Fasting plasma peptide YY concentrations are increased in patients with major depression who associate weight loss.

BACKGROUND: Many patients with major depression refer a decreased appetite and weight loss among their symptoms. Peptide YY (PYY) and ghrelin belong to the family of peptides of the gut-brain axis implicated in the regulation of appetite and energy metabolism. PYY stimulates a powerful central satiety response and ghrelin increases food intake and weight gain. Brain-derived neurotrophic factor (BDNF) also contributes to the central control of food intake as an anorexigenic factor. AIM: To study fasting plasma total and acylated ghrelin, plasma PYY and serum BDNF levels in patients with major depression with weight loss as one of their symptoms and compare them with matched healthy controls. SUBJECTS AND METHODS: Fifteen adult patients, 9 male and 6 female, with recent diagnosis of major depression, and 16 healthy adult subjects, matched by age and anthropometric parameters were studied. All depressed patients referred weight loss and were not under antidepressant therapy. Fasting total PYY, total ghrelin and acylated ghrelin and BDNF were determined. RESULTS: Fasting total PYY was higher in patients than controls (2.01±0.09 vs 1.29±0.16 pmol/l). There were no differences in fasting total ghrelin, acylated ghrelin or BDNF levels. CONCLUSIONS: Major depressed patients, with weight loss at diagnosis, showed higher fasting plasma PYY levels that could contribute to their reduced appetite.

Heart rate measured in the acute aftermath of trauma can predict post-traumatic stress disorder: a prospective study in motor vehicle accident survivors.

OBJECTIVE: To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries. METHODS: We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD. RESULTS: PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p<0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p=0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p=0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD. CONCLUSIONS: HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.

[Dissociative disorder and traumatic events. A study of Spanish population]. / Trastorno disociativo y acontecimientos traumáticos. Un estudio en población española.

Dissociative Disorder is relatively uncommon. It has been associated to the presence of traumatic events and especially to sexual abuse in childhood. Our study presents a clinical sample of 36 patients with Dissociative Disorder, prospectively evaluated with standardized scales in an outpatient department of general psychiatry. The sample is mainly made up of married (86.1%) women (34/36), from medium-low class with important comorbidity (38.9% affective disorders, 52.8% conversive disorders, 41.7% anxiety disorders and 38.9%, personality disorders). Our results show a high rate of childhood traumatic events (58.3%) and a background of sexual abuse (27.8%) in this population as well as other traumatic events in adulthood (55.6%). The prevalence of any traumatic event (27/36) is higher than in general spanish population. However sexual abuse is only slightly higher than the estimated rate of sexual abuse in childhood. Higher scores in the traumatic event scale are correlated with the severity of dissociative symptoms. Only traumatic sexual traumas in childhood correlate with the severity of dissociative features measured by the DES (Dissociative Experiences Scale). Age of the first traumatic event does not correlates with the severity of dissociative symptoms. A background of traumatic sexual abuse in childhood is the only factor related with higher presence of comorbid affective disorders and conversive disorders.

Trastorno disociativo y acontecimientos traumáticos. Un estudio en población española / Dissociative disorder and traumatic events. A study of Spanish population

El trastorno disociativo es una patología relativamente poco frecuente que se ha asociado a la presencia de acontecimientos traumáticos en la infancia y, especialmente, a los abusos sexuales. Nuestro estudio presenta una muestra clínica de 36 pacientes que padecen un trastorno disociativo, evaluados prospectivamente mediante escalas estandarizadas en las consultas habituales de psiquiatría general. La muestra se compone básicamente de mujeres (34/36), casadas (86,1%), de clase media-baja y con una importante comorbilidad (38,9 % trastornos afectivos, 52,8% de conversión, 41,7% de ansiedad y/o 38,9% trastornos de personalidad). Nuestros resultados muestran una alta tasa de acontecimientos traumáticos en la infancia (58,3 %) y de antecedentes de abusos sexuales (27,8%) en esta población, así como de otros acontecimientos traumáticos (55,6 %) en la edad adulta. La prevalencia de cualquier acontecimiento traumático (27/36) es más alta que en población general española, pero sólo discretamente para el caso de los abusos sexuales en la infancia. La gravedad de las puntuaciones de acontecimientos traumáticos correlaciona con la gravedad de la clínica disociativa. La presencia de acontecimientos traumáticos en la infancia de tipo sexual se asocian con la gravedad de la clínica disociativa medida con la Escala de disociación DES. En nuestra muestra, la edad del primer acontecimiento traumático no muestra relación con la gravedad de la clínica disociativa. Los antecedentes de abusos sexuales en la infancia (y no otros) también se relacionan con una mayor presencia de trastornos afectivos y conversivos (AU)

Dissociative Disorder is relatively uncommon. It has been associated to the presence of traumatic events and especially to sexual abuse in childhood. Our study presents a clinical sample of 36 patients with Dissociative Disorder, prospectively evaluated with standardized scales in an outpatient department of general psychiatry. The sample is mainly made up of married (86.1%) women (34/36), from medium-low class with important comorbidity (38.9% affective disorders, 52.8% conversive disorders, 41.7% anxiety disorders and 38.9%, personality disorders). Our results show a high rate of childhood traumatic events (58.3%) and a background of sexual abuse (27.8%) in this population as well as other traumatic events in adulthood (55.6%). The prevalence of any traumatic event (27/36) is higher than in general spanish population. However sexual abuse is only slightly higher than the estimated rate of sexual abuse in childhood. Higher scores in the traumatic event scale are correlated with the severity of dissociative symptoms. Only traumatic sexual traumas in childhood correlate with the severity of dissociative features measured by the DES (Dissociative Experiences Scale). Age of the first traumatic event does not correlates with the severity of dissociative symptoms. A background of traumatic sexual abuse in childhood is the only factor related with higher presence of comorbid affective disorders and conversive disorders (AU)

Venlafaxina retard en monoterapia en el tratamiento de episodios hospitalarios de depresión mayor / Venlafaxine extended release monotherapy in the treatment of episodes of major depression requiring hospitalization

Introducción: Se han publicado pocos estudios sobre las pautas de utilización de antidepresivos en las circunstancias reales de la práctica cotidiana en nuestras unidades de agudos hospitalarias. En especial, nuestro estudio pretende determinar la eficacia de la venlafaxina retard en monoterapia en el tratamiento de la depresión mayor en pacientes hospitalizados graves. Comparamos los resultados con otros tratamientos también en monoterapia. De forma paralela, se intentará determinar la rapidez de acción relativa de todos ellos. Material y métodos: Se trata de un estudio de cohortes de tipo retrospectivo y características observacionales. Se distinguen 3 grupos de sujetos tratados en monoterapia antidepresiva: pacientes hospitalizados diagnosticados de depresión mayor en episodio único o recurrente, con o sin síntomas psicóticos según criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-IV), en tratamiento con venlafaxina retard (grupo A); con antidepresivos del grupo de los inhibidores selectivos de la recaptación de serotonina (grupo B) o con antidepresivos tricíclicos (grupo C). Todos ellos ingresados en nuestra Unidad de Hospitalización de Agudos de Psiquiatría de la Corporació Sanitària Parc Taulí, Sabadell (Barcelona) en el período de enero de 2001 a enero de 2003, ambos incluidos. Resultados: Se detecta a 54 pacientes con depresión mayor tratados únicamente en monoterapia antidepresiva: 16 con venlafaxina retard (grupo A), 5 tratados con inhibidores selectivos de la recaptación de serotonina (grupo B) y 33 con antidepresivos tricíclicos (grupo C). No se observan diferencias en cuanto a las características sociodemográficas ni de gravedad entre los diferentes grupos. En lo referente a los síntomas, los pacientes tratados con antidepresivos tricíclicos presentan más síntomas psicóticos al inicio del tratamiento que en los otros 2 grupos. Se observa una diferencia a favor del grupo A respecto al B en cuanto a la duración del ingreso, en número de días, la Impresión Clínica Global (ICG) al alta, la ICG de mejoría al alta, y en cuanto a la rapidez de mejoría de la Escala de Evaluación de la Actividad Global (EEAG), diferencias no significativas. Se hallan diferencias significativas entre el grupo A y el C en cuanto a la ICG de gravedad al alta (p < 0,004), la ICG de mejoría al alta (p < 0,016) y la rapidez de mejoría de la ICG (p < 0,007) a favor del grupo A. Conclusiones: En nuestra muestra, la venlafaxina retard en monoterapia se muestra eficaz y rápida en el tratamiento de los episodios hospitalarios de depresión mayor

Introduction: Few studies have been published on patterns of utilization of antidepressants under real conditions of daily clinical practice in acute inpatient units in Spain. The aim of the present study was to determine the efficacy of venlafaxine extended release monotherapy in the treatment of inpatients with severe major depressive disorder (MDD) and to compare the results obtained with those of other treatments used as monotherapy. A further aim was to determine the relative speed of onset of antidepressant effect of these treatments. Material and methods: We performed a retrospective, observational, cohort study. There were three groups of patients who received antidepressant monotherapy: inpatients diagnosed with single-episode or recurrent MDD, with or without psychotic symptoms according to DSM-IV criteria, who received venlafaxine extended release, selective serotonin reuptake inhibitors (SSRI) or tricyclic antidepressants. All patients were admitted to the Acute Psychiatric Inpatient Unit of the Corporació Sanitària Parc Taulí between January 2001 and January 2003, inclusive. Results: There were 54 patients with MDD who received antidepressant monotherapy alone: 16 received venlafaxine extended release (group A), 5 received SSRI (group B) and 33 received tricyclic antidepressants (group C). There were no differences in sociodemographic characteristics or severity among the three groups. Patients treated with tricyclic antidepressants had more psychotic symptoms at treatment initiation than did patients in the other two groups. A non-significant difference was observed in favor of group A compared with group B in the number of days of hospitalization, Global Clinical Impression (GCI)-severity scale at discharge, GCI-improvement at discharge and in speed of improvement on the Global Assessment of Functioning (GAF) scale. Significant differences were found between group A and group C in GCI-severity at discharge (p<.004), GCI-improvement at discharge (p<.016) and CGI-speed of improvement (p<.007) in favor of group A. Conclusions: In our sample, venlafaxine extended release monotherapy is effective and rapid in the treatment of episodes of major depression requiring hospitalization

[Home enteral nutrition. Case load of the Clinical Hospital of Barcelona]. / Nutrición enteral domiciliaria. Casuística del Hospital Clínico de Barcelona.

The use of Enteral Nutrition at Home (ENH) in the Hospital Clínico de Barcelona has grown greatly over the last decade, with a certain trend towards stabilization being observed in the last two years, but still growing at a rate of 9.2% per annum. A transverse analysis of the active patients on our ENH register at a given moment has revealed a total of 315 patients receiving treatment. The retrospective analysis of our series during 1998 gave a figure of 643 new cases. The most frequent indication for ENH was neoplasia (44%), followed by neurological pathology (28%). The administration route most frequently used was oral (66% of cases). In the oral route, oncological diagnoses were dominant (52%), whereas administration by means of a naso-gastric tube was mainly due to neurological disorders (72%). The use of PEG (12.5% of administrations via tube) was distributed between oncological and neurological patients, with a slight predominance of the first. Of those patients completing ENH in the same year, duration was in most cases (67%) less than one month. The decrease of the patient due to the underlying disorder was the main cause of termination, followed by the need for short-term nutritional support following discharge from hospital.

Nutrición enteral domiciliaria. Casuística del Hospital Clínico de Barcelona / Enteral nutrition at home. Cases from the Hospital Clínico de Barcelona

El uso de la nutrición enteral a domicilio (NED) en el Hospital Clínico de Barcelona ha experimentado un gran crecimiento en la última década, observándose cierta tendencia a la estabilización en los últimos dos años, pero manteniendo un ritmo de crecimiento del 9,2 por ciento anual. Un análisis transversal de los pacientes activos en nuestro registro de NED en un momento dado reveló un total de 315 pacientes en tratamiento. El análisis retrospectivo de nuestra serie durante el año 1998 dio una cifra de 643 nuevos casos. La indicación más frecuente de NED fue la neoplasia (44 por ciento), seguida de la patología neurológica (28 por ciento). La vía de administración más frecuente fue la oral (66 por ciento de casos).En la vía oral predominaron los diagnósticos oncológicos (52 por ciento), mientras que la administración por sonda nasogástrica fue principalmente por trastornos neurológicos (72 por ciento). El uso de la PEG (un 12,5 por ciento de administraciones vía sonda) se repartió entre pacientes oncológicos y neurológicos, con cierta predominancia de los primeros. De los pacientes que finalizaron la NED durante el mismo año, en la mayoría de casos (67 por ciento) la duración fue inferior a un mes; siendo el éxitus por la enfermedad de base la principal causa de finalización, seguida por la necesidad de soporte nutricional de corta duración posterior al alta hospitalaria (AU)

The use of Enteral Nutrition at Home (ENH) in the Hospital Clínico de Barcelona has grown greatly over the last decade, with a certain trend towards stabilization being observed in the last two years, but still growing at a rate of 9.2% per annum. A transverse analysis G.f the active patients on our ENH register at a given moment has revealed a total of 315 patients receiving treatment. The retrospective analysis of our series during 1998 gave a figure of 643 new cases. The most frequent indication for ENH was neoplasia (44%), followed by neurological pathology (28%). The administration route most frequently used was oral (66% of cases). In the oral route, oncological diagnoses were dominant (52%), whereas administration by means of a nasogastric tube was mainly due to neurological disorders (72%). The use of PEG (12.5% of administrations via tube) was distributed between oncological and neurological patients, with a slight predominance of the first. Of those patients completing ENH in the same year, duration was in most cases (67%) less than one month. The decease of the patient due to the underlying disorder was the main cause of termination, followed by the need for short-term nutritional support following discharge from hospital (AU)

Catatonía inducida por corticoides. Caso clínico / Corticosteroid-induced catatonia. Case report

Se ha observado que aproximadamente un 5 por ciento de los pacientes1 que siguen tratamiento con corticoides presentan síndromes psiquiátricos secundarios a esta medicación. Mucho más raros son los casos en que estos fármacos provocan catatonía. Cuando ésta se produce, es importante realizar el diagnóstico diferencial con el estupor melancólico y con otras etiologías orgánicas. El tratamiento más efectivo es la terapia electroconvulsiva. Se presenta un caso de catatonía secundaria a glucocorticoides que se trató en nuestro servicio, así como la revisión realizada a propósito del mismo (AU)

Oral enoxacin for infection prevention in adults with acute nonlymphocytic leukemia. The Enoxacin Prophylaxis Study Group.

A randomized, double-blind, placebo-controlled trial was conducted in eight hematologic units to determine the efficacy and safety of oral enoxacin for infection prevention in adult patients with acute nonlymphocytic leukemia. One hundred nineteen patients undergoing remission induction or consolidation chemotherapy were enrolled; 62 of them received enoxacin (400 mg orally every 12 h). Patients received antifungal prophylaxis with oral mycostatin (1,000,000 U four times daily) or clotrimazole (1 troche five times daily). Analysis was performed on an intent-to-treat basis. There was no significant difference between groups in race, age, or type and stage of leukemia, but there were more males in the placebo group (P = 0.073 [Fisher's exact test]). Fewer enoxacin patients had gram-negative bacteremia (1 versus 14 [P < 0.001]), gram-negative infection at any site (2 versus 19 [P < 0.001]), or bacterial and/or fungal infection (17 versus 26 [P = 0.056]). There was no significant difference in the number of patients with gram-positive infection at any site (12 versus 16), gram-positive bacteremia (9 versus 10), deep fungal infection (6 versus 2), death (2 versus 3), other antimicrobial therapy required (48 versus 48), therapy with amphotericin B (15 versus 7 [P = 0.105]), any adverse event (45 versus 36), or any study drug-associated adverse events (13 versus 6). Logistic regression confirmed (odds ratios and 95% confidence intervals are given in parentheses) that enoxacin reduced the risk of gram-negative infection (0.07; 0.01 to 0.30), especially gram-negative bacillary bacteremia (0.05; 0.01 to 0.37), without altering the risk of gram-positive bacterial (0.63; 0.26 to 1.5), deep fungal (2.57; 0.47 to 13.9), or Clostridium difficile (1.16; 0.3 to 4.56) infection. The median time to the onset of fever of more than or equal 102.8 F (39.3 degree C) was 32 days for the enoxacin group versus 15 days for patients receiving placebo (P=0.0007 [Wilcoxon test]). In patients with acute nonlymphocytic leukemia, oral enoxacin prevents gram-negative infections, delays the onset of fever, does not alter the incidence of gram-positive or proven deep fungal infections, and is well tolerated.

The effectiveness of biologic markers to diagnose alcoholism.

This study explored the effectiveness of biologic markers in alcoholism where correct diagnosis does not result from relatively simple inspection. After review of the use of individual biologic markers and their limitations, data is presented from a multivariate analysis of 351 young healthy male alcoholics and 339 nonalcoholic male patients in which an overall accuracy rate of 84.3% was obtained. A discussion of what biologic markers may be measuring, issues in sample selection, statistical issues and problems with laboratory variability in the use of biologic markers is presented.

Monocyte suppression of antigen-specific lymphocyte responses in diffuse cutaneous leishmaniasis patients from the Dominican Republic.

Patients from the Dominican Republic with diffuse cutaneous leishmaniasis showed in vivo and in vitro anergy to leishmanial antigen. Relatives of these DCL patients living in the same endemic area frequently showed skin test and lymphocyte reactivity to leishmanial antigens. This further supports the concept of specific anergy in patients with diffuse cutaneous leishmaniasis. Adherent suppressor cells modulate the antigen-specific lymphocyte proliferative response. Suppressor cells could also be isolated by Percoll gradient centrifugation. Co-culturing of lymphocytes and monocytes from HLA-identical leishmanin responders and nonresponders also identified the suppressor cell as a monocyte. In one patient, this suppression disappeared when clinical cure had been accomplished.

Comparison of cephalothin and ceforanide prophylaxis in cardiac surgery with cardiopulmonary bypass.

Eighty-five patients undergoing cardiac surgery with cardiopulmonary bypass were given either cephalothin or ceforanide perioperatively in randomized, blinded fashion. The incidence of surgically related, postoperative infections was 23% for the cephalothin- and 26% for the ceforanide-treated groups. There were no statistically significant differences that could be identified between patients who became infected and those who remained free of infections, although the time spent in the operating theater was longer for the former group. Ceforanide achieves adequate levels in plasma and myocardial tissue that are sustained several hours after a 0.5-g parenteral dose and allows a 12-h interval between doses. Other currently available agents would have to be administered more frequently to achieve similar results.

Blockade of reserpine emesis in pigeons by metoclopramide.

Reserpine (0.5 mg/kg i.m.) produced emesis in pigeons with 60% of the animals responding. Metoclopramide HCl at 10, 20 and 40 mg/kg p.o. administered 30 min before or after reserpine injection was effective in blocking reserpine emesis. Metoclopramide was unable to antagonize reserpine-induced sedation and hypotension in rats, thus inviting discussion of its possible mechanism in blocking reserpine emesis.