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1.
J Clin Microbiol ; 57(8)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31142608

RESUMO

Quality standards as part of an effective quality management system (QMS) are the cornerstone for generating high-quality test results. Next-generation sequencing (NGS) has the potential to improve both clinical diagnostics and public health surveillance efforts in multiple areas, including infectious diseases. However, the laboratories adopting NGS methods face significant challenges due to the complex and modular process design. This document summarizes the first phase of quality system guidance developed by the Centers for Disease Control and Prevention (CDC) NGS Quality Workgroup. The quality system essentials of personnel, equipment, and process management (quality control and validation) were prioritized based on a risk assessment using information gathered from participating CDC laboratories. Here, we present a prioritized QMS framework, including procedures and documentation tools, to assist laboratory implementation and maintenance of quality practices for NGS workflows.

2.
Opt Lett ; 43(5): 1115-1118, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29489807

RESUMO

Planar laser-induced fluorescence (PLIF) of hydroxyl (OH) and formaldehyde (CH2O) radicals was performed alongside stereo particle image velocimetry (PIV) at a 20 kHz repetition rate in a highly turbulent Bunsen flame. A dual-pulse burst-mode laser generated envelopes of 532 nm pulse pairs for PIV as well as a pair of 355 nm pulses, the first of which was used for CH2O PLIF. A diode-pumped solid-state Nd:YAG/dye laser system produced the excitation beam for the OH PLIF. The combined diagnostics produced simultaneous, temporally resolved two-dimensional fields of OH and CH2O and two-dimensional, three-component velocity fields, facilitating the observation of the interaction of fluid dynamics with flame fronts and preheat layers. The high-fidelity data acquired surpass the previous state of the art and demonstrate dual-pulse burst-mode laser technology with the ability to provide pulse pairs at both 532 and 355 nm with sufficient energy for scattering and fluorescence measurement at 20 kHz.

3.
Appl Opt ; 56(21): 6029-6034, 2017 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-29047927

RESUMO

A fiber-coupled, hyperspectral imaging sensor (HSIS) ranging from ultraviolet (UV) to short-wavelength-infrared (SWIR) wavelengths is developed for remote detection of planar [two-dimensional (2D)], spectrally resolved flame emission. The key component of the sensor is a dimension-reduction 2D-to-1D (one-dimensional) fiber-optic array that contains 1024 fibers and features high-UV optical transmission (>30% transmission at 310-340 nm, >90% at 340-2000 nm), wide operational wavelengths (300-2400 nm), and a compact and robust design (full length <5 cm). The flame-emission signals are transmitted to the remote HSIS through a 3-m-long, UV-grade, imaging fiber bundle that consists of 30,000 single-mode fibers. The design of the 2D-to-1D fiber array, the fiber-characterization process, and the sensor development are discussed in detail. 2D spectrally resolved measurements of CH*, OH*, and C2* distribution are made in premixed laminar flames. Improved chemiluminescence-based fuel/air ratio measurements using spectrally resolved detection are demonstrated. The results of the current study indicate that implementation of fiber-coupled HSIS is feasible in practical gas-turbine-engine test facilities with limited optical access.

4.
Opt Lett ; 42(18): 3678-3681, 2017 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-28914931

RESUMO

Two-dimensional (2D) Raman scattering at 10 kHz in non-reacting flow mixtures is demonstrated by employing a burst-mode laser with a long-duration pulse of about 70 ns and pulse energy of about 750 mJ at 532 nm. To avoid optical breakdown, the pulse width of the laser was varied in the range of 10-1000 ns. The effects of pulse shape, pulse energy, and harmonic conversion on 2D measurements are also studied. The applications of high-speed, single-shot, 2D imaging of CH4 and H2 jets in N2 at elevated pressures are demonstrated. In addition, the scalar dissipation rate of CH4 in N2 at 20 bar is determined, and multi-dimensional, multi-species, high-speed imaging of flows at elevated pressures is demonstrated.

5.
Influenza Other Respir Viruses ; 11(3): 289-297, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28207986

RESUMO

BACKGROUND: Detections of influenza A subtype-specific antibody responses are often complicated by the presence of cross-reactive antibodies. We developed two novel multiplex platforms for antibody detection. The multiplexed magnetic fluorescence microsphere immunoassay (MAGPIX) is a high-throughput laboratory-based assay. Chembio Dual Path Platform (DPP) is a portable and rapid test that could be used in the field. METHODS: Twelve recombinant globular head domain hemagglutinin (GH HA1) antigens from A(H1N1)pdm09 (pH1N1), A(H2N2), A(H3N2), A(H5N1), A(H7N9), A(H9N2), A(H13N9), B/Victoria lineage, B/Yamagata lineage viruses, and protein A control were used. Human sera from U.S. residents either vaccinated (with H5N1 or pH1N1) or infected with pH1N1 influenza viruses and sera from live bird market workers in Bangladesh (BDPW) were evaluated. GH HA1 antigens and serum adsorption using full ectodomain recombinant hemagglutinins from A(pH1N1) and A(H3N2) were introduced into the platforms to reduce cross-reactivity. RESULTS: Serum adsorption reduced cross-reactivity to novel subtype HAs. Compared to traditional hemagglutination inhibition or microneutralization assays, when serum adsorption and the highest fold rise in signals were used to determine positivity, the correct subtype-specific responses were identified in 86%-100% of U.S. residents exposed to influenza antigens through vaccination or infection (N=49). For detection of H5N1-specific antibodies in sera collected from BDPW, H5 sensitivity was 100% (six of six) for MAGPIX, 83% (five of six) for DPP, H5 specificity was 100% (15/15), and cross-reactivity against other subtype was 0% (zero of six) for both platforms. CONCLUSION: MAGPIX and DPP platforms can be utilized for high-throughput and in-field detection of novel influenza virus infections.


Assuntos
Anticorpos Antivirais/sangue , Glicoproteínas de Hemaglutininação de Vírus da Influenza/imunologia , Ensaios de Triagem em Larga Escala/métodos , Imunoensaio/métodos , Vírus da Influenza A/imunologia , Influenza Humana/sangue , Animais , Anticorpos Antivirais/imunologia , Bangladesh , Doenças das Aves/sangue , Doenças das Aves/virologia , Aves , Reações Cruzadas , Humanos , Vírus da Influenza A/classificação , Vírus da Influenza A/isolamento & purificação , Influenza Humana/virologia , Especificidade da Espécie
6.
Opt Lett ; 42(1): 53-56, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28059176

RESUMO

See-through-wall coherent microwave scattering from resonance-enhanced multiphoton ionization (REMPI) for rotational temperature measurements of molecular oxygen has been developed and demonstrated in a flow reactor at atmospheric pressure. Through limited, single-ended optical access, a laser beam was focused to generate local ionization of molecular oxygen in a heated quartz flow reactor enclosed by ceramic heating elements. Coherent microwaves were transmitted, and the subsequent scattering off the laser-induced plasma was received, through the optically opaque ceramic heater walls and used to acquire rotational spectra of molecular oxygen and to determine temperature. Both axial and radial air-temperature profiles were obtained in the flow reactor with an accuracy of ±20 K⁢(±5%). The experimental results show good agreement with a steady-state computational heat transfer model. This technique shows great potential for non-invasive, high-fidelity measurement of spatially localized temperature and radical species concentration in combustion kinetic experiments and confined combustors constructed of advanced ceramic materials in which limited or non-existing optical access hinders usage of conventional optical diagnostic techniques to quantify thermal non-uniformity.

7.
J Virol Methods ; 243: 61-67, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28108183

RESUMO

Influenza hemagglutination inhibition (HI) and virus microneutralization assays (MN) are widely used for seroprevalence studies. However, these assays have limited field portability and are difficult to fully automate for high throughput laboratory testing. To address these issues, three multiplex influenza subtype-specific antibody detection assays were developed using recombinant hemagglutinin antigens in combination with Chembio, Luminex®, and ForteBio® platforms. Assay sensitivity, specificity, and subtype cross-reactivity were evaluated using a panel of well characterized human sera. Compared to the traditional HI, assay sensitivity ranged from 87% to 92% and assay specificity in sera collected from unexposed persons ranged from 65% to 100% across the platforms. High assay specificity (86-100%) for A(H5N1) rHA was achieved for sera from exposed or unexposed to hetorosubtype influenza HAs. In contrast, assay specificity for A(H1N1)pdm09 rHA using sera collected from A/Vietnam/1204/2004 (H5N1) vaccinees in 2008 was low (22-30%) in all platforms. Although cross-reactivity against rHA subtype proteins was observed in each assay platform, the correct subtype specific responses were identified 78%-94% of the time when paired samples were available for analysis. These results show that high throughput and portable multiplex assays that incorporate rHA can be used to identify influenza subtype specific infections.


Assuntos
Anticorpos Antivirais/sangue , Glicoproteínas de Hemaglutininação de Vírus da Influenza/imunologia , Ensaios de Triagem em Larga Escala/métodos , Influenza Humana/epidemiologia , Influenza Humana/virologia , Testes Sorológicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
8.
Opt Express ; 24(22): 24971-24979, 2016 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-27828437

RESUMO

Two-dimensional gas-phase coherent anti-Stokes Raman scattering (2D-CARS) thermometry is demonstrated at 1 kHz in a heated jet. A hybrid femtosecond/picosecond CARS configuration is used in a two-beam phase-matching arrangement with a 100-femtosecond pump/Stokes pulse and a 107-picosecond probe pulse. The femtosecond pulse is generated using a mode-locked oscillator and regenerative amplifier that is synchronized to a separate picosecond oscillator and burst-mode amplifier. The CARS signal is spectrally dispersed in a custom imaging spectrometer and detected using a high-speed camera with image intensifier. 1-kHz, single-shot planar measurements at room temperature exhibit error of 2.6% and shot-to-shot variations of 2.6%. The spatial variation in measured temperature is 9.4%. 2D-CARS temperature measurements are demonstrated in a heated O2 jet to capture the spatiotemporal evolution of the temperature field.

9.
Proc Natl Acad Sci U S A ; 112(10): 3050-5, 2015 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-25713354

RESUMO

CD8 T cells are a potent tool for eliminating intracellular pathogens and tumor cells. Thus, eliciting robust CD8 T-cell immunity is the basis for many vaccines under development. However, the relationship between antigen load and the magnitude of the CD8 T-cell response is not well-described in a human immune response. Here we address this issue by quantifying viral load and the CD8 T-cell response in a cohort of 80 individuals immunized with the live attenuated yellow fever vaccine (YFV-17D) by sampling peripheral blood at days 0, 1, 2, 3, 5, 7, 9, 11, 14, 30, and 90. When the virus load was below a threshold (peak virus load < 225 genomes per mL, or integrated virus load < 400 genome days per mL), the magnitude of the CD8 T-cell response correlated strongly with the virus load (R(2) ∼ 0.63). As the virus load increased above this threshold, the magnitude of the CD8 T-cell responses saturated. Recent advances in CD8 T-cell-based vaccines have focused on replication-incompetent or single-cycle vectors. However, these approaches deliver relatively limited amounts of antigen after immunization. Our results highlight the requirement that T-cell-based vaccines should deliver sufficient antigen during the initial period of the immune response to elicit a large number of CD8 T cells that may be needed for protection.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Carga Viral , Vacina contra Febre Amarela/imunologia , Estudos de Coortes , Perfilação da Expressão Gênica , Humanos , Vírus da Febre Amarela/genética , Vírus da Febre Amarela/imunologia , Vírus da Febre Amarela/isolamento & purificação
10.
Artigo em Inglês | MEDLINE | ID: mdl-27990325

RESUMO

Novel data streams (NDS), such as web search data or social media updates, hold promise for enhancing the capabilities of public health surveillance. In this paper, we outline a conceptual framework for integrating NDS into current public health surveillance. Our approach focuses on two key questions: What are the opportunities for using NDS and what are the minimal tests of validity and utility that must be applied when using NDS? Identifying these opportunities will necessitate the involvement of public health authorities and an appreciation of the diversity of objectives and scales across agencies at different levels (local, state, national, international). We present the case that clearly articulating surveillance objectives and systematically evaluating NDS and comparing the performance of NDS to existing surveillance data and alternative NDS data is critical and has not sufficiently been addressed in many applications of NDS currently in the literature.

11.
J Psychosom Res ; 78(3): 199-204, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25258356

RESUMO

OBJECTIVE: The aim of this study is to describe the clinical phenotype of alcohol use disorder (AUD) treatment-seeking patients with Roux-en-Y Gastric Bypass Surgery (RYGB) history; and to compare it to AUD obese non-RYGB controls. METHODS: Retrospective study of electronic medical records for all patients 30-60years treated at the Mayo Clinic Addiction Treatment Program, between June, 2004 and July, 2012. Comparisons were performed with consumption patterns pre-RYGB and at time of treatment; excluding patients with AUD treatments pre-RYGB. RESULTS: Forty-one out of 823 patients had a RYGB history (4.9%); 122 controls were selected. Compared to controls, the RYGB group had significantly more females [n=29 (70.7%) vs. n=35 (28.7%) p<0.0001]; and met AUD criteria at a significantly earlier age (19.1±0.4 vs. 25.0±1years old, p=0.002). On average, RYGB patients reported resuming alcohol consumption 1.4±0.2years post-surgery, meeting criteria for AUD at 3.1±0.5years and seeking treatment at 5.4±0.3years postoperatively. Pre-surgical drinks per day were significantly fewer compared to post-surgical consumption [2.5±0.4 vs. 8.1±1.3, p=0.009]. Prior to admission, RYGB patients reported fewer drinking days per week vs. controls (4.7±0.3 vs. 5.5±1.8days, p=0.02). Neither RYGB, gender, age nor BMI was associated with differential drinking patterns. CONCLUSION: The results of this study suggest that some patients develop progressive AUD several years following RYGB. This observation has important clinical implications, calling for AUD-preventive measures following RYGB. Further large-scale longitudinal studies are needed to clarify the association between RYGB and AUD onset.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/complicações , Derivação Gástrica , Obesidade/psicologia , Obesidade/cirurgia , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/diagnóstico , Progressão da Doença , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Período Pós-Operatório , Estudos Retrospectivos
12.
Opt Lett ; 39(22): 6462-5, 2014 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-25490494

RESUMO

A high-speed, master-oscillator power-amplifier burst-mode laser with ∼100 ps pulse duration is demonstrated with output energy up to 110 J per burst at 1064 nm and second-harmonic conversion efficiency up to 67% in a KD*P crystal. The output energy is distributed across 100 to 10,000 sequential laser pulses, with 10 kHz to 1 MHz repetition rate, respectively, over 10 ms burst duration. The performance of the 100 ps burst-mode laser is evaluated and been found to compare favorably with that of a similar design that employs a conventional ∼8 ns pulse duration. The nearly transform-limited spectral bandwidth of 0.15 cm(-1) at 532 nm is ideal for a wide range of linear and nonlinear spectroscopic techniques, and the 100 picosecond pulse duration is optimal for fiber-coupled spectroscopic measurements in harsh reacting-flow environments.

13.
Opt Lett ; 39(23): 6608-11, 2014 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-25490633

RESUMO

A method for simultaneous ro-vibrational and pure-rotational hybrid femtosecond/picosecond coherent anti-Stokes Raman scattering (fs/ps CARS) is presented for multi-species detection and improved temperature sensitivity from room temperature to flame conditions. N2/CH4 vibrational and N2/O2/H2 rotational Raman coherences are excited simultaneously using fs pump pulses at 660 and 798 nm, respectively, and a common fs Stokes pulse at 798 nm. A fourth narrowband 798 nm ps pulse probes all coherence states at a time delay that minimizes nonresonant background and the effects of collisions. The transition strength is concentration dependent, while the distribution among observed transitions is related to temperature through the Boltzmann distribution. The broadband excitation pulses and multiplexed signal are demonstrated for accurate thermometry from 298 to 2400 K and concentration measurements of four key combustion species.

14.
Curr Mol Pharmacol ; 7(1): 52-66, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25324047

RESUMO

Treatment of chemical dependence ("addiction") requires an understanding of its effects on the brain. To guide research in the area of chemical dependence, several foundational theories have been developed. These include the incentive salience, receptor down-regulation, opponent process, and psychomotor stimulant theories. These have been important both in summarizing and in guiding investigations. However, the extant theories do not provide a single unified framework nor have they yielded all of the guidance necessary for effective chemical dependence treatment. The present paper summarizes and then integrates these theories and suggests some implications for the treatment followed by this integration.


Assuntos
Modelos Teóricos , Transtornos Relacionados ao Uso de Substâncias/patologia , Animais , Encéfalo/anatomia & histologia , Encéfalo/metabolismo , Dopamina/metabolismo , Humanos , Modelos Animais , Motivação , Receptores Dopaminérgicos/metabolismo , Transtornos Relacionados ao Uso de Substâncias/metabolismo
15.
J Virol Methods ; 209: 121-5, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25239367

RESUMO

The relative performance of ELISA using globular head domain (GH) and ectodomain hemagglutinins (HAs) as antigens to detect influenza A virus IgG antibody responses was assessed. Assay sensitivity and subtype cross-reactivity were evaluated using sera collected from recipients of monovalent H5N1 vaccine and A(H1N1)pdm09 virus-infected persons. Assay specificity was determined using collections of sera from either individuals unexposed to either H5N1 or A(H1N1)pdm09 viruses or exposed to H5N1 or A(H1N1)pdm09 viruses through vaccination or infection, respectively. ELISA using GH HA showed a similar degree of sensitivity, significantly higher specificity, and significantly lower subtype cross-reactivity compared to ELISA using ectodomain HA.


Assuntos
Anticorpos Antivirais/sangue , Testes Diagnósticos de Rotina/métodos , Glicoproteínas de Hemaglutininação de Vírus da Influenza , Vírus da Influenza A/imunologia , Influenza Humana/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Cabeça , Hemaglutininas , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
16.
Opt Lett ; 39(16): 4735-8, 2014 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-25121861

RESUMO

The burst duration of an all-diode-pumped burst-mode laser is extended to 100 ms and 100 kHz (10,000 pulses) by utilizing dual-wavelength diode pumping. Total energies of 225 J at 10 kHz and 400 J at 100 kHz are achieved during the 100 ms burst period at 1064 nm. This represents an order-of-magnitude increase in the number of pulses compared with prior work, while maintaining similar or higher pulse energies. Amplitude tailoring of each pulse is used to flatten the burst profile, reducing the standard deviation in pulse energy over the 100 ms burst from 3.7% to 2.1% with a burst-to-burst standard deviation of 0.8%.

17.
Opt Lett ; 39(4): 739-42, 2014 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-24562194

RESUMO

High-repetition-rate, burst-mode lasers can achieve higher energies per pulse compared with continuously pulsed systems, but the relatively few number of laser pulses in each burst has limited the temporal dynamic range of measurements in unsteady flames. A fivefold increase in the range of timescales that can be resolved by burst-mode laser-based imaging systems is reported in this work by extending a hybrid diode- and flashlamp-pumped Nd:YAG-based amplifier system to nearly 1000 pulses at 100 kHz during a 10 ms burst. This enables an unprecedented burst-mode temporal dynamic range to capture turbulent fluctuations from 0.1 to 50 kHz in flames of practical interest. High pulse intensity enables efficient conversion to the ultraviolet for planar laser-induced fluorescence imaging of nascent formaldehyde and other potential flame radicals.

18.
J Chem Phys ; 140(2): 024316, 2014 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-24437886

RESUMO

The hybrid femtosecond∕picosecond coherent anti-Stokes Raman scattering (fs∕ps CARS) technique presents a promising alternative to either fs time-resolved or ps frequency-resolved CARS in both gas-phase thermometry and condensed-phase excited-state dynamics applications. A theoretical description of time-dependent CARS is used to examine this recently developed probe technique, and quantitative comparisons of the full time-frequency evolution show excellent accuracy in predicting the experimental vibrational CARS spectra obtained for two model systems. The interrelated time- and frequency-domain spectral signatures of gas-phase species produced by hybrid fs∕ps CARS are explored with a focus on gas-phase N2 vibrational CARS, which is commonly used as a thermometric diagnostic of combusting flows. In particular, we discuss the merits of the simple top-hat spectral filter typically used to generate the ps-duration hybrid fs∕ps CARS probe pulse, including strong discrimination against non-resonant background that often contaminates CARS signal. It is further demonstrated, via comparison with vibrational CARS results on a time-evolving solvated organic chromophore, that this top-hat probe-pulse configuration can provide improved spectral resolution, although the degree of improvement depends on the dephasing timescales of the observed molecular modes and the duration and timing of the narrowband final pulse. Additionally, we discuss the virtues of a frequency-domain Lorentzian probe-pulse lineshape and its potential for improving the hybrid fs∕ps CARS technique as a diagnostic in high-pressure gas-phase thermometry applications.

19.
Artigo em Inglês | MEDLINE | ID: mdl-25621280

RESUMO

With major advances in experimental techniques to track antigen-specific immune responses many basic questions on the kinetics of virus-specific immunity in humans remain unanswered. To gain insights into kinetics of T and B cell responses in human volunteers we combined mathematical models and experimental data from recent studies employing vaccines against yellow fever and smallpox. Yellow fever virus-specific CD8 T cell population expanded slowly with the average doubling time of 2 days peaking 2.5 weeks post immunization. Interestingly, we found that the peak of the yellow fever-specific CD8 T cell response was determined by the rate of T cell proliferation and not by the precursor frequency of antigen-specific cells as has been suggested in several studies in mice. We also found that while the frequency of virus-specific T cells increased slowly, the slow increase could still accurately explain clearance of yellow fever virus in the blood. Our additional mathematical model described well the kinetics of virus-specific antibody-secreting cell and antibody response to vaccinia virus in vaccinated individuals suggesting that most of antibodies in 3 months post immunization were derived from the population of circulating antibody-secreting cells. Taken together, our analysis provided novel insights into mechanisms by which live vaccines induce immunity to viral infections and highlighted challenges of applying methods of mathematical modeling to the current, state-of-the-art yet limited immunological data.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Varíola/imunologia , Vacinas Virais/administração & dosagem , Febre Amarela/imunologia , Adulto , Animais , Anticorpos Antivirais/química , Anticorpos Antivirais/imunologia , Linfócitos T CD8-Positivos/química , Feminino , Humanos , Imunidade , Cinética , Masculino , Camundongos , Modelos Teóricos , Varíola/virologia , Vacinação , Vacinas Virais/imunologia , Febre Amarela/virologia , Adulto Jovem
20.
Rev. neuropsiquiatr ; 76(4): 224-230, oct.-dic. 2013. tab, graf
Artigo em Inglês | PERNAL | ID: pnc-16350

RESUMO

The use of atypical antipsychotics as an adjunctive therapy to antidepressants for treating non-psychotic major depressive disorder (MDD) has been a common practice long before large-scale randomized double-blind placebo-controlled clinical trials demonstrated their efficacy. In this study, we aimed to study the frequency with which patients with non-psychotic major depression were prescribed antipsychotics (AP) and to examine the effect of age, race, and ethnicity on the type and dose of individual antipsychotics prescribed, in a cohort of patients before the recent Food and Drug Administration (FDA) approval of adjunctive aripiprazole. The charts of 1537 patients with unipolar depression were analyzed. 1376 had non-psychotic depression; among them 466 (33.9%) patients were prescribed antipsychotics with a significant predilection towards males (males vs. females: 41.7% vs. 27.8%. z=2.4, p<.02; odds ratio=1.97 with a standard error of 0.57) of Hispanic origin (X2 = 35.8, df = 1, p < 0.0001). Quetiapine was the most commonly prescribed antipsychotic (n=209, 44.8%) with a mean (±SEM) 195.1±13.1 mg. Our results confirm previous reports of the common clinical practice of the use of atypical antipsychotics, specifically quetiapine, as adjunctive treatment for non-psychotic patients with unipolar depression. Further research is required to study the long term effect of this class of medications in patients without a primary psychotic disorder. (AU)


El uso de antipsicóticos atípicos como terapia adjunta a antidepresivos en el tratamiento del trastorno depresivo mayor (TDM) no psicótico fue práctica común por un largo periodo antes de que los ensayos clínicos a doble-ciego, controlados (con placebo) y al azar, llevados a cabo a gran escala, demostraran su eficacia. El presente estudio se propuso evaluar la frecuencia con la cual pacientes diagnosticados con TDM recibieron tratamiento con agentes antipsicóticos (AP) y examinar los efectos de edad, raza y etnicidad sobre el tipo y dosis de los anti-psicóticos prescritos a una cohorte de pacientes antes de la reciente aprobación de aripiprazole por la Administración de Alimentos y Drogas (FDA), como medicación adjunta para el manejo de esta entidad clínica. Se analizaron las historias clínicas de 1537 pacientes portadores del diagnóstico de depresión unipolar. 1376 presentaron depresión no psicótica y de ellos, 466 (33,9%) recibieron antipsicóticos con predominio de pacientes varones (hombres vs. mujeres: 41,7% vs. 27,8%. z=2,4, p<0,02; odds ratio (OR)=1,97, con error estándar (SE) de 0,57) de origen Hispánico (X2 = 35,8, df = 1, p < 0,0001). Quetiapina fue el antipsicótico más comúnmente prescrito (n=209, 44,8%) con una dosis promedio (±SEM) de 195,1±13,1 mg. Nuestros resultados confirman reportes previos del uso de antipsicóticos (específicamente quetiapina) en la práctica clínica habitual, como tratamiento adjunto en pacientes no psicóticos con diagnóstico de depresión unipolar. Se requiere investigación adicional que indague los efectos a largo plazo de este tipo de medicación en pacientes sin un diagnóstico de trastorno psicótico primario. (AU)


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/terapia , Antipsicóticos/uso terapêutico , Estudos Retrospectivos
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