Acute pulmonary embolism in a patient with neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS)is a life-threatening complication seen in psychiatric patients exposed to antipsychotic medications. NMSis associated with medication with dopamine antagonist action. The typical tetrad of symptoms of NMS includes fever, muscle rigidity, altered mental status and autonomic dysfunction. Acute pulmonary embolism is one of the major complications seen in patients diagnosed with neuroleptic malignant symptoms. Here we present a case report of a 64 years old female with a history of psychiatric illness, presented with fever, rigidity andaltered mental status and diagnosed to haveNMS. Later her condition was complicated by pulmonary embolism. She was treated with bromocriptine and heparin infusion and improved symptomatically.

Exploitation of Heterosis among Phenotypically Diverse Capsicum Parents for Important Fruit Traits

Abstract One nuclear male sterile (NMS) line of chilli pepper and eight elite inbred lines of bell pepper were evaluated in a line × tester mating design to project heterotic F1's through studying plant growth and yield performance of developed hybrids in relation to phenotypic distance between their parental lines. Hybrids and their parental lines were grown and evaluated under poly-net house conditions at the Punjab Agricultural University, Ludhiana, India during the years 2017-2019. Pooled over the year, mean squares (MS) due to genotypes was recorded significant (p=0.05) for all the traits studied, suggesting that there existed significant differences among the genotypic means that included nine parental lines and their eight F1 hybrids. The MS due to the G × Y interaction effects were also significantly different for plant growth and fruit traits, indicating differential response of each genotype in the year. On the basis of heterotic performance, the hybrids namely MS-12 × PAU SM-31 had positive significant mid-parent heterosis (MPH) for total fruit yield plant-1 (96.68**), number of fruits plant-1 (51.98**), pericarp thickness (47.91**), fruit length (25.77**), and plant height (63.35**). Apart from this cross-combination, the hybrids MS-12 × PAU SM-3 and MS-12 × PAU SM-9 also depicted MPH for total fruit yield plant-1 (71.22** and 50.64**), fruit length (41.98** and 68.09**) and number of fruits plant-1 (27.60** and 44.73**). Based on better parent heterosis (BPH), the hybrid MS-12 × PAU SM-31 was found to be superior in respect of total fruit yield plant-1 (36.37**) and pericarp thickness (11.27**). These hybrids seem to be the utmost valuable materials for the future breeding program of bell pepper.

Lc-Ms/Ms Study Of The Trace Level Impurities Of Irbesartan An Angiotensin Ii Receptor Antagonist Molecule To Its Origin Through Nms2 Technique

Objective: The mass characterization of five trace level related impurities of Irbesartan was performed through the “nMS2” technique of triple quadrupole mass spectrometer and also to Correlated to the impurity origin. Methods: A simple and effective patented process was applied to get the impurity profile, and mass characterization was performed through the “nMS2” technique of triple quadrupole mass spectrometer analyser. Results: The simple production scan in differential collision energies is coined as “nMS2” technique of the triple quadrupole analyzer. The molecular ion fragmentation occurs with multiple collision energies and provides meaningful MSMS fragments for characterizing five trace level impurities less than 0.5% of angiotensin II receptor antagonist-Irbesartan. The origin of the impurity formation in the synthetic process was successfully related to the Spiro ketones. Conclusion: The results obtained in this research clearly indicates the approach of “nMS2” technique was very useful in the identification and structural prediction of trace level related impurities of Irbesrtan.

Loss of Autonomic Nervous System Control of Blood Pressure in Patients with Parkinson’s Disease.

Parkinson’s disease (PD) manifests with motor symptoms of tremor, bradykinesia, muscle rigidity and postural instability. However, various nonmotor symptoms (NMS) have recently been recognized, among which autonomic dysfunction is observed long before the advent of motor symptoms and is aggravated through the course of the disease. Blood pressure (BP) abnormalities also result from autonomic dysfunction which induces orthostatic hypotension (OH), postprandial hypotension (PPH), nocturnal hypertension (NH) and, in particular, great fluctuation of BP over the range of 100 mmHg in a day that is often monitored by 24-hour ambulatory blood pressure monitoring (ABPM). A number of investigations on autonomic dysfunction in PD using 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy, neuropathology and immunohistochemistry indicate the centripetal degeneration of the cardiac sympathetic nerves and other autonomic pathology in other organs. Since PD patients have lost neural control of BP, their BP should depend on humoral factors that cannot respond to changes in and out of the body as promptly as autonomic nerves. This may be one of the reasons for irregularly fluctuating and unpredictable BP. Hypertensive fluctuation is much riskier than OH and PPH for vascular events of cerebrovascular disease, cardiovascular disease and other organopathies. Non-medical and medical treatments such as calcium channel blocking may be effective to stabilize BP in patients.

Especificidad de forófito y preferencias microambientales de los líquenes cortícolas en cinco forófitos del bosque premontano de finca Zíngara, Cali, Colombia / Phorophyte specificity and microenvironmental preferences of corticolous lichens in five phorophyte species from premontane forest of Finca Zíngara, Cali, Colombia)

Phorophyte specificity and microenvironmental preferences of corticolous lichens in five phorophyte species from premontane forest of Finca Zíngara, Cali, Colombia). Lichenized fungi or lichens are organisms that have been little studied in the tropics and which distribution is affected by microenvironmental factors and substrate characteristics. The present study aimed to identify phorophyte specificity and microenvironmental preferences of corticolous lichens in five phorophyte species from premontane forest of the farm Finca Zingara in Cali, Colombia. For this, five individuals were selected from five tree species (phorophytes). Lichen species present in a 0.50x0.20m² quadrant located in the trunk of each tree at a height of 1.3m were identified. Substrate parameters such as bark pH, Diameter Breast Height (DBH) and bark structure were measured. Also, microenvironmental factors including temperature, humidity and irradiance were determined. In order to detect phorophyte preferences, a non-metric multidimensional scaling (NMS) and indicator species analysis were made. Spearman correlation analysis was used to assert the relationship between environmental variables and groupings found in the NMS. A total of 69 species of lichens were found, of which 37 were identified to species, 18 to genera and 14 were not determined because they were sterile or had no spores. NMS showed that some individuals of the same tree species were grouped alongside the analysis dimensions, and they were related with the factors of light intensity, temperature and DBH. Only three lichens with preference for certain tree species were found (Arthonia microsperma by Meriania sp., Cladonia ceratophylla and sorediado 8 by Clusia sp.), suggesting absence of phorophyte preferences. Thus, it can be concluded that lichens from the study area do not show phorophyte preference, but their distribution is affected by light, temperature and DBH. Rev. Biol. Trop. 60 (2): 843-856. Epub 2012 June 01.

El objetivo de este trabajo fue evaluar la especificidad de forófito y las preferencias microambientales de los líquenes cortícolas en el Bosque de la Finca Zíngara (Cali, Colombia). Asimismo, se seleccionaron cinco individuos de cinco especies de árboles. Además, se identificaron las especies de líquenes presentes en un cuadrante de 0.50x0.20m2 ubicado en el tronco de cada árbol a 1.3 m de altura. También, se midieron parámetros microambientales como pH de la corteza, diámetro a la altura del pecho (DAP), estructura de la corteza, humedad relativa e irradianza. Para detectar las preferencias de forófito, se realizó un escalamiento no métrico multidimensional (NMS) y un análisis de especies indicadoras. Luego se efectúo un análisis de correlación de Spearman para evaluar la relación entre las variables ambientales y los agrupamientos encontrados en el NMS. Se encontraron 69 especies de líquenes, de los cuales 37 fueron determinados hasta especie, 18 hasta género y 14 no fueron determinados. El resultado del NMS mostró que algunos individuos de la misma especie de árbol se agruparon a lo largo de las dimensiones del análisis, y están relacionados con los factores intensidad de luz, temperatura y DAP. Sólo tres especies mostraron preferencia por ciertas especies de árboles (Arthonia microsperma por Meriania sp., Cladonia ceratophylla y sorediado 8 por Clusia sp.), lo cual sugiere ausencia de preferencias de forófito.

A Case Of Neuroleptic Malignant Syndrome With Quetiapine From Iran

Objective: To report a case of neuroleptic malignant syndrome (NMS), secondary to low dose quetiapine in an elderly Iranian man. Methods: We report a 66-year-old male presented with a temperature of 39.30c, dysphagia, aphasia and decreased level of consciousness and mutism following the use of 25 mg quetiapine. Results: Some evidence suggests an atypical NMS presentation with the atypical antipsychotics. Atypical NMS has been defined as less severe than that seen with conventional antipsychotics. Symptoms include fewer EPS, smaller increases in CK, less muscle rigidity, and lower fever. Conclusion: Clinicians should be aware that NMS with a single dose of quetiapine is possible.

Effects of a New Hyperthermia Treatment, Nano-mist Sauna, on Our Body Temperature, Energy Production and Immune and Autonomic Nerve System / 日本温泉気候物理医学会雑誌

<b>Purpose</b><br> In a series of our recent studies, systematic mild hyperthermia treatments, such as sauna, hot spring and a special bath for medical treatment, were found to activate leucocytes and to enhance immunity. Although they are known to be effective for health promotion, it is not easy for general people to regularly take these conventional hyperthermia. It would be advantageous for elderly persons, sick people and pregnant women as well as pressed business persons if it is able to minimize stress which might be induced by the conventional hyperthermia, such as high temperature heat, water pressure and humidity. To pursue a further study of the effect of hyperthermia itself, in this research, we utilized nano-mist sauna (NMS), a new hyperthermia treatment. NMS, a new type sauna, is characterized by the ability to produce ultra small fog-shaped hot water called nano-mist, which hardly condenses dew. And we studied the effect of NMS on body temperature, leukocytes, autonomic nerve function and energy production.<br><b>Method</b><br> We obtained peripheral blood from six healthy male volunteers (age, 46.5±8.5 years) before and after NMS hyperthermia (20min, 40°C, 100%RH) for lactate and blood glucose measurement and flowcytometric analysis. Body temperature (hypoglossal) and pulse rates were also measured. The statistical analysis difference between the values was determined by paired <i>t</i>-test and Kruskal-Wallis test.<br><b>Result</b><br> After NMS hyperthermia body temperature and the level of PO₂ rose (36.8→37.2°C), (52→61mmHg) (p<0.05). On the other hand, the level of lactate showed decrease in all subjects. The ratio and the numbers of NK cells decreased (21.8→17.7%, 498→436/μL) (p<0.05) while those of B cells increased (9.5→12.1%, 261→349/μL) (p<0.05).<br><b>Discussion</b><br> Several investigators report that the conventional hyperthermia enhances the primordial immune system (i.e. extrathymic T cells, NK cells, NKT cells and granulocytes) via dominance of sympathetic nerve system function (SNS) . Conversely, in our study, those of the conventional immune system (i.e. T and B cells) was enhanced, suggesting suppression of SNS function. It is reported that the expression level of HLA-DR on the B cells was elevated during hyperthermia (body temperature rose). SNS function (hypothermia) is stimulated by stress and it is suppressed by relaxing (hyperthermia) in the opposite. And it is considered that NMS hyperthermia suppressed SNS and that it was also consistent with our result of lactate decrease. It is possible to consider that NMS hyperthermia may impact on autonomic nerve activating leucocytes. Therefore NMS may be a kind of effective health promotion for valetudinarian (ie an infant, a female) and both a caregiver and a caretaker.

Effects of a New Hyperthermia Treatment, Nano-mist Sauna, on Our Body Temperature, Energy Production and Immune and Autonomic Nerve System / 日本温泉気候物理医学会雑誌

Purpose  In a series of our recent studies, systematic mild hyperthermia treatments, such as sauna, hot spring and a special bath for medical treatment, were found to activate leucocytes and to enhance immunity. Although they are known to be effective for health promotion, it is not easy for general people to regularly take these conventional hyperthermia. It would be advantageous for elderly persons, sick people and pregnant women as well as pressed business persons if it is able to minimize stress which might be induced by the conventional hyperthermia, such as high temperature heat, water pressure and humidity. To pursue a further study of the effect of hyperthermia itself, in this research, we utilized nano-mist sauna (NMS), a new hyperthermia treatment. NMS, a new type sauna, is characterized by the ability to produce ultra small fog-shaped hot water called nano-mist, which hardly condenses dew. And we studied the effect of NMS on body temperature, leukocytes, autonomic nerve function and energy production. Method  We obtained peripheral blood from six healthy male volunteers (age, 46.5±8.5 years) before and after NMS hyperthermia (20min, 40°C, 100%RH) for lactate and blood glucose measurement and flowcytometric analysis. Body temperature (hypoglossal) and pulse rates were also measured. The statistical analysis difference between the values was determined by paired t-test and Kruskal-Wallis test. Result  After NMS hyperthermia body temperature and the level of PO2 rose (36.8→37.2°C), (52→61mmHg) (p<0.05). On the other hand, the level of lactate showed decrease in all subjects. The ratio and the numbers of NK cells decreased (21.8→17.7%, 498→436/μL) (p<0.05) while those of B cells increased (9.5→12.1%, 261→349/μL) (p<0.05). Discussion  Several investigators report that the conventional hyperthermia enhances the primordial immune system (i.e. extrathymic T cells, NK cells, NKT cells and granulocytes) via dominance of sympathetic nerve system function (SNS) . Conversely, in our study, those of the conventional immune system (i.e. T and B cells) was enhanced, suggesting suppression of SNS function. It is reported that the expression level of HLA-DR on the B cells was elevated during hyperthermia (body temperature rose). SNS function (hypothermia) is stimulated by stress and it is suppressed by relaxing (hyperthermia) in the opposite. And it is considered that NMS hyperthermia suppressed SNS and that it was also consistent with our result of lactate decrease. It is possible to consider that NMS hyperthermia may impact on autonomic nerve activating leucocytes. Therefore NMS may be a kind of effective health promotion for valetudinarian (ie an infant, a female) and both a caregiver and a caretaker.

Composição florística de trepadeiras em florestas sazonais semidecíduais do sudeste do Brasil / Species composition of climbers in seasonal semideciduous forest fragments of Southeastern Brazil

In this study we evaluated floristic composition patterns of communities of climbers within ten inventories carried out in semideciduous forest fragments of southeastern Brazil. One of the inventories is original, being carried out for the present study in Ribeirão Cachoeira forest, Campinas, São Paulo State, Southeastern Brazil. This inventory was then pooled together to other nine climbers' inventories made in other forests of Southeastern Brazil to form a data base, which was examined regarding species richness, similarity, species distribution and climbing methods. The total number of species obtained was 355, belonging to 145 genera and 43 families. The ten most diverse families Bignoniaceae (45 species), Fabaceae (42), Malpighiaceae (36), Asteraceae (31), Apocynaceae (29), Sapindaceae (28), Convolvulaceae (21), Cucurbitaceae (14), Passifloraceae (10), and Euphorbiaceae (8) contributed to 74.4 percent of the total number of species recorded. The commonest climbing method in the studied sites was main stem or branch twining, accounting for 178 species or 50.1 percent of the total, the second commonest was tendril climbing (121 species, 34.1 percent), and the least, scrambling (56 species, 15.8 percent). We found a high percentage of exclusive species i.e., those occurring in only one forest site, which accounted for 49.3 percent of the total recorded. The mean similarity among forest sites (30 percent) may be considered low. The climbing species contribution to the total wood plant richness recorded on the forests sites was very high in some of the sites (up to 52.5 percent). These results indicated the importance of climber communities to plant diversity for semideciduous forests in Southeastern Brazil, enhancing the regional diversity and the conservation value of these forest remnants.

No presente estudo avaliamos as variações na composição de espécies das comunidades de trepadeiras abordando dez inventários florísticos realizados em fragmentos de floresta estacional semidecidual do sudeste do Brasil. Um destes inventários é inédito e foi realizado especialmente para o presente estudo. Comparamos este levantamento a outros nove inventários florísticos de trepadeiras realizados em outras florestas do sudeste para investigar aspectos como riqueza, similaridade, distribuição de espécies e mecanismos de escalada. Ao todo foram encontradas 355 espécies, pertencentes a 145 gêneros e 43 famílias. As dez famílias mais ricas Bignoniaceae (45 espécies), Fabaceae (42), Malpighiaceae (36), Asteraceae (31), Apocynaceae (29), Sapindaceae (28), Convolvulaceae (21), Cucurbitaceae (14), Passifloraceae (10), e Euphorbiaceae (8) representaram 74,4 por cento do total de espécies encontrado. Considerando os mecanismos de escalada, observamos o predomínio de espécies volúveis (178 espécies ou 50,1 por cento), sobre espécies com gavinhas (121 espécies, 34,1 por cento), e apoiadoras (56 espécies, 15,8 por cento). A porcentagem de espécies exclusivas, i.e. aquelas que ocorreram em apenas uma das localidades estudadas, foi de 49,3 por cento do total amostrado e pode ser considerada alta. Além disso, a similaridade entre as florestas analisadas foi bastante baixa e a contribuição das espécies de trepadeiras para a diversidade de plantas lenhosas nestas áreas foi bastante elevada em algumas áreas, chegando a 52,5 por cento. Estes resultados indicaram a importância das comunidades de trepadeiras para a diversidade vegetal nas florestas semideciduais do sudeste do Brasil, aumentando a valor de conservação desses remanescentes florestais.

Aripiprazole overdose causing neuroleptic malignant syndrome: A clinical report and brief review.

A student on aripiprazole (an atypical second generation antipsychotic drug) was admitted with deliberate overdose of the drug, and in the course of her hospital stay developed a clinical picture of mild neuroleptic malignant syndrome (NMS). She survived after supportive care. A brief review is included on the incidence of NMS secondary to aripiprazole overdose, and reveals an increasing incidence

Rhabdomyolysis Associated with Ziprasidone / 대한정신약물학회지

We describe a case report of a young male patient with rhabdomyolysis associated with the use of atypical antipsychotic medication ziprasidone. A 23-year-old male was diagnosed with psychotic disorder not otherwise specified and treated with ziprasidone 120 mg a day. On hospital day 6, the patient developed acute dystonia. On day 8, the serum creatine kinase (CK) level was markedly elevated up to 53,880 IU/L, and a white blood cell (WBC) count was 10,500 cells/microliter. No other diagnostic criteria for neuroleptic malignant syndrome (NMS) were present. On discontinuation of the drug, serum CK concentrations returned to normal within 10 days. Atypical NMS should be considered when patients was treated with novel atypical antipsychotics who develop isolated serum CK elevation.

A Case of Neuroleptic Malignant Syndrome (NMS) with Myoglobulinemic Acute Renal Failure and Lithium Intoxication due to Lithium-olanzapine Combination / 대한신장학회잡지

We report a patient developed neuroleptic malignant syndrome (NMS) with myoglobulinemic acute renal failure and lithium intoxication due to lithium-olanzapine combination, who was successfully treated by hemodiafiltration. A 34-year-old woman with a 14-year history of bipolar disorder had been treated with lithium-olanzapine during last four days. She was admitted to our hospital for muscular rigidity, hyperthermia and altered consciousness. On admission, rhabdomyolsis was demonstratd by biochemical methods and serum level of lithium was 3.78 mEq/L which was far above toxic level. After the diagnosis of NMS with acute renal failure and lithium intoxication, olanzapine and lithium were discontinued and conservative measures and continuous venovenous hemodiafiltration were instituted. She recovered without any neurologic sequelae.

Neuroleptic Malignant Syndrome Caused by Risperidone Overdose: A case report / 대한마취과학회지

Neuroleptic malignant syndrome (NMS) is a rare, but potentially fatal idiosyncratic reaction to neuroleptics characterized by muscle rigidity, fever, altered consciousness, autonomic instability, leukocytosis and elevated creatinine phosphokinase level suggesting muscle injury. The incidence of NMS is estimated to be between 0.07 and 2.2% among patients receiving neuroleptics, with a motality of 11%. Although the pathophysiology of NMS is not completely understood, reduced dopaminergic activity secondary to antipsychotic induced dopamine receptor blockage is considered to be the best explanation to date. We experienced NMS in a 22-year-old male with antipsychotic drug intoxication who underwent primary closure of dual, self-inflicted wrist laceration. We recognized as NMS about 30 minutes after induction of general anesthesia. All anesthetics were stopped, and supportive care was performed with management of hyperthermia and fluid. Also, Dantrolene sodium and bromocriptine were administered. The patient recovered without any complication.