Tick-associated diseases identified from hunting dogs during the COVID-19 pandemic in a Mayan community in Yucatan, Mexico.

Background: Hunting activity in the Mayan communities has increased due to COVID-19 and domestic dogs have gained more importance. Due to their proximity to humans, domestic dogs are a bridge between tick-borne diseases (TBDs) and humans and their peri-domestic environment. In Mexico, and especially in rural regions, there were not adequate records of TBDs during the SARS-CoV-2 pandemic. Aim: Identify TBD of ticks collected during the COVID-19 pandemic in a rural community. Methods: Tick capture was carried out in March 2021, in Teabo, Yucatan. Ticks were removed using from domestic dogs and placed in ethanol. Collected ticks were morphologically identified and underwent DNA extraction and a partial segment of the mitochondrial 16S-rDNA gene was amplified to corroborate the tick species. The DNA was screened for the presence of Anaplasma spp., Borrelia spp., Ehrlichia spp., and Rickettsia spp. Purified amplification products were submitted for sequencing and the results were compared to those deposited in GenBank using BLAST. Results: We collected 33 ectoparasites, Ixodes affinis, Rhipicephalus sanguineus, Rhipicephalus microplus, and Amblyomma mixtum on 11 hunting dogs. The most frequent ectoparasite was R. sanguineus (66%). We detected the presence of DNA of Rickettsia endosymbiont in I. affinis and Anaplasma platys in R. sanguineus. Rickettsia endosymbiont presented a similarity of 100% with the partial sequence of R. endosymbiont of I. affinis isolate IACACTM001 16S ribosomal RNA gene and the sequence of A. platys had a similarity of 100% with the partial sequence of the isolate 23-33TX 16S ribosomal RNA gene of A. platys from dogs from Texas, USA and with the partial sequence of the isolate L134 16S ribosomal RNA gene of Ehrlichia canis from dogs from Piura, Peru. Conclusion: We confirmed for the first time the presence of A. platys in R. sanguineus and R. endosymbiont in I. affinis ticks from dogs in the state of Yucatan.

Suicide among physicians: Major risk for women physicians.

INTRODUCTION: The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS: All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS: The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS: . Suicide is higher among physicians than the general population and affects female physicians significantly more.

Microbial responses to warming enhance soil carbon loss following translocation across a tropical forest elevation gradient.

Tropical soils contain huge carbon stocks, which climate warming is projected to reduce by stimulating organic matter decomposition, creating a positive feedback that will promote further warming. Models predict that the loss of carbon from warming soils will be mediated by microbial physiology, but no empirical data are available on the response of soil carbon and microbial physiology to warming in tropical forests, which dominate the terrestrial carbon cycle. Here we show that warming caused a considerable loss of soil carbon that was enhanced by associated changes in microbial physiology. By translocating soils across a 3000 m elevation gradient in tropical forest, equivalent to a temperature change of ± 15 °C, we found that soil carbon declined over 5 years by 4% in response to each 1 °C increase in temperature. The total loss of carbon was related to its original quantity and lability, and was enhanced by changes in microbial physiology including increased microbial carbon-use-efficiency, shifts in community composition towards microbial taxa associated with warmer temperatures, and increased activity of hydrolytic enzymes. These findings suggest that microbial feedbacks will cause considerable loss of carbon from tropical forest soils in response to predicted climatic warming this century.

Complicaciones tardías de la traqueotomía percutánea con la modalidad de dilatación con balón / Late complications of percutaneous tracheostomy using the balloon dilation technique

OBJETIVO: Analizar las complicaciones a largo plazo de los pacientes críticos que requirieron traqueotomía percutánea (TP) con el método de dilatación con balón. DISEÑO: Estudio observacional, prospectivo, de cohorte. Ámbito: Dos unidades de cuidados intensivos (UCI) polivalentes. PACIENTES: Adultos ventilados mecánicamente ingresados en UCI con indicación de TP. Intervención: En todos los pacientes se realizó TP mediante Ciaglia Blue Dolphin® con guía endoscópica. Los pacientes decanulados vivos fueron evaluados clínicamente, así como mediante laringotraqueoscopia y tomografía axial computarizada cervical al cabo de al menos 6 meses tras la decanulación. VARIABLES: Complicaciones intraoperatorias, postoperatorias y tardías. Mortalidad intra-UCI y hospitalaria. RESULTADOS: Se incluyeron 114 pacientes. Las complicaciones intraoperatorias más frecuentes fueron la hemorragia leve (n=20) y la dificultad para insertar la cánula (n=19). Dos pacientes tuvieron complicaciones intraoperatorias graves (1,7%) (hemorragia e imposibilidad de finalización de la técnica, en un caso, y falsa vía y desaturación, en otro). Todos los pacientes decanulados vivos (n=52) fueron revisados a los 221±28 días tras la decanulación. Ningún paciente presentaba síntomas. La tomografía axial computarizada y la laringotraqueoscopia mostraron estenosis traqueal severa (>50%) en 2 pacientes (3,7%), ambos con periodos de canulación superiores a 100 días. CONCLUSIONES: La TP usando la técnica Ciaglia Blue Dolphin® con guía endoscópica es un procedimiento seguro. La estenosis traqueal grave es una complicación tardía que, aunque infrecuente, debe ser tenida en cuenta por su falta de expresividad clínica. Debería considerarse la evaluación de aquellos pacientes críticos que han sido traqueotomizados y han permanecido canulados durante periodos prolongados de tiempo

OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. Scope: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time

Late complications of percutaneous tracheostomy using the balloon dilation technique. / Complicaciones tardías de la traqueotomía percutánea con la modalidad de dilatación con balón.

OBJECTIVE: The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. DESIGN: A prospective, observational cohort study was carried out. SCOPE: Two medical-surgical intensive care units (ICU). PATIENTS: All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. INTERVENTIONS: All patients underwent PT according to the Ciaglia Blue Dolphin® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. VARIABLES: Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. RESULTS: A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. CONCLUSIONS: Percutaneous tracheostomy using the Ciaglia Blue Dolphin® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time.

S100A7: from mechanism to cancer therapy.

Within the tumor, malignant and stromal cells support each other by secreting a wide variety of growth factors and cytokines, allowing tumor growth and disease progression. The identification and regulation of those key factors in this crosstalk has opened the opportunity to develop new therapeutic strategies that not only act on the tumor cells but also on the stroma. Among these factors, S100A7 protein has gained interest in the last years. With key roles in cell motility its expression correlates with increased tumor growth, angiogenesis and metastatic potential. This work aims to deepen in the role played by extracellular S100A7 in the tumor microenvironment, offering a new integrative insight of its mechanism of action on each cellular compartment (tumor, endothelial, immune and fibroblast). As a result, we demonstrate its implication in cell migration and invasion, and its important contribution to the formation of a proinflammatory and proangiogenic environment that favors tumor progression and metastasis. Furthermore, we define its possible role in the pre-metastatic niche formation. Considering the relevance of S100A7 in cancer progression, we have developed neutralizing monoclonal antibodies, reporting for the first time the proof of principle of this promising therapeutic strategy for cancer treatment.

S100P antibody-mediated therapy as a new promising strategy for the treatment of pancreatic cancer.

Despite progresses in diagnosis and treatment, pancreatic cancer continues to have the worst prognosis of all solid malignant tumors. Recent evidences suggest that the metastasis-promoting protein S100P stimulates pancreatic tumor proliferation, survival, invasion and metastasis progression through extracellular functions. Moreover, its expression is strongly correlated with poor prognosis in patients with several types of cancer although the entire molecular mechanism responsible for the diverse biological functions is not fully understood. We showed that extracellular S100P stimulates pancreatic carcinoma BxPC3 cell line by promoting cell proliferation. We also demonstrated that S100P induces, in this cell line, the phosphorylation of IκBα and the secretion of matrix metalloproteinase 9 (MMP-9). In addition, treatment with S100P protected cells from injuries induced by the cytotoxic agent Gemcitabine. On the basis of these results, we developed function-blocking anti-S100P monoclonal antibodies (mAbs) that abolished all of its in vitro activities. Furthermore, in vivo treatment with the candidate 2H8 antibody decreased tumor growth and liver metastasis formation in a subcutaneous and orthotopic BxPC3 tumor model. We conclude here that a therapeutic strategy blocking the extracellular activity of S100P by means of specific mAbs could be an attractive therapeutic approach as a single agent or in combination with target-directed or chemotherapeutic drugs to treat pancreatic cancer.

Micropattern of antibodies imaged by shear force microscopy: comparison between classical and jumping modes.

Quartz tuning fork devices are increasingly being used as nanosensors in Scanning Probe Microscopy. They offer some benefits with respect to standard microfabricated cantilevers in certain experimental setups including the study of biomolecules under physiological conditions. In this work, we compare three different working modes for imaging micropatterned antibodies with quartz tuning fork sensors: apart from the classical amplitude and frequency modulation strategies, for first time the jumping mode is implemented using tuning forks. Our results show that the molecules suffer less degradation when working in the jumping mode, due to the reduction of the interaction forces.

Microbial carbon mineralization in tropical lowland and montane forest soils of Peru.

Climate change is affecting the amount and complexity of plant inputs to tropical forest soils. This is likely to influence the carbon (C) balance of these ecosystems by altering decomposition processes e.g., "positive priming effects" that accelerate soil organic matter mineralization. However, the mechanisms determining the magnitude of priming effects are poorly understood. We investigated potential mechanisms by adding (13)C labeled substrates, as surrogates of plant inputs, to soils from an elevation gradient of tropical lowland and montane forests. We hypothesized that priming effects would increase with elevation due to increasing microbial nitrogen limitation, and that microbial community composition would strongly influence the magnitude of priming effects. Quantifying the sources of respired C (substrate or soil organic matter) in response to substrate addition revealed no consistent patterns in priming effects with elevation. Instead we found that substrate quality (complexity and nitrogen content) was the dominant factor controlling priming effects. For example a nitrogenous substrate induced a large increase in soil organic matter mineralization whilst a complex C substrate caused negligible change. Differences in the functional capacity of specific microbial groups, rather than microbial community composition per se, were responsible for these substrate-driven differences in priming effects. Our findings suggest that the microbial pathways by which plant inputs and soil organic matter are mineralized are determined primarily by the quality of plant inputs and the functional capacity of microbial taxa, rather than the abiotic properties of the soil. Changes in the complexity and stoichiometry of plant inputs to soil in response to climate change may therefore be important in regulating soil C dynamics in tropical forest soils.

Acidobacteria appear to dominate the microbiome of two sympatric Caribbean Sponges and one Zoanthid.

BACKGROUND: Marine invertebrate-associated microbial communities are interesting examples of complex symbiotic systems and are a potential source of biotechnological products. RESULTS: In this work, pyrosequencing-based assessment from bacterial community structures of sediments, two sponges, and one zoanthid collected in the Mexican Caribbean was performed. The results suggest that the bacterial diversity at the species level is higher in the sediments than in the animal samples. Analysis of bacterial communities' structure showed that about two thirds of the bacterial diversity in all the samples belongs to the phyla Acidobacteria and Proteobacteria. The genus Acidobacterium appears to dominate the bacterial community in all the samples, reaching almost 80% in the sponge Hyrtios. CONCLUSIONS: Our evidence suggests that the sympatric location of these benthonic species may lead to common bacterial structure features among their bacterial communities. The results may serve as a first insight to formulate hypotheses that lead to more extensive studies of sessile marine organisms' microbiomes from the Mexican Caribbean.

Acidobacteria appear to dominate the microbiome of two sympatric Caribbean Sponges and one Zoanthid

BACKGROUND: Marine invertebrate-associated microbial communities are interesting examples of complex symbiotic systems and are a potential source of biotechnological products. RESULTS: In this work, pyrosequencing-based assessment from bacterial community structures of sediments, two sponges, and one zoanthid collected in the Mexican Caribbean was performed. The results suggest that the bacterial diversity at the species level is higher in the sediments than in the animal samples. Analysis of bacterial communities' structure showed that about two thirds of the bacterial diversity in all the samples belongs to the phyla Acidobacteria and Proteobacteria. The genus Acidobacteriumappears to dominate the bacterial community in all the samples, reaching almost 80% in the sponge Hyrtios. CONCLUSIONS: Our evidence suggests that the sympatric location of these benthonic species may lead to common bacterial structure features among their bacterial communities. The results may serve as a first insight to formulate hypotheses that lead to more extensive studies of sessile marine organisms' microbiomes from the Mexican Caribbean.

Dual effects of ß3 integrin subunit expression on human pancreatic cancer models.

BACKGROUND: Pancreatic cancer, the fifth leading cause of adult cancer death in Western countries, lacks early detection, and displays significant dissemination ability. Accumulating evidence shows that integrin-mediated cell attachment to the extracellular matrix induces phenotypes and signaling pathways that regulate tumor cell growth and migration. METHODS: In view of these findings, we examined the role of ß(3) in pancreatic cancer by generating two stable ß(3)-expressing pancreatic human cell lines and characterizing their behavior in vitro and in vivo. RESULTS: Transduction of ß(3) selectively augmented the functional membrane α(v)ß(3) integrin levels, as evident from the enhanced adhesion and migration abilities related to active Rho GTPases. No effects on in vitro anchorage-dependent growth, but higher anoikis were detected in ß(3)-overexpressing cells. Moreover, tumors expressing ß(3) displayed reduced growth. Interestingly, treatment of mice with an α(v)-blocking antibody inhibited the growth of ß(3)-expressing tumors to a higher extent. CONCLUSIONS: Our results collectively support the hypothesis that α(v)ß(3) integrin has dual actions depending on the cell environment, and provide additional evidence on the role of integrins in pancreatic cancer, which should eventually aid in improving prediction of the effects of therapies addressed to modulate integrin activities in these tumors.

Dual effects of ß3 integrin subunit expression on human pancreatic cancer models.

BACKGROUND: pancreatic cancer, the fifth leading cause of adult cancer death in Western countries, lacks early detection, and displays significant dissemination ability. Accumulating evidence shows that integrin-mediated cell attachment to the extracellular matrix induces phenotypes and signaling pathways that regulate tumor cell growth and migration. METHODS: in view of these findings, we examined the role of ß3 in pancreatic cancer by generating two stable ß3-expressing pancreatic human cell lines and characterizing their behavior in vitro and in vivo. RESULTS: transduction of ß3 selectively augmented the functional membrane αvß3 integrin levels, as evident from the enhanced adhesion and migration abilities related to active Rho GTPases. No effects on in vitro anchorage-dependent growth, but higher anoikis were detected in ß3-overexpressing cells. Moreover, tumors expressing ß3 displayed reduced growth. Interestingly, treatment of mice with an αv-blocking antibody inhibited the growth of ß3-expressing tumors to a higher extent. CONCLUSIONS: our results collectively support the hypothesis that αvß3 integrin has dual actions depending on the cell environment, and provide additional evidence on the role of integrins in pancreatic cancer, which should eventually aid in improving prediction of the effects of therapies addressed to modulate integrin activities in these tumors.

Validación psicométrica de la versión española del Cuestionario de Relaciones Médico-Paciente (CREM-P) / Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ)

Introducción. El principal objetivo del presente estudio fue la adaptación del instrumento internacional Patient-Doctor Relationship Questionnaire (PDRQ) que evalúa la calidad de la relación médico-paciente a una muestra española de pacientes de Medicina Interna en condiciones de práctica clínica habitual. Método. Fueron evaluados 188 pacientes de 6 médicos especialistas en Medicina Interna de un Hospital Universitario de Madrid capital. Se recogieron información clínica y sociodemográfica y fue administrada la traducción española del cuestionario PDRQ. Resultados. Los resultados indicaron niveles altos en fiabilidad, validez factorial y validez de contenido. Asimismo, a partir de los resultados obtenidos en la literatura científica se procedió al estudio de la validez criterial utilizando como criterio externo la continuidad del cuidado. Los resultados refrendan datos previos sobre la relación positiva entre calidad de la relación médico-paciente y continuidad del cuidado. Conclusiones. El cuestionario final obtenido (CREM-P )de 13 ítems se muestra como un instrumento fiable, válido y de fácil cumplimentación, diseñado para permitir la evaluación tanto en contextos clínicos como de investigación (AU)

Introduction. The main aim of this study was to make a Spanish adaption of the international Patient-Doctor Relationship Questionnaire (PDRQ) that assesses the quality of patient-doctor relationship in Spanish patients admitted to an Internal Medicine Service under conditions of regular clinical practice. Method. A total of 188 adult patients of 6 Internal Medicine physicians from a University Hospital in downtown Madrid were analyzed. Sociodemographic and clinical variables were collected and the PDRQ Spanish version questionnaire was administered. Results. Results showed excellent psychometric data on reliability, factorial, and construct validity. Furthermore, based on scientific literature, criteria validity was determined, considering continuity of care as external criteria. Results ratify previous data related to positive relation between quality of doctor-patient relation and continuity of care. Conclusions. The Spanish 13 item version of the PDRQ (CREM-P in Spanish) proved to be a valid instrument for assessing the quality of patient-doctor relation in adult patients, with clinical and research value (AU)

El estrés del médico residente en Urgencias / The stress of the Emergency resident physician

No disponible

Aplicación de la CIF para el estudio y evaluación del funcionamiento y la discapacidad en depresión unipolar en el ámbito de atención primaria / Applicability of the ICF in measuring functioning and disability in unipolar depression in Primary Care settings

Introducción. Se emplea el modelo biopsicosocial de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) para: a) estudiar el perfil de funcionamiento en depresión unipolar tratada en atención primaria; b) determinar variables predictoras y mediadoras de discapacidad en depresión, y c) analizar la eficacia del tratamiento psicofarmacológico habitual en la remisión funcional de pacientes con depresión. Diseño. Naturalístico, longitudinal, prospectivo. Emplazamiento. Estudio multicéntrico en atención primaria. Centros del Área 2 de la Comunidad de Madrid. Participantes. Pacientes adultos con diagnóstico de depresión unipolar que inician tratamiento con inhibidores selectivos de la recaptación de serotonina en centros de atención primaria. Se excluirán los pacientes con historia de trastorno bipolar, trastornos psicóticos, demencias y con historia de dependencia de sustancias adictivas. Medidas principales. Nivel de discapacidad en distintas áreas de funcionamiento evaluado con instrumentos desarrollados a partir de la CIF. Sucesos vitales estresantes, apoyo social y esquemas cognitivos serán explorados como variables mediadoras del funcionamiento. Características sociodemográficas y clínicas y el tratamiento psicofarmacológico son tratados como factores independientes. Discusión y aplicabilidad clínica. Sesgo en la representatividad y selección de la muestra podrían afectar a la generalización de resultados. Se aplica por primera vez en España el modelo biopsicosocial de la CIF y la metodología desarrollada en el estudio de la depresión en atención primaria. Se espera una mejor comprensión de factores ligados a discapacidad funcional en pacientes con depresión. El proyecto se suma a una de las líneas prioritarias de investigación en la UE (proyecto MHADIE)

Introduction. We use the biopsychosocial model of the International Classification of Functioning, Disability, and Health (ICF): a) to analyze functioning and disability patterns in unipolar depression cases attended in primary care settings; b) to study predictive and mediator variables related to disability in depression, and c) to determine the impact of traditional interventions in depression cases using functional remission as outcome measure. Design. Naturalistic, prospective, longitudinal. Setting. Multicenter study in primary care. Health Area 2. Region of Madrid. Participants. Adult patients with a diagnosis of unipolar depression who initiate psychopharmacological treatment with selective serotonin reuptake inhibitor (SSRI) in primary care sites. Patients with history of bipolar disorders, psychotic disorders, dementias, and dependence of toxic substances will be excluded. Main measurements. Level of functioning and disability in different domains of well-being assessed through ICF related instruments. Stressful life events, social support and cognitive schemes will be analyzed as mediator variables. Socio-demographic and clinical characteristics, psychopharmacological treatment and treatment compliance are considered independent factors. Discussion and practical use. Selection bias may affect the generalization of the results. The biopsychosocial model underlying the ICF and its methodology are applied to the study of depression in primary care settings for the first time in Spain. Improving our understanding of disability related factors in depressive patients is expected. This study is one of the main research priorities of the EU (MHADIE project)

[Applicability of the ICF in measuring functioning and disability in unipolar depression in Primary Care settings]. / Aplicación de la CIF para el estudio y evaluación del funcionamiento y la diacapacidad en depresión unipolar en el ámbito de atención primaria.

INTRODUCTION: We use the biopsychosocial model of the International Classification of Functioning, Disability, and Health (ICF): a) to analyze functioning and disability patterns in unipolar depression cases attended in primary care settings; b) to study predictive and mediator variables related to disability in depression, and c) to determine the impact of traditional interventions in depression cases using functional remission as outcome measure. DESIGN: Naturalistic, prospective, longitudinal. SETTING: Multicenter study in primary care. Health Area 2. Region of Madrid. PARTICIPANTS: Adult patients with a diagnosis of unipolar depression who initiate psychopharmacological treatment with selective serotonin reuptake inhibitor (SSRI) in primary care sites. Patients with history of bipolar disorders, psychotic disorders, dementias, and dependence of toxic substances will be excluded. MAIN MEASUREMENTS: Level of functioning and disability in different domains of well-being assessed through ICF related instruments. Stressful life events, social support and cognitive schemes will be analyzed as mediator variables. Socio-demographic and clinical characteristics, psychopharmacological treatment and treatment compliance are considered independent factors. DISCUSSION AND PRACTICAL USE: Selection bias may affect the generalization of the results. The biopsychosocial model underlying the ICF and its methodology are applied to the study of depression in primary care settings for the first time in Spain. Improving our understanding of disability related factors in depressive patients is expected. This study is one of the main research priorities of the EU (MHADIE project).

Estimulación del nervio vago y psicosis. A propósito de un caso / Vagus nerve stimulation and psychosis. A single case report

La aparición de alteraciones del comportamiento en el contexto de una disminución en el número de crisis en pacientes epilépticos es un hecho que ya fue descrito por Landolt a mediados del siglo XX en su teoría de la normalización forzada. Aquí proponemos, a través de un caso clínico, una serie de mecanismos que pretenden explicar a grandes rasgos la fisiopatología de este fenómeno. Entre ellos destaca la teoría del aumento en el estado de alerta provocado por los mecanismos inhibitorios secundarios a una epilepsia de varios años de evolución. Por otra parte, se plantea la posibilidad de que la estimulación intermitente del nervio vago izquierdo (ENV), procedimiento empleado como terapia coadyuvante en el manejo de pacientes epilépticos refractarios a politerapia farmacológica, pueda provocar una respuesta inhibitoria de características similares, que pudiese por sí misma originar una serie de cuadros psiquiátricos. Finalmente se barajan diversas alternativas en relación con el proceso fisiopatológico que conlleva la cronificación de dicha patología, entre las cuales destaca un deterioro cognitivo asociado al desarrollo de síntomas negativos en pacientes con epilepsia del lóbulo temporal

The appearance of behavioral disorders in the context of a decrease in the number of seizures in epileptic patients is a fact that was already described in Landolt's theory of forced normalization in the middle of the XX century. Through this clinical case, we propose several mechanisms that aim to give a general explanation to the physiopathology of this condition. Among them, the theory which suggests increased alertness as a result of inhibitory mechanisms secondary to a long lasting epileptic condition stands out. In addition, we consider the possibility that left vagus nerve stimulation (VNS), a procedure used as a second line treatment in epileptic patients refractary to multiple drug therapy, may cause an inhibitory reaction of similar characteristics as the previously described, and could therefore lead to different psychiatric disorders. Lastly, we bring up several alternatives that will try to throw some light on the physiopathological condition that leads to the chronification of this disease, the theory regarding a cognitive deterioration associated to the appearance of negative symptoms in patients with temporal lobe epilepsy standing out

[Vagus nerve stimulation and psychosis. A single case report]. / Estimulación del nervio vago y psicosis. A propósito de un caso.

The appearance of behavioral disorders in the context of a decrease in the number of seizures in epileptic patients is a fact that was already described in Landolt's theory of forced normalization in the middle of the XX century. Through this clinical case, we propose several mechanisms that aim to give a general explanation to the physiopathology of this condition. Among them, the theory which suggests increased alertness as a result of inhibitory mechanisms secondary to a long lasting epileptic condition stands out. In addition, we consider the possibility that left vagus nerve stimulation (VNS), a procedure used as a second line treatment in epileptic patients refractory to multiple drug therapy, may cause an inhibitory reaction of similar characteristics as the previously described, and could therefore lead to different psychiatric disorders. Lastly, we bring up several alternatives that will try to throw some light on the physiopathological condition that leads to the chronification of this disease, the theory regarding a cognitive deterioration associated to the appearance of negative symptoms in patients with temporal lobe epilepsy standing out.

Serum amino acid levels after permanent middle cerebral artery occlusion in the rat.

BACKGROUND AND PURPOSE: High levels of glutamate in plasma and cerebrospinal fluid (CSF) have been demonstrated in patients with acute ischemic stroke. Whereas this glutamate increase in CSF is only evidenced during the first 6 h in stable ischemic stroke, it is sustained for 24 h in progressing stroke. The aim of this investigation was to study the evolution of serum glutamate levels after stroke in a rat model of permanent cerebral artery occlusion. METHODS: Glutamate, glycine, aspartate, taurine and tryptophan were measured by high-performance liquid chromatography from serum samples taken before and at different times after permanent middle cerebral artery occlusion (MCAO) and from sham-operated rats. RESULTS: After MCAO, a 3-fold increase in glutamate and a 2-fold increase in glycine and aspartate were observed in rat serum. The onset of this amino acid increase began 4-6 h after ischemic induction, reached peak values at 8-24 h and returned to preischemic values by 48-72 h. Serum concentrations of taurine and tryptophan were not modified after MCAO. Sham-operated rats did not exhibit changes of basal amino acid concentrations in serum. CONCLUSIONS: The serum excitatory amino acid profile in this experimental model confirms that the early detection of increased concentrations of glutamate and glycine at systemic circulation observed in patients with acute stroke is a consequence of the cerebral ischemic process.