The incidence of neurological symptoms after thrombolytic therapy in elderly patients with acute myocardial infarction

&nbsp;&nbsp; BACKGROUND: Reperfusion therapy is the standard treatment of acute myocardial infarction (AMI). If the percutaneous coronary intervention (PCI), as a preferred reperfusion strategy, is not available, thrombolytic therapy would be chosen as an alternative treatment. However, the effect of thrombolytic therapy on old patients is still controversial especially due to its effects on increasing the incidence of intracranial hemorrhage (ICH). In this study, we evaluated the incidence of neurological symptoms and ICH after thrombolytic therapy in AMI patients over 65 years of age.&nbsp;&nbsp; METHODS: A total number of 300 AMI patients over 65 years of age who referred to the hospital within 12 hours of their symptom onset and had no contraindications for receiving thrombolytic therapy were selected. The patients were admitted in Noor Hospital, Isfahan, Iran, between 2004 and 2006. All of them received streptokinase (SK) in the same way. Their information was extracted from their files and collected by a questionnaire.&nbsp;&nbsp; RESULTS: Among 300 patients in our study, there were 124 women (41.33%) and 176 men (58.66%). Their mean age was 74 &plusmn; 9 years (range: 65-92 years). Moreover, 78% were discharged after one week of hospitalization and 22% (66 patients) died. Arrhythmias or myocardial reinfarction were the leading cause of death in 56.06% of all deaths. No death due to ICH and no evidence of ICH, such as hemiparesis or loss of consciousness, were observed.&nbsp;&nbsp;&nbsp; CONCLUSION: We suggest that thrombolytic therapy in old patients with AMI is a good alternative treatment when there is no access to an equipped PCI facility. In our study, the increase in mortality rate due to ICH was not high enough to prevent us from prescribing SK for AMI patients over 65 years of age.&nbsp;Keywords: Acute Myocardial Infarction, Percutaneous Coronary Intervention, Intracranial Hemorrhage, Streptokinase, Thrombolytic Therapy.</p

A triple-blinded, randomized, placebo-controlled trial to examine the efficacy of buspirone added to typical antipsychotic drugs in patients with chronic schizophrenia

Background: The purpose of this study was to test the hypothesis that the addition of buspirone, a partial agonist of 5HT1A receptor, to ongoing treatment with typical antipsychotics would improve the positive and negative symptoms in patients with chronic schizophrenia. Materials and Methods: In this study, 50 patients including 40 male and 10 female were recruited with chronic schizophrenia who were inpatients at psychiatric teaching hospital or asylums, aged between 18 and 65 years (mean age = 47 ± 10.02). All patients were on the stable dose of typical antipsychotics for at least 1-month, and their acute symptoms were controlled. Patients were allocated in a random fashion: 25 patients to buspirone at 30 mg/day plus typical antipsychotic and 25 patients to placebo plus typical antipsychotic. The positive and negative syndrome scale (PANSS), Simpson-Angus extrapyramidal rating scale (SAS) and mini mental state examination (MMSE), were administered at baseline, and 2, 4, and 6 weeks after the addition of buspirone. Results: The 30 mg/day buspirone was well-tolerated, and no clinically important adverse effects were seen. There was no statistically significant difference between the two groups in MMSE and SAS scales. There was a significant reduction in subscales of negative, general, positive, and total of PANSS over the 6-week trial in buspirone group. There was a statistically significant difference between the two groups negative subscale (mean ± standard deviation [SD] = 14.08 ± 1.4 in buspirone group) P = 0.0219, general subscale (mean ± SD = 27.42 ± 2.1 in buspirone group) P = 0.0004, and total subscale (mean ± SD = 55.63 ± 3.9 in buspirone group) P = 0.0298, of PANSS in the 6-week of trial. Conclusion: The results suggest that adjunctive treatment with 5HT1A agonist such as buspirone may improve the negative symptoms of schizophrenia. Further studies are indicated to determine the efficacy of 5HT1A agonist treatment in chronic schizophrenia