Real-world effectiveness and tolerability of Zelesse cream® for treating vulvovaginitis in adult women: an observational, prospective study.

OBJECTIVE: To assess the efficacy, acceptability, and tolerability of a vaginal cream based on plant extracts for treating signs and symptoms of vulvovaginitis (VV) (Zelesse cream®), either as monotherapy (non-infectious VV) or adjuvant to antimicrobial therapy (infectious VV). METHODS: This prospective, observational, multicenter study included women who attended outpatient offices for VV. The severity of signs (vaginal discharge, erythema, and edema) and symptoms (pruritus, burning, and dysuria) was assessed before and after 15±5 days of daily treatment with Zelesse cream on a 4-point scale (18-point global score). RESULTS: The study included 58 women aged 43.0±13.2 years, including 42 who were treated with Zelesse cream only and 16 who used Zelesse cream as adjuvant to antimicrobial therapy. All participants showed significantly reduced scores and absolute prevalence of individual signs and symptoms in both groups. Similarly, the median signs/symptoms decreased by 4.0 and 8.0 points in women using Zelesse only and those using Zelesse plus antimicrobial therapy, respectively. This product was well tolerated and had high acceptability. CONCLUSIONS: Zelesse cream relieves signs and symptoms of VV, either as monotherapy in non-infectious VV or as adjuvant to antimicrobial therapy in infectious VV. Future randomized, placebo-controlled trials with larger sample sizes are warranted.

"Yo soy tres". A propósito de un caso de trastorno de identidad disociativo / "I am three". A case of dissociative identity disorder

Objetivo. Actualización del trastorno de identidad disociativo a través de la presentación de un caso y la revisión teórica del concepto. Caso clínico. Varón de 17 años internado en Unidad de Agudos por intento autolítico que a lo largo del ingreso manifiesta la coexistencia de tres identidades subjetivas de manera alterna, junto a episodios de alteración de la memoria e inestabilidad emocional. Resultados. Tanto las entrevistas clínicas como la evolución del caso confirman la existencia de un trastorno de identidad disociativo con una base traumática en relación con acontecimientos altamente estresantes en la primera infancia y un establecimiento patológico del apego con los cuidadores principales. Conclusiones. El trastorno de identidad disociativo es una psicopatología compleja caracterizada por alteraciones en la memoria e identidad. Resulta interesante considerar la prevalencia de patología de tipo disociativo en unidades de hospitalización de adolescentes, en su gran mayoría vinculadas a experiencias traumáticas tempranas

Objective. To present an update on dissociative identity disorder through the presentation of a case and a theoretical review of the concept. Clinical case. A 17-year-old male admitted to the Acute Unit due to a suicide attempt, that during his admission manifested the coexistence of three subjective identities alternately, together with episodes of memory alteration and emotional instability. Results. Both the clinical interviews and the evolution of the case confirm the existence of a Dissociative Identity Disorder with a traumatic basis in relation to highly stressful events in early childhood and a pathological establishment of attachment with the main caregivers. Conclusions. Dissociative identity disorder is a complex psychopathology characterised by alterations in memory and identity. It is of interest to consider the prevalence of dissociative pathology in adolescent hospitalisation units, most of them linked to early traumatic experiences

Spanish Validation of the MacArthur Competence Assessment Tool for Clinical Research Interview for Assessing Patients' Mental Capacity to Consent to Clinical Research.

The aim of the study was to assess a Spanish adaptation of a method that determines the categorical capacity status of potential participants in research projects. The sample consisted of 120 subjects (40 general medicine inpatients, 40 psychiatric inpatients, and 40 healthy controls). The MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) interview and Mini-Mental State Examination (MMSE) were used. A feasibility study was carried out and reliability and validity calculations were made against the expert-judgment gold standard. The mean duration of the MacCAT-CR was 13 min. For the MacCAT-CR understanding, appreciation, reasoning, and expressing a choice subscales, the intraclass coefficient correlation (interrater reliability) was .93, .88, .90, and .50, respectively, and internal consistency (Cronbach's alpha) was .96, .94, and .95, respectively. Patients considered to be incompetent for expert-judgment obtained lower scores in the MacCAT-CR interview. The Spanish version of the MacCAT-CR is feasible, reliable, and valid for assessing the capacity of patients to give consent in research.

[Sociodemographic Traits and Comorbidities in Pathological Gamblers With a Suicide Attempt in Spain]. / Características sociodemográficas y comorbilidad de sujetos con juego patológico e intento de suicidio en España.

OBJECTIVE: Suicide is the first cause of non-natural death in Spain. Among addictive disorders, pathological gambling is one the most significant independent risk factors for suicidal behavior. The objective of this study is to describe and compare the sociodemographic traits, comorbidity and attempt characteristics, between suicide attempters who fulfill diagnostic criteria for pathological gambling and those who do not. METHODS: A total of 345 patients admitted to the emergency department of a University Hospital in Madrid between 1999 and 2004 were interviewed for this study. To describe and compare the demographic characteristics, comorbidity and those related to attempted suicide, using logistic regression models adjusted for sex and age were used. RESULTS: Suicide attempters who fulfilled diagnostic criteria for pathological gambling were predominantly male, with a low education level, and had more offspring. Furthermore, these patients had more comorbidities, such as: global substance dependence, nicotine, cocaine and opioid dependence. CONCLUSIONS: The present study suggests that pathological gamblers represent a distinct subgroup among suicide attempters, with particular characteristics, similar to those found in pathological gamblers in the general population.

Características sociodemográficas y comorbilidad de sujetos con juego patológico e intento de suicidio en España / Sociodemographic Traits and Comorbidities in Pathological Gamblers With a Suicide Attempt in Spain

Objetivo: El suicidio se sitúa en España como la primera causa de muerte no natural, y el juego patológico es uno de sus principales factores de riesgo de los trastornos adictivos. El estudio realizado tiene como objetivo describir y comparar las características sociodemográficas, la comorbilidad y las características del intento en pacientes con intentos de suicidio que cumplen criterios de juego patológico frente a pacientes con intento de suicidio sin criterios de juego patológico. Métodos: Para los distintos análisis se empleó una muestra de 345 pacientes con intento de suicidio recogida a partir de las admisiones en el servicio de Urgencias de un Hospital Universitario de la Comunidad Autónoma de Madrid durante el periodo comprendido entre 1999 y 2004. Para describir y comparar las características sociodemográficas, de comorbilidad y las relacionadas con el intento de suicidio, se utilizaron modelos de regresión logística ajustados por sexo y edad. Resultados: Los resultados muestran que los pacientes con intento de suicidio que cumplen criterios de juego patológico son predominantemente varones, con bajo nivel de estudios y con mayor tendencia a tener descendencia. Además presentan mayor prevalencia en determinadas comorbilidades: dependencia global de sustancias, dependencia de nicotina, dependencia de cocaína y dependencia de opiáceos. Conclusiones: En este estudio se muestra cierta evidencia sobre la existencia de un subtipo de suicida (jugador patológico suicida) con ciertas características propias, similares a las encontradas en muestras de jugadores patológicos.

Objective: Suicide is the first cause of non-natural death in Spain. Among addictive disorders, pathological gambling is one the most significant independent risk factors for suicidal behavior. The objective of this study is to describe and compare the sociodemographic traits, comorbidity and attempt characteristics, between suicide attempters who fulfill diagnostic criteria for pathological gambling and those who do not. Methods: A total of 345 patients admitted to the emergency department of a University Hospital in Madrid between 1999 and 2004 were interviewed for this study. To describe and compare the demographic characteristics, comorbidity and those related to attempted suicide, using logistic regression models adjusted for sex and age were used. Results: Suicide attempters who fulfilled diagnostic criteria for pathological gambling were predominantly male, with a low education level, and had more offspring. Furthermore, these patients had more comorbidities, such as: global substance dependence, nicotine, cocaine and opioid dependence. Conclusions: The present study suggests that pathological gamblers represent a distinct subgroup among suicide attempters, with particular characteristics, similar to those found in pathological gamblers in the general population.

Differences between early-onset pathological gambling and later-onset pathological gambling: data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

AIMS: To examine differences between early-onset versus later-onset pathological gamblers in socio-demographic characteristics, rates of Axis I and II disorders, preferred type of gambling and rates of treatment-seeking in a large nationally representative survey of adults in the United States. DESIGN: Data were collected from face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV). SETTING AND MEASUREMENT: The study drew on data from the United States' National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). PARTICIPANTS: All individuals with a DSM-IV diagnosis of pathological gambling (PG). To be consistent with prior studies, age of onset of PG was dichotomized as 25 years and younger (early-onset) versus 26 years and older (later-onset). FINDINGS: Individuals with early-onset PG were more likely than individuals with later-onset PG to be male [odds ratio (OR) = 2.86; 95% confidence interval (CI) = 1.20, 6.82], never married (OR = 3.51; 95% CI = 1.39, 8.84), to have income below US$70 000 (OR = 0.09; 95% CI = 0.01, 0.61), to belong to younger cohorts (OR = 0.93; 95% CI = 0.89, 0.97) and to have a cluster B personality disorder (OR = 4.11; 95% CI = 1.77, 9.55), but less likely to have a mood disorder (OR = 0.42; 95% CI = 0.19, 0.94). There were no differences between individuals with early- and later-onset PG regarding rates of treatment-seeking (OR = 0.71; 95% CI = 0.20, 2.43) or preferred type of gambling (OR = 2.00; 95% CI = 0.55, 7.3). All results remained significant after adjusting for age, sex and race, except the difference in the prevalence for mood disorders, which was no longer significant. CONCLUSIONS: Individuals with early-onset versus later-onset pathological gambling differ in several socio-demographic and clinical characteristics, but not in their preferred types of game. Individuals from more recent cohorts appear to be at significantly increased risk for developing early-onset pathological gambling.

Contrasting spatial patterns in active-fire and fire-suppressed Mediterranean climate old-growth mixed conifer forests.

In Mediterranean environments in western North America, historic fire regimes in frequent-fire conifer forests are highly variable both temporally and spatially. This complexity influenced forest structure and spatial patterns, but some of this diversity has been lost due to anthropogenic disruption of ecosystem processes, including fire. Information from reference forest sites can help management efforts to restore forests conditions that may be more resilient to future changes in disturbance regimes and climate. In this study, we characterize tree spatial patterns using four-ha stem maps from four old-growth, Jeffrey pine-mixed conifer forests, two with active-fire regimes in northwestern Mexico and two that experienced fire exclusion in the southern Sierra Nevada. Most of the trees were in patches, averaging six to 11 trees per patch at 0.007 to 0.014 ha(-1), and occupied 27-46% of the study areas. Average canopy gap sizes (0.04 ha) covering 11-20% of the area were not significantly different among sites. The putative main effects of fire exclusion were higher densities of single trees in smaller size classes, larger proportion of trees (≥ 56%) in large patches (≥ 10 trees), and decreases in spatial complexity. While a homogenization of forest structure has been a typical result from fire exclusion, some similarities in patch, single tree, and gap attributes were maintained at these sites. These within-stand descriptions provide spatially relevant benchmarks from which to manage for structural heterogeneity in frequent-fire forest types.

Maintenance of attention and pathological gambling.

In the study of addiction, attentional bias refers to the observation that substance-related cues tend to capture the attention of experienced substance users. Attentional bias is a cognitive intermediate in the conditioned association between drug-related cues, craving, and relapse. Numerous studies have documented the existence of attentional bias for cues associated with substances. By contrast, few studies have investigated attentional bias in individuals with pathological gambling (PG) or problematic gambling. In this study, we sought to assess attentional bias at the level of maintenance of attention in a sample of pathological gamblers. Twenty-three pathological gamblers and 21 healthy volunteers performed the Visual Probe Task to compare attentional bias with gambling-related cues between individuals with PG and healthy volunteers. The measured of attentional bias was based on their reaction times (RTs) to probes replacing neutral and gambling-related cues (images). Second, we examined the correlation between PG severity and degree of attentional bias among individuals with PG. Results show that pathological gamblers, but not healthy volunteers, had attentional bias for gambling-related cues with exposure times that assess maintenance of attention. There was no correlation between PG severity and degree of attentional bias. Theoretical and clinical implications of these results are discussed.

Monitorización de niveles plasma de antipsicóticos atípicos / Atypical antipsychotics plasma level monitoring

Introducción: El estudio de la concentración de psicofármaco en sangre o en suero permite individualizar el perfil farmacocinético del sujeto tratado. Esto se conoce como monitorización de fármacos. Actualmente se pueden analizar antidepresivos, antipsicóticos, estabilizadores del ánimo, fármacos sustitutivos de los opioides, ansiolíticos e hipnóticos. Objetivos: Revisar el estado actual del conocimiento sobre monitorización de antipsicóticos, de utilidad tanto para evaluar la adherencia terapéutica como para conocer la concentración del fármaco en plasma. Metodología: Se revisaron los trabajos publicados sobre monitorización de antipsicóticos desde 1975 hasta 2010. Como fuente de información se empleó:Embase, Medline y Pubmed. Conclusiones: La monitorización de antipsicóticos, así como de otros psicofármacos, es una práctica establecida que debe conocerse y ser objeto de actualización por parte del psiquiatra interesado en un ejercicio terapéutico basado en datos objetivos(AU)

Introduction: Analysis of psychotropic drug concentration in blood or serum is a mean to ascertain the pharmacokinetic profile of the treated subject. This is known as drug monitoring. Currently plasma antidepressants, antipsychotics, mood stabilizers, drugs substitutes for opioids, anxiolytics and hypnotics can be monitorized. Methodology: We reviewed all published articles on monitoring of psychotropic drugs in general from 1975 to 2010. As a source of information used: Embase, Medline and Pubmed. Objetive: To review the current state of science in relation to the monitoring of atypical antipsychotics. Antipsychotic plasma level monitoring is crucial both to assess adherence and to determine the plasma drug concentration. Conclusions: The monitoring of antipsychotics and other psychotropic drugs, is an established practice must be known and be maintained by a psychiatrist, like other aspects of psychopharmacology, for a therapeutic exercise based on the current state of science(AU)

An evaluation of leaf biomass : length ratio as a tool for nondestructive assessment in eelgrass (Zostera marina L.).

The characterization of biomass and its dynamics provides valuable information for the assessment of natural and transplanted eelgrass populations. The need for simple, nondestructive assessments has led to the use of the leaf biomass-to-length ratio for converting leaf-length measurements, which can be easily obtained, to leaf growth rates through the plastochrone method. Using data on leaf biomass and length collected in three natural eelgrass populations and a mesocosm, we evaluated the suitability of a leaf weight-to-length ratio for nondestructive assessments. For the data sets considered, the isometric scaling that sustains the weight-to-length proxy always produced inconsistent fittings, and for leaf-lengths greater than a threshold value, the conversion of leaf length to biomass generated biased estimations. In contrast, an allometric scaling of leaf biomass and length was highly consistent in all the cases considered. And these nondestructive assessments generated reliable levels of reproducibility in leaf biomass for all the ranges of variability in leaf lengths. We argue that the use of allometric scaling for the representation of leaf biomass in terms of length provides a more reliable approach for estimating eelgrass biomass.

Effectiveness and risks of combining antipsychotic drugs with electroconvulsive treatment.

INTRODUCTION: The simultaneous application of electroconvulsive therapy (ECT) and psychotropic drugs is based on sparse data. Despite this, and the restrictive approach of the Guidelines and Consensus is widespread in the usual care, it is widely practiced in routine clinical. METHOD: We reviewed the results of search on the topic in MEDLINE, PsychINFO, EMBASE and Cochrane, and the main guidelines on the subject and analyzed for drug groups. RESULTS: Except some reservation with regard to classical MAOIs, antidepressants are safe and effective enhancers of the TEC. It is desirable to discontinuation of BZD whenever clinically possible before the course of ECT for risk of interference, if not possible will have to use proper technique to ensure effective incentives. It is advisable to stop or reduce the dose of lithium prior to ECT based on a cost-benefit analysis of the risk of relapse, if maintained will be adjusted lower levels and cognitive effects minimizing techniques. The combination with "classic" and "atypical" antipsychotics power positive clinical effects and the risk of combined use is low. The positive data are collected with clozapine and ECT-resistant psychosis, with little presence of effects of the decrease of seizure threshold by clozapine, and important effect of empowerment, but of limited duration. CONCLUSIONS: Although it is strictly necessary to identify situations in terms of drugs, patient and ECT technique, and care necessary to develop tests that provide methodologically sound data, the combined use of ECT and psychotropic drugs in general presents an acceptable risk level and efficacy data by encouraging empowerment.

Electroconvulsive therapy as treatment for malignant neuroleptic syndrome.

In the era of new antipsychotic drugs the severe symptomatology known by the name of neuroleptic malignant syndrome (NMS) continues to have a high incidence and mortality. We review its origin, pathophysiology, diagnostic criteria and staging, particularly with electroconvulsive therapy (ECT), and proposing a less restrictive use and more adjusted to the updated knowledge of this technique. In particular, we consider the justified use of bilateral lead placement, a frequency of three sessions per week, and loads calculated for age, which would ensure effective seizures with an early response, thus avoiding the use of repeated sub-seizure stimuli to calculate the threshold by titration. We believe there is little evidence on the fear of the risk of increasing malignant hyperthermia in NMS due to the substances used in anaesthesia, but is justified to use non-depolarising relaxants due to the risk of hyperkalaemia on being exposed to succinylcholine. Finally we believe it is essential to familiarise the other specialists involved in the treatment with ECT, to increase the availability of the technique and our training in this to the currently available complexity.

An allometric method for the projection of eelgrass leaf biomass production rates.

We demonstrate that an allometric model for eelgrass leaf-growth rates can be derived from data on leaf architecture and growth form. Using this construct, we produced indirect assessments of growth rates of leaves that we call projections, which can be easily obtained in terms of allometric parameters and proxy values for leaf area, expressed as the product of leaf length and width. These projections of leaf-growth rates displayed a high level of correspondence with values observed in our data, as well as with other sets of reference data. A comparison with growth rates obtained by using the plastochrone index method showed that our model provides more accurate estimations while using a simpler methodology. Our results also show that whenever allometric parameters for the scaling of eelgrass leaf dry weight in terms of leaf area are available, the proposed model provides an accurate, cost-effective and non-destructive alternative to assessments based on traditional or plastochrone methods.

An economical non-destructive method for estimating eelgrass, Zostera marina (Potamogetonaceae) leaf growth rates: formal development and use in northwestern Baja California

Seagrass beds provide much of the primary production in estuaries; host many fishes and fish larvae, and abate erosion. The present study presents original analytical methods for estimating mean leaf-growth rates of eelgrass (Zostera marina). The method was calibrated by using data collected in a Z. marina meadow at Punta Banda estuary in Baja California, Mexico. The analytical assessments were based on measurements of leaf length and standard regression procedures. We present a detailed explanation of the formal procedures involved in the derivation of these analytical methods. The measured daily leaf-growth rate was 10.9 mm d-1 leaf-1. The corresponding value projected by our method was 10.2 mm d-1 leaf-1. The associated standard errors were of 0.53 and 0.56 mm d-1 leaf-1 respectively. The method was validated by projecting leaf-growth rates from an independent data set, which gave consistent results. The use of the method to obtain the mean leaf growth rate of a transplanted plot is also illustrated. Comparison of our leaf-growth data with previously reported assessments show the significant forcing of sea-surface temperature on eelgrass leaf dynamics. The formal constructs provided here are of general scope and can be applied to equivalent eelgrass data sets in a straightforward manner. Rev. Biol. Trop. 56 (3): 1003-1013. Epub 2008 September 30.

Las praderas de pastos marinos abaten la erosión y aportan gran parte de la productividad primaria de los esteros y son refugio de muchos peces y sus larvas. El presente trabajo introduce métodos analíticos para estimar las tasas medias de crecimiento foliar de Zostera marina L. y sus varianzas. La calibración del método se llevó a cabo utilizando datos de una pradera de esta fanerógama en el Estero de Punta Banda Baja California, México. Las referidas estimaciones analíticas, se basan en medias de longitud foliar y en procedimientos estandarizados de regresión. Dichas determinaciones son por ende no-destructivas. Se proporciona una explicación detallada de los aspectos formales de la derivación del método. El valor promedio observado de la tasa media diaria de crecimiento foliar fue de 10.9 mm d-1 leaf-1. El valor correspondiente proyectado mediante nuestro método fue de 10.2 mm d-1 leaf-1. Los errores estándar asociados fueron 0.53 y 0.56 mm d-1 leaf-1 respectivamente. Valores proyectados de la tasa media de crecimiento foliar diario utilizando datos de longitudes foliares publicadas por otros autores dieron también resultados consistentes. Se ilustra también el uso del método para proyectar la media de crecimiento foliar de una parcela transplantada de Zostera marina. La comparación de los resultados de este estudio con equivalentes reportados previamente nos permite concluir que las diferencias observadas pueden ser explicadas en función de la variabilidad de la temperatura superficial del mar en virtud del control de esta variable sobre la dinámica foliar de Z. marina. Las herramientas de estimación indirecta presentadas en este trabajo pueden aplicarse fácilmente a datos equivalentes de Z. marina.

An economical non-destructive method for estimating eelgrass, Zostera marina (Potamogetonaceae) leaf growth rates: formal development and use in northwestern Baja California.

Seagrass beds provide much of the primary production in estuaries; host many fishes and fish larvae, and abate erosion. The present study presents original analytical methods for estimating mean leaf-growth rates of eelgrass (Zostera marina). The method was calibrated by using data collected in a Z. marina meadow at Punta Banda estuary in Baja California, Mexico. The analytical assessments were based on measurements of leaf length and standard regression procedures. We present a detailed explanation of the formal procedures involved in the derivation of these analytical methods. The measured daily leaf-growth rate was 10.9 mm d(-1) leaf(-1). The corresponding value projected by our method was 10.2 mm d(-1) leaf(-). The associated standard errors were of 0.53 and 0.56 mm d(-1) leaf(-1) respectively. The method was validated by projecting leaf-growth rates from an independent data set, which gave consistent results. The use of the method to obtain the mean leaf growth rate of a transplanted plot is also illustrated. Comparison of our leaf-growth data with previously reported assessments show the significant forcing of sea-surface temperature on eelgrass leaf dynamics. The formal constructs provided here are of general scope and can be applied to equivalent eelgrass data sets in a straightforward manner.