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Amisulpride versus Risperidone in the Treatment of Acute Exacerbation of Schizophrenia  [PDF]
S Ranjan,JN Vyas
Journal of Universal College of Medical Sciences , 2013, DOI: 10.3126/jucms.v1i1.8417
Abstract: Introduction: Amisulpride and risperidone are both atypical antipsychotic having different receptor affinity characteristics. Although there are many studies comparing the efficacy of both drugs with conventional antipsychotics, studies comparing the efficacy of amisulpride with risperidone are less. There are no such studies published till yet from Nepal. This study aims to compare the efficacy and safety of amisulpride with that of risperidone in patients with acute exacerbation of schizophrenia in Nepal. Methods: 100 patients with acute exacerbation of schizophrenia were randomly put on flexible dose of amisulpride (200-1000mg/day) or risperidone (2-10mg/day) for six weeks after three to six day placebo wash-out period. Efficacy was assessed by changes in score of Brief Psychiatry Rating Scale (BPRS). Safety assessment was done by adverse event reporting, physical examination, blood pressure, heart rate monitoring and applying modified Simpson-Angus Scale for extra pyramidal symptoms. Results: Most of the patients in both group responded equally to medication. 84% of amisulpride receiving patients versus 86% in risperidone group responded to treatment. Both drugs were safe and caused comparable extra pyramidal symptoms (amisulpride/risperidone: 14/16). However, risperidone caused more weight gain than amisulpride (64% vs. 12%). Conclusion: Amisulpride and risperidone are equally effective in the treatment of acute exacerbation of schizophrenia. Both drugs were well tolerated. Amisulpride was associated with less weight gain. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8417 ? Journal of Universal College of Medical Sciences Vol.1(1) 2013: ?15-19
Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report
Mariam Rauf, Charise Gleason, Ajay K Nooka, Abbie Husman, Edmund K Waller
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-372
Abstract: A 51-year-old Caucasian woman presented with fever and profound neutropenia (48 neutrophils/uL). Her clinical history included non-Hodgkin lymphoma, in remission following treatment with allogeneic bone marrow transplantation, quiescent chronic graft-versus-host disease, and squamous cell carcinoma of the skin metastatic to cervical lymph nodes. Medications included atenolol, topical clobetasol, Ditropan (oxybutynin), prophylactic voriconazole, prophylactic valganciclovir, Soriatane (acitretin), and Carac (fluorouracil) cream. The bone marrow was hypocellular without metastatic cancer or myelodysplasia. Neutropenia did not respond to stopping medications that have been associated with neutropenia (valganciclovir, voriconazole and Soriatane) or treatment with antibiotics or granulocyte colony stimulating factor. Blood tests revealed absence of antineutrophil antibodies, normal folate and B12 levels, moderate zinc deficiency and severe Vitamin B6 deficiency. Replacement therapy with oral Vitamin B6 restored blood vitamin levels to the normal range and corrected the neutropenia. Her cervical adenopathy regressed clinically and became negative on scintography following Vitamin B6 therapy and normalization of the blood neutrophil count.Severe pyridoxine deficiency can lead to neutropenia. Screening for Vitamin B6 deficiency, along with folate and Vitamin B12 levels, is recommended in patients with refractory neutropenia, especially those with possible malabsorption syndromes, or a history of chronic-graft-versus host disease. Severe neutropenia may facilitate progression of squamous cell carcinoma.Neutropenia has been associated with medications, infections, autoimmune diseases, and deficiencies of Vitamin B12 and folate [1]. An association of Vitamin B6 deficiency with severe neutropenia is a rare finding [2-4]. We describe the case of a patient who had severe neutropenia (neutrophil count of 48 cells/uL) associated with profound Vitamin B6 deficiency that markedly impr
Association of HLA-G Low Expressor Genotype with Severe Acute Graft-Versus-Host Disease after Sibling Bone Marrow Transplantation  [PDF]
Marc Busson,Antoine Toubert,Dominique Charron,Ryad Tamouza
Frontiers in Immunology , 2011, DOI: 10.3389/fimmu.2011.00074
Abstract: Background: Human leukocyte antigen-G (HLA-G) molecules play a prominent role in immune tolerance. Structurally similar to their classical HLA homologs, they are distinct by having high rate of polymorphism in the non-coding regions including a functionally relevant 14-base pair (bp) insertion/deletion (Ins/Del) allele in the 3′ untranslated region (3′UTR), rarely examined in a hematopoietic stem cell transplantation (HSCT) setting. Here, we analyzed the potential impact of HLA-G Ins/Del dimorphism on the incidence of acute graft-versus-host disease (aGvHD), transplant-related mortality (TRM), overall survival (OS), and incidence of relapse after HSCT using bone marrow (BM) as stem cell source from HLA-matched donors. Methods: One hundred fifty-seven sibling pairs, who had undergone HSCT, were studied for the distribution of the HLA-G 14 bp Ins/Del polymorphism using a polymerase chain reaction (PCR)-based technique. Potential genetic association with the incidence of aGvHD, TRM, and OS was analyzed by monovariate and multivariate analyses. Results: Monovariate analysis showed that the homozygous state for the 14-bp Ins allele is a risk factor for severe aGvHD (grade III and IV; P = 0.008), confirmed subsequently by multivariate analysis [hazard ratio (HR) = 3.5; 95% confidence interval (95%CI) = 1.3–9.5; P = 0.012]. We did not find any association between HLA-G polymorphism and the other studied complications. Conclusion: Our data suggest that the HLA-G low expressor 14 bp Ins allele constitutes a risk factor for the incidence of severe aGvHD in patients who received BM as stem cell source.
Valproate-Risperidone versus Valproate-Lithium combination in acute mania  [cached]
M Barekatain,A Fatemi,N Bashardoost,A Darougheh
Journal of Research in Medical Sciences , 2005,
Abstract: Background: We evaluated the efficacy of valproate plus risperidone versus valproate plus lithium combination in the treatment of acute mania. Methods: In 2-week, randomized, double-blind, parallel group study, 46 acute manic patients according to DSM-IV criteria were randomly assigned to receive combination of valproate 20 mg/ kg/day plus risperidone 2-4 mg/day (n=23) or lithium600-1200 mg/day (n=23). The assessment of efficacy measures were according to Young Mania Rating Scale (YMRS) and Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scale. Other effectiveness measures included YMRS response (YMRS reduction >50 %) and YMRS remission (YMRS total scores <12). Results: In each group, 16 of 23 patients (70 %) completed the study. YMRS response, CGI-Improvement, and reduction in the total scores of YMRS and CGI-S observed in both groups, significantly greater for valproate-risperidone than valproate-lithium combination group (P=0.006, P=0.015, P=0.004, and P=0.007, respectively).YMRS remission were shown in both groups without statistical significance (P=0.073). The total scores of YMRS at 4th, 8th, and 14th days of trial were lower in valproate-risperidone than valproate-lithium combination group (P=0.017, P=0.005, and P=0.004, respectively). The rate of adverse events and mean weight gain in both groups were not statistically different. Conclusion: In acute manic patients, both combinations of valproate with lithium or with risperidone had efficacy in acutely manic patients, but valproate-risperidone combination was more effective. Both treatments were safe and well tolerated. Considering the small sample size and limited period of observation, further studies need to be conducted to find out the best combination in the treatment of acute mania. Key words: Acute mania, Valproate, Risperidone, Lithium, Combination Therapy
Yokukansan Inhibits Neuronal Death during ER Stress by Regulating the Unfolded Protein Response  [PDF]
Toru Hiratsuka,Shinsuke Matsuzaki,Shingo Miyata,Mitsuhiro Kinoshita,Kazuaki Kakehi,Shinji Nishida,Taiichi Katayama,Masaya Tohyama
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0013280
Abstract: Recently, several studies have reported Yokukansan (Tsumura TJ-54), a traditional Japanese medicine, as a potential new drug for the treatment of Alzheimer's disease (AD). Endoplasmic reticulum (ER) stress is known to play an important role in the pathogenesis of AD, particularly in neuronal death. Therefore, we examined the effect of Yokukansan on ER stress-induced neurotoxicity and on familial AD-linked presenilin-1 mutation-associated cell death.
Interval exercise versus continuous exercise in patients with moderate to severe chronic obstructive pulmonary disease – study protocol for a randomised controlled trial [ISRCTN11611768]
Milo A Puhan, Gilbert Büsching, Evelien vanOort, Christian Zaugg, Holger J Schünemann, Martin Frey
BMC Pulmonary Medicine , 2004, DOI: 10.1186/1471-2466-4-5
Abstract: We will assign patients with moderately severe to severe COPD to either continuous exercise or interval exercise using a stratified randomisation. Patients will follow 12–15 exercise sessions during a comprehensive inpatient respiratory rehabilitation. Primary end point for effectiveness is HRQL as measured by the Chronic Respiratory Questionnaire (CRQ) two weeks after the end of rehabilitation and secondary endpoints include additional clinical outcomes such as functional exercise capacity, other HRQL measures, patients' experience of physical exercise as well as physiological measures of the effects of physical exercise such as cardiopulmonary exercise testing. Including expected drop-outs, we will need 52 patients per group to show differences corresponding to the minimal clinically important difference of the CRQ. Outcome assessors and investigators involved in data analysis will be blinded to group assignment until analyses have been carried out.Clinicians and the scientific community need evidence on the benefits and tolerance of exercise protocols available in clinical practice. The proposed trial will provide important and needed data on interval and continuous exercise for decision making in clinical practice.Impaired exercise capacity, dyspnoea and reduced health-related quality of life (HRQL) are common complaints of patients with chronic obstructive pulmonary disease (COPD). A major exercise-limiting factor in COPD is peripheral muscle dysfunction characterised by atrophic muscles and reduced fatigue resistance due morphological and metabolic alterations of peripheral muscles[1] As much as 70% of COPD patients may be affected by peripheral muscle dysfunction.[2]Respiratory rehabilitation with physical exercise improves exercise capacity and HRQL.[3] Although physical exercise is a mandatory component of respiratory rehabilitation programmes[4,5], there is an ongoing debate about what type of exercise at which exercise intensity patients should perform.[1
Risperidone versus zuclopenthixol in the treatment of schizophrenia with substance abuse comorbidity: a long-term randomized, controlled, crossover study
Rubio,Gabriel; Martínez,Isabel; Recio,Ana; Ponce,Guillermo; López-Mu?oz,Francisco; Alamo,Cecilio; Jiménez-Arriero,Miguel ángel; Palomo,Tomás;
The European Journal of Psychiatry , 2006, DOI: 10.4321/S0213-61632006000300001
Abstract: background: substance use disorders (suds) are present in more than 50% of subjects diagnosed with schizophrenia. however, there are no controlled studies assessing the efficacy of antipsychotic drugs in this subgroup of patients. the aim of the present work was to compare the efficacy of risperidone and zuclopenthixol in a sample of schizophrenic subjects with dual diagnosis. method: thirty-three male were selected for treatment with risperidone, while another 33 were treated with zuclopenthixol. substances most commonly used were alcohol, cannabis (both 82%) and cocaine (32%). patients were randomized and treated for the first six months with one antipsychotic and the second six months with the other antipsychotic. psychopathological and clinical scales were used every two months. participants received training on how to reduce their consumption of substances (substance abuse management module, samm). results: during the first six months risperidone group patients presented fewer positive urine tests and showed better compliance with the samm programme. in the second period the patients treated with risperidone significantly improved their scores on the panss-negative subscale. differences between the cgis indicated that the subjects who moved from risperidone to zuclopenthixol worsened, while those who moved from zuclopenthixol to risperidone significantly improved. conclusions: risperidone was more effective than zuclopenthixol in improving the symptoms of schizophrenia and substance use.
Risperidone versus zuclopenthixol in the treatment of schizophrenia with substance abuse comorbidity: a long-term randomized, controlled, crossover study  [cached]
Gabriel Rubio,Isabel Martínez,Ana Recio,Guillermo Ponce
The European Journal of Psychiatry , 2006,
Abstract: Background: Substance use disorders (SUDs) are present in more than 50% of subjects diagnosed with schizophrenia. However, there are no controlled studies assessing the efficacy of antipsychotic drugs in this subgroup of patients. The aim of the present work was to compare the efficacy of risperidone and zuclopenthixol in a sample of schizophrenic subjects with dual diagnosis. Method: Thirty-three male were selected for treatment with risperidone, while another 33 were treated with zuclopenthixol. Substances most commonly used were alcohol, cannabis (both 82%) and cocaine (32%). Patients were randomized and treated for the first six months with one antipsychotic and the second six months with the other antipsychotic. Psychopathological and clinical scales were used every two months. Participants received training on how to reduce their consumption of substances (Substance Abuse Management Module, SAMM). Results: During the first six months risperidone group patients presented fewer positive urine tests and showed better compliance with the SAMM programme. In the second period the patients treated with risperidone significantly improved their scores on the PANSS-negative subscale. Differences between the CGIs indicated that the subjects who moved from risperidone to zuclopenthixol worsened, while those who moved from zuclopenthixol to risperidone significantly improved. Conclusions: Risperidone was more effective than zuclopenthixol in improving the symptoms of schizophrenia and substance use.
Parenteral nutrition versus enteral nutrition in severe acute pancreatitis
Vieira, Josiel Paiva;Araújo, Gutemberg Fernandes de;Azevedo, José Raimundo Araújo de;Goldenberg, Alberto;Linhares, Marcelo Moura;
Acta Cirurgica Brasileira , 2010, DOI: 10.1590/S0102-86502010000500012
Abstract: purpose: to compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. methods: the study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (balthazar classes c, d, and e). the patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. results: there was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. more complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). there was no difference in average length of hospitalization in the two groups. there were three deaths in the parenteral group and none in the enteral group. conclusion: enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.
Treatment-completion rates with olanzapine long-acting injection versus risperidone long-acting injection in a 12-month, open-label treatment of schizophrenia: indirect, exploratory comparisons
Ascher-Svanum H, Montgomery WS, McDonnell DP, Coleman KA, Feldman PD
International Journal of General Medicine , 2012, DOI: http://dx.doi.org/10.2147/IJGM.S29052
Abstract: eatment-completion rates with olanzapine long-acting injection versus risperidone long-acting injection in a 12-month, open-label treatment of schizophrenia: indirect, exploratory comparisons Original Research (2297) Total Article Views Authors: Ascher-Svanum H, Montgomery WS, McDonnell DP, Coleman KA, Feldman PD Published Date May 2012 Volume 2012:5 Pages 391 - 398 DOI: http://dx.doi.org/10.2147/IJGM.S29052 Received: 10 December 2011 Accepted: 29 March 2012 Published: 04 May 2012 Haya Ascher-Svanum1, William S Montgomery2, David P McDonnell3, Kristina A Coleman4, Peter D Feldman1 1Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA; 2Eli Lilly Australia Pty Ltd, West Ryde, New South Wales, Australia; 3Eli Lilly and Company, Cork, Ireland; 4OptumInsight, Lilyfield, New South Wales, Australia Background: Little is known about the comparative effectiveness of atypical antipsychotics in long-acting injection formulation. Due to the absence of head-to-head studies comparing olanzapine long-acting injection and risperidone long-acting injection, this study was intended to make exploratory, indirect, cross-study comparisons between the long-acting formulations of these two atypical antipsychotics in their effectiveness in treating patients with schizophrenia. Methods: Indirect, cross-study comparisons between olanzapine long-acting injection and risperidone long-acting injection used 12-month treatment-completion rates, because discontinuation of an antipsychotic for any cause is a recognized proxy measure of the medication's effectiveness in treating schizophrenia. Following a systematic review of the literature, two indirect comparisons were conducted using open-label, single-cohort studies in which subjects were stabilized on an antipsychotic medication before depot initiation. The first analysis compared olanzapine long-acting injection (one study) with pooled data from nine identified risperidone long-acting injection studies. The second analysis was a “sensitivity analysis,” using only the most similar studies, one for olanzapine long-acting injection and one for risperidone long-acting injection, which shared near-identical study designs and involved study cohorts with near-identical patient characteristics. Pearson Chi-square tests assessed group differences on treatment-completion rates. Results: Comparison of olanzapine long-acting injection data (931 patients) with the pooled data from the nine risperidone long-acting injection studies (3950 patients) provided almost identical 12-month treatment-completion rates (72.7% versus 72.4%; P = 0.87). When the two most similar studies were compared, the 12-month completion rate for olanzapine long-acting injection was significantly higher than for risperidone long-acting injection (81.3% versus 47.0%; P < 0.001). However, any conclusions drawn from this comparison may be limited by differences in the studies' geographic catchment areas. Conclusion: Using treatment-completion ra
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