Prevalence and risk factors of hyperprolactinemia among patients with various psychiatric diagnoses and medications

Abstract

Objectives: Hyperprolactinemia is a common adverse event associated with psychotropic medications (mainly antipsychotics) used in the management of schizophrenia and bipolar disorders. The aim of this study was to estimate the prevalence of hyperprolactinemia in psychiatric patients and to evaluate its association with various psychiatric diagnoses and the use of various psychotropic medications.

Methods: A cross-sectional observational study was conducted between July 2012 and June 2014. Patients were recruited from a number of hospitals located in the five regions of Saudi Arabia. Hyperprolactinemia was defined as blood prolactin levels >25?ng/mL in females and >20?ng/mL in males, regardless of the presence of symptoms.

Results: A total of 997 patients (553 males and 444 females) were included in the current analysis. The average blood prolactin level was 32.6?±?44.1?ng/mL, with higher levels among females than males (42.9?±?61.3 versus 24.4?±?18.6, p?<?.001). The prevalence of hyperprolactinemia was 44.3%, with no significant gender difference (41.9% in females versus 46.3% in males, p?=?.164) but with huge variability according to individual antipsychotic and other psychotropic medications. In the multivariate analysis adjusted for demographic and clinical characteristics, hyperprolactinemia was independently and positively associated with using antipsychotic medications (OR?=?2.08, 1.26–3.42, p?=?.004). Additionally, previous hospitalisation, diabetes and hypothyroidism were positively associated, whereas having primary depressive disorders was negatively associated.

Conclusions: We report a high prevalence of hyperprolactinemia among a large sample of psychiatric patients in Saudi Arabia, which was linked to the use of antipsychotic medications. Routine measurement of blood prolactin levels for all patients maintained on antipsychotic agents is recommended, regardless of symptoms.     

Prevalence of tobacco use among students aged 13-15 years in Health Ministers' Council/Gulf Cooperation Council Member States, 2001-2004

BACKGROUND: This article examines differences and similarities in adolescent tobacco use among Member States of the Health Ministers' Council for the Gulf Cooperation Council (HMC/GCC) using Global Youth Tobacco Survey (GYTS) data. METHODS: Nationally representative samples of students in grades associated with ages 13-15 in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen. Schools were selected proportional to enrollment size, classes were randomly selected within participating schools, and all students in selected classes were eligible to participate. RESULTS: GYTS results confirmed that boys are significantly more likely than girls to smoke cigarettes or use shisha (water pipe). Students had higher rates of tobacco use than adults in Bahrain, Oman, and United Arab Emirates. For boys and girls, shisha use was higher than cigarette smoking in almost all countries. Susceptibility to initiate smoking among never smokers was higher than current cigarette smoking in all countries. Exposure to secondhand smoke in public places was greater than 30%, direct protobacco advertising exposure was greater than 70% on billboards and in newspapers, and more than 10% of students were influenced by indirect advertising. Finally, less than half of the students were taught in school about the dangers of tobacco use in the past year. CONCLUSIONS: For boys and girls, high prevalence of cigarette smoking, high prevalence of shisha use, and high susceptibility of never smokers to initiate smoking in the next year are troubling indicators for the future of chronic disease and tobacco-related mortality in the Member States of the HMC/GCC.     

Myeloid progenitor cells in the premetastatic lung promote metastases by inducing mesenchymal to epithelial transition

Tumors systemically initiate metastatic niches in distant target metastatic organs. These niches, composed of bone marrow-derived hematopoietic cells, provide permissive conditions for future metastases. However, the mechanisms by which these cells mediate outgrowth of metastatic tumor cells are not completely known. Using mouse models of spontaneous breast cancer, we show enhanced recruitment of bone marrow-derived CD11b(+)Gr1(+) myeloid progenitor cells in the premetastatic lungs. Gene expression profiling revealed that the myeloid cells from metastatic lungs express versican, an extracellular matrix proteoglycan. Notably, versican in metastatic lungs was mainly contributed by the CD11b(+)Ly6C(high) monocytic fraction of the myeloid cells and not the tumor cells or other stromal cells. Versican knockdown in the bone marrow significantly impaired lung metastases in vivo, without impacting their recruitment to the lungs or altering the immune microenvironment. Versican stimulated mesenchymal to epithelial transition of metastatic tumor cells by attenuating phospho-Smad2 levels, which resulted in elevated cell proliferation and accelerated metastases. Analysis of clinical specimens showed elevated versican expression within the metastatic lung of patients with breast cancer. Together, our findings suggest that selectively targeting tumor-elicited myeloid cells or versican represents a potential therapeutic strategy for combating metastatic disease.     

Frequency and clinicopathologic correlates of KRAS amplification in non-small cell lung carcinoma

Background

Characterization of the non-small cell lung cancer (NSCLC) genome has suggested that KRAS amplification is one of the commonest molecular abnormalities in NSCLC. However, the prevalence and clinicopathologic significance of KRAS amplification, and its relationship with KRAS activating mutations have not been well-defined. The purpose of this study was to establish the prevalence of KRAS amplification in two separate, large NSCLC cohorts, to define the clinicopathologic features of KRAS-amplified NSCLC in a single uniformly treated cohort, and to investigate the interplay between KRAS amplification and KRAS mutation.

Methods

Fluorescence in situ hybridization was utilized to detect KRAS amplification on tissue microarrays constructed from a Swiss cohort of 538 NSCLCs and a series of 402 patients with NSCLC treated in a single institution in New York. DNA sequencing to detect KRAS codon 12 activating mutations was performed on a subset of tumors. Amplification and mutation status were compared with patient baseline characteristics, tumor characteristics, and overall- and disease-free survival.

Results

The prevalence of KRAS amplification was 13.7% in the Swiss cohort and 15.1% in the New York cohort. Among adenocarcinomas, KRAS amplification was associated with larger (mean size 2.8 ± 1.8 cm vs. 2.1 ± 1.3 cm, p = 0.003), less well-differentiated tumors (18% vs. 42%, p = 0.004) that were more likely to be invasive (95% vs. 77%, p = 0.004) and to exhibit angiolymphatic invasion (24% vs. 12%, p = 0.04). These differences were statistically significant within the subset of adenocarcinomas harboring activating KRAS mutations, suggesting a synergistic relationship between amplification and mutation. No significant association between KRAS amplification and nodal metastasis or survival was seen.

Conclusions

KRAS amplification is a common molecular alteration in NSCLC, characterizing ∼15% of tumors. This alteration is associated with indicators of local aggressiveness, and may act synergistically with KRAS mutations to promote tumor progression.     

Stability of the mandible after bilateral sagittal split osteotomy: Comparison between positioning screws and plate

Relapse is one of the complications of orthognathic surgery. In this study, we compared the stability of mandibular bilateral sagittal split osteotomy by using two different methods of fixation. In Group 1, eight patients with prognathic mandible underwent BSSO and set back average of 6.0 mm. The method of fixation was positioning screws. In Group 2, eight patients with prognathic mandible underwent BSSO and set back average of 6.0 mm. The method of fixation was plate and monocortical screws. In Group 3, eight patients with retrognathic mandible underwent BSSO and advancement average of 6.0 mm. The method of fixation was positioning screws. In Group 4, eight patients with retrognathic mandible underwent BSSO and advancement average of 6.0 mm. The method of fixation was plate and monocortical screws. The results showed in terms of advancement that there was no significant difference between the groups after one year. However, in terms of set back, this study showed significant difference.     

Anatomy of the accessory mental foramen in a Saudi subpopulation: A multicenter CBCT study

AimThe aim of this is to evaluate the prevalence and location of the accessory mental foramen (AMF) in a Saudi population using cone-beam computed tomography (CBCT).MethodologyCBCT data were retrieved from two dental facilities at two universities located in two different cities and filtered over a period of four years. The scans were aligned when the AMF was noticed, and then the size of both the AMF and mental foramen (MF), its location, and the distance from the AMF to the MF were recorded. The AMF measurements were compared between males and females and between the two sides of the mandible.ResultsIn total, 603 CBCT scans were investigated. The percentage of scans with an AMF was 9.95% (n = 60), and AMFs were almost equally distributed on both sides. Only four cases (0.66%) of a second AMF were detected among the scans. The MFs on both sides were significantly larger in males than in females (P > 0.05), but they showed no differences in the sizes of the AMFs. The AMFs were most commonly located inferior and posterior to the MF. The distance between the MF and AMF ranged from 2.32 to 5 mm.ConclusionsThe prevalence of the AMF in this Saudi population was 9.95%, and it was significantly more prevalent in males than in females. Its proximity to the MF makes it clinically important to conduct proper detailed planning prior to performing any procedure that might risk the vital structures.     

Partial-Thickness Tears of the Gluteus Medius: Rationale and Technique for Trans-Tendinous Endoscopic Repair

Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment. We reviewed the literature on trochanteric pain syndrome and gluteus medius tendon injuries. Existing techniques for endoscopic and open gluteus tendon repair and potential challenges in restoration of abductor function were analyzed. Partial-thickness undersurface tears of the gluteus medius were identified as a common pathologic entity. Although these tears are otherwise analogous to partial-thickness tears of the rotator cuff, the lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge. To address the difficulty in visualizing and thus repairing undersurface tears of the gluteus medius, a novel endoscopic trans-tendinous repair technique was developed. The purposes of this article are to review the anatomy, pathology, and existing repair techniques of gluteus medius tendon tears and to describe the rationale and surgical steps for endoscopic trans-tendinous repair.     

Double jeopardy: assessing the association between internal displacement,housing quality and chronic illness in a low-income neighborhood

Purpose  

This study analyzed associations between war-related internal displacement, housing quality and the prevalence of chronic illness in Nabaa, a low-income neighborhood on the outskirts of Beirut, Lebanon.