scholarly journals Changes in smoking status, mental state and plasma clozapine concentration: retrospective cohort evaluation

2019 ◽  
Vol 43 (6) ◽  
pp. 271-274
Author(s):  
Inti Qurashi ◽  
Paul Stephenson ◽  
Chitra Nagaraj ◽  
Simon Chu ◽  
Richard Drake ◽  
...  
Keyword(s):  
Mental State ◽  
Retrospective Cohort ◽  
Dosage Adjustment ◽  
Smoking Status ◽  
Serum Levels ◽  
Clinical Implications ◽  
Clozapine Concentration ◽  
Clozapine Dose ◽  
Forensic Psychiatric ◽  
Almost All

Aims and methodTo investigate the percentage of patients who commenced smoking after transferring out of a non-smoking forensic psychiatric unit, the corresponding clozapine dose adjustments, the effects on plasma clozapine/norclozapine concentrations and observed changes in mental state. We reviewed the notes and plasma clozapine/norclozapine concentrations of 46 patients transferred to medium secure units between July 2008 and December 2013.ResultsThirty-five patients commenced smoking. Their median clozapine dose was increased by 50 mg/d. In the non-smokers, the median clozapine dose remained unchanged. Plasma clozapine/norclozapine concentrations were significantly reduced in smokers despite dosage adjustment. Eighteen patients experienced deterioration in mental state after transfer; almost all these patients were smokers.Clinical implicationsApproximately three-quarters of patients who were non-smokers by virtue of being in a secure non-smoking environment commenced smoking after transfer. Monitoring of clozapine serum levels and assessment of mental state in the immediate period after a change in smoking status is indicated.

scholarly journals Factors predicting serum clozapine levels in Middle Eastern patients

2022 ◽  
Author(s):  
Ahmed Hassab Errasoul ◽  
Mohammed A. Alarabi
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Smoking Status ◽  
Middle Eastern ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Therapeutic Drug ◽  
Clinical Predictors ◽  
Cross Sectional ◽  
Clozapine Dose

Objectives: Despite its superiority over other drugs for psychosis, clozapine remains underused and is associated with many clinical challenges, including difficulties in predicting serum levels. We thus investigated the clinical predictors of clozapine serum levels in Middle Eastern patients. Methods: This was a cross-sectional study including 94 patients of Middle Eastern ethnicity. Results: The average clozapine dose and serum level were 400 mg/daily and 705 ng/mL, respectively. Clozapine dose and serum levels were positively correlated (rs [94]=0.32, p=0.002). A predictive model of serum clozapine levels revealed that the daily dose, smoking status, use of fluvoxamine or lamotrigine, and body mass index predicted 43.6% of the variance in serum levels (p<0.001). Using this model, the maximum doses of clozapine to avoid levels above the optimal range (>650 ng/mL) were 300, 250, or 225 mg/day for non-smokers with a body mass index of 25, 30, or 35 kg/m2, respectively, and 475, 425, or 400 mg/day for smokers with a body mass index of 25, 30, or 35 kg/m2, respectively. Conclusions: These findings do not reduce the value of individualised therapeutic drug monitoring but may assist clinicians when prescribing clozapine to Middle Eastern patients. Further psychopharmacological studies are needed on this demographic population.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Facilities for carers of in-patients in forensic psychiatric services in England and Wales

2010 ◽  
Vol 34 (9) ◽  
pp. 381-384 ◽  
Author(s):  
Irene Cormac ◽  
Drew Lindon ◽  
Hannah Jones ◽  
Trevor Gedeon ◽  
Michael Ferriter
Keyword(s):  
Mental Health ◽  
Postal Survey ◽  
Psychiatric Services ◽  
Clinical Implications ◽  
England And Wales ◽  
Mental Health Settings ◽  
Forensic Psychiatric ◽  
Minority Ethnic ◽  
Psychiatric Facilities

Aims and methodA postal survey of forensic psychiatric facilities in England and Wales was undertaken to obtain information about the services provided for carers of in-patients within these services.ResultsForensic psychiatric services vary in the support and facilities provided for carers. Many do not comply with current legislation for carers. Most units informed carers of their rights to have an assessment, but only a minority provided facilities for carers from Black and minority ethnic backgrounds.Clinical implicationsForensic psychiatric services should meet standards for the involvement and support of carers in mental health settings, and comply with legislation for carers.

scholarly journals The Importance of Antioxidant Status in Gastric Intestinal Metaplasia

2021 ◽  
Author(s):  
Nilay Danis ◽  
Aysegul Ertinmaz Ozkan ◽  
Fatih Karatas ◽  
Cagri Cakici ◽  
Turkan Yigitbasi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Intestinal Metaplasia ◽  
Prognostic Marker ◽  
Smoking Status ◽  
Serum Levels ◽  
Control Group ◽  
Gastric Intestinal Metaplasia ◽  
Oxidative Stress Status ◽  
Cancer Types ◽  
The Mean

Background and Aim: Oxidative stress status in different cancer types was investigated before, but not studied in gastric intestinal metaplasia to the best of our knowledge. Purpose of this study is to examine whether there is a difference between oxidative stress status in patients with intestinal metaplasia (IM) compared to individuals without IM, we compared the serum levels of disulfide (SS), total thiol (TT) and native thiol (NT). Patients and Methods: This was a prospective, non-randomized case-control study including 67 patients with histopathologically confirmed IM and 60 individuals demographically matched in terms of age, gender, BMI, smoking status, and chronic diseases as control group. Results: The mean NT, TT and NT to TT(NT/TT) ratios were statistically significantly higher in IM group compared to controls [(351.71±81.9µmol/L vs. 271.82±54.13µmol/L, p=0.000),(391.5±92.69µmol/L vs. 308.59±55.53 µmol/L, 0.000) and (0.89±0.6 vs. 0.87±0.29,  p=0.022), respectively].The mean SS to TT(SS/TT) ratio was significantly lower in IM group than control group (0.050±0.31 vs. 0.060±0.014, P=0.022). Median SS and mean SS/NT ratio was similar in both groups[16.3 (3.3 – 78) vs. 18.3 (10 – 32.7), p=0.271 and 0.055 ± 0.041 vs. 0.070 ± 0.019, p=0.068, respectively). In ROC analysis, cut off value of SS/NT for IM was found 0.062, in regression analysis, SS/NT<0.062 was found as an independently prognostic marker for IM (OR, 2.38; 95%CI: 1.168 - 4.865, P=0.017). Conclusion: SS /NT ratio lower than 0.062 was found as an independently prognostic marker for IM. This ratio could help to distinguish which patients should be followed closely for gastric cancer.

Limitations Using Neuroimaging to Reconstruct Mental State After a Crime

2021 ◽  
Vol 30 (4) ◽  
pp. 694-701
Author(s):  
Michael J. Vitacco ◽  
Alynda M. Randolph ◽  
Rebecca J. Nelson Aguiar ◽  
Megan L. Porter Staats
Keyword(s):  
Mental State ◽  
Insanity Defense ◽  
Physical Conditions ◽  
Clinical Diagnoses ◽  
History Of ◽  
Forensic Psychiatric ◽  
Brain And Behavior ◽  
And Behavior ◽  
The Relationship ◽  
The Brain

AbstractNeuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

scholarly journals Anticonvulsant monitoring in psychiatric practice

2001 ◽  
Vol 25 (9) ◽  
pp. 356-358 ◽  
Author(s):  
Debbie Nelson ◽  
Douglas Gray
Keyword(s):  
Psychiatric Illness ◽  
Best Practice ◽  
Literature Search ◽  
Serum Levels ◽  
Psychiatric Practice ◽  
Clinical Implications

Aims and MethodA Medline literature search revealed a large number of articles on anticonvulsant monitoring. More relevant articles were selected with the aim of summarising current best practice in this area.ResultsMost articles were written to address monitoring in epilepsy and not psychiatric illness. Serum ranges should only be regarded as guidelines. Some patients may show toxic signs at therapeutic serum levels while others may show tolerance and require higher levels.Clinical ImplicationsAppropriate monitoring of serum levels improves efficacy and enhances safety. Clinician ignorance may lead to inappropriate or inaccurate sampling with resultant adverse consequences for the patient.

A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant

2020 ◽  
Vol 30 (4) ◽  
pp. 329-334
Author(s):  
Josiane Luzia Sibioni Moraes ◽  
Ramon Antonio Oliveira ◽  
Marcos Naoyuki Samano ◽  
Vanessa de Brito Poveda
Keyword(s):  
Risk Factors ◽  
Retrospective Cohort ◽  
Lung Transplant ◽  
Smoking Status ◽  
High Body Mass Index ◽  
Surgical Site Infections ◽  
Tube Placement ◽  
Chest Drain ◽  
Related Risk ◽  
Lung Transplant Recipients

Background: Surgical site infections (SSIs) are among the leading health care–associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. Methods: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. Results: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index ( P = .041), prolonged surgery time ( P = .043), and prolonged duration of chest drain placement ( P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status ( P = .05) and positive bronchoalveolar lavage ( P < .001). Having an SSI was associated with an increased length of stay in intensive care units ( P = .003), reoperation ( P = .014), and a higher 1-year mortality rate ( P = .02). Conclusions: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.

scholarly journals Concept and connotation of oxidative stress in preeclampsia

2018 ◽  
Vol 10 (03) ◽  
pp. 276-282 ◽  
Author(s):  
Hayder M. Al-Kuraishy ◽  
Ali I. Al-Gareeb ◽  
Thabat J. Al-Maiahy
Keyword(s):  
Oxidative Stress ◽  
Body Mass Index ◽  
Pregnant Women ◽  
Lipid Profile ◽  
Body Mass ◽  
Smoking Status ◽  
Serum Levels ◽  
Normal Pregnancy ◽  
The Body ◽  
Related Disorder

ABSTRACT BACKGROUND: Preeclampsia (PE) is a systemic pregnancy-related disorder characterized by hypertension, proteinuria, and edema. Free radicals seem to play an important role in the induction of endothelial dysfunction in PE. AIM: The aim of the present study was to investigate serum levels of nitric oxide (NO), peroxynitrite (ONOO−), paraoxonase (PON-1), malondialdehyde (MDA), and lipid profile in preeclamptic patients compared to the women with normal pregnancy. MATERIALS AND METHODS: A total of 68 pregnant women were recruited. They were divided into two groups - Group A, 40 women were a newly diagnosed with PE and Group B, 28 women with normal pregnancy. Anthropometric measurements including body mass index and blood pressure in accordance with biochemical measurements including NO, ONOO−, PON-1, MDA, and lipid profile were done for preeclamptic pregnant women compared to the controls. RESULTS: Pregnant women with pre-eclampsia illustrated insignificant differences in the age (31.22±2.87) compared to the age of control P > 0.05. There were significant changes in the body mass index (BMI) , type of delivery and smoking status of pregnant women with pre-eclampsia compared to the control P < 0.05. Both systolic and diastolic blood pressures were high in pregnant women with pre-eclampsia compared to the control P < 0.01. PON-1 and NO serum levels were significantly decreased (P < 0.01) while ONOO− and MDA serum levels were significantly increased in PE compared to the women with normal pregnancy. Conclusions: This study concluded that PE is associated with the augmentation of oxidative stress and reduction of endogenous antioxidant capacity regarding PON-1.

scholarly journals Association of GDF-15 and Syntax Score in Patient with Acute Myocardial Infarction

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Shiqiang Liu ◽  
Xu Chen ◽  
Hua Wang ◽  
Bo Ming ◽  
Mingle Wu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Protective Factor ◽  
Smoking Status ◽  
Elevated Serum ◽  
Serum Levels ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Online Methods

Aims. GDF-15 is considered to be an important biomarker for cardiovascular events, but the differences in serum GDF-15 levels between acute myocardial infarction (AMI) patients and non-AMI patients warrant further investigation. Methods. A cohort of 409 subjects was enrolled in the current study. The Syntax score was calculated from the baseline coronary angiography results by using online methods. Blood samples were obtained at the start of the study for an assessment of GDF-15 by using ELISA methods. Results. Patients with AMI had significantly higher levels of serum GDF-15 (Wilcox test, P < 0.001), Syntax scores (Wilcox test, P = 0.006), and left ventricular ejection fractions (LEVF, Wilcox test, P< 0.001). However, no significant differences were present among the other clinical characteristics. The logistical regression analysis indicated that serum GDF-15 levels (P=0.01534) were independent predictors of non-AMI and AMI after adjusting for age, sex, smoking status, and LVEF. Conclusions. Elevated serum levels of GDF-15 are independently associated with the risk of MI, and GDF-15 may serve as a protective factor for MI in the cardiovascular system.

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