This document discusses Neuroleptic Malignant Syndrome (NMS), a life-threatening reaction that can occur due to treatment with antipsychotic medications. It defines NMS as a condition characterized by fever, severe muscle rigidity, and changes in mental status and autonomic function. The document outlines risk factors for NMS, diagnostic criteria, treatment recommendations including immediate discontinuation of the causative drug, and supportive care. Dopaminergic medications like bromocriptine may help reduce time to recovery and mortality rates.
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
The use of Reglan, a drug used to treat diabetes and heartburn, has been linked to conditions such as Neuroleptic Malignant Syndrome (NMS).
Read more on: http://www.reglan-lawsuit-attorney.com/neuroleptic-malignant-syndrome/
Serotonin Syndrome is an increasingly prevalent, life-threatening problem. It is caused when herbs, over the counter medications or prescriptions which increase serotonin increase serotonin levels too much causing agitation, high fever, confusion, loss of motor control and many other symptoms. DXM (dextromethorphan) overdose often causes serotonin syndrome. Other OTC supplements of concern include SAM-e, 5HTP, St. Johns Wort. Any of these alone or in combination with alcohol can dangerously increase serotonin levels.
Epilepsy case presentation by mehreen taj IVth parm DMehreen taj
Epilepsy:Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.The main causes of Epilepsy and resultant seizures include Meningitis, head injury or trauma, stroke, brain tumour, high fever (Febrile Seizure), and parasite infection Neuro-cysticercosis. The main triggering factors include light, noise, sleep loss, alcohol intake and cigarette smoking.
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizure.
The use of Reglan, a drug used to treat diabetes and heartburn, has been linked to conditions such as Neuroleptic Malignant Syndrome (NMS).
Read more on: http://www.reglan-lawsuit-attorney.com/neuroleptic-malignant-syndrome/
Serotonin Syndrome is an increasingly prevalent, life-threatening problem. It is caused when herbs, over the counter medications or prescriptions which increase serotonin increase serotonin levels too much causing agitation, high fever, confusion, loss of motor control and many other symptoms. DXM (dextromethorphan) overdose often causes serotonin syndrome. Other OTC supplements of concern include SAM-e, 5HTP, St. Johns Wort. Any of these alone or in combination with alcohol can dangerously increase serotonin levels.
Epilepsy case presentation by mehreen taj IVth parm DMehreen taj
Epilepsy:Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.The main causes of Epilepsy and resultant seizures include Meningitis, head injury or trauma, stroke, brain tumour, high fever (Febrile Seizure), and parasite infection Neuro-cysticercosis. The main triggering factors include light, noise, sleep loss, alcohol intake and cigarette smoking.
Epileptic seizures vary in intensity and symptoms depending on what part of the brain is involved. In partial seizures, the most common form of seizure in adults, only one area of the brain is involved. Partial seizures are classified as simple partial, complex partial (also known as psychomotor), and absence (also known as myoclonic or petit mal) seizure.
Leptospirosis - clinical manifestations and diagnosis.pdfJim Jacob Roy
Leptospirosis is a commonly encountered infection , especially in tropical regions.
In this document , the clinical manifestations and diagnosis of leptospirosis is described.
The modified FAINE'S criteria is also described at the end.
Primary and secondary lymphoma of brain differences as regard location, imaging ,presentation and treatment. Different lines to treat pri.ary CNS lymphoma
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Definition NMS is an idiosyncratic, life-threatening complication of treatment with antipsychotic drugs that is characterized by fever, severe muscle rigidity, and autonomic and mental status changes ( Strawn et al 2007)
3. Prevalence Although estimates of the incidence of NMS once ran as high as 3% of patients treated with antipsychotics, more recent data suggest an incidence of 0.01%–0.02% This decrease in frequency likely reflects increased awareness of the disorder, more conservative prescribing patterns, and the shift to use of atypical antipsychotics.
4. Morbidity and Mortality NMS remains a significant source of morbidity and mortality among patients receiving antipsychotics. For example, data from the U.S. Agency for Healthcare Research and Quality indicate that about 2,000 cases of NMS are diagnosed annually in hospitals in the United States, incurring health care costs of $70 million, with a mortality rate of 10%,
5. Differential Diagnosis of Neuroleptic Malignant Syndrome Infectious Meningitis or encephalitis Post infectious encephalomyelitis syndrome Brain abscess Sepsis Psychiatric or neurological Idiopathic malignant catatonia Agitated delirium Benign extrapyramidal side effects No convulsive status epilepticus Structural lesions, particularly involving the midbrain Toxic or pharmacological Anticholinergic delirium Salicylate poisoning Malignant hyperthermia (inhalational anaesthetics, succinylcholine) Serotonin syndrome (monoamine oxidase inhibitors, triptans, linezolid) Substances of abuse (amphetamines, hallucinogens) Withdrawal from dopamine agonists, baclofen, sedative hypnotics, and alcohol Endocrine Thyrotoxicosis Pheochromocytoma Environmental Heatstroke
6. Diagnosis Box 1: Clinical and laboratory features of neuroleptic malignant syndrome* • The development of severe muscle rigidity and elevated temperature associated with the use of neuroleptic medication. • Two or more of the following: diaphoresis, dysphagia, tremor, incontinence, changes in level of consciousness ranging from confusion to coma, mutism, tachycardia, elevated or labile blood pressure, leucocytosis, laboratory evidence of muscle injury (e.g., elevated creatinine phosphokinase). • The symptoms are not due to another substance (e.g., phencyclidine) or a neurologic or other general medical condition. • The symptoms are not better accounted for by a mental disorder (e.g., mood disorder with catatonic features).
7. PCP (Phencyclidine) Angel dust has a reputation for causing psychotic episodes, but what are the true facts behind PCP? PCP, or phenylcyclohexylpiperidine, is a stimulant with strong hallucinogenic properties. It's sold as a white crystalline powder which can be prepared for injection, sniffing, smoking or swallowing. A liquid form, commonly called embalming fluid, can also be found. What are the effects of PCP? Feelings of dreaminess and mild hallucinations Users also experience distortions in their perception of time and space. What are the risks of taking PCP? Even in low doses, PCP can lead to severe psychological trauma Users may feel agitated and paranoid, leading to outbursts of violent behaviour including self-mutilation Large doses can cause respiratory arrest or kidney failure Excessive doses can lead to convulsions and even death It can be difficult to administer safe doses of a drug whose strength wildly fluctuates PCP is frequently laced with other illicit substances (such as marijuana) and the buyer not made aware of its presence. The law and PCP: Phencyclidine is a Class A drug, meaning possession can carry a sentence of up to seven years in prison. Other terms for PCP: Angel dust, ozone, embalming fluid, wack, rocketfuel, elephant tranquiliser, dust, kools, and sherms
8. Definitions Diaphoresis Leukocytosis, A simple and easy way to understand the profuse diaphoresis definition is to think of this condition as simply sweating excessively. Leukocytosis, defined as a white blood cell count greater than 11,000 per mm3 (11 X 109 per L),1 is frequently found in the course of routine laboratory testing. An elevated white blood cell count typically reflects the normal response of bone marrow to an infectious or inflammatory process. Occasionally, leukocytosis is the sign of a primary bone marrow abnormality in white blood cell production, maturation or death (apoptosis) related to a leukemia or myeloproliferative disorder.
9. Significance of elevated levels of serum creatine phosphokinase in febrile diseases: a prospective study. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis The incidence and significance of elevated serum levels of creatinephosphokinase (CPK) in febrile diseases were studied prospectively in all patients admitted with fever to a department of medicine during 1 year. High serum CPK levels were detected in 70 (28%) of 247 febrile patients but in only six (6%) of 105 afebrile control patients (P =.0001). Elevated CPK levels were not related to any specific diagnosis. Logistic regression analysis identified five factors that correlated both significantly and independently with elevation of CPK values: increased blood urea nitrogen level, low serum phosphate level, a stuporous or comatose state, tremor, and muscle tenderness. Myoglobinuria, detected in 14 patients, was predictive of a fatal outcome, but a high CPK level by itself was not an independent correlate of mortality. In summary, CPK elevation is not uncommon in febrile diseases, but because it does not reflect a specific etiology it does not necessarily indicate that an extensive diagnostic work-up is required. Acute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF. Methods Thirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated. Results The median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (>10 000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL. Conclusions The peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.
10. Diagnosis NMS is often difficult to distinguish from more common extrapyramidal side effects of antipsychotics and from other disorders presenting with similar symptoms. About 16% of cases of NMS develop within 24 hours after initiation of antipsychotic treatment, 66% within the first week, and virtually all cases within 30 days (11). It would be unusual for NMS to occur beyond 1 month after initiation of treatment unless the dose was increased or an additional antipsychotic administered.
11. Length of Recovery Once NMS is diagnosed and oral antipsychotic drugs are discontinued, NMS is self-limited in most cases. The mean recovery time after drug discontinuation is in the range of 7–10 days, with 63% of patients recovering within 1 week and nearly all within 30 days However, the duration of NMS episodes may be prolonged when long-acting depot antipsychotics are implicated. In addition, there have been several reports of patients in whom residual catatonia and parkinsonism persisted for weeks after the acute metabolic symptoms of NMS resolved
12. Risk Factors Several clinical, systemic, and metabolic factors have been correlated with the incidence of NMS, including agitation, dehydration, restraint, pre existing abnormalities of CNS dopamine activity or receptor function, and iron deficiency Nearly all case series of NMS patients have reported physical exhaustion and dehydration prior to the onset of NMS . Elevated environmental temperature has been proposed as a contributing factor in some series, although NMS can occur independent of ambient conditions. A prior episode of NMS has been described in 15%–20% of cases
13. Treatment Supportive Therapy The offending agent must be withdrawn immediately, after which supportive medical therapy is the mainstay of management of NMS Volume resuscitation should be aggressive, especially given that most patients with NMS are dehydrated in the acute phase of the illness. Serial monitoring and correction of electrolyte abnormalities is critical. In extreme hyperthermia, physical cooling measures are paramount, as the peak and duration of temperature elevation are predictive of morbidity and mortality Intensive medical care should include careful monitoring for complications, including cardiorespiratory failure, renal failure, aspiration pneumonia, and coagulopathies, and may involve support of cardiac, respiratory, and renal function
14. Pharmacological Treatments NMS is a self-limited iatrogenic disorder, and in many cases medical management and cessation of antipsychotic medication may suffice to reverse the symptoms. Benzodiazepines. Although a controlled evaluation of NMS risk factors suggests that benzodiazepines do not have a preventive effect, several clinical reports suggest that benzodiazepines, administered orally or parenterally, may ameliorate symptoms and hasten recovery in NMS, particularly in milder cases.
15. Dopaminergic Agents Several dopaminergic drugs, including bromocriptine and amantadine, may reverse parkinsonism in NMS and have been reported in case reports and meta-analyses to reduce time to recovery and halve mortality rates when used alone or in combination with other treatments. Bromocriptine can worsen psychosis and hypotension. It also may precipitate vomiting and thus should be used carefully in patients at risk of aspiration. Premature discontinuation of bromocriptine has resulted in rebound symptoms in some cases. Bromocriptine (Parlodel) is classified as a dopamine agonist drug that lowers prolactin levels. Primarily used in Parkinson's disease patients to lower high prolactin level. Bromocriptine was soon discovered to be of great use in many medical conditions as well as off label uses. Elevation of dopamine levels may lead to a marked increase in sex drive, improvement in mood, alertness, learning ability and creativity. Known off-label uses for dopaminergic drugs such as Bromocriptine include sex drive enhancement and increased ejaculation volume, mood elevation, appetite suppression and fat loss. Amantadine is generally initiated at 200–400 mg/day in divided doses administered orally or through a nasogastric tube. The starting dose of bromocriptine is 2.5 mg orally two or three times a day, increased to a total daily dose of 45 mg if necessary
16. Dantrolene. Because of its efficacy in anaesthetic-induced malignant hyperthermia, the muscle relaxant dantrolene has been used in the treatment of NMS. Dantrolene may be useful only in cases of NMS with extreme temperature elevations, rigidity, and true hyper metabolism Generally, rapid reversal of the hyperthermia and rigidity is observed in patients treated with dantrolene, but symptoms may return if treatment is discontinued prematurely.
17. ECT A review (32) found that ECT was consistently effective even after failed pharmacotherapy and that clinical response often occurred over the course of the first several treatments. Treatment response to ECT was not predicted by age, sex, psychiatric diagnosis, or any particular features of NMS. A typical ECT regimen for acute NMS would include six to 10 treatments with bilateral electrode placement.
18. Antipsychotic Use Following NMS Restarting antipsychotic treatment after resolution of an NMS episode has been associated with an estimated likelihood of developing NMS again as high as 30% At least 2 weeks should be allowed to elapse after recovery from NMS before rechallenge; low doses of low-potency conventional antipsychotics or atypical antipsychotics should be titrated gradually after a test dose; and patients should be carefully monitored for early signs of NMS.
19. References http://www.steroidsclub.eu/bromocriptine-buy-204.html http://www.thesite.org/drinkanddrugs/drugsafety Cohen O, LeiboviciL, MorF, WysenbeekAJSignificance of elevated levels of serum creatine phosphokinase in febrile diseases: a prospective study. Reviews of Infectious Diseases [1991, 13(2):237-42] Kasaoka S, TodaniM, Kaneko T, Kawamura Y, OdaY, TsurutaR, Maekawa T, Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis.Journal of Critical Care [2010, 25(4):601-4]