Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 33-41).

The association of extrapyramidal symptoms (EPS) with the use of antipsychotics was first discovered in the 1950s. To our knowledge, little research has been conducted with any retrospective observational database to evaluate the comparative risk of EPS between first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) users in the U.S. population. The purpose of the study was to compare EPS risk between FGA and SGA users using propensity score-matching (PSM) and instrumental variable (IV) analyses. A retrospective cohort design with an intention-to-treat (ITT) analysis (where the patients included in the cohort were assumed to take the medications without switching or dropping out) was chosen to examine the relationship between antipsychotic treatment and EPS risk. First-time antipsychotic users (as identified in the MEPS database), during the time frame 2002 to 2009, were included in the cohort. All subjects included in the cohort were followed over time to assess EPS risk. Propensity score-based logistic regression (using the Greedy 5[right arrow]1 digit match technique) was used to compare EPS risk between the SGA and FGA users after adjusting for demographic variables and risk factors (associated with EPS). In order to identify the presence of unobserved confounding, an instrumental variable analysis was attempted. Based on previous research findings, "delay in obtaining prescribed medicines" was selected as the instrument to evaluate the relationship between EPS risk and antipsychotic type. The feasibility of instrumental variable analyses was examined by evaluating the strength of the chosen instrument. The propensity score-based logistic regression analysis showed no difference in EPS risk [OR = 1.77, 95% CI = (0.49, 6.40)] between FGA and SGA users. The strength (partial r² = 0.0002) of the instrument was low. A weak instrument used in a regression model may produce biased estimates while evaluating treatment/outcome relationship; therefore, instrumental variable analysis was not conducted. EPS risk was found not to differ between the FGA and SGA users. However, clinicans may choose to evaluate other side-effects (in addition to EPS) of antipsychotics while making treatment decisions. Evaluation of economic, clinical and humanistic outcomes associated with treatment of antipsychotic-related side-effects (besides EPS) can provide clinicans the rationale for selecting one class of antipsychotics over the other. Interpretation of the study findings should be considered in light of the limitations of the MEPS database. Future research is necessary to identify a strong instrument to assess the presencec of unobserved confounding between antipsychotic exposure and EPS risk. Furthermore, additional research is warranted to assess differences in time to development of EPS between the FGA and SGA users. / text

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Originally Published: 2002; Revised / 3 pp. / Environmental conditions between awn emergence and the end of flowering is the overriding factor in disease development. 2 The University of Arizona Cooperative Extension Cultural practices may be partially effective in controlling Karnal bunt but cannot eliminate the disease completely. Karnal bunt is most likely to be found in areas where lodging or water ponding have occurred.

In medical practice today, diabetic ketoacidosis results in a fatal outcome for 10% of patients, and in the hyperosmolar non-ketoacidosis syndrome 50% die. Thrombotic complications account for a considerable proportion of the deaths of these patients and cerebral manifestations are characteristic of their hyperosmolar state. A strategy which leads to improved management and survival of these severely decompensated patients remains to be found. Recommendations for management of these patients are presently controversial because the aetiology of their cerebral disturbance is ill-defined. This thesis describes novel alterations in blood from patients with ketoacidosis which are particularly associated with the development of the hyperosmolar state. The combination of these abnormalities with other factors present, leads to an unique summated effect on the flow properties of blood during severe diabetic decomposition. Subsequently impaired perfusion could therefore account for the depressed conscious level, strokes and fatal thrombotic phenomena commonly associated with diabetic ketoacidosis. The biochemical alterations underlying the blood abnormalities were studied both in humans and in animals with severe diabetic ketoacidosis. The findings which emerged from the study are particularly relevant to planning treatment and monitoring the pathophysiological response of vital tissue in these patients. It is possible that we can reduce the mortality of these serious medical conditions and improve the outlook for the diabetic individual if we elucidate the underlying pathophysiological changes and adjust treatment accordingly.

No description available.

No description available.

Thesis (M.A.)--State University of New York at Binghamton, Dept. of Psychology, 2006. / Includes bibliographical references.

Class of 2012 Abstract / Specific Aims: The purpose of this study is to identify the incidence of symptoms associated after exposure to “bath salts,” a term for synthetic cathinones in Arizona. Methods: This is a retrospective chart review of reported exposures to synthetic cathinones to the Arizona Poison and Drug Information Center and the Banner Good Samaritan Poison and Drug Information Center. Main Results: There were 306 cases of synthetic cathinone exposures reviewed and 76.5% were males (n=234) and 23.5% were females (n=72). They were ingested, inhaled, snorted, or injected. The mean age of exposure to synthetic cathinones was 29 years old. The most common symptoms included agitation (48.7%), hallucinations (27.1%), confusion (17.6%), hypertension (21.9%), tachycardia (50.6%), CK elevation (17.3%) and chest pain (9.5%). Less frequent symptoms exhibited in synthetic cathinone abuse included other CNS effects, gastrointestinal symptoms, muscular dysfunction, visual disturbances, and respiratory issues. Conclusions: The symptoms exhibited after exposure to synthetic cathinones were mainly neurologic and cardiovascular. In most cases, symptoms were effectively resolved within 24 to 48 hours after treatment with intravenous fluids and benzodiazepines. In some reports, patients were also given oxygen, anti-emetics, sedatives and anti-psychotic medications. Medical outcomes included major (1.6%), moderate (42.2%) and minor effects (26.1%) while 92 patients were lost to follow-up.

No description available.