Safety and efficacy of lithium in children and adolescents: A systematic review in bipolar illness.

INTRODUCTION: Many clinicians are reluctant to use traditional mood-stabilizing agents, especially lithium, in children and adolescents. This review examined the evidence for lithium's safety and efficacy in this population. METHODS: A systematic review was conducted on the use of lithium in children and adolescents with bipolar disorder (BD). Relevant papers published through June 30th 2018 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: 30 articles met inclusion criteria, including 12 randomized controlled trials (RCTs). Findings from RCTs demonstrate efficacy for acute mania in up to 50% of patients, and evidence of long-term maintenance efficacy. Lithium was generally safe, at least in the short term, with most common side effects being gastrointestinal, polyuria, or headache. Only a minority of patients experienced hypothyroidism. No cases of acute kidney injury or chronic kidney disease were reported. CONCLUSIONS: Though the available literature is mostly short-term, there is evidence that lithium monotherapy is reasonably safe and effective in children and adolescents, specifically for acute mania and for prevention of mood episodes.

Clinical management of perinatal anxiety disorders: A systematic review.

BACKGROUND: In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. METHODS: A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS: 18 articles met inclusion criteria. Selected studies supported the use of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD), panic disorder (PD) and specific phobia both in pregnancy and postpartum. Selective serotonin reuptake inhibitors (SSRIs) led to significant OCD and PD improvement both in pregnancy and postpartum with no side effects for the babies. In the largest clinical sample to date, 65% of postpartum patients who entered the open-label trial of fluvoxamine (up to 300mg/day) experienced a 30% or greater decrease in the total score of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). During pregnancy, SSRIs and tricyclic antidepressants (TCAs) led to remission of panic symptoms and healthy outcomes for the babies. LIMITATIONS: Study design, mostly case reports, and enrolment of subjects mainly from outpatient specialty units might have limited community-wide generalisability. CONCLUSIONS: Keeping in mind the scantiness and heterogeneity of the available literature, the best interpretation of the available evidence appears to be that CBT should be the first treatment offered to pregnant and breastfeeding women with AnxD. However SSRIs can represent a first line treatment strategy, and not exclusively in cases where AnxD is refractory to CBT.

Analysis of environmental pollution by radiofrequency radiation from teleradiocommunication devices.

The environmental radiofrequency radiation pollution, including microwaves, generated by teleradiocommunication devices is particularly great where there exists a concentration of such apparatus. The wide-band field detectors commonly used for environmental protection surveys do not make it possible to discern the contributions of the individual emitters at a given point. It is possible to obtain this result theoretically by using only a personal computer, and by using the characteristics of the emitter and of surrounding territory as inputs. For this purpose, a basic program has been prepared. An analysis of this type, besides being an effective tool for the planning of environmental pollution abatement, provides the necessary information for forecasting field levels produced as a consequence of the installation of new repeaters. This data provides indispensable information for issuing installation licenses by the competent authorities. This article concludes with a comparison between the theoretical results and those detected experimentally in one specific case.

Effects of continuous low-level exposure to radiofrequency radiation on intrauterine development in rats.

To assess the effect of low-level radiofrequency radiation on pregnant rats, gravid dams were exposed continuously to 0.1 mW cm-2 at 27.12 MHz during different periods of pregnancy. Biological assays consisted of determining pre- and post-implantation losses and the effects on maternal body weight increase. Fetal parameters monitored included sex, mean viable fetal weight on Day 20 of gestation, external, skeletal and visceral fetal malformations, anomalies and variations. Dosimetric evaluations were made in terms of average specific absorption rate (SAR) and basal metabolic rate (BMR). Findings included a considerable increase in the percentage of total resorptions, reduced body weight increase in the exposed dams and incomplete cranial ossification in their fetuses. Results obtained were compared with those shown by other authors. It seems possible to ascribe some of the effects to a specific action of the radiofrequency radiation occurring independently of the rise in temperature. The hypothesis the exposure time, together with SAR, plays an important role in inducing specific exposure effects due to radiofrequency radiation is presented.

Electric field and current density distributions induced in an anatomically-based model of the human head by magnetic fields from a hair dryer.

We have used the impedance method to calculate the induced electric (E) fields and current densities (J) for the spatially varying vector magnetic fields due to a hair dryer. In this method, applicable for low-frequency exposures where the quasi-static approximation may be made, the biological body or the exposed parts thereof are represented by a three-dimensional (3-D) network of impedances whose individual values are obtained from the electrical properties sigma, epsilon r for the various tissues. We have measured the 3-D variations of the 50-Hz magnetic fields from a typical hair dryer and found that the various components correlate well with those for a helical coil. The non-uniform magnetic fields thus obtained are used to calculate the induced E and J with a resolution of 1.31 cm for the model of the head and neck. The induced E values are compared with the fields endogenous to the body and the minimum detectable E-field limits based on the cellular thermal noise model proposed by Weaver and Astumian (1990, 1992).

Spectral analysis of magnetic fields from domestic appliances and corresponding induced current densities in an anatomically based model of the human head.

Magnetic fields emitted by electric appliances such as razors, hair dryers, and drills were measured in the frequency domain. Results show the presence of high-frequency components (up to 96 kHz for razors, up to 3.4 kHz for hair dryers, and up to 8.6 kHz for drills) in the harmonic content of the fields. The measured fields were used to calculate the induced current densities in an anatomically based model of the human head (resolution 1.31 cm) by using the impedance method. The harmonic field contribution to the current density was higher than that from the carrier frequency for all the tested appliances.

Static and ELF magnetic fields induce tumor growth inhibition and apoptosis.

The ability of static and extremely low frequency (ELF) Magnetic Fields (MF) to interfere with neoplastic cell function has been evaluated. In vitro experiments were carried out to study the role of MF characteristics (intensity, frequency, and modulation) on two transformed cell lines (WiDr human colon adenocarcinoma and MCF-7 human breast adenocarcinoma) and one nontransformed cell line (MRC-5 embryonal lung fibroblast). Increase in cell death morphologically consistent with apoptosis was reported exclusively in the two transformed cell lines. Cell-death induction was observed with MF of more than 1 mT. It was independent of the MF frequency and increased when modulated MF (static with a superimposition of ELF at 50 Hz) were used. Based on the in vitro results, four different MF exposure characteristics were selected and used to treat nude mice xenografted with WiDr cells. The treatment of nude mice bearing WiDr tumors subcutaneously. with daily exposure for 70 min to MF for 4 weeks caused significant tumor growth inhibition (up to 50%) by the end of the treatment when modulated MF were used for at least 60% of the whole treatment period and the time-averaged total MF intensity was higher than 3.59 mT. No toxic morphological changes induced by exposure were observed in renewing, slowly proliferating, or static normal cells. A discussion on the possible biophysical mechanism at the base of the observed biological results is also offered.

Static and ELF magnetic fields enhance the in vivo anti-tumor efficacy of cis-platin against lewis lung carcinoma, but not of cyclophosphamide against B16 melanotic melanoma.

Previous works showed that exposure to static and extremely low frequency (ELF) magnetic fields (MF) over 3 mT slows down the growth kinetics of human tumors engrafted s.c. in immunodeficient mice, reducing their metastatizing power and prolonging mouse survival. In the experiments reported here, immunocompetent mice bearing murine Lewis Lung carcinomas (LLCs) or B16 melanotic melanomas were exposed to MF and treated respectively with two commonly used anti-cancer drugs: cis-diamminedichloroplatinum (cis-platin) and N,N-bis (2-chloroethyl)tetra-hydro-2H-1,3,2-oxazaphosphorin-2-amine 2-oxide (cyclophosphamide). The experiment endpoint was survival time. The survival time of mice treated with cis-platin (3mg/kg i.p.) and exposed to MF was significantly (P<0.01) longer than that of mice treated only with cis-platin or only exposed to MF, superimposing that of mice treated with 10mg/kg i.p. of the drug, showing that MF act synergically with the pharmacological treatment. On the contrary, when mice treated with cyclophosphamide (50mg/kg i.p.) were exposed to MF no synergic effects were observed, the survival curve being exactly the same as that of mice treated with the drug alone. No clinical signs or toxicity were seen in any of the mice exposed to MF alone or along with cis-platin or cyclophosphamide treatment, compared to mice given only the two known drugs.A possible explanation for the synergic effect of MF being found in mice treated with cis-platin could be that the platinum ion stimulates radical production and that MF enhance active oxygen production bringing about changes in tumor cell membrane permeability, influencing positively the drug uptake. Alternatively, or in addition to this, it has been demonstrated that the rate of conversion of cis-platin to reactive species able to bind to DNA, is increased by localized production of free radicals by MF.