Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review.

CONTEXT: Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce. OBJECTIVE: This systematic review aimed to compile the scientific evidence available for addressing the question "What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?" DATA SOURCES: The Pubmed, Web of Science, and Scopus databases were searched. DATA EXTRACTION: The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function. DATA ANALYSIS: A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers. CONCLUSION: Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5-6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, ß-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD480674.

Oncological and functional results after robot-assisted radical prostatectomy in high-risk prostate cancer patients.

BACKGROUND: Pentafecta is currently the standard in the comprehensive evaluation of patients undergoing radical prostatectomy, the objective of this study is the evaluation of oncological and functional outcomes in patients with prostate cancer of high risk undergoing robot-assisted radical prostatectomy. METHOD: Descriptive, retrospective study of 20 cases with a diagnosis of high-risk prostate cancer. The high-risk group is composed of a prostate-specific antigen equal or greater than 20 ng/mL, Gleason score equal or greater than 8, or clinical stages T2/T3 treated with robotic approach. RESULTS: Biochemical control was achieved from the first six weeks after the surgical event. 75% (n = 15) had negative surgical margins. 100% of the patients (n = 20) presented urinary continence immediately after removal of the urinary catheter. Erectile function was preserved at 3, 6 and 12 months in 100% of the patients who underwent neuropreservation but with use of an PDE inhibitor. (n = 5). Complications were reported in 10% (Clavien-Dindo I-II). CONCLUSIONS: Robot-assisted radical prostatectomy in patients with high-risk prostate cancer is considered an appropriate treatment option in selected patients. A different experimental design is needed to define the advantages or disadvantages of this approach, as well as to determine its role and application in clinical practice.

ANTECEDENTES: Pentafecta es el estándar en la evaluación integral de los pacientes sometidos a prostatectomía radical. El objetivo de este estudio es evaluar y describir los desenlaces oncológicos y funcionales en pacientes con cáncer de próstata de alto riesgo sometidos a prostatectomía radical asistida por robot. MÉTODO: Estudio descriptivo, retrospectivo, de 20 pacientes con diagnóstico de cáncer de próstata de alto riesgo. El grupo de alto riesgo se compone por pacientes con antígeno prostático específico mayo o igual a 20 ng/ml, reporte histopatológico con Gleason mayor o igual a 8 y/o estadios clínicos T2/T3 tratados con abordaje robótico. RESULTADOS: El control bioquímico se alcanzó a partir de las primeras 6 semanas posterior al evento quirúrgico. El 75% (n = 15) presentaron márgenes quirúrgicos negativos. El 100% de los pacientes (n = 20) presentaron continencia urinaria inmediatamente después del retiro de la sonda vesical. La función eréctil se conservó a 3, 6 y 12 meses en el 100% de los pacientes a los que se realizó neuropreservación, pero con uso de inhibidor de la fosfodiesterasa (n = 5). Se reportaron complicaciones en el 10% de los casos (Clavien-Dindo I-II). CONCLUSIONES: La prostatectomía radical asistida por robot en pacientes con cáncer de próstata de alto riesgo se considera una opción de tratamiento adecuada en casos seleccionados. Se necesita un diseño experimental distinto para definir las ventajas o desventajas de este abordaje, así como determinar su papel y aplicación en la práctica clínica.

Oncological Care During First Peruvian National Emergency COVID-19 Pandemic: A Multicentric Descriptive Study.

Purpose: The aim of this study is to evaluate the oncological care during the first state of national emergency due to the COVID-19 pandemic in several public cancer hospitals in Peru. Materials and Methods: A multicentric cross-sectional descriptive study was conducted by interviewing adult cancer patients diagnosed and treated between January 2019 and February 2020 from 18 hospitals. This study was carried out in September 2020, the last month of the first state of national emergency. Demographic and clinical characteristics were evaluated, including COVID-19 status and cancer treatment features. Results: A total of 1472 patients were included; the median age was 55 years (range 19-97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n = 198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected, and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was discontinued. In total, 10.3% (n = 117) of patients whose disease was controlled or in remission, experienced progression of disease during the state of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72) died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and 8.1% (n = 8) from undetermined causes. Patients with hematological malignancies [hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99-13.07)] and no response to therapy before the onset of the pandemic [5.01 (1.44-17.42)] had an increased risk of death among COVID-19 infected individuals, whereas advanced clinical stage [5.09 (2.37-10.95)] and discontinuation of treatment [3.66 (1.97-6.78)] were risk factors among non-COVID-19 patients. Conclusion: Our study suggests that the COVID-19 pandemic has an adverse impact on the outcomes of Peruvian cancer patients. In our cohort, cancer mortality was higher than COVID-19 disease mortality.

Experiencia de la plastia laparoscópica de uréter retrocavo en el Hospital General de México Dr. Eduardo Liceaga.

INTRODUCCIÓN: El uréter retrocavo es una anomalía congénita rara que requiere manejo quirúrgico. OBJETIVO: Reportar los resultados en el manejo laparoscópico para uréter retrocavo y hacer una revisión bibliográfica. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de uréter retrocavo que fueron sometidos a plastia laparoscópica de uréter retrocavo. RESULTADOS: Cuatro pacientes sometidos a plastia laparoscópica por diagnóstico de uréter retrocavo, 1 hombre y 3 mujeres, con una media de edad de 40.7 años. La media del tiempo operatorio fue de 138.2 minutos. La pérdida de sangre cuantificada transoperatoria media fue de 23.7 ml. Ningún paciente presentó complicaciones transoperatorias ni posoperatorias. Los pacientes permanecieron hospitalizados hasta su egreso una media de 2.5 días. Todos los pacientes presentaron mejoría de su sintomatología. CONCLUSIONES: El uréter retrocavo es una condición rara y aún no existe un consenso sobre su diagnóstico, tratamiento y seguimiento. El manejo quirúrgico laparoscópico es una opción para el tratamiento de estos pacientes. INTRODUCTION: The retrocave ureter is a rare congenital anomaly that requires surgical management. OBJECTIVE: Report the results in laparoscopic management for retrocave ureter and literature review. METHOD: Retrospective, descriptive, cross-sectional study in patients with a diagnosis of retrocave ureter who were sometimes a laparoscopic retrocave ureter. RESULTS: Four patients sometimes underwent laparoscopic plasty for diagnosis of retrocave ureter, 1 man and 3 women, with a mean age of 40.7 years. The mean operative time was 138.2 minutes. The mean intraoperative quantified blood loss was 23.7 ml. No patient presented transoperative or postoperative complications. The patients remained hospitalized until their progress with an average of 2.5 days. All patients visualize improvement in their symptoms. CONCLUSION: The retrocave ureter is a rare condition and there is still no consensus on its diagnosis, treatment and follow-up. Laparoscopic surgical management is an option for the treatment of these patients.

Adrenal cyst: our experience in its laparoscopic management.

ANTECEDENTES: Los quistes suprarrenales son una afección rara. Su diagnóstico y su tratamiento son un desafío debido a la escasa información, lo que genera incertidumbre respecto al mejor manejo. CASOS CLÍNICOS: Presentamos tres casos de quistes suprarrenales que recibieron tratamiento de mínima invasión con cirugía laparoscópica, sin presentar complicaciones y con una evolución favorable. DISCUSIÓN: Las nuevas técnicas quirúrgicas de mínima invasión ofrecen una oportunidad terapéutica que permite preservar estructuras y obtener material necesario para su diagnóstico histopatológico, así como la resolución de la sintomatología. BACKGROUND: Adrenal cysts are a rare entity; their diagnosis and treatment are challenging due to the lack of information, generating uncertainty regarding the best management. CASE REPORTS: We present three cases of adrenal cysts that received minimally invasive treatment with laparoscopic surgery, without complications and with a favorable evolution. DISCUSSION: The new minimally invasive surgical techniques offer a therapeutic opportunity that allows preserving structures and obtaining the necessary material for histopathological diagnosis, as well as a resolution of the symptoms.

Effects of a single dose of beetroot juice on cycling time trial performance at ventilatory thresholds intensity in male triathletes.

BACKGROUND: Beetroot juice (BJ) is classified as a high-level supplement for improving sports performance. There is some controversy over the benefits of BJ supplementation for endurance exercise performance, especially when referring to well-trained athletes. This study examines the effects of acute BJ supplementation on cardioventilatory responses, exercise economy/efficiency, slow component of oxygen uptake, time trial performance, blood lactate, energy consumption, and carbohydrate and fat oxidation. METHODS: Twelve well-trained, male triathletes (aged 21-47 yr) were assigned in a randomized, double-blind, crossover design to receive 70 ml of BJ (6.5 mmol NO3-) or placebo (PL). Three hours after taking the supplement, participants completed an endurance test on a cycle ergometer at a constant work rate (W) corresponding to first ventilatory threshold (VT1) (30 min) and second ventilatory threshold (VT2) time trial (~ 15 min). RESULTS: Maximal oxygen uptake was 54.78 ± 3.13 mL·min- 1·kg- 1, and gross efficiency was > 22% at each load intensity and experimental condition. No significant interaction effect (supplement*intensity) was observed on any of the cardioventilatory variables, efficiency/economy, VT2 time trial, energy expenditure, carbohydrate oxidation and fat oxidation (p > 0.05). CONCLUSION: Our findings do not support an improvement in the variables examined in response to acute BJ supplementation. Probably, higher doses are needed for improving time trial performance in male triathletes during a cycle ergometer test conducted at a load intensity equivalent to the first and second ventilatory threshold.

Effects of Beetroot Juice Supplementation on Performance and Fatigue in a 30-s All-Out Sprint Exercise: A Randomized, Double-Blind Cross-Over Study.

As a nitric oxide precursor, beetroot juice (BJ) is known to enhance high-intensity exercise performance (80⁻100% VO2max) yet its impacts on higher intensity sprint exercise (>100% VO2max) remain to be established. This study sought to examine the effects of BJ supplementation on performance and subsequent fatigue during an all-out sprint exercise. Using a randomized cross-over, double-blind, placebo-controlled design, 15 healthy resistance-trained men (22.4 ± 1.6 years) ingested 70 mL of either BJ or placebo. Three hours later, participants undertook a 30-s all-out Wingate test. Before and after the sprint exercise and at 30 s and 180 s post-exercise, three countermovement jumps (CMJ) were performed and blood lactate samples were obtained. Compared to placebo, BJ consumption improved peak (placebo vs. BJ, 848 ± 134 vs. 881 ± 135 W; p = 0.049) and mean (641 ± 91 vs. 666 ± 100 W; p = 0.023) power output and also reduced the time taken to reach Wpeak in the Wingate test (8.9 ± 1.4 vs. 7.3 ± 0.9 s; p = 0.003). No differences were detected in the fatigue index. In addition, while over time CMJ height and power diminished (ANOVA p < 0.001) and blood lactate levels increased (ANOVA p < 0.001), no supplementation effect was observed. Our findings indicate that while BJ supplementation improved performance at the 30-s cycling sprint, this improvement was not accompanied by differences in fatigue during or after this type of exercise.

Effects of beetroot juice supplementation on intermittent high-intensity exercise efforts.

Beetroot juice contains high levels of inorganic nitrate (NO3-) and its intake has proved effective at increasing blood nitric oxide (NO) concentrations. Given the effects of NO in promoting vasodilation and blood flow with beneficial impacts on muscle contraction, several studies have detected an ergogenic effect of beetroot juice supplementation on exercise efforts with high oxidative energy metabolism demands. However, only a scarce yet growing number of investigations have sought to assess the effects of this supplement on performance at high-intensity exercise. Here we review the few studies that have addressed this issue. The databases Dialnet, Elsevier, Medline, Pubmed and Web of Science were searched for articles in English, Portuguese and Spanish published from 2010 to March 31 to 2017 using the keywords: beet or beetroot or nitrate or nitrite and supplement or supplementation or nutrition or "sport nutrition" and exercise or sport or "physical activity" or effort or athlete. Nine articles fulfilling the inclusion criteria were identified. Results indicate that beetroot juice given as a single dose or over a few days may improve performance at intermittent, high-intensity efforts with short rest periods. The improvements observed were attributed to faster phosphocreatine resynthesis which could delay its depletion during repetitive exercise efforts. In addition, beetroot juice supplementation could improve muscle power output via a mechanism involving a faster muscle shortening velocity. The findings of some studies also suggested improved indicators of muscular fatigue, though the mechanism involved in this effect remains unclear.

Effects of Beetroot Juice Supplementation on a 30-s High-Intensity Inertial Cycle Ergometer Test.

Background: Beetroot juice (BJ) is rich in inorganic nitrates and has proved effective at increasing blood nitric oxide (NO) levels. When used as a supplement BJ has shown an ergogenic effect on cardiorespiratory resistance exercise modalities, yet few studies have examined its impact on high intensity efforts. Objective: To assess the effects of BJ intake on anaerobic performance in a Wingate test. Methods: Fifteen trained men (age 21.46 ± 1.72 years, height 1.78 ± 0.07 cm and weight 76.90 ± 8.67 kg) undertook a 30-s maximum intensity test on an inertial cycle ergometer after drinking 70 mL of BJ (5.6 mmol NO3-) or placebo. Results: Despite no impacts of BJ on the mean power recorded during the test, improvements were produced in peak power (6%) (p = 0.034), average power 0-15 s (6.7%) (p = 0.048) and final blood lactate levels (82.6%) (p < 0.001), and there was a trend towards a shorter time taken to attain peak power (-8.4%) (p = 0.055). Conclusions: Supplementation with BJ has an ergonomic effect on maximum power output and on average power during the first 15 s of a 30-s maximum intensity inertial cycle ergometer test.

Effects of Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes. A Systematic Review.

Athletes use nutritional supplementation to enhance the effects of training and achieve improvements in their athletic performance. Beetroot juice increases levels of nitric oxide (NO), which serves multiple functions related to increased blood flow, gas exchange, mitochondrial biogenesis and efficiency, and strengthening of muscle contraction. These biomarker improvements indicate that supplementation with beetroot juice could have ergogenic effects on cardiorespiratory endurance that would benefit athletic performance. The aim of this literature review was to determine the effects of beetroot juice supplementation and the combination of beetroot juice with other supplements on cardiorespiratory endurance in athletes. A keyword search of DialNet, MedLine, PubMed, Scopus and Web of Science databases covered publications from 2010 to 2016. After excluding reviews/meta-analyses, animal studies, inaccessible full-text, and studies that did not supplement with beetroot juice and adequately assess cardiorespiratory endurance, 23 articles were selected for analysis. The available results suggest that supplementation with beetroot juice can improve cardiorespiratory endurance in athletes by increasing efficiency, which improves performance at various distances, increases time to exhaustion at submaximal intensities, and may improve the cardiorespiratory performance at anaerobic threshold intensities and maximum oxygen uptake (VO2max). Although the literature shows contradictory data, the findings of other studies lead us to hypothesize that supplementing with beetroot juice could mitigate the ergolytic effects of hypoxia on cardiorespiratory endurance in athletes. It cannot be stated that the combination of beetroot juice with other supplements has a positive or negative effect on cardiorespiratory endurance, but it is possible that the effects of supplementation with beetroot juice can be undermined by interaction with other supplements such as caffeine.

Nutritional needs in the professional practice of swimming: a review.

PURPOSE: Swimming requires developing a high aerobic and anaerobic capacity for strength and technical efficiency. The purpose of this study was to establish the nutritional requirements and dietary strategies that can optimize swimming performance. METHODS: Several related studies retrieved from the databases, Dialnet, Elsevier, Medline, Pubmed, and Web of Science, through keyword search strategies were reviewed. RESULTS: The recommended carbohydrate intake ranges between 6-10-12 g/kg/d, protein 2 g/kg/d, and fat should surpass 20-25% of the daily intake. CONCLUSION: Performance can be optimized with a hydration plan, as well as adequate periodization of supplements, such as caffeine, creatine, sodium bicarbonate, B-alanine, beetroot juice, Vitamin D, bovine colostrum, and HMB.

Orgasmic dysfunction: prevalence and risk factors from a cohort of young females in Mexico.

INTRODUCTION: Orgasmic dysfunction (OD) is defined as the inability to achieve an orgasm, markedly diminished intensity of orgasmic sensations, or marked delay of orgasm during any kind of sexual stimulation. OD definition and method of diagnosis vary widely across studies. AIM: The aim of this study was to identify the prevalence and risk factors that predispose Mexican women to OD. METHODS: A representative sample of women from Mexico City was surveyed using an online website. Women between 18 to 40 years old were selected, and the orgasm domain from the Female Sexual Function Index was used to identify OD. A cutoff point was calculated using a construct with a histogram and calculated median. A univariate and multivariate analysis was conducted to examine the relationship between potential risk factors and sexual function. MAIN OUTCOME MEASURES: OD prevalence; significant risk factors on multivariate analysis. RESULTS: OD prevalence was 18.3%. Univariate analysis showed younger age (P = 0.01), lower degree of education (P = 0.02), single marital status (P = 0.038), and dissatisfaction with the thickness and/or size of partner's penis (P = 0.01) as significant variables related to OD. In multivariate analysis, younger age (P = 0.01) and dissatisfaction with the thickness/size of partner's penis (hazard ratio 3.04, P = 0.01) remained significant. CONCLUSION: OD is a prevalent alteration in young women. Marital status, education, and dissatisfaction with thickness/size of partner's penis are definitely related variables.

Aproximación histórica al descubrimiento del meprobamato y su introducción en psiquiatría: medio siglo de terapéutica ansiolítica / Historical approach to the discovery of meprobamate and its introduction in psychiatry: half-century of century of anxiety drug treatment

La introducción clínica del meprobamate en 1955 abrió una nueva puerta en el abordaje farmacológico de los trastornos de ansiedad. En el presente trabajo se describe el proceso de descubrimiento del meprobamato, beneficiado en parte del azar científico, y se analizan las dificultades en su introducción clínica, debido al gran peso de las teorías psicoanalíticas de la época. La historia del meprobamato parte de la terapéutica antimicrobiana empleada durante la Segunda Guerra Mundial, pasa por la obtención de una serie de análogos del fenoxietanol y culmina con la síntesis de la mefenesina, gracias al trabajo del farmacólogo checo Frank Berger. Finalmente, en mayo de 1950 se sintetizó el meprobamato, cuyas tres características farmacológicas principales fueron la relajación muscular, la acción anticonvulsionante y su acción de apaciguamiento. El meprobamato fue aprobado por le FDA en julio de 1955, siendo el primer fármaco comercializado específicamente como ansiolítico (Miltown). La introducción clínica de las benzodiazepinas al principio de la década de los 60, junto a las observaciones de tolerancia, abuso, sobredosis y dependencia acabaron por eclipsar el uso del meprobamato. Sin embargo, a este fármaco se deben notables aportaciones a la historia de la psiquiatría; la primera diferenciación farmacológica entre sedación y ansiolisis, el tratamiento rutinario de las “formas menores” (neurosis) de los trastornos mentales, una mejoría en la calidad metodológica de la investigación clínica, el planteamiento de una nueva nosología de las “neurosis”, y una importante contribución al desarrolloo, desde planteamientos neurobioquímicos, de nuevas teorías etiopatogénicas de los trastornos de ansiedad

The clinical introduction of meprobamate in 1955 opened a new door in the pharmacological treatment of anxiety disorders. This paper traces the discovery of meprobamate, a process that was partly due to scientific serendipity. The difficulties surrounding its introduction into the clinical field, owing to the clout of the period´s psychoanalytic theories, are also analysed. The history of meprobamate starts with the antimicrobial therapy used during the Second World War, touches on the obtaining of a series of phenoxyethanol analogues, and culminates with the mephenesin synthesis, thanks to the world of the Czech pharmacologist Frank Berger. Finally, in May 1950, meprobamate was synthesized. Its three main pharmacological features were muscle relaxation, anticonvulsion action, and tranquillizing effects. Meprobamate was approved by the FDA in July 1955 and was the first drug ever to be specifically marketed as an anxiolytic (Miltown). The clinical introduction of benzodiazepines in the early 1960s, along with related issues of tolerance, abuse, overdoses and dependence, had the effect of overshadowing meprobamate and dimishing its use. Neverthless, remarkable contributions to the history of psychiatry are attributable to this drug: the first pharmacological differentiation between sedation and anxiolysis; consolidation of routine treatment of the “minor forms” (neuroses) of mental disorders; improvement in the quality of scientific methodology in clinical research; the establishment of a new nosology of “neuroses”; and important advances in the development, from neurobiochemical perspectives, of the new etiopathogenic theories of anxiety disorders

History of the discovery and clinical introduction of chlorpromazine.

BACKGROUND: The historical process of discovery and clinical introduction of chlorpromazine, one of the greatest advances of 20th century medicine and history of psychiatry, is analyzed. METHODS: In this review, we have studied the original works of pioneers in the discovery and clinical use of chlorpromazine, as well as the contributions of prestigious researchers (historians, pharmacologists, psychiatrists, etc.) about this topic. RESULTS: The discovery of phenothiazines, the first family of antipsychotic agents has its origin in the development of German dye industry, at the end of the 19th century (Graebe, Liebermann, Bernthsen). Up to 1940 they were employed as antiseptics, antihelminthics and antimalarials (Ehrlich, Schulemann, Gilman). Finally, in the context of research on antihistaminic substances in France after World War II (Bovet, Halpern, Ducrot) the chlorpromazine was synthesized at Rhône-Poulenc Laboratories (Charpentier, Courvoisier, Koetschet) in December 1950. Its introduction in anaesthesiology, in the antishock area (lytic cocktails) and "artificial hibernation" techniques, is reviewed (Laborit), and its further psychiatric clinical introduction in 1952, with initial discrepancies between the Parisian Val-de-Grâce (Laborit, Hamon, Paraire) and Sainte-Anne (Delay, Deniker) hospital groups. The first North-American publications on chlorpromazine took place in 1954 (Lehmann, Winkelman, Bower). The introduction of chlorpromazine in the USA (SKF) was more difficult due to their strong psychoanalytic tradition. The consolidation of the neuroleptic therapy took place in 1955, thanks to a series of scientific events, which confirmed the antipsychotic efficacy of the chlorpromazine. CONCLUSIONS: The discovery of the antipsychotic properties of chlorpromazine in the 1950s was a fundamental event for the practice of psychiatry and for the genesis of the so-called "psychopharmacological revolution."

La contribución de la reserpina al desarrollo de la psiquiatría y su papel en la investigación neurobiológica / The reserpine contribution to the development of psychiatry and its role in the neurobiological research

La introducción en clínica como antipsicótico de reserpina, un alcaloide aislado de la planta Rauwolfia serpentina, en 1954, no solamente supuso un gran avance en el manejo terapéutico de los pacientes esquizofrénicos, sino que contribuyó de una forma muy importante a impulsar el desarrollo de las disciplinas neurocientíficas. En esta revisión histórica se analizan dos aspectos diferenciales de esta aportación; uno de carácter socio-sanitario y otro de tipo neurobiológico y farmacológico. El primero hace referencia a la contribución de la reserpina a la denominada "revolución de la psiquiatría", que tuvo lugar en la década de los 50 del pasado siglo XX, con la incorporación de numerosos agentes al arsenal psicofarmacológico, y cuya consecuencia más evidente fue el inicio del fenómeno de "desinstitucionalización" que sufrió la psiquiatría de la época. El segundo aspecto, mucho más perdurable, ha sido su papel como herramienta imprescindible para la investigación farmacológica y fisiológica del sistema nervioso. Desde la perspectiva histórica destaca, en este sentido, la descripción del "fenómeno reserpínico" (Valdecasas) y el desarrollo de varios modelos experimentales de actividad antidepresiva, fundamentados en el antagonismo de los efectos de la reserpina (hipotermia, ptosis, acatisia). Por último, se resalta el papel capital jugado por la reserpina en el origen de las primeras hipótesis etipatógénicas de las enfermedades mentales, sobre todo las teorías monoaminérgicas de la depresión (Brodie) y de la esquizofrenia (Carlsson), además de otras enfermedades neurológicas, como la enfermedad de Parkinson (AU)

Bibliometric analysis of biomedical publications on SSRI during 1980-2000.

We performed a bibliometric study of the scientific publications referring to selective serotonin reuptake inhibitors (SSRIs). The database used was EMBASE: Psychiatry. We applied the principal bibliometric indicators: Price's and Bradford's laws on the increase or dispersion of scientific literature, Lotka's law on the productivity of authors, the participation index (PaI) of countries, the productivity index (PI) of authors, and the collaboration index. By means of manual coding, documents were classified according to type of study and to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) or nonpsychiatric categories. We analysed 3,622 original documents published between 1980 and 2000. Our results show nonfulfilment of Price's law because production on SSRIs does not grow exponentially (r=0.937 vs. r = 0.946, after linear adjustment). The journal most employed is the Journal of Clinical Psychiatry (Bradford's first zone). The United States is the most productive country (PaI=41.50). The documents were distributed in four groups: experimental pharmacology (8.38%), tolerance and safety (34.94%), clinical efficacy (49.11%), and not specified (7.56%). The drug most studied was fluoxetine (1,745 articles), followed by paroxetine (659). The DSM-IV diagnostic categories most studied were depression (834), obsessive-compulsive disorder (171), and panic disorder (75). The control antidepressants most used in comparative clinical studies were amitriptyline (51) and imipramine (42). The results of the present study show that the SSRIs are not solely antidepressant drugs, but also have a wide range of uses both within the psychiatric sphere (especially in the field of anxiety) and outside it, which explains the considerable scientific production generated in relation to these drugs.

Aportación de la clorpromazina al desarrollo de la psiquiatría / Chlorpromazine contribution to psychiatry development

La introducción clínica de la clorpromazina, en el año 1952, constituye uno de los mayores avances de la medicina del siglo xx. En este trabajo se analizan, desde la perspectiva histórica, las consecuencias directas y diferidas de su introducción clínica, que afectaron a distintas áreas de la realidad sociosanitaria. Entre ellas hay que resaltar el progresivo fenómeno de 'desinstitucionalización' de la psiquiatría y la implicación de la Atención Primaria en materia de salud mental, hechos ambos que han mitigado el componente de estigmatización que acompañaba a la asistencia psiquiátrica, y el desarrollo de nuevos fármacos eficaces en el tratamiento de los trastornos psicóticos. Otras consecuencias de esta 'revolución de la psiquiatría' hay que situarlas en un plano más específicamente científico, como el postulado de las primeras hipótesis biológicas sobre la etiología de la esquizofrenia, la introducción de cambios en las conceptualizaciones nosológicas o el desarrollo de una moderna metodología en investigación clínica dentro del ámbito psiquiátrico (AU)

Bases neurobiológicas de la agresividad / The neurobiological basis of aggressivity

En la presente revisión se pretende abordar, desde una perspectiva neurobiológica, el conocimiento íntimo de la fisiopatología de la agresividad, en base a los datos aportados en las más recientes investigaciones neuroanatómicas y neuroquímicas, que han utilizado modelos animales de agresividad, herramientas farmacológicas que manipulan vías específicas de neurotransmisión, capaces de inducir o bloquear conductas agresivas, o estudios anatómicos basados en técnicas de neuroimagen no invasivas. La hipótesis más plausible sobre el fundamento neuroquímico de la agresividad propone una reducción del funcionalismo serotoninérgico, junto a una hiperactividad de los sistemas centrales de neurotransmisión noradrenérgico y dopaminérgico. Además, otros sistemas neuroquímicos, como el colinérgico, gabérgico, opioidérgico o glutamatérgico, podrían estar implicados en este tipo de conductas, al menos en modelos animales. Las disfunciones en los distintos sistemas de neurotransmisión implicados en la agresividad son explicados en base a diferentes parámetros de estudio; modificaciones en los niveles de neurotransmisor o sus metabolitos en cerebro o líquido cefalorraquídeo, fijación de radioligandos y densidad de receptores en cerebro, respuesta a agentes que exploran el funcionalismo de los distintos sistemas de neurotransmisión y evaluación indirecta del funcionalismo de los mismos mediante pruebas neuroendocrinas, así como la relación entre éstos a nivel intraneuronal. Por último, se comenta la participación del sistema endocrino y la relación entre genética y agresividad. (AU)