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Biomedical subjects

R J Holt

Publications and source records attributed to R J Holt.

At least 37 records · Page 2Linked to original sources
PubMed1984

Alprazolam reversal of reserpine-induced depression in patients with compensated tardive dyskinesia.

Two patients are described who developed neuroleptic drug-induced tardive dyskinesia (TD) secondary to the treatment of schizophrenia. In both patients, neuroleptic drug discontinuation brought about a decrease in the severity of the TD and an increase in schizophrenic symptomatology. Reserpine was added for both antipsychotic coverage and reported beneficial effects in the treatment of TD. The patients' schizophrenia was controlled using reserpine 1 mg/d; the TD dissipated in one patient and decreased in the other. After about seven weeks of reserpine therapy, both patients developed depressive symptoms that required the addition or alprazolam. Within a month of the initiation of alprazolam, the depressions had cleared. Alprazolam may block reserpine-induced increases in beta-adrenergic receptors in the brain and may account for the antidepressive effects in these two patients.

Adult↗
PubMed1984

An analysis of poison control center reports of ciguatera toxicity in Puerto Rico for one year.

Forty-five cases of ciguatera poisoning in Puerto Rico (P.R.) are described. These cases represent all those reported to the P.R. Poison Control Center in 1982. Most of the cases were reported in the spring and summer months. The most common fish ingested was the grouper. The clinical presentation of acute and long term symptoms was similar to that reported in other geographical areas, except the incidence of paresthesias. Paresthesias were reported in 11% of the patients reported to the poison center. A companion telephone survey indicated that persons in P.R. that do not eat fish do so because of fear of ingesting the toxin. Our findings indicate an overall familial contact with the ciguatera toxin in Puerto Rico at 7%. This study is the first to document that ciguatera is a common poisoning reported to the Poison Control Center in Puerto Rico. Our findings also support other authors contentions of geographical variations in clinical symptomatology.

Adolescent↗
PubMed1984

Neuroleptic drug-induced changes in platelet levels.

The results of a prospective study on the incidence of thrombocytopenia in matched psychiatric inpatients receiving different antipsychotics are reported. Patients were receiving haloperidol (N = 159), chlorpromazine (N = 164), fluphenazine decanoate (N = 152), or no drug therapy (control, N = 102). The groups did not differ statistically in respect to the incidence of thrombocytopenia, mean platelet levels, age, chlorpromazine equivalent dosages, or duration of drug therapy (p greater than 0.05). The two phenothiazine-treated groups had significantly higher numbers of patients with low-normal platelet levels when compared to both the haloperidol and control groups (p less than 0.05). Also, a nonsignificant trend was noted for increased incidence of thrombocytopenia among the phenothiazine groups compared with the haloperidol and control groups. Upon retrospective analysis of preneuroleptic treatment platelet levels, significant decreases in platelet values were observed with the phenothiazine-treated patients (p less than 0.001), but not with haloperidol (p greater than 0.05). The results indicate that neuroleptic drug-induced thrombocytopenia is rare but may be more common with phenothiazine antipsychotics.

Adult↗
PubMed1983

Familial warfarin resistance.

Warfarin, a coumarin anticoagulant, acts by interfering with the hepatic synthesis of the vitamin-K-dependent clotting factors. It is used clinically in the treatment or prophylaxis of venous thrombosis and embolisms. Resistance to the effects of the coumarin and indanedione anticoagulants has been reported in rats and man, but its incidence has been defined as extremely rare. Resistance has been described as relative, acquired, or hereditary. The first well-documented case was also the first report to identify a genetic basis for this resistance. Since that time, there has been only one other study that strengthened the evidence for a hereditary transmission, and only a few other reports have suggested hereditary influence as a reason for coumarin resistance. In this report, a patient who presented with a familial-type warfarin resistance is described. A discussion of previous reports and possible mechanisms for nonfamilial warfarin resistance is also included.

Drug Resistance↗
PubMed1982

Chemoprophylaxis of recurrent otitis media using trimethoprim/sulfamethoxazole.

This study was undertaken during the late fall, winter, and early spring months to determine the efficacy of daily trimethoprim/sulfamethoxazole (TMP/SMX) administration in the prevention of recurrent acute otitis media (RAOM) in a specific high-risk pediatric population. Twenty-one ambulatory patients, 10 in the study group and 11 in the control group, were selected from a medical university clinic and a local private practice. The study group receiving prophylactic therapy for six months suffered no recurrences, as compared with eight children suffering one recurrence each in the control group that was treated only acutely. The results were significant at p less than 0.005 with df = 1, determined by the Fischer's exact test and the chi-square method using Yates's correction factor. These data indicated that a mean dose of TMP/SMX 6.8/34 mg/kg/d divided into twice daily doses and given for six months was safe and effective in controlling RAOM infections in a high-risk pediatric population.

Acute Disease↗
PubMed1981

Neuroleptic drug use in a family-practice center.

A three-year retrospective review of neuroleptic drug use at the Family Practice Center of the Medical University of South Carolina was conducted. The charts of 73 patients who had taken neuroleptic agents were reviewed for compliance with the most recent guidelines established by the National Institute of Mental Health (NIMH). Information retrieved included: age, sex, number of clinic visits, diagnosis, neuroleptic agent used, dosages, duration of therapy, concomitant psychotropics, antiparkinson agents, and extrapyramidal side effects. Neuroleptic drug use was considered inappropriate for 26% of the patients' diagnoses. Twenty percent of the dosage regimens were outside the ranges recommended by NIMH. Almost 15% of the medications used consisted of th fixed-combination products of perphenazine and amitriptyline hydrochloride, and 77% of these prescriptions were for dosages below the recommended amounts. Polypsychopharmacy was a common problem, with 36% of the patients receiving one or more psychotropic drugs with a neuroleptic agent. Nineteen patients (26%) had been prescribed an inappropriate psychotropic combination. Nine patients (12%) had received antiparkinson agents. Eight patients (11%) had documented extrapyramidal side effects. Neuroleptic drug use was found to be suboptimal. Various deficiencies were documented particularly in the use of fixed-combination products and because of the problems associated with polypsychopharmacy.

Antiparkinson Agents↗
PubMed1980

Progress in antimycotic chemotherapy 1945-1980.

Before 1950 no reliable or safe therapy existed for systemic and invasive mycoses, and only traditional and empirical topical preparations were available for dermatomycoses. Two distinct eras of rapid progress in antifungal therapy followed: first, in the 1950's came the introduction of the polyenes, nystatin and pimaricin for cutaneous, vaginal and intestinal candidiasis, and amphotericin B for the treatment of severe systemic mycoses. The second phase saw the successful introduction and clinical use of 5-fluorocytosine and several imidazole derivatives some twenty years later, at a time when the vast increase in iatrogenic systemic mycoses caused by opportunistic fungi had created an urgent and pressing need for new agents in addition to those still effective.

Amphotericin B↗