Effect of metabolic control on recurrent major adverse cardiovascular events and cardiovascular mortality in patients with premature coronary artery disease: Results of the Genetics of Atherosclerotic Disease study.

BACKGROUND AND AIMS: Coronary artery disease (CAD) is the leading cause of death around the world, and its rate of presentation is increasing at young ages. Despite the evidence that secondary prevention in CAD reduces the risk of recurrent major adverse cardiovascular events (MACE), no studies have analyzed the composite control of blood pressure, lipids, and glucose control in premature CAD. METHODS AND RESULTS: This was a real-world prospective cohort study of patients with premature CAD. The composite control in blood pressure <140/80 mmHg, LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and Hemoglobin A1c <8% was considered as metabolic control. The primary endpoint was the occurrence of non-fatal and fatal MACE. The data included 1042 patients with premature CAD. The mean age of the patients was 54.1 ± 8.1 years, 18.5% were women, and had a median follow-up of 59.1 ± 11.8 months. Of them, 7% had non-fatal MACE, and 4% had a fatal MACE. Overall, 21.3% achieved metabolic control, and 3.0% did not achieve any target. Cox regression analysis showed that percutaneous coronary intervention (Hazzard ratio = 1.883 [95% CI, 1.131-3.136]), C-reactive protein (1.046 [1.020-1.073]), blood pressure >140/90 mmHg (2.686 [1.506-4.791]), fibrates (2.032 [1.160-3.562]), calcium channel blockers (2.082 [1.158-3.744]) had greater risk to present a recurrent non-fatal MACE; whereas familial history of premature CAD (2.419 [1.240-4.721]), heart failure (2.139 [1.032-4.433]), LDL-C >70 mg/dL (4.594 [1.401-15.069]), and diuretics (3.328 [1.677-6.605]) were associated with cardiovascular mortality. CONCLUSIONS: The composite goal achievement in lipids, blood pressure and glucose, reduced the risk for recurrent MACE in 80%.

Oxidative modifications of foetal LDL-c and HDL-c lipoproteins in preeclampsia.

BACKGROUND: Oxidative modifications have been observed in lipids and proteins in lipoproteins isolated from women with preeclampsia. Thus, newborns could also be susceptible to this damage directly through their mothers. In this study, we evaluated the oxidative profile of LDL-c and HDL-c lipoproteins isolated from the umbilical cord from newborns born to women with preeclampsia. METHODS: Thirty newborns born to women with preeclampsia and thirty newborns born to women with healthy pregnancies were included. Lipid-damage biomarkers, including conjugated dienes, lipohydroperoxides and malondialdehyde, were measured. The reduction of nitroblue tetrazolium, formation of dityrosines, and carbonylation of proteins were assessed as indicators of protein damage. The protective activity of paraoxonase-I on HDL-c particles was evaluated. The total antioxidant capacity and lipid profiles were quantified in plasma. Data were analysed using Student's t-tests and Pearson correlation coefficients. RESULTS: Compared with the control group, the preeclampsia group had an increase in the percentage of lipid damage in both lipoproteins. There was an increase of 23.3 and 19.9% for conjugated dienes, 82.4 and 21.1% for lipohydroperoxides, and 103.8 and 51.5% for malondialdehyde in LDL-c and HDL-c, respectively. However, these infants did not show evident damage in protein oxidation. The activity of the enzyme paraoxonase-I was decreased by 36.2%; by contrast, the total antioxidant capacity was increased by 40% (protein) and 28.8% (non-protein). CONCLUSIONS: The oxidative modifications that occur in HDL-c and LDL-c isolated from newborns from women with preeclampsia are mainly caused by lipoperoxidation processes related to evident paraoxonase-I inactivation. The absence of protein damage is likely linked to an increase in total antioxidant capacity. Therefore, antioxidant support could be helpful in reducing oxidative stress in mother/newborn dyads.

What Is the most Important for Elite Control: Genetic Background of Patient, Genetic Background of Partner, both or neither? Description of Complete Natural History within a Couple of MSM.

BACKGROUND: We describe a homosexual man who strongly controlled HIV-1 for ten years despite lack of protective genetic background. METHODS: HIV-1 DNA was measured in blood and other tissues. Cell susceptibility was evaluated with various strains. HIV-1-specific (CD4 and CD8 activation markers and immune check points) and NK cells responses were assessed; KIRs haplotypes and HLA alleles were determined. FINDINGS: Two HIV-1 RNA copies/mL of plasma were detected in 2009, using an ultra-sensitive assay. HIV-DNA was detected at 1.1 and 2 copies/106 PBMCs in 2009 and 2015 respectively, at 1.2 copies/106 cells in rectal cells in 2011. WBs showed weak reactivity with antibodies to gp160, p55 and p25 from 2007 to 2014, remaining incomplete in 2017. CD4 T cells were susceptible to various strains including HIVKON, a primary isolate of his own CRF02_AG variant. CD8 T cells showed a strong poly-functional response against HIV-Gag, producing mainly IFN-γ; a robust capacity of antibody-dependant cell cytotoxicity (ADCC) was observed in NK cells. Case patient was group B KIR haplotype. Neutralizing antibodies were not detected. CD4 and CD8 blood T cells showed normal proportions without increased activation markers. Phylogenetic analyses identified the same CRF02_AG variant in his partner. The patient and his partner were heterozygous for the CCR5ΔD32 deletion and shared HLA-B*07, C*07 non-protective alleles. INTERPRETATION: This thorough description of the natural history of an individual controlling HIV-1 in various compartments for ten years despite lack of protective alleles, and of his partner, may have implications for strategies to cure HIV-1 infection.

Características epidemiológicas del cáncer de mama en el área metropolitana de Buenos Aires y La Plata. Estudio de una serie de 4.041 casos del Registro de Cáncer de Mama (RCM) / Epidemiological aspects of breast cancer in metropolitana area of Buenos Aires and La Plata. Study of 4.041 patients of breast cancer registry (RCM)

Introducción: En la Argentina se estima que se detectan más de 18.000 casos nuevos de cáncer de mama por año; sin embargo, en nuestro país no contamos con registros de dicha patología que posean poder estadístico adecuado. Por este motivo, desde la Sociedad Argentina de Mastología surgió el interés de crear una base de datos. Aquí presentamos el análisis de los datos recabados de la misma luego de 2 años de su implementación en distintos centros de atención de Mastología del Área Metropolitana de la Ciudad de Buenos Aires (AMBA). Objetivo: Describir las características epidemiológicas de las pacientes atendidas en los centros participantes, así como la presentación clínica, estadio y tratamiento instaurado. Material y método: Estudio descriptivo, de corte transversal, donde se analizaron los datos ingresados hasta el día 30/09/2012, en la base de web "registro de cáncer de mama" (RCM), de 4.041 pacientes. Dichos datos fueron ingresados por los dieciséis centros participantes hasta ese momento, todos ellos ubicaodos en el AMBA y la ciudad de la Plata. Resultados: El 99,6% de los pacientes fue de sexo femenino, con una media de edad 57,7±13,2 años. Se registró una media de edad de aparición para la menarca de 12,5±1,4 años y de 48,6±4,1 años para la menopausia. El 68,8% de las pacientes eran posmenopáusicas. El 20,3% de las pacientes era nulípara. El 19,3% presentó el antecedente heredo-familiar de cáncer de mama. El principal motivo de consulta registrado fue el de autodetección sospechosa 54,3%. La distribución del estadio clínico fue la siguiente: estadio 0 11,6%; estadio I 40,6%; estadio II 36,5%; estadio III 10,3% y estadio IV 1,0%. En el 69,4% se realizó resección sectorial como cirugía mamaria. Antes del año 2000 predominó la linfadenectomía axilar (67,9%), luego de esta fecha la frecuencia de indicación del ganglio centinela pasó a aplicarse al 63,6%.

Características epidemiológicas del cáncer de mama en el área metropolitana de Buenos Aires y La Plata. Estudio de una serie de 4.041 casos del Registro de Cáncer de Mama (RCM) / Epidemiological aspects of breast cancer in metropolitana area of Buenos Aires and La Plata. Study of 4.041 patients of breast cancer registry (RCM)

Introducción: En la Argentina se estima que se detectan más de 18.000 casos nuevos de cáncer de mama por año; sin embargo, en nuestro país no contamos con registros de dicha patología que posean poder estadístico adecuado. Por este motivo, desde la Sociedad Argentina de Mastología surgió el interés de crear una base de datos. Aquí presentamos el análisis de los datos recabados de la misma luego de 2 años de su implementación en distintos centros de atención de Mastología del Area Metropolitana de la Ciudad de Buenos Aires (AMBA). Objetivo: Describir las características epidemiológicas de las pacientes atendidas en los centros participantes, así como la presentación clínica, estadio y tratamiento instaurado. Material y método: Estudio descriptivo, de corte transversal, donde se analizaron los datos ingresados hasta el día 30/09/2012, en la base de web "registro de cáncer de mama" (RCM), de 4.041 pacientes. Dichos datos fueron ingresados por los dieciséis centros participantes hasta ese momento, todos ellos ubicaodos en el AMBA y la ciudad de la Plata. Resultados: El 99,6% de los pacientes fue de sexo femenino, con una media de edad 57,7±13,2 años. Se registró una media de edad de aparición para la menarca de 12,5±1,4 años y de 48,6±4,1 años para la menopausia. El 68,8% de las pacientes eran posmenopáusicas. El 20,3% de las pacientes era nulípara. El 19,3% presentó el antecedente heredo-familiar de cáncer de mama. El principal motivo de consulta registrado fue el de autodetección sospechosa 54,3%. La distribución del estadio clínico fue la siguiente: estadio 0 11,6%; estadio I 40,6%; estadio II 36,5%; estadio III 10,3% y estadio IV 1,0%. En el 69,4% se realizó resección sectorial como cirugía mamaria. Antes del año 2000 predominó la linfadenectomía axilar (67,9%), luego de esta fecha la frecuencia de indicación del ganglio centinela pasó a aplicarse al 63,6%. (AU)

Implicación de la molécula de adhesión ALCAM en el daño cerebral. Modelo de daño neuronal mediante la administración de MDMA/éxtasis en rata / Implication of the adhesion molecule ALCAM in the experimental rat model of brain damage caused by MDMA/ecstasy

Objetivo: Caracterizar la expresión de ALCAM en vasos de corteza cerebral de ratas tratadas con MDMA. 2) Estudiar el efecto que sobre su expresión y sobre la neurotoxicidad producida por MDMA tiene ibuprofeno. Materiales y métodos: Se administró una dosis neurotóxica de MDMA a ratas Dark Agouti e buprofeno a diferentes tiempos. Se midió la temperatura de los animales durante los tratamientos y se estudió la expresión de ALCAM en los vasos de corteza. El daño cerebral se estudió midiendo los niveles de ácido 5-indolacético, serotonina y la densidad de su transportador. Resultados: MDMA produce un aumento de ALCAM a las 24 horas (p<0.01). El co-tratamiento con ibuprofeno lo disminuye (p<0.01) y atenúa el daño cerebral disminuyendo los efectos neurotóxicos de MDMA sobre los niveles de serotonina cortical (p<0.0001) y la densidad del transportador (p<0.0001). Ibuprofeno disminuye ligeramente la hipertermia producida por MDMA. Conclusiones: MDMA aumenta la expresión de ALCAM. Los datos sugieren la posibilidad de utilizar compuestos anti-inflamatorios como ibuprofeno que reducen este efecto sobre ALCAM y que disminuyen parcialmente el daño cerebral, si bien es necesario analizar la participación de la disminución de la temperatura en dicha protección (AU)

Objective: 1) Characterization of ALCAM adhesion molecule expression in cortical vessels of MDMA-treated rats. 2) Study of the effect of the anti-inflammatory compound ibuprofen on ALCAM expression and on the neurotoxicity produced by MDMA. Material and methods: Male Dark Agouti rats were given a neurotoxic dose of MDMA. Ibuprofen was given before and at various times after MDMA. Rectal temperature was monitored during the treatment and ALCAM expression in vessels from cerebral cortex was determined at 24 h. In neurotoxicity studies, cortical 5-HT tissue levels and 5-HT transporter density were measured. Results: ALCAM expression was increased 24 h after MDMA treatment (p<0.01). Co-treatment with ibuprofen attenuated the increase in ALCAM levels (p<0.01) and partially prevented cerebral injury, reducing MDMA-induced 5-HT (p<0.0001) and 5-HT transporter (p<0.0001) loss. Ibuprofen produced a minor modification in the MDMA-induced hyperthermia. Conclusions: Our study demonstrates an effect of MDMA on ALCAM expression. Thus, anti-inflammatory compounds such as ibuprofen may result useful in brain protection by inhibiting the effects of ALCAM and reducing brain damage although the potential contribution of the attenuation of MDMA-induced hyperthermia must also be considered (AU)

Features and costs of patients admitted for cardiac arrhythmias in Spain.

AIM: Cardiac rhythm alterations are a frequent cause of hospital admission. However, we do not know their characteristics and economic costs. We have analyzed the epidemiology and cost of hospitalizations due to cardiac arrhythmias in the National Health System. METHODS: The characteristics and costs were reviewed in patients admitted with a principal diagnosis of cardiac arrhythmia (1997-2010;diagnosis related groups [DRG] -138 and 139 of the National Health System minimum data base set). Atrial fibrillation/flutter accounted for 65% of these DRGs. The secondary diagnoses prevalent in such DRGs were also reviewed. RESULTS: Hospitalizations due to cardiac arrhythmias were approximately 26.000 per year and close to 1.6% for mortality. In 2010 there were 26.421 hospitalizations with an estimated cost of 65 million Euros. Frequent comorbidities were recorded, such as hypertension (43%), heart failure (12%) or diabetes mellitus (20%). A total of 43% were admitted to cardiology and 36% to internal medicine. CONCLUSIONS: During the period 1997-2010, there was a significant annual number of hospitalizations for cardiac arrhythmias (mainly atrial fibrillation), with measurable costs, in Spain. More than one third were attended by internists.

Pioglitazone improves the cardiovascular profile in patients with uncomplicated systemic lupus erythematosus: a double-blind randomized clinical trial.

OBJECTIVE: We studied the effect of pioglitazone on insulin levels, inflammation markers, high-density lipoprotein (HDL) composition and subclasses distribution, in young women with uncomplicated systemic lupus erythematosus (SLE). METHODS: This double-blind trial included 30 premenopausal women (30 ±8 years old) with SLE, who were randomized to pioglitazone (30 mg/day) or placebo treatment for 3 months. Plasma and HDL lipids were determined by colorimetric enzymatic assays, insulin by radioimmunometric assay, inflammation by immunonephelometry and HDL size and subclasses distribution by a native 4-30% polyacrylamide gradient gel electrophoresis. RESULTS: Compared with placebo, pioglitazone significantly increased HDL-cholesterol plasma levels (14.2%), reduced fasting insulin plasma levels (23.6%) and the homeostasis model assessment-insulin resistance (31.7%). C-reactive protein (70.9%) and serum amyloid A (34.9%) were also significantly reduced with the pioglitazone use, whereas the HDL particle size was increased (8.80 nm vs. 8.95 nm; p = 0.044) by changes in the distribution of HDL(2b), HDL(3b), and HDL(3c) subclasses. The change in HDL size correlated with a rise in free and cholesterol-ester content in the HDL particles. CONCLUSION: Pioglitazone significantly enhanced insulin sensitivity, reduced inflammation, and modified HDL characteristics, suggesting a potential beneficial effect of this drug in patients with SLE with a risk to develop cardiovascular disease. TRIAL REGISTRATION: This trial is registered at ClinicalTrials.gov Protocol Registration System, with the number NCT01322308.

Effect of using reporting guidelines during peer review on quality of final manuscripts submitted to a biomedical journal: masked randomised trial.

OBJECTIVE: To investigate the effect of an additional review based on reporting guidelines such as STROBE and CONSORT on quality of manuscripts. DESIGN: Masked randomised trial. Population Original research manuscripts submitted to the Medicina Clínica journal from May 2008 to April 2009 and considered suitable for publication. CONTROL GROUP: conventional peer reviews alone. Intervention group: conventional review plus an additional review looking for missing items from reporting guidelines. Outcomes Manuscript quality, assessed with a 5 point Likert scale (primary: overall quality; secondary: average quality of specific items in paper). Main analysis compared groups as allocated, after adjustment for baseline factors (analysis of covariance); sensitivity analysis compared groups as reviewed. Adherence to reviewer suggestions assessed with Likert scale. RESULTS: Of 126 consecutive papers receiving conventional review, 34 were not suitable for publication. The remaining 92 papers were allocated to receive conventional reviews alone (n=41) or additional reviews (n=51). Four papers assigned to the conventional review group deviated from protocol; they received an additional review based on reporting guidelines. We saw an improvement in manuscript quality in favour of the additional review group (comparison as allocated, 0.25, 95% confidence interval -0.05 to 0.54; as reviewed, 0.33, 0.03 to 0.63). More papers with additional reviews than with conventional reviews alone improved from baseline (22 (43%) v eight (20%), difference 23.6% (3.2% to 44.0%), number needed to treat 4.2 (from 2.3 to 31.2), relative risk 2.21 (1.10 to 4.44)). Authors in the additional review group adhered more to suggestions from conventional reviews than to those from additional reviews (average increase 0.43 Likert points (0.19 to 0.67)). CONCLUSIONS: Additional reviews based on reporting guidelines improve manuscript quality, although the observed effect was smaller than hypothesised and not definitively demonstrated. Authors adhere more to suggestions from conventional reviews than to those from additional reviews, showing difficulties in adhering to high methodological standards at the latest research phases. To boost paper quality and impact, authors should be aware of future requirements of reporting guidelines at the very beginning of their study. Trial registration and protocol Although registries do not include trials of peer review, the protocol design was submitted to sponsored research projects (Instituto de Salud Carlos III, PI081903).

Anemia en la insuficiencia cardiaca crónica / Anemia in chronic heart failure

La anemia es una de las comorbilidades más frecuentes en los pacientes con insuficiencia cardiaca crónica descompensada que ingresan en los servicios de Medicina Interna. Sin embargo, aunque existen evidencias que avalan su corrección para mejorar la capacidad funcional de estos pacientes y reducir su tasa de reingreso, las guías de práctica clínica no dan directrices sobre su abordaje. Constituye un problema clínico idóneo para el internista por su origen multifactorial y la visión integradora necesaria para abordar la conjunción de síndromes que se dan en estos pacientes (anemia, insuficiencia cardiaca, síndromes geriátricos, diabetes…). La elección de la estrategia de tratamiento en el caso de decidir hacerlo, debe iniciarse tras corregir los signos congestivos en el paciente ambulatorio con tratamiento óptimo de la insuficiencia cardiaca(AU)

Anemia is one of the most common comorbidities in patients with decompensated chronic heart failure admitted to the Internal Medicine Ward. However, although there is evidence supporting its treatment to improve the functional capacity of the patients and to reduce the new admissions rate, the clinical practice guidelines do not provide any directives regarding its approach. This is an ideal clinical problem for the internist due to its multifactorial origin and the comprehensive point of view needed to approach the group of syndromes that occur in these patients (anemia, heart failure, geriatric syndromes, diabetes, etc.) The choice of treatment strategy, if such treatment is decided, should always begin after correcting the congestive signs in the outpatient with optimal treatment of heart failure(AU)

[Anemia in chronic heart failure]. / Anemia en la insuficiencia cardiaca crónica.

Anemia is one of the most common comorbidities in patients with decompensated chronic heart failure admitted to the Internal Medicine Ward. However, although there is evidence supporting its treatment to improve the functional capacity of the patients and to reduce the new admissions rate, the clinical practice guidelines do not provide any directives regarding its approach. This is an ideal clinical problem for the internist due to its multifactorial origin and the comprehensive point of view needed to approach the group of syndromes that occur in these patients (anemia, heart failure, geriatric syndromes, diabetes, etc.) The choice of treatment strategy, if such treatment is decided, should always begin after correcting the congestive signs in the outpatient with optimal treatment of heart failure.

Patrones antropométricos y consumo máximo de oxígeno (VO2) entre niños escolares chilenos Aymaras y no Aymaras de 10 a 12 años, que viven en altura (3.500 msnm) y en la planicie (500 msnm) / Anthropometric patterns and oxygen consumption (VO2) of school-children Aymara and non-Aymara of 10-12 years, living in high altitude (3500m) and the plain (500 m), from Chile

El objetivo del estudio fue comparar peso, talla, índice de masa corporal (IMC) y consumo de oxígeno (VO2 max) en una muestra de 73 alumnos de 10 a 12 años del poblado de Putre a 3500 metros de altitud (n=31) y del pueblito de San Miguel de Azapa, que lo hacen a 500 metros de altitud (n=42). Los sujetos fueron evaluados según, procedencia, sexo y etnia aymará y No aymará. Los resultados muestran una disminución significativa de los patrones antropométricos de niños y niñas de Putre en comparación con los de San Miguel de Azapa. Los aymará de Putre damas y varones presentan un IMC bajo lo normal (<20). Los varones aymará de San Miguel de Azapa presentan un peso significativamente mayor que los varones no aymará, sin embargo todos los alumnos de San Miguel expresan un IMC de normales. La distancia recorrida en metros (Test de 6 minutos de carrera continua) y el consumo máximo de oxígeno expresado en litros por minuto (VO2), no presentan diferencias significativas según sexo, etnia y localidad de origen de los niños y niñas en estudio. Se concluye que el ambiente multiestresante de la altura (hipoxia hipobárica, bajas temperaturas y el nivel socioeconómico), tendría un gran impacto en el crecimiento infantil y el consumo máximo de oxígeno, lo que posiblemente reflejarían mecanismos adaptativos de los niños y niñas de Putre.

The objective of this study was to evaluate weight, height, body mass index (BMI) and oxygen consumption (VO2 max) in a sample of 73 students of 10 to 12 years from Putre to 3500 meters of altitude (n = 31) and San Miguel de Azapa, 500 meters of altitude (n = 42). Subjects were grouped according origin, gender, and aymara and non-aymara ethnic. The results show a significant decrease in anthropometric patterns in children of Putre compared with students from San Miguel de Azapa. Girls and boys Aymara of Putre have a BMI below normal (<20). Boys Aymara from San Miguel de Azapa have a significantly greater weight than boys non-aymara, however all students from San Miguel express a normal BMI. The distance traveled in meters (Test of 6 minutes of continuous running) and maximal oxygen consumption in liters per minute (VO2), not show significant differences by gender, ethnicity and geographic origin. We conclude that multistressful environment of the high altitude (hypobaric hypoxia, low temperatures and socioeconomic status), would have a major impact on child growth, and maximum oxygen consumption, possibly reflecting adaptive mechanisms of boys and girls from Putre.

[Antiepileptic drugs in the control of the impulses disorders]. / Trastornos del control de impulsos y tratamiento con antiepilépticos.

The disorders classified as control of the impulses; explosive intermittent disorder, pathological gambling, kleptomania, pyromania, pathological gambling, hair pullers, compulsive purchases, skin picking and onychophagia are a heterogeneous set of clinical entities, most of them with little prevalence. Nevertheless, they cause important personal and social dysfunctions and present great comorbidity with other psychiatric disorders. Antipsychotics, antidepressive agents, serotoninergic agonists, naltrexone, beta blockers antiandrogen, lithium and anticonvulsants have been used in their pharmacological treatment. Currently, interest is growing on the use of the antiepileptics because their possible usefulness has been described in these disorders. However, the neurobiological effects are only partially known in some cases. We have reviewed the literature regarding the treatment of these disorders with mood stabilizers, (lithium, carbamazepine, valproate, phenitoin, oxcarbacepin, topiramate, lamotrigin, leviteracetam) and have described those studies on which the current knowledge and evidence are based. The results must be considered as provisional and must be updated in the future, since they are mostly based on case reports, case series or opened clinical trials, their being little knowledge based on double blind clinical trials.

Trastornos del control de impulsos y tratamiento con antiepilépticos / Antiepilectic drugs in the control of the impulses disorders

Los trastornos clasificados como del control de los impulsos; trastorno explosivo intermitente, ludopatía, cleptomanía, piromanía, juego patológico, tricotilomanía, compras compulsivas, rasgado compulsivo y onicofagia, son un conjunto heterogéneo de entidades clínicas, la mayoría de ellas poco prevalentes. Sin embargo producen importantes disfunciones personales y sociales y presentan gran comorbilidad con otros trastornos psiquiátricos. En el tratamiento farmacológico se han utilizado fármacos antipsicóticos, antidepresivos, agonistas serotoninérgicos, naltrexona, betabloqueantes antiandrógenos, litio y antiepilépticos. En la actualidad existe creciente interés sobre el uso de los antiepilépticos, ya que se ha descrito la posible utilidad en estos trastornos, sin embargo en algunos casos sólo se conoce parcialmente las acciones neurobiológicas.Se revisa la literatura referente al tratamiento de estos trastornos con eutimizantes (litio, carbamazepina, ácido valproico, fenitoína, oxcarbazepina, topiramato, lamotrigina, leviteracetam) describiéndose los estudios en los que se basa el conocimiento actual. Los resultados deben ser considerados provisionales y ser actualizados en el futuro, pues están basados mayoritariamente en casos clínicos, series de casos o ensayos abiertos, existiendo poco conocimiento fundamentado en ensayos clínicos doble ciego (AU)

The disorders classified as control of the impulses; explosive intermittent disorder, pathological gambling, kleptomania, pyromania, pathological gambling, hair pullers, compulsive purchases, skin picking and onychophagia are a heterogeneous set of clinical entities, most of them with little prevalence. Nevertheless, they cause important personal and social dysfunctions and present great comorbidity with other psychiatric disorders. Antipsychotics, antidepressive agents, serotoninergic agonists, naltrexone, beta blockers antiandrogen, lithium and anticonvulsants have been used in their pharmacological treatment. Currently, interest is growing on the use of the antiepileptics because their possible usefulness has been described in these disorders. However, the neurobiological effects are only partially known in some cases. We have reviewed the literature regarding the treatment of these disorders with mood stabilizers, (lithium, carbamazepine, valproate, phenitoin, oxcarbacepin, topiramate, lamotrigin, leviteracetam) and have described those studies on which the current knowledge and evidence are based. The results must be considered as provisional and must be updated in the future, since they are mostly based on case reports, case series or opened clinical trials, their being little knowledge based on double blind clinical trials (AU)

[Anemia prevalence in heart failure. GESAIC study results]. / Prevalencia de la anemia en la insuficiencia cardiaca. Resultados del estudio GESAIC.

INTRODUCTION AND OBJECTIVES: There is a great variability in the prevalence of anemia in heart failure (HF) according to cohort based studies where the majority of patients have depressed left ventricular ejection fraction (LVEF). Our study has aimed to evaluate the prevalence of anemia in HF within the usual hospital clinical practice. METHODS: An initial analysis was made of a prospective cohort of inpatients with HF admitted during 3 months in 15 Internal Medicine Services including all health system levels. We used the World Health Organization (WHO) criteria to define anemia (hemoglobin [Hb] < 12 g/l in women and < 13 g/l in men) and a value > or = 45% as preserved LVEF. RESULTS: A total of 391 patients with an average age of 77.9 +/- 9.4; 239 women (61.1%). The 52.7% of the cases had anemia. Regarding multiple associated factors to anemia in the bivariant analysis, the regression model indicated the following variables: preserved LVEF (odds ratio [OR] 3.03), not being HF debut (OR 1.85), glomerular filtration (OR 0.97), functional class III-IV of the New York Heart Association (NYHA) (OR 0.53), arterial vascular disease (OR 0.41), antiaggregant treatment (OR 0.56) and treatment with nitrites (OR 0.48). CONCLUSION: Prevalence of anemia in HF is very high in usual clinical practice, that most frequently occurs in subjects with preserved LVEF.