Rupa L Iyengar

A Placebo Controlled Crossover Trial of Liquid Fluoxetine on Repetitive Behaviors in Childhood and Adolescent Autism

Repetitive behaviors are a core symptom domain in autism that has been linked to alterations in the serotonin system. While the selective serotonin-receptive inhibitor fluvoxamine has been shown to be effective in adults with autism, as yet no published placebo controlled trials with these agents document safety and efficacy in children with autism. This study examines the selective serotonin reuptake inhibitor liquid fluoxetine in the treatment of repetitive behaviors in childhood and adolescent autism spectrum disorders (ASDs). In total, 45 child or adolescent patients with ASD were randomized into two acute 8-week phases in a double-blind placebo-controlled crossover study of liquid fluoxetine. Study design included two randomized 8-week fluoxetine and placebo phases separated by a 4-week washout phase. Outcome measures included measures of repetitive behaviors and global improvement. Low-dose liquid fluoxetine (mean final dose: 9.9±4.35 mg/day) was superior to placebo in the treatment of repetitive behaviors by CY-BOCS compulsion scale. The effect size was in the moderate to large range, and the doses used were low. Liquid fluoxetine was only slightly, and not significantly, superior to placebo on CGI autism score partially due to a phase order effect. However, fluoxetine was marginally superior to placebo on a composite measure of global effectiveness. Liquid fluoxetine did not significantly differ from placebo on treatment emergent side effects. Liquid fluoxetine in low doses is more effective than placebo in the treatment of repetitive behaviors in childhood autism. Limitations include small sample size and the crossover design of the study. Further replication and long-term maintenance trials are needed.

Increased repetitive behaviours and prolactin responsivity to oral m-chlorophenylpiperazine in adults with autism spectrum disorders

Autism is a neurodevelopmental disorder characterized by dysfunction in three primary behavioural domains: repetitive behaviours, social deficits, and language abnormalities. There is evidence that abnormalities exist in the serotonin (5-HT) system in autism spectrum patients. Furthermore, 5-HT is known to play a role in repetitive and social behaviours. This study examined the effect of m-chlorophenylpiperazine (m-CPP) on repetitive behaviours and prolactin response in 11 adults with autism or Aspergers disorder and 8 age- and gender-matched healthy controls via randomized double-blind, m-CPP and placebo challenges. The primary outcome measure was an instrument rating six repetitive behaviours: need to know, repeating, ordering, need to tell/ask, self-injury, and touching. Patients with autism spectrum disorders showed a significant increase in repetitive behaviours at end-point following oral m-CPP in comparison to placebo. Additionally subjects with autism spectrum disorders showed a significantly increased prolactin response to m-CPP compared to normal controls, with neither group responding to placebo. This study provides further evidence for altered 5-HT sensitivity in individuals with autism spectrum disorders, as well as a possible relationship between repetitive behaviours in autism spectrum disorders and abnormalities in the 5-HT system.

The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

BACKGROUND Law enforcement officers (LEOs) experience high rates of cardiovascular events compared with the general US population. Metabolic syndrome (MetS) confers an increased risk of cardiovascular disease and all-cause mortality. Data regarding MetS among LEOs are limited. METHODS We sought to determine the prevalence of MetS and its associated risk factors as well as gender differences among LEOs who participated in the World Trade Center (WTC) Law Enforcement Cardiovascular Screening (LECS) Program from 2008 to 2010. We evaluated a total of 2,497 participants, 40 years and older, who responded to the 9/11 WTC attacks. RESULTS The prevalence of MetS was 27%, with abdominal obesity and hypertension being the most frequently occurring risk factors. MetS and its risk factors were significantly higher among male compared to female LEOs, except for reduced HDL-cholesterol levels. CONCLUSIONS MetS is a rising epidemic in the United States, and importantly, approximately one in four LEOs who worked at the WTC site after 9/11 are affected. Am. J. Ind. Med. 59:752-760, 2016.

EXPOSURE TO PARTICULATE MATTER IN WORLD TRADE CENTER LAW ENFORCEMENT AND ITS RELATIONSHIP TO CARDIOVASCULAR RISK

Background: Exposure to particulate matter (PM) is a risk factor for cardiovascular disease (CVD). Different mechanisms, including inflammatory processes, are responsible for acute and chronic toxic effects. First responders during the World Trade Center (WTC) tragedy were exposed to PM leading to

GC1QR: A NOVEL BIOMARKER ASSOCIATED WITH RISK OF CARDIOVASCULAR EVENTS

The gC1qR is a 33KDa protein, which interacts with components of the complement, kinin, and coagulation cascades, and select microbial pathogens. It is highly expressed in atherosclerotic lesions and on a variety of cells, including activated platelets and endothelial cells. Circulating gC1qR has

1381 LOW SERUM TESTOSTERONE IS ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA IN MIDDLE AGED MEN

reported into a volunteer, post-market registry, from July 14, 2000 to Sept 30, 2011 were reviewed and compared with infections reported in the product evaluation database. The advanced Titan includes hydrophilic coating across all components allowing for the absorption of an aqueous solution, while no components of the Alpha 1 employed a hydrophilic coating. Data was analyzed using a Pearson’s chi-square test to determine significance of reduction in reported infection between the Alpha IPP and the hydrophilic-coated Titan IPP. RESULTS: A total of 7031 implants and 322 infections (4.6%) were reported with the Alpha 1 implant, and 29,360 implants with 402 infections (1.4%) reported with the Titan implant, showing a statistically significant (p-value 0.0001) decrease in reported infections between the Alpha IPP and hydrophilic-coated Titan IPP. CONCLUSIONS: New advances in technology continue to improve efficacy and decrease adverse events for patients with severe ED treated with penile implants. Significant decreases in reported infection rates between the non-coated Alpha 1 IPP and the hydrophilic-coated Titan IPP suggest that the technology may contribute to decreased infections.