A Tribute to Mentors

Xiao-Planes Xiaohong. Ji Zhaojin, A History of Modem Shanghai Banking. The Rise and Decline of China's Finance Capitalism, 2002. In: Études chinoises, n°23, 2004. pp. 582-584

Metoprolol-induced visual hallucinations: a case series

<p>Abstract</p> <p>Introduction</p> <p>Metoprolol is a widely used beta-adrenergic blocker that is commonly prescribed for a variety of cardiovascular syndromes and conditions. While central nervous system adverse effects have been well-described with most beta-blockers (especially lipophilic agents such as propranolol), visual hallucinations have been only rarely described with metoprolol.</p> <p>Case presentations</p> <p>Case 1 was an 84-year-old Caucasian woman with a history of hypertension and osteoarthritis, who suffered from visual hallucinations which she described as people in her bedroom at night. They would be standing in front of the bed or sitting on chairs watching her when she slept. Numerous medications were stopped before her physician realized the metoprolol was the causative agent. The hallucinations resolved only after discontinuation of this medication.</p> <p>Case 2 was a 62-year-old Caucasian man with an inferior wall myocardial infarction complicated by cardiac arrest, who was successfully resuscitated and discharged from the hospital on metoprolol. About 18 months after discharge, he related to his physician that he had been seeing dead people at night. He related his belief that since he 'had died and was brought back to life', he was now seeing people from the after-life. Upon discontinuation of the metoprolol the visual disturbances resolved within several days.</p> <p>Case 3 was a 68 year-old Caucasian woman with a history of severe hypertension and depression, who reported visual hallucinations at night for years while taking metoprolol. These included awakening during the night with people in her bedroom and seeing objects in her room turn into animals. After a new physician switched her from metoprolol to atenolol, the visual hallucinations ceased within four days.</p> <p>Conclusion</p> <p>We suspect that metoprolol-induced visual hallucinations may be under-recognized and under-reported. Patients may frequently fail to acknowledge this adverse effect believing that they are just dreaming, or may be embarrassed to report visions that they feel will not be perceived by others to be real. Similarly, healthcare providers can also fail to recognize this visual toxicity or attribute visual hallucinations to concurrent illness or other medications. Clinicians must maintain diligent surveillance when managing patients receiving this drug.</p

Metoprolol-induced visual hallucinations: a case series.

INTRODUCTION: Metoprolol is a widely used beta-adrenergic blocker that is commonly prescribed for a variety of cardiovascular syndromes and conditions. While central nervous system adverse effects have been well-described with most beta-blockers (especially lipophilic agents such as propranolol), visual hallucinations have been only rarely described with metoprolol. CASE PRESENTATIONS: Case 1 was an 84-year-old Caucasian woman with a history of hypertension and osteoarthritis, who suffered from visual hallucinations which she described as people in her bedroom at night. They would be standing in front of the bed or sitting on chairs watching her when she slept. Numerous medications were stopped before her physician realized the metoprolol was the causative agent. The hallucinations resolved only after discontinuation of this medication.Case 2 was a 62-year-old Caucasian man with an inferior wall myocardial infarction complicated by cardiac arrest, who was successfully resuscitated and discharged from the hospital on metoprolol. About 18 months after discharge, he related to his physician that he had been seeing dead people at night. He related his belief that since he \u27had died and was brought back to life\u27, he was now seeing people from the after-life. Upon discontinuation of the metoprolol the visual disturbances resolved within several days.Case 3 was a 68 year-old Caucasian woman with a history of severe hypertension and depression, who reported visual hallucinations at night for years while taking metoprolol. These included awakening during the night with people in her bedroom and seeing objects in her room turn into animals. After a new physician switched her from metoprolol to atenolol, the visual hallucinations ceased within four days. CONCLUSION: We suspect that metoprolol-induced visual hallucinations may be under-recognized and under-reported. Patients may frequently fail to acknowledge this adverse effect believing that they are just dreaming, or may be embarrassed to report visions that they feel will not be perceived by others to be real. Similarly, healthcare providers can also fail to recognize this visual toxicity or attribute visual hallucinations to concurrent illness or other medications. Clinicians must maintain diligent surveillance when managing patients receiving this drug

The challenge of simulating the warmth of the mid-Miocene climatic optimum in CESM1

The mid-Miocene climatic optimum (MMCO) is an intriguing climatic period due to its above-modern temperatures in mid-to-high latitudes in the presence of close-to-modern CO₂ concentrations. We use the recently released Community Earth System Model (CESM1.0) with a slab ocean to simulate this warm period, incorporating recent Miocene CO₂ reconstructions of 400 ppm (parts per million). We simulate a global mean annual temperature (MAT) of 18 °C, ~4 °C above the preindustrial value, but 4 °C colder than the global Miocene MAT we calculate from climate proxies. Sensitivity tests reveal that the inclusion of a reduced Antarctic ice sheet, an equatorial Pacific temperature gradient characteristic of a permanent El Niño, increased CO₂ to 560 ppm, and variations in obliquity only marginally improve model–data agreement. All MMCO simulations have an Equator to pole temperature gradient that is at least ~10 °C larger than that reconstructed from proxies. The MMCO simulation most comparable to the proxy records requires a CO₂ concentration of 800 ppm. Our results illustrate that MMCO warmth is not reproducible using the CESM1.0 forced with CO₂ concentrations reconstructed for the Miocene or including various proposed Earth system feedbacks; the remaining discrepancy in the MAT is comparable to that introduced by a CO₂ doubling. The model's tendency to underestimate proxy derived global MAT and overestimate the Equator to pole temperature gradient suggests a major climate problem in the MMCO akin to those in the Eocene. Our results imply that this latest model, as with previous generations of climate models, is either not sensitive enough or additional forcings remain missing that explain half of the anomalous warmth and pronounced polar amplification of the MMCO

Does Antarctic Glaciation Cool the World

In this study, we compare the simulated climatic impact of adding an Antarctic ice sheet (AIS) to the greenhouse world of the Eocene and removing the AIS from the modern world. The modern global mean surface temperature anomaly (ΔT) induced by Antarctic Glaciation depends on the background CO2 levels and ranges from −1.22 to −0.18 K. The Eocene ΔT is nearly constant at ~−0.25 K. We calculate an climate sensitivity parameter S[Antarctica] which we define as ΔT divided by the change in effective radiative forcing (ΔQAntarctica) which includes some fast feedbacks imposed by prescribing the glacial properties of Antarctica. The main difference between the modern and Eocene responses is that a negative cloud feedback warms much of the Earth\u27s surface as a large AIS is introduced in the Eocene, whereas this cloud feedback is weakly positive and acts in combination with positive sea-ice feedbacks to enhance cooling introduced by adding an ice sheet in the modern. Because of the importance of cloud feedbacks in determining the final temperature sensitivity of the AIS, our results are likely to be model dependent. Nevertheless, these model results suggest that the effective radiative forcing and feedbacks induced by the AIS did not significantly decrease global mean surface temperature across the Eocene–Oligocene transition (EOT −34.1 to 33.6 Ma) and that other factors like declining atmospheric CO2 are more important for cooling across the EOT. The results illustrate that the efficacy of AIS forcing in the Eocene is not necessarily close to one and is likely to be model and state dependent. This implies that using EOT paleoclimate proxy data by itself to estimate climate sensitivity for future climate prediction requires climate models and consequently these estimates will have large uncertainty, largely due to uncertainties in modelling low clouds