Intracranial bleeding risk after minor traumatic brain injury in patients on antithrombotic drugs.

BACKGROUND: Intracranial haemorrhage (ICH) risk after minor traumatic brain injury (mTBI) in patients on antithrombotic treatment is unclear. We compared ICH rates in mTBI patients on single, double and no antithrombotic therapy. Antithrombotic drugs encompassed vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) and antiplatelets. Secondary aim was to identify potential predictors of ICH. METHODS: We retrospectively analysed consecutive adults referred to our emergency department for mTBI. All clinical information was retrieved by patients' charts review. Patients were divided in 5 groups: 1) no antithrombotic users, 2) antiplatelet users, 3) vitamin K antagonist users, 4) direct oral anticoagulants users, and 5) double antithrombotic users. RESULTS: A total of 1846 patients were enrolled, mean age 71 years (IQR 46-83); 1222 (66.2%) were in group 1, 407 (22.0%) in group 2, 120 (6.5%) in group 3, 51 (2.7%) in group 4 and 46 (2.5%) in group 5. At entry, 1387 (75.1%) patients underwent brain CT, 787 (64.4%) in group 1, 387 (95.1%) in group 2, 119 (99.2%) in group 3 and 51 (100%) in group 4 and 43 (93.5%) in group 5. ICH was documented in 36 patients (4.6%; CI 95%: 3.2-6.3) in group 1, 22 (5.9%; CI 95%: 3.6-8.5) in group 2, 5 (4.2%; CI 95%: 1.4-9.5) in group 3, 2 (3.9%; CI 95%: 0.5-13.5) in group 4 and 3 (7.0%; CI 95%: 1.5-19.1) in group 5 (p-value for across groups comparison = 0.86). At multivariable analysis GCS < 15 (OR 7.95 CI 95%: 3.12-20.28), post-traumatic amnesia (OR 6.49; CI 95%:3.57-11.82), vomiting (OR 4.45 CI 95%:1.47-13.50), clinical signs of cranial fractures (OR 8.41 CI 95%: 2.12-33.33), scalp lesions (OR 2.31 CI 95%: 1.09-4.89), but none of antithrombotic drugs were independently associated with ICH. CONCLUSION: mTBI-related ICH rate was similar in patients with and without antithrombotic use. Potential predictors of ICH can be drawn from patients' clinical examination.

Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders.

Part II of this review critically evaluates antidepressants' (AD) efficacy in children and adolescents with anxiety, physical, and behavioral disorders as well as AD's side-effect spectrum. AD are administered increasingly to youths with specific anxiety syndromes phenomenologically paralleling those in adults which are responsive to AD (e.g., panic, obsessive-compulsive disorders). While several trials have not substantiated earlier theoretical considerations suggesting their usefulness in separation anxiety, their recent success in ameliorating obsessive-compulsive symptoms is encouraging. Systematic drug treatment studies however are limited because of the common overlap of anxiety syndromes with each other and other prominent psychiatric disturbances. More consistent benefits with AD are seen in the physical (e.g., enuresis, bulimia nervosa) and behavioral disorders (e.g., attention deficit-hyperactivity disorder). The wide-ranging benefits of AD in nonaffective disorders suggest AD are more appropriately viewed as broad spectrum pharmacotherapeutics.

Antidepressant treatments in children and adolescents. I. Affective disorders.

Part I of this review critically evaluates antidepressants' benefits for children and adolescents with affective disorders. The effectiveness of antidepressants is characterized with specific references regarding diagnostic methodology, measurement characteristics, response definitions, recovery rates, length of treatment, and plasma level monitoring. Antidepressants' efficacy for depressed youths is quite circumscribed, and their superiority to placebo remains unproved. Their intriguing lack of efficacy in affective disorders is discussed based on methodological issues and from a theoretical perspective. Clinical and research implications are presented.

Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents.

The concurrent validity of the Beck Depression Inventory (BDI) was evaluated in 122 outpatient adolescents referred to a clinic for depression. Criterion validators were Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) generated diagnoses and a 17-item clinician-rated depression scale extracted from the K-SADS. Initial BDI scores of greater than 13 yielded sensitivity, specificity, and positive predictive powers of 86%, 82%, and 83%, respectively, in differentiating syndromal major depressive disorder (MDD) from nonaffective disordered patients. In repeated interviews in 2 weeks with a BDI score of greater than 13, these parameters were 89%, 88%, and 93%, respectively, in those meeting MDD criteria. The BDI correlated significantly with the 17-item depression score in depressed females but not depressed males because BDI scores were more than 30% higher in females. BDI internal consistency among all cases was 0.91 and was higher in depressed than nondepressed patients.

Protective effects of vitamin c against cisplatin-induced nephrotoxicity and lipid peroxidation in adult rats: a dose-dependent study.

Cisplatin is one of the most active cytotoxic agents in the treatment of cancer, but its clinical use is associated with nephrotoxicity. In the present study we report the effects of different amounts of vitamin C (50, 100 or 200 mg kg(-1)body wt.) in rat kidneys treated with cisplatin (5 mg kg(-1)body wt.), using single doses of both compounds. Cisplatin administration induced lipid peroxidation which was accompanied by a decrease in renal glutathione level in animals killed 7 days after treatments. Furthermore, an increase in serum creatinine has been observed. Treatment of animals with vitamin C 10 min prior to the cisplatin inhibited cisplatin-mediated damage. Seven days after vitamin C plus cisplatin treatments, the depleted level of glutathione and changes in the creatinine clearance recovered to significant levels (P<0.05). Similarly, the enhanced serum creatinine levels which are indicative of renal injury showed a significant reduction (P<0.05) with the three doses of vitamin C tested. The protective effect of vitamin C was dose-dependent. The results suggest that vitamin C is an effective chemoprotective agent against nephrotoxicity induced by the antitumoral cisplatin in Wistar adult rats.

Effect of vitamin C supplementation against cisplatin-induced toxicity and oxidative DNA damage in rats.

Antitumor agents are used as a common therapy against some kinds of cancer. However, as with many agents that have mammalian cell toxicity as a target, physiological adverse effects can occur such as nephrotoxicity and genotoxicity that can be induced in non-tumor cells by generating activated oxygen species, which attack the DNA frequently resulting in oxidative DNA damage. To diminish the undesirable side-effects of therapy and to reduce the levels of oxidative DNA damage, it is recommended for patients to ingest food supplements and vitamins combinations containing substantial amounts of antioxidants. In the present study, we investigated the effects of cisplatin and vitamin C on the renal toxicity and on the oxidative DNA damage. Rats were co-treated with the chemotherapeutic agent cisplatin (5 mg kg(-1) body weight) and dietary doses of vitamin C (50 and 100 mg kg(-1) body weight). Results demonstrated that depending on the treatment protocol, we observed alterations in parameters such as body weight, urinary volume and urinary creatinine, indicating some kidney toxicity. We also observed changes in the urinary levels of 8-OHdG, suggesting possible oxidative DNA damage.