Historia de la terapia electroconvulsiva: ¿cuándo empezó a utilizarse anestesia para este procedimiento? / History of electroconvulsive therapy: when did anesthesia begin to be used for this procedure?

Resumen: La terapia electroconvulsiva consiste en la aplicación de corriente eléctrica a través de electrodos colocados en regiones frontotemporales (bilateral) o unilateral, con el objetivo de inducir una crisis convulsiva, controlada y monitorizada, que se realiza bajo anestesia general con la presencia de un equipo multidisciplinario. En este trabajo, se hace una reseña de la historia de la aplicación de anestésicos y relajantes musculares que se han utilizado para este tratamiento y de cómo el anestesiólogo se ha posicionado como un elemento fundamental para la aplicación del mismo.

Abstract: Electroconvulsive therapy consists of the application of electric current, through electrodes placed in frontotemporal regions (bilateral) or unilateral, with the aim of inducing a seizure, controlled and monitored, and performed under general anesthesia, with the presence of a multidisciplinary team. This paper reviews the history of the application of anesthetics and muscle relaxants, which have been used for this treatment and how the anesthesiologist has positioned himself as a fundamental element for its application.

Selective Moonlighting Cell-Penetrating Peptides.

Cell penetrating peptides (CPPs) are molecules capable of passing through biological membranes. This capacity has been used to deliver impermeable molecules into cells, such as drugs and DNA probes, among others. However, the internalization of these peptides lacks specificity: CPPs internalize indistinctly on different cell types. Two major approaches have been described to address this problem: (i) targeting, in which a receptor-recognizing sequence is added to a CPP, and (ii) activation, where a non-active form of the CPP is activated once it interacts with cell target components. These strategies result in multifunctional peptides (i.e., penetrate and target recognition) that increase the CPP's length, the cost of synthesis and the likelihood to be degraded or become antigenic. In this work we describe the use of machine-learning methods to design short selective CPP; the reduction in size is accomplished by embedding two or more activities within a single CPP domain, hence we referred to these as moonlighting CPPs. We provide experimental evidence that these designed moonlighting peptides penetrate selectively in targeted cells and discuss areas of opportunity to improve in the design of these peptides.

Role of autophagy in the chemopreventive effect of the IFC-305 compound in the sequential model of cirrhosis-hepatocellular carcinoma in the rat and in vitro.

Hepatocellular carcinoma (HCC) can be originated from various etiologies and is preceded mostly by cirrhosis. Unfortunately, there is no effective treatment due to its late prognosis. Alterations in autophagy have been reported during the development and progression of HCC. Autophagy allows for the maintenance of a positive energy balance and the proper functioning of organelles through the selective degradation of cellular components. It has been demonstrated that autophagy suppresses spontaneous tumorigenesis in the liver. Therefore, autophagy has become a therapeutic target for effective HCC therapies. We have previously demonstrated that the adenosine-derived compound, IFC-305, has a chemopreventive effect on HCC, in addition to maintaining mitochondrial function in a sequential model of cirrhosis-HCC. Thus, the aim of this work was to determine if IFC-305 has an effect on autophagy in the sequential model of cirrhosis-HCC induced by diethylnitrosamine or in vitro in the HCC cell line HepG2 and mouse embryonic fibroblasts. The results of this work showed that IFC-305 modifies the levels of the BECN1, p62/SQSTM1 and LC3-II proteins that play an important role in the autophagic process. In vivo, IFC-305 regulates the levels of the PINK1 and PARKIN proteins that specifically mark mitochondria for repair or degradation. In the HepG2 cell line, its effect was accompanied by a decrease in cell viability. Interestingly, in nontumoral cells the time to autophagy induction was different compared to the HepG2 cells. This study suggests that autophagy induction may be part of the mechanism by which IFC-305 maintains mitochondrial function, thereby facilitating the prevention and reversal of HCC.

Smoking transitions in a sample of Hispanic daily light and intermittent smokers.

Few studies have documented the differences between daily light (DLS; ≤10 cigarettes per day) and intermittent (ITS; nondaily) smokers. The primary aim of this study was to assess the potential transitions (i.e., increased/stayed at same level) between baseline and a 3month follow-up of Hispanic DLS and ITS who were randomly assigned to a control group of a brief cessation intervention. Additionally, potential nicotine addiction differences between groups of smokers (e.g., ITS who became DLS vs. those who did not change) were assessed. Participants were 190 Hispanic DLS/ITS (who represent a subsample from a larger dataset, n=370) with complete data (53.7% female; Mage=38.6years, SD=15.1; range=18-74years) randomized to the control arm of a brief cessation intervention. Participants completed sociodemographics, tobacco use history, and the Fagerström Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker and Fagerström, 1991). The majority of participants remained DLS (41.1%) or ITS (21.6%). ANCOVA findings indicated significant group differences regarding FTND scores (F [5114]=6.93, p<0.001). Those who remained DLS had significantly higher FTND scores than those who remained ITS and those who converted from ITS to DLS. Within these DLS/ITS who were randomized to a control group, smoking transitions primarily remained stable over time, particularly among DLS (who demonstrated higher nicotine dependence), suggesting the need for low level cessation interventions to continue and include a focus on dependence symptoms.

Plasmaféresis en el tratamiento del síndrome hemolítico-urémico típico / Plasmapheresis in the treatment of typical haemolytic-uraemic syndrome

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Streptomycin action to the mammalian inner ear vestibular organs: comparison between pigmented guinea pigs and rats.

Streptomycin is the antibiotic of choice to treat tuberculosis and other infectious diseases but it causes vestibular malfunction and hipoacusia. Rodents are usually employed as models of drug action to the inner ear and results are extrapolated to what happens in humans. In rats, streptomycin destroys macular sensory cells and does not affect cochlear ones, whereas in guinea pigs the contrary is true. Action on the vestibular cristae cells involved in vestibulo-ocular reflex integrity is less clear. Thus, we compared this response in both pigmented guinea pigs (Cavia cobaya) and rats (Rattus norvegicus) after parallel streptomycin chronic treatment. In guinea pigs, the reflex was obliterated along treatment time; in rats this behavior was not observed, suggesting that the end organ target was diverse. In recent studies, streptidine, a streptomycin derivative found in the blood of humans and rats treated with streptomycin, was the actual ototoxic agent. The putative streptomycin vestibular organ target observed in humans corresponds with the guinea pig observations. Results observed in rats are controversial: streptidine did not cause any damage either to vestibular cristae nor auditory cells. We hypothesize differential drug metabolism and distribution and conclude that results in laboratory animals may not always be applicable in the human situation.

Estrogens cross-talk to alpha1b-adrenergic receptors.

beta-Estradiol induced alpha1b-adrenergic receptor desensitization in U373 MG cells stably expressing alpha1b-adrenoceptors, as evidenced by a reduction in the adrenergic-mediated Ca2+ mobilization; desensitization was associated with receptor phosphorylation and internalization. These effects of beta-estradiol were rapid (taking place during 15 min) and were blocked by the estrogen receptor antagonist ICI 182,780 (faslodex). Likewise, inhibitors of phosphoinositide 3-kinase [wortmannin and 2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one (LY294002)] and of protein kinase C [staurosporine, 3-[1-[3-(amidinothio)propyl-1H-indol-3-yl]-3-(1-methyl-1H-indol-3-yl) maleimide (Ro31-8220), and rottlerin] blocked the desensitization and phosphorylation of alpha1b-adrenoceptors induced by estradiol. The formation of a complex was suggested by coimmunoprecipitation assays. The regulatory and catalytic subunits of phosphoinositide 3-kinase (p85 and p110) and protein kinase C delta were associated with alpha1b-adrenoceptors in the absence of stimulus, and such association further increased in a dynamic fashion in response to beta-estradiol. In cells cotransfected with the estrogen receptor alpha and alpha1b-adrenoceptors, beta-estradiol induced phosphorylation, desensitization and internalization of the adrenergic receptors; pretreatment with ICI 182,780 inhibited these effects. Our data support the idea that estrogens modulate alpha1b-adrenergic action through estrogen receptor alpha.

Third-party informed consent in research with adolescents: the good, the bad and the ugly.

Third-party informed consent for child and adolescent participation in research is a legal requirement that has been questioned by authors who argue that children over 10 are fully able to make decisions regarding this matter. The extent to which this requirement encumbers survey researches in this age range has not been fully reported. In order to understand the reasons for the inconsistent use of condoms among adolescent students in Rio de Janeiro, we designed a survey based on an anonymous self-reported questionnaire. Two informed consent terms were distributed: one for the adolescent and one for the legal representative signature. Participation was offered to all students aged 12-18 attending class at the day of the consent term distribution. Among 906 distributed legal represents consent terms, 734 (81%) were not returned. The final sample probably presented a bias of selection. Researchers must foresee third-party consent as a major encumbrance. There is a need for the definition of a range of interventions in which the adolescent might have the legal recognition of autonomy for decision about his/her voluntary participation.

Histamine potentiates IP(3)-mediated Ca(2+) release via thapsigargin-sensitive Ca(2+) pumps.

We have studied the histamine-induced potentiation of inositol 1,4,5-trisphosphate (IP(3))-mediated Ca(2+) release in HeLa cells. Intracellular IP(3) levels were increased by IP(3) dialysis with the whole-cell configuration of the patch-clamp technique (cell dialysis of IP(3)). Low concentrations of extracellular histamine (1 microM) accelerated the rate of IP(3)-mediated Ca(2+) release, an effect that required the coincidence of both histamine signalling and the increase in IP(3) levels. Our data suggest that the potentiation effect of histamine cannot be explained simply by agonist-induced increase in IP(3) levels. Disordering microfilaments with cytochalasin D and microtubules with colchicine caused a decrease in the histamine-induced Ca(2+) response. Furthermore, both cytochalasin D and colchicine diminished the rate of IP(3)-mediated Ca(2+) release, while only the former reduced slightly the histamine-induced potentiation effect. Remarkably, rapid inhibition of SERCA pumps with thapsigargin to avoid the depletion of internal Ca(2+) stores diminished the histamine-induced potentiation of IP(3)-mediated Ca(2+) release, without affecting the rate of IP(3)-mediated Ca(2+) release. These data indicate that histamine-induced potentiation of Ca(2+) release in HeLa cells requires active SERCA pumps and suggest that SERCA pumps are an important factor in determining the efficiency of agonist-induced Ca(2+) release.

Susceptibilidad in vitro de candida albicans a itraconazol y fluconazol: estudio comparativo por tres métodos / Susceptibility in vitro of candida albicans to itraconazole and fluconazole: comparative study by three methods

La frecuencia de las infecciones fúngicas se ha ido incrementando desde las últimas décadas debido a diferentes factores, tales como: la inmunodeficiencia por el VIH, el uso y abuso de antibióticos de amplio espectro, el incremento de infecciones fúngicas nocosomiales entre los pacientes con cáncer, cirugía, pacientes quemados y finalmente la prolongada vida de los pacientes con falla en el sistema inmune. El tratamiento para la candidiasis ha sido insatisfactorio debido al limitado número de drogas antifúngicas. El fluconazol e itraconazol son las mejores drogas azólicas usadas para el tratamiento de candidiasis. El fluconazol es un triazol, usado ampliamente para el tratamiento de micosis superficial (onicomicosis) y sistémicas. La aparición de cepas de candida albicans resistentes a las drogas antifúngicas hace necesario evaluar la susceptibilidad a las drogas antifúngicas más comúnmente usadas en nuestro medio: fluconazol e itraconazol. El objetivo del trabajo fue evaluar la susceptibilidad in vitro de cepas de candida albicans aisladas de muestras biológicas a itraconazol y fluconazol. Se emplearon tres metodologías diferentes: E-TEST, difusión por disco y la concentración mínima inhibitoria (CMI) en medio líquido, siguiendo las recomendaciones de la NCCLS

Candida albicans: susceptibilidad in vitro al fluconazol por el método del disco / Candida albicans: susceptibility in vitro to fluconazole for the disk method

La rapidez y precisión del diagnóstico de las infecciones causadas por levaduras, determina el éxito de la conducta terapéutica requerida en cada caso en particular. El objetivo del trabajo, fue determinar la influencia de la concentración de fluconazol en los ensayos de susceptibilidad ®in vitro¼ para candida albicans, utilizando el método del disco. Se prepararon discos de papel de filtro, de 6 mm de diámetro, impregnados con fluconazol en concentraciones de 50 y 25 ug/ml y se determinó la susceptibilidad a este antifúngico en 30 cepas de C. albicans aislados de muestras clínicas, utilizando agar Casitone y siguiendo la metodología del Instituto Pasteur de París. Se determinó que la concentración de 50 ug/ml es la adecuada para determinar la susceptibilidad de C. albicans al fluconazol, lo cual se correlaciona con el método de referencia Etest (AB Biodisc Suecia). El análisis estadístico mediante la prueba de ANOVA confirma que el método del disco es preciso y reproductible, lo cual permite recomendarlo como alternativa frente a otras metodologías

Micosis profundas sistémicas: casuística del Departamento de Micología del Instituto Nacional de Higiene durante 17 años (1980-1996) / Sistemic mycosis: analysis of the mycotic systemics diseases of the Departament of Mycology of the National Higiene Institute during 17 years (1980-1996)

Durante 17 años (1980-1996) en el Departamento de Micología, del Instituto Nacional de Higiene "Rafael Rangel" se procesaron 5.776 muestras clínicas para el diagnóstico de micosis profundas sistémicas (histoplasmosis paracoccidioidomicosis, coccidioidomicosis, aspergilosis y criptococosis) por medio de pruebas serológicas, aglutinación de latex y aislamiento del agente etiológico, según el caso: 352 muestras (6,1 por ciento) resultaron positivas. La revisión de la casuística de enfermedades micóticas sistémicas es de gran relevancia para el infectólogo, ya que su conocimiento le permite incrementar el diagnóstico y orientar mejor el tratamiento de los pacientes

Insuficiencia mitral post-valvuloplastía mitral con catéter balón: incidencia, factores predictores y pronóstico / Mitral regurgitation following ballon-catheter mitral valvuloplasty

Un total de 205 pacientes con diagnóstico de estenosis mitral reumática, fueron sometidos a VMTP de octubre de 1990 a octubre de 1993: 178 mujeres y 27 hombres, con edades de 16 a 72 años, media de 38. La incidencia global de insuficiencia mitral fue de 10 por ciento antes de VMPT y de 37 por ciento post-VMPT (p<0.05): fue considerada grado I en 45 pacientes (22 por ciento), grado II en 24 pacientes (12 por ciento), grado III en 4 pacientes (2 por ciento) y grado IV en 3 pacientes (1.5 por ciento), con p de 0.003, 0.002, N.S. y N.S. respectivamente. De los 205 pacientes, 83 (40 por ciento) permanecieron sin cambios en la aparición y/o progresión de la I.M., en 55 pacientes (26.8 por ciento) apareció I.M. de novo (p0.004), en 47 pacientes (23 por ciento) la I.M. aumentó un grado (p0.002) y en 20 pacientes (9.7 por ciento) la I.M. aumentó 2 o más grados (p0.007). De las 138 comisurotomías realizadas con catéter de Inoue, la incidencia de I.M. fue de 56 pacientes (40.5 por ciento), mientras que de las 67 realizadas con doble balón fue de 11 pacientes (16.4 por ciento) p0.03. En cuanto a la severidad de la I.M. con técnica de Inoue y doble balón fue: grado I en 27 por ciento vs 9 por ciento (p0.001), grado II 9.4 por ciento vs 6 por ciento (p o.05), grado III 2.1 por ciento vs 1.5 por ciento (N.S.), y grado IV 2.1 por ciento vs 0 por ciento (N.S.). Sólo la presencia de calcio en las comisuras, y una puntuación ecocardiográfica mayor de 8 puntos, fueron encontradas como variables independientes predictoras de I.M. severa. La insuficiencia mitral leve y moderada, es frecuente en los pacientes sometidos VMTP, siendo mayor cuando es realizada con catéter de Inoue con relevancia estadística. En su forma severa, la insuficiencia mitral post-VMTP es poco frecuente, y también se aprecia más comúnmente si es realizada con catéter de Inoue, aunque sin alcanzar significancia estadística