Osteoporosis and fracture risk in people with schizophrenia

PURPOSE OF REVIEW: Excessive bone mineral density (BMD) loss has been associated with schizophrenia, but its mechanisms and clinical implications are less clear. The aim of this review was to summarize the risk of osteoporosis and bone fractures in schizophrenia patients. Moreover, we aimed to examine the impact of antipsychotic-induced hyperprolactinemia on bone metabolism. RECENT FINDINGS: Fifteen of 16 studies (93.8%) reported lower BMD or higher prevalence of osteoporosis in at least one region, or in at least one subgroup of schizophrenia patients compared with controls, but results were inconsistent across measured areas. Higher fracture risk was associated with schizophrenia in 2/2 studies (independently: n?=?1), and 3/4 studies with antipsychotics. Reasons for this difference include insufficient exercise, poor nutrition, smoking, alcohol use, and low vitamin D levels. Altogether, 9/15 (60.0%) studies examining the relationship between antipsychotic-induced hyperprolactinemia and BMD loss found some effects of hyperprolactinemia. However, results were mixed, samples and effects were small, and only two studies were prospective. SUMMARY: Schizophrenia is associated with reduced BMD and fracture risk. Prevention, early detection, and intervention are required. The relative contributions of antipsychotic-related hyperprolactinemia and unhealthy lifestyle behaviors remain unclear, needing to be assessed in well designed, prospective studies, including bone turnover markers as intermediary endpoints.     

Synthesis and anti-histaminic activity of some novel pyrimidines

Novel pyrimidines were prepared by the condensation of chalcones of 4′-piperazine acetophenone with guanidine HCl. The structures of the synthesized compounds RP 1–5 were assigned on the basis of elemental analysis, IR, ¹H NMR and mass spectroscopy. These compounds were also screened for anti-histaminic activity. The recorded percentage of histamine inhibition showed a significant anti-histaminic activity when compared to the reference anti-histaminic drug mepiramine.     

What factors predetermine the risk of having a high-order multiple pregnancy with gamete intra-Fallopian transfer?

Limiting the number of oocytes transferred at gamete intra-Fallopiantransfer (GIFT) has limited the incidence of high-order pregnancybut at the same time compromised the fertility potential ofsome patients. A review of 300 patients who have undergone GIFTusing a flexible approach as to the number of oocytes transferredidentifies the patients at risk of high-order pregnancy as thoseaged under 30 years hi whom more than six oocytes are returnedand whose partner's spermatozoa have high progressive motUity.     

Patterns of diagnostic testing in the academic setting: The influence of medical attendings' subspeciality training

Internists with subspecialty training (subspecialists) constitute the majority of the medical faculty members and the test-ordering behavior of these subspecialists influences how house officers and students solve clinical problems. To assess whether test-ordering patterns are influenced by the ward attendings' subspecialty status, we identified the number of gastrointestinal endoscopic procedures, bone marrow procedures and exercise stress tests that were ordered on 9608 patients admitted to a medical service during a 3 year period. The patient management was supervised by attendings, 8 of whom were generalists and 37 of whom were subspecialists. House officers supervised by generalists ordered 23% fewer gastrointestinal procedures, 47% fewer bone marrow procedures, 43% fewer exercise stress tests and 29% fewer total procedures than house staff supervised by subspecialists (P—not significant, P < 0.001, P < 0.05 and P < 0.01, respectively). House officers perceive a difference between the test-ordering patterns of subspecialists and generalists. They attribute this difference to post-residency training and believe that the use of more tests indicates a greater compulsion toward an exhaustive evaluation.     

Abdominal compartment syndrome related to noninvasive ventilation

OBJECTIVE: To study the effects of noninvasive positive pressure ventilation (NIPPV) on intra-abdominal pressure. DESIGN AND SETTING: Single case report from a tertiary teaching hospital. PATIENTS AND METHODS: A 65-year-old man who experienced a sudden respiratory and cardiovascular collapse during NIPPV. This was caused by gastric overdistension due to aerophagia followed by raised intra-abdominal pressure leading to intra-abdominal hypertension and abdominal compartment syndrome. RESULTS: The respiratory and cardiovascular problems resolved immediately after the introduction of a nasogastric tube. This resulted in normalization of IAP. CONCLUSIONS: This is the first case reported of an abdominal compartment syndrome related to NIPPV. Clinicians should be aware of this possible complication while using NIPPV.