Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial.

BACKGROUND: Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. METHODS AND FINDINGS: The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. CONCLUSIONS: In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. TRIAL REGISTRATION: NCT04375098.

Hipercalcemia severa en el curso de rabdomiolisis: caso clínico / Rhabdomyolysis and severe hypercalcemia: report of one case

Rhabdomyolysis (RD) is the process that leads to cell destruction of striated muscle. Causes include inherited metabolic defects or acquired disorders. RD is frequently associated with acute kidney injury (AKI) and disorders of calcium metabolism. We report a 33 year old man that after amphetamine consumption and an uninterrupted 3,000 km driving presented vomiting, muscle pain and dark urine. He had elevated creatinkinase levels, severe hypocalcemia and an acute renal failure. He was treated with hemodialysis and calcitriol. He was transferred to our hospital and on admission a serum calcium of 18 mg/dl was detected. He continued on hemodialysis, recovering renal function and with normalization of creatinkinase levels and serum calcium level.

Vigencia del efecto placebo: su biología desde la genética a la conducta / Biological and genetic mechanisms underlying the placebo effect

The placebo effect has been seldom studied in the history of medicine. However, during the last decades, the great impact of this phenomenon in clinical practice, ranging from surgical to psychiatric field, has been revealed. Research elucidated both the psychological mechanisms and genetic polymorphisms that affect the susceptibility of individuals to express this phenomenon. We herein review the psychological mechanisms, brain structures (anterior cingulate cortex, nucleus accumbens, dorsolateral prefrontal cortex, insular cortex, thalamus) and neurotransmission systems involved (opioid, dopaminergic, cannabinoid, serotoninergic, cholecystokinin). These are the clue to recognize the polymorphisms that have been identified so far. The biological basis of both the placebo effect and its alter ego, the nocebo effect, are well recognized, and related to corresponding psychological processes. Finally, the implications of the findings in clinical practice and medical training are discussed.

[Suicide in hospitalized patients and medical liability]. / Consideraciones acerca de la conducta suicida de pacientes hospitalizados y responsabilidad del médico tratante.

Suicide is a complex phenomenon that has accompanied human beings throughout history. Its strong association with mental disorders led to its medicalization and psychiatrists became the physicians in charge of diagnosing and treating patients at risk of suicide. This article discusses the potential limitations that psychiatrists may face when diagnosing suicide risk and providing optimal care. Evidence of the eventual inevitability of suicide and the tension that may arise between providing optimal treatments on the one hand and preserving the rights of patient's autonomy and dignity on the other is also presented. We propose that although diagnosing and adequately treating patients at risk of suicide would be the psychiatrist's responsibility, the act of suicide itself is personal and non-transferable. Considering the latter as part of the medical team's responsibilities would turn working with patients with mental disorders into a fearless act. Finally, suicide should be considered to be part of the natural history of the evolution of many mental disorders and, thus, should constitute a specific topic when training specialists.

Description of internet addiction among Chilean medical students: a cross-sectional study.

OBJECTIVE: Internet addiction (IA) has been described as an emerging behavior related to the development of new technologies, with scarce studies on the subject and none involving medical students. The Internet Addiction Test (IAT) is a screening instrument used to detect IA worldwide, which was published in 1998 and inspired by the DSM-IV criteria for pathologic gambling. The objective of this study aims to measure the prevalence of IA in Chilean medical students and its possible association with demographic variables and depressive symptoms. METHODS: First- to fifth-year undergraduate medical students at a medical school in Santiago de Chile answered a self-administered survey that included demographic data, the IAT scale, and the Goldberg's General Health Questionnaire (GHQ-12) to screen for IA and depressive symptoms, respectively. RESULTS: Three hundred eighty-four students participated, achieving a response rate of 69.8 %, of which 11.5 % were classified as problematic users according to the IAT. The authors found a statistical association between positive results on the IAT and positive scores on the GHQ-12, as well as with the male gender. CONCLUSION: In this first study of IA in medical students, the authors found a rate of incidence similar to what has been published in the literature focusing on college students. Additionally, there was a positive association between emotional symptoms and other abuse behaviors.

Neurobiologic basis of craving for carbohydrates.

OBJECTIVES: There is a relationship between emotional disorders, obesity, and craving for carbohydrates. This relationship complicates the success of treatments aimed at combatting obesity, which is considered to be the epidemic of the twenty-first century. We conducted a review of the neurobiologic basis for carbohydrate craving, with the hope that this understanding will enable the design of more efficient therapeutic strategies. METHOD: We conducted a non-systematic literature search in PubMed using MeSH. RESULTS: Research on the basis of carbohydrate craving is varied, but may be grouped into five main areas: the serotonergic system, palatability and hedonic response, the motivational system, stress response systems, and gene-environment interaction. CONCLUSIONS: The models that integrate motivational systems with palatability and hedonic response studies are the ones that we believe can best explain both craving for carbohydrates and related addictive phenomena. Research has contributed to a greater understanding of the neurobiologic basis of carbohydrate craving. The latter, in turn, contributes to an understanding of the implications, challenges, and possible therapies that might be put in place to cope with this phenomenon.

[Geriatric vs. non-geriatric psychiatric hospitalization to the psychiatric services of a general hospital in Chile]. / Internación psiquiátrica geriátrica vs. no geriátrica en un servicio de psiquiatría de un Hospital General en Chile.

INTRODUCTION: It is estimated that Chilean geriatric population (=65 years) will hit 16% in the year 2030. Psychiatric longer stays have been described for those equal 65 years vs. less than 65 years. We aim to describe the characteristics associated with lengths of stay in our psychiatric unit. MATERIAL AND METHODS: Retrospective review of 3112 admissions between July 2001 and June 2010 to the general psychiatric service of the Pontific Catholic University of Chile. RESULTS: 5.1% (n=132) of the sample was geriatric patients. The average length of stay for this group was 12.4 days (p=0.41). Both the geriatric and non-geriatric population presented a high prevalence of affective disorders (63.7% and 55.1%, respectively). In the geriatric group, there was a higher presence of bipolar disorder (27.3 vs. 19.5%; p less than 0.05) and dementia (16.7% vs. 0.5%). In contrast, for = 65 years, there was significantly less prevalence of adaptive and anxiety disorders (3% vs. 13%; p less than 0.01). There was just one case of personality disorder and no cases of eating disorders in the geriatric group. There were no differences in the lengths of stay according to diagnosis. CONCLUSIONS: We did not find longer stay times, in general or associated with specific diagnoses, in geriatric patients versus non-geriatric patients.

[Status of health psychology teaching in Chilean schools of medicine]. / Enseñanza de Psicología Médica en las escuelas de medicina chilenas.

BACKGROUND: Physicians should be exposed, during their training to basic concepts in psychology. AIM: To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. MATERIAL AND METHODS: We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. RESULTS: Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. CONCLUSIONS: There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn.

[The contribution of Jose Juan Bruner to Chilean psychiatry]. / José Juan Bruner (1825-1899): una estrella fugaz en la historia de la psiquiatría chilena.

The contribution of Dr. Bruner to psychology and psychiatry is largely unknown. This is a summary of the ideas proposed in his "Medical-Psychological Monograph" from 1857, that was written after a case of a possibly possessed woman from Santiago. In this work Dr. Bruner discards the spirit-brain duality, proposes a functional morphology of the brain, recognizes the importance of remote history taking when interviewing patients, proposes a theory for self-formation and the risks of self-fragmentation. He proposes that the case of the woman corresponds to a brain disease, opposing the thought of an ovarian and uterine origin. He proposes a hypothesis of the psychogenic origin of the disease, the importance of what happened during dreams and beyond the conscience of the patient. Many of his ideas preceded by decades those of Charcot and Freud, but they have not had a proper recognition.

[Illicit and psychotropic drug use among medical students at the Pontificia Universidad Católica de Chile]. / Consumo de sustancias ilícitas y psicotrópicos entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile.

BACKGROUND: Illicit drug abuse is a public health problem, generally starting in adolescence. Medical students are not an exception. AIM: To assess the consumption of illicit drugs among medical students of the Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: A questionnaire used by the National Council for the Control of Substance Abuse (CONACE) to evaluate substance use and the Goldberg Health Questionnaire (GHQ-12), were applied to medical students. The questionnaires were self administered under supervision. RESULTS: The survey was completed by 569 of 775 students (74%). "Ever used" reached 33% for marijuana, 1.196 for cocaine, 2.1% for amphetamines without prescription, 6.9% for not prescribed benzodiazepines and 5.8% for not prescribed antidepressants. The use of these substances was only associated for ever used marijuana and level of career (p <0.01), with the highest rate in the seventh final year (51.4%). Benzodiazepine use was also associated with the level of career (p <0.01) with less than 6% prevalence from first to fourth and the highest in seventh year (32.4%). Non prescribed antidepressant use was significantly higher among women. Tobacco and alcohol use were associated with consumption of marijuana (p <0.0001) and benzodiazepines (p <0.0001). CONCLUSIONS: Our medical students have low marijuana consumption rates, only above Turkey. Cocaine and amphetamines use is low, benzodiazepine consumption is higher among final year students. Antidepressant use is higher among women.

[Smoking and alcohol drinking among medical students at the Pontificia Universidad Católica de Chile]. / Consumo de tabaco y alcohol entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile.

BACKGROUND: Tobacco and alcohol consumption are public health problems, generally starting in adolescence. Medical students are not an exception. AIM: To determine the characteristics of tobacco and alcohol use among medical students at the Pontificia Universidad Católica de Chile and their association with gender, career level and mental health. MATERIAL AND METHODS: A questionnaire to evaluate substance use was applied along with Goldberg Health Questionnaire (GHQ-12), as a mental health risk predictor, to all medical students in November 2005. RESULTS: The survey was completed by 569 of 775 students (74%). Current smokers were 23- 7%, with the lowest figure, 13-5% in sixth year, and the highest, 40.5% in seventh year (p <0.01). Thirty one percent of students with an score of five and over in the GHQ-12 were smokers, compared to 19% among those with a lower score. Daily smokers were 40%o of the current smokers. Seventy four percent of students consumed alcohol during the last month. No association with sex or GHQ-12 was observed. The lowest alcohol consumption rate was observed in second year, and the highest in sixth year (66%o and 89-2%o, respectively, p <0.01). Fifty three percent of men and 26%o of women drank three or more drinks in any given day (p <0.01). Sixty three percent of men and 81% of women never drank more than five drinks in one day, during the last month (p <0.01). CONCLUSIONS: Our medical students smoke less than Chilean youth but more than medical students of countries such as the USA. They drink less than Anglo-Saxon medical students but more than Chilean youth. Male consumption is greater than that of women. Smoking and alcohol drinking are mutually associated.

Consumo de sustancias ilícitas y psicotrópicos entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile / Illicit and psychotropic drug use among medical students at the Pontificia Universidad Católica de Chile

Background: Illicit drug abuse is a public health problem, generally starting in adolescence. Medical students are not an exception. Aim: To assess the consumption of illicit drugs among medical students of the Pontificia Universidad Católica de Chile. Material and Methods: A questionnaire used by the National Council for the Control of Substance Abuse (CONACE) to evaluate substance use and the Goldberg Health Questionnaire (GHQ-12), were applied to medical students. The questionnaires were self administered under supervision. Results: The survey was completed by 569 of 775 students (74%). “Ever used” reached 33% for marijuana, 1.1% for cocaine, 2.1% for amphetamines without prescription, 6.9% for not prescribed benzodiazepines and 5.8% for not prescribed antidepressants. The use of these substances was only associated for ever used marijuana and level of career (p <0.01), with the highest rate in the seventh final year (51.4%). Benzodiazepine use was also associated with the level of career (p <0.01) withless than 6% prevalence from first to fourth and the highest in seventh year (32.4%). Non prescribed antidepessant use was significantly higher among women. Tobacco and alcohol use were associated with consumption of marijuana (p <0.0001) and benzodiazepines (p <0.0001). Conclusions: Our medical students have low marijuana consumption rates, only above Turkey. Cocaine and amphetamines use is low, benzodiazepine consumption is higher among final year students. Antidepressant use is higher among women.

Consumo de tabaco y alcohol entre los estudiantes de medicina de la Pontificia Universidad Católica de Chile / Smoking and alcohol drinking among medical students at the Pontificia Universidad Católica de Chile

Background: Tobacco and alcohol consumption are public health problems, generally starting in adolescence. Medical students are not an exception. Aim: To determine the characteristics of tobacco and alcohol use among medical students at the Pontificia Universidad Católica de Chile and their association with gender, career level and mental health. Material and methods: A questionnaire to evaluate substance use was applied along with Goldberg Health Questionnaire (GHQ-12), as a mental health risk predictor, to all medical students in November 2005- Results: The survey was completed by 569 of 775 students (74 percent). Current smokers were 23- 7 percent, with the lowest figure, 13-5 percent in sixth year, and the highest, 40.5 percent in seventh year (p <0.01). Thirty one percent of students with an score of five and over in the GHQ-12 were smokers, compared to 19 percent among those with a lower score. Daily smokers were 40 percento of the current smokers. Seventy four percent of students consumed alcohol during the last month. No association with sex or GHQ-12 was observed. The lowest alcohol consumption rate was observed in second year, and the highest in sixth year (66 percento and 89-2 percento, respectively, p <0.01). Fifty three percent of men and 26 percento of women drank three or more drinks in any given day (p <0.01). Sixty three percent of men and 81 percent of women never drank more than five drinks in one day, during the last month (p <0.01). Conclusions: Our medical students smoke less than Chilean youth but more than medical students of countries such as the USA. They drink less than Anglo-Saxon medical students but more than Chilean youth. Male consumption is greater than that of women. Smoking and alcohol drinking are mutually associated.

Síndrome de discontinuación de antidepresivos / Withdrawal syndrome of antidepressants

Introducción: Considerando el amplio uso de los antidepresivos evaluamos la existencia y características del síndrome de discontinuación de antidepresivos. Métodos. Usando MEDLINE identificamos reportes y artículos de revisión relevantes acerca de síntomas secundarios al retiro de antidepresivos. Resultados. Existe amplia evidencia acerca de un síndrome de discontinuación tras el retiro de antidepresivos tricíclicos, inhibidores de la monoaminooxidasa e inhibidores de recaptura de serotonina, habiéndose descrito desde molestias leves a cuadros severos con síntomas psicóticos y agitación, siendo en general más graves los síntomas asociados a discontinuación de inhibidores de la manoamino-oxidasa y tricíclicos. Conclusiones. La información obtenida debe ser considerada por los clínicos al momento de prescribir el inicio o retiro de antidepresivos. Debe tenerse en cuenta el síndrome de discontinuación de antidepresivos en pacientes que presentan bruscas exacerbaciones sintomáticas. Se sugiere como medida preventiva la disminución gradual de las dosis antes de suspender un antidepresivo

Personalidad premórbida en los trastornos del ánimo y en la esquizofrenia: un estudio empírico / Pre-morbid personality in mood disorders and schizophrenia: an empirical study

Numerosos autores han asociado ciertos rasgos de la personalidad a las diferentes formas de trastorno mental. Las depresiones unipolares han sido asociadas a una estructura de personalidad premórbida rígida, fijada al rol y al orden e intolerante a la ambigüedad. Los trastornos bipolares a estructuras cambiantes, flexibles, creativas y sociables y los trastornos esquizofrénicos a rasgos introvertidos. Este trabajo analiza empíricamente las características e interacciones entre algunos constructos de la personalidad premórbida y los trastornos de ánimo y esquizofrénicos. 20 pacientes bipolares, 27 depresivos unipolares y 17 esquizofrénicos, diagnósticados de acuerdo al DSM-III R e ICD-10 y hospitalizados en la Clínica Psiquiátrica de la Universidad de Chile, junto a un grupo control, fueron comparados psicométricamente mediante escalas F, MP-T y de Intolerancia a la ambigüedad de Kischkel, todas de autoevaluación, junto a la escala MP-T de evaluación externa. Los pacientes debieron completar las escalas al momento del alta, encontrándose asintomáticos. El análisis de covarianza de los resultados demostró mayores índices de rígidez e intolerancia a la ambigüedad para el grupo depresivo unipolar, mayores valores de rasgos ciclotímicos como flexibilidad, creatividad y sociabilidad para el grupo bipolar y menores índices de extroversión para el grupo esquizofrénico. Los resultados confirman hallazgos previos registrados en Alemania y Japón, corroborando la hipótesis de que esas formas de personalidad son independientes de las influencias culturales. Finalmente se discute el significado de estos hallazgos para la comprensión de la patogénesis, la psicopatología, las formas de evolución y el adecuado tratamiento de estos trastornos

El sistema A.M.D.P. en la evaluación psicopatológica / The A.M.D.P. system in psychopathological evaluation

Numerosos estudios psicométricos han demostrado reiteradamente discrepancias significativas en la definición y concepción de terminología en psiquiatría clínica. En este trabajo se presenta el sistema de categorización psicopatológica AMDP en su versión española, anexando un formulario de evaluación graduada y un listado de ejemplos comunes. Analizando comparativamente las diferentes estrategías e instrumentos de evaluación psicopatológica se intenta discutir las cualidades e imperfecciones del sistema AMDP. Finalmente es subraya la necesidad de homogenizar las definiciones psicopatológicas con el objeto de aumentar la confiabilidad y la comparabilidad de la información psiquiátrica utilizada en clínica, docencia e investigación