Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement.

OBJECTIVE: There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. MATERIAL AND METHOD: A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. RESULTS: The mean concentration of antibiotic was 23.16 µg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 µg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 µg/g. These results were statistically significant for both concentrations (P<.00001). DISCUSSION: The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection.

[Neurotrophic factors and their importance in attention deficit hyperactivity disorde]. / Factores neurotróficos y su trascendencia en el trastorno por déficit de atención/hiperactividad.

The existing literature that reports findings linked with the involvement of neurotrophic factors in attention deficit hyperactivity disorder (ADHD) is reviewed. Neurotrophins, a family of neurotrophic factors, are a kind of proteins that are specific to the nervous system and play an essential role in neuron survival, differentiation and proliferation during the development of the central and peripheral nervous system. These molecules stimulate axonal growth and exert an influence on the connections with the target tissue in order to establish the synaptic connections. The study of neurotrophins in ADHD, a neurodevelopmental disorder, is of interest mainly due to the functions that these proteins perform in the central nervous system. Studies on animal, pharmacological and molecular genetic models yield evidence that relates neurotrophins with the disorder. This work reviews the results from the studies conducted to date on ADHD and neurotrophic factors, especially brain-derived neurotrophic factor (BDNF). Thus, although pharmacological studies suggest that the response to atomoxetine in adults with ADHD is not directly mediated by the effect on the BDNF, reductions in BDNF levels in the plasma of adult patients with ADHD have been reported. Further studies with broader samples and greater control of environmental factors that can regulate neurotrophin expression, such as diet, physical exercise and situations of social risk, are needed to be able to determine the role they play in the aetiology of ADHD.

TITLE: Factores neurotroficos y su trascendencia en el trastorno por deficit de atencion/hiperactividad.Se revisa la bibliografia existente sobre los hallazgos de la implicacion de los factores neurotroficos en el trastorno por deficit de atencion/hiperactividad (TDAH). Las neurotrofinas, una familia de factores neurotroficos, son un tipo de proteinas especificas del sistema nervioso con un papel esencial en la supervivencia, diferenciacion y proliferacion neuronal durante el desarrollo del sistema nervioso central y periferico. Estas moleculas estimulan el crecimiento axonal e influyen en las conexiones con el tejido diana para el establecimiento de las conexiones sinapticas. El interes por el estudio de las neurotrofinas en el TDAH, un trastorno del neurodesarrollo, deriva principalmente de las funciones que estas proteinas ejercen en el sistema nervioso central. Existen evidencias derivadas de estudios en modelos animales, farmacologicos y de genetica molecular que relacionan a las neurotrofinas con el trastorno. En el presente trabajo se revisan los resultados de los estudios realizados hasta el momento sobre TDAH y factores neurotroficos, principalmente factor neurotrofico derivado de cerebro (BDNF). Asi, aunque estudios farmacologicos sugieren que la respuesta a la atomoxetina en adultos con TDAH no esta directamente mediada por el efecto sobre el BDNF, se han descrito disminuciones en los niveles plasmaticos de BDNF en pacientes adultos con TDAH. Se requieren estudios con muestras mas amplias y mayor control de factores ambientales que pueden regular la expresion de la neurotrofinas, como la dieta, el ejercicio fisico y situaciones de riesgo social, con el fin de determinar el papel de estas en la etiologia del TDAH.

[Diagnosis and treatment of attention deficit hyperactivity disorder in adults]. / Diagnostico y tratamiento del trastorno por deficit de atencion/hiperactividad en adultos.

AIM: To review the latest data available concerning the diagnosis and treatment of adults with attention deficit hyper-activity disorder (ADHD). DEVELOPMENT AND CONCLUSIONS: A number of different instruments for evaluating ADHD have been adapted to the adult patient and allow a reliable diagnosis of the disorder to be reached. Semi-structured interviews, like the Diagnostisch Interview Voor ADHD 2.0 (DIVA), simplify the task of performing a rigorous evaluation of both the symptoms of the disorder in adulthood and the dysfunctions generated by ADHD. Quick screening instruments that allow better detection of ADHD in adults, such as the Adult Self-Report Scale 1.1 (ASRS), have been validated. In recent years, there has been a notable increase in the number of studies focused on ADHD in adults and that research has provided solid data regarding the safety and effectiveness of different treatments. According to the recommendations of the European Consensus statement by the European Network Adult ADHD, the treatment ought to be multimodal, which means combining pharmacological interventions with psychological and psychosocial ones. Methylphenidate displays a high degree of effectiveness and safety in the treatment of adults at doses of around 1 mg/kg/day. Amphetamines, such as lisdexamphetamine, have also proved to be effective in the treatment of adults with ADHD. Among non-stimulant treatments, atomoxetine has proved to be effective and safe in adults in doses of about 80-100 mg/day. Excellent studies have been conducted on the cognitive-behavioural treatment of adults with ADHD, the results of which highlight its effectiveness in both the short and the long term.