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Current Drug Safety 2019Extrapyramidal adverse effects of antipsychotic drugs are more reported in children. Biperiden is an anticholinergic agent to treat the adverse effects of antipsychotic...
OBJECTIVE
Extrapyramidal adverse effects of antipsychotic drugs are more reported in children. Biperiden is an anticholinergic agent to treat the adverse effects of antipsychotic drugs. The drug has the potential to induce delirium at toxic doses. However, data are scarce about delirium associated with biperiden in children. Thus far, a case of delirium has been associated with biperiden in an adolescent patient. We report the first case of delirium associated with the use of biperiden in a preadolescent patient.
CASE REPORT
A boy aged five years and weighing 20 kilograms had been diagnosed as having oppositional defiant disorder and separation anxiety disorder in the previous treatment center. Ten milligrams fluoxetine and 0.25 milligrams risperidone had been initiated. On the third day of treatment, dystonia developed and he was administered with biperiden. An hour later, he was brought to our emergency clinic due to disorganized speech and behavior. His vital signs were stable. There were no findings in blood and urine tests. No electrolyte imbalance, liver, kidney, and thyroid dysfunction have been observed. His neurologic examination was unremarkable and no abnormal findings were shown on cranial magnetic resonance imaging. No other system findings or findings pointing out to infectious diseases have been observed. One milligram physostigmine was administered with intravenous infusion. However, symptoms did not resolve and he was diagnosed with delirium. Naranjo Adverse Drug Reaction Probability Scale score was seven, indicating a "Probable" Adverse Drug Reaction. Half milligram haloperidol was administered bid for three days and he was discharged with complete recovery.
CONCLUSION
Clinicians must be aware of the risk of delirium when using non-toxic doses of biperiden in young children.
Topics: Attention Deficit and Disruptive Behavior Disorders; Biperiden; Child; Delirium; Humans; Male; Muscarinic Antagonists
PubMed: 30370855
DOI: 10.2174/1574886313666181029101830 -
Methods in Molecular Biology (Clifton,... 2021Mammalian protein expression systems are ideally suited for the high-level production of recombinant eukaryotic secreted and membrane proteins for structural biology...
Mammalian protein expression systems are ideally suited for the high-level production of recombinant eukaryotic secreted and membrane proteins for structural biology applications. Here, we present genetic transduction of HEK293-derived cells using lentivirus as a robust and cost-efficient method for the rapid generation of stable expression cell lines. We describe the features of the lentiviral transfer plasmid pHR-CMV-TetO, as well as detailed protocols for production of lentiviral particles, determination of functional lentiviral titer, infection of expression cells, culture and expansion of the resulting stable cell lines, their adaptation to adherent and suspension growth, and constitutive or inducible milligram-scale protein production. The typical lead-time for a full production run is ~3-4 weeks, with an anticipated yield of up to tens of milligrams of protein per liter of expression medium.
Topics: Animals; Biotechnology; Cell Culture Techniques; Cell Line; Genetic Vectors; HEK293 Cells; Humans; Lentivirus; Membrane Proteins; Plasmids; Recombinant Proteins; Transduction, Genetic; Transfection
PubMed: 33950385
DOI: 10.1007/978-1-0716-1406-8_4 -
The Western Journal of Emergency... May 2021Intravenous haloperidol has been shown to decrease milligram morphine equivalents (MME) of analgesia and reduce hospital admissions for diabetic gastroparesis. The...
INTRODUCTION
Intravenous haloperidol has been shown to decrease milligram morphine equivalents (MME) of analgesia and reduce hospital admissions for diabetic gastroparesis. The objective of this study was to evaluate whether haloperidol decreases MME for the treatment of non-specific abdominal pain diagnoses in the emergency department (ED), including gastroparesis, cyclic vomiting, cannabinoid hyperemesis syndrome, and unspecified abdominal pain. The primary outcome compared the difference in MME between encounters. Secondary outcomes included admission rate, pain scores, length of stay, rescue therapy administration, and adverse effects.
METHODS
This retrospective chart review included patients ≥ 18 years old who presented to the ED. Patients must have had ≥ 2 ED encounters for abdominal pain, one in which they received conventional therapy with opioids (C-encounter), and the other in which they received haloperidol (H-encounter). Agitated patients were excluded. Seventy-five patients were needed to detect a 3 MME difference with 80% power and two-sided alpha of 0.05.
RESULTS
We analyzed 107 patients with self-matched encounters. The median dose of haloperidol administered was 5.0 milligrams (mg) (interquartile range [IQR] 2.0 - 5.0). C-encounters had significantly more MME administered than H-encounters (median 5.7 mg [IQR 4.0 - 8.0] vs 0.0 mg [IQR 0.0 - 2.5], P < 0.001). These results remained significant despite route of haloperidol administration. C-encounters had higher rates of rescue therapy administration than H-encounters, (56% vs 33.6%, P < 0.001). There were higher rates of ketorolac administration in the H-encounter (P = 0.02).
CONCLUSION
Encounters in which patients received haloperidol and ketorolac for abdominal pain had a statistically significant reduction in MME administered and lower rates of rescue therapy administration than encounters in which patients were treated with opioids.
Topics: Abdominal Pain; Adolescent; Adult; Analgesics, Opioid; Antiemetics; Cross-Over Studies; Emergency Service, Hospital; Haloperidol; Humans; Male; Middle Aged; Pain Management; Retrospective Studies
PubMed: 34125037
DOI: 10.5811/westjem.2021.2.50390 -
Surgery Oct 2018In 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be "called in" to a pharmacy. We analyzed current postoperative opioid prescribing...
BACKGROUND
In 2014, hydrocodone was moved from Schedule III to II, thus it could no longer be "called in" to a pharmacy. We analyzed current postoperative opioid prescribing patterns and the impact of the schedule change on the type and amount prescribed.
METHODS
Opioid prescriptions for common surgeries at 1 medical center from 2013 to 2016 were analyzed retrospectively. Milligram morphine equivalents prescribed before and after the schedule change were compared by t tests, and interrupted time series models and drug frequencies were compared by χ and Fisher exact tests.
RESULTS
Data from 7,046 patients (7,361 prescriptions) after 29 different operations were analyzed. Milligram morphine equivalents prescribed for minor open procedures ranged from 211 to 342 milligram morphine equivalents, from 323 to 1297 for major open procedures, from 238 to 359 for basic laparoscopic procedures, and from 221 to 868 for complex laparoscopic procedures. Mean milligram morphine equivalents prescribed were not affected for most procedures, but over the entire population, milligram morphine equivalents prescribed began decreasing after the rule change. The percentage of hydrocodone prescriptions decreased after the rule change (from 33.8% down to 27.0%) and oxycodone and tramadol prescriptions increased.
CONCLUSION
Before versus after the rule change, hydrocodone prescriptions decreased and oxycodone and tramadol prescriptions increased. Milligram morphine equivalents prescribed varied considerably across and within classes of procedures, but the schedule change did not affect mean milligram morphine equivalents prescribed for most procedures.
Topics: Analgesics, Opioid; Drug Administration Schedule; Humans; Hydrocodone; Pain, Postoperative; Postoperative Period; Practice Patterns, Physicians'; Retrospective Studies; United States
PubMed: 30093274
DOI: 10.1016/j.surg.2018.06.018 -
Radiology Jul 1963
Topics: Female; Humans; Radiology; Radium; Technology, Radiologic; Uterine Cervical Neoplasms
PubMed: 13979164
DOI: 10.1148/81.1.126 -
Nature Jun 2019Heavier-than-air flight at any scale is energetically expensive. This is greatly exacerbated at small scales and has so far presented an insurmountable obstacle for...
Heavier-than-air flight at any scale is energetically expensive. This is greatly exacerbated at small scales and has so far presented an insurmountable obstacle for untethered flight in insect-sized (mass less than 500 milligrams and wingspan less than 5 centimetres) robots. These vehicles thus need to fly tethered to an offboard power supply and signal generator owing to the challenges associated with integrating onboard electronics within a limited payload capacity. Here we address these challenges to demonstrate sustained untethered flight of an insect-sized flapping-wing microscale aerial vehicle. The 90-milligram vehicle uses four wings driven by two alumina-reinforced piezoelectric actuators to increase aerodynamic efficiency (by up to 29 per cent relative to similar two-wing vehicles) and achieve a peak lift-to-weight ratio of 4.1 to 1, demonstrating greater thrust per muscle mass than typical biological counterparts. The integrated system of the vehicle together with the electronics required for untethered flight (a photovoltaic array and a signal generator) weighs 259 milligrams, with an additional payload capacity allowing for additional onboard devices. Consuming only 110-120 milliwatts of power, the system matches the thrust efficiency of similarly sized insects such as bees. This insect-scale aerial vehicle is the lightest thus far to achieve sustained untethered flight (as opposed to impulsive jumping or liftoff).
PubMed: 31243384
DOI: 10.1038/s41586-019-1322-0 -
Health Services Research Aug 2019To estimate the own-price elasticity of demand for naloxone, a prescription medication that can counter the effects of an opioid overdose, and predict the change in...
OBJECTIVE
To estimate the own-price elasticity of demand for naloxone, a prescription medication that can counter the effects of an opioid overdose, and predict the change in pharmacy sales following a conversion to over-the-counter status.
DATA SOURCES/STUDY SETTING
The primary data source was a nationwide prescription claims dataset for 2010-2017. The data cover 80 percent of US retail pharmacies and account for roughly 90 percent of prescriptions filled. Additional covariates were obtained from various secondary data sources.
STUDY DESIGN
We estimated a longitudinal, simultaneous equation model of naloxone supply and demand. Our primary variables of interest were the quantity of naloxone sold, measured as total milligrams sold at pharmacies, and the out-of-pocket price paid per milligram, both measured per ZIP Code and quarter-year.
DATA COLLECTION/EXTRACTION METHODS
Primary data came directly from payers and processors of prescription drug claims.
PRINCIPAL FINDINGS
We found that, on average, a 1 percent increase in the out-of-pocket price paid for naloxone would result in a 0.27 percent decrease in pharmacy sales. We predict that the total quantity of naloxone sold in pharmacies would increase 15 percent to 179 percent following conversion to over-the-counter status.
CONCLUSIONS
Naloxone is own-price inelastic, and conversion to over-the-counter status is likely to lead to a substantial increase in total pharmacy sales.
Topics: Adult; Commerce; Female; Humans; Male; Middle Aged; Models, Economic; Naloxone; Narcotic Antagonists; Nonprescription Drugs; Pharmacies; Socioeconomic Factors
PubMed: 30790269
DOI: 10.1111/1475-6773.13125 -
Science (New York, N.Y.) May 1966Average difference in size between queens and workers of four social Halictinae common to southern Ontario ranges from 6 percent in Augochlorella striata (Prov.) to 15...
Average difference in size between queens and workers of four social Halictinae common to southern Ontario ranges from 6 percent in Augochlorella striata (Prov.) to 15 percent in Evylaeus cinctipes (Prov.). Spring larvae receive. provisions averaging 33.9 milligrams and become small workers; summer larvae consume on average 61.7 milligrams and develop into large queens and males.
PubMed: 17769541
DOI: 10.1126/science.152.3726.1262 -
Journal of Chromatography. A Jul 2016Monoclonal antibodies (mAbs) have become the fastest growing segment in the drug market with annual sales of more than 40 billion US$ in 2013. The selection of lead...
Monoclonal antibodies (mAbs) have become the fastest growing segment in the drug market with annual sales of more than 40 billion US$ in 2013. The selection of lead candidate molecules involves the generation of large repertoires of antibodies from which to choose a final therapeutic candidate. Improvements in the ability to rapidly produce and purify many antibodies in sufficient quantities reduces the lead time for selection which ultimately impacts on the speed with which an antibody may transition through the research stage and into product development. Miniaturization and automation of chromatography using micro columns (RoboColumns(®) from Atoll GmbH) coupled to an automated liquid handling instrument (ALH; Freedom EVO(®) from Tecan) has been a successful approach to establish high throughput process development platforms. Recent advances in transient gene expression (TGE) using the high-titre Expi293F™ system have enabled recombinant mAb titres of greater than 500mg/L. These relatively high protein titres reduce the volume required to generate several milligrams of individual antibodies for initial biochemical and biological downstream assays, making TGE in the Expi293F™ system ideally suited to high throughput chromatography on an ALH. The present publication describes a novel platform for purifying Expi293F™-expressed recombinant mAbs directly from cell-free culture supernatant on a Perkin Elmer JANUS-VariSpan ALH equipped with a plate shuttle device. The purification platform allows automated 2-step purification (Protein A-desalting/size exclusion chromatography) of several hundred mAbs per week. The new robotic method can purify mAbs with high recovery (>90%) at sub-milligram level with yields of up to 2mg from 4mL of cell-free culture supernatant.
Topics: Antibodies, Monoclonal; Automation; Chromatography, Affinity; Chromatography, Gel; Chromatography, High Pressure Liquid; HEK293 Cells; Humans; Miniaturization; Recombinant Proteins; Robotics; Staphylococcal Protein A
PubMed: 27283099
DOI: 10.1016/j.chroma.2016.05.076 -
Journal of Blood Medicine 2021The prevalence of chewing and the use of ascorbic acid is increasing from time to time. Their subchronic effects on hematological indices are not well examined. The...
BACKGROUND
The prevalence of chewing and the use of ascorbic acid is increasing from time to time. Their subchronic effects on hematological indices are not well examined. The present study was aimed to investigate their subchronic effects on hematological indices in rats.
MATERIALS AND METHODS
A total of 36 adult (7-8 weeks) wild-type rats weighing between 213 and 229g were used in this study. They received extract (Ce) (100 milligrams/kilogram, 200 milligram/kilogram and 300 milligram/kilogram b.w), juice (2.5 mL/kg), ascorbic acid (AA 200 milligram/kilogram), and 2% tween 80 in distilled water (T80W- v/v) for twelve weeks. Hematological indices were measured with Sysmex KX-21. Data were analyzed by SPSS version 21.0 and Microsoft Excel.
RESULTS
Neutrocytes (p < 0.01), lymphocytes (p < 0.05), plateletcrit (p < 0.05), average size of platelets (p < 0.05), platelet size variability (p < 0.01), platelet-large cell ratio (p < 0.05) and neutrocytes/lymphocytes ratio (p < 0.001) were significantly greater, while hemoglobin concentration per red blood cell (p < 0.05) and hemoglobin concentration per volume of red blood cells were significantly reduced (p < 0.05) in rats received khat. The red cell distribution width (p < 0.05), platelet size variability (p < 0.05) and platelet-large cell ratio (p < 0.01) were significantly greater in rats received ascorbic acid.
CONCLUSION
Crude extract and juice changed some hematological indices and increased platelet activities. The platelet activity was also increased by ascorbic acid. The mechanisms for these changes need to be investigated.
PubMed: 34602828
DOI: 10.2147/JBM.S328703