Estado actual y perspectivas futuras en el manejo de la hipertensión intracraneal posterior a traumatismo craneoencefálico: craniectomía descompresiva, hipotermia terapéutica y barbitúricos / Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates

Introducción: El aumento de la presión intracraneal se ha asociado a un pronóstico neurológicodesfavorable y a un incremento en la mortalidad en pacientes con traumatismo craneoencefálico grave. Tradicionalmente, las terapias para disminuir la presión intracraneal se administranutilizando un enfoque progresivo, reservando el uso de opciones más agresivas para los casossin respuesta a intervenciones de primer nivel, o de hipertensión intracraneal refractaria. Desarrollo: El valor terapéutico de las intervenciones de rescate para la hipertensión intracraneal, así como el momento adecuado para su uso ha sido debatido constantemente en laliteratura. En esta revisión, discutiremos las principales opciones de tratamiento para la hipertensión intracraneal refractaria posterior a un traumatismo craneoencefálico grave en adultos.Tenemos la intención de llevar a cabo una revisión en profundidad de los ensayos controladosaleatorios más representativos sobre las diferentes intervenciones terapéuticas de rescate,incluyendo la craniectomía descompresiva, hipotermia terapéutica y barbitúricos. Además,discutiremos las perspectivas futuras de estas opciones de tratamiento. Conclusiones: La evidencia parece mostrar que se puede reducir la mortalidad al utilizar estasintervenciones de rescate como terapia de último nivel, sin embargo, este beneficio vieneacompanado de una discapacidad severa. La decisión de realizar o no estas intervencionesdebe ser individualizada y centrada en el paciente. El desarrollo e integración de diferentesvariables fisiológicas a través de monitorización multimodal es de suma importancia para poderproporcionar información pronóstica más sólida a los pacientes que enfrentan este tipo dedecisiones.(AU)

Introduction: Increased intracranial pressure has been associated with poor neurological out-comes and increased mortality in patients with severe traumatic brain injury. Traditionally,intracranial pressure-lowering therapies are administered using an escalating approach, withmore aggressive options reserved for patients showing no response to first-tier interventions,or with refractory intracranial hypertension. Development: The therapeutic value and the appropriate timing for the use of rescue treat-ments for intracranial hypertension have been a subject of constant debate in literature. Inthis review, we discuss the main management options for refractory intracranial hypertensionafter severe traumatic brain injury in adults. We intend to conduct an in-depth revision of themost representative randomised controlled trials on the different rescue treatments, includingdecompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss futureperspectives for these management options. Conclusions: The available evidence appears to show that mortality can be reduced whenrescue interventions are used as last-tier therapy; however, this benefit comes at the cost ofsevere disability. The decision of whether to perform these interventions should always bepatient-centred and made on an individual basis. The development and integration of differentphysiological variables through multimodality monitoring is of the utmost importance to providemore robust prognostic information to patients facing these challenging decisions.(AU)

Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates.

INTRODUCTION: Increased intracranial pressure (ICP) has been associated with poor neurological outcomes and increased mortality in patients with severe traumatic brain injury (TBI). Traditionally, ICP-lowering therapies are administered using an escalating approach, with more aggressive options reserved for patients showing no response to first-tier interventions, or with refractory intracranial hypertension. DEVELOPMENT: The therapeutic value and the appropriate timing for the use of rescue treatments for intracranial hypertension have been a subject of constant debate in literature. In this review, we discuss the main management options for refractory intracranial hypertension after severe TBI in adults. We intend to conduct an in-depth revision of the most representative randomised controlled trials on the different rescue treatments, including decompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss future perspectives for these management options. CONCLUSIONS: The available evidence appears to show that mortality can be reduced when rescue interventions are used as last-tier therapy; however, this benefit comes at the cost of severe disability. The decision of whether to perform these interventions should always be patient-centred and made on an individual basis. The development and integration of different physiological variables through multimodality monitoring is of the utmost importance to provide more robust prognostic information to patients facing these challenging decisions.

Flower sharing and pollinator health: a behavioural perspective.

Disease is an integral part of any organisms' life, and bees have evolved immune responses and a suite of hygienic behaviours to keep them at bay in the nest. It is now evident that flowers are another transmission hub for pathogens and parasites, raising questions about adaptations that help pollinating insects stay healthy while visiting hundreds of plants over their lifetime. Drawing on recent advances in our understanding of how bees of varying size, dietary specialization and sociality differ in their foraging ranges, navigational strategies and floral resource preferences, we explore the behavioural mechanisms and strategies that may enable foraging bees to reduce disease exposure and transmission risks at flowers by partitioning overlapping resources in space and in time. By taking a novel behavioural perspective, we highlight the missing links between disease biology and the ecology of plant-pollinator relationships, critical for improving the understanding of disease transmission risks and the better design and management of habitat for pollinator conservation. This article is part of the theme issue 'Natural processes influencing pollinator health: from chemistry to landscapes'.

Current status and outlook for the management of intracranial hypertension after traumatic brain injury: decompressive craniectomy, therapeutic hypothermia, and barbiturates. / Estado actual y perspectivas futuras en el manejo de la hipertensión intracraneal posterior a traumatismo craneoencefálico: craniectomía descompresiva, hipotermia terapéutica y barbitúricos.

INTRODUCTION: Increased intracranial pressure has been associated with poor neurological outcomes and increased mortality in patients with severe traumatic brain injury. Traditionally, intracranial pressure-lowering therapies are administered using an escalating approach, with more aggressive options reserved for patients showing no response to first-tier interventions, or with refractory intracranial hypertension. DEVELOPMENT: The therapeutic value and the appropriate timing for the use of rescue treatments for intracranial hypertension have been a subject of constant debate in literature. In this review, we discuss the main management options for refractory intracranial hypertension after severe traumatic brain injury in adults. We intend to conduct an in-depth revision of the most representative randomised controlled trials on the different rescue treatments, including decompressive craniectomy, therapeutic hypothermia, and barbiturates. We also discuss future perspectives for these management options. CONCLUSIONS: The available evidence appears to show that mortality can be reduced when rescue interventions are used as last-tier therapy; however, this benefit comes at the cost of severe disability. The decision of whether to perform these interventions should always be patient-centred and made on an individual basis. The development and integration of different physiological variables through multimodality monitoring is of the utmost importance to provide more robust prognostic information to patients facing these challenging decisions.

Utilidad pronóstica del electrocardiograma en pacientes hipertensos mayores de 65 años. Estudio FAPRES / rognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study

Objetivo: La hipertrofia ventricular izquierda es el marcador de daño de órgano diana más frecuente en la hipertensión arterial. Habitualmente se realiza un ECG para su identificación. El objetivo de este trabajo es analizar la utilidad pronóstica de otras alteraciones electrocardiográficas en pacientes hipertensos, más allá de la hipertrofia ventricular. Materiales y métodos: Se incluyeron 1.003 pacientes hipertensos mayores de65años. Se recogieron factores de riesgo, historia cardiovascular previa y tratamiento médico. Se analizaron diferentes alteraciones electrocardiográficas, incluyendo índice de Sokolow-Lyon, índice de Cornell, presencia de sobrecarga ventricular y bloqueos de rama, entre otros. Se llevó a cabo un seguimiento de 2años con recogida de eventos cardiovasculares mayores (mortalidad, infarto de miocardio, accidentes cerebrovascular o ingreso por insuficiencia cardiaca). Resultados: La edad media de la población era de 72,9+/-5,8años, con un 47,5% de varones. Durante el seguimiento el 13,9% sufrieron un evento cardiovascular mayor. Estos pacientes eran de mayor edad, más fumadores y practicaban menos ejercicio físico, sin presentar diferencias en el tratamiento antihipertensivo empleado ni en el control tensional. El patrón de sobrecarga ventricular (HR: 1,93; IC95%: 1,160-3,196; p=0,011) y el bloqueo completo de rama izquierda (HR: 2,27; IC95%: 1,040-4,956; p=0,040) se comportaron como factores electrocardiográficos predictores independientes de eventos cardiovasculares mayores, no así la hipertrofia ventricular izquierda por Sokolow y/o Cornell. Conclusiones: En pacientes hipertensos, la existencia en el ECG basal de un bloqueo completo de rama izquierda o un patrón de sobrecarga ventricular identifica a una población de mayor riesgo cardiovascular

Objective: Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy. Materials and methods: The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure). Results: The study population's mean age was 72.9+/-5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such. Conclusions: For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk

Prognostic utility of electrocardiograms in patients with hypertension older than 65 years. The PAFRES study. / Utilidad pronóstica del electrocardiograma en pacientes hipertensos mayores de 65 años. Estudio FAPRES.

OBJECTIVE: Left ventricular hypertrophy is the most common marker of target organ damage in arterial hypertension. Electrocardiograms are typically performed to identify left ventricular hypertrophy. The aim of this study was to analyse the prognostic utility of other electrocardiographic abnormalities in patients with arterial hypertension, beyond ventricular hypertrophy. MATERIALS AND METHODS: The study included 1003 patients older than 65years with arterial hypertension. We recorded risk factors, previous cardiovascular history and medical treatment and analysed various electrocardiographic abnormalities including the Sokolow-Lyon index, the Cornell index, ventricular overload and branch blocks. The study conducted a 2-year follow-up, recording the major cardiovascular events (mortality, myocardial infarction, stroke and hospitalisation for heart failure). RESULTS: The study population's mean age was 72.9±5.8years, 47.5% of whom were men. During the follow-up, 13.9% of the patients experienced a major cardiovascular event. These patients were older, more often smokers and engaged in less physical exercise, without presenting differences in the antihypertensive therapy or blood pressure control. The ventricular overload pattern (HR: 1.93; 95%CI: 1.160-3.196; P=.011) and the complete left bundle branch block (HR: 2.27; 95%CI: 1.040-4.956; P=.040) behaved as independent electrocardiographic predictors of major cardiovascular events; however, left ventricular hypertrophy using the Sokolow and/or Cornell index did not behave as such. CONCLUSIONS: For patients with hypertension, the presence in the baseline electrocardiogram of complete left bundle branch block or a pattern of ventricular overload identifies a population at increased cardiovascular risk.

A matter of taste: the adverse effect of pollen compounds on the pre-ingestive gustatory experience of sugar solutions for honeybees.

In addition to sugars, nectar contains multiple nutrient compounds in varying concentrations, yet little is known of their effect on the reward properties of nectar and the resulting implications for insect behaviour. We examined the pre-ingestive responses of honeybees to sucrose solutions containing a mix of pollen compounds, the amino acids proline or phenylalanine, or known distasteful substances, quinine and salt. We predicted that in taste and learning assays, bees would respond positively to the presence of nutrient compounds in a sucrose solution. However, bees' proboscis extension responses decreased when their antennae were stimulated with pollen- or amino acid-supplemented sucrose solutions. Compared to pure sucrose, bees exhibited worse acquisition when conditioned to an odour with pollen-supplemented sucrose as the unconditioned stimulus. Such learning impairment was also observed with quinine-containing sucrose solutions. Our results suggest that bees can use their antennae to detect pollen compounds in floral nectars. Depending on the type and concentrations of compounds present, this may result in nectar being perceived as distasteful by bees, making it less effective in reinforcing the learning of floral cues. Such reward devaluation might be adaptive in cases where plants benefit from regulating the frequency of bee visitation.

Effect of feed intake level and dietary protein content on the body temperature of pigs housed under thermo neutral conditions.

Feed intake and diet composition appear to affect the body temperature of pigs. Two trials were conducted to analyse the effect of feed intake level and dietary protein content on the intestinal temperature (IT) of pigs housed under thermo neutral conditions. Ten pigs (64.1 ± 1.3 kg initial body weight) fitted with an ileal cannula were used. A thermometer set to register the IT at 5-min intervals was implanted into the ileum through the cannula. In both trials, the ambient temperature ranged from 19.1 to 21.6°C and the pigs were fed at 07:00 and 19:00 hr (same amount each time). In trial 1, the pigs were fed daily 1.2 or 1.8 kg of a wheat-soybean meal diet. The IT followed a similar pattern along a 24-hr period regardless the feed intake level. The IT rapidly increased up to 0.61 and 0.74°C after the morning meal and up to 0.53 and 0.47°C after the evening meal in pigs fed 1.2 and 1.8 kg/d respectively. The postprandial IT was higher in pigs fed 1.8 kg after each meal (p < .05). In trial 2, pigs were fed daily 1.8 kg of a low (11%) or a high (22%) crude protein diet. The IT followed a similar pattern along the 24-hr period regardless the dietary protein level. The postprandial IT did not differ between pigs fed the low protein or the high protein (p > .10). The IT rapidly increased up to 0.66 and 0.62°C after the morning meal in pigs fed the high- and low-protein diet (p < .05), but there was no change after the evening meal (p > .10). In conclusion, the feed intake level affected the IT of pigs housed under TN conditions, but the dietary protein content had no effect.

Patient with disseminated tuberculosis and rare perianal involvement / Paciente con tuberculosis diseminada y un raro compromiso perianal

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Heat stress affects the apparent and standardized ileal digestibilities of amino acids in growing pigs.

Heat stress (HS) appears to impair the pig's small intestine digestive and absorptive capacities and, therefore, may affect the AA digestibilities. A crossover-designed experiment was conducted utilizing two 7-d periods with 8 pigs (30.8 kg initial BW) surgically fitted with T-type cannulas at the terminal ileum to analyze the effect of HS on both apparent (AID) and standardized (SID) ileal digestibility of AA in pigs fed a wheat-soybean meal diet. Subcutaneous skin and ileal lumen temperatures were continuously monitored in 15-min intervals during the entire experiment. After recovery from surgery, all pigs were adapted to the diet and trained to consume the same amount of feed twice a day for 5 d in thermal-neutral (TN) conditions (22°C ± 2°C). Following adaptation, pigs were divided into 2 groups (4 pigs each); 1 remained in TN conditions, and the other group was exposed to natural HS (24°C to 45°C) for 7 d (period 1). In period 2, the 2 groups switched environments. Ileal digesta were continuously collected for 12 h, starting at 0700 h, on d 6 and 7 of each period. Chromic oxide was used as an indicator of intestinal digesta flow. The subcutaneous and the ileal temperatures were increased between 1.3°C and 1.6°C in HS compared to TN pigs ( < 0.001). The AID of AA (%) for the TN and HS pigs were Arg, 90.6, 88.1; His, 88.7, 85.9; Ile, 84.8, 83.9; Leu, 86.9, 84.1; Lys, 86.8, 86.2; Met, 89.8, 89.1; Phe, 86.0, 84.8; Thr, 76.7, 74.3; and Val, 82.8, 81.7, respectively. The SID (%) of AA for the TN and HS pigs were Arg, 94.0, 92.0; His, 92.5, 90.2; Ile, 89.5, 88.1; Leu, 90.1, 88.6; Lys, 91.0, 90.1; Met, 94.4, 93.6; Phe, 90.4, 88.9; Thr, 86.0, 83.7; and Val, 88.1, 86.5, respectively. The AID of Arg, His, and Leu was lower ( < 0.01) in HS pigs, and the SID of Arg and His was also lower in HS pigs. Neither the AID nor the SID of the remaining essential AA was affected by HS. In summary, the digestibility of essential AA is differentially affected in pigs exposed to natural HS, and thus, special attention should be given to Arg and His when formulating diets for growing pigs under HS conditions.

Effect of heat stress on the serum concentrations of free amino acids and some of their metabolites in growing pigs.

Exposure to heat stress (HS) may affect the intestinal epithelia of pigs, resulting in impaired digestive and absorptive capacity. The serum concentration (SC) of free AA in pigs can be used as indicators of their availability. This study was conducted with 12 crossbred (Landrace × Hampshire × Duroc) pigs (29.0 ± 2.8 kg initial BW) distributed into 2 groups to analyze the SC of free AA and some AA metabolites in pigs exposed to HS conditions. The treatments were pigs housed under natural HS conditions in a room with no ambient temperature control (23.6 to 37.6°C, HS) and pigs housed at thermoneutral conditions (24 ± 2°C), feed restricted to a level similar to that of their HS counterparts. All pigs received a wheat-soybean meal diet. Blood samples were collected at both the absorptive (2.5 h after a meal) and postabsorptive (10.0 h after a meal) phase. At the absorptive phase, the SC of free Arg, Leu, Lys, Phe, Thr, and Trp were lower ( < 0.05) and the SC of His, Val, Ala, Pro, Ser, and Tyr tended to be lower ( < 0.10) in HS pigs. At the postabsorptive phase, the SC of free Arg, His, Met, Asn, Gln, and Tyr were higher ( < 0.05) but the SC of Ala was lower ( < 0.01) and the SC of Pro tended to be lower ( < 0.10) in HS pigs. The absorptive SC of carnosine, ornithine (Orn), and Tau were lower ( < 0.05) and of citrulline (Cit), cystathionine, and urea tended to be lower ( < 0.10) in HS pigs. The postabsorptive SC of 3-methyl-His, homo-Cys, OH-Lys, and OH-Pro increased ( = 0.05) and of Cit tended to increase ( = 0.10) but that of carnosine and sarcosine ( < 0.05) decreased in HS pigs. The results of this study show a marked and differential effect of HS on the SC of AA. These data indicate that HS negatively affects the digestive and absorptive capacity of pigs and that the metabolism of some AA is modified in pigs to counteract the negative effects of the HS.

Motion cues improve the performance of harnessed bees in a colour learning task.

The proboscis extension conditioning (PER) is a successful behavioural paradigm for studying sensory and learning mechanisms in bees. Whilst mainly used with olfactory and tactile stimuli, more recently reliable PER conditioning has been achieved with visual stimuli such as colours and looming stripes. However, the results reported in different studies vary quite strongly, and it remains controversially discussed how to best condition visual PER. It is particularly striking that visual PER leads to more limited performance as compared to visual conditioning of free-flying bees. It could be that visual PER learning is affected by the lack of movement and that the presence of visual motion cues could compensate for it. We tested whether bees would show differences in learning performances when conditioned either with a colour and motion stimulus in combination or with colour alone. Colour acquisition was improved in the presence of the motion stimulus. The result is consistent with the idea that visual learning might be tightly linked to movement in bees, given that they use vision predominantly during flight. Our results further confirm recent findings that successful visual PER conditioning in bees is achievable without obligatorily removing the antennae.

'The thieving magpie'? No evidence for attraction to shiny objects.

It is widely accepted in European culture that magpies (Pica pica) are unconditionally attracted to shiny objects and routinely steal small trinkets such as jewellery, almost as a compulsion. Despite the long history of this folklore, published accounts of magpies collecting shiny objects are rare and empirical evidence for the behaviour is lacking. The latter is surprising considering that an attraction to bright objects is well documented in some bird species. The present study aims to clarify whether magpies show greater attraction to shiny objects than non-shiny objects when presented at the same time. We did not find evidence of an unconditional attraction to shiny objects in either captive or free-living birds. Instead, all objects elicited responses indicating neophobia in free-living birds. We suggest that humans notice when magpies occasionally pick up shiny objects because they believe the birds find them attractive, while it goes unnoticed when magpies interact with less eye-catching items. The folklore may therefore result from observation bias and cultural inflation of orally transmitted episodic events.

Mechanisms, functions and ecology of colour vision in the honeybee.

Research in the honeybee has laid the foundations for our understanding of insect colour vision. The trichromatic colour vision of honeybees shares fundamental properties with primate and human colour perception, such as colour constancy, colour opponency, segregation of colour and brightness coding. Laborious efforts to reconstruct the colour vision pathway in the honeybee have provided detailed descriptions of neural connectivity and the properties of photoreceptors and interneurons in the optic lobes of the bee brain. The modelling of colour perception advanced with the establishment of colour discrimination models that were based on experimental data, the Colour-Opponent Coding and Receptor Noise-Limited models, which are important tools for the quantitative assessment of bee colour vision and colour-guided behaviours. Major insights into the visual ecology of bees have been gained combining behavioural experiments and quantitative modelling, and asking how bee vision has influenced the evolution of flower colours and patterns. Recently research has focussed on the discrimination and categorisation of coloured patterns, colourful scenes and various other groupings of coloured stimuli, highlighting the bees' behavioural flexibility. The identification of perceptual mechanisms remains of fundamental importance for the interpretation of their learning strategies and performance in diverse experimental tasks.

Allotriploid genotypic assignment in abalone larvae by detection of microsatellite-recombinant genotypes.

Abalone species are different from most mollusks utilized in aquaculture as they are known to hybridize in laboratory-induced matings. Allotriploidization of hybrid abalone has not yet been studied, and methodology useful in verifying the genotypic condition of such allotriploids do not exist. Genotypic verification of hybridization and allotriploidization in a cross of Haliotis fulgens and Haliotis rufescens was performed utilizing 6 crossamplifying microsatellite loci. Five H. rufescens spawns were used in this experiment, dividing each spawn into control and experimental hybrid groups and further into diploids and triploids. Two microsatellite loci developed for H. fulgens and H. rufescens allowed for the genotypic identification of hybrids within diploid and triploids. To further verify the percentage of allotriploids within the genotypic hybrids in the triploid hybrid groups, microsatellite loci originally developed in Haliotis corrugata and Haliotis kamtschatkana were tested for crossamplification in H. fulgens and H. rufescens. Of 21 loci, 4 were chosen for this study based on their crossamplification, heterozygosity in the females, and centromere recombination frequencies. Allotriploids in triploid-hybrid larvae were then detected by identifying larvae with recombinant genotypes at any of those loci. One family had low success verification associated with reduced recombination frequencies for all loci in that family. These results demonstrate that allotriploid verification at larval stages is feasible but depends on the number of loci available, their crossamplification in the species, and their recombination frequencies.

Fast learning but coarse discrimination of colours in restrained honeybees.

Colours are quickly learnt by free-moving bees in operant conditioning settings. In the present study, we report a method using the classical conditioning of the proboscis extension response (PER) in restrained honeybees (Apis mellifera), which allows bees to learn colours after just a few training trials. We further analysed how visual learning and discrimination is influenced by the quality of a stimulus by systematically varying the chromatic and achromatic properties of the stimuli. Using differential conditioning, we found that faster colour discrimination learning was correlated with reduced colour similarity between stimuli. In experiments with both absolute and differential conditioning, restrained bees showed poor colour discrimination and broad generalisation. This result is in strong contrast to the well-demonstrated ability of bees to finely discriminate colours under free-flight conditions and raises further questions about the temporal and perceptual processes underlying the ability of bees to discriminate and learn colours in different behavioural contexts.

Validity and reliability of the Spanish versions of the Bech-Rafaelsen's mania and melancholia scales for bipolar disorders.

OBJECTIVE: To assess classical psychometric properties of the Spanish versions of the Bech-Rafaelsen's mania (MAS) and melancholia (MES) scales. METHOD: Observational, prospective, and multicentric study in bipolar out-patients. Convergent validity was assessed against the Young Mania Rating Scale and the Montgomery-Asberg Depression Rating Scale. Discriminant validity, reliability, and sensitivity to change, were also assessed. RESULTS: One hundred and thirteen bipolar patients with a manic episode and 102 bipolar patients with a depressive episode were included. Both the MAS and the MES showed appropriate convergent validity (r > 0.90), discriminant validity (P < 0.0001), internal consistency (Cronbach's alpha >0.80), test-retest reliability [intraclass correlation coefficient (ICC) = 0.69 for the MAS and 0.94 for the MES], inter-rater reliability (ICC > 0.80), and sensitivity to change at 4 weeks since inception (P < 0.0001; within-group effect size >or=1.8). CONCLUSION: The Spanish versions of both scales present appropriate psychometric estimates in bipolar patients treated in ambulatory care.

The sufficiency of the HAM-D6 as an outcome instrument in the acute therapy of antidepressants in the outpatient setting.

Objective. To re-analyse the Spanish outpatient study on the various versions of the Hamilton Depression Scale (HAM-D) by using item-response theory models for measuring unidimensionality. Methods. The Mokken analysis, based on the coefficient of homogeneity, was used. A coefficient of 0.40 or higher was accepted for unidimensionality. The three HAM-D versions were compared: HAM-D6 (core items of depression), HAM-D17 and HAM-D21. Results. In total, 113 of the 116 patients included in the study completed the planned treatment period of 6 weeks. As the Mokken analysis depends as much on the sample of patients under examination (dispersion of scores on the item) as on the scale itself, the endpoint was used. For HAM-D6, but not for HAM-D17 or HAM-D21, the coefficient of homogeneity was acceptable (0.44). Conclusion. The HAM-D6 is a valid version of the Hamilton Scale to be recommended for monitoring depressed patients in antidepressant therapy in the outpatient setting.

Efectividad de los neurolépticos típicos y atípicos en el control de los síntomas conductuales y psicopatológicos de la demencia. Resultados de un estudio retrospectivo / Effectiveness of typical and atypical neuroleptics in the control of behavioral and psychopathological symptoms of dementia. Results of a retrospective study

Introducción. La presencia de síntomas psicológicos y comportamentales en la demencia (SPCD) es altamente prevalente y los fármacos neurolépticos suelen ser frecuentemente utilizados para su control. Diferentes revisiones han señalado la equivalencia clínica de las distintas familias de neurolépticos en el control de SPCD, aunque dicha equivalencia se ha evaluado sólo indirectamente, comparando sus efectos frente a placebo, por lo que hay poca información comparativa directa de la efectividad de los distintos neurolépticos. Así, el objetivo de este estudio fue el de obtener información preliminar de la efectividad de neurolépticos típicos (haloperidol, tioridazina) y atípicos (olanzapina, risperidona) sobre el control de SPCD.Métodos. Estudio multicéntrico, observacional y retrospectivo basado en la revisión de los datos de prescripción de neurolépticos en pacientes con demencia y sus resultados a las 12 semanas de tratamiento.Resultados. No se observaron diferencias significativas en la mejora de SPCD según los distintos neurolépticos evaluados (n=78; test exacto de Kruskal-Wallis; p=0,47). Tampoco se observaron diferencias al estratificar el análisis por niveles de deterioro cognitivo (test exacto de Kruskal-Wallis; p=0,86 y 0,87, respectivamente, para los niveles moderados y graves de deterioro cognitivo). Los efectos secundarios más importantes se recogieron en el grupo de pacientes tratados con haloperidol (n=19) y fueron, fundamentalmente, rigidez (test exacto de Fisher; p=0,01), temblor (test exacto de Fisher; p=0,03) y acatisia (test exacto de Fisher; p=0,03).Conclusiones. Nuestros resultados apoyan la equivalencia en efectividad para los distintos tipos de neurolépticos habitualmente utilizados para tratar los SPCD, aunque estos resultados necesitan ser confirmados por ensayos clínicos prospectivos con adecuado poder estadístico y estudios de farmacovigilancia para evaluar su seguridad

Introduction. Presence of disruptive behavioural and psychological symptoms in dementia (BPSD) is highly prevalent and, as a consequence, neuroleptics are frequently used in these patients to control BPSD. Several reviews have shown the clinical equivalence of different classes of neuroleptics in BPSD control, although that equivalence has been only indirectly assessed by comparing the combined results of different types of active drugs versus placebo. Thus, little is known on the comparative effectiveness, head to head, of different neuroleptics on BPSD. The aim of this study was to gather preliminary information on the effectiveness of typical (haloperidol, thioridazine) and atypical (olanzapine, risperidone) neuroleptics on BPSD. ;;Methods. Multicenter, observational and retrospective study using chart reviews of patients with dementia to assess neuroleptic prescriptions and clinical outcomes at 12 weeks on treatment. Results. No significant differences on BPSD improvement were found by type of neuroleptic (n=78; Kruskal- Wallis exact test; p=0.47). There also were no differences by neuroleptics when the analysis was stratified by levels of cognitive decline (Kruskal-Wallis exact test; p=0.86 and 0.87 for moderate and severe levels of deterioration, respectively). Recorded side effects were worse in the haloperidol group (n=19) regarding rigidity (Fisher's exact; p=0.01), tremor (Fisher's exact p=0.03) and akathisia (Fisher's exact; p=0.03). Conclusions. Our findings support the equivalence in effectiveness of several classes of neuroleptics commonly used to treat BPSD. Nevertheless these results need to be confirmed by adequately powered randomized trials and further pharmacoepidemiological studies to assess their safety