Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria / Neuropsychiatric symptoms in people living with dementia related to COVID-19 pandemic lockdown. Exploratory systematic review

Introducción: En pacientes con deterioro cognitivo leve y demencia, son frecuentes los síntomas neuropsiquiátricos, que pueden aparecer o exacerbarse ante los cambios en la rutina y el entorno habitual del paciente. La situación de confinamiento durante la pandemia de la COVID-19 ha supuesto un cambio en la vida cotidiana de la población general, con especial impacto en los grupos más vulnerables, como los pacientes con afectación cognitiva. Objetivo: Conocer la repercusión de las medidas de confinamiento y cuarentena impuestas por la pandemia de la COVID-19 en la sintomatología neuropsiquiátrica en personas con deterioro cognitivo leve (DCL) y demencia. Materiales y métodos: Revisión sistemática exploratoria, siguiendo las directrices PRISMA, de artículos en las bases datos PubMed y PsycINFO publicados entre enero de 2020 y abril de 2021, que relacionaron el confinamiento por la COVID-19 con la presentación o el empeoramiento de síntomas neuropsiquiátricos en pacientes con DCL o con demencia. Resultados: Se observó un empeoramiento de los síntomas neuropsiquiátricos en los pacientes con demencia y DCL, especialmente agitación/agresión, ansiedad, depresión y apatía. Los síntomas neuropsiquiátricos fueron más comunes en los pacientes con demencia que en los que presentaban DCL, aunque su tipología varió en función de la gravedad de la demencia. Conclusiones: Durante el confinamiento se ha objetivado un detrimento en la esfera psicoconductual en personas con DCL o demencia. Consecuentemente, surge la reflexión sobre la necesidad de fomentar el contacto social en las personas con DCL y demencia, evitando las situaciones de aislamiento y baja estimulación.(AU)

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient’s usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment. Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia. Materials and methods. Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia. Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia. Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.(AU)

[Neuropsychiatric symptoms in people living with dementia related to COVID-19 pandemic lockdown. Exploratory systematic review]. / Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria.

INTRODUCTION: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment. AIM: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia. MATERIALS AND METHODS: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia. RESULTS: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia. CONCLUSIONS: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

TITLE: Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria.Introducción. En pacientes con deterioro cognitivo leve y demencia, son frecuentes los síntomas neuropsiquiátricos, que pueden aparecer o exacerbarse ante los cambios en la rutina y el entorno habitual del paciente. La situación de confinamiento durante la pandemia de la COVID-19 ha supuesto un cambio en la vida cotidiana de la población general, con especial impacto en los grupos más vulnerables, como los pacientes con afectación cognitiva. Objetivo. Conocer la repercusión de las medidas de confinamiento y cuarentena impuestas por la pandemia de la COVID-19 en la sintomatología neuropsiquiátrica en personas con deterioro cognitivo leve (DCL) y demencia. Materiales y métodos. Revisión sistemática exploratoria, siguiendo las directrices PRISMA, de artículos en las bases datos PubMed y PsycINFO publicados entre enero de 2020 y abril de 2021, que relacionaron el confinamiento por la COVID-19 con la presentación o el empeoramiento de síntomas neuropsiquiátricos en pacientes con DCL o con demencia. Resultados. Se observó un empeoramiento de los síntomas neuropsiquiátricos en los pacientes con demencia y DCL, especialmente agitación/agresión, ansiedad, depresión y apatía. Los síntomas neuropsiquiátricos fueron más comunes en los pacientes con demencia que en los que presentaban DCL, aunque su tipología varió en función de la gravedad de la demencia. Conclusiones. Durante el confinamiento se ha objetivado un detrimento en la esfera psicoconductual en personas con DCL o demencia. Consecuentemente, surge la reflexión sobre la necesidad de fomentar el contacto social en las personas con DCL y demencia, evitando las situaciones de aislamiento y baja estimulación.

Amino acid consumption in naïve and recombinant CHO cell cultures: producers of a monoclonal antibody.

Most commercial media for mammalian cell culture are designed to satisfy the amino acid requirements for cell growth, but not necessarily those for recombinant protein production. In this study, we analyze the amino acid consumption pattern in naïve and recombinant Chinese hamster ovary (CHO) cell cultures. The recombinant model we chose was a CHO-S cell line engineered to produce a monoclonal antibody. We report the cell concentration, product concentration, and amino acid concentration profiles in naïve and recombinant cell cultures growing in CD OptiCHO™ medium with or without amino acid supplementation with a commercial supplement (CHO CD EfficientFeed™ B). We quantify and discuss the amino acid demands due to cell growth and recombinant protein production during long term fed batch cultivation protocols. We confirmed that a group of five amino acids, constituting the highest mass fraction of the product, shows the highest depletion rates and could become limiting for product expression. In our experiments, alanine, a non-important mass constituent of the product, is in high demand during recombinant protein production. Evaluation of specific amino acid demands could be of great help in the design of feeding/supplementation strategies for recombinant mammalian cell cultures.

An original architectured NiTi silicone rubber structure for biomedical applications.

This paper deals with composite structures for biomedical applications. For this purpose, an architectured tubular structure composed of Nickel Titanium (NiTi) Shape Memory Alloy (SMA) and silicone rubber was fabricated. One of the main interests of such structures is to ensure a good adhesion between its two constitutive materials. A previous study of the authors (Rey et al., 2014) has shown that the adhesion between NiTi and silicone rubber can be improved by an adhesion promoter or plasma treatment. However, adhesion promoters are often not biocompatible. Hence, plasma treatment is favored to be used in the present study. Three different gases were tested; air, argon and oxygen. The effects of these treatments on the maximum force required to pull-out a NiTi wire from the silicone rubber matrix were investigated by means of pull-out tests carried out with a self-developed device. Among the three gases, a higher maximum force was obtained for argon gas in the plasma treatment. A tube shaped architectured NiTi/silicone rubber structure was then produced using this treatment. The composite was tested by means of a bulge test. Results open a new way of investigations for architectured NiTi-silicone structures for biomechanical applications.

Tuberculosis esofágica: informe de un caso / A Case Report of Esophageal Tuberculosis

Informamos el caso de un hombre inmunocompetente que consultó por cuadro de sangrado digestivo alto secundario a una úlcera esofágica de origen tuberculoso. El compromiso gastrointestinal por el Mycobacterium tuberculosis es raro aun en pacientes con altas prevalencias de enfermedad pulmonar y extrapulmonar; los sitios de mayor afectación son íleon terminal y el peritoneo, la enfermedad esofágica es exótica y generalmente es secundaria a la extensión proveniente de órganos vecinos infectados, como ganglios mediastinales y/o bronquios. La clínica, las imágenes endoscópicas y radiológicas de la enfermedad esofágica suele simular una neoplasia maligna. La quimioterapia antituberculosa es la base del tratamiento, rara vez se requiere manejo quirúrgico.

We report the case of an immune-competent man with symptoms of upper gastrointestinal bleeding secondary to esophageal ulcers of tubercular origin. Gastrointestinal involvement from Mycobacterium tuberculosis is rare even in patients with numerous occurrences of pulmonary and extrapulmonary diseases. The most frequently affected sites are the terminal ileum and the peritoneum. Esophageal tuberculosis is exotic and is usually secondary to extension from neighboring infected organs such as the mediastinal nodes and/or the bronchi. Clinical, endoscopic and radiological pictures of the esophageal disease often mimic malignancy. Tuberculosis treatment is the mainstay of treatment, and surgery is rarely required.

Utilidad de la hemoperfusión en el tratamiento del paciente séptico grave. Actualización / Usefulness of haemoperfusion in the treatment of the severe septic patient: an update

La hemoperfusión es un procedimiento extracorpóreo que consiste en la retirada de endotoxina y/o mediadores inflamatorios por un mecanismo de adsorción durante el paso de la sangre por un filtro específico. La mayor parte de los estudios publicados han empleado la polimixina B como adsorbente. Este tratamiento se basa en la premisa de que la eliminación de endotoxina y mediadores de la circulación atenúa la respuesta inflamatoria en la sepsis. Se revisan las bases teóricas y los resultados clínicos publicados con el uso de la hemoperfusión. Si bien la mayoría de los estudios que emplean esta técnica presentan resultados positivos, existen dudas acerca de la idoneidad de los métodos empleados (grupos pequeños, baja calidad en el diseño de los estudios, mortalidad excesiva en los grupos control). También existen inconsistencias en la base teórica de su uso (ausencia de beneficios tras la eliminación de endotoxina por otros mecanismos, discrepancias en el momento de iniciar la terapia, aparente utilidad en enfermedades sin elevación de endotoxina). Los autores opinan que la hemoperfusión es prometedora en el tratamiento de la sepsis, pero requiere su confirmación en estudios bien diseñados antes de ser incluida en los protocolos habituales de tratamiento(AU)

Haemoperfusion is an extracorporeal technique that removes endotoxin and/or inflammatory mediators by means of an adsorptive mechanism during the passage of the blood through a porous filter. Most of the studies in the literature use polymyxin B as the adsorptive agent. This treatment is based on the assumption that the removal of endotoxin and inflammatory mediators from the circulation attenuates the inflammatory response in sepsis. This review summarizes the theoretical basis, and the experimental and clinical results published to date with the use of haemoperfusion. Although most of the studies show positive results, some doubts have arisen about the suitability of the methods described (small number of cases, low quality of the experimental design, and excessive mortality in the control groups). There are also some inconsistencies regarding the theoretical basis of its use (lack of positive effects after the removal of endotoxin from the circulation using alternative mechanisms, discrepancies regarding the best moment to initiate the therapy, unexplained beneficial effects in the absence of increased endotoxin levels). It is the opinion of the authors that haemoperfusion represents a promising therapy for the treatment of sepsis, but consider that its usefulness requires confirmation in well designed studies before being included in protocols(AU)

An experimental system to study responses of Medicago truncatula roots to chitin oligomers of high degree of polymerization and other microbial elicitors.

KEY MESSAGE: A fully acetylated, soluble CO preparation of mean DP of ca. 7 was perceived with high sensitivity by M. truncatula in a newly designed versatile root elicitation assay. The root system of legume plants interacts with a large variety of microorganisms, either pathogenic or symbiotic. Understanding how legumes recognize and respond specifically to pathogen-associated or symbiotic signals requires the development of standardized bioassays using well-defined preparations of the corresponding signals. Here we describe the preparation of chitin oligosaccharide (CO) fractions from commercial chitin and their characterization by a combination of liquid-state and solid-state nuclear magnetic resonance spectroscopy. We show that the CO fraction with highest degree of polymerization (DP) became essentially insoluble after lyophilization. However, a fully soluble, fully acetylated fraction with a mean DP of ca. 7 was recovered and validated by showing its CERK1-dependent activity in Arabidopsis thaliana. In parallel, we developed a versatile root elicitation bioassay in the model legume Medicago truncatula, using a hydroponic culture system and the Phytophthora ß-glucan elicitor as a control elicitor. We then showed that M. truncatula responded with high sensitivity to the CO elicitor, which caused the production of extracellular reactive oxygen species and the transient induction of a variety of defense-associated genes. In addition, the bioassay allowed detection of elicitor activity in culture filtrates of the oomycete Aphanomyces euteiches, opening the way to the analysis of recognition of this important legume root pathogen by M. truncatula.

[Usefulness of haemoperfusion in the treatment of the severe septic patient: an update]. / Utilidad de la hemoperfusión en el tratamiento del paciente séptico grave. Actualización.

Haemoperfusion is an extracorporeal technique that removes endotoxin and/or inflammatory mediators by means of an adsorptive mechanism during the passage of the blood through a porous filter. Most of the studies in the literature use polymyxin B as the adsorptive agent. This treatment is based on the assumption that the removal of endotoxin and inflammatory mediators from the circulation attenuates the inflammatory response in sepsis. This review summarizes the theoretical basis, and the experimental and clinical results published to date with the use of haemoperfusion. Although most of the studies show positive results, some doubts have arisen about the suitability of the methods described (small number of cases, low quality of the experimental design, and excessive mortality in the control groups). There are also some inconsistencies regarding the theoretical basis of its use (lack of positive effects after the removal of endotoxin from the circulation using alternative mechanisms, discrepancies regarding the best moment to initiate the therapy, unexplained beneficial effects in the absence of increased endotoxin levels). It is the opinion of the authors that haemoperfusion represents a promising therapy for the treatment of sepsis, but consider that its usefulness requires confirmation in well designed studies before being included in protocols.

[Antifungal prophylaxis in the postoperative period of lung transplant surgery in Spain]. / Profilaxis antifúngica en el postoperatorio de trasplante de pulmón en España.

OBJECTIVES: To examine the type and duration of antifungal prophylaxis provided during the postoperative period of lung transplant recipients, together with the most frequent complications during admission to Intensive Care Units in Spain. PATIENTS AND METHODS: A questionnaire was developed including demographic data on each transplant center, the type of antifungal prophylaxis used, its duration, and the most frequent complications. The questionnaire was distributed among the 7 Spanish national lung transplant centers, followed by analysis of the results obtained. RESULTS: All 7 centers completed the questionnaire. All of them provided universal prophylaxis in lung transplant patients. Monotherapy was the most widely used protocol (5/7; 71.4%), with amphotericin B in liposomal or conventional form being the most frequent drug, administered via the inhalatory route. In the case of combination therapy, a great diversity of drugs was observed. The most frequently administered second choice drug was anidulafungin (3/7; 43%), followed by voriconazole (2/7; 28.5%). Antifungal therapy was maintained on an indefinite basis by 43% of the centers. Invasive fungal infection (IFI) in the postoperative period of transplantation during admission to the Intensive Care Unit was suspected in 5-10% of the cases but was confirmed in less than 5%. Among other complications registered in these patients in the Intensive Care Unit, the most frequent problems were respiratory infections (5/7; 71.5%). CONCLUSIONS: Antifungal prophylaxis during the postoperative period of lung transplantation is provided on a universal basis, though consensus is lacking as to the drug of choice, the administration route and the duration of such treatment.

Análisis del Estrés Laboral y Estrés Oxidativo en profesionales de un servicio de Urgencias Hospitalarias / Occupational and Oxidative Stress in professionals of an Urgency Service

Fundamento: El ritmo de vida laboral actual, las exigenciasde determinados cargos y el grado de implicación profesionalse consideran factores básicos en la etiología de numerosaspatologías propias del envejecimiento.OBJETIVODeterminar estrés oxidativo y envejecimiento en profesionalescon elevado estrés laboral, analizando la influencia de factoressociodemográficos, laborales y el estilo de vida.MÉTODOSSe analizaron 70 profesionales del Servicio de Urgencias delHospital Gregorio Marañon de Madrid. Todos ellos cumplimentaronun cuestionario de características sociodemográficas, laboralesy estilo de vida. En todos se determinó la actividad de dos enzimasantioxidantes superóxido dismutasa (SOD) y catalasa (CAT)y los niveles de malondialdehído (MDA). El análisis estadísticoincluye “t” de Student, test de Kolmogorov-Smirnov y ANOVA. RESULTADOSAspectos sociodemográficos: los parámetros analizadosvarían en función de la edad, pero no por sexo, estado civil,número de hijos o procedencia. Aspectos laborales: mayor actividadenzimática (SOD y CAT) y niveles más altos de MDA enprofesionales del Servicio Urgencias que en grupo control. Influyenla categoría profesional, nivel de estudios, antigüedad en laprofesión y el estilo de vida.CONCLUSIONESEn profesionales sometidos a elevado estrés laboral seobserva un incremento del estrés oxidativo que podría desencadenartrastornos propios del envejecimiento

Background: The stressing conditions of nowadays working life,the specific requirements associated to several professions andthe level of personal implication at work are considered importantfactors in the aetiology of many pathologies related to aging.OBJECTIVETo determine oxidative stress and aging in professionalswhich are under high occupational stress, analysing the influenceof sociodemographic and occupational factors and life style.METHODS70 professionals of Urgency Service of Gregorio MarañonHospital took part in the study. A general questionnaire of sociodemographic,occupational and life style characteristics wasused. Superoxide dismutase (SOD), catalase (CAT) and malondialdehyde(MDA) were determined. The statistical analysisincluded: the Student “t” test, the Kolmogorov-Smirnov test andthe ANOVA. RESULTSAs far as sociodemographic aspects are concerned: theparameters analyzed vary with age, but not with sex, maritalstatus, number of children or place of birth. As for occupationalaspects: higher enzymatic activity (SOD and CAT) and MDAlevels were found in Urgency Service professionals as comparedwith the control group. Professional category, educationallevel and life style had an influence on those levels.CONCLUSIONSAn increase in oxidative stress is observed in professionalsunder high occupational stress. This increase could lead to agerelateddiseases

Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery.

BACKGROUND: The effect of different opioids on postoperative nausea and vomiting (PONV) has not been conclusively determined yet, thus the aim of this study was to compare the incidence of PONV in propofol-anaesthetized patients receiving either fentanyl or remifentanil as opioid supplement. METHODS: Sixty ASA physical status I and II patients scheduled for plastic surgery gave their written informed consent for this prospective, randomized, double-blind study. Anaesthesia was induced with propofol, rocuronium and fentanyl (n = 30; 2 microg kg(-1)) or remifentanil (n = 30; 1 microg kg(-1)). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and an infusion of the opioid studied, which was modified according to clinical criteria. Baseline postoperative analgesia was achieved with intravenous propacetamol + metamizol. Intravenous morphine was given if visual analogic scale (VAS) for pain was > or = 4 (scale 0-10) and metoclopramide was administered if a patient presented > or = 2 PONV episodes (nausea or vomiting) in less than 30 min. Postoperatively (2, 12 and 24 h), we registered VAS, rescue morphine consumption, number of patients with episodes of PONV and number of patients requiring metoclopramide. P < 0.05 was considered significant. RESULTS: There were no significant differences between groups in the demographic parameters, ASA physical status, propofol dose, VAS, and rescue morphine requirements. Fourteen patients in the fentanyl group and four in the remifentanil group presented PONV episodes 2-12 h postoperative hours' interval; (P < 0.05). Ten patients in the fentanyl group and four in the remifentanil group presented vomiting episodes in the same period (P < 0.05); and eight patients in the fentanyl group and one in the remifentanil group required metoclopramide; (P < 0.05). The number of postoperative PONV episodes were low, both in the 0-2-h period (n = 2 vs. n = 1, fentanyl and remifentanil, respectively) and in the 12-24-h period (n = 3 vs. n = 1). CONCLUSION: Propofol + fentanyl anaesthesia resulted in a higher incidence of PONV and requirements of antiemetic drugs in the period between 2 and 12 postoperative hours compared with propofol + remifentanil, in patients undergoing plastic surgery.

The effect of inert atmospheric packaging on oxidative degradation in formulated granules.

PURPOSE: Oxidative degradation of drug substances in pharmaceutical products is well documented and is thought to occur in many cases via autoxidative processes involving headspace molecular oxygen in the primary package. Reducing the headspace oxygen concentration inside a package could thus be an option for reducing oxidative degradation in pharmaceutical products. The purpose of this study is to examine the effect of headspace oxygen concentration and relative humidity (RH) on the oxidative degradation of a model pharmaceutical formulation. METHODS: Model formulations, including a drug substance known to exhibit oxidative degradation, at two different drug/excipient ratios were packaged in stoppered glass vials maintained at different oxygen concentrations, (from 0% to 20.9%) and headspace relative humidities and were stored at 40 degrees C. The oxidative degradation was quantified as a function of time. RESULTS: The results clearly show dependence of oxidative degradation on headspace oxygen concentration, relative humidity, drug loading and time. CONCLUSIONS: The results provided insight into the effectiveness of inert atmospheric packaging (IAP) for protecting oxidation-labile products. In light of these observations, a few strategies for practically implementing inert atmosphere packaging are also presented.

Tratamiento con antipsicóticos atípicos del síndrome de Gilles de la Tourette / Treatment with atypical antipsychotics of Gilles de la Tourette syndrome

El tratamiento óptimo del síndrome de Gilles de la Tourette (SGT) incluye intervenciones educativas, de apoyo, psicológicas y tratamiento farmacológico. El tratamiento farmacológico, en especial con fármacos antipsicóticos, es la modalidad de tratamiento más efectiva para suprimir tics graves, El tratamiento actual con antipsicóticos atípicos (risperidona, olanzapina) de niños y adolescentes con SGT parece ser tan efectivo como con los antipsicóticos clásicos, aunque con menos efectos secundarios. Trastornos comórbidos como trastorno por déficit de atención con hiperactividad, trastorno obsesivo-compulsivo (TOC) y trastornos del aprendizaje, pueden ser fuente de mayor malestar y deterioro que los propios tics. El tratamiento farmacológico del TOC incluye inhibidores selectivos de la recaptación de serotonina (ISRS) como sertralina. Objetivo: La finalidad de este estudio fue evaluar la eficacia y seguridad de los antipsicóticos atípicos en el tratamiento del SGT en niños y adolescentes, Método: Este estudio de casos incluía cuatro sujetos (todos varones) con una edad media de 11.00+-0.50 años. Todos los sujetos cumplían criterios de la Clasificación Internacional de las Enfermedades (CIE-lO) para SGT. Tres niños presentaban también un TOC comórbido. Resultados: La respuesta clínica cuantificada según la escala Impresión Clínica Global (ICG) indicaba mejoría y disminución en la gravedad de los tics motores y fónicos. El efecto secundario más frecuente fue el aumento de peso. Conclusiones: Estos hallazgos sugieren que los antipsicóticos atípicos parecen ser efectivos y seguros para reducir la frecuencia e intensidad de los tics motores y fónicos en niños y adolescentes con SGT

The optimal treatment of Gilles de la Tourette syndrome (GTS) involves educational and supportive interventions, psychological approaches and pharmacological treatment. Pharmacotherapy, especially with antipsychotic drugs, has been the most effective treatment modality in suppressing severe tics. Current treatment with atypical antipsychotics (risperidone, olanzapine) of children and adolescents with GTS appears to be as effective as traditional antipsychotics, while having fewer side effects. Comorbid conditions as attention-deficit/hyperactivity disorder, obsessive-compulsive disorder (OCD), and learning disorders, can be a source of more distress and impairment than the tics themselves. Drug treatment of OCD includes selective serotonin reuptake inhibitors (SSRIs) as sertraline. Objective: The purpose of this study was to assess the efficacy and safety of atypical antipsychotics in the treatment of GTS in children and adolescents. Method: This case study inc1uded four subjects (all boys) with a mean age of 11.00 +- 0.50 years. All subjects met Intemational Classification of Diseases (ICD-l0) criteria for GTS. Three children also had a comorbid OCD. Results: Clinical response, as measured by the Clinical Global Impression (CGI) scale showed improvement and reduction in the severity of motor and phonic tics. The most common side effect was weight gain. Conc1usions: These findings suggest that atypical antipsychotics appear to be effective and safe in diminishing motor and phonic tics frequency and intensity in children and adolescents with GTS

Agonistas Adrenérgicos en Psiquiatría Infantil: I. Clonidina / Adrenergic agonists in child psychiatry: I. Clonidine

Clonidina es un fármaco agonista de los receptores adrenérgicos alfa2 que, aunque no tienen aprobada indicaciones en Psiquiatría infantil, ha visto recientemente avalado su uso en patologías como el trastornos por déficit de atención con hiperactividad, tanto en monoterapia como asociado a metilfenidato, resultando especialmente efectiva si predomina la hiperactividad y el comportamiento agresivo. También hay estudios que la avalan en el trastorno oposicionista desafiante, trastorno de conducta y en la desintoxicación de opioides. Se estudian los trabajos que apoyan el uso de Clonidina en estas y otras patologías, así como la pauta de administración y los efectos adversos más frecuente (AU)

Pharmaceutical and immunological evaluation of a single-shot hepatitis B vaccine formulated with PLGA microspheres.

A single-shot Hepatitis B vaccine formulation using poly(d,l)-lactide-co-glycolide acid (PLGA) microspheres as a delivery system was examined using a variety of biophysical and biochemical techniques as well as immunological evaluation in C3H mice. PLGA microsphere encapsulation of the Hepatitis B surface antigen (HBsAg), a lipoprotein particle, resulted in good recoveries of protein mass, protein particle conformational integrity, and in vitro antigenicity. Some partial delipidation of the HBsAg, however, was observed. The loading and encapsulation efficiency of HBsAg into the PLGA microspheres were measured along with the morphology and size distribution of the vaccine-loaded PLGA microspheres. The in vitro release kinetics of HBsAg from the PLGA microspheres was evaluated and found to be affected by experimental conditions such as stirring rate. HBsAg showed enhanced storage stability at 37 degrees C in the slightly acidic pH range reported to be found inside PLGA microspheres; thus, the antigen is relatively stable under conditions of temperature and pH that may mimic in vivo conditions. The immunogenicity of the microsphere formulations of HBsAg was compared with conventional aluminum adjuvant formulated HBsAg vaccine in C3H mice. Comparisons were made between aluminum formulations (one and two injections), PLGA microsphere formulations (single injection), and a mixture of aluminum and PLGA microsphere formulations (single injection). The nine-month serum antibody titers indicate that a single injection of a mixture of aluminum and PLGA-formulated HBsAg results in equal or better immune responses than two injections of aluminum-formulated HBsAg vaccine. Based on these in vitro and in vivo studies, it is concluded that HBsAg can be successfully encapsulated and recovered from the PLGA microspheres and a mixture of aluminum-adjuvanted and PLGA-formulated HBsAg can auto-boost an immune response in manner comparable to multiple injections of an aluminum-formulated vaccine.

Manifestaciones neuropsiquiátricas del lupus eritematoso sistémico / Neuropsychiatric manifestations of systemic erythematosus

El Lupus Eritematoso Sistémico es una enfermedad inflamatoria crónica de tipo autoinmune que afecta a múltiples órganos. Presenta gran variedad de manifestaciones clínicas y su evolución es fluctuante con sucesivas exacerbaciones y remisiones. Es relativamente frecuente encontrar alteraciones psiquiátricas en distintos momentos de esta enfermedad, siendo dificil establecer si la etiología de las mismas es consecuencia de la afectación primaria del Sistema Nervioso Central o secundaria a la cronicidad o los tratamientos utilizados. Un mayor conocimiento de los elementos implicados en la génesis y mantenimiento de las alteraciones psiquiátricas permitirá diseñar un abordaje integral y adoptar una actitud preventiva en estos pacientes (AU)