Pronóstico y recaída alcohólica en el hospital psiquiátrico n°14 de la Caja Nacional de Salud / Prognosis and alcoholic relapse at the Hospital Psiquiátrico N° 14, Caja Nacional de Salud

Objetivo: Estimar el tiempo de recaída alcohólica de pacientes internados en el hospital psiquiátrico N° 14 y construir un modelo predictivo de aquellos factores; pronóstico que cotidianamente se evalúan y registran en la historia clínica. Material y Métodos: Cohorte histórica descriptiva. La cohorte se construyó a través de la información contenida en 70 fichas clínicas de pacientes internados por intoxicación y dependencia alcohólica. El inicio del estudio fue el momento de la internación y se consideró un tiempo de seguimiento de 6 meses. Se usó el estimador de Kaplan Meier y regresión de Cox para los factores pronósticos. Resultados: El promedio de edad fue de 44.5 años, de 23.1 meses el tiempo de bebedor y de 16.2 días la ingesta de alcohol previa recaída. El 61 por ciento presenta una pareja legal y a los 6 meses, el 51 por ciento de los pacientes presentaron a lo menos una recaída. Controlando por factores de confusión, los factores predictores de recaída son la edad (HR 0.7 IC95 por ciento0.5, 0.99), tiempo de bebedor (HR 1.5 IC95 por ciento 1.1, 2.2), tiempo de ingesta previa recaída (HR 1.2 IC95 por ciento 0.97, 1.5), tenencia de pareja (HR<0.002 IC95 por ciento <0.004, 0.05), buena relación con la pareja (HR 0.002 IC95 por ciento <0.006, 0.4) y uso de drogas (HR 58.6IC95 por ciento 1.2, 2977). Conclusión: El tiempo estimado para la primera recaída de los pacientes del hospital psiquiátricos es de 5.8 meses. Controlando por factores de confusión, los factores de mal pronóstico son el uso asociado de drogas, mayor tiempo de bebedor e ingesta alcohol previa a la recaída.

Objective: To estimate the time to alcoholic relapse at the psychiatric hospital No. 14 and to estimate a predictive model of prognostic factors in clinical records. Methods: This is a historical cohort descriptive study. The cohort was constructed with the information contained in 70 clinical records. The onset of the study was considered when the patient was admitted for the first time and considered a follow-up period of 6 months. The time to alcoholic relapse and predictive model was estimated with the Kaplan-Meier estimator and Cox regression model. Results: The mean age was 44.5 years, 23.1 months for the time of alcohol intake and 16.2 drinking days and alcohol intake before the relapse. The 61 percent of the patients were married. At 6 months, 51 percent of patients experienced at least one alcoholic relapse. Controlling for confounders, predictors of relapse were age (HR 0.7CI95 percent 0.5, 0.99), time of alcohol intake (HR 1.5 CI95 percent 1.1, 2.2), while previous intake relapse (HR 1.2 95 percent 0.97, 1.5) having a partner (HR <0.002 95 percent <0.004, 0.05), good relationship with partner (HR 0.002 95 percent <0.006, 0.4) and drug use (HR 58.6IC95 percent 1.2, 2977). Conclusion: The estimated time to first alcoholic relapse of psychiatric hospital patients is 5.8 months. Controlling for confounders, the predictors of first relapse are drug use, longer drinking and alcohol intake prior to a relapse.

A systematic approach to analyse health-related quality of life in multiple sclerosis: the GEDMA study.

OBJECTIVE: To describe a holistic and comprehensive approach to the assessment of sufferer's perceptions of health-related quality of life (HRQoL) in a cohort of multiple sclerosis (MS) patients. METHODS: The GEDMA (Grupo de Enfermedades Desmielinizantes de Madrid, in Spanish) study is an ongoing longitudinal survey using quantitative and qualitative methodologies. The baseline cohort consisted of a large sample of MS patients recruited from 13 hospitals in Madrid, Spain. Using a standardized protocol we collected data concerning the sociodemographic and health status characteristics of patients, as well as implementing a modified Spanish version of the Functional Assessment of Multiple Sclerosis quality of life instrument Primary caregivers were interviewed using a specific protocol combined with the Zarit Burden Interview. RESULTS: The index cohort comprised 371 MS patients (68.7% female) of mean age 38.9+/-0.9 years. Age, sex and clinical form distribution were similar to other MS population-based surveys. There were 258 (69.5%) relapsing-remitting (RR) MS patients and 113 (30.5%) progressive MS patients. More than one-third of the married patients with progressive MS and almost a quarter of the RRMS patients separated or divorced following a diagnosis of MS; 71.3% of the progressive MS patients as well as 65.8% of the RRMS patients were unemployed as a consequence of the disease. Qualitative analysis showed that friendship and family relationships and occupational status were the most significant dimensions influenced by MS. On the other hand, the speech analysis of primary caregivers showed that emotional burden was related to patients' physical disability. Furthermore, primary caregivers described the influence of MS on their own occupational status, their nonacceptance of the disease, a perception of a lack of support by other members of the family as well as a 'selfish and intransigent' attitude of the patients themselves. CONCLUSIONS: The analysis of the GEDMA cohort provides valuable information that helps clarify the impact of MS on patients' HRQoL.

Isoflurane enhances glutamatergic agonist-stimulated nitric oxide synthesis in cultured neurons.

The purpose of this study was to determine how halothane, isoflurane, and enflurane, three commonly used volatile anesthetic agents, affect glutamate receptor-modulated nitric oxide signaling in cultured cortical neurons. Primary cultures of cortical neurons were prepared from fetal Sprague-Dawley rats and experiments were performed after 11-13 days in culture. Cyclic GMP was measured as an indicator of nitric oxide production. Glutamate (100 microM), N-methyl-D-aspartate (100 microM), quisqualate (300 microM), or kainate (100 microM) increased cyclic GMP production. At clinically relevant concentrations, isoflurane enhanced responses to each of these agonists, while halothane or enflurane had no effect. Thus, isoflurane, but not halothane or enflurane, enhanced nitric oxide signaling stimulated by glutamatergic agonists.

Pentobarbital enhances cyclic adenosine monophosphate production in the brain by effects on neurons but not glia.

BACKGROUND: Cyclic adenosine monophosphate (cAMP) is an important regulator of neuronal excitability. The effects of barbiturates on cAMP production in intact neurons are not known. This study used cultures of cortical neurons, cultures of glia, and slices of cerebral cortex from the rat to study the effects of barbiturates on cAMP regulation in the brain. METHODS: Primary cultures of cortical neurons or glia were prepared from 17-day gestational Sprague-Dawley rat fetuses and were used after 12-16 days in culture. Cross-cut slices (300 microns) were prepared from cerebral cortex of adult rats. Cyclic AMP accumulation was determined by measuring the conversion of [3H]adenosine triphosphate (ATP) to [3H]cAMP in cells preloaded with [3H]adenine. RESULTS: Pentobarbital enhanced isoproterenol- and forskolin-stimulated, but not basal, cAMP accumulation in cultures of cerebral neurons. Cyclic AMP production was enhanced by pentobarbital in a dose-dependent fashion up to a concentration of 250 microM; This concentration of pentobarbital increased cAMP production by 40-50% relative to that in controls without pentobarbital. At 500 microM pentobarbital, the magnitude of the enhancement was less. Pentobarbital had no effect on isoproterenol-stimulated cAMP production in cultures containing only glia. Pentobarbital also enhanced isoproterenol-stimulated, but not basal, cAMP production in slices of cerebral cortex by approximately 30% at concentrations of 62.5-250 microM and by almost 100% at 500 microM. CONCLUSIONS: Pentobarbital enhances stimulated cAMP accumulation in cultured preparations from brain and fresh cortical slices. Neurons are required for this effect. Because cAMP modulates neuronal excitability, this effect of pentobarbital may be an important mechanism by which this anesthetic influences brain function.

Anesthetic barbiturates enhance Gs alpha-dependent cyclic AMP production in S49 mouse lymphoma cells.

Cyclic AMP (cAMP) regulates many important physiological processes. Barbiturates influence cAMP regulation, possibly through effects on G proteins. This study used intact S49 mouse lymphoma cells to characterize the role of G proteins in the effect of barbiturates on cAMP regulation. cAMP accumulation was determined in intact S49 WT (wild-type) and S49 cyc- cells (the Gs alpha-deficient mutant) by measuring the conversion of [3H]-ATP to [3H]cAMP in cells preloaded with [3H]adenine. Pentobarbital enhanced cAMP accumulation in WT cells in the absence (basal) or presence of isoproterenol but had no effect on the EC50 for isoproterenol. This effect was dose dependent with a 50-60% enhancement at 2 mM pentobarbital. Pentobarbital did not affect forskolin-stimulated cAMP accumulation in WT cells. In cyc- cells, basal and forskolin-stimulated cAMP accumulation were stimulated only at the highest concentration of pentobarbital used (2 mM). Pentobarbital did not affect the inhibition of cAMP accumulation by somatostatin in WT cells, and pertussis toxin treatment of WT cells did not affect the action of pentobarbital on cAMP accumulation. Pentobarbital did not affect isoproterenol-stimulated adenylyl cyclase activity in whole-cell homogenates or membranes prepared from WT cells. The S-(-)-isomer of pentobarbital enhanced isoproterenol-stimulated cAMP accumulation more than the R-(-)-isomer. Phenobarbital and barbituric acid did not enhance isoproterenol-stimulated cAMP accumulation, whereas the anesthetic barbiturates hexobarbital, pentobarbital, and thiopental all enhanced activity. These results suggest that pentobarbital enhances cAMP accumulation in intact WT cells by a mechanism that is dependent on Gs alpha but independent of Gi.(ABSTRACT TRUNCATED AT 250 WORDS)

Ketamine inhibits glutamate-, N-methyl-D-aspartate-, and quisqualate-stimulated cGMP production in cultured cerebral neurons.

BACKGROUND: Glutamatergic signaling has been linked to the recently discovered neurotransmitter/neuromodulator nitric oxide (NO), and several classes of anesthetics block some step in glutamatergic signaling. This study was designed to determine whether or not ketamine would prevent NO-dependent cGMP production stimulated by glutamate (GLU) and the GLU analogs NMDA, quisqualate (QUIS), and kainate (KAIN). METHODS: Primary cultures of cortical neurons and glia (prepared from 16-day gestational rat fetuses) were used after 12-16 days in culture. Reactions were carried out in magnesium-free buffer containing 100 microM 3-isobutyl-1-methylxanthine, and cGMP content of cultures was used as a bioassay of NO production. RESULTS: Cyclic GMP production stimulated by sodium nitroprusside (100 microM) occurred predominately in neurons and not in glia. Neurons were spontaneously active in these cultures; basal cGMP production was decreased by 50% in the presence of 1 microM tetrodotoxin (TTX). Glutamate (100 microM), NMDA (100 microM), QUIS (300 microM), and KAIN (100 microM) each increased cGMP content of neuronal cultures. L-NMMA (100 microM), a NO synthase inhibitor, prevented the stimulation of cGMP production by GLU or its analogs. Pretreatment with MK-801 (1 microM) or ketamine (10-100 microM) inhibited GLU-, NMDA-, and QUIS-stimulated cGMP production. Quisqualate-stimulated responses were the most sensitive to inhibition by ketamine and NMDA-stimulated responses were the least sensitive to inhibition. MK-801 and ketamine did not significantly inhibit KAIN-stimulated cGMP production. CNQX (10 microns) blocked KAIN-stimulated cGMP production only. CONCLUSIONS: The authors' data demonstrate that ketamine inhibited NO synthesis stimulated by NMDA- and non-NMDA-receptor specific analogs. Our findings indicate that blockade of QUIS- as well as NMDA-subtypes of GLU- receptor may be important in the development of ketamine-induced anesthesia.

Down-regulation of beta-adrenergic receptors by pindolol in Gs alpha-transfected S49 cyc- murine lymphoma cells.

The role of the alpha subunit of the guanine nucleotide-binding regulatory protein that stimulates adenylyl cyclase (GS alpha) in the down-regulation of beta-adrenergic receptors by pindolol was studied in S49 cyc- cells (normally GS alpha-deficient) transfected to express functional recombinant rat GS alpha. An inducible cell line (S49 GS alpha IND) was derived from S49 cyc- cells transfected with a vector containing the full-length coding sequence of GS alpha under the inducible control of the mouse mammary tumor virus long-terminal repeat promoter. GS alpha was not detectable in S49 GS alpha IND cells by immunoblot or by ADP-ribosylation in the presence of cholera toxin and [alpha-32P]NAD. When cells were grown in 100 nM dexamethasone, isoproterenol-stimulated cyclic AMP accumulation increased within 3 h. After 15 h, GS alpha was present at a level 40-50% of that found in S49 wild-type (WT) cells as measured either by immunoblot analysis or by [alpha-32P]ADP-ribosylation. Membranes prepared from GS alpha IND cells grown in the presence of dexamethasone bound agonist with high affinity, and this binding was sensitive to guanine nucleotides. A second vector, DzbGS alpha +, contained the coding sequence of GS alpha under the constitutive regulatory control of the SV40 early promoter. This vector was introduced into cyc- cells, and the resulting cells, S49 GS alpha CST cells, expressed GS alpha at a level comparable to that found in S49 WT cells as measured by immunoblot analysis. Isoproterenol-stimulated cyclic AMP accumulation in S49 GS alpha CST cells was at least as great as in S49 WT cells. When cells were grown in the presence of dexamethasone, exposure to 50 nM pindolol for 12 h down-regulated the density of beta-adrenergic receptors in S49 WT cells to 60% of that in cells grown in the absence of pindolol, but pindolol had no effect on the density of receptors on cyc- or GS alpha IND cells. When GS alpha CST cells were exposed to 50 nM pindolol for 12 h, the density of beta-adrenergic receptors was down-regulated by the same amount as in S49 WT cells. These results suggest that GS alpha is necessary to restore the ability of pindolol to down-regulate beta-adrenergic receptors in S49 cyc- cells and that the protein must be expressed at a level comparable to that found in S49 WT cells.

Influence of training and experience in fine-needle aspiration biopsy of breast. Receiver operating characteristics curve analysis.

In an effort to assess the influence of training and experience on the interpretation of fine-needle aspiration biopsy (FNAB) specimens, five observers with varying degrees of training and experience reviewed a series of 50 breast FNAB specimens. The cases selected were from the cytology registry of the University of California, San Francisco; all cases necessarily had histologic follow-up. By using receiver operating characteristics analysis, we were able to show that training and experience significantly influenced the interpretation of breast FNAB specimens. The two experts operated at a higher level of sensitivity and specificity than did three nonexperts. This study shows that training and experience are important in the interpretation of breast FNAB specimens. It also demonstrates the utility of receiver operating characteristics analysis in anatomic pathology.

Fine-needle aspiration biopsy. Perceptions of physicians at an academic medical center.

In an earlier survey, we asked private practitioners in San Francisco about their perceptions of fine-needle aspiration biopsy (FNAB). In the present study we sent the same survey to clinicians in our hospital, a tertiary medical center. Although the response rate to this survey was lower, it appears that FNAB is used more often in our hospital than it is among private practitioners for the evaluation of palpable masses (53% vs 24%), and that it is most often performed by pathologists. Seventy percent of the FNAB at this institution were performed by pathologists; a small percentage (7%) of cases (nonpalpable) were performed by a radiologist for the evaluation of intra-thoracic and intra-abdominal lesions. Fifty-nine percent of private practitioners performed the FNAB themselves, and the remainder (39%) were referred to pathologists, radiologists, and surgeons. That there are differences in perceptions concerning the use of FNAB in a variety of specific clinical settings was also illustrated by this survey.

Suturas colonicas mecanicas EEA y manuales en cirugia experimental. / Colonic mechanical EEA and manual sutures in experimental surgery

Se analizan los resultados anatomopatologicos obtenidos en una serie de 28 perros, a los que se les efectuo suturas colonicas EEA y manuales. Con el objeto de obtener cifras estadisticamente significativas, se tomaron 18 perros sacrificados en 3 lotes de 6 cada uno a los 5, 15, y 30 dias. Las suturas mecanicas evidenciaron mayor lisura, conservacion de la mucosa, continuidad de la pared muscular, mayor diametro interno, menor necrosis y reparacion angioblastica, como asi tambien ausencia de granulomas por cuerpo extrano. El numero de dehiscencias producido a nivel de sutura manual fue 4 veces mayor que las de la sutura automatica

Suturas colonicas mecanicas EEA y manuales en cirugia experimental. / Colonic mechanical EEA and manual sutures in experimental surgery

Se analizan los resultados anatomopatologicos obtenidos en una serie de 28 perros, a los que se les efectuo suturas colonicas EEA y manuales. Con el objeto de obtener cifras estadisticamente significativas, se tomaron 18 perros sacrificados en 3 lotes de 6 cada uno a los 5, 15, y 30 dias. Las suturas mecanicas evidenciaron mayor lisura, conservacion de la mucosa, continuidad de la pared muscular, mayor diametro interno, menor necrosis y reparacion angioblastica, como asi tambien ausencia de granulomas por cuerpo extrano. El numero de dehiscencias producido a nivel de sutura manual fue 4 veces mayor que las de la sutura automatica