Seasonal and temperature effect on serum lithium concentrations

2019 ◽  
Vol 54 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Sonia Cheng ◽  
Nicholas A Buckley ◽  
William Siu ◽  
Angela L Chiew ◽  
Elia Vecellio ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Lithium Concentration ◽  
Therapeutic Index ◽  
Effect Of Temperature ◽  
Short Term ◽  
Narrow Therapeutic Index ◽  
Serum Lithium Concentration ◽  
Hot Weather ◽  
Maximum Temperatures ◽  
Sydney Australia

Background: Lithium remains the gold standard treatment for bipolar disorder. However, it has a very narrow therapeutic index (0.6–0.8 mmol/L). It has been suggested that high environmental temperature can lead to dehydration, elevated plasma lithium concentration and then lithium toxicity. Objectives: We aimed to investigate the effect of seasonal and short-term changes in temperature on serum lithium concentrations in Sydney, Australia. Methods: We retrospectively analysed data from all patients who had serum lithium concentrations taken from the Prince of Wales and Sutherland Hospitals between 2008 and 2018. Temperature data came from the Bureau of Meteorology. We examined correlations between lithium concentrations and the preceding 5 days maximum temperatures, month and season. We also performed a longitudinal analysis of the effect of temperature and seasons within selected patients who had repeated levels. Results: A total of 11,912 serum lithium concentrations from 2493 patients were analysed. There was no significant association between higher lithium concentration and preceding higher temperatures ( r = –0.008, p = 0.399). There was also no important seasonal or monthly variation, across all patients or in the smaller cohort with longitudinal data ( n = 123, r = 0.008, 95% confidence interval: [–0.04, 0.06]). Conclusion: There were no clinically important differences in serum lithium concentration related to seasons, months or temperatures, which suggests that patients on lithium are able to adequately maintain hydration during hot weather in Sydney.

scholarly journals Nanomedicine Reformulation of Chloroquine and Hydroxychloroquine

Molecules ◽  
2020 ◽  
Vol 26 (1) ◽  
pp. 175
Author(s):  
David M. Stevens ◽  
Rachael M. Crist ◽  
Stephan T. Stern
Keyword(s):  
Safety Evaluation ◽  
Therapeutic Index ◽  
Short Term ◽  
Tissue Concentrations ◽  
History Of ◽  
History Of Use ◽  
Novel Applications ◽  
Therapeutic Doses ◽  
Extensive Clinical Experience ◽  
Higher Doses

The chloroquine family of antimalarials has a long history of use, spanning many decades. Despite this extensive clinical experience, novel applications, including use in autoimmune disorders, infectious disease, and cancer, have only recently been identified. While short term use of chloroquine or hydroxychloroquine is safe at traditional therapeutic doses in patients without predisposing conditions, administration of higher doses and for longer durations are associated with toxicity, including retinotoxicity. Additional liabilities of these medications include pharmacokinetic profiles that require extended dosing to achieve therapeutic tissue concentrations. To improve chloroquine therapy, researchers have turned toward nanomedicine reformulation of chloroquine and hydroxychloroquine to increase exposure of target tissues relative to off-target tissues, thereby improving the therapeutic index. This review highlights these reformulation efforts to date, identifying issues in experimental designs leading to ambiguity regarding the nanoformulation improvements and lack of thorough pharmacokinetics and safety evaluation. Gaps in our current understanding of these formulations, as well as recommendations for future formulation efforts, are presented.

scholarly journals The art and science of drug titration

2020 ◽  
Vol 11 ◽  
pp. 204209862095891
Author(s):  
Aisling R. Caffrey ◽  
Eric P. Borrelli
Keyword(s):  
Real World ◽  
Therapeutic Index ◽  
Clinical Expertise ◽  
Coordination Of Care ◽  
Patient Centered ◽  
Narrow Therapeutic Index ◽  
Drug Dosing ◽  
Scientific Principles ◽  
Suboptimal Adherence ◽  
Personalized Approach

A “one-size-fits-all” approach has been the standard for drug dosing, in particular for agents with a wide therapeutic index. The scientific principles of drug titration, most commonly used for medications with a narrow therapeutic index, are to give the patient adequate and effective treatment, at the lowest dose possible, with the aim of minimizing unnecessary medication use and side effects. The art of drug titration involves the interplay of scientific drug titration principles with the clinical expertise of the healthcare provider, and an individualized, patient-centered partnership between the provider and the patient to review the delicate balance of perceived benefits and risks from both perspectives. Drug titration may occur as up-, down-, or cross-titration depending on whether the goal is to reach or maintain a therapeutic outcome, decrease the risk of adverse effects, or prevent withdrawal/discontinuation syndromes or recurrence of disease. Drug titration introduces additional complexities surrounding the conduct of clinical trials and real-world studies, confounding our understanding of the true effect of medications. In clinical practice, wide variations in titration schedules may exist due to a lack of evidence and consensus on titration approaches that achieve an optimal benefit-harm profile. Further, drug titration may be challenging for patients to follow, resulting in suboptimal adherence and may require increased healthcare-related visits and coordination of care amongst providers. Despite the challenges associated with drug titration, it is a personalized approach to drug dosing that blends science with art, and with supportive real-world outcomes-based evidence, can be effective for optimizing pharmacotherapeutic outcomes and improving drug safety.

Properties of Hard Rubber. XIX. Effect of Temperature on Cross-Breaking Strength and Elongation

1947 ◽  
Vol 20 (2) ◽  
pp. 525-526
Author(s):  
W. H. Willott
Keyword(s):  
Breaking Strength ◽  
Testing Machine ◽  
Effect Of Temperature ◽  
Loading Test ◽  
Standard Size ◽  
Test Pieces ◽  
The Cross ◽  
Hot Weather ◽  
Electric Radiator ◽  
Usual Order

Abstract In a series of cross-breaking tests carried out on hard rubber during hot weather, the values of the breaking elongation were higher than was expected, although the cross-breaking strength was of the usual order. It was thought that the high temperature might account for these results by making the hard rubber more plastic. The following experiments were, therefore, performed to investigate the effect of small changes of temperature, such as are encountered at different times of the year, on the cross-breaking strength and elongation. Test-pieces of standard size (75 × 25 × 5 mm.) were cut from a sheet of hard rubber of the composition: 68 per cent rubber, 32 per cent sulfur, which had been vulcanized for 5 hours at 155° C. They were immersed in a beaker of water and kept at the required temperature for about 15 minutes, when they were judged to have attained a steady temperature. The tests were carried out on an Avery fabric-testing machine fitted with special clamps to give a three-point loading test, the distance between the supporting knife-edges being 50.4 mm. (2 in.). These clamps were heated to the temperature of the specimens by means of an electric radiator. The specimens were tested as soon as possible after they had been removed from the water, so that the change of temperature during the test was reduced as far as possible. The standard conditions already laid down, were observed.

scholarly journals Stabilization of the Serum Lithium Concentration by Regulation of Sodium Chloride Intake: Case Report

2016 ◽  
Vol 136 (3) ◽  
pp. 517-521 ◽  
Author(s):  
Takashi Tomita ◽  
Hidekazu Goto ◽  
Kenji Sumiya ◽  
Tadashi Yoshida ◽  
Katsuya Tanaka ◽  
...  
Keyword(s):  
Case Report ◽  
Sodium Chloride ◽  
Lithium Concentration ◽  
Serum Lithium Concentration ◽  
Sodium Chloride Intake

scholarly journals Relationship between daily suicide counts and temperature in England and Wales

2007 ◽  
Vol 191 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Lisa A. Page ◽  
Shakoor Hajat ◽  
R. Sari Kovats
Keyword(s):  
Time Series ◽  
Seasonal Fluctuation ◽  
Daily Temperature ◽  
Short Term ◽  
Time Series Regression ◽  
England And Wales ◽  
Increased Risk ◽  
Hot Weather ◽  
The Impact ◽  
The Relationship

BackgroundSeasonal fluctuation in suicide has been observed in many populations. High temperature may contribute to this, but the effect of short-term fluctuations in temperature on suicide rates has not been studied.AimsTo assess the relationship between daily temperature and daily suicide counts in England and Wales between 1 January 1993 and 31 December 2003 and to establish whether heatwaves are associated with increased mortality from suicide.MethodTime-series regression analysis was used to explore and quantify the relationship between daily suicide counts and daily temperature. The impact of two heatwaves on suicide was estimated.ResultsNo spring or summer peak in suicide was found. Above 18 °, each 1 ° increase in mean temperature was associated with a 3.8 and 5.0% rise in suicide and violent suicide respectively. Suicide increased by 46.9% during the 1995 heatwave, whereas no change was seen during the 2003 heat wave.ConclusionsThere is increased risk of suicide during hot weather.

scholarly journals Extended exposure to elevated temperature affects escape response behaviour in coral reef fishes

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3652 ◽  
Author(s):  
Donald T. Warren ◽  
Jennifer M. Donelson ◽  
Mark I. McCormick
Keyword(s):  
Elevated Temperature ◽  
Escape Response ◽  
Community Dynamics ◽  
Thermal Exposure ◽  
Reef Fishes ◽  
Effect Of Temperature ◽  
Short Term ◽  
Physical Ability ◽  
Pomacentrus Amboinensis ◽  
Extended Exposure

The threat of predation, and the prey’s response, are important drivers of community dynamics. Yet environmental temperature can have a significant effect on predation avoidance techniques such as fast-start performance observed in marine fishes. While it is known that temperature increases can influence performance and behaviour in the short-term, little is known about how species respond to extended exposure during development. We produced a startle response in two species of damselfish, the lemon damselPomacentrus moluccensis,and the Ambon damselfishPomacentrus amboinensis,by the repeated use of a drop stimulus. We show that the length of thermal exposure of juveniles to elevated temperature significantly affects this escape responses.Short-term (4d) exposure to warmer temperature affected directionality and responsiveness for both species. After long-term (90d) exposure, onlyP. moluccensisshowed beneficial plasticity, with directionality returning to control levels. Responsiveness also decreased in both species, possibly to compensate for higher temperatures. There was no effect of temperature or length of exposure on latency to react, maximum swimming speed, or escape distance suggesting that the physical ability to escape was maintained. Evidence suggests that elevated temperature may impact some fish species through its effect on the behavioural responses while under threat rather than having a direct influence on their physical ability to perform an effective escape response.

scholarly journals Animal size and seawater temperature, but not pH, influence a repeatable startle response behaviour in a wide-ranging marine mollusc

2020 ◽  
Author(s):  
Jeff Clements ◽  
Kirti Ramesh ◽  
Jacob Nysveen ◽  
Sam Dupont ◽  
Fredrik Jutfelt
Keyword(s):  
Startle Response ◽  
Marine Invertebrates ◽  
Seawater Temperature ◽  
Effect Of Temperature ◽  
Short Term ◽  
Blue Mussels ◽  
Marine Mollusc ◽  
Closure Duration ◽  
Ecosystem Level ◽  
Animal Size

Startle response behaviours are important in predator avoidance and escape for a wide array of animals. For many marine invertebrates, however, startle response behaviours are understudied, and the effects of global change stressors on these responses are unknown. We exposed two size classes of blue mussels (Mytilus edulis × trossulus) to different combinations of temperature (15 and 19 °C) and pH (8.2 and 7.5 pHT) for three months and subsequently measured individual time to open following a tactile predator cue (i.e., startle response time) over a series of four consecutive trials. Time to open was highly repeatable on the short-term and decreased linearly across the four trials. Individuals from the larger size class had a shorter time to open than their smaller-sized counterparts. High temperature increased time to open compared to low temperature, while pH had no effect. These results suggest that bivalve time to open is repeatable, related to relative vulnerability to predation, and affected by temperature. Given that increased closure times impact feeding and respiration, the effect of temperature on closure duration may play a role in the sensitivity to ocean warming in this species and contribute to ecosystem-level effects.

scholarly journals Systematic treatment and prevention of cardiac digoxin toxicity

2021 ◽  
Author(s):  
Omar Rezk Alshaer ◽  
Abdullah Obaid Binobaid ◽  
Abdelelah Hesham Mofti ◽  
Mohannad Mahmood Sadagah ◽  
Khalid Mustafa Olwi ◽  
...  
Keyword(s):  
Therapeutic Index ◽  
Digoxin Toxicity ◽  
Clinical Settings ◽  
Clinical Effects ◽  
Systematic Treatment ◽  
Narrow Therapeutic Index ◽  
Serious Adverse Events ◽  
Treatment And Prevention ◽  
Cost Efficacy ◽  
The Cost

Digoxin has a narrow therapeutic index, such as complicated pharmacokinetics and dynamics.  Many drug interactions may occur when the administration of one drug alters the clinical effects of another. As a result, digoxin toxicity can be a common condition within clinical settings that might lead to the development of many morbidities and even mortality. Many studies were published to investigate the efficacy and safety of different management modalities to enhance the outcomes that follow digoxin administration. The aim of the study was to discuss the approaches to systematically treat and prevent the development of cardiac digoxin toxicity. The findings are based on evidence from previous studies in the literature. To be specific, Fab fragments are the most effective modalities that can be used to treat severe cases within ideal periods. However, evidence regarding their administration for asymptomatic or mild cases is still poor regarding the cost-efficacy and the development of serious adverse events. Physicians should primarily care for a better intervention as it is usually associated with a significantly more enhanced prognosis and clinical outcomes. Nevertheless, adequate monitoring of the patients and evaluation of their personal and medical history are important steps in the process, and further approaches are still needed. Also, detailed information about our intended outcomes is furtherly discussed within the manuscript.

scholarly journals Az etopozid szervezeten belüli eloszlásában és metabolizmusában szerepet játszó epigenetikai hatások

2018 ◽  
Vol 159 (32) ◽  
pp. 1295-1302
Author(s):  
Erika Rozália Kovács ◽  
Sára Tóth ◽  
Dániel János Erdélyi
Keyword(s):  
Topoisomerase Ii ◽  
Therapeutic Index ◽  
Antitumor Agent ◽  
Hematologic Malignancies ◽  
Short Term ◽  
Drug Dosing ◽  
And Personalized Medicine ◽  
Insight Into ◽  
Pharmacogenomic Studies

Abstract: Etoposide is a topoisomerase II inhibitor antitumor agent which is widely used in the treatment of several hematologic malignancies and solid tumors. The therapeutic index of etoposide is quite high, thus its application causes several short-term and long-term side effects which can decrease the chance to cure patients. Drug dosing is based on body surface area calculation; recommendations for individual dosing do not exist yet. The biotransformation and transportation of etoposide are carried out by enzymes and transporters as reported in pharmacogenomic studies published in this area. Nowadays pharmacoepigenetics research has come to the fore. The authors wish to give an insight into the research of the epigenetical changes of the etoposide pathways, especially focusing on published findings on enzymes and transporters with pharmacokinetic relevance. In the future, epigenetical changes of the etoposide pathway might have a great role in diagnostics, prognostics and personalized medicine. Orv Hetil. 2018; 159(32): 1295–1302.

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