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1.
Int Clin Psychopharmacol ; 32(3): 155-160, 2017 05.
Article in English | MEDLINE | ID: mdl-28059928

ABSTRACT

The aim of this study was to determine whether the incidence of pneumonia in patients taking clozapine was more frequent compared with those taking risperidone or no atypical antipsychotics at all before admission to a tertiary care medical center. This was a retrospective, case-matched study of 465 general medicine patients over a 25 month period from 1 July 2010 to 31 July 2012. Detailed electronic medical records were analyzed to explore the association between the use of two atypical antipsychotics and incidence of pneumonia. Of the 155 patients in the clozapine group, 54 (34.8%) had documented pneumonia compared with 22 (14.2%) in the risperidone group and 18 (11.6%) in the general population group. Clozapine, when compared with the untreated general population, was associated with an increased risk of pneumonia (odds ratio=4.07; 95% confidence interval=2.25-7.36). There was, however, no significant increase in the risk of pneumonia associated with the use of risperidone (odds ratio=1.26; 95% confidence interval=0.65-2.45). Clozapine use is associated with increased risk of pneumonia that may be related to immunologic factors or side effects of sedation and drooling that make aspiration more likely, although causative mechanisms require further investigation. These findings suggest that providers should use added caution in choosing candidates for clozapine therapy.


Subject(s)
Clozapine/adverse effects , Pneumonia/chemically induced , Pneumonia/epidemiology , Risperidone/adverse effects , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Case-Control Studies , Clozapine/therapeutic use , Female , Humans , Incidence , Male , Middle Aged , Minnesota/epidemiology , Retrospective Studies , Risperidone/therapeutic use , Schizophrenia/drug therapy
2.
Bol Asoc Med P R ; 105(4): 41-4, 2013.
Article in English | MEDLINE | ID: mdl-25154173

ABSTRACT

Synchronous multicentric osteosarcoma is a very rare condition that might be confused with metastatic osteosarcoma. We report the first pediatric case of synchronous multicentric osteosarcoma reported in the Puerto Rican. The child presented with multiple osteoblastic bone lesions followed by right upper lid ptosis. Orbital CT-Scan showed a lytic lesion involving the sphenoid bone. Management consisted of chemotherapy for forty-two weeks after which she remained without new secondary bone lesions.


Subject(s)
Bone Neoplasms/pathology , Neoplasms, Multiple Primary/pathology , Osteosarcoma/pathology , Child , Female , Humans , Puerto Rico
3.
Psychosomatics ; 51(6): 520-7, 2010.
Article in English | MEDLINE | ID: mdl-21051685

ABSTRACT

BACKGROUND: The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients. OBJECTIVE: The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services. METHOD: Program directors of seven academic Psychosomatic Medicine (PM) programs in the Northeast were surveyed to establish current staffing patterns and patient volumes. Survey data were reviewed and analyzed along with data from the literature and The Academy of Psychosomatic Medicine (APM) fellowship directory. RESULTS: Staffing patterns varied widely, both in terms of the number and disciplines of staff providing care for medical and surgical inpatients. The ratio of initial consultations performed per hospital bed varied from 1.6 to 4.6. CONCLUSION: Although staffing patterns vary, below a minimum staffing level, there is likely to be significant human and financial cost. Efficient sizing of a PM staff must be accomplished in the context of a given institution's patient population, the experience of providers, the presence/absence and needs of trainees, and the financial constraints of the department and institution. National survey data are needed to provide benchmarks for both academic and nonacademic PM services.


Subject(s)
Hospitals, General , Physicians/supply & distribution , Psychosomatic Medicine , Humans , New England , Pilot Projects , Surveys and Questionnaires , Workforce
4.
Phys Med Rehabil Clin N Am ; 21(4): 711-24, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20977957

ABSTRACT

Myofascial pain syndrome is a common nonarticular local musculoskeletal pain syndrome caused by myofascial trigger points located at muscle, fascia, or tendinous insertions, affecting up to 95% of people with chronic pain disorders. Clinically, myofascial pain syndrome can present as painful restricted range of motion, stiffness, referred pain patterns, and autonomic dysfunction. The underlying cause is often related to muscular imbalances, and following a thorough physical examination the condition should be treated with a comprehensive rehabilitation program. Additional treatment options include pharmacologic, needling with or without anesthetic agents or nerve stimulation, and alternative medicine treatments such as massage or herbal medicines. Repeated trigger point injections should be avoided, and corticosteroids should not be injected into trigger points.


Subject(s)
Myofascial Pain Syndromes , Comorbidity , Fibromyalgia/epidemiology , Glucocorticoids/administration & dosage , Humans , Muscle Contraction/physiology , Myofascial Pain Syndromes/epidemiology , Myofascial Pain Syndromes/physiopathology , Myofascial Pain Syndromes/rehabilitation , Physical Examination , Range of Motion, Articular , Vitamin D Deficiency/epidemiology
5.
Curr Psychiatry Rep ; 8(3): 223-7, 2006 Jun.
Article in English | MEDLINE | ID: mdl-19817073

ABSTRACT

Panic disorder is a common illness with significant impact on function and, at times, disabling consequences. Advances over recent years have yielded potential pathophysiologic mechanisms, including neurotransmitter systems and neural substrates. This article provides an overview of various models and hypotheses regarding the etiology of panic disorder. Because its symptoms overlap with the symptoms of various medical disorders, this discussion reviews the comorbidity of panic disorder with medical conditions, especially cardiac and respiratory disorders.


Subject(s)
Mind-Body Relations, Metaphysical , Panic Disorder/psychology , Arousal/physiology , Asphyxia/physiopathology , Asphyxia/psychology , Carbon Dioxide/blood , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/psychology , Diagnosis, Differential , Humans , Lung Diseases, Obstructive/diagnosis , Lung Diseases, Obstructive/physiopathology , Lung Diseases, Obstructive/psychology , Panic Disorder/diagnosis , Panic Disorder/physiopathology , Patient Care Team , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/physiopathology , Psychophysiologic Disorders/psychology , Referral and Consultation
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