Miocarditis inducida por Clozapina: Revisión y protocolo de Screening

Clozapina, el gold standard en esquizofrenia refractaria, presenta algunos efectos adversos que ocasionalmente pueden ser graves. Entre ellos, la miocarditis precoz es un efecto cardiovascular severo poco frecuente que puede aparecer en las primeras 4-6 semanas. Las cifras de incidencia oscilan entre el 0,015-0.188% en el mundo, siendo más altas en Australia. La etiología es desconocida, postulándose hipersensibilidad mediada por Ig E; hipereosinofilia y hiperadrenergia. Múltiples investigaciones avalan a la ecocardiografía como una de las técnicas más útiles para el diagnóstico. La biopsia endomiocárdica es definitoria pero no viable. Existen, asimismo, criterios de RNM indicativos de inflamación miocárdica. Para facilitar el diagnóstico, se han propuesto criterios clínicos y analíticos de screening (hemograma, ECG, CK, PCR, troponinas). En caso de sospecha de miocarditis, el cese de clozapina y el tratamiento de soporte es la actitud a seguir, habitualmente con buenos resultados.

Although Clozapine is the gold standard treatment in resistant-schizophrenia, severe or even life-threatening adverse effects must be taked into account. Early myocarditis, a severe but unusual cardiovascular effect, can appear in the first 4-6 weeks of initiation. Incidence rates of myocarditis are about 0,015-0,188% around the world, being more elevated in Australia. Aethiology is unknown, suggesting Ig E mediated hipersensibility, hiperaeosinophilia and hiperadrenergy. Echocardiography seems to be one of the most helpful tools for diagnosing myocarditis. Endomyocardial biopsy is definitive, but not usually available. A role for cardiac magnetic resonance imaging (MRI) also has been proposed (findings of inflammation). In order to make an early diagnosis, several screening-criteria, considering clinical and laboratory ones, have been proposed: aeosinophylia, creatininkinase, C Reactive Proteine, troponin, and EKG. If we suspected clozapine-induced myocarditis, the drug must be removed and support medical treatment must be indicated.

Evaluation of diabetes-related short-chain organic acids in rat plasma by capillary electrophoresis.

A capillary zone electrophoresis method was optimised to analyse low-molecular-mass organic acids for the purpose of monitoring diabetes in rat plasma. The method included acetoacetic, 2-hydroxybutyric, lactic and uric acids. A variation in the background electrolyte allowed us to measure pyruvic acid in the same sample. Conditions have been optimised for measuring a large number of plasma samples corresponding to control and diabetic rats. Samples were mixed with acetonitrile (1:1, v/v) to precipitate proteins, centrifuged, diluted and injected. Tropic acid was chosen as an adequate internal standard. Separation was developed with reversed voltage by using a column cartridge pre-treated with polyacrylamide. Two electrophoretic buffers were employed: 0.150 M H3PO4 made up pH 6.20 with NaOH and 0.3 mM CaCl2 for acetoacetic, hydroxybutyric, lactic and uric acids, and 200 mM phosphate-10 mM acetate pH 4.0 for pyruvic acid, both with direct detection at 200 nm. The method was validated for linearity, accuracy and precision and the limits of quantification were calculated. The method was successfully applied to analyse these organic acids in control and diabetic animals. Acetoacetic and hydroxybutyric acids were clearly increased in diabetic rats, meanwhile no statistically significant difference has been found with the other acids.

[Agreement in the measurement of blood pressure among different health professionals. Are mercury sphygmomanometers reliable?]. / Concordancia en la medición de presión arterial entre diferentes profesionales sanitarios. ¿Son fiables los esfigmomanómetros de mercurio?

OBJECTIVES: To assess reliability in terms of inter-observer agreement of blood pressure (BP) readings. Various health professionals and measuring systems. Influence of observer's experience. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Urban health centre, Córdoba. PARTICIPANTS: 131 hypertensive, randomised patients, belonging to a functional care unit. 11 were excluded. MEASUREMENTS: To reduce variability: course on the right way to take blood pressure, otoscope and verification of visual sharpness of observers, calibration and validation of measuring devices, limited time and blinding of measurements. 4 BP measurements per patient: 3 with mercury sphygmomanometer (2 simultaneously, one individual) and one with an automatic device. Descriptive, clinical and somatometric variables were gathered. Inter-observer agreement was evaluated through the intraclass correlation coefficient (ICC), the mean of differences method (MDM) and the simple concordance index (CI). An ICC > 0.75 was thought acceptable. A difference > 5 mmHg was thought clinically relevant (MDM and CI). MAIN RESULTS: Acceptable consistency for MDM: alone, systolic and diastolic pressure of OBS 1/ OBS 2, bi-auricular, -6.1/+8.9 mmHg and -6.8/+5.8 mmHg. Less favourable results: for systolic and diastolic pressure: OBS 1/AUTO -20.9/25.0 and -16.4/15.1; OBS 2/AUTO -22.8/24.4 and -16.6/15.2. Remaining intervals always > 10 mmHg; CI > 0.75 in all comparisons except diastolic pressure OBS 1/AUTO and diastolic pressure OBS 2/AUTO (0.69 in both cases). 41% of comparisons were > 5 mmHg. No differences in less expert professionals were found. CONCLUSIONS: Inaccuracy of the standard BP measurement method (mercury sphygmomanometer) for MDM and CI. Contradictory conclusions according to method of measurement. Differences not clinically acceptable.