Grado de satisfacción de los usuarios del circuito de diagnóstico rápido del cáncer / Patients' satisfaction with the rapid diagnosis and treatment programme for cancer (RDTPC). Observational study

Objetivo. Conocer el grado de satis-facción de los usuarios del Circuito de Diagnóstico Rápido del Cáncer (CDRC) así como la percepción de ansiedad. Método. Estudio transversal de una muestra de personas (n=294) atendidas de forma consecutiva en un CDRC de pulmón, mama y colon. La recogida de datos se realizó median-te cuestionario en la primera visita al CDRC y llamada telefónica al mes de la última visita al CDRC. El cuestionario contenía 23 preguntas que exploraban distintas dimensiones de satisfacción (accesibilidad, trato personal, información y coordinación), una sobre ansiedad percibida y una de satisfacción global. También se recogieron variables sociodemográficas, procedencia de la derivación y diagnóstico de cáncer. Resultados. La media de edad fue de 60,1 años (DE =1 2,9) con un 57,8% de mujeres. Fueron diagnosticados de cáncer el 34,4%. El grado de satis-facción global con la asistencia recibida en el CDRC fue de 9,3 (DE = 1,2) sobre 10. El 92,2% de los pacientes afirmó que el hecho de haber entrado en el CDRC le había ayudado a disminuir la ansiedad de todo el proceso. Según el diagnóstico final de cáncer o no, observamos diferencias significativas en las áreas de accesibilidad y trato. Los pacientes diagnosticados de cáncer estuvieron más satisfechos con el tiempo trascurrido entre la primera visita y el diagnóstico y entre el diagnóstico e inicio del tratamiento y valoraron mejor el trato de la enfermera gestora. Conclusiones. La satisfacción de los pacientes que entran en el CDRC es muy alta. Su evaluación complementa otros indicadores de eficacia del programa

Objective. Evaluation of patients' satisfaction with the Rapid Diagnosis and Treatment Programme for Cancer (RDTPC) and perception of anxiety Method. A cross-sectional study was performed on a sample (n = 294) of patients who subsequently were followed at the RDTPC for lung, breast and colon cancer. Data collection was carried out using a questionnaire administered to users during their first visit at the RDTPC and a tele-phone call one month after their last visit. The questionnaire included 23 items that explore different aspects of satisfaction (accessibility, personal treatment, information and coordination), one item on perceived anxiety and one on overall satisfaction. Socio-demographic variables, origin of referral and diagnosis of cancer were also collected. Results. The mean age was 60.1 years (SD=12.9); 57.8% were women. A total of 34.4%. were diagnosed of cancer. The level of overall satisfaction with the care received at the RDTPC was 9.3 (SD =1.2) out of 10 and 92.2% of patients reported that entering the RDTPC had helped them decrease their anxiety throughout the whole process. Depending on whether cancer was finally diagnosed or not, significant differences were observed in areas of accessibility and attention received. Patients diagnosed with cancer were more satisfied with the time period between the initial visit and diagnosis and between time of diagnosis and start of treatment. They also reported a higher satisfaction with the attention they received from the nurse in charge. Conclusions. The satisfaction of patients on the RDTPC is very high. Their assessment completes other indicators of the efficacy of the programme

Alcohol Consumption during Pregnancy: Analysis of Two Direct Metabolites of Ethanol in Meconium.

Alcohol consumption in young women is a widespread habit that may continue during pregnancy and induce alterations in the fetus. We aimed to characterize prevalence of alcohol consumption in parturient women and to assess fetal ethanol exposure in their newborns by analyzing two direct metabolites of ethanol in meconium. This is a cross-sectional study performed in September 2011 and March 2012 in a series of women admitted to an obstetric unit following childbirth. During admission, socio-demographic and substance use (alcohol, tobacco, cannabis, cocaine, and opiates) during pregnancy were assessed using a structured questionnaire and clinical charts. We also recorded the characteristics of pregnancy, childbirth, and neonates. The meconium analysis was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to detect the presence of ethyl glucuronide (EtG) and ethyl sulfate (EtS). Fifty-one parturient and 52 neonates were included and 48 meconium samples were suitable for EtG and EtS detection. The median age of women was 30 years (interquartile range (IQR): 26-34 years); EtG was present in all meconium samples and median concentration of EtG was 67.9 ng/g (IQR: 36.0-110.6 ng/g). With respect to EtS, it was undetectable (<0.01 ng/g) in the majority of samples (79.1%). Only three (6%) women reported alcohol consumption during pregnancy in face-to-face interviews. However, prevalence of fetal exposure to alcohol through the detection of EtG and EtS was 4.2% and 16.7%, respectively. Prevention of alcohol consumption during pregnancy and the detection of substance use with markers of fetal exposure are essential components of maternal and child health.

Biochemical and Physiological Improvement in a Mouse Model of Smith-Lemli-Opitz Syndrome (SLOS) Following Gene Transfer with AAV Vectors.

Smith-Lemli-Opitz syndrome (SLOS) is an inborn error of cholesterol synthesis resulting from a defect in 7-dehydrocholesterol reductase (DHCR7), the enzyme that produces cholesterol from its immediate precursor 7-dehydrocholesterol. Current therapy employing dietary cholesterol is inadequate. As SLOS is caused by a defect in a single gene, restoring enzyme functionality through gene therapy may be a direct approach for treating this debilitating disorder. In the present study, we first packaged a human DHCR7 construct into adeno-associated virus (AAV) vectors having either type-2 (AAV2) or type-8 (AAV2/8) capsid, and administered treatment to juvenile mice. While a positive response (assessed by increases in serum and liver cholesterol) was seen in both groups, the improvement was greater in the AAV2/8-DHCR7 treated mice. Newborn mice were then treated with AAV2/8-DHCR7 and these mice, compared to mice treated as juveniles, showed higher DHCR7 mRNA expression in liver and a greater improvement in serum and liver cholesterol levels. Systemic treatment did not affect brain cholesterol in any of the experimental groups. Both juvenile and newborn treatments with AAV2/8-DHCR7 resulted in increased rates of weight gain indicating that gene transfer had a positive physiological effect.

Developmental effects of aerosols and coal burning particles in zebrafish embryos.

Embryo toxicity of particles generated by combustion processes is of special concern for human health. A significant part of these toxic effects is linked to the binding of some pollutants (like polycyclic aromatic hydrocarbons or PAHs) to the Aryl hydrocarbon Receptor (AhR) and the activation of target genes, like the cytochrome P4501A. This activity was analyzed for ambient air and coal-combustion particle extracts in zebrafish embryos (the cyp1aDarT assay) and in two single-cell bioassays: the yeast-based YCM-RYA and the DR-luc (rat cells) assay. Observed AhR ligand activity of samples generally correlated to the predicted toxic effect according to their PAH composition, except for one of the coal combustion samples with an anomalously high activity in the cyp1aDarT assay. This sample induced deformities in zebrafish embryos. We concluded that the combination of morphological and molecular assays may detect embryonic toxic effects that cannot be predicted from chemical analyses or single-cell bioassays.

Association between symptomatic profile and remission following antidepressant treatment in unipolar major depression.

BACKGROUND: To evaluate, in patients affected by an acute major depressive episode, what predictive value certain baseline psychopathological characteristics have with regard to expected therapeutic remission following biological antidepressant treatment (pharmacological/electroconvulsive; non-psychological). METHODS: Six predefined psychopathological characteristics in acute major depressive episode were evaluated using a logistic regression model through a protocolised antidepressant treatment to assess their predictive value with regard to expected remission rate. RESULTS: The final study sample consisted of 129 subjects affected by an acute major depressive episode. From the baseline evaluation of the anguish/restlessness, reduced emotional reactivity, reduced attention, reduced motor response, feeling of worthlessness, and mood characteristics items, it was possible to correctly classify 88.1% of the sample as remitter/non-remitter with sensitivity of 0.77 and specificity of 0.96. Addition of the 17-item HRSD baseline variable to the regression model increased the capacity for correct classification of the baseline sample by only 0.09%. LIMITATIONS: Protocolised antidepressant treatment was used. The results of this study may not be generalisable to pharmacological treatments not included in this protocol. CONCLUSIONS: The results of this study suggest that certain baseline psychopathological characteristics (and perhaps other clinical variables too) of the acute major depressive episode may be of great use in establishing patient subgroups according to expected clinical remission to the administration of biological antidepressant treatment. This could have considerable consequences for individualised therapeutic decision-making and for future researches (clinical trials included).

Hair and skin sterols in normal mice and those with deficient dehydrosterol reductase (DHCR7), the enzyme associated with Smith-Lemli-Opitz syndrome.

Our recent studies have focused on cholesterol synthesis in mouse models for 7-dehydrosterolreductase (DHCR7) deficiency, also known as Smith-Lemli-Opitz syndrome. Investigations of such mutants have relied on tissue and blood levels of the cholesterol precursor 7-dehydrocholesterol (7DHC) and its 8-dehydro isomer. In this investigation by gas chromatography/mass spectrometry (GC/MS) we have identified and quantified cholesterol and its precursors (7DHC, desmosterol, lathosterol, lanosterol and cholest-7,24-dien-3ß-ol) in mouse hair. The components were characterized and their concentrations were compared to those found in mouse skin and serum. Hair appeared unique in that desmosterol was a major sterol component, almost matching in concentration cholesterol itself. In DHCR7 deficient mice, dehydrodesmosterol (DHD) was the dominant hair Δ(7) sterol. Mutant mouse hair had much higher concentrations of 7-dehydrosterols relative to cholesterol than did serum or tissue at all ages studied. The 7DHC/C ratio in hair was typically about sevenfold the value in serum or skin and the DHD/D ratio was 100× that of the serum 7DHC/C ratio. Mutant mice compensate for their DHCR7 deficiency with maturity, and the tissue and blood 7DHC/C become close to normal. That hair retains high relative concentrations of the dehydro precursors suggests that the apparent up-regulation of Dhcr7 seen in liver is slower to develop at the site of hair cholesterol synthesis.

Increasing cholesterol synthesis in 7-dehydrosterol reductase (DHCR7) deficient mouse models through gene transfer.

Smith-Lemli-Opitz syndrome (SLOS) is caused by deficiency in the terminal step of cholesterol biosynthesis: the conversion of 7-dehydrocholesterol (7DHC) to cholesterol (C), catalyzed by 7-dehydrocholesterol reductase (DHCR7). This disorder exhibits several phenotypic traits including dysmorphia and mental retardation with a broad range of severity. There are few proven treatment options. That most commonly used is a high cholesterol diet that seems to enhance the quality of life and improve behavioral characteristics of patients, although these positive effects are controversial. The goal of our study was to investigate the possibility of restoring DHCR7 activity by gene transfer. We constructed an adeno-associated virus (AAV) vector containing the DHCR7 gene. After we infused this vector into affected mice, the introduced DHCR7 gene could be identified in liver, mRNA was expressed and a functional enzyme was produced. Evidence of functionality came from the ability to partially normalize the serum ratio of 7DHC/C in treated animals, apparently by increasing cholesterol production with concomitant decrease in 7DHC precursor. By 5 weeks after treatment the mean ratio (for 7 animals) had fallen to 0.05 while the ratio for untreated littermate controls had risen to 0.14. This provides proof of principle that gene transfer can ameliorate the genetic defect causing SLOS and provides a new experimental tool for studying the pathogenesis of this disease. If effective in humans, it might also offer a possible alternative to exogenous cholesterol therapy. However, it would not offer a complete cure for the disorder as many of the negative implications of defective synthesis are already established during prenatal development.

The comparison of mouse full metallothionein-1 versus alpha and beta domains and metallothionein-1-to-3 mutation following traumatic brain injury reveals different biological motifs.

Traumatic injury to the brain is one of the leading causes of injury-related death or disability, but current therapies are limited. Previously it has been shown that the antioxidant proteins metallothioneins (MTs) are potent neuroprotective factors in animal models of brain injury. The exogenous administration of MTs causes effects consistent with the roles proposed from studies in knock-out mice. We herewith report the results comparing full mouse MT-1 with the independent alpha and beta domains, alone or together, in a cryoinjury model. The lesion of the cortex caused the mice to perform worse in the horizontal ladder beam and the rota-rod tests; all the proteins showed a modest effect in the former test, while only full MT-1 improved the performance of animals in the rota-rod, and the alpha domain showed a rather detrimental effect. Gene expression analysis by RNA protection assay demonstrated that all proteins may alter the expression of host-response genes such as GFAP, Mac1 and ICAM, in some cases being the beta domain more effective than the alpha domain or even the full MT-1. A MT-1-to-MT-3 mutation blunted some but not all the effects caused by the normal MT-1, and in some cases increased its potency. Thus, splitting the two MT-1 domains do not seem to eliminate all MT functions but certainly modifies them, and different motifs seem to be present in the protein underlying such functions.

Accidentes asociados al uso de restricciones físicas en ancianos con trastornos cognitivos: estudio de tres casos / Accidents associated with the use of physical restraints in the elderly with cognitive disorders: a study of three cases

IntroducciónLa restricción física suele aplicarse en ancianos con trastornos cognitivos bajo la convicción de que mejora su seguridad. Sin embargo, diversos estudios advierten del riesgo de que se produzca un percance grave cuando estas personas quedan atrapadas por el dispositivo al tratar de salir de la cama o del sillón. Se estima que sólo en EE. UU. se producen unas 200 muertes al año como resultado de un accidente causado por estos mecanismos.Material y métodosSe estudiaron las circunstancias en las que se produjo la muerte de 3 ancianos con trastornos cognitivos a los que se les estaba aplicando un cinturón de sujeción abdominal en el momento de su fallecimiento. Los datos fueron recopilados de las historias clínicas y a través de una entrevista semiestructurada con los profesionales responsables de los pacientes.ResultadosEntre los factores que pudieron facilitar los sucesos estarían la desorientación y la incapacidad de los pacientes para reconocer riesgos, la escasa vigilancia sobre éstos, la aplicación incorrecta de los dispositivos, una baja ratio de personal en determinados turnos y una insuficiente formación.ConclusionesSe observa que tanto los casos analizados como los descritos en la bibliografía presentan patrones comunes y que una probable combinación de factores sea lo que incremente la posibilidad de que ocurra un accidente(AU)

IntroductionPhysical restraint is normally applied to the elderly with cognitive disorders in the belief that it improves their safety. However, several studies warn about the risk of a serious accident when these people become trapped by the equipment when trying to get up from a bed or chair. It is estimated that in the USA alone, as many as 200 deaths are caused annually by these devices.Material and methodsThe circumstances resulting in the deaths of three elderly people with cognitive impairment and an abdominal belt restraint at the time of death were studied. The information was collected from clinical histories and through a semi-structured interview with the professionals in charge of the patients.ResultsAmong the possible contributing factors to these incidents could be the patients’ disorientation and inability to recognize risks, the lack of adequate supervision, incorrect application of the devices, a low staff ratio on some shifts and insufficient staff training.ConclusionsBoth the literature review and the cases analyzed show a common pattern. A probable combination of factors could increase the possibility of an accident occurring(AU)

Accidentes asociados al uso de restricciones físicas en ancianos con trastornos cognitivos: estudio de tres casos / Accidents associated with the use of physical restraints in the elderly with cognitive disorders: a study of three cases

IntroducciónLa restricción física suele aplicarse en ancianos con trastornos cognitivos bajo la convicción de que mejora su seguridad. Sin embargo, diversos estudios advierten del riesgo de que se produzca un percance grave cuando estas personas quedan atrapadas por el dispositivo al tratar de salir de la cama o del sillón. Se estima que sólo en EE. UU. se producen unas 200 muertes al año como resultado de un accidente causado por estos mecanismos.Material y métodosSe estudiaron las circunstancias en las que se produjo la muerte de 3 ancianos con trastornos cognitivos a los que se les estaba aplicando un cinturón de sujeción abdominal en el momento de su fallecimiento. Los datos fueron recopilados de las historias clínicas y a través de una entrevista semiestructurada con los profesionales responsables de los pacientes.ResultadosEntre los factores que pudieron facilitar los sucesos estarían la desorientación y la incapacidad de los pacientes para reconocer riesgos, la escasa vigilancia sobre éstos, la aplicación incorrecta de los dispositivos, una baja ratio de personal en determinados turnos y una insuficiente formación.ConclusionesSe observa que tanto los casos analizados como los descritos en la bibliografía presentan patrones comunes y que una probable combinación de factores sea lo que incremente la posibilidad de que ocurra un accidente(AU)

IntroductionPhysical restraint is normally applied to the elderly with cognitive disorders in the belief that it improves their safety. However, several studies warn about the risk of a serious accident when these people become trapped by the equipment when trying to get up from a bed or chair. It is estimated that in the USA alone, as many as 200 deaths are caused annually by these devices.Material and methodsThe circumstances resulting in the deaths of three elderly people with cognitive impairment and an abdominal belt restraint at the time of death were studied. The information was collected from clinical histories and through a semi-structured interview with the professionals in charge of the patients.ResultsAmong the possible contributing factors to these incidents could be the patients’ disorientation and inability to recognize risks, the lack of adequate supervision, incorrect application of the devices, a low staff ratio on some shifts and insufficient staff training.ConclusionsBoth the literature review and the cases analyzed show a common pattern. A probable combination of factors could increase the possibility of an accident occurring(AU)

[Accidents associated with the use of physical restraints in the elderly with cognitive disorders: a study of three cases]. / Accidentes asociados al uso de restricciones físicas en ancianos con trastornos cognitivos: estudio de tres casos.

INTRODUCTION: Physical restraint is normally applied to the elderly with cognitive disorders in the belief that it improves their safety. However, several studies warn about the risk of a serious accident when these people become trapped by the equipment when trying to get up from a bed or chair. It is estimated that in the USA alone, as many as 200 deaths are caused annually by these devices. MATERIAL AND METHODS: The circumstances resulting in the deaths of three elderly people with cognitive impairment and an abdominal belt restraint at the time of death were studied. The information was collected from clinical histories and through a semi-structured interview with the professionals in charge of the patients. RESULTS: Among the possible contributing factors to these incidents could be the patients' disorientation and inability to recognize risks, the lack of adequate supervision, incorrect application of the devices, a low staff ratio on some shifts and insufficient staff training. CONCLUSIONS: Both the literature review and the cases analyzed show a common pattern. A probable combination of factors could increase the possibility of an accident occurring.

Two ParaHox genes, SpLox and SpCdx, interact to partition the posterior endoderm in the formation of a functional gut.

We report the characterization of the ortholog of the Xenopus XlHbox8 ParaHox gene from the sea urchin Strongylocentrotus purpuratus, SpLox. It is expressed during embryogenesis, first appearing at late gastrulation in the posterior-most region of the endodermal tube, becoming progressively restricted to the constriction between the mid- and hindgut. The physiological effects of the absence of the activity of this gene have been analyzed through knockdown experiments using gene-specific morpholino antisense oligonucleotides. We show that blocking the translation of the SpLox mRNA reduces the capacity of the digestive tract to process food, as well as eliminating the morphological constriction normally present between the mid- and hindgut. Genetic interactions of the SpLox gene are revealed by the analysis of the expression of a set of genes involved in endoderm specification. Two such interactions have been analyzed in more detail: one involving the midgut marker gene Endo16, and another involving the other endodermally expressed ParaHox gene, SpCdx. We find that SpLox is able to bind Endo16 cis-regulatory DNA, suggesting direct repression of Endo16 expression in presumptive hindgut territories. More significantly, we provide the first evidence of interaction between ParaHox genes in establishing hindgut identity, and present a model of gene regulation involving a negative-feedback loop.

Continuation/maintenance treatment with nortriptyline versus combined nortriptyline and ECT in late-life psychotic depression: a two-year randomized study.

OBJECTIVE: The identification of effective continuation and maintenance strategies for elderly patients with psychotic depression is a critical issue that has not been fully explored. The aim of this study was to assess the tolerability and efficacy of continuation/maintenance electroconvulsive therapy (ECT) in elderly patients with psychotic depression after acute ECT remission. METHODS: The authors used a longitudinal, randomized, single-blind design to compare by survival analysis the 2-year outcome of two subgroups of elderly patients with psychotic unipolar depression who were ECT (plus nortriptyline) remitters. One group was treated with a continuation/maintenance nortriptyline regimen (N = 17) and the other with combined continuation/maintenance ECT plus nortriptyline (N = 16). RESULTS: Over 2 years of treatment in elderly, psychotic, unipolar depressed ECT (plus nortriptyline) remitters, the mean survival time was significantly longer in the combined ECT plus nortriptyline subgroup than in the nortriptyline subgroup. No differences were observed between treatments with regard to tolerability. CONCLUSIONS: This study supports the judicious use of combined continuation/maintenance ECT and antidepressant treatment in elderly patients with psychotic unipolar depression who are ECT remitters.

Evaluation of storage mite contamination of commercial dry dog food.

Storage mites may be considered important allergens in dogs with atopic dermatitis. High sensitization rates to Tyrophagus, Acarus, and Lepidoglyphus species have been reported in atopic dogs, and dry pet food has been suggested as a potential source of storage mite exposure. The aim of the present study was to evaluate commercial dry dog food for contamination with storage mites, and how storage time and conditions could influence the risk of contamination. Ten different premium commercial dry dog foods formulated for skin disorders were selected. Food bags were opened and stored for 6 weeks under two different environmental conditions. At different time points, samples from each bag were collected and analysed by microscopy, guanine test, storage mite-specific traps, and a modified flotation technique. On opening, two storage mites identified as Acarus siro were isolated from one of the 10 bags by flotation technique, indicating that storage mites can be present in packaged dry dog food bags. After 5 weeks of storage under environmental conditions optimal for mite growth (23.2 +/- 2.1 degrees C and 71 +/- 5.6% of relative humidity), mites were detected by microscopic observation in nine of the 10 diets. When mites were identified by the flotation technique, Tyrophagus spp. were found to be the most common contaminating species. These results show that dry dog food can be a suitable substrate for storage mite reproduction, and that environmental and storage conditions may influence food contamination and mite development.

A multifunctional desaturase involved in the biosynthesis of the processionary moth sex pheromone.

The sex pheromone of the female processionary moth, Thaumetopoea pityocampa, is a unique C16 enyne acetate that is biosynthesized from palmitic acid. Three consecutive desaturation reactions transform this saturated precursor into the triunsaturated fatty acyl intermediate: formation of (Z)-11-hexadecenoic acid, acetylenation to 11-hexadecynoic acid, and final Delta(13) desaturation to (Z)-13-hexadecen-11-ynoic acid. By using degenerate primers common to all reported insect desaturases, a single cDNA sequence was isolated from total RNA of T. pityocampa female pheromone glands. The full-length transcript of this putative desaturase was expressed in elo1Delta/ole1Delta yeast mutants (both elongase 1 and Delta(9) desaturase-deficient) for functional assays. The construct fully rescued the Deltaole1 yeast phenotype, confirming its desaturase activity. Analysis of the unsaturated products from transformed yeast extracts demonstrated that the cloned enzyme showed Delta(11) desaturase, Delta(11) acetylenase, and Delta(13) desaturase activities. Therefore, this single desaturase may account for the three desaturation steps involved in the sex pheromone biosynthetic pathway of the processionary moth.

Development and characterization of a canine skin equivalent.

The development of a complex cellular model, which incorporates the basic cell components of the dog skin, would be a useful tool to investigate the biology and pathology of canine skin and also to replace animal testing partially. The aim of the present study was to develop and characterize a canine skin equivalent. Epidermal keratinocytes and dermal fibroblasts were freshly isolated from skin biopsies from healthy dogs. Fibroblasts were embedded into a bio-matrix from collagen type I matrix protein; this built the scaffold where the keratinocytes were seeded, at air exposed conditions. At 3, 7, 15 and 21 days of culture in special growth media, skin equivalents were analysed by histological, immunohistochemical and electron microscopical techniques. At 15 days, keratinocytes underwent differentiation to a multilayer epidermis with stratum basal, stratum spinosum, stratum granulosum and stratum corneum. Expression of epidermal cytokeratins in keratinocytes was detected by immunhistochemistry, and followed the same pattern than in the normal canine epidermis. Fibroblasts from the skin equivalent expressed vimentin as dermal fibroblasts do. A basement membrane (BM) was observed underneath the epidermis; ultrastructurally, it was similar to the normal canine BM and collagen IV and laminin 5 were detected immunohistochemically as major components of this structure. Skin equivalents developed from canine cutaneous cells presented a similar morphological structure than healthy canine skin. Moreover, the immunohistochemical analysis revealed the expression of the major markers of the epidermis (keratins), dermis (vimentin) and BM (collagen type IV, laminin 5).

Synthesis and use of deuterated palmitic acids to decipher the cryptoregiochemistry of a Delta13 desaturation.

The synthesis of two hexadeuterated palmitic acids differing in the position of the diagnostic labels, and their use to decipher the cryptoregiochemistry of a Delta13 desaturation are described. A dithiane and a triple bond functionalities were used to introduce the diagnostic (C13 or C14) and tagging (C8 and C9) labels, respectively, in the palmitic acid skeleton. Using these probes, the cryptoregiochemistry of the Delta13 desaturation involved in the biosynthesis of Thaumetopoea pityocampa sex pheromone was studied by means of kinetic isotope effect determinations. Transformation of both (Z)-11-hexadecenoic and 11-hexadecynoic acids into (Z, Z)-11,13-hexadecadienoic and (Z)-13-hexadecen-11-ynoic acids, respectively, is initiated by abstraction of the hydrogen atom at the C13 position, followed by the fast elimination of the C14 hydrogen to give the double bond.

Syndrome of inappropriate secretion of antidiuretic hormone due to citalopram and venlafaxine.

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) and venlafaxine are often used to treat depression in the elderly due to their low incidence of side effects. All five of the SSRIs currently available and venlafaxine have been associated with hyponatremia. CASE REPORT: This article describes the case of an 87-year-old man with depression who presented with hyponatremia after starting treatment with citalopram. After excluding other common causes of hyponatremia, a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was confirmed. Sodium levels returned to the normal range following discontinuation of citalopram. Subsequently, due to the persistence of depression, treatment with venlafaxine was initiated. Three weeks later, hyponatremia associated with SIADH was once again diagnosed and venlafaxine was discontinued. The hyponatremia resolved in 2 weeks. DISCUSSION: Both SSRIs and venlafaxine have been associated with SIADH in numerous case reports and retrospective studies. Risk factors for developing hyponatremia with these drugs are advanced age and treatment with other medications. To our knowledge, this is the first case report in which SIADH was associated with two different families of antidepressants in the same patient. CONCLUSION: Physicians should be aware of the risk of hyponatremia when prescribing SSRIs and venlafaxine in elderly patients with multiple drug therapies. Sodium levels should be monitored during treatment.