Altered Serotonin 1B Receptor Binding After Escitalopram for Depression Is Correlated With Treatment Effect.

BACKGROUND: Major depressive disorder (MDD) is commonly treated with selective serotonin reuptake inhibitors (SSRIs). SSRIs inhibit the serotonin transporter (5-HTT), but the downstream antidepressant mechanism of action of these drugs is poorly understood. The serotonin 1B (5-HT1B) receptor is functionally linked to 5-HTT and 5-HT1B receptor binding and 5-HT1B receptor mRNA is reduced in the raphe nuclei after SSRI administration in primates and rodents, respectively. The effect of SSRI treatment on 5-HT1B receptor binding in patients with MDD has not been examined previously. This positron emission tomography (PET) study aimed to quantify brain 5-HT1B receptor binding changes in vivo after SSRI treatment for MDD in relation to treatment effect. METHODS: Eight unmedicated patients with moderate to severe MDD underwent PET with the 5-HT1B receptor radioligand [11C]AZ10419369 before and after 3 to 4 weeks of treatment with the SSRI escitalopram 10 mg daily. Depression severity was assessed at time of PET and after 6 to 7 weeks of treatment with the Montgomery-Åsberg Depression Rating Scale. RESULTS: We observed a significant reduction in [11C]AZ10419369 binding in a dorsal brainstem (DBS) region containing the median and dorsal raphe nuclei after escitalopram treatment (P = .036). Change in DBS [11C]AZ10419369 binding correlated with Montgomery-Åsberg Depression Rating Scale reduction after 3-4 (r = 0.78, P = .021) and 6-7 (r = 0.94, P < .001) weeks' treatment. CONCLUSIONS: Our findings align with the previously reported reduction of 5-HT1B receptor binding in the raphe nuclei after SSRI administration and support future studies testing change in DBS 5-HT1B receptor binding as an SSRI treatment response marker.

Neumonía por varicela en población adulta: revisión de 21 casos / Varicella pneumonia in adult population: review of 21 cases

Fundamento. Estudio retrospectivo con el fin de conocer la incidencia de neumonía por varicela en adultos, así como estudiar las características epidemiológicas, clínicas, tratamiento y evolución de los pacientes ingresados en hospital de Toledo en los últimos 9 años. Material y métodos. Se analizó a 21 pacientes adultos ingresados con el diagnóstico de neumonía por varicela mediante estudio retrospectivo de historias clínicas entre enero de 1995 y enero de 2004. Se registraron datos sobre embarazo, sexo, hábito tabáquico, patología subyacente, contacto previo con varicela y época de diagnóstico. Éste se estableció por criterios clinicorradiológicos en el contexto de un episodio de varicela. Resultados. Se han evaluado 21 pacientes (10 varones y 11 mujeres) entre 25 y 73 años, el 81% de los casos presentaba hábito tabáquico, en el 71,4% se había documentado contacto con varicela y en 4 pacientes (19%) existía un trastorno de la inmunidad. La sintomatología aparecida entre 3-7 días tras el desarrollo de lesiones cutáneas (100%), consistió en fiebre, 20 casos (95,2%) y disnea, 14 casos (66,7%) como síntomas más frecuentes. Cuatro pacientes (33,3%) no presentaron clínica respiratoria y en 5 (23,8%) la hipoxemia fue manifiesta. La evolución fue favorable en 20 casos (95,2%), requiriendo ingreso en Unidad de Cuidados Intensivos tres pacientes. La radiología de tórax presentó predominio de patrón intersticial en vidrio deslustrado en 11 casos (52,4%), nodular en 4 casos (19%) y en el 23,8% el patrón fue mixto. En 20 pacientes se usó tratamiento con aciclovir y en un caso foscarnet. Se utilizó coadyuvancia con corticoides en el 28,57% de los casos. Conclusiones. El tabaco podría ser un factor de riesgo que se asociara con un incremento de la incidencia de neumonía por varicela. Es recomendable la realización de radiografía de tórax independientemente de la ausencia de clínica respiratoria. Los adultos con neumonía tienen mejor pronóstico cuando se instaura tratamiento precoz con aciclovir. El uso coadyuvante de corticoides debería emplearse especialmente en aquellos casos con fracaso respiratorio

Background. Retrospective study of the varicella pneumonia in adults, in order to know incidence, environmental and clinical characteristics and treatments of patients with this diagnosis during the last 9 years in Toledo. Material and methods. Twenty-one adult patients with the diagnosis of varicella pneumonia were studied, using the information of clinical histories and codified data. The backgrounds of pregnancy, smoking habit, concomitant diseases, previous contacts with another patients and the season of the year, were evaluated. Diagnosis was established by clinical and radiologic criteria in the course of varicella infection. Results. 21 patients (10 males and 11 females, between 25 and 73 years) were studied. 17 (81%) were smokers, in 15 (71.4%) there was documented contact with varicella infection and 4 (19%) were immunocompromised. In the first 3-7 days after the development of skin lesions (100%), there was fever in 20 cases (95.2%) and dyspnea in 14 (66.7%). There were 4 patients (33,3%) without respiratory symptoms and in 5 (23,8%) there was important hypoxemia. Evolution was satisfactory in 20 cases (95.2%); three others requiring admission to Intensive Care Unit. Chest X-ray revealed an interstitial pattern in 11 cases (52.4%), nodular in 4 (19%) and a mixed pattern in 5 (23.8%). 20 patients were treated with acyclovir and in one case with foscarnet. In 28.57% cases, corticosteroids were needed. Conclusions. We believe smoking habit could be a risk factor related to an increase of varicella pneumonia. A chest X-ray should be made in every patient, despite the symptoms. Adults with pneumonia have a better prognosis if acyclovir is started early in time. Concomitant treatment with corticosteroids should be used in those cases with respiratory insufficiency

Derrame pleural mielomatoso / Myelomatous pleural effusion

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