Enseñanza y evaluación en pediatría mediante la simulación: descripción de dos escenarios simulados / Teaching and evaluation in pediatrics using simulation: description of two simulated scenarios / Ensino e avaliação em pediatria utilizando simulação: descrição de dois cenários simulados

La educación basada en la simulación en áreas de la salud ha sido ampliamente utilizada en los últimos años, al punto de constituir \r\nuna forma de enseñanza y evaluación a la vanguardia de la tecnología, ya que permite el perfeccionamiento de habilidades, el \r\ndesarrollo de competencias y la evaluación objetiva. De esa manera, esta se ha convertido en una estrategia de innovación educa\r\n-\r\ntiva que permite afrontar algunos de los nuevos retos en la educación médica. Dentro de las estrategias de simulación se destacan \r\nla devolución constructiva inmediata y el examen clínico objetivo estructurado. En el presente trabajo se describen dos escenarios \r\nsimulados pediátricos diseñados por los autores: uno aborda el manejo inmediato del recién nacido y otro el reconocimiento de \r\nsignos de enfermedad respiratoria aguda en niños de dos meses a cinco años de edad, escenarios que pueden ser utilizados para \r\nla enseñanza y la evaluación tanto en programas de pregrado como de posgrado.

Teaching based on simulation in health areas has been widely \r\nused in the last years, constituting a form of teaching method \r\nand evaluation at the forefront of technology, which allows \r\nthe improvement of skills, acquisition of competences, and an \r\nobjective evaluation. In this way, it has converted to an educa\r\n-\r\ntional innovate strategy that allows to face some of the new \r\nchallenges of medical teaching. Among the strategies of simu\r\n-\r\nlation, the immediate constructive feedback and the objective \r\nstructured clinical examination was highlighted. In the present \r\nstudy two simulated pediatric scenarios developed by the \r\nauthors of this document are described: one of them is about \r\nthe immediate care of a newborn and the other about recog\r\n-\r\nnizing signs of acute respiratory pathology in children from two \r\nmonths to five years old; both of these scenarios can be used to \r\nteach and evaluate at a undergraduate and postgraduate level.

A educação baseada na simulação, em áreas da saúde, tem \r\nsido amplamente utilizada nos últimos anos, constituindo-se \r\nem uma forma de ensino e avaliação da vanguarda da tecno\r\n-\r\nlogia, uma vez que permite o aperfeiçoamento de habilidade, \r\naquisição de competências e avaliação objetiva. Deste modo, \r\nela se converteu em uma estratégia de inovação educativa, \r\nque permitiu enfrentar alguns dos novos desafios na educação \r\nmédica. Dentro das estratégias de simulação se destacam \r\no retorno construtivo imediato e o exame clínico objetivo \r\nestruturado. No presente trabalho são descritos os cenários \r\npediátricos simulados, elaborados pelos autores do presente \r\ndocumento: um deles é sobre o manuseio imediato do recém-\r\nnascido e outro sobre o reconhecimento de sinais de doença \r\nrespiratória aguda em crianças de dois meses a cinco anos \r\nde idade, cenários que podem ser utilizados para o ensino e \r\navaliação tanto em programas de graduação quanto de pós-\r\ngraduação.

Tuberculosis cutánea: revisión del tema a propósito de dos casos / Cutaneous tuberculosis: two cases and literature review

La Tuberculosis Cutánea es una enfermedad infecciosa crónica causada por el Mycobacterium tuberculosis. Pese a ser una forma poco frecuente de presentación de la Tuberculosis, representa un gran desafío para los clínicos que se enfrentan a estos casos, debido principalmente a la gran diversidad de formas clínicas existentes. A continuación presentamos 2 casos clínicos de Tuberculosis Cutánea diagnosticados en el Hospital Regional de Talca y una revisión del tema basada en la clasificación, diagnóstico y tratamiento de la enfermedad.

Cutaneous Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis. Despite being a rare presentation of the disease, Cutaneous Tuberculosis is a major challenge for clinicians who face these cases, mainly due to the great diversity of clinical forms. We present 2 cases of Cutaneous Tuberculosis diagnosed in Hospital Regional de Talca and a review of the topic based in classification, diagnosis and treatment of the disease.

RIPK1 both positively and negatively regulates RIPK3 oligomerization and necroptosis.

Necroptosis is a form of programmed cell death that depends on the activation of receptor interacting protein kinase-1 (RIPK1) and RIPK3 by receptors such as tumor necrosis factor (TNF) receptor-1. Structural studies indicate that activation of RIPK3 by RIPK1 involves the formation of oligomers via interactions of the RIP homotypic interaction motif (RHIM) domains shared by both proteins; however, the molecular mechanisms by which this occurs are not fully understood. To gain insight into this process, we constructed versions of RIPK3 that could be induced to dimerize or oligomerize in response to a synthetic drug. Using this system, we find that although the formation of RIPK3 dimers is itself insufficient to trigger cell death, this dimerization seeds a RHIM-dependent complex, the propagation and stability of which is controlled by caspase-8 and RIPK1. Consistent with this idea, we find that chemically enforced oligomerization of RIPK3 is sufficient to induce necroptosis, independent of the presence of the RHIM domain, TNF stimulation or RIPK1 activity. Further, although RIPK1 contributes to TNF-mediated RIPK3 activation, we find that RIPK1 intrinsically suppresses spontaneous RIPK3 activation in the cytosol by controlling RIPK3 oligomerization. Cells lacking RIPK1 undergo increased spontaneous RIPK3-dependent death on accumulation of the RIPK3 protein, while cells containing a chemically inhibited or catalytically inactive form of RIPK1 are protected from this form of death. Together, these data indicate that RIPK1 can activate RIPK3 in response to receptor signaling, but also acts as a negative regulator of spontaneous RIPK3 activation in the cytosol.

Síndrome de disfunción cognitiva de perros geriátricos: [revisión] / Cognitive dysfunction syndrome in senior canines: [review]

Durante su vida geriátrica, algunos perros pueden presentar cambios progresivos en su comportamiento habitual, como desorientación, disminución en la interacción con los miembros de la familia, irritabilidad y vocalización excesiva, entre otros. La inespecificidad de estas alteraciones ha hecho que muchas de estas modificaciones comportamentales sean consideradas, erróneamente, como signos típicos del envejecimiento “normal”. No obstante, estas pueden ser reflejo de un proceso patológico cerebral que provoca deterioro progresivo de las funciones cognitivas en perros geriátricos. Recientemente, fue descrita una enfermedad conocida como Síndrome de Disfunción Cognitiva de perros senior o “enfermedad de Alzheimer del perro”, debido a las similitudes clínicas y patológicas con esta enfermedad en humanos. Los animales afectados desarrollan cambios morfofuncionales en diferentes zonas cerebrales, lo que probablemente conduce a la aparición de cambios asociados al decline cognitivo, es decir, disminución en la capacidad de recopilar información, procesarla, retenerla y tomar decisiones, lo que termina provocando efectos deletéreos sobre la calidad de vida del paciente afectado al no lograr desenvolverse normalmente en su medio. Dada la inespecificidad de los signos clínicos, la anamnesis y los test comportamentales han sido considerados como las principales herramientas diagnósticas para identificar este síndrome. Por otra parte, debido a que aún no han sido plenamente establecidos los aspectos etiopatológicos, los mecanismos implicados en el desarrollo de esta neuropatología aún siguen inconclusos, por lo tanto, no son muchas las estrategias terapéuticas disponibles, de las cuales solo la selegilina ha sido aprobada por la FDA.

Cinta suburetral transobturatriz libre de tensión para el tratamiento de la incontinencia de orina de esfuerzo: 3 años de seguimiento / Tension-free subureteral tape for stress urinary incontinence

Objetivos: Evaluar nuestros resultados en la corrección de la incontinencia de orina de esfuerzo (IOE) con una técnica de cinta suburetral transobturatriz modificada (TOTm) con malla desnuda de polipropileno y anestesia local, midiendo efectividad, calidad de vida y grado de satisfacción por 3 años de seguimiento. Método: Evaluación prospectiva de 56 pacientes operadas entre los años 2003 y 2005, con IOE moderada o severa, según diagnóstico por clínica y cistometría simple. Se logró realizar un seguimiento del 87 por ciento de las pacientes, por 37,9 meses (19-51 meses). Se realizó control con examen físico y se aplicó una encuesta de satisfacción en visita domiciliaria por un grupo independiente de encuestadores. Resultados: Un 88 por ciento de las pacientes se encuentra sin IOE en el examen físico. A la encuesta de satisfacción, las pacientes manifestaron sentirse mejor o mucho mejor en frecuencia miccional diurna (79 por ciento), disfunción del vaciamiento vesical (69 por ciento), dolor pelviano (58 por ciento), urgeincontinencia (84 por ciento) y función sexual (53 por ciento). Un 90 por ciento manifiesta sentirse mejor o mucho mejor de la IOE que antes de la operación. La urgencia o urgeincontinencia de novo apareció en un 6 por ciento. Conclusiones: La técnica TOTm utilizada por nuestro grupo tiene resultados comparables con las técnicas TOT originales, con mejoría significativa en la calidad de vida de las pacientes.

Objective: To review our results in the correction of stress urinary incontinence (SUI) with a modified TOT technique using polypropylene mesh and local anesthesia, measuring effectiveness, quality of life and degree of satisfaction during 3 years of follow-up. Method: Prospective evaluation of 56 patients operated between 2003 and 2005, with modérate or severe SUI, or mixed urinary incontinence with effort predominance, according to clinical diagnosis and simple cystometry. A follow-up of 87 percent of the patients over a period of 37.9 months (19-51 months) was achieved. A physical examination was realized and a survey of satisfaction was applied by a team of independent interviewers on home visits. Results: On physical examination, 88 percent of patients are without SUI. In the survey of satisfaction, the patients manifested feeling better or much better in terms of daytime voiding frequency (79 percent), voiding dysfunction (69 percent), groin pain (58 percent), urge incontinence (84 percent) and sexual function (53 percent); 90 percent manifested feeling better or much better about their SUI than before the operation. De novo urgency or urge incontinence appeared in 6 percent. Conclusions: The modified TOT technique used by our group obtains results that are comparable to those of the original TOT techniques, with a significant improvement in the quality of life of patients.

Microscopic mild focal cortical dysplasia in temporal lobe dual pathology: an electrocorticography study.

BACKGROUND: Associations between electrophysiological and histological findings might provide an insight into the epileptogenicity of mild focal cortical dysplasia (FCD) in patients with temporal lobe epilepsy (TLE) and a dual pathology. SUBJECTS AND METHODS: A total of 22 patients with pharmacoresistant TLE were included in the study, 16 of them with histologically confirmed hippocampal sclerosis (HS) associated with neocortical temporal mild Palmini Type-I FCD subtypes and 6 with HS. Intraoperative electrocorticography (ECoG) recordings were analysed for epileptiform discharge frequency and morphology. Associations between histological, and electrocorticography pattern findings in these patients were analysed. Electroclinical outcomes in these patients were also evaluated. RESULTS: Neocortical areas with mild Palmini Type-I FCD showed a significantly higher spike frequency (SF) recorded in the inferior temporal gyrus than those neocortical areas in patients with HS. There was a tendency to higher spike frequency and lower amplitude in neocortical areas with histopathologic subtype IB FCD in relation with IA during intraoperative ECoG. Post-SF excision and amplitude were significantly lower during neocortical post-excision intraoperative ECoG than during neocortical pre-excision recording. There was no difference found in the clinical outcome between patients with and without FCD. CONCLUSIONS: Intraoperative electrocorticographic interictal spike frequency recorded in the neocortical inferior temporal gyrus may help to characterize the histopathologic subtypes of mild Palmini Type-I FCD in patients with temporal lobe epilepsy (TLE) and a dual pathology. Our data support the epileptogenicity of neocortical mild FCD in TLE and assessments of ECoG patterns are relevant to determine the extent of the resection in these patients which can influence the electroclinical outcome.

Human mesenchymal stromal cells from adult and neonatal sources: comparative analysis of their morphology, immunophenotype, differentiation patterns and neural protein expression.

BACKGROUND: Bone marrow (BM) has been recognized as the main source of mesenchymal stromal cells (MSC); however, MSC have also been detected in umbilical cord blood (UCB) and placenta (PL). In the present study, we obtained MSC from these three sources and characterized them in a comparative manner. METHODS: MSC were obtained from BM, UCB and PL samples and analyzed to determine their morphology, cell-surface antigen (Ag) expression and differentiation potential. Particular emphasis was placed on the expression of neural markers. RESULTS: MSC were detected in 9/9, 11/104 and 5/5 samples from BM, UCB and PL, respectively. MSC populations comprised several morphologically distinct cell types, including neural-like cells. MSC were positive for 'mesenchymal' Ag (CD105, CD73 and CD90), although CD90 expression was very heterogeneous. Interestingly, CD13 expression was high in all three sources. In all cases, MSC showed osteogenic and chondrogenic differentiation; however, UCB MSC showed no adipogenic potential. Furthermore, MSC from UCB produced a different type of cartilage compared with MSC from BM and PL. It is noteworthy that in all three sources we detected the expression of neural proteins without any neural differentiation stimuli. A significant increase in the proportion of neural marker-positive MSC was observed in the presence of neural inducers. DISCUSSION: Our results indicate that PL may prove to be a more appropriate source for obtaining MSC than UCB, and suggest the possibility that a subpopulation of MSC may possess neural potential, which is favored by neural inducers.

[Paraneoplasic cerebellar degeneration as a presentation of breast cancer recurrence]. / Degeneración cerebelosa paraneoplasica como presentación de una recidiva de carcinoma de mama.

Paraneoplastic cerebellar degeneration (PCD) is a rare condition which is characterised by global cerebellar dysfunction. Patients may present with these syndromes months or years before the diagnosis of underlying malignancy is established. Less often, PCD occurs in patients with a known malignancy or heralds the onset of a recurrence. The presence of specific antibodies in serum simples helps to guide identification the occult malignancy. We report here the case of a PCD in 74-year-old lady underwent a left mastectomy for breast cancer 5 years ago. She remained well until now. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is preformed with the aid of positron mission tomography (PET) to detect the presence of abdominal lymph node metastases. We briefly review the clinical and laboratory features of this syndrome, and emphasize the importance of its prompt recognition, which many times makes possible the early detection and treatment of the primary disorder.

Degeneración cerebelosa paraneoplásica como presentación de una recidiva de carcinoma de mama / Paraneoplatic cerebellar degeneration as a presentation of breast cancer recurrence

La degeneración cerebelosa paraneoplasica (DCP) es un síndrome paraneoplásico poco frecuente que se caracteriza por disfunción cerebelosa global. La DCP a menudo precede meses o años a una neoplasia potencialmente curable, con menos frecuencia ocurre en pacientes con neoplasia conocida o indica recurrencia. La presencia de anticuerpos específicos en suero ayuda a guiar la identificación de una neoplasia oculta. Comunicamos el caso de una paciente de 74 años que presentó disfunción cerebelosa. Había sido diagnosticada de carcinoma ductal de mama hacia 5 años, permaneciendo asintomática hasta entonces. Con la pruebas de imagen convencionales no fue posible detectar recidiva tumoral, el diagnóstico se realizó con la ayuda de la tomografía con emisión de positrones que detectó adenopatías abdominales. Revisamos brevemente las características clínicas de este síndrome, remarcando la importancia de un rápido reconocimiento del síndrome, que en muchas ocasiones permite una rápida detección y tratamiento de la enfermedad primaria

Paraneoplastic cerebellar degeneration (PCD) is a rare condition which is characterised by global cerebellar dysfunction. Patients may present with these syndromes months or years before the diagnosis of underlying malignancy is established. Less often, PCD occurs in patients with a known malignancy or heralds the onset of a recurrence. The presence of specific antibodies in serum simples helps to guide identification the occult malignancy. We report here the case of a PCD in 74-year-old lady underwent a left mastectomy for breast cancer 5 years ago. She remained well until now. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is preformed with the aid of positron mission tomography (PET) to detect the presence of abdominal lymph node metastases. We briefly review the clinical and laboratory features of this syndrome, and emphasize the importance of its prompt recognition, which many times makes possible the early detection and treatment of the primary disorder

99mTc-cisteina-glucosamina (99mTc-CG) en la evaluación de pacientes con tumores malignos: correlación histopatológica / 99mTc-glucosamine-cysteine in the evaluation of patient with malignant tumors: histopathological correlates

Las imágenes de PET con 18Fluordeoxyglucosa (18FDG-PET) son utilizadas para estudiar tumores. Debido a su alto costo y baja disponibilidad, el PET es inaccesible para muchos pacientes. Algunas moléculas marcadas con 99mTc utilizadas para imágenes SPECT podrían ser una alternativa al 18FDG-PET. La Glucosamina(G) es un aminoazúcar de 6 carbonos que entra a la célula a través de un sistema transportador de glucosa, se fosforila y forma glucosamina-6-fosfato. Combinando G con cisteína(C) y marcándolas con 99mTc se obtiene un compuesto (99mTc-CG) que puede ser utilizado para demostrar lesiones hipermetabólicas en forma similar al 18FDG-PET. Objetivo: Evaluar la utilidad de las imágenes con 99mTc-CG en la detección de tumores y correlacionarlas con los resultados histopatológicos. Material y Métodos: La marcación de 99mTc-CG fue realizada agregando G, C, N-hydroxisuccinimida, carbodiimida y cloruro estanoso al 99mTc. 35 pacientes (23F, 12M, edad promedio 52 años, rango 7-79) con diagnóstico histopatológico fueron derivados para centellografía con 99mTc-CG. Los pacientes ayunaron por 12hs, 1-4 hs luego de la inyección EV de 920-1088MBq de 99mTc-CG se adquirierion 1) barrido corporal total y 2) imágenes SPECT(reconstruídas con algoritmo OSEM) en el área de interés de las lesiones. Para eliminar la actividad intravascular e intersticial de las imágenes con 99mTc-CG, se administraron 737MBq de 99mTc-albúmina sérica humana (99mTc-ASH) y se realizó otro SPECT. Se norquirierion 1) barrido corporal total y 2) imágenes SPECT(reconstruídas con algoritmo OSEM) en el área de interés de las lesiones. Para eliminar la actividad intravascular e intersticial de las imágenes con 99mTc-CG, se administraron 737MBq de 99mTc-albúmina sérica humana (99mTc-ASH) y se realizó otro SPECT. Se normalizaron ambos SPECT y posteriormente las imágenes con 99mTc-ASH fueron sustraídas de las de 99mTc-CG. Las imágenes fueron analizadas visualmente. Resultados: 32 lesiones fueron malignas (5 de mama)...

Evaluación de la eficacia de un programa integral de prevención secundaria de la enfermedad cardiovascular en atención primaria: estudio PREseAP

Objetivo. Evaluar la eficacia de un programa integral de prevención secundaria para reducir la morbimortalidad en los pacientes que han tenido una enfermedad cardiovascular, controlar los factores de riesgo y el cumplimiento de la medicación profiláctica para prevenir recurrencias y mejorar la calidad de vida de los pacientes con enfermedad cardiovascular. Diseño. Ensayo clínico aleatorizado por clusters, abierto, pragmático, en atención primaria. Emplazamiento. Un total de 42 centros de salud de 8 comunidades autónomas del estado español. Participantes. Varones y mujeres hasta 85 años de edad, diagnosticados de enfermedad coronaria y/o accidente cerebrovascular y/o enfermedad vascular periférica en el último año, y que no presenten una enfermedad grave o terminal. Intervención. Se aleatorizarán los centros de salud para seguir la atención habitual en los pacientes diagnosticados de enfermedad cardiovascular (grupo control) o para implantar un programa integral de prevención secundaria (grupo intervención). Mediciones principales. Acontecimientos letales atribuibles a enfermedad cardiovascular, acontecimientos no letales atribuibles a enfermedad cardiovascular, acontecimientos letales por cualquier causa y calidad de vida relacionadas con la salud (SF-36).(AU)

Neuropharmacological effects of an ethanol extract of the Magnolia dealbata Zucc. leaves in mice.

Magnolia dealbata Zucc. is considered to have tranquilizer and anticonvulsant properties in Mexican traditional medicine. In the present study we report the effects of a crude extract of Magnolia dealbata (30, 100 and 300 mg/kg) on mouse central nervous system (CNS). Pharmacological effects were tested on ambulatory activity, anti-anxiety response, sodium pentobarbital-induced hypnosis and pentylenetetrazole (PTZ)-induced seizures in comparison to honokiol, buspirone, ethosuximide and diazepam as corresponding reference drugs. No changes in spontaneous locomotor activity were produced posterior to Magnolia dealbata administration; however, a significant and dose-dependent diminution in the anxiety response was observed in experimental models such as plus-maze, head-dipping and exploratory rearing tests. Magnolia dealbata not only prolonged the time of sodium pentobarbital-induced hypnosis and delayed the onset of PTZ-induced mioclonus and clonus, but also hindered the presence of tonic seizures and avoided mortality. The hypnotic, anxiolytic and anticonvulsant effects obtained in these experiments support the hypothesis that Magnolia dealbata possesses CNS activity and reinforces the popular use in Mexican traditional medicine.

Hyperthermia-induced seizures modify the GABAA and benzodiazepine receptor binding in immature rat brain.

Effects of hyperthermia-induced seizures (HS) on GABAA and benzodiazepine (BDZ) receptor binding in immature rat brain were evaluated using in vitro autoradiography. HS were induced in 10-day-old rats by a regulated stream of moderately heated air directed 50 cm above the animals. Rats were killed 30 min, 24 h, or 20 days after HS and their brains were used for in vitro autoradiography experiments to determine GABAA and BDZ receptor binding. GABAA binding was significantly enhanced in all brain areas evaluated 30 min after HS, an effect that endures 24 h and 20 days after seizures. Concerning BDZ receptor binding, a significant increase was detected in entorhinal and perirhinal cortices and decreased in basolateral amygdala 30 min following HS. One day after HS, animals demonstrated enhanced BDZ binding in the cingulate, frontal, posterior parietal, entorhinal, temporal, and perirhinal cortices; striatum, accumbens, substantia nigra pars compacta, and amygdala nuclei. Twenty days after HS enhanced BDZ binding was restricted in the cingulated, frontal, anterior and posterior parietal cortices, as well as in substantia nigra pars reticulata, whereas decreased values were found in accumbens nucleus and substantia nigra pars compacta. Our data indicate differential effects of HS in GABAA and BDZ binding in immature brain. HS-induced GABAA and BDZ changes are different from those previously described in experimental models of temporal lobe epilepsy in adult animals.

Ecotomografía doppler arterial intrarrenal en pacientes cirróticos con ascitis, con y sin síndrome hepatorrenal / Intrarenal arterial doppler ultrasonography in cirrhotic patients with ascites, with and without hepatorenal syndrome

Background: The pathophysiological hallmark of the hepatorenal syndrome (HRS) is renal vasoconstriction. Doppler ultrasonography can be used to assess the vascular resistance in small renal intraparenchymal vessels through analysis of the Doppler waveform by a parameter termed Resistive Index (RI). We postulated that the RI could be important for the diagnosis and prognosis of HRS. Aims: to assess the RI in cirrhotic patients with ascites, with and without HRS. Patients and methods: We studied 48 cirrhotics with ascites, of whom 12 were with and 36 without HRS and other 23 were normal subjects. We measured the intrarenal arterial RI (Resistive index = Peak systolic velocity - Minimum diastolic velocity/Peak systolic velocity) with color Doppler ultrasonography after visualization of interlobular or arcuate arteries. It was considered abnormal when higher than 0.70. Results: The RI values, mean and SD) were: normal subjects: 0.58 ñ 0.05, cirrhotics with ascites: 0.65 ñ 0.05 and cirrhotics with ascites and HRS: 0.78 ñ 0.11. Patients with HRS had significantly higher values than those without HRS (p < 0.001). The Relative Risk of developing the HRS in patients with a RI ü 0.70 were 3.32 (CI 95 percent = 1.79 - 6.2) Conclusions: The RI was useful in patients with cirrhosis and ascites for the prognosis of HRS and could suggest diagnosis of HRS with values of 0.78 or higher, if other clinical conditions that produce renal vasoconstriction are excluded

Ethanol increases plasma Delta(9)-tetrahydrocannabinol (THC) levels and subjective effects after marihuana smoking in human volunteers.

Marihuana and alcohol are often used together, yet little is known about why they are combined. Male volunteers were assigned to one marihuana treatment group (placebo, low or moderate dose Delta(9)-tetrahydrocannabinol (THC)) and, on three separate study days, they also drank a different dose of ethanol (placebo, 0.35 or 0.7 g/kg). Plasma THC levels and changes in subjective mood states were recorded for 90 min after smoking. For many of the drug combinations, when subjects consumed ethanol they detected marihuana effects more quickly, reported more episodes of euphoria and had higher plasma THC levels than when they consumed placebo ethanol. These data suggest that ethanol may increase the absorption of THC resulting in an increase in the positive subjective mood effects of smoked marihuana and contributing to the popularity of this drug combination.

Efficacy and safety of atorvastatin in hyperlipidemic, type 2 diabetic patients. A 34-week, multicenter, open-label study.

Hyperlipidemia is common in type 2 diabetic patients and is an independent risk factor for cardiovascular disease. The aim of this trial was to evaluate the efficacy and safety of once-daily atorvastatin 10-80 mg for the treatment of hyperlipidemia in type 2 diabetics with plasma low-density lipoprotein cholesterol (LDL-C) levels exceeding 3.4 mmol/l (130 mg/dl). One hundred and two patients met the study criteria and received 10 mg/day atorvastatin. Patients who reached the target LDL-C level of

Gender differences in acculturation and aggression as predictors of drug use in minorities.

High acculturation and aggression may signal increased risk of drug use among different ethnic groups. Drug use histories were compared with the degree of acculturation in 18 African-Americans and ten Hispanics. Aggressive responding was measured using The Point Subtraction Aggression Paradigm (PSAP) developed by Cherek, D.R., 1981, Psychopharmacology, 75, 339-345. Males were more acculturated and used more drugs than females. In PSAP responding, each gender responded more aggressively towards the ethnic group in which they identified with the most. Ethnic Identification and gender were associated with increased drug use. Acculturation and drug studies must consider the importance of gender within and across ethnic sub-populations.

Influence of alcohol on electrophysiological responses to facial stimuli.

A facial discrimination task adapted for use in an event-related potential paradigm was administered to 15 male subjects following oral administration of placebo and 0.56 g/kg alcohol. The stimuli (digital photographs of males and females with happy, sad and neutral facial expressions) generated a series of waves including a prominent positive potential with a latency between 400-550 msec, designated the P450. Three factor repeated measures multivariate analysis of variance was used to evaluate the effect of alcohol on the amplitudes and latencies of the P450 component to the happy and sad faces. As compared to placebo, following alcohol ingestion, male subjects had decreased P450 amplitudes but only to male happy faces compared to female happy faces. These data suggest that this ERP paradigm may be sensitive to detecting subtle effects of alcohol on brain responses to gender-related affective stimuli.