[Chemotherapy at the end of life: Uncommon clinical practice?] / Quimioterapia al final de la vida: ¿práctica clínica poco frecuente?

BACKGROUND: In view of the apparent increase in the aggressiveness of palliative chemotherapy, the purpose of this study was to find out and analyse the characteristics of cancer patients treated in our hospital, and who received chemotherapy near the end of life. PATIENTS AND METHODS: Retrospective, observational study in oncology-haematological patients who received chemotherapy between January 2016 and May 2017, and who died in that same period. Data on sociodemographic and clinical variables were collected. In order to determine the risk factors for receiving chemotherapy in the last month of life, a multivariate logistic regression model was developed and subsequently validated using "bootstrap" re-sampling techniques. RESULTS: A total of 293 patients who received chemotherapy during the study period died. The median time between the last cycle of chemotherapy and death was 52 (0-459) days. Chemotherapy was received in their last month of life in 98 (33.4% of patients. the multivariate analysis indicated that the low chemo-sensitivity of the tumour, the particular medical oncologist, and the fact of dying in the hospital setting, were associated with an increased risk of receiving chemotherapy in the last month of life. CONCLUSIONS: A worrying percentage of patients receive chemotherapy near the end of life. This makes it difficult to receive high-quality palliative care, as well as to die in a familiar environment. It is necessary to review the decision-making process in advanced cancer patients.

Peripheral Th17 cells expressing ß7 intestinal homing receptor in recent and chronic HIV infections.

The objective of this study was to conduct an analysis of peripheral blood Th17 cells with the ability to home to gut mucosa (CD4+ Th17+ ß7+ ) during recent or chronic human immunodeficiency virus (HIV) infections. The relationship between HIV load and systemic inflammation markers was studied. Twenty-five patients with recent (n = 10) or chronic (n = 15) untreated HIV infections; 30 treated HIV-infected patients with undetectable HIV load at the time of inclusion and 30 healthy controls were included. Bacterial translocation markers (16S rDNA), soluble CD14 (sCD14) and interleukin (IL)-6 monocyte activation parameters, CD4/CD8 ratio and T helper type 17 (Th17) subpopulations [CD4+ Th17+ expressing the IL-23 receptor (IL-23R) or ß7] were analysed at baseline and after 6 and 12 months of anti-retroviral therapy (ART). 16S rDNA was detected in all patients. Significantly increased serum levels of sCD14 and IL-6 and a decreased CD4/CD8 ratio were observed in patients. Similar percentages of CD4+ IL-23R+ and CD4+ Th17+ ß7+ cells were observed in healthy controls and patients at baseline. After 12 months of therapy, patients with a recent HIV infection showed significant increases of CD4+ IL-23R+ and CD4+ Th17+ ß7+ cell percentages and a decrease in IL-6 levels, although 16S rDNA continued to be detectable in all patients. No significant differences were observed in Th17 subpopulations in patients with chronic HIV infection after therapy. Early initiation of ART helps to increase the number of Th17 cells with the ability to home to the intestinal mucosa and to partially restore gut mucosal homeostasis. These results provide a rationale for initiating ART during the acute phase of HIV infection.

Prescripción dinámica de los analgésicos (PDA) / Dynamic prescription of analgesics (PDA)

No disponible

Fentanilo: una molécula y múltiples formulaciones galénicas de trascendencia clínica en el tratamiento del dolor irruptivo oncológico / Fentanyl: a molecule and multiple dose formulations of clinical transcendence in the in the treatment of breakthrough cancer pain

El manejo del dolor irruptivo oncológico exige tener prevista una medicación 'de rescate' con opioides de liberación rápida. Sin embargo, pese a la existencia de medios para su control, este es muchas veces inadecuado. La mayoría de los autores señalan que el inicio y la duración de la acción de los opiáceos orales no son las adecuadas para el tratamiento del dolor irruptivo. Los opioides de acción rápida, especialmente el fentanilo, son los fármacos de elección para el tratamiento del dolor irruptivo. En este trabajo se revisan las características de las diferentes formulaciones transmucosas bucales, sublinguales e intranasales de fentanilo que, pese a ser siempre la misma molécula, tienen matices diferenciales de importancia. De hecho, estas presentaciones no son intercambiables. La elección del tratamiento más adecuado para cada paciente debe tener en consideración los perfiles farmacocinéticos de las distintas formulaciones, ya que estas definen cuándo se inicia el efecto, cuánto dura la analgesia y cuál es el nivel del pico plasmático máximo (Cmax), muchas veces responsable de los efectos adversos. La bibliografía general y diversos consensos de expertos recomiendan individualizar el tratamiento tras una cuidadosa evaluación del dolor. Las dosis de productos de fentanilo administradas deben tener en cuenta el nivel de tolerancia opioide de los pacientes, el perfil farmacocinético de cada preparado y las condiciones de cada paciente en relación con las vías de administración. En determinadas circunstancias clínicas, las presentaciones de fentanilo intranasal parece tener un inicio de acción más rápido y ser mejor toleradas desde el punto digestivo que las presentaciones transmucosas orales. La preferencia del paciente debe también tenerse en consideración (AU)

The breakthrough cancer pain management requires planned a 'rescue' medication with quick-release opioids. However, despite the existence of media for their control, this is often inappropriate. Most of the authors point out that the onset and duration of action of oral opioids are not appropriate for the treatment of breakthrough pain. Fast-acting opioid, notably fentanyl, are the drugs of choice for the treatment of breakthrough pain. This paper reviews the characteristics of the different transmucosal formulations of fentanyl that, despite the same molecule, have differential degrees of importance. In fact, these presentations are not interchangeable. The choice of the most appropriate treatment for each patient should take into consideration the different Pharmacokinetic profiles, since they define when the effect starts, how long lasting analgesia and what is the level of the plasma peak (Cmax), often responsible for the adverse effects. General bibliography and various consensus of experts recommended to individualize the treatment after a carefully evaluation of the pain. Administered doses of different fentanyl formulations must take into account patient’s opioid tolerance, the pharmacokinetic profile of each products and conditions of each patient in relation to the routes of administration. In certain clinical circumstances, intranasal fentanyl appears to have a faster onset of action and be better tolerated at the gastrointestinal level that buccal presentations. The preference of the patient must also be taken into consideration (AU)

¿Existen argumentos para combinar un opioide con otro opioide? / Are there arguments for combining an opioid with another opioid?

No disponible

Fiebre Q aguda: riesgo de desarrollo de endocarditis / Acute Q fever and the risk of developing endocarditis

Objetivo: Valorar los datos clínicos y serológicos como parámetros indicativos de posible evolución a endocarditis tras un episodio de fiebre Q aguda. Pacientes y métodos: Estudio de cohortes retrospectivo de la evolución a endocarditis tras un episodio de fiebre Q aguda, analizando evolución clínica, serológica y tratamiento antibiótico recibido. Resultados: Se reclutó a 80 pacientes, presentando el 20% niveles de anticuerpos IgG de fase I ≥ 1:1.024 en los primeros 3 meses. Solo el 44% recibió antibioterapia en la fase aguda; únicamente 2 enfermos recibieron antibioterapia prolongada. Se realizó ecocardiograma al 15%. Ningún paciente presentó síntomas indicativos de infección crónica ni evolucionó a endocarditis tras una mediana de seguimiento de 100 meses, independientemente de la elevación precoz de anticuerpos IgG de fase I. Conclusiones: La elevación precoz de anticuerpos IgG fase I no se asoció a evolución a endocarditis a pesar de no haberse realizado tratamiento antibiótico prolongado en pacientes asintomáticos (AU)

Objectives: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. Patients and methods: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. Results: Eighty patients were recruited, 20% of whom had phase I IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase I IgG antibodies. Conclusions: The early increase in phase I IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment (AU)

Acute Q fever and the risk of developing endocarditis. / Fiebre Q aguda: riesgo de desarrollo de endocarditis.

OBJECTIVES: Assess clinical and serological data as parameters indicative of a possible evolution to endocarditis after an episode of acute Q fever. PATIENTS AND METHODS: Retrospective cohort study of evolution to endocarditis after an acute Q fever episode, analyzing the clinical and serological evolution and the antibiotic treatment administered. RESULTS: Eighty patients were recruited, 20% of whom had phase i IgG antibody levels ≥ 1:1024 in the first 3 months. Only 44% of the patients underwent antibiotherapy in the acute phase; only 2 patients underwent extended antibiotherapy. Fifteen percent of the patients underwent an echocardiogram. None of the patients had symptoms suggestive of chronic infection or progressed to endocarditis after a median follow-up of 100 months, regardless of the early increase in phase i IgG antibodies. CONCLUSIONS: The early increase in phase i IgG antibodies in asymptomatic patients is not associated with progression to endocarditis despite not undergoing prolonged antibiotic treatment.

[Viral infections]. / Infecciones víricas.

Viruses cause disease after they break through the natural protective barriers of the body, evade immune control, and either kill cells of an important tissue or trigger a destructive immune and inflammatory response. The outcome of a viral infection is determined by the nature of the virushost interaction and the host's response to the infection. Viral infections can be lytic or persistent (latency, recurrence and / or transformation of the the cell). Immune response is the best treatment, but it often contributes to the pathogenesis of a viral infection. The laboratory methods accomplish the following results: description of virus-induced cytopathologic effects (CPEs) on cells, electron microscopic detection of viral particles, isolation and growth of the virus, detection of viral components (proteins and nucleic acids) and evaluation of the patient's immune response to the virus.

Prescripción electrónica de Atención Primaria, ¿una herramienta fiable para conciliar medicación al ingreso hospitalario? / Electronic prescription for Primary Care: a reliable tool to conceal medication at hospital admission?

Objetivo: Analizar la fiabilidad de un programa de prescripción electrónica en receta de atención primaria (Medoracyl®) para conciliar la medicación al ingreso hospitalario. Método: Estudio prospectivo comparativo del tratamiento domiciliario validado de pacientes al ingreso, con el prescrito en Medoracyl®. La medicación al ingreso se obtuvo mediante entrevista clínica, informes médicos y revisión de la medicación aportada; la medicación activa en Medoracyl®, mediante consulta a la aplicación el día del ingreso. Se analizaron las discrepancias entre ambos tratamientos. Resultados: Se incluyeron 47 pacientes con 273 líneas de tratamiento domiciliario validado y 274 líneas de tratamiento Medoracyl®. Resultaron 48/273 líneas discrepantes (17,6% [IC95%: 13,1-21,6]). Se consideraron justificadas 27/48, resultando un riesgo final de no concordancia del 7,8% [IC95%: 4,6-11,0]. Conclusiones: Medoracyl® es una herramienta útil y de fácil acceso que permite conocer más del 90% de la medicación domiciliaria de los pacientes (AU)

Objective: To analyze the reliability of an electronic prescription software at primary care (Medoracyl®) to conceal the medication at hospital admission. Method: Prospective, comparative study of the home-based validated treatment of patients admitted to the hospital as compared to the one prescribed through Medoracyl®. The medication at admission was gathered by medical interview, medical records, and revision of the medication brought by the patients; the medication active in Medoracyl® by consulting the application the admission day. The discrepancies between both therapies were analyzed. Results: 47 patients were included with 273 lines of home validated treatments and 274 lines of Medoracyl®treatment. 48 out of 273 lines were in discrepancy (17.6% [95% CI: 13.121.6]). 27 out of 48 were justified, whereas 7.8% represented a discrepancy risk [95% CI: 4.6-11.0]. Conclusions: Medoracyl® is a useful tool and easy to access that allows knowing more than 90% of the home medication of the patients (AU)

[Electronic prescription for Primary Care: a reliable tool to conceal medication at hospital admission?]. / Prescripción electrónica de Atención Primaria, ¿una herramienta fiable para conciliar medicación al ingreso hospitalario?

OBJECTIVE: To analyze the reliability of an electronic prescription software at primary care (Medoracyl®) to conceal the medication at hospital admission. METHOD: Prospective, comparative study of the home-based validated treatment of patients admitted to the hospital as compared to the one prescribed through Medoracyl®. The medi cation at admission was gathered by medical interview, medi cal records, and revision of the medication brought by the patients; the medication active in Medoracyl® by consulting the application the admission day. The discrepancies between both therapies were analyzed. RESULTS: 47 patients were included with 273 lines of home validated treatments and 274 lines of Medoracyl® treatment. 48 out of 273 lines were in discrepancy (17.6% [95% CI: 13.1- 21.6]). 27 out of 48 were justified, whereas 7.8% represented a discrepancy risk [95% CI: 4.6-11.0]. CONCLUSIONS: Medoracyl® is a useful tool and easy to access that allows knowing more than 90% of the home medication of the patients.

Objetivo: Analizar la fiabilidad de un programa de prescripción electrónica en receta de atención primaria (Medoracyl®) para conciliar la medicación al ingreso hospitalario. Método: Estudio prospectivo comparativo del tratamiento domiciliario validado de pacientes al ingreso, con el prescrito en Medoracyl®. La medicación al ingreso se obtuvo mediante entrevista clínica, informes médicos y revisión de la medicación aportada; la medicación activa en Medoracyl®, mediante consulta a la aplicación el día del ingreso. Se analizaron las discrepancias entre ambos tratamientos. Resultados Se incluyeron 47 pacientes con 273 líneas de tratamiento domiciliario validado y 274 líneas de tratamiento Medoracyl ®. Resultaron 48/273 líneas discrepantes (17,6% [IC95%: 13,1-21,6]). Se consideraron justificadas 27/48, resultando un riesgo final de no concordancia del 7,8% [IC95%: 4,6-11,0]. Conclusiones: Medoracyl® es una herramienta útil y de fácil acceso que permite conocer más del 90% de la medicación domiciliaria de los pacientes.

Conocimiento de los tratamientos en pacientes hospitalarios: herramienta necesaria para la seguridad asistencial / Knowledge of treatments in hospital patients: a necesary tool for safety in health care

Objetivo. Determinar la cantidad y calidad de información sobre medicamentos que reciben los pacientes atendidos en un hospital. Método. Estudio descriptivo transversal realizado durante febrero de 2011, mediante diseño de una encuesta y entrevista a 60 pacientes: 30 ingresados y 30 externos. Análisis descriptivo de los resultados: número y grado de conocimiento de los medicamentos respecto al tratamiento «real», analizado de forma global, por edad y por vía de administración. Resultados. En el grupo de pacientes ingresados se analizaron 234 medicamentos «reales». Según los resultados de la encuesta, 45/234 (19,2%; IC95%:14-25) fueron conocidos de forma adecuada por los pacientes. En los pacientes externos esta cifra ascendió a 29/42 (69,0%; IC95%:53-82). El 33,3% de los pacientes verificó su medicación antes de ser administrada o dispensada. Los pacientes ingresados conocían mejor los medicamentos administrados por vía oral: el 28,6% frente al 5,1% de los parenterales. El 45,3% de los ingresados y el 2,4% de los externos desconocían la medicación. La edad media de los pacientes con conocimiento nulo de su medicación fue de 68,5 años (DE=10,1) y tenían 8,7 medicamentos prescritos (DE=3,0). El 53,3% y el 93,3% de los pacientes ingresados y externos respectivamente, consideraban haber sido informado correctamente. El 96,7% dijeron estar satisfechos con la información recibida. Conclusiones. Los resultados obtenidos muestran un potencial de mejora importante respecto a la información que se da a los pacientes, especialmente ingresados, en el hospital. Informarles permitiría su participación como filtro ante posibles errores de medicación y como pieza necesaria para la mejora de la seguridad asistencial(AU)

Objective. To determine the quantity and quality of drug information that patients receive in hospital. Method. Cross-sectional study conducted in February 2011, by designing and conducting a structured questionnaire on 60 patients: 30 inpatients and 30 outpatients. Descriptive analysis of the results was performed including, number and level of knowledge of medication treatment versus the "real" one, globally analysed by age and route of administration. Results. A total of 234 drugs were analysed in the inpatient group. It was considered that 45/234 (19.2%;95% CI: 14-25) were known properly by patients. In outpatients, this rises to 29/42 (69.0%;95% CI: 53-82). One third (33.3%) of patients check the medication before it is administered or provided. Inpatients are more aware of orally administered drugs, they knew 28.6% vs 5.1% of parenteral treatments. Just under half (45.3%) of inpatients and 2.4% of outpatients completely unknown the medication. The average age of patients with no knowledge of their medication was 68.5 years (SD=10.1) and had 8.7 drugs prescribed (SD=3.0). A total of 53.3% of inpatients and 93.3% of outpatients, considered to have been properly informed. Most of patients (96.7%) were satisfied with the information received. Conclusions. The results show an opportunity for improvement in the information given to patients, particularly to inpatients. To inform them, would enable them to act as a filter to potential medication errors, and as a necessary part to improve the safety of care(AU)

La glándula pineal como instrumento físico de las facultades del alma: una conexión histórica persistente / The pineal gland as physical tool of the soul faculties: a persistent historical connection

Introducción: La ubicación anatómica del alma humana ha constituido un controvertido motivo de discusión en los ámbitos filosófico, teológico y científico a lo largo de la historia. Una de las hipótesis más conocidas sobre este tema fue propuesta por Descartes, para quien el alma se alojaría en la glándula pineal, órgano cerebral cuya especial localización le permitiría dirigir adecuadamente el funcionamiento del cuerpo humano.Desarrollo: En el presente trabajo, analizaremos las influencias históricas que posibilitaron el modelo cartesiano de relación entre el pensamiento (res cogitans) y la extensión (cuerpo-máquina) y las bases técnicas de su principio de dualismo espíritu-materia. En materia filosófica, Descartes se apoyó en los planteamientos de San Agustín y en materia fisiológica y anatómica adoptó gran parte de las teorías vigentes desde la Antigüedad clásica, fundamentalmente las propuestas de la escuela neumática alejandrina (Herófilo, Erasístrato) en relación con los espíritus animales. Asimismo, también podría conocer las hipótesis de algunos anatomistas coetáneos (Diemerbroeck), que establecían la localización del sensorium commune en la glándula pineal (AU)

Introduction: The anatomic seat of the human soul has been a controversial matter of discussion in the philosophical, theological and scientific fields throughout history. One of more known hypotheses on this subject was proposed by Descartes, for whom the soul would host in the pineal gland, a brain body with a special location that would adequately address the functionalism of the human body.Development: In this work, we discuss the historical influences which made possible the Cartesian model of the relationship between spirit (res cogitans) and body-machine (res extensa) and the technical bases of his dualism doctrine. In philosophical terms, Descartes supported Augustine approaches and in physiological and anatomical terms adopted some theories of the classical Antiquity, essentially the proposals of Alexandrian pneumatic school (Herophilos, Erasistratus) in relation to the animal spirits. Descartes might also have known the hypotheses of some contemporary anatomists (Diemerbroeck) which established the location of sensorium commune in the pineal gland. Conclusions: Although Cartesian theories had strong criticism even in his time, some aspects of these postulates remained up to mid 19th century (AU)

[Knowledge of treatments in hospital patients: a necesary tool for safety in health care]. / Conocimiento de los tratamientos en pacientes hospitalarios: herramienta necesaria para la seguridad asistencial.

OBJECTIVE: To determine the quantity and quality of drug information that patients receive in hospital. METHOD: Cross-sectional study conducted in February 2011, by designing and conducting a structured questionnaire on 60 patients: 30 inpatients and 30 outpatients. Descriptive analysis of the results was performed including, number and level of knowledge of medication treatment versus the "real" one, globally analysed by age and route of administration. RESULTS: A total of 234 drugs were analysed in the inpatient group. It was considered that 45/234 (19.2%;95% CI: 14-25) were known properly by patients. In outpatients, this rises to 29/42 (69.0%;95% CI: 53-82). One third (33.3%) of patients check the medication before it is administered or provided. Inpatients are more aware of orally administered drugs, they knew 28.6% vs 5.1% of parenteral treatments. Just under half (45.3%) of inpatients and 2.4% of outpatients completely unknown the medication. The average age of patients with no knowledge of their medication was 68.5 years (SD=10.1) and had 8.7 drugs prescribed (SD=3.0). A total of 53.3% of inpatients and 93.3% of outpatients, considered to have been properly informed. Most of patients (96.7%) were satisfied with the information received. CONCLUSIONS: The results show an opportunity for improvement in the information given to patients, particularly to inpatients. To inform them, would enable them to act as a filter to potential medication errors, and as a necessary part to improve the safety of care.

[The pineal gland as physical tool of the soul faculties: a persistent historical connection]. / La glándula pineal como instrumento físico de las facultades del alma: una conexión histórica persistente.

INTRODUCTION: The anatomic seat of the human soul has been a controversial matter of discussion in the philosophical, theological and scientific fields throughout history. One of more known hypotheses on this subject was proposed by Descartes, for whom the soul would host in the pineal gland, a brain body with a special location that would adequately address the functionalism of the human body. DEVELOPMENT: In this work, we discuss the historical influences which made possible the Cartesian model of the relationship between spirit (res cogitans) and body-machine (res extensa) and the technical bases of his dualism doctrine. In philosophical terms, Descartes supported Augustine approaches and in physiological and anatomical terms adopted some theories of the classical Antiquity, essentially the proposals of Alexandrian pneumatic school (Herophilos, Erasistratus) in relation to the animal spirits. Descartes might also have known the hypotheses of some contemporary anatomists (Diemerbroeck) which established the location of sensorium commune in the pineal gland. CONCLUSIONS: Although Cartesian theories had strong criticism even in his time, some aspects of these postulates remained up to mid 19th century.

Tósigos y antídotos en la literatura cervantina: sobre los venenos en la España tardorrenacentista / “Tosigos” and antidotes in Cervantine literature: on the poisons in the late Renaissance Spain

Los textos cervantinos constituyen una interesante fuente para el estudio de la sociedad española tardorrenacentista. Nosotros hemos abordado las obras de Cervantes desde la óptica de la toxicología, analizando el uso de agentes tóxicos y venenosos, fundamentalmente alucinógenos y narcóticos en el ámbito de la práctica de la brujería y hechicería (ungüentos de brujas, filtros de amor, pócimas venenosas, etc.), así como las menciones a las hipotéticas sustancias dotadas de acción alexifármaca, como la verbena (Verbena officinalis), el cuerno de unicornio, las piedras bezoares o el castóreo. Las obras cervantinas en las que se hace referencia a estos preparados son las novelas El Quijote, La Galatea, Viaje del Parnaso y cuatro Novelas Ejemplares (La española inglesa, El licenciado Vidriera, El celoso extremeño y El coloquio de los perros), así como en las comedias Pedro de Urdemalas, La entretenida y El laberinto del amor. Entre los agentes tóxicos de origen herbal citados expresamente por Cervantes en el contexto analizado se encuentran el beleño (Hyoscyamus niger / albus), el tabaco (Nicotiana tabacum), la adelfa (Nerium oleander), el tártago (Euphorbia lathyris), el ruibarbo (Rheum officinale, Rumex alpinus) y, de forma enmascarada, el opio (Papaver somniferum). En relación con el resto de preparados dotados de actividad tóxica, Cervantes no identifica sus ingredientes, aunque, a tenor de la sintomatología descrita por el autor, podrían ser plantas de la familia de las solanáceas, como el beleño, el solano, la datura, la belladona o la mandrágora. Con respecto a los tóxicos minerales, únicamente hay referencias a los efectos del mercurio o azogue. El Dioscórides comentado por Andrés Laguna pudo ser la fuente técnica utilizada por Cervantes para documentarse en esta materia (AU)

Cervantine texts are an interesting source for the study of Spanish late Renaissance society. We have studied the works of Cervantes from the toxicology viewpoint, analyzing the use of toxic and poisonous substances, essentially hallucinogenic and narcotic agents in the field of witchcraft and sorcery practice (witches ointments, love filters, poisonous potions, etc.), as well as references to hypothetical substances endowed with alexipharmic action, as the vervain (Verbena officinalis), unicorn horn, bezoar stones or castoreum. Cervantine works which refers to these preparations are the novels Don Quixote, The Galatea, Voyage to Parnassus and four Exemplary Novels (The Spanish-English Lady, The Licentiate of Glass, The Jealous Extremaduran and The Colloquy of the Dogs), as well as the comedies Pedro de Urdemalas, The Amusing Woman and The Labyrinth of Love. Toxic agents of herbal origin mentioned explicitly by Cervantes in the analyzed context include the henbane (Hyoscyamus niger / albus), tobacco (Nicotiana tabacum), oleander (Nerium oleander), spurge (Euphorbia lathyris), rhubarb (Rheum officinale, Rumex alpinus), and masked way, opium (Papaver somniferum). In relation to the rest of preparations endowed with toxic activity, Cervantes does not identify its ingredients, though, within the meaning of the symptoms described by the author, they could be plants of the Solanaceae family, as the henbane, nightshade, jimsonweed, belladonna or mandrake. Concerning toxic minerals, only there are references to the effects of mercury (“azogue”). The Dioscorides commented by Andrés Laguna could be the technical font used by Cervantes to document in this matter (AU)

An historical view of the pineal gland and mental disorders.

Since Classical Antiquity numerous authors have linked the origin of some mental disorders to physical and functional changes in the pineal gland because of its attributed role in humans as the connection between the material and the spiritual world. The pineal organ was seen as a valve-like structure that regulated the flow of animal spirits through the ventricular system, a hypothesis that took on more vigour during the Middle Ages and the Renaissance. The framework for this theory was "the three cells of the brain", in which the pineal gland was even called the "appendix of thought". The pineal gland could also be associated with the boom, during this period, of certain legends about the "stone of folly". But the most relevant psychopathological role of this organ arrived with Descartes, who proposed that it was the seat of the human soul and controlled communications between the physical body and its surroundings, including emotions. After a period of decline during which it was considered as a mere vestigial remnant of evolution, the link between the pineal gland and psychiatric disorders was definitively highlighted in the 20th century, first with the use of glandular extracts in patients with mental deficiency, and finally with the discovery of melatonin in 1958. The physiological properties of melatonin reawakened interest in the relationship between the pineal gland and mental disorders, fundamentally the affective and sleep disorders, which culminated in the development of new pharmacological agents acting through melatonergic receptors (ramelteon and agomelatine).

Una visión histórica de las drogas de abuso desde la perspectiva criminológica (Parte I) / An historical vision of drugs of abuse from the criminological perspective (Part I)

La relación entre el consumo de drogas (incluyendo el fenómeno de las drogodependencias) y la criminología es sumamente estrecha, aunque aún no se ha podido establecer un nexo causal definitivo entre ambas. En el presente trabajo se revisa la historia de las drogodependencias y del uso de drogas y de la normativa legal para combatir estos problemas, iniciada en EE.UU. (Pure Food and Drug Act, 1906) y que culminaría, a nivel internacional, con la Convención Única sobre Estupefacientes de Viena (1988). En la segunda parte de este trabajo se analizará el vínculo entre el uso/abuso de drogas y la delictogénesis (AU)

The relation between drug use (including drug addiction) and criminology is extremely narrow, although it has not yet been possible to establish a definitive causal nexus between both. In the present paper, we review the history of drug dependence and drug use and the legal norms to fight against these problems. It was initiated in the USA Pure Food and Drug Act (1906) and was culminated at an international level, with the Single Convention on Narcotic Drugs of Vienna (1988). In the second part of this paper, we will analyse the link between the drug use/abuse and the crime genesis (AU)

Cartesian theories on the passions, the pineal gland and the pathogenesis of affective disorders: an early forerunner.

The relationship between physical and functional alterations in the pineal gland, the 'passions' (emotions or feelings) and psychopathology has been a constant throughout the history of medicine. One of the most influential authors on this subject was René Descartes, who discussed it in his work The Treatise on the Passions of the Soul (1649). Descartes believed that 'passions' were sensitive movements that the soul, located in the pineal gland, experienced due to its union with the body, by circulating animal spirits. Descartes described sadness as one of the six primitive passions of the soul, which leads to melancholy if not remedied. Cartesian theories had a great deal of influence on the way that mental pathologies were considered throughout the entire 17th century and during much of the 18th century, but the link between the pineal gland and psychiatric disorders it was definitively highlighted in the 20th century, with the discovery of melatonin in 1958. The recent development of a new pharmacological agent acting through melatonergic receptors (agomelatine) has confirmed the close link between the pineal gland and affective disorders.

Zonisamide versus diazepam in the treatment of alcohol withdrawal syndrome.

INTRODUCTION: Anticonvulsant drugs have been used in the treatment of alcohol detoxification. The purpose of the present study was to evaluate the efficacy and safety of zonisamide in a sample of patients presenting alcohol withdrawal syndrome. METHOD: In this 3-week, randomized, flexible-dose trial, 40 inpatients with alcohol dependence disorder received zonisamide or diazepam for detoxification. Zonisamide was started at a dose of 400-600 mg/day (week 1), tapering to a minimum dose of 100-300 mg/day (week 3). Diazepam was administered using a similar regimen (from 130-50 mg/day tapering to 5-15 mg/day). Subjects were treated initially (weeks 1 and 2) in an inpatient unit and for the final week in an outpatient facility. During the inpatient period, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was used to assess the efficacy of each substance. During the outpatient period the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and a craving scale were used. RESULTS: All subjects completed the study. During the inpatient period both drugs reduced alcohol withdrawal symptoms, but the decrease was more marked in the zonisamide group. At the end of the study (week 3) participants treated with zonisamide showed lower CIWA-Ar scores than subjects receiving diazepam. Also, individuals in the zonisamide group had less craving for alcohol, less anxiety, and less daytime sedation compared with participants treated with diazepam. CONCLUSION: Zonisamide can be a valuable alternative to benzodiazepines in the prevention of alcohol withdrawal syndrome.

Hepatocyte growth factor and chronic hepatitis C.

OBJECTIVE: The hepatocyte growth factor (HGF) is a pleiotropic cytokine produced by hepatic stellate cells and implicated in liver regeneration and fibrosis. Serum levels of HGF vary in liver diseases, reflecting hepatic damage and hepatocellular dysfunction. In this study, serum levels of HGF and the relationship between HGF and biochemical, histological and virological data, have been analysed in patients suffering from chronic hepatitis C (CHC). PATIENTS AND METHODS: Serum HGF concentration was measured by ELISA in sandwich in 45 patients with CHC. Correlation between HGF levels and histological (necroinflammatory activity and fibrosis score) and biochemical (transaminases, prothrombin activity, albumin, bilirubin), or virological (hepatitis C virus load) parameters was analyzed. Serum HGF concentration was also studied in a subgroup of the original sample treated with interferon and ribavirin. RESULTS: Sserum HGF concentrations of patients with CHC were significantly higher than those detected in healthy controls. Patients with significant fibrosis (F > or = 2) had a significantly older age, lower count of platelets and higher values of AST, GGT and HGF, than those patients with a fibrosis score F < 2. HGF concentration was identified by multivariate analysis as the only independent factor associated with significant fibrosis. Moreover, area under receiver operating curve, using HCG levels, showed similar values to those of previously validated non-invasive indexes of fibrosis. However, levels of HGF did not show a significant decrease in patients with a sustained response to anti-virus C therapy. CONCLUSION: Serum HGF concentration correlates with fibrosis score in patients with CHC, but is insensitive to monitor changes induced by anti-virus C therapy.