including long acting drugs. About 40%patients developed NMS within the first week of antipsychotic treatment,and 90%occurred within one month after the treatment. The clinical features included disturbance of consciousness,muscle rigidity,hyperthermia,tachycardia,tachypnea,labile blood pressure,diaphoresis and others. Labo-ratory abnormalities were leukocytosis and elevation of creatine kinase. After discontinuation of causative drugs ,giving supportive medical therapy and symptomatic treatment

  4. Immunomagnetic Separation of Fat Depot-Specific Sca1high Adipose-Derived Stem Cells (Ascs)

    Science.gov (United States)

    Barnes, Richard H; Chun, Tae-Hwa

    2016-01-01

    The isolation of adipose-derived stem cells (ASCs) is an important method in the field of adipose tissue biology, adipogenesis, and extracellular matrix (ECM) remodeling. In vivo, ECM-rich environment consisting of fibrillar collagens provides a structural support to adipose tissues during the progression and regression of obesity. Physiological ECM remodeling mediated by matrix metalloproteinases (MMPs) plays a major role in regulating adipose tissue size and function1, 2. The loss of physiological collagenolytic ECM remodeling may lead to excessive collagen accumulation (tissue fibrosis), macrophage infiltration, and ultimately, a loss of metabolic homeostasis including insulin resistance3, 4. When a phenotypic change of the adipose tissue is observed in gene-targeted mouse models, isolating primary ASCs from fat depots for in vitro studies is an effective approach to define the role of the specific gene in regulating the function of ASCs. In the following, we define an immunomagnetic separation of Sca1high ASCs. PMID:27583550

  5. AUTOMATED GUIDED VEHICLE (AGV SYSTEMS AND ROUTING PROBLEM IN DEPOT MAINTENANCE

    Directory of Open Access Journals (Sweden)

    Fatih YİĞİT

    2003-02-01

    Full Text Available When full automation is realized in factory automation, material handing systems (MHS have a fairly important role. The most technological development among MHS's has been concentrated on Automated Guided Vehicle (AGV systems. An AGV is an unmanned vehicle capable of following an external guidance signal to deliver a unit load from destination to destination. Nowadays, there are a lot of applications lie along service sector to industrial sector because of flexibilities of AGVs. In this study, these subjects have been applied on the Army Aviation Depot Maintenance where aircraft's and aircraft parts can be maintained and overhauled is an application fields of AGV, requiring AGV numbers and AGV routing. The AGV routing problem and traveling sales person (TSP problems are identical problems; where the AGV routing problem is formulated as a zero one integer programming. Examples are presented to demonstrate the approach and LINGO has been used to solve the example.

  6. A Brownian Energy Depot Model of the Basilar Membrane Oscillation with a Braking Mechanism

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    Zhang, Yong; Lee, Kong-Ju-Bock; Park, Youngah

    2008-01-01

    High auditory sensitivity, sharp frequency selectivity, and otoacoustic emissions are signatures of active amplification of the cochlea. The human ear can also detect very large amplitude sound without being damaged as long as the exposed time is not too long. The outer hair cells are believed as the best candidate for the active force generator of the mammalian cochlea. In this paper, we propose a new model for the basilar membrane oscillation which successfully describes both the active and the protective mechanisms by employing an energy depot concept and a critical velocity of the basilar membrane. One of the main results is that thermal noise in the absence of external stimulation can be amplified leading to the spontaneous basilar membrane oscillation. The compressive response of the basilar membrane at the characteristic frequency and the dynamic response to the stimulation are consistent with the experimental results as expected. Our model also shows the nonlinear distortion of the response of the bas...

  7. Location and multi-depot vehicle routing for emergency vehicles using tour coverage and random sampling

    Directory of Open Access Journals (Sweden)

    Alireza Goli

    2015-09-01

    Full Text Available Distribution and optimum allocation of emergency resources are the most important tasks, which need to be accomplished during crisis. When a natural disaster such as earthquake, flood, etc. takes place, it is necessary to deliver rescue efforts as quickly as possible. Therefore, it is important to find optimum location and distribution of emergency relief resources. When a natural disaster occurs, it is not possible to reach some damaged areas. In this paper, location and multi-depot vehicle routing for emergency vehicles using tour coverage and random sampling is investigated. In this study, there is no need to visit all the places and some demand points receive their needs from the nearest possible location. The proposed study is implemented for some randomly generated numbers in different sizes. The preliminary results indicate that the proposed method was capable of reaching desirable solutions in reasonable amount of time.

  8. A case of mental retardation with paraphilia treated with depot leuprorelin.

    Science.gov (United States)

    Park, Woo Sung; Kim, Kyung Min; Jung, Yong Woo; Lim, Myung Ho

    2014-09-01

    Paraphilia is a psychiatric disease that has been difficult to cure. However, recently developed therapeutic methods hold promise. The patient was a 20-yr-old male with chief complaints of continuous masturbation, genital exposure, and aggressive behavior that started 2 yr ago. We administered leuprorelin 3.6 mg intramuscular injection per month, a depot gonadotrophin-releasing hormone analogue, to this patient who a severe mentally retardation with paraphilia. The clinical global impression (CGI)-severity, CGI-improvement and aberrant behavior checklist were performed. After one month, we observed significant improvement in symptoms, such as decreases of abnormal sexual behavior and sexual desire. The GnRH analogues are suggested to be used as an alternative or supplementary therapeutic method for sexual offenders after clinical studies.

  9. A generalized multi-depot vehicle routing problem with replenishment based on LocalSolver

    Directory of Open Access Journals (Sweden)

    Ying Zhang

    2015-01-01

    Full Text Available In this paper, we consider the multi depot heterogeneous vehicle routing problem with time windows in which vehicles may be replenished along their trips. Using the modeling technique in a new-generation solver, we construct a novel formulation considering a rich series of constraint conditions and objective functions. Computation results are tested on an example comes from the real-world application and some cases obtained from the benchmark problems. The results show the good performance of local search method in the efficiency of replenishment system and generalization ability. The variants can be used to almost all kinds of vehicle routing problems, without much modification, demonstrating its possibility of practical use.

  10. Improving Inventory Management and Supply Chain of Diesel Fuel in Pertamina 5 Main Depots

    Directory of Open Access Journals (Sweden)

    Togar M Simatupang

    2012-01-01

    Full Text Available Planning Operation subdivision at PT Pertamina has to generate supply decisions includingmain depot to supply, supply point and transportation mode. However, the variability inplanning a supply schedule renders the process of determining a supply decision asineffective. The last assessment on uncertainties was done at 2006 and has not beenconsidered during decision making process. On the other hand, the result of this researchindicates that the uncertainty level is too high to be ignored and the poor informationexchange between the regional offices and the head office decreases the Planning Operation’sability to create plans that covers the company condition. This paper proposes an appropriatesafety stock to withstand the uncertainties and a supply scheduling process that also considersuncertainties by using Monte-Carlo Simulation with random numbers to simulate the events inthe upcoming period.Key words: inventory management, distribution planning, managing uncertainties, montecarlosimulation

  11. Successful treatment of Depot Medroxyprogesterone acetate-related vaginal bleeding improves continuation rates in Adolescents

    Directory of Open Access Journals (Sweden)

    Kristin M. Rager

    2006-01-01

    Full Text Available High discontinuation rates for depot medroxyprogesterone acetate (DMPA in adolescents may contribute to the number of unintended pregnancies. Many cite vaginal bleeding as a reason for discontinuing DMPA use. In this study, we attempted to determine if treating DMPA-associated vaginal bleeding with monophasic oral contraceptive pills (OCP raised continuation rates. A total of 131 patients who reported vaginal bleeding while on DMPA were included in this study and 83 were treated with monophasic OCP. Of those who received OCP, 38.7% reported that vaginal bleeding stopped completely, 51.8% reported that vaginal bleeding stopped temporarily, and 6.0% reported no change. Overall, 94% of enrolled patients who received OCP as a treatment for DMPA-associated vaginal bleeding continued DMPA use. Our findings indicate that vaginal bleeding due to DMPA can be successfully treated, leading to improvement in continuation rates.

  12. Depot-medroxyprogesterone acetate (DMPA) and cancer: memorandum from a WHO meeting.

    Science.gov (United States)

    1993-01-01

    Depot-medroxyprogesterone acetate (DMPA) is a long-acting progestational contraceptive, which is administered by injection. It was developed in the mid-1960s, when it was seen as a method that would be particularly useful for women seeking reversible contraception who had difficulty taking a pill every day. DMPA has been shown to be a highly effective contraceptive, and it has proved acceptable in a variety of settings. The drug is licensed as a contraceptive in more than 90 countries and has been widely used in a number of them, such as Thailand and New Zealand. On a worldwide basis, the licensing, acceptability, and prevalence of use have been influenced by concern that DMPA may increase the risk of cancer. Cancer of the breast has been a particular concern. This Memorandum reviews comprehensively the results of toxicological tests in animals and epidemiological studies in humans concerning the carcinogenicity of DMPA. PMID:8313485

  13. Depot-medroxyprogesterone acetate (DMPA) and cancer: Memorandum from a WHO Meeting*

    Science.gov (United States)

    1986-01-01

    A review of all available data including those from the WHO Collaborative Study of Neoplasia and Steroid Contraceptives has shown no increased risk of cancers of the breast, endometrium, ovary or liver in women using depot-medroxyprogesterone acetate (DMPA). The issue of a causal association between DMPA use and cervical cancer is as yet unresolved and will require the accumulation of additional data. To date, in the WHO study only a small number of women have used DMPA for prolonged periods or have had a long interval since first use. Information on cancer risk in these women can only be gained by continuing the present study or by initiating additional studies focused on these specific topics. PMID:2945666

  14. Serum adipocytokines and adipose weight gain: a pilot study in adolescent females initiating depot medroxyprogesterone acetate.

    Science.gov (United States)

    Bonny, Andrea E; Lange, Hannah L H; Hade, Erinn M; Kaufman, Bram; Reed, Michael D; Mesiano, Sam

    2015-10-01

    To evaluate whether serum adipocytokine concentrations, controlling for baseline adiposity, are predictive of adipose weight gain in adolescents initiating depot medroxyprogesterone acetate (DMPA). Percent body fat was measured at baseline and 6 months. Baseline serum adipocytokine concentrations were quantified. Mean percent body fat was 31.6% (±7.6) at baseline and 33.5% (±7.6) at 6 months. In multivariable linear regression modeling (adjusted for baseline percent body fat), Hispanic ethnicity and baseline serum adiponectin concentration were inversely associated (p≤.05) with absolute change in percent body fat at 6 months. Serum adiponectin concentration may be useful for assessing risk of DMPA-associated adipose gains. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Effect of Depot Medroxyprogesterone Acetate on Glucose Tolerance in Generalized Lipodystrophy

    Science.gov (United States)

    Yauger, Belinda J.; Gorden, Phillip; Park, Jean; Cochran, Elaine; Stratton, Pamela

    2012-01-01

    BACKGROUND Lipodystrophy is a rare condition causing severe insulin resistance and frank diabetes. Depot medroxyprogesterone acetate (DMPA), a commonly used contraceptive, may worsen glucose tolerance in diabetics and those with lipodystrophy. CASE A young woman with generalized lipodystrophy, who previously required greater than 1,000 units of insulin daily, had a normal hemoglobin A1c on leptin and metformin only. After an injection of DMPA, she developed severe hyperglycemia. Her levels returned to near normal only with extremely high doses of insulin (up to 1,700 units/d) and increased doses of leptin and metformin. CONCLUSION Progestin-only contraceptives may detrimentally affect glucose tolerance, particularly in patients with lipodystrophy, a cause of severe insulin resistance and leptin deficiency. One DMPA injection appeared to profoundly alter glucose metabolism in this patient with frank diabetes resulting from lipodystrophy. The effect of progestin-only contraceptives on glucose tolerance should be monitored closely in any diabetic patient. PMID:18669758

  16. ERTS-1 DCS technical support provided by Wallops Station. [ground truth stations and DCP repair depot

    Science.gov (United States)

    Smith, R.

    1975-01-01

    Wallops Station accepted the tasks of providing ground truth to several ERTS investigators, operating a DCP repair depot, designing and building an airborne DCP Data Acquisition System, and providing aircraft underflight support for several other investigators. Additionally, the data bank is generally available for use by ERTS and other investigators that have a scientific interest in data pertaining to the Chesapeake Bay area. Working with DCS has provided a means of evaluating the system as a data collection device possibly applicable to ongoing Earth Resources Program activities in the Chesapeake Bay area as well as providing useful data and services to other ERTS investigators. The two areas of technical support provided by Wallops, ground truth stations and repair for DCPs, are briefly discussed.

  17. Leuprolide Acetate 1-Month Depot for Central Precocious Puberty: Hormonal Suppression and Recovery

    Directory of Open Access Journals (Sweden)

    Neely EKirk

    2011-01-01

    Full Text Available Methods. This prospective US multicenter trial of leuprolide acetate 1-month depot (7.5–15 mg for central precocious puberty utilized an open-label treatment period, long-term follow-up, and adult callback. Forty-nine females Results. Subjects were treated for years. Mean peak GnRH-stimulated LH and FSH were prepubertal after the first dose and remained suppressed throughout treatment. During treatment, mean estradiol decreased to the limit of detection and mean testosterone decreased but remained above prepubertal norms. During posttreatment follow-up ( years, all patients achieved a pubertal hormonal response within 1 year and menses were reported in all females ≥12 years old. No impairment of reproductive function was observed at adulthood (mean age: 24.8 years.

  18. LEUPRORELIN ACETATE DEPOT (ELIGARD IN THE TREATMENT OF PROSTATE CANCER: WHAT DO PATIENTS WIN?

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2010-01-01

    Full Text Available Eligard (leupropelin acetate, Atrigel delivery system is a synthetic analogue of luteinizing-hormone-realizing hormone (LHRH, which causes a rapid reduction in the level of testosterone to the concentration comparable with that after surgical castration. Eligard demonstrated a considerable advantage over other LHRH analogues in the depth of androgenic suppression and in the frequency of transient increases in testosterone levels at the beginning and during therapy. Eligard is available as 1-, 3-, and 6-month depot formulations, which allows a flexible approach to be applied to individually making up a therapy regimen. Eligard is as effective as castration therapy techniques. Treatment with this drug shows the low frequency of side effects and is well tolerated by patients.

  19. LEUPRORELIN ACETATE DEPOT (ELIGARD IN THE TREATMENT OF PROSTATE CANCER: WHAT DO PATIENTS WIN?

    Directory of Open Access Journals (Sweden)

    V. B. Matveev

    2014-08-01

    Full Text Available Eligard (leupropelin acetate, Atrigel delivery system is a synthetic analogue of luteinizing-hormone-realizing hormone (LHRH, which causes a rapid reduction in the level of testosterone to the concentration comparable with that after surgical castration. Eligard demonstrated a considerable advantage over other LHRH analogues in the depth of androgenic suppression and in the frequency of transient increases in testosterone levels at the beginning and during therapy. Eligard is available as 1-, 3-, and 6-month depot formulations, which allows a flexible approach to be applied to individually making up a therapy regimen. Eligard is as effective as castration therapy techniques. Treatment with this drug shows the low frequency of side effects and is well tolerated by patients.

  20. Depot-dependent effects of adipose tissue explants on co-cultured hepatocytes

    DEFF Research Database (Denmark)

    Du, Zhen-Yu; Ma, Tao; Lock, Erik-Jan

    2011-01-01

    than that from epididymal ATE. However, expressions of lipolysis related genes (ATGL, HSL, perilipin-1) were higher in the epididymal adipocytes than inguinal adipocytes. Moreover, secretion of IL-6 and PGE(2) was higher from inguinal ATEs than from epididymal ATEs. There was a trend that the total...... a stronger cytotoxic response and higher level of insulin resistance in the co-cultured hepatocytes. In conclusion, our results reveal depot-dependent effects of ATEs on co-cultured primary hepatocytes, which in part may be related to a more pronounced infiltration of stromal vascular cells (SVCs......), particularly macrophages, in inguinal adipose tissue resulting in stronger responses in terms of hepatotoxicity and insulin-resistance....

  1. Disposal of chemical agents and munitions stored at Umatilla Depot Activity, Hermiston, Oregon

    Energy Technology Data Exchange (ETDEWEB)

    Zimmerman, G.P.; Hillsman, E.L.; Johnson, R.O.; Miller, R.L.; Patton, T.G.; Schoepfle, G.M.; Tolbert, V.R.; Feldman, D.L.; Hunsaker, D.B. Jr.; Kroodsma, R.L.; Morrissey, J.; Rickert, L.W.; Staub, W.P.; West, D.C.

    1993-02-01

    The Umatilla Depot Activity (UMDA) near Hermiston, Oregon, is one of eight US Army installations in the continental United States where lethal unitary chemical agents and munitions are stored, and where destruction of agents and munitions is proposed under the Chemical Stockpile Disposal Program (CSDP). The chemical agent inventory at UMDA consists of 11.6%, by weight, of the total US stockpile. The destruction of the stockpile is necessary to eliminate the risk to the public from continued storage and to dispose of obsolete and leaking munitions. In 1988 the US Army issued a Final Programmatic Environmental Impact Statement (FPEIS) for the CSDP that identified on-site disposal of agents and munitions as the environmentally preferred alternative (i.e., the alternative with the least potential to cause significant adverse impacts), using a method based on five measures of risk for potential human health and ecosystem/environmental effects; the effectiveness and adequacy of emergency preparedness capabilities also played a key role in the FPEIS selection methodology. In some instances, the FPEIS included generic data and assumptions that were developed to allow a consistent comparison of potential impacts among programmatic alternatives and did not include detailed conditions at each of the eight installations. The purpose of this Phase 1 report is to examine the proposed implementation of on-site disposal at UMDA in light of more recent and more detailed data than those included in the FPEIS. Specifically, this Phase 1 report is intended to either confirm or reject the validity of on-site disposal for the UMDA stockpile. Using the same computation methods as in the FPEIS, new population data were used to compute potential fatalities from hypothetical disposal accidents. Results indicate that onsite disposal is clearly preferable to either continued storage at UMDA or transportation of the UMDA stockpile to another depot for disposal.

  2. Quantification of abdominal fat depots in rats and mice during obesity and weight loss interventions.

    Science.gov (United States)

    Kn, Bhanu Prakash; Gopalan, Venkatesh; Lee, Swee Shean; Velan, S Sendhil

    2014-01-01

    Obesity is a leading healthcare issue contributing to metabolic diseases. There is a great interest in non-invasive approaches for quantitating abdominal fat in obese animals and humans. In this work, we propose an automated method to distinguish and quantify subcutaneous and visceral adipose tissues (SAT and VAT) in rodents during obesity and weight loss interventions. We have also investigated the influence of different magnetic resonance sequences and sources of variability in quantification of fat depots. High-fat diet fed rodents were utilized for investigating the changes during obesity, exercise, and calorie restriction interventions (N = 7/cohort). Imaging was performed on a 7T Bruker ClinScan scanner using fast spin echo (FSE) and Dixon imaging methods to estimate the fat depots. Finally, we quantified the SAT and VAT volumes between the L1-L5 lumbar vertebrae using the proposed automatic hybrid geodesic region-based curve evolution algorithm. Significant changes in SAT and VAT volumes (pfat quantification correlation between FSE (with and without water suppression) sequences and Dixon for SAT and VAT were 0.9709, 0.9803 and 0.9955, 0.9840 respectively. The algorithm significantly reduced the computation time from 100 sec/slice to 25 sec/slice. The pre-processing, data-derived contour placement and avoidance of strong background-image boundary improved the convergence accuracy of the proposed algorithm. We developed a fully automatic segmentation algorithm to quantitate SAT and VAT from abdominal images of rodents, which can support large cohort studies. We additionally identified the influence of non-algorithmic variables including cradle disturbance, animal positioning, and MR sequence on the fat quantification. There were no large variations between FSE and Dixon-based estimation of SAT and VAT.

  3. Metformin induces glucose uptake in human preadipocyte-derived adipocytes from various fat depots.

    Science.gov (United States)

    Fischer, M; Timper, K; Radimerski, T; Dembinski, K; Frey, D M; Zulewski, H; Keller, U; Müller, B; Christ-Crain, M; Grisouard, J

    2010-04-01

    To evaluate the effect of metformin on basal and insulin-induced glucose uptake in subcutaneous and visceral preadipocyte-derived adipocytes from obese and non-obese patients, preadipocytes were obtained from subcutaneous and visceral fat depots during abdominal surgery. Differentiation efficiency was evaluated by measurement of intracellular triglyceride accumulation. Preadipocyte-derived adipocytes were treated with metformin (1 mM) for 24 h with or without the addition of insulin (100 nM) for 20 min and glucose uptake was measured. In cells from each donor, intracellular triglyceride accumulation was more abundant in subcutaneous preadipocyte-derived adipocytes than in visceral preadipocyte-derived adipocytes (p < 0.001). Insulin stimulated glucose uptake in subcutaneous preadipocyte-derived adipocytes from both non-obese and obese patients (p < 0.001 vs. basal). In visceral preadipocyte-derived adipocytes, insulin did not increase basal glucose uptake. In subcutaneous preadipocyte-derived adipocytes from non-obese and obese patients, metformin alone increased glucose uptake to 2.7 +/- 0.2 (p < 0.001) and 2.1 +/- 0.1 fold (p < 0.001) respectively. Metformin increased glucose uptake in visceral preadipocyte-derived adipocytes from non-obese (1.7 +/- 0.1 fold vs. basal, p < 0.001) and obese (2.0 +/- 0.2 fold vs. basal, p < 0.001) patients. Combined treatment with metformin and insulin increased glucose uptake in subcutaneous preadipocyte-derived adipocytes from both non-obese and obese patients (p < 0.001 vs. insulin alone). In preadipocyte-derived adipocytes glucose uptake is induced by metformin independent of the fat depot origin of the preadipocytes (subcutaneous or visceral) and the obesity state of the patients (non-obese or obese). In adipocytes, metformin seems to induce glucose uptake independent of insulin suggesting an alternative mechanism of action of this drug.

  4. Disposal of chemical agents and munitions stored at Anniston Army Depot, Anniston, Alabama

    Energy Technology Data Exchange (ETDEWEB)

    Hunsaker, D.B. Jr.; Zimmerman, G.P.; Hillsman, E.L.; Miller, R.L.; Schoepfle, G.M.; Johnson, R.O.; Tolbert, V.R.; Kroodsma, R.L.; Rickert, L.W.; Rogers, G.O.; Staub, W.P.

    1990-09-01

    The purpose of this Phase I report is to examined the proposed implementation of on-site disposal at Anniston Army Depot (ANAD) in light of more detailed and more recent data than those included in the Final Programmatic Environmental Impact Statement (EPEIS). Two principal issues are addressed: (1) whether or not the new data would result in identification of on-site disposal at ANAD as the environmentally preferred alternative (using the same selection method and data analysis tools as in the FPEIS), and (2) whether or not the new data indicate the presence of significant environmental resources that could be affected by on-site disposal at ANAD. In addition, a status report is presented on the maturity of the disposal technology (and now it could affect on-site disposal at ANAD). Inclusion of these more recent data into the FPEIS decision method resulted in confirmation of on-site disposal for ANAD. No unique resources with the potential to prevent or delay implementation of on-site disposal at ANAD have been identified. A review of the technology status identified four principal technology developments that have occurred since publication of the FPEIS and should be of value in the implementation of on-site disposal at ANAD: the disposal of nonlethal agent at Pine Bluff Arsenal, located near Pine Bluff, Arkansas; construction and testing of facilities for disposal of stored lethal agent at Johnston Atoll, located about 1300 km (800 miles) southwest of Hawaii in the Pacific Ocean; lethal agent disposal tests at the chemical agent pilot plant operations at Tooele Army Depot, located near Salt Lake City, Utah; and equipment advances. 18 references, 13 figs., 10 tabs.

  5. The effect of regular medication on the outcome of paracetamol poisoning

    DEFF Research Database (Denmark)

    Schmidt, L E; Dalhoff, K

    2002-01-01

    BACKGROUND: Patients admitted with paracetamol overdose frequently receive one or more types of regular medication that may affect the outcome of the paracetamol intoxication. AIM: To describe the use of regular medication in patients with paracetamol poisoning and to evaluate its effects...... on morbidity and mortality. METHODS: Seven hundred and thirty-seven consecutive patients admitted with paracetamol poisoning were studied and the use of regular medication was recorded. The relative risk of hepatic encephalopathy, death or liver transplantation, severe hepatic dysfunction and severe......, neuroleptics, paracetamol, oral contraceptives, beta-agonists or anticonvulsants in the multivariate analysis. CONCLUSIONS: Regular medication with psychotropic medication, analgesics, oral contraceptives, beta-agonists or anticonvulsants was frequent in patients admitted with paracetamol poisoning. Medication...

  6. [Association polymorphic variants of GRIN2B gene with paranoid schizophrenia and response to common neuroleptics in Russians and Tatars from Bashkortostan Republic].

    Science.gov (United States)

    Gareeva, A E; Zakirov, D F; Khusnutdinova, E K

    2013-09-01

    An analysis of the association of paranoid schizophrenia seeking with polymorphic variants of GRIN2B gene was performed in order to identify genetic risk factors of disease development and genetic markers of the response to therapy by neuroleptics in Russian and Tatar patients from Bashkortostan Republic (BB). In the course of the analysis, we revealed the following: 1) genetic markers of increased risk of developing paranoid schizophrenia in various ethnic groups, including, in Tatars, the GRIN2B* T/*Tgenotype (p = 0.003; OR = 2.33) and GRIN2B*T allele (p = 0.001; OR = 2.36), rs1805247; in Russians, the GRIN2B*T/*T genotype (p = 0.038; OR = 2.12) and GRIN2B* T allele (p = 0.028; OR = 2.03), rs1805247, genotype GRIN2B*A/*A (p = 0.042; OR = 2.12), rs1805476; 2) genetic markers of the reduced risk of developing paranoid schizophrenia; 3) genetic markers of therapy response and the risk of side effects development during neuroleptics (haloperidol) treatment in Bashkortostan. The significant interethnic diversity of genetic factors related to the risk of this disease development was noted.

  7. Neuroleptics up-regulate adenosine A2a receptors in rat striatum: implications for the mechanism and the treatment of tardive dyskinesia.

    Science.gov (United States)

    Parsons, B; Togasaki, D M; Kassir, S; Przedborski, S

    1995-11-01

    Neuroleptics, which are potent dopamine receptor antagonists, are used to treat psychosis. In the striatum, dopamine subtype-2 (D2) receptors interact with high-affinity adenosine subtype-2 (A2a) receptors. To examine the effect of various neuroleptics on the major subtypes of striatal dopamine and adenosine receptors, rats received 28 daily intraperitoneal injections of these drugs. Haloperidol (1.5 mg/kg/day) increased the density of striatal D2 receptors by 24% without changing their affinity for [3H]sulpiride. Haloperidol increased the density of striatal A2a receptors by 33% (control, 522.4 +/- 20.7 fmol/mg of protein; haloperidol, 694.6 +/- 23.6 fmol/mg of protein; p sulpiride (100 mg/kg/day) and clozapine (20 mg/kg/day) did not (control, 290.3 +/- 8.7 fmol/mg of protein; haloperidol, 358.1 +/- 6.9 fmol/mg of protein; fluphenazine, 381.3 +/- 13.6 fmol/mg of protein; sulpiride, 319.8 +/- 18.9 fmol/mg of protein; clozapine, 309.2 +/- 13.7 fmol/mg of protein).(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Chronic administration of l-sulpiride at non-neuroleptic doses reduces the duration of immobility in experimental models of "depression-like" behavior.

    Science.gov (United States)

    Vergoni, A V; Forgione, A; Bertolini, A

    1995-09-01

    It has been shown that long-term administration of l-sulpiride induces a down-regulation of beta receptor-associated adenylate cyclase activity in the frontal cortex of rats, and adaptive response that is typically associated with the chronic administration of antidepressants. Here we show that in two animal models of "depression-like" behavior (forced swim in rats and tail suspension in mice), the long-term (21 days) administration of l-sulpiride at a non-neuroleptic dose (2 mg/kg IP twice a day) significantly decreases the duration of immobility, the effect being similar to that of desipramine (20 mg/kg IP). The same dose (2 mg/kg) of l-sulpiride, acutely administered, has no effect at all. On the other hand, either chronic (21 days) or acute administration of neuroleptic doses of l-sulpiride have an opposite effect, and indeed increase the duration of immobility. These results are an in vivo support to the in vitro findings suggesting that low doses of l-sulpiride may have antidepressant-like activity.

  9. Combined high dose vitamin C and E increases oxidative stress and visceral fat mass in rats treated by depot-medroxyprogesterone acetate

    Directory of Open Access Journals (Sweden)

    Endang Sri Wahyuni

    2016-12-01

    Conclusion: DMPA treatment induces oxidative stress in visceral fat. Combined high dose vitamin C and E increases oxidative stress and visceral fat mass in rats treated by depot-medroxyprogesterone acetate.

  10. Depot specific differences in the adipogenic potential of precursors are mediated by collagenous extracellular matrix and Flotillin 2 dependent signaling

    Directory of Open Access Journals (Sweden)

    Gerald Grandl

    2016-10-01

    Conclusions: We show that adipose tissue SVF secretes collagenous ECM, which directly modulates terminal differentiation of adipocyte precursors in a depot specific manner. These data demonstrate the importance of the tissue microenvironment in preadipocyte differentiation.

  11. Comparison of two strategies for the administration of injectable depot medroxyprogesterone acetate: among women who returned to a family planning clinic at three- or six-month intervals.

    Science.gov (United States)

    Ferreira, Jéssica M; Bottura, Bruna F; Gonçalves, Mayara P; Monteiro, Ilza; Bahamondes, Luis

    2016-10-01

    The aim of this study was to compare the clinical performance of depot medroxyprogesterone acetate (DMPA) in women who received injections every 3 months at the Family Planning Clinic, and those who received every other injection at a health care facility near their place of residence, only returning to the clinic every 6 months. The medical charts of DMPA users from 2 January 1980 through 31 December 2012 were evaluated for this study. Two cohorts of women were created and compared: those who regularly received DMPA injections every 3 months (3-month group) at the clinic and those who received alternating 3-month injections at a health care facility near their residence house, returning to the clinic every 6 months for an injection (6-month group). In addition, effectiveness rates, reasons for discontinuation, and continuation rates were evaluated. Overall, 2637 women received all injections at 3-month intervals at the clinic, and 1190 women received every other injection at a health care facility near their residence. The women in the 3-month group had higher pregnancy rates and higher discontinuation rates (with the exception of discontinuation due to the loss of libido). The women who received alternating injections near their homes were more likely to continue using DMPA as a contraception method and presented lower pregnancy and discontinuation rates (for the majority of reasons), when compared to those women who returned to the clinic every 3 months.

  12. Neurolépticos en el tratamiento de la esquizofrenia paranoide del paciente hospitalizado Neuroleptic drugs for the treatment of paranoid squizophrenia in the hospitalizad patient

    Directory of Open Access Journals (Sweden)

    Ismary González Hernánde

    2008-12-01

    Full Text Available Se realizó un estudio de utilización de medicamentos: indicación-prescripción, con elementos de consumo y consecuencias prácticas en el Hospital Psiquiátrico de Santa Clara durante el año 2006. Se elaboró un formulario con datos como: edad, sexo, tiempo de evolución, neurolépticos usados, estadía hospitalaria y precio de los medicamentos por unidad. Se propuso describir el uso de neurolépticos en el manejo de la esquizofrenia paranoide del paciente hospitalizado, contrastar el número de neurolépticos utilizados según estadía hospitalaria y tiempo de evolución, así como los costos del tratamiento en estos pacientes. El análisis se realizó mediante pruebas paramétricas y no paramétricas, con un nivel de significación de 0,01 ó 0,05. Como resultados relevantes se observaron que los fármacos usados con mayor frecuencia fueron flufenacina y clorpromacina. La combinación más empleada resultó ser la flufenacina y clorpromacina. El grupo de pacientes con más de 63 días de estadía hospitalaria, mostró el más alto gasto promedio en medicamentos. Se concluyó que los neurolépticos más utilizados fueron la flufenacina, la clorpromacina y el levomepromacina. Existe asociación entre el número de neurolépticos utilizados y el tiempo de evolución de la enfermedad. La estadía hospitalaria constituye el indicador que más encareció la terapéutica del paciente esquizofrénico.A drug use evaluation study that considered prescription, consumption elements and practical consequences was carried out in the Psychiatric Hospital of Santa Clara city in Villa Clara province during 2006. A form to collect data such as age, sex, time of evolution, neuroleptic drugs used, stay at hospital and price of drug per unit was made. The objective was to describe the use of neuroleptic drugs in the management of paranoid squizophrenia of the hospitalized patient, to compare the number of neuroleptic drugs that was used according to stay at

  13. Results of a Study Investigating the Plant Uptake of Explosive Residues From Compost of Explosives-Contaminated Soil Obtained from the Umatilla Army Depot Activity

    Science.gov (United States)

    1998-11-01

    and explosive by-products in nine plant species. These plant species included: Radish ( Raphanus sativus L. variety Cherry Belle), Kale (Brassica...Umatilla Army Depot Activity Vegetable Crops: • Radish ( Raphanus sativus L. variety Cherry Belle) - A quick-growing root crop which can be grown to...seeds of radish ( Raphanus sativus variety Cherry Belle), lettuce Plant Uptake of Explosives 3-18 Umatilla Army Depot Activity o < o ft <u Q >> T3

  14. Validation of the Algorithms for Depot Exchangeable Repair and Modification Costs for NSNS and Engines for the Component Support Cost System (D160B).

    Science.gov (United States)

    2014-09-26

    IDENTIFICATION OI 03 NOMENCLATURE . ITEM 012 03 PRICE. STANDARD INVENTORY 013 03 CODE. WEAPON SYSTEM SUPPORT 014 06 CODE. WEAPON SYSTEM SUPPORT. POSITIONS I TO...calculation of standard depot repair prices ( sales prices). Various knowledgeable Air Force personnel have noted that it is not unusual for an engine to be both...cost elements not used in calculation of standard depot repair prices (" sales prices"). ISI affirms the congruence of the definitions of repair prices as

  15. 基于Prolog的粮库环境专家系统的研究%The Study on Grain Depot Environment Expert System Based on Prolog

    Institute of Scientific and Technical Information of China (English)

    刘晓军

    2001-01-01

    All links of building grain depot environment expert system was discussed with Turbo Prolog. The foundation was established for the next stage to build grain depot intelligent management system.%论述了用Turbo-Prolog语言构造环境专家系统的各环节,为进一步构建粮库智能监测专家系统打下了基础。

  16. An Analysis of the Defense Logistics Agency’s Forward Stocking Initiatives at Albany and Barstow Distribution Depots and the Impact on Logistics Response Time

    Science.gov (United States)

    2016-12-01

    RESPONSE TIME GRADUATE RESEARCH PAPER Broderick S. Morris, Captain, USAF AFIT-ENS-MS-16-D-047 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR FORCE...AT ALBANY AND BARSTOW DISTRIBUTION DEPOTS AND THE IMPACT ON LOGISTICS RESPONSE TIME GRADUATE RESEARCH PAPER Presented to the Faculty Department...the customers at Marine Corps Logistics Bases Albany and Barstow, where DLA depots are co-located with the retail mission. This research does not

  17. An Ant Colony Optimization algorithm for solving the fixed destination multi-depot multiple traveling salesman problem with non-random parameters

    Science.gov (United States)

    Ramadhani, T.; Hertono, G. F.; Handari, B. D.

    2017-07-01

    The Multiple Traveling Salesman Problem (MTSP) is the extension of the Traveling Salesman Problem (TSP) in which the shortest routes of m salesmen all of which start and finish in a single city (depot) will be determined. If there is more than one depot and salesmen start from and return to the same depot, then the problem is called Fixed Destination Multi-depot Multiple Traveling Salesman Problem (MMTSP). In this paper, MMTSP will be solved using the Ant Colony Optimization (ACO) algorithm. ACO is a metaheuristic optimization algorithm which is derived from the behavior of ants in finding the shortest route(s) from the anthill to a form of nourishment. In solving the MMTSP, the algorithm is observed with respect to different chosen cities as depots and non-randomly three parameters of MMTSP: m, K, L, those represents the number of salesmen, the fewest cities that must be visited by a salesman, and the most number of cities that can be visited by a salesman, respectively. The implementation is observed with four dataset from TSPLIB. The results show that the different chosen cities as depots and the three parameters of MMTSP, in which m is the most important parameter, affect the solution.

  18. In-situ forming gel-like depot of a polyaspartamide-polylactide copolymer for once a week administration of sulpiride.

    Science.gov (United States)

    Fiorica, Calogero; Palumbo, Fabio Salvatore; Pitarresi, Giovanna; Giorgi, Mario; Calascibetta, Filippo; Giammona, Gaetano

    2015-01-01

    An in-situ forming gel-like depot, prepared by using an appropriate polyaspartamide-polylactide graft copolymer, has been employed to release in a sustained way sulpiride. α,β-poly(N-2-hydroxyethyl)-D,L-aspartamide-g-polylactic acid (PHEA-g-PLA) has been used as a polymer component. Its physicochemical properties make possible to dissolve it in N-methyl-2-pyrrolidone, with the obtainment of a solution able to form a gel-like depot once injected into a physiological medium. Cell compatibility of PHEA-g-PLA depot has been investigated, using murine dermal fibroblasts as cell model. 3-(4,5-Dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt assay and fluorescence microscopy have been employed to evaluate cell viability and morphology after contact with PHEA-g-PLA depot. Pharmacokinetic parameters of sulpiride released from depot have been determined following subcutaneous administration to rabbits and compared with corresponding parameters following administration of free sulpiride solution. It has been demonstrated that the system does not affect significantly the viability of fibroblasts and is able to sustain the release of sulpiride until a week, with a burst effect dependent on the initial weight ratio polymer/drug. In-vivo release profiles and pharmacokinetic parameters suggest that PHEA-g-PLA depot could have interesting clinical applications for a once a week administration of poorly soluble drugs to humans or animals. © 2014 Royal Pharmaceutical Society.

  19. Working alliance and its relationship to outcomes in a randomized controlled trial (RCT of antipsychotic medication

    Directory of Open Access Journals (Sweden)

    Wykes Til

    2013-01-01

    Full Text Available Abstract Background Long acting injections (LAI have been associated with perceptions of coercion in cross sectional studies but there have been no longitudinal studies of the effects on clinical relationships with newer depot medications. Method Randomized controlled trial with (50 participants with a diagnosis of schizophrenia randomized to risperidone LAI or oral atypical antipsychotic medication. The main outcome was the Working Alliance Inventory (WAI with background variables (symptoms, side effect, social functioning, quality of life measured before randomization and at two years. Results At follow-up (14 risperidone LAI and 16 oral medication analyses including predictors of missing data and baseline score showed a trend for those on risperidone LAI to reduce WAI score and those on oral medication showing no change. Sensitivity analyses showed (i a significant detrimental effect of LAI on WAI and (ii the pattern of results was not affected by change in symptoms over the study. Conclusion This is the first study to show that the prescription of depot atypical depot medication is associated with detrimental effects on clinical relationships after 2 years of continual treatment.

  20. Identification of Relevant Costs in the Decision to Consolidate or Maintain Two Marine Corps Recruit Training Depots

    Science.gov (United States)

    2015-06-01

    under the direct support category. Organizational clothing is another subcategory of costs that fall under the recruit training category. The costs ...RELEVANT COSTS IN THE DECISION TO CONSOLIDATE OR MAINTAIN TWO MARINE CORPS RECRUIT TRAINING DEPOTS by Jeremy M. Forrer June 2015 Thesis...REPORT DATE June 2015 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE IDENTIFICATION OF RELEVANT COSTS IN THE DECISION TO

  1. The waste collection VRP with intermediate facilities, a heterogeneous fixed fleet and a flexible assignment of origin and destination depot

    OpenAIRE

    Markov, Iliya; Varone, Sacha; Bierlaire, Michel

    2015-01-01

    We consider a complex recyclable waste collection problem that extends the class of vehicle routing problems with intermediate facilities by integrating a heterogeneous fixed fleet and a flexible assignment of origin and destination depot. Several additional side constraints, such as a mandated break period contingent on tour start time, multiple vehicle capacities and site dependencies are also included. This specific problem was inspired by a real-world application and does not appear in th...

  2. Impact evaluation of an orbital depot on on-orbit servicing infrastructures dedicated to modularized earth-orbiting platforms

    Science.gov (United States)

    Sarton du Jonchay, Tristan; Ho, Koki

    2017-03-01

    This paper aims to quantify the responsiveness of two on-orbit servicing infrastructures providing services to multiple serviceable platforms in coplanar medium Earth orbit (MEO) and geostationary orbit (GEO). The platforms to be serviced are assumed to be made of elementary units (EUs). EUs are small standardized structural units capable of aggregating with each other and gathering the key functions of a typical satellite within the size of a 6U cubesat. The first servicing infrastructure considered in this paper, called "Without Depot" (WoD), includes a launch vehicle and a robotic servicer. The second servicing infrastructure, called "With Depot" (WD) includes a launch vehicle, a robotic servicer and an orbital depot of EUs. The responsiveness of these infrastructures is quantified using a queueing theory-based stochastic simulation on Simulink taking into account the launch and platform random failures. The metrics used to quantify the responsiveness are the service completion rate and the average waiting time before an EU is replaced over a 10-year period of operation. With respect to those metrics, it is demonstrated that WD is more responsive than WoD. However, WD is also shown to be likely to cost more than WoD. Finally, the sensitivity of the responsiveness of WD to the capacity of the orbital depot is analyzed to find the minimum storage capacity for which WD is the most responsive. This last result could be of interest for space designers dealing with the sizing of on-orbit servicing infrastructures. We believe that the concept introduced in this paper will be a critical milestone in the design of a responsive integrated space infrastructure dedicated to the development and prosperity of a new MEO/GEO economy.

  3. Quantification of abdominal fat depots in rats and mice during obesity and weight loss interventions.

    Directory of Open Access Journals (Sweden)

    Bhanu Prakash Kn

    Full Text Available BACKGROUND & AIMS: Obesity is a leading healthcare issue contributing to metabolic diseases. There is a great interest in non-invasive approaches for quantitating abdominal fat in obese animals and humans. In this work, we propose an automated method to distinguish and quantify subcutaneous and visceral adipose tissues (SAT and VAT in rodents during obesity and weight loss interventions. We have also investigated the influence of different magnetic resonance sequences and sources of variability in quantification of fat depots. MATERIALS AND METHODS: High-fat diet fed rodents were utilized for investigating the changes during obesity, exercise, and calorie restriction interventions (N = 7/cohort. Imaging was performed on a 7T Bruker ClinScan scanner using fast spin echo (FSE and Dixon imaging methods to estimate the fat depots. Finally, we quantified the SAT and VAT volumes between the L1-L5 lumbar vertebrae using the proposed automatic hybrid geodesic region-based curve evolution algorithm. RESULTS: Significant changes in SAT and VAT volumes (p<0.01 were observed between the pre- and post-intervention measurements. The SAT and VAT were 44.22±9%, 21.06±1.35% for control, -17.33±3.07%, -15.09±1.11% for exercise, and 18.56±2.05%, -3.9±0.96% for calorie restriction cohorts, respectively. The fat quantification correlation between FSE (with and without water suppression sequences and Dixon for SAT and VAT were 0.9709, 0.9803 and 0.9955, 0.9840 respectively. The algorithm significantly reduced the computation time from 100 sec/slice to 25 sec/slice. The pre-processing, data-derived contour placement and avoidance of strong background-image boundary improved the convergence accuracy of the proposed algorithm. CONCLUSIONS: We developed a fully automatic segmentation algorithm to quantitate SAT and VAT from abdominal images of rodents, which can support large cohort studies. We additionally identified the influence of non-algorithmic variables

  4. Interest in self-administration of subcutaneous depot medroxyprogesterone acetate in the United States.

    Science.gov (United States)

    Upadhyay, Ushma D; Zlidar, Vera M; Foster, Diana Greene

    2016-10-01

    Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a low-dose formulation of depot medroxyprogesterone acetate (DMPA) that nonmedical personnel can administer safely and effectively. We sought to determine United States women's interest in self-administration of DMPA-SC to understand whether such use can overcome barriers to contraceptive access. We analyzed survey data on contraceptive attitudes collected in March-July 2011 from 1592 women at 13 family planning and six abortion clinics throughout the US. A mixed-effects logistic regression model with random site effects examined the determinants of interest in self-administering DMPA-SC. Overall, 21% [95% confidence interval (CI): 19%-23%] of women reported interest in self-administration. A multivariable model found that women currently using DMPA (Adjusted Odds Ratio [AOR]=3.93, 95% CI: 2.37-6.53, p<.001) and women who previously used DMPA (AOR=1.71, 95% CI: 1.26-2.32, p<.001) were more likely to have an interest in DMPA-SC than those who never used it. Women reporting difficulty obtaining or refilling a prescription were almost twice as likely to have interest in DMPA-SC as women who reported no difficulty (AOR=1.99, 95% CI: 1.43-2.77, p<.001). Women surveyed at abortion sites were more likely to report interest in self-administration than women surveyed at family planning sites (AOR=1.55, 95% CI: 1.05-2.30, p<.05). Interest in DMPA-SC was primarily driven by a desire to eliminate unnecessary return visits to a facility for repeat injections. Offering women the option to self-administer DMPA-SC at home can expand access and tailor contraceptive provision to the needs of clients, thus supporting client-centered care. To the extent that self-administration may improve contraceptive continuation, DMPA-SC can prevent unintended pregnancies among women who discontinue DMPA use because of difficulty returning for repeat injections. There is substantial interest in self-administration of DMPA-SC among current

  5. Endurance exercise training induces fat depot-specific differences in basal autophagic activity

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Goki; Kato, Hisashi; Izawa, Tetsuya, E-mail: tizawa@mail.doshisha.ac.jp

    2015-10-23

    The purpose of this study was to uncover the effect of exercise training on the expression of autophagy marker proteins in epididymal white adipose tissue (eWAT), inguinal WAT (iWAT), and the stromal vascular fraction (SVF) collected from eWAT. Male Wistar rats aged 4–5 weeks were randomly divided into two groups, sedentary control (n = 7) and exercise-trained (n = 7). Rats in the exercise-trained group were exercised on a treadmill set at a 5° incline 5 days/week for 9 weeks. We determined that the expression levels of an autophagosome-associating form of microtubule-associated protein 1 light chain 3 (LC3)-II and of p62 were significantly higher in eWAT from exercise-trained than from control rats, while those of adipose-specific deletion of autophagy-related protein (ATG7) and lysosomal-associated membrane protein type 2A (LAMP2a) showed no difference between groups. However, in iWAT, the expression levels of LC3-II and ATG7 were significantly higher in exercise-trained than in control rats. The expression of p62 was highly correlated with that of peroxisome proliferator-activated receptor γ (PPARγ), a master regulator of adipogenesis and lipid metabolism, in both WAT types (eWAT, r = 0.856, P < 0.05; iWAT, r = 0.762, P < 0.05), whereas LC3-II and PPARγ levels were highly correlated in eWAT (r = 0.765, P < 0.05) but not in iWAT (r = −0.306, ns). In SVF, the expression levels of LC3II, ATG7, and LAMP2a were significantly higher in exercise-trained than in control rats. These results suggest that exercise training suppresses basal autophagy activity in eWAT, but that this activity is enhanced in iWAT and SVF collected from eWAT. Thus, the adaptation of basal autophagic activity following exercise training exhibits fat depot-specific differences. - Highlights: • Autophagy has been associated with obesity and associated diseases. • We examined exercise-associated rat white adipose tissue (WAT) autophagy markers. • Exercise increased

  6. Ototoxic Medications (Medication Effects)

    Science.gov (United States)

    ... Information for the Public / Hearing and Balance Ototoxic Medications (Medication Effects) By Barbara Cone, Patricia Dorn, Dawn Konrad- ... Audiology Information Series [PDF]. What Is Ototoxicity? Certain medications can damage the ear, resulting in hearing loss, ...

  7. The safety of subcutaneously administered depot medroxyprogesterone acetate (104mg/0.65mL): A systematic review.

    Science.gov (United States)

    Dragoman, Monica V; Gaffield, Mary E

    2016-09-01

    Depot medroxyprogesterone acetate (DMPA), a progestogen-only contraceptive injectable, has traditionally been formulated as a crystalline suspension delivered intramuscularly (IM) at a dose of 150mg/1.0mL. A new, lower dose formulation of DMPA (104mg/0.65mL) has been developed for subcutaneous administration (SC). Given its increasing global availability and public health relevance, DMPA-SC was prioritized for inclusion as a new method referenced in the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use (MEC), 5th Edition. This systematic review evaluated the published peer-reviewed literature regarding the safety of DMPA-SC among women with various characteristics or medical conditions. Results of this review informed the decision-making of a WHO Guideline Development Group in order to include recommendations on contraceptive eligibility within the revised MEC. We searched PubMed and Cochrane Library databases to identify all relevant evidence published in peer-reviewed journals regarding the safety of DMPA-SC when used by women of reproductive age, particularly those with select characteristics or conditions specified in the MEC, from inception through June 2015. The quality of each individual study was assessed using the system for grading evidence developed by the United States Preventive Services Task Force. Fourteen studies met criteria for inclusion. Ten reported results relevant to DMPA users of varying age or with obesity, endometriosis or HIV; four compared the safety of DMPA-SC and DMPA-IM when used by general populations of healthy women. A randomized trial evaluating changes in bone mineral density among adult DMPA-SC and DMPA-IM users demonstrated no differences at 2years of follow-up. Limited evidence reported no consistent differences in weight change or bleeding patterns according to age; however, adolescents (<18years) were not included in any studies. Similar contraceptive efficacy, weight change, bleeding patterns

  8. Amphiphilic Beads as Depots for Sustained Drug Release Integrated into Fibrillar Scaffolds

    Science.gov (United States)

    Gaharwar, Akhilesh K.; Mihaila, Silvia M.; Kulkarni, Ashish A.; Patel, Alpesh; Di Luca, Andrea; Reis, Rui L.; Gomes, Manuela E.; van Blitterswijk, Clemens; Moroni, Lorenzo; Khademhosseini, Ali

    2014-01-01

    Native extracellular matrix (ECM) is a complex fibrous structure loaded with bioactive cues that affects the surrounding cells. A promising strategy to mimicking native tissue architecture for tissue engineering applications is to engineer fibrous scaffolds using electrospinning. By loading appropriate bioactive cues within these fibrous scaffolds, various cellular functions such as cell adhesion, proliferation and differentiation can be regulated. Here, we report on the encapsulation and sustained release of model hydrophobic drug (dexamethasone (Dex)) within beaded fibrillar scaffold of poly(ethylene oxide terephthalate)-poly(butylene terephthalate) (PEOT/PBT), a polyether-ester multiblock copolymer to direct differentiation of human mesenchymal stem cells (hMSCs). The amphiphilic beads act as depots for sustained drug release that is integrated into the fibrillar scaffolds. The entrapment of Dex within the beaded structure results in sustained release of drug over the period of 28 days. This is mainly attributed to the diffusion driven release of Dex from the amphiphilic electrospun scaffolds. In vitro results indicate that hMSCs cultured on Dex containing beaded fibrillar scaffolds exhibit an increase in osteogenic differentiation potential, as evidenced by increased alkaline phosphatase (ALP) activity, compared to the direct infusion of Dex in culture medium. The formation of mineralized matrix is also significantly enhanced due to the controlled Dex release from the fibrous scaffolds. This approach can be used to engineer scaffolds with appropriate chemical cues to direct tissue regeneration. PMID:24794894

  9. Lessons from a geospatial analysis of depot medroxyprogesterone acetate sales by licensed chemical sellers in Ghana.

    Science.gov (United States)

    Shelus, Victoria; Lebetkin, Elena; Keyes, Emily; Mensah, Stephen; Dzasi, Kafui

    2015-08-01

    To map access to depot medroxyprogesterone acetate (DMPA) from licensed chemical sellers (LCS); to estimate the proportion of women of reproductive age in areas with access; and to examine affordability and variability of costs. A geospatial analysis was conducted using data collected from 298 women who purchased DMPA from 49 geocoded LCS shops in the Amansie West and Ejisu-Juabeng districts of Ghana from June 4 to August 31, 2012. The women reported on cost and average distance traveled to purchase DMPA. In Amansie West, 21.1% of all women of reproductive age lived within average walking distance and 80.4% lived within average driving distance of an LCS. In Ejisu-Juabeng, 41.9% and 60.1% of women lived within average walking and driving distance, respectively. Distribution of affordability varied across each district. Access to LCS shops is high, and training LCS to administer DMPA would increase access to family planning in Ghana, with associated time and cost savings. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Scale-up from batch to flow-through wet milling process for injectable depot formulation.

    Science.gov (United States)

    Lehocký, Róbert; Pěček, Daniel; Štěpánek, František

    2016-12-01

    Injectable depot formulations are aimed at providing long-term sustained release of a drug into systemic circulation, thus reducing plasma level fluctuations and improving patient compliance. The particle size distribution of the formulation in the form of suspension is a key parameter that controls the release rate. In this work, the process of wet stirred media milling (ball milling) of a poorly water-soluble substance has been investigated with two main aims: (i) to determine the parametric sensitivity of milling kinetics; and (ii) to develop scale-up methodology for process transfer from batch to flow-through arrangement. Ball milling experiments were performed in two types of ball mills, a batch mill with a 30ml maximum working volume, and a flow-through mill with a 250ml maximum working volume. Milling parameters were investigated in detail by methodologies of QbD to map the parametric space. Specifically, the effects of ball size, ball fill level, and rpm on the particle breakage kinetics were systematically investigated at both mills, with an additional parameter (flow-rate) in the case of the flow-through mill. The breakage rate was found to follow power-law kinetics with respect to dimensionless time, with an asymptotic d50 particle size in the range of 200-300nm. In the case of the flow-through mill, the number of theoretical passes through the mill was found to be an important scale-up parameter.

  11. Effect of the injectable contraceptive depot-medroxyprogesterone acetate on coagulation parameters in new users.

    Science.gov (United States)

    Melhado-Kimura, Vaneska; Bizzacchi, Joyce Maria Annichino; Quaino, Susan Kelly Picoli; Montalvao, Silmara; Bahamondes, Luis; Fernandes, Arlete

    2017-06-01

    The aim of this study was to assess the effects of the injectable depot-medroxyprogesterone acetate (DMPA) contraceptive on selected blood coagulation parameters in young, healthy new users. The prospective study included 39 healthy women aged 20-39 years, with a body mass index (BMI; kg/m(2) ) < 30, who were never users of DMPA, and who opted to use DMPA (21 women) or a copper intrauterine device (IUD; 18 women). The women in the two groups were matched for age (±1 year) and BMI (±1). Blood samples were obtained from all participants at baseline and at 6 and 12 months. Activated partial thromboplastin time, D-dimer, protein C, antithrombin, protein S, and thrombin generation test (lag time, endogenous thrombin potential, time to peak, and velocity index of thrombin generation) were analyzed. Repeated-measures analysis of variance was used to compare the groups. There were no significant differences between the groups at baseline with respect to any of the parameters evaluated; however, in the DMPA group, D-dimer levels were lower and the time to peak thrombin generation was longer than in the IUD group at 12 months of evaluation. Lower D-dimer and longer time to peak thrombin generation in new users of DMPA suggest a positive profile against hypercoagulability. © 2017 Japan Society of Obstetrics and Gynecology.

  12. Objective Measurement of Inaccurate Condom Use Reporting Among Women Using Depot Medroxyprogesterone Acetate for Contraception.

    Science.gov (United States)

    Heffron, Renee; Parikh, Urvi M; Penrose, Kerri J; Mugo, Nelly; Donnell, Deborah; Celum, Connie; Mellors, John W; Baeten, Jared M

    2017-07-01

    Observational analyses have suggested that women using the injectable contraceptive depot medroxyprogesterone acetate (DMPA) may have heightened risk of acquiring HIV. However, those analyses were potentially confounded by sexual behavior, with possible differential condom use and reporting by women using DMPA versus no contraception. In a cross-sectional study, we measured the presence of a biomarker of recent condomless sex (Y chromosomal [Yc] DNA) in vaginal swabs from HIV-uninfected African women who had an HIV-infected partner and reported 100 % condom use. Half of the samples tested were from women reporting DMPA and half were from women using no contraception. Among 428 specimens tested (213 from DMPA users and 215 from women using no contraception), 32.0 % had Yc DNA detected, with a mean of 193 copies/10,000 human cells (range 0.1-8201). The frequency of detection did not differ by contraceptive use: 34.2 % of DMPA users versus 29.8 % of women using no contraception, adjusted odds ratio 1.3 (95 % confidence interval 0.9-2.0). These results suggest that inaccurate reporting of condom use by DMPA users may not account for the heightened risk of HIV acquisition among DMPA users in some observational studies.

  13. A percutaneous needle biopsy technique for sampling the supraclavicular brown adipose tissue depot of humans.

    Science.gov (United States)

    Chondronikola, M; Annamalai, P; Chao, T; Porter, C; Saraf, M K; Cesani, F; Sidossis, L S

    2015-10-01

    Brown adipose tissue (BAT) has been proposed as a potential target tissue against obesity and its related metabolic complications. Although the molecular and functional characteristics of BAT have been intensively studied in rodents, only a few studies have used human BAT specimens due to the difficulty of sampling human BAT deposits. We established a novel positron emission tomography and computed tomography-guided Bergström needle biopsy technique to acquire human BAT specimens from the supraclavicular area in human subjects. Forty-three biopsies were performed on 23 participants. The procedure was tolerated well by the majority of participants. No major complications were noted. Numbness (9.6%) and hematoma (2.3%) were the two minor complications noted, which fully resolved. Thus, the proposed biopsy technique can be considered safe with only minimal risk of adverse events. Adoption of the proposed method is expected to increase the sampling of the supraclavicular BAT depot for research purposes so as to augment the scientific knowledge of the biology of human BAT.

  14. Prompt Gamma Activation Analysis of the Nyírlugos obsidian core depot find

    Directory of Open Access Journals (Sweden)

    Zsolt Kasztovszky

    2014-03-01

    Full Text Available The Nyírlugos obsidian core depot find is one of the most important lithic assemblages in the collection of the Hungarian National Museum (HNM. The original set comprised 12 giant obsidian cores, of which 11 are currently on the permanent archaeological exhibition of the HNM. One of the cores is known to be inDebrecen. The first publication attributed the hoard, on the strength of giant (flint blades known from the Early and Middle Copper Age Tiszapolgár and Bodrogkeresztúr cultures, to the Copper Age. In the light of recent finds it is more likely to belong to the Middle Neolithic period. The source area was defined as Tokaj Mts., about100 kmto the NW from Nyírlugos. The size and beauty of the exceptional pieces exclude any invasive analysis. Using Prompt Gamma Activation Analysis (PGAA, we can measure major chemical components and some key trace elements of stone artefacts with adequate accuracy to successfully determine provenance of obsidian. Recent methodological development also facilitated the study of relatively large objects like the Nyírlugos cores. The cores were individually measured by PGAA. The results show that the cores originate from the Carpathian 1 sources, most probably the Viničky variety (C1b. The study of the hoard as a batch is an important contribution to the assessment of prehistoric trade and allows us to reconsider the so-called Carpathian, especially Carpathian 1 (Slovakian sources.

  15. Patient-reported outcomes with lanreotide Autogel/Depot for carcinoid syndrome: An international observational study.

    Science.gov (United States)

    Ruszniewski, Philippe; Valle, Juan W; Lombard-Bohas, Catherine; Cuthbertson, Daniel J; Perros, Petros; Holubec, Luboš; Delle Fave, Gianfranco; Smith, Denis; Niccoli, Patricia; Maisonobe, Pascal; Atlan, Philippe; Caplin, Martyn E

    2016-05-01

    Lanreotide Autogel/Depot effectively controls symptoms in patients with carcinoid syndrome associated with neuroendocrine tumours. Data on patient-reported outcomes are sparse. To evaluate the effect of lanreotide on patient-reported outcomes (PROs) with carcinoid syndrome. This was an international, open-label, observational study of adults with neuroendocrine tumours and history of diarrhoea, receiving lanreotide for >3 months for relief of carcinoid syndrome symptoms. The primary PRO measure was satisfaction with diarrhoea control. Secondary PRO measures included severity, change in symptoms and impact on daily life of diarrhoea; and patient satisfaction with flushing control. Of 273 patients enrolled, 76% were 'completely' or 'rather' satisfied with diarrhoea control; 79% reported improvement in diarrhoea with lanreotide. The proportion of patients with 'mild', 'minimal', or 'no diarrhoea' increased from 33% before treatment to 75% during treatment; 75% were unconcerned about the impact of diarrhoea on daily life. Satisfaction with flushing control amongst patients with significant flushing at treatment initiation was 73%. Lanreotide treatment was associated with improvements in symptoms as well as a range of PROs in patients with neuroendocrine tumours and carcinoid syndrome (ClinicalTrials.gov: NCT01234168). Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. 恶性综合征的临床分析与预后探讨%Clinical analysis and prognosis of neuroleptic malignant syndrome

    Institute of Scientific and Technical Information of China (English)

    赵庆杰; 孟珊珊; 曹旭政; 许玫

    2007-01-01

    目的 探讨恶性综合征(neuroleptic malignant syndrome,NMS)的临床特点与预后,提高临床工作者对本综合征的认识.方法 对17例NMS患者进行临床评价.结果 ①17患者均有肌强直、高热、肌酸激酶值增高;②发病3 d内确诊者8例,全部存活;1周内未得到确诊者3例,全部死亡.结论 NMS以肌强直、发热、肌酸激酶值增高为主要特征;避免误诊、早诊断早治疗是改善预后的关键所在.

  17. Uso de olanzapina e eletroconvulsoterapia em um paciente com esquizofrenia catatônica refratária e antecedentes de síndrome neuroléptica maligna Olanzapina y ECT en un enfermo con esquizofrenia catatónica refractaria y alto riesgo de síndrome neuroléptico maligno Olanzapine and ECT combined therapy in a refractory catatonic subtype schizophrenia patient with previous neuroleptic malignant syndrome episodes

    Directory of Open Access Journals (Sweden)

    Pedro Gomes de Alvarenga

    2005-12-01

    Full Text Available Este artigo descreve a história clínica e o manejo de um paciente masculino adulto com esquizofrenia catatônica refratária a dois neurolépticos típicos (haloperidol e clorpromazina e a outro agente atípico (risperidona, e com antecedente de dois episódios de síndrome neuroléptica maligna em vigência de neurolépticos típicos. Os autores optaram pela associação de eletroconvulsoterapia (ECT e olanzapina (7,5 mg. Foram obtidos consideráveis benefícios para o paciente.Presentamos un relato clínico referente a la historia precedente y al desarrollo de un enfermo varón con esquizofrenia catatónica refractaria a los neurolépticos convencionales (clorpromazina y haloperidol y a otro agente de nueva generación (risperidona. El enfermo presentó, en dos ocasiones, síndrome neuroléptico maligno, provocado por el uso de los neurolépticos convencionales. Los autores emplearon ECT y olanzapina (7,5 mg obteniendo considerable éxito clínico.This article describes the clinical history and management of an adult male patient with refractory catatonic schizophrenia to two typically used neurolpetic medications (haloperidol and chlorpromazine and to another atypical agent (risperidone.The patient had also presented two neuroleptic malignant syndrome episodes due to typical neuroleptic agents. The authors combined ECT and olanzapine (7.5 mg as treatment, and a considerable clinical improvement was obtained.

  18. The moderate affinity of clozapine at H3 receptors is not shared by its two major metabolites and by structurally related and unrelated atypical neuroleptics.

    Science.gov (United States)

    Schlicker, E; Marr, I

    1996-02-01

    We determined the affinity and/or potency of two metabolites of clozapine (clozapine-N-oxide and N-desmethylclozapine) and of five atypical neuroleptics, chemically related (olanzapine) or unrelated to clozapine (remoxipride, risperidone, thioridazine, zotepine), at H3 receptors. The specific binding of 3H-N alpha-methylhistamine to rat brain cortex homogenates was inhibited by the seven compounds; the pKi values were: N-desmethylclozapine (5.33); clozapine-N-oxide (4.18); olanzapine (5.45); thioridazine (4.91); zotepine (4.75); remoxipride (4.51) and risperidone (4.43). Three compounds were examined in a functional H3 receptor model as well. The electrically evoked tritium overflow from superfused mouse brain cortex slices, which represents quasi-physiological noradrenaline release, was not affected by N-desmethylclozapine (3.2 and 10 microM), clozapine-N-oxide (3.2-100 microM) and olanzapine (3.2-32 microM). On the other hand, the three compounds shifted to the right the concentration-response curve of histamine for its inhibitory effect on the evoked overflow; the apparent pA2 values were 5.84, 4.21 and 5.80, respectively. The present study shows that five atypical neuroleptics of different chemical classes and the two major metabolites of clozapine possess a lower affinity and/or antagonistic potency at H3 receptors than clozapine itself (pKi 6.15, pA2 6.33; Kathmann M, Schlicker E, Göthert M (1994). Psychopharmacology 116: 464-468).

  19. Effects of Pollutant Diesel Fuels on Neurobehavioral Performance among Workers in Locomotive Depot

    Directory of Open Access Journals (Sweden)

    Anuar Ithnin

    2011-01-01

    Full Text Available Problem statement: Diesel fuel contains various combinations of hydrocarbons such as cyclohexane, n-hexane, benzene and toluene which can cause health problems in major exposure of that pollutant in locomotive depots. Studies were conducted to evaluate the exposure towards diesel fuel pollutant and the effect on neurobehavioral performances among workers in locomotive depots. Approach: Method used was questionnaire form and neurobehavioral performances were measured by WHO NCTB test among 17 exposure workers and 17 control workers. Air pollutant measurement was carried out by GilAir Sampler Low flow pump and analyzed using NMAM method 1500 and 1501. Measured diesel fuel pollutant are Total Volatile Organic Compound (TVOC, cyclohexane, n-hexane, benzene and toluene in three sampling point which are Power Generator Car (PGC, Locomotive (LOCO, producer and receiver of diesel fuel (PPD. Impact assessment NCTB neurobehavioral was carried out. Results: Measured result showed that overall mean of concentration for Total Volatile Organic Compound (TVOC was respectively 1.93 Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso

  20. Seismo-acoustic analysis of the Buncefield oil depot explosion in the UK, 2005 December 11

    Science.gov (United States)

    Ottemöller, L.; Evers, L. G.

    2008-03-01

    A massive vapour cloud explosion occurred at the Buncefield fuel depot near Hemel Hempstead, UK, in the morning of 2005 December 11. The explosion was the result of an overflow from one of the storage tanks with the release of over 300 tons of petrol and generating a vapour cloud that spread over an area of 80000 m2, before being ignited. Considerable damage was caused in the vicinity of the explosion and a total of 43 people were injured. The explosion was detected by seismograph stations in the UK and the Netherlands and by infrasound arrays in the Netherlands. We analysed the seismic recordings to determine the origin time of 06:01:31.45 +/-0.5 s (UTC) from P-wave arrival times. Uncertainties in determination of origin time from acoustic arrival times alone were less than 10 s. Amplitudes of P-, Lg and primary acoustic waves were measured to derive decay relationships as function of distance. From the seismic amplitudes we estimated a yield of 2-10 tons equivalent to a buried explosion. Most seismic stations recorded primary and secondary acoustic waves. We used atmospheric ray tracing to identify the various travel paths, which depend on temperature and wind speed as function of altitude, leading to directional variation. Refracted waves were observed from the troposphere, stratosphere and thermosphere with a good match between observed and calculated traveltimes. The various wave types were also identified through array processing, which provides backazimuth and slowness, of recordings from an infrasound array in the Netherlands. The amplitude of stratospheric refracted acoustic waves recorded by the array microbarometers was used to estimate a yield of 21.6 (+/-5) tons TNT equivalent. We have demonstrated through joint seismo-acoustic analysis of the explosion that both the seismic velocity model and the atmospheric model are sufficient to explain the observed traveltimes.