Striatal and thalamic automatic segmentation, morphology, and clinical correlates in Parkinsonism: Parkinson's disease, multiple system atrophy and progressive supranuclear palsy.

Parkinson's disease (PD), multisystem atrophy (MSA), and progressive supranuclear palsy (PSP) present similarly with bradykinesia, tremor, rigidity, and cognitive impairments. Neuroimaging studies have found differential changes in the nigrostriatal pathway in these disorders, however whether the volume and shape of specific regions within this pathway can distinguish between atypical Parkinsonian disorders remains to be determined. This paper investigates striatal and thalamic volume and morphology as distinguishing biomarkers, and their relationship to neuropsychiatric symptoms. Automatic segmentation to calculate volume and shape analysis of the caudate nucleus, putamen, and thalamus were performed in 18 PD patients, 12 MSA, 15 PSP, and 20 healthy controls, then correlated with clinical measures. PSP bilateral thalami and right putamen were significantly smaller than controls, but not MSA or PD. The left caudate and putamen significantly correlated with the Neuropsychiatric Inventory total score. Bilateral thalamus, caudate, and left putamen had significantly different morphology between groups, driven by differences between PSP and healthy controls. This study demonstrated that PSP patient striatal and thalamic volume and shape are significantly different when compared with controls. Parkinsonian disorders could not be differentiated on volumetry or morphology, however there are trends for volumetric and morphological changes associated with PD, MSA, and PSP.

Tratamiento farmacológico de la desnutrición en la EPOC / Drug therapy for malnutrition in COPD

El tratamiento farmacológico de la desnutrición en la enfermedad pulmonar obstructiva crónica (EPOC) es un campo de conocimiento controvertido y limitado por la escasa evidencia científica generada. Sus objetivos se centrarían en reducir inflamación, estrés oxidativo y pérdida progresiva de la masa muscular esquelética. Varias vías fisiopatológicas se han propuesto como dianas terapéuticas. Desde un punto de vista teórico, se ha planteado la posible eficacia de fármacos orexígenos (progestágenos, ciproheptadina y cannabinoides) esteroides anabolizantes (nandrolona), moduladores selectivos de los receptores de andrógenos, hormonas peptídicas (somatotropina -GH- y grelina), antiinflamatorios (talidomida, celecoxib y ácidos grasos omega 3, entre otros), aminoácidos y metabolitos activos (L-carnitina, creatina, leucina y β-hidroxi-β-metilbutirato), vitamina D, antioxidantes (vitaminas A, E, ácido alfa lipoico, resveratrol y N-acetil-cisteína) e inhibidores de la miostatina. Solo se han publicado datos con algunos de estos fármacos, y las guías de práctica clínica aún no reconocen su papel en esta patología

Drug therapy for malnutrition in chronic obstructive pulmonary disease (COPD) is a controversial and limited field of knowledge due to scarce generated scientific evidence. Its objectives would be reducing inflammation, oxidative stress and progressive skeletal muscle mass loss. Several pathological ways have been proposed as therapeutic target. From a theoretical point of view, the possible efficacy of different drugs has been studied. Among them: orexigenic drugs (progestagens, cyproheptadine and cannabinoids), anabolizing steroids (nandrolone), selective androgen receptor modulators, peptidic hormones (somatotropin -GH- and ghreline), anti-inflammatories (thalidomide, celecoxib and omega 3 fatty acids), amino acids and active metabolites (L-carnitine, creatin, leucin and β-hydroxy β-methylbutyrate), vitamin D, antioxidants (vitamins A, E, alpha-lipoic acid, resveratrol and N-acetyl-cysteine) and myostatin inhibitors. Studies have been published with some of these drugs, but the different clinical guidelines do not recognize their role in this entity

Situación actual de la rehabilitación respiratoria en los hospitales de la Comunidad de Madrid / No disponible

Introducción: A pesar de que la rehabilitación respiratoria (RR) es considerada como una intervención terapéutica con alto nivel de evidencia científica, la estructura y la organización de las unidades de RR pueden repercutir en sus resultados. Nuestra intención era conocer la situación actual de las unidades de RR de la Comunidad de Madrid. Material y métodos: Análisis de los resultados de la encuesta distribuida a todos los hospitales de la Comunidad de Madrid mediante correo electrónico desde la Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) y la Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). La encuesta fue diseñada de acuerdo a los estándares de calidad asistencial en RR propuestos por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Resultados: Once (61,6%) hospitales señalaron que contaban con una unidad de RR y en el 54,5% de ellas no existía acceso desde atención primaria. El 72,7% de unidades indicó que la derivación de pacientes no era adecuada. Casi todas las unidades ofrecían programas de fisioterapia, entrenamiento aeróbico, de fuerza muscular y soporte educativo, sin embargo solo el 27,3% daba soporte nutricional y 18,2% apoyo psicosocial. El 45,4% usaba la prueba de esfuerzo progresivo para pautar el entrenamiento. Existían 3 cicloergómetros (rango intercuartílico 2-5) y 1 tapiz rodante (0-2) por unidad. Todas las unidades contaba con médicos rehabilitadores y fisioterapeutas y en el 60% también participaban neumólogos. Conclusiones: No todos los hospitales de la Comunidad de Madrid cuentan con unidades de RR. Además, el análisis de los indicadores de calidad asistencial en RR demuestran limitaciones en protocolos, evaluación del paciente, componentes y características de los programas, y aspectos administrativos y de investigación

Introduction: Although respiratory rehabilitation (RR) is considered as a therapeutic intervention with a high level of scientific evidence, the structure and organization of the RR units may have repercussions on its results. Our intention was to know the current situation of RR units in the Community of Madrid. Material and Methods: Analysis of results of the survey distributed to all hospitals in the Community of Madrid by email from the Sociedad Madrileña de Neumología y Cirugía Torácica (NEUMOMADRID) and the Sociedad Española de Rehabilitación Cardiorrespiratoria (SORECAR). The survey was designed according to the standards of care quality in RR proposed by the Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Results: 11 (61.6%) hospitals reported that they had a RR unit. 54.5% of them did not have an access from primary care. 72.7% of the units indicated that referral of patients was not adequate. Almost all the units offered programs of physical therapy, aerobic training, muscular strength and educational support, however only 27.3% gave nutritional support and 18.2% psychosocial support. Progressive incremental test was used by 45.4% RR units. There were 3 cycle ergometers (interquartile range 2-5) and 1 treadmill (0-2) per unit. All units had rehabilitation physicians and physiotherapists, and 60% also had pulmonologists. Conclusions: Not all hospitals in the Community of Madrid have RR units. Moreover, the analysis of the indicators of care quality of the RR shows limitations in protocols, patient evaluation, components and characteristics of the programs, administrative and research aspects

To which countries do European psychiatric trainees want to move to and why?

BACKGROUND: There is a shortage of psychiatrists worldwide. Within Europe, psychiatric trainees can move between countries, which increases the problem in some countries and alleviates it in others. However, little is known about the reasons psychiatric trainees move to another country. METHODS: Survey of psychiatric trainees in 33 European countries, exploring how frequently psychiatric trainees have migrated or want to migrate, their reasons to stay and leave the country, and the countries where they come from and where they move to. A 61-item self-report questionnaire was developed, covering questions about their demographics, experiences of short-term mobility (from 3 months up to 1 year), experiences of long-term migration (of more than 1 year) and their attitudes towards migration. RESULTS: A total of 2281 psychiatric trainees in Europe participated in the survey, of which 72.0% have 'ever' considered to move to a different country in their future, 53.5% were considering it 'now', at the time of the survey, and 13.3% had already moved country. For these immigrant trainees, academic was the main reason they gave to move from their country of origin. For all trainees, the overall main reason for which they would leave was financial (34.4%), especially in those with lower (<500€) incomes (58.1%), whereas in those with higher (>2500€) incomes, personal reasons were paramount (44.5%). CONCLUSIONS: A high number of psychiatric trainees considered moving to another country, and their motivation largely reflects the substantial salary differences. These findings suggest tackling financial conditions and academic opportunities.

Nuevos tratamientos farmacológicos en el TDAH. A propósito de un caso clínico / New pharmacological treatments for ADHD. A case report

El Trastorno por Déficit de Atención/Hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más prevalentes en la infancia que frecuentemente se mantiene en la adolescencia y edad adulta. Los psicoestimulantes son generalmente el tratamiento farmacológico de primera línea para el TDAH, aunque alguno de estos pacientes no consiguen una remisión sintomática completa, especialmente los que tienen comorbilidad con el Trastorno Negativista Desafiante (TND). En estos casos, hay cada vez una mayor evidencia de que la combinación de psicoestimulantes y medicamentos no específicos para manejar el TDAH puede ser útil. La Guanfacina de liberación prolongada (GXR, Guanfacine Extended Release), un nuevo fármaco no psicoestimulante que actúa como agonista alfa 2 adrenérgico, ha sido aprobado recientemente por la Agencia Europea de Medicamentos como un nuevo tratamiento para el TDAH. En España se ha empezado a comercializar a finales de enero 2017. El objetivo de este estudio es evaluar la eficacia y tolerabilidad de la GXR administrada conjuntamente con dimesilato de lisdexanfetamina en un paciente con Trastorno por Déficit de atención e Hiperactividad (TDAH) y Trastorno Negativista Desafiante(TND)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood, which shows diagnostic persistence and morbidity into adulthood. Psychostimulants are generally first-line pharmacotherapy for ADHD, but some patients do not achieve symptomatic remission, especially those who have Oppositional Defiant Disorder (ODD) comorbidity. In those cases, there is growing evidence that a combination of psychostimulants and nonscheduled medications to manage ADHD, may be useful. The alpha-2 adrenergic agonist guanfacine extended release (GXR), a non-stimulant treatment, has recently been approved by the European Medicines Agency (EMA) as new therapeutic option for ADHD. In Spain it has been available from the end of January 2017. The aim of this study is to test the efficacy and tolerability of a combined therapy of psychostimulant (lisdexamfetamine) and GXR in a patient with ADHD and ODD

Poderoso caballero es "Don Dinero" / No disponible

No disponible

Estudios de resonancia magnética funcional en los trastornos de la conducta alimentaria / Functional magnetic resonance studies in eating behavior disorders

Los trastornos de la conducta alimentaria (TCA) constituyen una condición somática y psiquiátrica grave, que sucede principalmente en mujeres adolescentes y jóvenes adultas y que se caracteriza por deseo persistente de extrema delgadez, miedo patológico a engordar y distorsión de la percepción corporal. Desde un punto de vista neurobiológico, se ha sugerido la existencia de alteraciones en algunos de los sistemas neurales de estas pacientes, bien como causa o consecuencia de su patología. En los últimos años, se están realizando múltiples estudios de investigación en este ámbito, con el objetivo de determinar las alteraciones cerebrales subyacentes en los TCA. El propósito de este artículo es realizar una revisión de los principales hallazgos obtenidos en los estudios de neuroimagen realizados, incluyendo PET, SPECT, resonancia magnética con imagen espectroscópica (MRS) y centrándonos, principalmente, en la imagen de resonancia magnética funcional (fMRI). Se revisarán también algunas de las alteraciones y cambios metabólicos y de perfusión sanguínea que acompañan a los hallazgos de neuroimagen, así como los estudios encaminados a concretar si estas alteraciones persisten tras la recuperación de la enfermedad (AU)

Eating behavior disorders (EBD) constitute a serious somatic and psychiatric condition that occurs mainly in adolescent and young adult women and is characterized by a persistent desire to be extremely thin, pathologic fear of gaining weight and distortion of body perception. From a neurobiological vantage point, it has been suggested that alterations in some neural systems of these patients may exist, either as a cause or effect of their condition. In recent years various research studies have been conducted with the aim of identifying underlying brain disorders in EBD. The purpose of this article was to review the main findings obtained in neuroimaging studies, including PET, SPECT, magnetic resonance spectroscopy (MRS), focusing mainly on functional magnetic resonance imaging (fMRI). Some alterations and changes in metabolism and blood perfusion that accompany the neuroimaging findings will be reviewed, as well as studies designed to determine whether these alterations persist after recovery from the disease (AU)