Prevalence of clozapine-induced sialorrhea and its effect on quality of life.

RATIONALE: Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. OBJECTIVES: To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. METHODS: We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. RESULTS: Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (B = 0.417; p = 2.1e - 6, R2 = 0.156) and nocturnal CIS (B = 0.411; p = 7.7e - 6, R2 = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. CONCLUSIONS: The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. TRIAL REGISTRATION: Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.

[Patients treated with micafungin during their stay in intensive care unit]. / Micafungina en pacientes críticos ingresados en unidad de cuidados intensivos.

OBJECTIVES: To determine the reasons of prescription, the characteristics of patients and factors that affected the outcome of critically ill patients treated with micafungin (MCF) during their stay in Spanish ICUs. MATERIAL AND METHODS: Observational, retrospective and multicenter study. Patients admitted to the ICU between March 2011 and October 2012 (20-month period) treated with MCF for any reason were included in the study. Severity of patients at the beginning of treatment was measured with the APACHE II, SOFA, Child-Pugh and MELD scores. Reasons for the use of MCF were classified as prophylaxis, preemptive treatment, empirical treatment and directed treatment. Continuous variables are expressed as mean and standard deviation or median, and categorical variables as percentages. A multivariate analysis was performed to identify variables related to intra-ICU mortality. RESULTS: The study population included 139 patients admitted to 19 Spanish ICUs, with a mean age of 57.3 (17.1) years, 89 (64%) men, with surgical (53.2%) and/or medical (44.6%) conditions, APACHE II score of 20.6 (7.7) and SOFA score of 8.4 (4.3), with 84.2% of patients requiring mechanical ventilation, 59% parenteral nutrition, 37.4% extrarenal depuration procedures and 37.4% treatment with steroids. MCF was indicated as empirical treatment of a proven infection in 51 (36.7%) cases, pre-emptive treatment in 50 (36%) especially as a result of the application of the Candida score (32 cases), directed treatment of fungal infection in 23 (16.5%) and as prophylactic treatment in 15 (10.8%) cases. In 108 (77%) cases, a daily dose of 100mg was administered, with a loading dose in only 9 cases (6.5%). The mean duration of treatment was 13.1 (13) days. A total of 59 (42.4%) patients died during their stay in the ICU and 16 after ICU discharge (hospital mortality 53.9%). Independent risk factors for intra-ICU mortality were the Child-Pugh score (OR 1.45, 95% CI 1.162-1.813; P=.001) and the MELD score (OR 1.05, 95% CI 1.011-1.099; P=.014). CONCLUSIONS: MCF is usually administered at a dose of 100mg/day, without loading dose and in 72.7% of cases as pre-emptive or empirical treatment. Factors that better predicted mortality were indicators of liver insufficiency at the time of starting treatment.

[Lobenhoffer approach to stabilize fractures of the posteromedial tibial plateau]. / Vía de Lobenhoffer para la estabilización de fracturas de la región posteromedial de la meseta tibial.

OBJECTIVE: To provide the first description in Spanish of the Lobenhoffer approach to treat fractures of the posteromedial region of the tibial plateau. MATERIAL AND METHODS: We report 14 clinical cases of patients with fractures of the posteromedial region of the tibia treated at our service using the Lobenhoffer approach. RESULTS: All patients were retrospectively assessed after a minimum follow-up period of two years. Complications and the knee status and function were assessed using the Knee Society System (KSS) score. Knee status results were good to excellent, while functional results were excellent to good in 8 patients, fair in 3 and poor in the 3 remaining ones. CONCLUSION: The Lobenhoffer approach represents and easy and reproducible posterior approach and has a low complication rate.

Association of topical amphotericin B lipid complex treatment to standard therapy for rhinomaxillary mucormycosis after liver transplantation: a case report.

Solid organ transplantation is becoming increasingly more common in the treatment of end-stage organ failure. The advent of newer immunosuppressive protocols and refined surgical techniques has allowed therapy to become standard care. Infection is a major and frequently life-threatening complication after transplantation and the incidence of opportunistic fungal infections in organ transplant recipients ranges from 2%-50% depending on the type of organ transplanted. We present a case of rhinomaxillary form of mucormycosis infection after liver transplantation. The succession of multiple risk factors in a torpid postoperative period was a key factor in the development of this disease. Multidisciplinary management with an early diagnosis, aggressive surgery, and intravenous and topical antifungal therapy care were definitive for the eradication of infection. The goal of the present report was to show efficacious management including the association of topical treatment with amphotericin B complex lipid to standard therapy and the absence of side effects.

Time and frequency analysis of the static balance in young adults with Down syndrome.

The main objective of this study is to understand the differences in equilibrium control between normal subjects and those with Down syndrome. A total of 54 subjects participated voluntarily, divided into control group and Down syndrome group. The equilibrium of the subjects was tested under two conditions: bipedal support with eyes open and closed. The signals were analyzed in a time and frequency domain. The statistical parameters selected (i.e., RMS distance, mean velocity, mean frequency and sway area) to analyze the behavior of the center of pressures (CoP) are calculated employing the result of the combination of the time series data in both directions (i.e. resultant distance). In order to calculate the frequency bands produced by the displacements of the CoP, a Fast Fourier Transform of the data was performed. The group with Down syndrome showed poorer static equilibrium control than the control group in the time domain. In the frequency domain, we found differences between the groups in the distribution of energy in the frequency bands analyzed. In addition, we observed the existence of an interaction effect of the group and the condition tested (p<0.001). These findings show that in the absence of visual information, the control group increases the energy at low frequencies, while the group with Down syndrome decreases it. Additionally, the lower amount of energy observed in this band under the 'eyes closed' condition may serve to identify abnormalities in the functioning of the vestibular apparatus of individuals with Down syndrome and/or difficulties experienced by these individuals in extracting relevant information from this route.

[Adaptation parameters in non-invasive mechanical ventilation. Experimental comparative study]. / Parámetros de adaptación en ventilación mecánica no invasiva. Estudio comparativo experimental.

OBJECTIVE: To evaluate response to pressure and flow triggering in an experimental model of the normal, obstructive and restrictive lung with six non-invasive mechanical ventilation units: Vintil+ (VP), Respironics STD20 (RR), Puritan Bennet 335 (PB), Quantum (QT), DP90 (DP) and Sullivan II ST (SV). METHOD: Analog signals of volume, pressure and flow from a lung simulator were recorded by a Mingograph 34 polygraph. Positive inspiratory pressure (PIP) was 12 cmH2O, respiratory rate was 17 cycles/min, end expiratory pressure (PEEP) was 4 cmH2O, and inspiratory effort (P0.1) was 4 cmH2O. Parameters calculated were negative trigger pressure, trigger time (or the flow wave delay in triggering), and the percentage of peak inspiratory flow at which a change to exhalation or cycle phase. RESULTS: The RR and PB units had the best trigger response with pressure triggering below -1 cmH2O and trigger times less than 100 ms. VP proved to have the poorest response. The cycle of the RR agreed most closely with the standard (5-25% of peak inspiratory flow), whereas change to exhalation occurred with the other units with zero flow (in all patterns with DP90, and in restrictive patterns with PB and VP) or greater than 50% of peak inspiratory flow (in all models with QT). Analysis of pressure curves showed great differences in slope, plateau and depressurization. CONCLUSIONS: The RR unit proved to have the most homogeneous behavior for all the phase parameters studied as being the ones that most influence a patient's adaptation to a ventilator.

[Clinical practice guidelines of the Spanish Society of Cardiology for pulmonary thromboembolism and hypertension]. / Guías de práctica clínica de la Sociedad Española de Cardiología en tromboembolismo e hipertensión pulmonar.

Primary pulmonary hypertension is a progressive disease. Most affected patients are young and middle-aged women. Etiology is unknown, although a familial and genetic factor is present in up to 6% of cases. Endothelial dysfunction and abnormalities in calcium channels of smooth muscle fibers are the present pathogenetics theories. Diagnostic tests try to exclude secondary causes of pulmonary hypertension and to evaluate its severity. Acute vasodilatory test is vital in the selection of treatment. Oral anticoagulation is indicated in all patients. Lung transplant is performed when medical treatment is unsuccessful. Atrial septostomy is an alternative and palliative treatment for selected cases. Chronic thromboembolic pulmonary hypertension is a special form of secondary pulmonary hypertension, clinically undistinguishable from primary primary hypertension, is of mandatory diagnosis because it can be cured with thromboembolectomy. Pulmonary embolism is common in hospitalised patients. The mortality rate for pulmonary embolism continues to be high: up to 30% in untreated patients. The accurate detection of pulmonary embolism remains difficult, as pulmonary embolism can accompany as well as mimic other cardiopulmonary illnesses. Non-invasive diagnostic tests have poor specificity and sensitivity. The D-dimer level and the spiral CT angiography have also been employed as new alternatives and important tools for precise diagnosis of suspected pulmonary embolism. The standard therapy of pulmonary embolism is intravenous heparin for 5 to 10 days in conjunction with oral anticoagulants posteriorly for 3 to 6 months. The incidence of deep venous thrombosis, pulmonary embolism and death due to pulmonary embolism, can be reduced significantly and shown clear benefits only by adoption of a prophylactic strategy with low-molecular-weight-heparins or dextrans in patients at risk.