Health Care Professionals as Relatives in Organ Donation Interviews: Analysis of the Important Role of Health Care Professionals as Family Members.

INTRODUCTION: The organ and tissue donation interview is a vital step in obtaining the donation. Therefore, it is important to obtain as much information as possible regarding the relatives of the potential donor prior to this interview and know if there is a health care professional among the relatives who may act as an interlocutor. OBJECTIVE: The objective of this study is to assess the influence that relatives who are health care professionals may have if present at the interview for the organ and tissue donation request. METHODS: This is a descriptive study of all the organ donations from 1996 to 2019. Variables of the interview record form were completed by the Regional Transplant Coordination Office. Quantitative variables are expressed as mean (standard deviation) or median (interquartile range), and qualitative variables are expressed in percentage. The χ2 test was used for inferential statistics. RESULTS: Health care professionals were present as interlocutors in 8.4% of the total interviews conducted (9279). Organ donation was accepted in 86% of these interviews, while the relative who was a health care professional gave a 93.8% (729) positive response to the donation. Having a health care professional as an interlocutor favors the acceptance of the donation (odds ratio 9.325, 95% confidence interval: 5.054-17.205; P < .001). CONCLUSION: Health care professionals have a very positive attitude toward donation. This attitude positively impacts other relatives' acceptance of the donation.

Neuropsychological and neuroimaging underpinnings of schizoaffective disorder: a systematic review.

OBJECTIVES: The neurobiological basis and nosological status of schizoaffective disorder remains elusive and controversial. This study provides a systematic review of neurocognitive and neuroimaging findings in the disorder. METHODS: A comprehensive literature search was conducted via PubMed, ScienceDirect, Scopus and Web of Knowledge (from 1949 to 31st March 2015) using the keyword 'schizoaffective disorder' and any of the following terms: 'neuropsychology', 'cognition', 'structural neuroimaging', 'functional neuroimaging', 'multimodal', 'DTI' and 'VBM'. Only studies that explicitly examined a well defined sample, or subsample, of patients with schizoaffective disorder were included. RESULTS: Twenty-two of 43 neuropsychological and 19 of 51 neuroimaging articles fulfilled inclusion criteria. We found a general trend towards schizophrenia and schizoaffective disorder being related to worse cognitive performance than bipolar disorder. Grey matter volume loss in schizoaffective disorder is also more comparable to schizophrenia than to bipolar disorder which seems consistent across further neuroimaging techniques. CONCLUSIONS: Neurocognitive and neuroimaging abnormalities in schizoaffective disorder resemble more schizophrenia than bipolar disorder. This is suggestive for schizoaffective disorder being a subtype of schizophrenia or being part of the continuum spectrum model of psychosis, with schizoaffective disorder being more skewed towards schizophrenia than bipolar disorder.

Brain structural changes in schizoaffective disorder compared to schizophrenia and bipolar disorder.

OBJECTIVE: Brain structural changes in schizoaffective disorder, and how far they resemble those seen in schizophrenia and bipolar disorder, have only been studied to a limited extent. METHOD: Forty-five patients meeting DSM-IV and RDC criteria for schizoaffective disorder, groups of patients with 45 matched schizophrenia and bipolar disorder, and 45 matched healthy controls were examined using voxel-based morphometry (VBM). RESULTS: Analyses comparing each patient group with the healthy control subjects found that the patients with schizoaffective disorder and the patients with schizophrenia showed widespread and overlapping areas of significant volume reduction, but the patients with bipolar disorder did not. A subsequent analysis compared the combined group of patients with the controls followed by extraction of clusters. In regions where the patients differed significantly from the controls, no significant differences in mean volume between patients with schizoaffective disorder and patients with schizophrenia in any of five regions of volume reduction were found, but mean volumes in the patients with bipolar disorder were significantly smaller in three of five. CONCLUSION: The findings provide evidence that, in terms of structural gray matter brain abnormality, schizoaffective disorder resembles schizophrenia more than bipolar disorder.

Brain functional abnormality in schizo-affective disorder: an fMRI study.

BACKGROUND: Schizo-affective disorder has not been studied to any significant extent using functional imaging. The aim of this study was to examine patterns of brain activation and deactivation in patients meeting strict diagnostic criteria for the disorder. METHOD: Thirty-two patients meeting research diagnostic criteria (RDC) for schizo-affective disorder (16 schizomanic and 16 schizodepressive) and 32 matched healthy controls underwent functional magnetic resonance imaging (fMRI) during performance of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups. RESULTS: Controls showed activation in a network of frontal and other areas and also deactivation in the medial frontal cortex, the precuneus and the parietal cortex. Schizo-affective patients activated significantly less in prefrontal, parietal and temporal regions than the controls, and also showed failure of deactivation in the medial frontal cortex. When task performance was controlled for, the reduced activation in the dorsolateral prefrontal cortex (DLPFC) and the failure of deactivation of the medial frontal cortex remained significant. CONCLUSIONS: Schizo-affective disorder shows a similar pattern of reduced frontal activation to schizophrenia. The disorder is also characterized by failure of deactivation suggestive of default mode network dysfunction.

Executive dysfunction and memory impairment in schizoaffective disorder: a comparison with bipolar disorder, schizophrenia and healthy controls.

BACKGROUND: Deficits in memory and executive performance are well-established features of bipolar disorder and schizophrenia. By contrast, data on cognitive impairment in schizoaffective disorder are scarce and the findings are conflicting. METHOD: We used the Wechsler Memory Scale (WMS-III) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to test memory and executive function in 45 schizophrenic patients, 26 schizomanic patients and 51 manic bipolar patients in comparison to 65 healthy controls. The patients were tested when acutely ill. RESULTS: All three patient groups performed significantly more poorly than the controls on global measures of memory and executive functioning, but there were no differences among the patient groups. There were few differences in memory and executive function subtest scores within the patient groups. There were no differences in any test scores between manic patients with and without psychotic symptoms. CONCLUSIONS: Schizophrenic, schizomanic and manic patients show a broadly similar degree of executive and memory deficits in the acute phase of illness. Our results do not support a categorical differentiation across different psychotic categories with regard to neuropsychological deficits.

Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas / A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department

Introducción. La agitación psicomotriz es una situación frecuente en urgencias de psiquiatría con una prevalencia aproximada del 10 %. No hay un consenso total respecto a su manejo; benzodiazepinas, antipsicóticos típicos y, más recientemente, los atípicos han demostrado una eficacia similar. El objetivo del presente estudio es describir las características epidemiológicas y el manejo clínico de los pacientes agitados en la práctica clínica en un servicio de urgencias psiquiátricas.Métodos. Estudio naturalístico de los episodios de agitación psicomotriz recogidos consecutivamente en un servicio de urgencias psiquiátricas. Se recogieron variables demográficas, clínicas y terapéuticas. Las variables de eficacia fueron determinadas mediante la escala Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) y la Agitation-Calmness Evaluation Scale (ACES). Se analizaron variables pragmáticas como la necesidad de sucesivas intervenciones farmacológicas o la necesidad de contención física.Resultados. Fueron incluidos 100 episodios de agitación psicomotriz. La edad media fue de 36,2 años y el 54% eran mujeres. Los diagnósticos más frecuentes fueron de trastorno psicótico (48 %) y de trastorno de la personalidad (24 %). El 39 % requirió contención física y el 52 % aceptó el tratamiento por vía oral. El haloperidol fue el fármaco más utilizado por vía oral y la olanzapina por vía intramuscular.Conclusiones. Una aproximación naturalística permite obtener datos de la práctica real en los servicios de urgencias psiquiátricas. Los estrictos diseños de investigación de los ensayos clínicos de eficacia implican sesgos de selección de la muestra y se suelen alejar de la realidad clínica. Los antipsicóticos atípicos se están convirtiendo en fármacos de primera línea en el tratamiento de la agitación

Introduction. Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in «real-life» in a psychiatric emergency service. Methods. A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. Results. The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. Conclusions. A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

[A naturalistic study: 100 consecutive episodes of acute agitation in a psychiatric emergency department]. / Estudio naturalístico: 100 episodios de agitación psicomotriz consecutivos en urgencias psiquiátricas.

INTRODUCTION: Psychomotor agitation is a common event in psychiatric emergency services (PES) with a prevalence of approximately 10 %. There is no general consensus on to how to manage psychomotor agitation; benzodiazepines, typical antipsychotics and now atypical antipsychotics have demonstrated similar efficacy. The aim of our study was to describe the epidemiology and clinical management of agitation in "real-life" in a psychiatric emergency service. METHODS: A naturalistic study was performed in acutely agitated patients recruited consecutively in a psychiatric emergency service. Demographics, clinical and therapeutic characteristics were analyzed. Efficacy was assessed by the Excitement Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Pragmatic variables such as the need for second pharmacological intervention and the need for physical restraints were assessed. RESULTS: The study included 100 patients with psychomotor agitation. Mean age was 36.2 % and 54% were women. The most prevalent diagnoses were psychotic disorder (48 %) and personality disorder (24 %). Physical restraint was required in 39 % of patients and 52 % accepted oral treatment. Haloperidol was the most frequent oral treatment and olanzapine was the most frequent intramuscular treatment. CONCLUSIONS: A naturalistic approach provides data based on clinical reality in psychiatric emergency services. Strict research designs of clinical trials of efficacy imply sample selection biases and are generally distanced from the clinical reality. Atypical antipsychotics have become the first-line treatment in acute agitation

Injectable atypical antipsychotics for agitation in borderline personality disorder.

Agitation is relatively common among Borderline Personality Disorder (BPD) patients in Psychiatric Emergency Services (PES). New injectable atypical antipsychotics are indicated for treatment in agitated psychotic or maniac patients but not for agitated BDP patients. Twenty agitated BPD patients were treated with intramuscular atypical antipsychotics (olanzapine or ziprasidone). Results suggest intramuscular atypical antipsychotics may be effective, fast and safe for treating acute BPD patients.

Self-assembly and lyomesophases formed by long-chain alkoxymethyl-nucleobase derivatives.

Amphiphilic complementary nucleobase derivatives, containing n-octadecyloxymethyl substituents at the N1 position of pyrimidine and N9 of purine, dissolved in chloroform form non-specific lyotropic mesophases, which were analyzed by optical polarizing microscopy. Molecular modeling studies visualize hypothetical horizontal and vertical nucleobase hydrogen-bonding and stacking arrangements, as well as aliphatic long-chain interstrand interaction.

Biomesogenic matrix systems.

The bifunctionally reactive nucleoside and distant nucleoside analogs adenosine (Ado), S-[(adenine-9-yl)methoxyethyl]-L-cysteine (Na-salt) (cysA) and 9-vinyladenine (vA) in aqueous solutions assemble on complementary polyuridylic acid templates to form complex lyomesophases. The systems are investigated by polarizing microscopy, differential scanning calorimetry (DSC) and 1H- and 31P-nmr spectroscopies, assisted by molecular modeling studies. The results indicate the importance of biomesogenic (pre)ordering in nucleic acid native and artificial matrix reactions.

Immunoregulatory effects of N9-benzyl- and N7-benzyl-8-bromoguanines.

In this study we investigated the effects of two guanine derivatives, 9-benzyl- (I) and 7-benzyl-8-bromoguanines (II) on the proliferation of human T-cell leukemia and T-cell lymphoma, normal human peripheral blood mononuclear cells (PBMC), and mouse Th1 (pGL10) and Th2 (D10.G4.1) clones. We also assessed their effects on cytokine production (IL-3, IL-10 and IFN-gamma) in PBMC, T-cell lymphoma, HUT78 (IL-2), and murine Th1 (IL-2) and Th2 (IL-4 and IL-5) clones. These compounds were synthesize as analog of known inhibitors of purine nucleoside phosphorylase (PNP) 8-amino-9-benzylguanine. These compounds suppressed proliferation of human leukemia MOLT-4 cells, human cutaneous lymphoma HUT78 cells and normal PMBC. Compound II was a significantly more potent inhibitor than compound I. Exogenous recombinant human IL-2 reversed the anti-proliferative effects of both compounds on HUT78 cells. These compounds had low toxicity to human EBV-transformed B-lymphocytes. Both compounds suppressed the production of IL-2 by activated human HUT78 cells, IFN-gamma by PBMC and did not affect IL-3 and IL-10 production in PBMC. Compound I inhibited anti-CD3-activated IL-2 secretion from the murine Th1 clone. The murine Th2 clone was less sensitive to both compounds as compared with Thl. The production of IL-4 and IL-5 by this clone was not suppressed. Thus, it has been shown that not only 9-substituted guanines but also their 7-isomers selectively inhibit T-cell functions and both selectively inhibit Th1-related cytokines secretion.

[Lead blood levels in children in the metropolitan area of Madrid]. / Niveles de plomo en sangre de los niños de la corona metropolitana de Madrid.

The objective is to determine the blood lead levels of the children (7-8 years of age) living in some of Madrid's satellite towns, and to establish links between these levels and different socioeconomic items, life styles and environmental factors, among other variables. A cross-sectional study using a sample based on 205 schoolchildren of Second Grade Primary Education, was under taken during 1995. Venous blood samples were analysed through atomic absorption spectrophotometry. Parents answered a questionnaire with items used in this study. The average blood lead level found was 3.9 mud/dl (CI 95% 3.7-4.1), with higher levels among the children of the Northern zone of Madrid. Between the associated factors to blood lead level was found to be the habit of nail biting, mother's studies and some variables associated with habitual dwelling. We reached the conclusion that the blood lead levels of Madrid's suburban children are low.

Cardiovascular risk factors in relation to the serum concentrations of copper and zinc: epidemiological study on children and adolescents in the Spanish province of Navarra.

This investigation was carried out to show the possible association between groups of children with extreme values of copper and zinc concentrations and cardiovascular risk indicators. Serum copper and zinc concentrations were analysed in a group of 3887 children from Navarra, Spain (both sexes. aged 4-17 years). Hypertension, unfavourable serum lipid profile (total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, and cholesterol/HDL and LDL/HDL ratios), and degree of adiposity (weight, height, subcutaneous skinfolds, Quetelet's index and mean of subcutaneous skinfolds) were evaluated. Positive correlation was found between several lipid parameters and copper and zinc concentrations, i.e. degree of correlation related with age, except for copper/HDL and triglycerides/zinc ratios, where correlation remained negative at all points. Copper levels were correlated with adiposity parameters in an age-dependent fashion (Quetelet's index: r = 0.01 for ages 4-7 years to r = 0.10, p < 0.01 for ages 14-17 years; mean skinfold thickness: r = 0.05 for ages 4-7 years up to r = 0.18, p < 0.01 for ages 14-17 years). Most correlations between lipid parameters and copper and zinc are markedly amplified if adiposity parameters are taken into account. However, the only significant association was the established relation between high copper concentrations (> x + 2SD) and unfavourable serum lipid profile (LDL/HDL > 2.2).

[Purine nucleoside analogs. 5. Acycloguanosine derivatives containing O-alkoxyalkyl substituents in acyclic parts of the molecule]. / Analogi purinnukleozidov. 5. Proizvodnye atsikloguanozina, soderzhashchie O-alkoksialkil'nyi zamestitel' v atsiklicheskoi chasti molekuly.

A series of new acycloguanosine O-alkoxyalkyl derivatives have been obtained by the reaction of 9-(2-hydroxyethoxymethyl)- and 8-bromo-9-(2-hydroxyethoxymethyl)-N2-acetylguanines with cyclic and acyclic alpha-vinyl ethers. 9-[2-(Alkoxyalkyl)oxyethoxymethyl]-N2-acetylguanines are better soluble in water and low-polar organic solvents as compared with acycloguanosine. The compounds have the pronounced antiviral activity against HSV-I in the experiments in vivo and can be applied as acycloguanosine prodrugs.