Clozapine for Treatment-Resistant Bipolar Disorder: A Systematic Review

Objective To evaluate the efficacy and safety of clozapine for treatment-resistant bipolar disorder (TRBD). Methods A systematic review of randomized controlled studies, open-label prospective studies, and retrospective studies of patients with TRBD was carried out. Interventions included clozapine monotherapy or clozapine combined with other medications. Outcome measures were efficacy and adverse drug reactions (ADRs). Results Fifteen clinical trials with a total sample of 1,044 patients met the inclusion criteria. Clozapine monotherapy or clozapine combined with other treatments for TRBD was associated with improvement in: (i) symptoms of mania, depression, rapid cycling, and psychotic symptoms, with many patients with TRBD achieving a remission or response; (ii) the number and duration of hospitalizations, the number of psychotropic co-medications, and the number of hospital visits for somatic reasons for intentional self-harm/overdose; (iii) suicidal ideation and aggressive behavior; and (iv) social functioning. In addition, patients with TRBD showed greater clinical improvement in long-term follow-up when compared with published schizophrenia data. Sedation (12%), constipation (5.0%), sialorrhea (5.2%), weight gain (4%), and body ache/pain (2%) were the commonly reported ADRs; however, these symptoms but did not usually require drug discontinuation. The percentage of severe ADRs reported, such as leukopenia (2%), agranulocytosis (0.3%), and seizure (0.5%), appeared to be lower than those reported in the published schizophrenia literature. Conclusion The limited current evidence supports the concept that clozapine may be both an effective and a relatively safe medication for TRBD

Factors influencing the density of aerobic granular sludge.

Contains fulltext : 125448.pdf (publisher's version ) (Closed access)In the present study, the factors influencing density of granular sludge particles were evaluated. Granules consist of microbes, precipitates and of extracellular polymeric substance. The volume fractions of the bacterial layers were experimentally estimated by fluorescent in situ hybridisation staining. The volume fraction occupied by precipitates was determined by computed tomography scanning. PHREEQC was used to estimate potential formation of precipitates to determine a density of the inorganic fraction. Densities of bacteria were investigated by Percoll density centrifugation. The volume fractions were then coupled with the corresponding densities and the total density of a granule was calculated. The sensitivity of the density of the entire granule on the corresponding settling velocity was evaluated by changing the volume fractions of precipitates or bacteria in a settling model. Results from granules originating from a Nereda reactor for simultaneous phosphate COD and nitrogen removal revealed that phosphate-accumulating organisms (PAOs) had a higher density than glycogen-accumulating organisms leading to significantly higher settling velocities for PAO-dominated granules explaining earlier observations of the segregation of the granular sludge bed inside reactors. The model showed that a small increase in the volume fraction of precipitates (1-5 %) strongly increased the granular density and thereby the settling velocity. For nitritation-anammox granular sludge, mainly granular diameter and not density differences are causing a segregation of the biomass in the bed.1 augustus 201

Toxins and their phytoremediation

The agricultural and industrial revolutions in the last few decades have resulted in increased concentration of toxins in our environment that are now-a-days a major cause of toxicity in plants and animals. Among different toxins, increasing levels of salts, heavy metal, pesticides and other chemicals are posing a threat to agricultural as well as natural ecosystems of the world. These contaminants result in soil, air and water pollution, and loss of arable lands as well as crop productivity. They also cause changes in species composition and loss of biodiversity by bringing about changes in the structure of natural communities and ecosystems. In this situation, different approaches are being adopted to reclaim polluted environments. Among these, phytoremediation has a potential in removing these toxins from the environment. This approach is based on the use of natural hyperaccumulator plant species that can tolerate relatively high levels of pollutants in the environment. Pollutants accumulated in stems and leaves of high biomass producing and tolerant plants can be harvested and removed from the site. Therefore, this approach has a potential to remove large amounts of toxins by harvesting the above-ground biomass. However, the effectiveness of phytoremediation approach can be increased if we have better knowledge of physiological, biochemical, molecular and genetic bases of plant resistance to natural and anthropogenic induced toxins. All these aspects of toxicity mechanisms and their removal techniques are comprehensively reviewed in this book. © Springer Science+Business Media B.V. 2010