Atypical antipsychotics in bipolar disorder: systematic review of randomised trials

Background: Atypical antipsychotics are increasingly used for treatment of mental illnesses like schizophrenia and bipolar disorder, and considered to have fewer extrapyramidal effects than older antipsychotics. Methods: We examined efficacy in randomised trials of bipolar disorder where the presenting episode was either depression, or manic/mixed, comparing atypical antipsychotic with placebo or active comparator, examined withdrawals for any cause, or due to lack of efficacy or adverse events, and combined all phases for adverse event analysis. Studies were found through systematic search (PubMed, EMBASE, Cochrane Library), and data combined for analysis where there was clinical homogeneity, with especial reference to trial duration. Results: In five trials (2,206 patients) participants presented with a depressive episode, and in 25 trials (6,174 patients) the presenting episode was manic or mixed. In 8-week studies presenting with depression, quetiapine and olanzapine produced significantly better rates of response and symptomatic remission than placebo, with NNTs of 5-6, but more adverse event withdrawals (NNH 12). With mania or mixed presentation atypical antipsychotics produced significantly better rates of response and symptomatic remission than placebo, with NNTs of about 5 up to six weeks, and 4 at 6-12 weeks, but more adverse event withdrawals (NNH of about 22) in studies of 6-12 weeks. In comparisons with established treatments, atypical antipsychotics had similar efficacy, but significantly fewer adverse event withdrawals (NNT to prevent one withdrawal about 10). In maintenance trials atypical antipsychotics had significantly fewer relapses to depression or mania than placebo or active comparator. In placebo-controlled trials, atypical antipsychotics were associated with higher rates of weight gain of ≥7% (mainly olanzapine trials), somnolence, and extrapyramidal symptoms. In active controlled trials, atypical antipsychotics were associated with lower rates of extrapyramidal symptoms, but had higher rates of weight gain and somnolence. Conclusion: Atypical antipsychotics are effective in treating both phases of bipolar disorder compared with placebo, and as effective as established drug therapies. Atypical antipsychotics produce fewer extrapyramidal symptoms, but weight gain is more common (with olanzapine). There is insufficient data confidently to distinguish between different atypical antipsychotics.© 2007 Derry and Moore; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Derry, S. & Moore, R. A. (2007). 'Atypical antipsychotics in bipolar disorder: systematic review of randomised trials', BMC Psychiatry, 7:40. [Available at http://www.biomedcentral.com/1471-244X/7/40]

Systematic review and meta-analysis of randomised trials and cohort studies of mycophenolate mofetil in lupus nephritis

Mycophenolate mofetil (MMF) is an immunosuppressant drug being used for induction and maintenance of remission of lupus nephritis in systemic lupus erythematosus. Evidence about its use was sought from full publications and abstracts of randomised trials and cohort studies by using a variety of search strategies. Efficacy and adverse event outcomes were sought. Five randomised trials enrolled patients with World Health Organization (WHO) class III, IV, or V (mostly IV) lupus nephritis, predominantly comparing MMF (1 to 3 g daily) with cyclophosphamide and steroid. Complete response and complete or partial response was significantly more frequent with MMF than with cyclophosphamide, with numbers needed to treat of 8 (95% confidence interval 4.3 to 60) to induce one additional complete or partial response, with wide confidence intervals. Death was reported less frequently with MMF (0.7%, 1 death in 152 patients) than with cyclophosphamide (7.8%, 12 deaths in 154 patients), with a number needed to treat to prevent (NNTp) one death of 14 (8 to 48). Hospital admission was also lower with MMF (1.7% versus 15%; NNTp 7.4 [4.8 to 16]). Serious infections, leucopaenia, amenorrhoea, and hair loss were all significantly less frequent with MMF than with cyclophosphamide, but diarrhoea was significantly more common with MMF. Ten of 18 cohort studies enrolled only patients with lupus nephritis (author-defined or WHO class III to V). Seven of these 10 reported that complete or partial response with MMF (mostly 1 or 2 g daily) with steroid occurred in 121/151 (80%) and that treatment failure or no response occurred in 30/151 (20%). Adverse events were generally similar in cohort studies with and without only patients with lupus nephritis. In all 18 cohorts, gastrointestinal adverse events (diarrhoea, nausea, vomiting) occurred in 30%, infection in 23%, and serious infection in 4.3%. Adverse event discontinuations occurred in 14% and lack of efficacy occurred in 10%. There was a single death with MMF, a mortality rate over the course of 1 year of approximately 0.2%. The results form a basis on which to plan future studies and provide a guide for the use of MMF in lupus nephritis until results of larger studies are available. At least one such study is under way

Judged in a foreign language : A Chinese-Spanish court interpreting case study

Recent legislation in Spain has transposed Directive 2010/64/EU, which recognises interpretation as an essential tool for safeguarding fairness in criminal proceedings, in particular, for preventing any state of defencelessness. Previous research, however, has suggested important deficiencies in court interpreting in this country. This article analyses court interpreting from Chinese to Spanish, based on a case study of a recording of a criminal trial that took place in Barcelona in February 2015. The trial was transcribed verbatim and annotated in accordance with Cecilia Wadensjö's distinction between "talk as text" and "talk as activity." The analysis focuses on examples of errors of interpretation (non-translated speech acts, omissions, and additions), speech style and non-renditions. The results are compared with those of a corpus of 55 court proceedings in which the interpretation was from Spanish to English and from French to Romanian. The article concludes with a discussion of the factors-such as lack of specialised training, lack of deontological codes or general unawareness of the interpreter's role-that may have affected the quality of the interpretation in the trial analysed. The low proportion of interpretation during that court session (only 17.6% of the total duration) is perhaps the most striking result of the case stud

Is there an association between low dose aspirin and anemia (without overt bleeding)?: narrative review

<p>Abstract</p> <p>Background</p> <p>Overt bleeding associated with low dose aspirin (LDA) is well-recognized, little attention is given to the possibility of association between LDA and occult bleeding, although this is known to occur in healthy volunteers. LDA is used increasingly in primary and secondary prevention of a number of medical conditions, many of which are common in older people, as is anemia. Anemia in older people is associated with adverse outcomes including disability, morbidity and mortality. The purpose of this study was to review the evidence that LDA might cause anemia without overt bleeding.</p> <p>Methods</p> <p>An extensive narrative review was carried out. Electronic searching (including database links) and reference lists of reports were used to identify studies reporting on use of aspirin ≤325 mg/day and anemia or change in hemoglobin (Hb) without overt bleeding. Data were extracted from reports of trials, adverse drug reactions (ADRs) and prevalence studies of adults aged ≥18 years, published since 1980.</p> <p>Results</p> <p>There are few relevant data, with considerable heterogeneity among trial designs, duration, and patient characteristics in studies of LDA. In five randomised trials (n = 5879) in (mostly secondary) prevention, the majority of patients were men without peptic ulcer disease aged 50-70 years and no consistent association between LDA and change in Hb was found. In two smaller studies (n = 609) of primary prevention in healthy patients aged ≥70 years, there was a small but statistically significant fall in Hb with LDA. Observational studies, and data from trials in which use of LDA was not a primary focus of the study, were inconclusive.</p> <p>Conclusions</p> <p>It is not clear whether there is an association between LDA and anemia in the absence of overt bleeding, but there may be an association between LDA and fall in Hb in (a subset of) older patients. The available evidence has significant limitations, which are discussed; studies including more older patients, and publication of individual patient data, would help clarify this important matter.</p

Spectral and dynamic characteristics of buried-heterostructure single quantum well (Al,Ga)As lasers

We demonstrate that, as predicted, (Al,Ga)As single quantum well (SQW) lasers have substantially narrower spectral linewidths than bulk double-heterostructure lasers. We have observed a further major reduction (>3×) in the linewidth of these SQW lasers when the facet reflectivities are enhanced. This observation is explained theoretically on the basis of the very low losses in coated SQW lasers and the value of the spontaneous emission factor at low threshold currents. We also report on the modulation frequency response parameter of these SQW lasers

AKT-1 Regulates DNA-Damage-Induced Germline Apoptosis in C. elegans

SummaryThe cellular response to genotoxic stress involves the integration of multiple prosurvival and proapoptotic signals that dictate whether a cell lives or dies. In mammals, AKT/PKB regulates cell survival by modulating the activity of several apoptotic proteins, including p53 [1]. In Caenorhabditis elegans, akt-1 and akt-2 regulate development in response to environmental cues by controlling the FOXO transcription factor daf-16[2], but the role of these genes in regulating p53-dependent apoptosis is not known. In this study, we show that akt-1 and akt-2 negatively regulate DNA-damage-induced apoptosis in the C. elegans germline. The antiapoptotic activity of akt-1 is independent of its target gene daf-16 but dependent on cep-1/p53. Although only akt-1 regulates the apoptotic activity of cep-1, both akt-1 and akt-2 modulate the intensity of the apoptotic response independently of the transcriptional activity of CEP-1. Finally, we show that AKT-1 regulates apoptosis but not cell-cycle progression downstream of the HUS-1/MRT-2 branch of the DNA damage checkpoint

Space Shuttle orbiter entry heating and TPS response: STS-1 predictions and flight data

Aerothermodynamic development flight test data from the first orbital flight test of the Space Transportation System (STS) transmitted after entry blackout is given. Engineering predictions of boundary layer transition and numerical simulations of the orbiter flow field were confirmed. The data tended to substantiate preflight predictions of surface catalysis phenomena. The thermal response of the thermal protection system was as expected. The only exception is that internal free convection was found to be significant in limiting the peak temperature of the structure in areas which do not have internal insulation

Faecal blood loss with aspirin, nonsteroidal anti-inflammatory drugs and cyclo-oxygenase-2 selective inhibitors: systematic review of randomized trials using autologous chromium-labelled erythrocytes

INTRODUCTION: Faecal blood loss has been measured using autologous erythrocytes labelled with radioactive chromium for several decades, using generally similar methods. We conducted a systematic review of studies employing this technology to determine the degree of blood loss associated with use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase-2 selective inhibitors (coxibs). METHODS: A systematic search of PubMed and the Cochrane Library (to December 2006) was conducted to identify randomized trials in which treatment with aspirin, NSAIDs, or coxibs was continued for at least 7 days, and with at least 7 days of washout for crossover trials. Rates of faecal blood loss associated with these agents were determined in the randomized trials identified. Comparators were placebo, active, or no treatment. Outcomes of interest were mean daily faecal blood loss, and the number or proportion of individuals recording faecal blood above 5 ml/day and above 10 ml/day. RESULTS: Forty-five reports of 47 trials were included, including 1,162 individuals, mostly healthy volunteers and predominantly young men. Only 136 patients (as opposed to healthy volunteers; 12%) were included, and these were mostly older people with an arthritic condition. Most NSAIDs and low-dose (325 mg) aspirin resulted in a small average increase in faecal blood loss of 1 to 2 ml/day from about 0.5 ml/day at baseline. Aspirin at full anti-inflammatory doses resulted in much higher average levels of blood loss of about 5 ml/day. Some individuals lost much more blood than average, at least for some of the time, with 5% of those taking NSAIDs having daily blood loss of 5 ml or more and 1% having daily blood loss of 10 ml or more; rates of daily blood loss of 5 ml/day or 10 ml/day were 31% and 10%, respectively, for aspirin at daily doses of 1,800 mg or greater. CONCLUSION: At baseline, or with placebo, faecal blood loss is measured at 1 ml/day or below. With low-dose aspirin and some NSAIDs, average values may be two to four times this, and anti-inflammatory doses of aspirin result in much higher average losses. A small proportion of individuals respond to aspirin or NSAIDs with much higher faecal blood loss of above 5 ml/day or 10 ml/day. There are significant limitations regarding the quality and validity of reporting of these studies, such as limited size and inclusion of inappropriate participants. The potential for blood loss and consequent anaemia requires more study

RANCANG BANGUN APLIKASI MOBILE DETECTIVE BAGI ANGGOTA INTELIJEN PADA SMARTPHONE ANDROID

Detektif merupakan profesi yang dituntut untuk mencari informasi secara cepat dan lengkap tentang suatu kasus yang sedang berada dalam proses penyidikan atau penyelidikan. Terdapat beberapa peralatan yang digunakan untuk mendukung kinerja detektif seperti kamera, laptop, smartphone, serta beberapa perangkat lainnya. Sekarang ini smartphone sudah banyak digunakan untuk mempermudah pekerjaan detektif. Dengan ruang lingkup pekerjaan detektif yang sangat luas serta mobilitas yang tinggi, membuat smartphone menjadi pilihan yang praktis dalam melaksanakan tugas intelijen. Aplikasi mobile detective bagi Anggota Intelijen merupakan aplikasi berbasis sistem operasi Android yang dapat membantu anggota intelijen mengambil data-data yang ada di lapangan (berupa dokumen atau data multimedia tentang suatu peristiwa yang dapat dijadikan sebagai barang bukti maupun bahan dokumentasi) kemudian data-data ini dikirimkan ke server agar dapat diakses oleh kepala intelijen sebagai decision maker, sehingga dapat segera diambil tindakan agar suatu kasus dapat diselesaikan dengan cepat dan tepat. Setelah dilakukan pengujian didapatkan hasil bahwa aplikasi mobile detective dapat diimplementasikan dengan baik di Direktorat Intelijen dan Keamanan Polisi Daerah Jawa Barat. Sistem pelaporan online pada aplikasi ini dapat membantu anggota intelijen dalam melaksanakan pekerjaannya. Kata kunci : mobile, detective, androi