Analysis of how nurses cope facing the death of a paediatric patient.

AIMS: To evaluate how nurses cope with the death of a paediatric patient, relate it to the different sociodemographic variables, and to describe personal coping strategies used by nurses in managing the process and accepting the death of the patient. METHODOLOGY: An observational, descriptive and cross-sectional study, carried out from January to June 2018 with nurses from the palliative care area, intensive care unit, neonatology and oncohaematology area of a tertiary paediatric hospital in Barcelona city. An ad hoc questionnaire was applied, divided into three parts: socio-demographic data, the Bugen Scale of coping with death and two open questions. RESULTS: 31.37% of the respondents faced the process of death of the paediatric patient adequately, while 33.33% did not cope well. The best coping was in paediatric palliative care, followed by paediatric oncohaematology, neonatology and, finally, the intensive care unit. In addition, the variables related to this coping are the work shift, the death of a loved one in less than 3 years and previous training. On the other hand, the age of the respondents, experience in the unit and having children are not related to coping. Moreover, the professionals surveyed demand more training to improve their coping in this area, as well as interdisciplinary sessions to discuss cases of deceased patients.

Runoff initiation, soil detachment and connectivity are enhanced as a consequence of vineyards plantations.

Rainfall-induced soil erosion is a major threat, especially in agricultural soils. In the Mediterranean belt, vineyards are affected by high soil loss rates, leading to land degradation. Plantation of new vines is carried out after deep ploughing, use of heavy machinery, wheel traffic, and trampling. Those works result in soil physical properties changes and contribute to enhanced runoff rates and increased soil erosion rates. The objective of this paper is to assess the impact of the plantation of vineyards on soil hydrological and erosional response under low frequency - high magnitude rainfall events, the ones that under the Mediterranean climatic conditions trigger extreme soil erosion rates. We determined time to ponding, Tp; time to runoff, Tr; time to runoff outlet, Tro; runoff rate, and soil loss under simulated rainfall (55 mm h-1, 1 h) at plot scale (0.25 m2) to characterize the runoff initiation and sediment detachment. In recent vine plantations (<1 year since plantation; R) compared to old ones (>50 years; O). Slope gradient, rock fragment cover, soil surface roughness, bulk density, soil organic matter content, soil water content and plant cover were determined. Plantation of new vineyards largely impacted runoff rates and soil erosion risk at plot scale in the short term. Tp, Tr and Tro were much shorter in R plots. Tr-Tp and Tro-Tr periods were used as connectivity indexes of water flow, and decreased to 77.5 and 33.2% in R plots compared to O plots. Runoff coefficients increased significantly from O (42.94%) to R plots (71.92%) and soil losses were approximately one order of magnitude lower (1.8 and 12.6 Mg ha-1 h-1 for O and R plots respectively). Soil surface roughness and bulk density are two key factors that determine the increase in connectivity of flows and sediments in recently planted vineyards. Our results confirm that plantation of new vineyards strongly contributes to runoff initiation and sediment detachment, and those findings confirms that soil erosion control strategies should be applied immediately after or during the plantation of vines.

Cutaneous metastasis of inflammatory breast carcinoma mimicking an erythema annulare centrifugum: a sign of locally recurrent cancer.

Erythema annulare centrifugum (EAC) is a clinical reaction pattern that includes lupus erythematosus, spongiotic dermatitis (particularly pityriasis rosea), pseudolymphoma and cutaneous B-cell lymphoma. However, it can be the result of cutaneous metastasis by an internal carcinoma. We present the case of a 38-year-old woman with bilateral inflammatory breast cancer following multimodal therapy. After chemotherapy, the patient developed EAC on her back, clinically suspect of subacute cutaneous lupus erythematosus. A skin biopsy of annular lesion revealed dermal lymphatic infiltration by inflammatory breast carcinoma. Immunohistochemically, HER2 overexpression and negativity for hormone receptor are the hallmarks of this disease. Cutaneous metastasis by inflammatory breast carcinoma mimicking EAC is rare, and it has not been described in extramammary locations. Its recognition by the dermatologist is important because it can be a clinical manifestation of locally recurrent cancer.

Zaleplon increases nocturnal melatonin secretion in humans.

Insomnia is the most common sleep condition. Many hypnotics decrease nocturnal melatonin secretion. The aim of this research consists of studying the effect of the hypnotic drug zaleplon on melatonin secretion. Twelve non-smoker drug-free healthy male subjects participated in the study. All participants were normal sleepers and aged 33.2 +/- 11.7 years. They orally took 10 mg of zaleplon at 22:00 h in a double-blind, randomized, cross-over design. The study was carried out during two consecutive days in a week-end. Blood samples were extracted at 22:00, 23:00, 24:00, 01:00, 02:00 and 12:00 h. Melatonin was measured by an ELISA assay. All the subjects had a circadian rhythm of melatonin secretion. Zaleplon compared to placebo increased significantly the melatonin levels at 23:00, 24:00 and 01:00 h. No differences in melatonin levels between placebo and zaleplon were found at 12:00, 22:00 and 02:00 h. Zaleplon compared to placebo increased by 46% the Area Under the Curve of melatonin secretion. The present study indicates that zaleplon increases nocturnal melatonin secretion without increasing daytime melatonin levels. We suggest that when clinicians prescribe a hypnotic, the effect on melatonin levels should be another parameter to be taken into account.

Acute phase proteins as biological markers of negative psychopathology in paranoid schizophrenia.

INTRODUCTION: Acute inflammatory response is one of the pathophysiological elements involved in the etiology of schizophrenia. This paper aims to study the relationship between Acute Phase Proteins (APPs) and psychopathology in paranoid schizophrenia. METHOD: Fifteen physically healthy inpatients meeting DSM-IV criteria for paranoid schizophrenia took part in the study. The Spanish version of the Positive and Negative Syndrome Scale (PANSS) was used in order to rate psychopathology. Ceruloplasmin, Complement's fraction 3 (C3) and fraction 4 (C4) levels were measured as APPs. RESULTS: Five out of seven items of the PANSS negative subscale showed a positive correlation with the APPs at a significant level. Poor Attention and Active Social Avoidance, two items of the general psychopathology subscale, correlated significantly with the APPs. No single item of the positive subscale correlated with the APPs. CONCLUSIONS: Ceruloplasmin, C3 and C4 blood levels are useful peripheral biological markers of negative acute paranoid schizophrenic symptoms.

[Melatonin therapeutic use in psychiatry: a 39 year bibliographic study]. / Uso terapéutico de la melatonina en psiquiatría: un análisis bibliográfico de 39 años.

INTRODUCTION: The therapeutic uses of melatonin in psychiatry are reviewed. METHODS: Data source and search strategy: a 39 year period search covering a 39 year period (1966-2004) was carried out using Medline data base. The search strategy consisted in the combination of the key words ((mental disorders or psychiatry)) and ((melatonin and therapeutic use)). Two restrictive criteria were applied: a) selection of studies carried out in humans, and b) only randomized controlled trials were admitted RESULTS: 56 articles were found. Twelve were excluded because they were not directly related to the study aim. Melatonin was used in 44 articles related to different clinical conditions. It was used because of its hypnotic and/or resynchronizing actions in 93.2 % of the articles, while in 4.5 % of the articles melatonin was used due to its antioxidant properties. CONCLUSIONS: The main use of melatonin as a therapeutic agent in psychiatry is in sleep disorders and its use in other psychiatric is minor.

Seasonality of psychopathology and circannual melatonin rhythm.

The association of seasonal changes in health and disease has been known for centuries. The prevalence of psychopathological symptoms with seasonal fluctuations and the use of melatonin as a biological marker of circadian and circannual rhythms is well documented. The aim of this work was to study the variability of melatonin secretion between summer and winter in our geographical area (28 degrees N, 16 degrees W) and relate the changes to the level of psychopathology. Ten drug-free, nonsmoker, healthy subjects were studied in summer (August) and winter (December). Blood samples for melatonin assays were collected every hour at night for 5 hr, from 22:00 to 02:00 hr, and next day at noon. Melatonin was assayed by an ELISA technique. Psychopathology was evaluated by means of the 28-item version of the General Health Questionnaire (GHQ-28). All subjects had a circadian rhythm of melatonin secretion in summer and winter. There was a seasonal rhythm with melatonin levels being significantly higher at night in winter than in summer. Melatonin levels at 22:00, 23:00, 24:00 and 01:00 hr and mean melatonin area under the curve (AUC) were significantly higher in winter than in summer. Melatonin AUC increased 80% in winter compared with summer. The GHQ-28 somatic and anxiety subscales and the total GHQ-28 score were significantly higher in winter than summer. Psychopathology scores were significantly and negatively correlated with melatonin production in summer and winter. Our data strongly suggest that melatonin production and psychopathology levels present seasonal fluctuations and these variations should be taken into account when conducting research in this field.

A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer's disease.

OBJECTIVE: To determine the usefulness of an interactive multimedia internet-based system (IMIS) for the cognitive stimulation of Alzheimer's disease. METHODS: This is a 24-week, single-blind, randomised pilot study conducted on 46 mildly impaired patients suspected of having Alzheimer's disease receiving stable treatment with cholinesterase inhibitors (ChEIs). The patients were divided into three groups: (1) those who received 3 weekly, 20-min sessions of IMIS in addition to 8 h/day of an integrated psychostimulation program (IPP); (2) those who received only IPP sessions; and (3) those who received only ChEI treatment. The primary outcome measure was the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog). Secondary outcome measures were: Mini-Mental State Examination (MMSE), Syndrom Kurztest, Boston Naming Test, Verbal Fluency, and the Rivermead Behavioral Memory Test story recall subtest. RESULTS: After 12 weeks, the patients treated with both IMIS and IPP had improved outcome scores on the ADAS-Cog and MMSE, which was maintained through 24 weeks of follow-up. The patients treated with IPP alone had better outcome than those treated with ChEIs alone, but the effects were attenuated after 24 weeks. All patients had improved scores in all of the IMIS individual tasks, attaining higher levels of difficulty in all cases. CONCLUSION: Although both the IPP and IMIS improved cognition in patients with Alzheimer's disease, the IMIS program provided an improvement above and beyond that seen with IPP alone, which lasted for 24 weeks.

A study of risk factors for hypospadias in the Rhône-Alpes region (France).

OBJECTIVE: Hypospadias is one of the most common congenital urogenital malformations in males with a significantly increasing incidence over the past 20 years. The causes of this insufficient virilization of the genital tubercle are essentially unknown. SUBJECTS AND METHODS: A hospital-based controlled study was realized with 225 hypospadias cases at Debrousse Hospital, Lyon, using a detailed questionnaire completed during a consultation with the patients' parents and those of controls of the same age. The chi(2), the P-value, the odds ratios and the 95% confidence interval were assessed. RESULTS: Hypospadias was found to be positively associated with genetic factors (as defined by the presence of other case(s) in the family in one case in four) and with neonatal low birth weight, fair-haired boys, maternal history such as viral infection during the first trimester, order of parity, toxaemia of pregnancy, delivery modality such as caesarean section, and environmental pollution. CONCLUSIONS: These results show that aetiological factors of hypospadias are likely to be related to three main fields which interact: genes, the placenta and environmental factors.

[Safety in melatonin use]. / Seguridad en el uso de la melatonina.

INTRODUCTION: The interest on melatonin (MLT) as a psychiatric treatment has increased a lot in the last decade. This is mainly due to MLT safety and its lack of serious adverse reactions. The aim of this paper consists of reviewing the adverse effects to MLT consumption in humans. METHOD: A 35-year (1966-2000) bibliographic search using the Medline database was carried out. The intersection of the key word melatonin with the group of words adverse effects or side effects or adverse reactions or toxicity was the strategy of the search. RESULTS: 307 articles were elicited and 9 were related to MLT adverse effects. The range of MLT dose involved in the adverse reactions oscillated between 1 mg and 36 mg. The adverse reactions were: one patient with autoimmune hepatitis, one case of confusion due to MLT overdose, one case of optic neuropathy, four subjects with fragmented sleep, one psychotic episode, one case of nistagmus, four cases of seizures, one case of headache and two cases of skin eruptions. CONCLUSIONS: Attention should be paid on the necessity of enquiring about the drugs that patients are taking, because this product is not harmless for health.

FLRG, an activin-binding protein, is a new target of TGFbeta transcription activation through Smad proteins.

The FLRG gene encodes a secreted glycoprotein that binds to activin and is highly homologous to follistatin, an activin ligand. We cloned the promoter region of the human FLRG gene, and defined the minimal region necessary for transcription activation in a reporter-system assay. We showed that the fragment between positions -130 and +6, which consists of multiple consensus Sp1-binding sites, is required for the constitutive expression of the FLRG gene. We demonstrate here that FLRG mRNA expression is rapidly induced by TGFbeta or by transfection with Smad protein expression vectors in human HepG2 cells. We investigated the transcription-regulation mechanism of FLRG expression in HepG2 cells following treatment with TGFbeta. By deletion and point-mutation analysis of the FLRG promoter, we identified a Smad-binding element involved in the TGFbeta-inducible expression of the FLRG gene. Moreover, transactivation of the FLRG promoter by TGFbeta was compromised by dominant-negative mutants of Smad3 and Smad4 proteins. In addition, gel electrophoresis mobility-shift assays demonstrated the specific interaction of Smad3 and Smad4 proteins with the Smad-binding element consensus motif found in the FLRG promoter. Taken together, our data imply that Smad proteins participate in the regulation of expression of FLRG, a new target of TGFbeta transcription activation.

MT1-MMP in rat testicular development and the control of Sertoli cell proMMP-2 activation.

Metalloproteases (MMPs) are likely to be involved in the restructuring events occurring in the testis throughout development. We here demonstrate that membrane-type 1 (MT1)-MMP, a physiological activator of proMMP-2 under TIMP-2 control, is present within the testis together with MMP-2 and TIMP-2. In the prepubertal testis MT1-MMP immunoreactivity was uniformly distributed, whereas in the adult it was confined to the apical compartment of the tubules, where meiosis and spermiogenesis occur. We further showed that the two cell lineages (somatic and germinal) expressed MT1-MMP and TIMP-2, whereas MMP-2 was of somatic origin. To get a better picture into proMMP-2 activation, use was made of a model of cultured Sertoli cells treated with FSH or co-cultured with germ cells to mimic an immature or a mature developmental period, respectively. We found that follicle-stimulating hormone enhanced the expression of MMP-2 and TIMP-2 but not of MT1-MMP, and promoted the activation of proMMP-2. In co-cultures, a tremendous elevation and activation of MMP-2 was observed, which might relate to the processed MT1-MMP form solely detected in germ cells. That MMP-2 synthesis and activation are under local (germ cells) and hormonal (follicle-stimulating hormone) regulation emphasizes the importance of MMPs in testicular physiology.

[Efficiency of melatonin in the treatment of insomnia]. / Eficacia de la melatonina en el tratamiento del insomnio.

UNLABELLED: The aim of this research consists of studying whether melatonin (MLT) may be considered as an alternative for the treatment of insomnia. METHODS: A 33-year period (1966-1998) of computerised search using Medline database was performed. Melatonin, pineal gland and insomnia were used as key words. RESULTS: 93 articles were elicited; 85 were excluded because they were reviews (44) or were not directly related to the research topic (41). 111 insomniac patients were treated with MLT in 8 articles. 60% of the patients reported an improvement of sleep quality. Objective sleep measures also improved; there was a decrease in the sleep latency time and the number of awakenings (62% and 50% of patients respectively) after MLT treatment. CONCLUSIONS: Melatonin may have a promising future for the treatment of insomnia. The lack of standardised criteria for diagnosing sleep disorders and the lack of structured psychiatric interviews for ruling out psychiatric pathology are clear obstacles in generalizing these results.

Risperidone and clozapine combination for the treatment of refractory schizophrenia.

Clozapine is the most widely used antipsychotic drug for the treatment of refractory schizophrenia. Here we report the case of two residual schizophrenic patients refractory to conventional antipsychotics who showed a poor response to atypical antipsychotics. The combination of risperidone and clozapine produced a noticeable improvement in the patients' clinical status and a shortening of the treatment response latency.

Tumor necrosis factor-alpha regulates plasminogen activator inhibitor-1 in rat testicular peritubular cells.

We examined the regulation by tumor necrosis factor-alpha (TNF alpha) of plasminogen activator inhibitor-1 (PAI-1) in cultured peritubular cells recovered from 20-day-old rat testes. We demonstrated that TNF alpha in a nanomolar dose range stimulated PAI-1 messenger RNA (mRNA; Northern blots) as well as immunoreactive (Western blots) and bioactive (Stachrom) PAI-1 protein. Induction of PAI-1 mRNA started 4 h after the addition of TNF alpha (2.5-fold increase) and peaked (7-fold increase) after 24 h of treatment. Actinomycin D and cycloheximide inhibited the effects of TNF alpha on PAI-1 mRNA, suggesting that ongoing RNA and protein syntheses were required. The combined actions of transforming growth factor-alpha (TGF alpha), a potent inducer of PAI-1, and TNF alpha on PAI-1 were less than additive, suggesting the activation of some common pathway. TNF alpha action on PAI-1, like that of TGF alpha demonstrated previously, was masked by a preexposure to phorbol myristate acetate (a stimulator of protein kinase C) and strongly reduced by staurosporine (an inhibitor of the protein kinase C). Furthermore, using genistein to inhibit tyrosine kinase activity, we not only blocked the action of TGF alpha on PAI-1 [initiated upon binding to the tyrosine kinase epidermal growth factor/TGF alpha receptor (EGFR)], but also markedly reduced that of TNF alpha. Finally, TNF alpha, at a dose range that stimulated PAI-1, enhanced EGFR mRNA levels and EGF binding. Together, the present findings suggest that some of the biological effects of TNF alpha on PAI-1 might be secondary to de novo synthesis of EGFR. Because TNF alpha probably originates from testicular macrophages, such a regulation of PAI-1 by TNF alpha may occur in the context of physiological interactions between the testis and the immune system.

[Acute obstruction of the colon secondary to biliary lithiasis]. / Obstrucción aguda de colon secundaria a litiasis biliar.

Gallstone ileus is an unusual cause of mechanical obstruction of the gastrointestinal tract; but obstruction of the colon by a gallstone is an even more rare event, and there are few references in the literature. We describe the cases of two elderly women who were admitted to the Emergency Service with a mechanical obstruction of the colon and air in the biliary tract. A barium-enema examination showed the presence of a foreign body in the sigmoid colon; this was found to be a gallstone in a subsequent colonoscopy in one of the patients; a precise preoperative diagnosis was not possible in the other. In both cases the obstruction was caused by a gallstone impacted in the sigmoid colon and a cholecystocolonic fistula was evident in a postoperative barium enema examination. Correction of the obstruction is the main objective of initial treatment. The repair of the fistula can be performed at the same time or at a later date.

A clinical trial on the prevention of catheter-related sepsis using a new hub model.

BACKGROUND: Catheter hub contamination is being increasingly recognized as a source of catheter-related sepsis. The authors have investigated the efficacy of a new hub design in preventing endoluminal catheter contamination and catheter-related sepsis arising at the hub. METHODS: Adult surgical and intensive care patients requiring a subclavian catheter for at least 1 week were randomly assigned to receive catheters with standard connectors (control group, n=73) or equipped with a new hub model (new hub group, n=78). Skin, catheter tip, and hub cultures were performed at the time the catheter was withdrawn because therapy was terminated or because of suspicion of sepsis, in which case peripheral blood cultures were taken. RESULTS: Of the 151 patients included, 15 (10%) developed catheter-related sepsis. Catheters were more often withdrawn because suspicion of infection in the control group (42 vs. 19%, p<0.005). Catheter sepsis rate was higher in the control group (16 vs. 4%, p<0.01) because of the low rate of catheter sepsis arising at the hub observed in the new hub group (1 vs. 11%, p<0.01). The prevalence of culture-positive catheter hubs without associated bacteremia (colonization) was higher in the control group (18 vs. 5%, P<0.03). CONCLUSIONS: A new catheter hub has proved to be useful in preventing endoluminal bacterial colonization and catheter-related sepsis in subclavian lines inserted for a mean of 2 weeks.