Effectiveness and tolerance of anti-inflammatory drugs' add-on therapy in major mental disorders: a systematic qualitative review.

OBJECTIVE: To provide a systematic review of the literature regarding the efficacy of anti-inflammatory drugs in three major mental disorders [major depressive disorder (MDD), schizophrenia and bipolar disorders]. METHOD: Four databases were explored, without any year or language restrictions. The baseline search paradigm was limited to open-labelled clinical and randomized controlled trials (RCTs). RESULTS: Four major classes of anti-inflammatory drugs were identified, namely polyunsaturated fatty acids (PUFAs), cyclooxygenase (COX) inhibitors, anti-TNFalpha and minocycline. Effectiveness and benefit/risk ratio of each class in MDD, bipolar disorders and schizophrenia was detailed when data were available. Several meta-analyses indicated effectiveness of PUFAs in MDD with a good tolerance profile. One meta-analysis indicated that COX-2 specific inhibitors showed effectiveness in schizophrenia. Anti-TNFalpha showed important effectiveness in resistant MDD with blood inflammatory abnormalities. Minocycline showed effectiveness in schizophrenia. CONCLUSION: Polyunsaturated fatty acids seem to have the best benefit/risk ratio profile but proved their effectiveness only in MDD. A number of anti-inflammatory drugs are available as adjunct treatment for treatment-resistant patients with MDD, schizophrenia and bipolar disorder. If used with caution regarding their possible side-effects, they may be reasonable therapeutic alternatives for resistant symptomatology.

[Neuro-ophthalmological assessments in the Ophthalmology Department at University Medical Center, Brest: retrospective study of 269 patients (January 2004-October 2009)]. / Bilans neuro-ophtalmologiques dans le service d'ophtalmologie du CHU de Brest : étude rétrospective sur 269 patients (janvier 2004-octobre 2009).

AIMS: To evaluate the neuro-ophthalmological assessments carried out in the ophthalmology department of the university medical center, Brest, identifying the population seen, the examinations performed, the pathologies treated and patient outcomes, so as to suggest solutions to improve quality of care. METHODOLOGY: Retrospective study over a period of more than five years, between January 1st, 2004 and October 31st, 2009. Data were collected from each patient's chart with the help of a standardized spreadsheet including epidemiological, clinical, paraclinical and treatment data. RESULTS: Analysis of the 269 charts reveals that optic neuropathies are the most frequently encountered etiologies. In addition to the standardized assessment currently used on the service, we suggest adding a specific neuro-ophthalmological clinical intake form so as to standardize and perfect the diagnostic approach. CONCLUSION: Optimization of quality of care in neuro-ophthalmology involves a multidisciplinary approach, requiring close collaboration between ophthalmologists, neurologists and radiologists. A careful, regular analysis of our practice patterns with respect to scientific advances should improve consistency and quality of care for our patients.

Effect of cyclosporin and the prostacyclin analogue iloprost on human glomerular vasoreactivity.

Cyclosporin is known to cause a decrease in renal blood flow and glomerular filtration rate in both humans and animals. These acute modifications are reversible if the drug is withdrawn, and seem to be caused by a local hormonal imbalance between vasoconstricting and vasodilating substances. We studied human glomeruli incubated with either CsA alone, iloprost alone, or CsA + iloprost. Photomicrographs of glomeruli were taken at t0, t1, t2 and t5 min and glomerular areas were measured with a videoanalyser linked to a computer. Results show a significant vasoconstriction with CsA alone, and no significant modification of glomerular areas with iloprost or CsA + iloprost. We conclude that iloprost prevents CsA-induced vasoconstriction in human glomeruli in vitro.

[Kinetics of tobramycin in newborn infants in intensive care]. / Cinétique de la tobramycine chez le nouveau-né en réanimation.

Maximal and minimal tobramycin concentrations were studied in 16 preterm and 4 fullterm neonates on the last day of a four-day course of tobramycin (infusion of 2 mg/kg twice a day). Maximal concentrations were under 6 mg/l in all patients and minimal concentrations were above 2 mg/l in one-third of the preterm babies. Next, tobramycin pharmacokinetic parameters were studied in 4 fullterm and 4 preterm neonates following a first infusion of 2 mg/kg. Half-life was 4 hours in term babies and 7.75 hours in preterm babies. Mean clearance was 0.118 l/h/kg and 0.06 l/h/kg in fullterm and preterm babies respectively (significant difference). Our results show that the 2 mg/kg dosage is too low and that, in preterm neonates, the 12-hour interval between infusions is too short.