Discontinuation Symptoms with Nefazodone

1999 ◽  
Vol 33 (4) ◽  
pp. 594-597 ◽  
Author(s):  
Mani Rajagopalan ◽  
John Little
Keyword(s):  
Clinical Picture ◽  
Withdrawal Symptoms ◽  
The Past ◽  
Increased Risk

Objective: We report a patient who developed discontinuation symptoms following nefazodone cessation. Clinical picture: The patient experienced nausea, vomiting, diarrhoea, ataxia, insomnia, marked agitation, headache and flu-like symptoms. Treatment: She was reluctant to recommence nefazodone and was symptomati-cally treated with oxazepam. Outcome: The patient recovered completely in 10 days. Conclusions: Nefazodone discontinuation can result in withdrawal symptoms and therefore needs to be tapered gradually. Those who have experienced discontinuation symptoms with other antidepressants in the past may be at increased risk.

Vitamin A: dietologist’s position

2020 ◽  
pp. 49-57
Author(s):  
S. V. Orlova ◽  
E. A. Nikitina ◽  
L. I. Karushina ◽  
Yu. A. Pigaryova ◽  
O. E. Pronina
Keyword(s):  
Immune Response ◽  
Urinary Tract ◽  
Gastrointestinal Tract ◽  
Vitamin A ◽  
Developed Countries ◽  
Therapeutic Practice ◽  
The Past ◽  
Increased Risk ◽  
Mucous Membranes

Vitamin A (retinol) is one of the key elements for regulating the immune response and controls the division and differentiation of epithelial cells of the mucous membranes of the bronchopulmonary system, gastrointestinal tract, urinary tract, eyes, etc. Its significance in the context of the COVID‑19 pandemic is difficult to overestimate. However, a number of studies conducted in the past have associated the additional intake of vitamin A with an increased risk of developing cancer, as a result of which vitamin A was practically excluded from therapeutic practice in developed countries. Our review highlights the role of vitamin A in maintaining human health and the latest data on its effect on the development mechanisms of somatic pathology.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

CONGENITAL HYPOPLASIA OF THE ADRENAL GLANDS

PEDIATRICS ◽  
1965 ◽  
Vol 35 (1) ◽  
pp. 70-75
Author(s):  
Anadil Roselli ◽  
Luiz Torres Barbosa
Keyword(s):  
Clinical Picture ◽  
Adrenal Glands ◽  
Medical Literature ◽  
The Past ◽  
Adrenal Hypoplasia

The cases of two sisters with extreme bilateral adrenal hypoplasia, verified at necropsy, have been presented. Two other siblings died in infancy with symptoms which make it very likely that they also had adrenal hypoplasia. A review of the medical literature revealed 23 cases in which necropsy had been performed. These included 15 males and 8 females as well as one set of twins and 3 siblings. Although the incidence of reported cases of adrenal hypoplasia is low, the authors suggest that many cases may have been missed in the past. The clinical picture and possible etiology of this condition have been discussed.

The epidemiological trend of esophageal cancer in Mumbai, India over the past two decades.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16095-e16095
Author(s):  
Anbarasan Sekar ◽  
Akhil Rajendra ◽  
Vanita Noronha ◽  
Smruti Mokal ◽  
Vijay Maruti Patil ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Alcohol Use ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Female Ratio ◽  
Histologic Subtype ◽  
The Past ◽  
Increased Risk ◽  
History Of

e16095 Background: There has been a definite histopathological shift in esophageal cancer in the West over the past few decades, with adenocarcinoma overtaking squamous cell carcinoma as the commonest type. Asian countries with a high human development index like China have also reported an increased incidence of esophageal adenocarcinoma. Data on the epidemiology of esophageal cancer in India are limited. Methods: We retrospectively evaluated the data of all patients with histologically proven esophageal cancer at Tata Memorial Hospital, from 2003 to 2018. We excluded non-squamous and non-adenocarcinoma histologies. Results: Of a total of 7,874 patients with esophageal cancer, 5,092 (64.7%) were men, for a male to female ratio of 2.5:1. The median age was 57 years (IQR, 50-65); 4,465 (56.7%) were below 60 years old. Of the 4912 patients in whom a history of tobacco or alcohol use had been elicited, there were 1,360 (27.7%) patients with no history of substance use. The site of the primary was the upper third in 906 (12.8%), middle third esophagus in 2,942 (41.5%), lower third in 2,331 (32.8%) and gastroesophageal junction in 917 (12.9%) patients. The predominant histology was squamous cell carcinoma in 6,413 (81.4%) patients and adenocarcinoma in 1461 (18.6%). There was no change in the histologic pattern over the period of the study; squamous cell carcinoma constituted 78.5% of the cases in 2003, and 85.5% in 2018; Chi square test for the year wise trend in histologic patterns was not significant, p=0.143. Evaluation of the histologic subtype according to sex revealed that in the male patients, there were 3890 (76.4%) squamous and 1202 (23.6%) adenocarcinoma cases, while in female patients, there were 2523 (90.7%) squamous and 259 (9.3%) adenocarcinoma cases. On a uni variate analysis, male sex (p<0.001), a history of tobacco or alcohol use (p<0.001), and the presence of comorbidity (p<0.007) were associated with an increased risk of squamous cell carcinoma. Multivariate analysis by logistic regression model revealed that female sex and use of tobacco or alcohol were positively associated with squamous cell carcinoma, while the presence of comorbities and primary in lower esophagus/GEJ were positively associated with adenocarcinoma. Conclusions: Squamous cell carcinoma continues to be the commonest esophageal cancer histologic subtype in over 80% Indian patients. The mid esophagus is the most common site (42%). There is no evidence of an epidemiological shift or an increase in the occurrence of adenocarcinoma or of lower esophageal/GEJ malignancy over the past two decades.

scholarly journals Advances in Antiplatelet Therapy for Dentofacial Surgery Patients: Focus on Past and Present Strategies

Materials ◽  
2019 ◽  
Vol 12 (9) ◽  
pp. 1524 ◽  
Author(s):  
Gabriele Cervino ◽  
Luca Fiorillo ◽  
Ines Paola Monte ◽  
Rosa De Stefano ◽  
Luigi Laino ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Oral Surgery ◽  
Case Reports ◽  
Case Series ◽  
Antiplatelet Agents ◽  
Preventive Therapy ◽  
Antiplatelet Drugs ◽  
Risk Of Bleeding ◽  
The Past ◽  
Increased Risk

Background: Nowadays, patients involved in antiplatelet therapy required special attention during oral surgery procedures, due to the antiplatelet drugs assumption. The motivations of the assumption may be different and related to the patient’s different systemic condition. For this reason, accordingly to the current international guidelines, different protocols can be followed. The aim of this work is to analyze how the dentist’s approach to these patients has changed from the past to the present, evaluating the risk exposure for the patients. Methods: This review paper considered different published papers in literature through quoted scientific channels, going in search of “ancient” works in such a way as to highlight the differences in the protocols undertaken. The analyzed manuscripts are in the English language, taking into consideration reviews, case reports, and case series in such a way as to extrapolate a sufficient amount of data and for evaluating the past therapeutic approaches compared to those of today. Results: Colleagues in the past preferred to subject patients to substitution therapy with low molecular weight anticoagulants, by suspending antiplatelet agents to treatment patients, often for an arbitrary number of days. The new guidelines clarify everything, without highlighting an increased risk of bleeding during simple oral surgery in patients undergoing antiplatelet therapy. Conclusion: Either patients take these medications for different reasons, because of cardiovascular pathologies, recent cardiovascular events, or even for simple prevention, although the latest research shows that there is no decrease of cardiovascular accidents in patients who carry out preventive therapy. Surely, it will be at the expense of the doctor to assess the patient’s situation and risk according to the guidelines. For simple oral surgery, it is not necessary to stop therapy with antiplatelet agents because the risk of bleeding has not increased, and is localized to a post-extraction alveolus or to an implant preparation, compared to patients who do not carry out this therapy. From an analysis of the results it emerges that the substitutive therapy should no longer be performed and that it is possible to perform oral surgery safely in patients who take antiplatelet drugs, after a thorough medical history. Furthermore, by suspending therapy, we expose our patients to more serious risks, concerning their main pathology, where present.

scholarly journals Factors Associated with Celecoxib and Rofecoxib Utilization

2005 ◽  
Vol 39 (4) ◽  
pp. 597-602 ◽  
Author(s):  
Nigel SB Rawson ◽  
Parivash Nourjah ◽  
Stella C Grosser ◽  
David J Graham
Keyword(s):  
Cardiovascular Disease ◽  
Disease Burden ◽  
Multiple Logistic Regression Analysis ◽  
Underlying Disease ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nonselective Nsaid ◽  
Antiinflammatory Drugs ◽  
The Past ◽  
Increased Risk ◽  
Cox 2

BACKGROUND: The cyclooxygenase-2 (COX-2) selective nonsteroidal antiinflammatory drugs (NSAIDs) celecoxib and rofecoxib (before its removal) are marketed as having fewer gastrointestinal (GI)-related complications than nonselective NSAIDs. However, adverse reaction data suggest that the use of COX-2 selective NSAIDs is associated with clinically significant GI events. OBJECTIVE: To assess whether patients receiving celecoxib and rofecoxib have a greater underlying disease burden than patients prescribed nonselective NSAIDs. METHODS: The study population consisted of members of 11 health plans, aged >34 years, with a pharmacy claim for celecoxib or rofecoxib or a nonselective NSAID dispensed between February 1, 1999, and July 31, 2001, who had been continuously enrolled for >364 days before the dispensing date. Celecoxib and rofecoxib patients were randomly selected without replacement from a pool of eligible users in each of the 30 months. Nonselective NSAID users were randomly chosen without replacement within each month on a 2:1 ratio to cases; they could be chosen in more than one month. Univariate analyses comparing 9000 cases and 18 000 controls were performed, followed by a multiple logistic regression analysis conditioned on time. RESULTS: Increasing age, treatment by a rheumatologist or an orthopedic specialist, treatment with a high number of different medications in the past year, treatment with oral corticosteroids in the past year, and having had a previous GI bleed increased the likelihood of receiving celecoxib or rofecoxib, whereas treatment with a high number of nonselective NSAID prescriptions in the past year decreased it. Treatment with a high number of different medications was a predictor of increased prevalence of underlying diabetes mellitus and cardiovascular disease. CONCLUSIONS: Patients having a greater underlying disease burden were more likely to receive COX-2 selective NSAIDs than nonselective ones. Paradoxically, patients at higher risk for cardiovascular disease were channeled toward treatment with COX-2 selective NSAIDs, many of which may confer an increased risk of acute myocardial infarction and other adverse cardiovascular outcomes.

Hemolytic-Uremic (Nephropathic) Syndrome: A Clinical Picture Unrecognized in the Past?

1967 ◽  
Vol 56 (6) ◽  
pp. 665-670 ◽  
Author(s):  
GJERMUND FLUGE ◽  
PETER JOHAN MOE
Keyword(s):  
Clinical Picture ◽  
The Past

scholarly journals Does early onset asthma increase childhood obesity risk? A pooled analysis of 16 European cohorts

2018 ◽  
Vol 52 (3) ◽  
pp. 1800504 ◽  
Author(s):  
Zuelma A. Contreras ◽  
Zhanghua Chen ◽  
Theano Roumeliotaki ◽  
Isabella Annesi-Maesano ◽  
Nour Baïz ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Childhood Asthma ◽  
Early Onset ◽  
Pooled Analysis ◽  
Obesity Risk ◽  
Obese Children ◽  
The Past ◽  
Increased Risk ◽  
The Uk

The parallel epidemics of childhood asthma and obesity over the past few decades have spurred research into obesity as a risk factor for asthma. However, little is known regarding the role of asthma in obesity incidence. We examined whether early-onset asthma and related phenotypes are associated with the risk of developing obesity in childhood.This study includes 21 130 children born from 1990 to 2008 in Denmark, France, Germany, Greece, Italy, The Netherlands, Spain, Sweden and the UK. We followed non-obese children at 3–4 years of age for incident obesity up to 8 years of age. Physician-diagnosed asthma, wheezing and allergic rhinitis were assessed up to 3–4 years of age.Children with physician-diagnosed asthma had a higher risk for incident obesity than those without asthma (adjusted hazard ratio (aHR) 1.66, 95% CI 1.18–2.33). Children with active asthma (wheeze in the last 12 months and physician-diagnosed asthma) exhibited a higher risk for obesity (aHR 1.98, 95% CI 1.31–3.00) than those without wheeze and asthma. Persistent wheezing was associated with increased risk for incident obesity compared to never wheezers (aHR 1.51, 95% CI 1.08–2.09).Early-onset asthma and wheezing may contribute to an increased risk of developing obesity in later childhood.

A PAncreatic cancer screening study in individuals with New-onset or DeteriOrating diabetes MEllitus (PANDOME study).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS10607-TPS10607
Author(s):  
Richard C. Frank ◽  
Tammy Lo ◽  
Dugho Jin ◽  
Cornelius Ferreira ◽  
Ramanathan Seshadri ◽  
...  
Keyword(s):  
Blood Glucose ◽  
High Risk ◽  
Blood Donation ◽  
Early Stage ◽  
Fasting Blood Glucose ◽  
Tumor Board ◽  
The Past ◽  
Pancreatic Cancer Screening ◽  
Increased Risk ◽  
New Onset

TPS10607 Background: Pancreatic adenocarcinoma (PC) has a persistently high mortality as it presents in the advanced stages and has largely not benefited from the genomic and immunotherapeutic revolutions in oncology. Improvements in screening to detect early stage cancers are therefore urgently needed. Screening studies such as those from the International CAPS Consortium have demonstrated improved survivals in hereditary high risk individuals. In the sporadic population, individuals with new-onset diabetes (NOD) or long-standing deteriorating diabetes (DD) are at substantially increased risk of PC in the 12 months following these diagnoses and have been proposed as target populations for screening efforts. This trial will study the benefits of PC screening in the latter populations in a community setting. Methods: Individuals ≥ 50 years of age with either NOD or DD will be eligible. Criteria for NOD (within the past 12 months) include: fasting blood glucose ≥ 126 mg/dL, random blood glucose ≥ 200 mg/dL, or HbA1c ≥ 6.5%, with confirmed prior normal values. For those without prior glycemic values, a HbA1c ≥ 7.0% is required. Transition from pre-diabetes requires an increase in HgA1c of ≥ 0.5%. DD is defined by an increase in HbA1c of ≥ 2% within the past six months that is not associated with medication non-compliance or weight gain. Study participants will undergo every 6 months: evaluation by an APRN, testing for anxiety and depression and blood donation for biobanking purposes. High resolution MRI/MRCP with gadolinium will be performed at study entry and annually for 2 years. Images will be reviewed at a multi-disciplinary tumor board consisting of body-image certified radiologists, interventional gastroenterologists, hepatobiliary surgeons and medical oncologists. MRI results will be classified according to a novel PANC-RADS system. High-risk pancreatic findings will be further interrogated by endoscopic ultrasound (EUS). Study endpoints include detection rate of high-risk lesions, referrals for EUS and surgery and detection of incidental findings leading to unnecessary procedures. Adverse psychological impacts will be assessed through HADS testing. Target accrual: 500 patients within 3 years. Clinical trial information: NCT03937453 .

Abstract MP86: The Joint Effect of Outdoor Recreational Activity and 25-Hydroxyvitamin D on Cardiovascular Mortality in THE NHANES III Population

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Macarius Donneyong ◽  
Carlton A Hornung
Keyword(s):  
Elevated Risk ◽  
Physical Activities ◽  
Mortality Data ◽  
Nhanes Iii ◽  
Additive Interaction ◽  
Joint Effects ◽  
The Past ◽  
Increased Risk ◽  
Cvd Mortality

Purpose Recreational physical activity (PA) reduces the risk of cardiovascular disease (CVD) morbidity and mortality. Outdoor-based recreational physical activities (ORA) have been reported to be associated with elevated 25(OH)D levels. We investigate the joint effects of frequent ORA and 25(OH)D levels on the risk of CVD mortality and the modifying effects of 25(OH)D. Methods Our sample consisted of 13,031 nationally representative adults (20 - 90 years old) free from CVD and cancer at baseline in the NHANES III (1988 - 1994) linked mortality dataset with follow-up mortality data through 2006. CVD mortality was based on reported deaths with corresponding ICD-10 codes for CVD as underlying cause of death. ORA was defined as self-reported participation in recreational physical activities considered to have occurred outdoors in the past month. Time to CVD mortality was estimated from multivariable adjusted Cox proportional hazards (CPH) models. A joint effects model was used in estimating multiplicative and additive interaction between ORA and 25(OH)D. Results A crude unweighted CVD mortality rate of 7.4% (964/13,031) occurred during a median follow-up of 14.33 years. Frequency of ORA <5 in the past month (HR=1.38, 95%CI:1.09 - 1.75) and 25(OH)D <30 ng/mL (HR=1.28, 95%CI:1.01 - 1.60) were associated with increased risk of CVD mortality compared to ORA ≥5 and 25(OH)D ≥30 ng/mL respectively, in a multivariable adjusted CPH model. In the joint effects model, frequency of ORA <5 and 25(OH)D <30 ng/mL (HR=1.81, 95%CI:1.05 - 3.10) and frequency of ORA <5 and 25(OH)D ≥30 ng/mL (HR=1.33, 95%CI:1.02 - 1.73) were associated with elevated risk of CVD mortality compared to the joint effects of ORA ≥5 and 25(OH)D ≥30 ng/mL. The joint effects model indicated the presence of multiplicative interaction. The synergy index, 1.52 (95%CI:0.31 - 7.41) suggested presence of additive interaction even though not statistically significant. Conclusion Lower frequency of ORA and serum 25(OH)D levels were jointly associated with elevated risk of CVD mortality. Serum 25(OH)D modified the risk of CVD mortality associated with lower frequency of outdoor-based recreational activities.

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