Taquicardia paroxística supraventricular en lactantes. A propósito de un caso / No disponible

La taquicardia paroxística supraventricular (TPSV) es la arritmia más frecuente en Pediatríay constituye una urgencia médica. Se presenta en un 0,1-0,4% de la población pediátrica,la mayoría de ocasiones como hallazgo casual o palpitaciones, siendo bien toleraday en ocasiones de resolución espontánea.No obstante, suele requerir ingreso hospitalario preferentemente en una unidad de cuidadosintensivos (UCI), ya que puede desencadenar arritmias malignas, insuficiencia cardiacay miocardiopatía dilatada, sobre todo en lactantes. La evolución a muerte oscila del 1%en pacientes con cardiopatía al 0,25% en los pacientes sin cardiopatía asociada.El tratamiento basado en la realización de maniobras vagales y la administración deadenosina suele ser efectivo aunque recientemente ha venido constatándose la escasa eficaciade las dosis bajas de ATP (50-100 μg/kg), imperando una revisión de los protocolosactuales.En ocasiones, la primera asistencia es prestada en centros de Atención Primaria, inclusocentros rurales con accesibilidad limitada a un centro hospitalario. A nuestro entenderes básico que el médico de Atención Primaria conozca el manejo de esta patología ytambién que Enfermería sea adecuadamente entrenada, sobre todo en la obtención devías venosas periféricas con el fin de prestar una adecuada asistencia al enfermo, más aúnsi no es posible organizar el traslado medicalizado del paciente en un lapso de tiempo razonable.Es nuestra intención llamar la atención sobre dicha patología y con ayuda de un casoclínico centrar los aspectos básicos de su diagnóstico y manejo terapéutico, especialmenteen lactantes pequeños(AU)

Paroxistical supraventricular tachycardia is the most frequent arrhythmia in Pediatrics and itis a medical emergency. It happens in 0.1-0.4% of the pediatric population, mostly as an accidentalfinding or palpitations, it is well tolerated and sometimes with a spontaneous resolution.Nevertheless, it frequently requires admission preferably in an intensive care unit(UCI), since it can be followed by malignant arrhythmias, cardiac insufficiency and dilatedmyocardiopathy, especially in infants. The evolution to death goes from 1% in patientswith cardiopathy to 0,25% in patients without cardiopathy.The treatment based on vagal stimulation manoeuvres and Adenosine (ATP) is usuallysuccessful, although recently has been communicated the low effectiveness of low doses ofATP (50-100 Ìg/kg), making necessary a review of current protocols.Occasionally, the first assistance is given at primary care centres, even at rural medicalcentres. So we think that it is basic that primary care doctors knew about this pathology andalso that nurses must be trained in periferical venous access, especially if the patient cannotbe moved to a reference centre in a brief time.We wish to draw the attention to this condition and with the help of a clinical case toshow the basics of its diagnosis and treatment, especially in infants(AU)

Efficacy and safety of lesopitron in outpatients with generalized anxiety disorder.

OBJECTIVE: To compare the relative efficacy and safety of lesopitron 4-80 mg/d versus lorazepam 2-4 mg/d and placebo in a subgroup of patients with anxiety history taken from a larger study of patients with a primary diagnosis of generalized anxiety disorder (GAD). DESIGN: Six-week, randomized, double-blind, parallel, placebo and lorazepam-controlled, Phase II, single-center, outpatient study. SETTING: Outpatient clinic. PATIENTS: One hundred sixty-one patients with GAD were randomized in the main study; 68 with a documented history of GAD or anxiety disorder not otherwise specified were included in the subgroup. METHODS: After a one-week placebo lead-in, patients were randomized to receive placebo, lesopitron, or lorazepam twice daily for six weeks, followed by a one-week taper period. Efficacy was assessed using the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impressions scale. Safety was assessed through physical examinations, monitoring of vital signs, 12-lead electrocardiograms, laboratory analyses, and adverse event monitoring. RESULTS: An overall mean improvement in the HAM-A total score between baseline and end point for all three treatment groups was seen, with mean changes of 3.4 (95% CI 2.0 to 4.8), 6.1 (95% CI 4.1 to 8.1), and 6.1 (95% CI 4.6 to 7.6) for the placebo, lesopitron, and lorazepam groups, respectively (omnibus p = 0.044, uncorrected). Positive treatment effects were also observed in the subgroup population on several other measures and suggest that additional therapeutic trials may be warranted. Future trials could be stratified on the basis of referral status (symptomatic volunteer vs. clinical patient with preexisting illness) or previous exposure to anxiolytics, and use a fixed-dose rather than flexible-fixed-dose design. CONCLUSIONS: The subgroup analysis represents a comparison of treatment outcome in GAD patients presenting with a history of previous episodes of GAD or anxiety disorder not otherwise specified compared with those who were experiencing their first episode of GAD and reported no anxiety history. Although the overall study analysis was equivocal, for the approximately 40% of patients with recurrent anxiety disorder, beneficial effects for both lesopitron and lorazepam are suggested.

Establishing the maximum tolerated dose of lesopitron in patients with generalized anxiety disorder: a bridging study.

Lesopitron, a 5-hydroxytryptamine 1A agonist, is a new potential anxiolytic of the azapirone class. It has greater potency in animal models of anxiety than buspirone, gepirone, or ipsapirone, and it lacks the antidopaminergic effects associated with buspirone. Lesopitron has been tolerated at single doses up to 50 mg and repeated dosages of 45 mg/day in healthy volunteers. Forty-two patients with generalized anxiety disorder (GAD) were enrolled in this double-blind bridging study to determine the safety and tolerability of fixed doses of lesopitron (20, 25, 30, 40, 45, 50, and 60 mg two times a day) over a 6 1/2-day inpatient administration period. Each of the seven panels included six patients (four drug/two placebo). One patient in the 25-mg, two-times-a-day panel voluntarily withdrew because of increased anxiety symptoms. One patient experienced severe orthostatic hypotension at 60 mg two times a day, and moderate to severe adverse events (dizziness, lightheadedness, nausea, headache) occurred in two other patients at this dosage. The most commonly reported adverse events in all the panels were headache, dizziness, and nausea. Lesopitron is rapidly absorbed in patients, having a time to maximum concentration (Tmax) ranging from 0.5 to 1 hour, and its elimination half-life ranged from 1.1 to 5.6 hours. Peak plasma concentrations showed high interindividual variability for lesopitron, but increased linearly with dose for the main metabolite, 5-hydroxylesopitron. We defined the maximum tolerated dose in GAD patients as 50 mg two times a day, twice as high as the highest dose tested in healthy volunteers.