Adherencia al tratamiento como pilar fundamental en la calidad de vida en hemodializados / Adherence to treatment as a fundamental pillar in the quality of life of hemodialysis patients

Introducción: La carga farmacológica en pacientes en hemodiálisis supera a otros pacientes crónicos, la no adherencia al tratamiento presenta implicaciones en la calidad de vida, la supervivencia y el coste económico de su tratamiento. El objetivo fue evaluar el puntaje de calidad de vida relacionada con la salud según el tipo de adherencia al tratamiento en pacientes en terapia de hemodiálisis. Métodos: El estudio es de tipo observacional, prospectivo, transversal y descriptivo, el universo de estudio está compuesto por los pacientes que recibieron hemodiálisis en COSSMIL durante el año 2020, la muestra fue de 27 pacientes, la adherencia al tratamiento se midió a través del Test de Morisky-Green y la calidad de vida relacionada con la salud mediante el Kidney Disease Quality of Life de 36 ítems. Resultados: Se hallaron un total de 7 pacientes adherentes al tratamiento (25,9%). En la escala del 1 al 100, el 100% de las puntuaciones del componente mental y 96,3 % del componente físico fueron menores del puntaje referencial de 50. La subescala de carga de enfermedad renal obtuvo puntuaciones de 0. Conclusión: La calidad de vida de estos pacientes se encuentra notablemente afectada, sin diferencias en relación el tipo de adherencia al tratamiento, donde la subescala de carga de enfermedad renal expresa el mayor impacto sobre la calidad de vida, se identifica la necesidad de fortalecer un abordaje integral clínico médico, multidisciplinario y biopsicosocial que incluya estrategias de afrontamiento y apoyo psicosocial para enfrentar los desafíos socioemocionales asociados a la enfermedad renal crónica.

Introduction: The pharmacological burden in hemodialysis patients exceeds that of other chronic patients, non- adherence to treatment has implications for quality of life, survival and the economic cost of their treatment. The objective was to evaluate the health-related quality of life score according to the type of adherence to treatment in patients on hemodialysis therapy. Methods: The study is observational, prospective, cross-sectional and descriptive, the study universe is made up of patients who received hemodialysis at COSSMIL during 2020, the sample was 27 patients, adherence to treatment was measured by through the Morisky-Green Test and health-related quality of life using the 36-item Kidney Disease Quality of Life. Results: A total of 7 patients adherent to the treatment (25.9%) were found. On the scale from 1 to 100, 100% of the scores for the mental component and 96.3% for the physical component were less than the reference score of 50. The subscale of kidney disease burden obtained scores of 0. Conclusion: The quality of life of these patients is significantly affected, with no differences related to the type of treatment adherence. The subscale of renal disease burden expresses the greatest impact on the quality of life. There is a need to strengthen a comprehensive, multidisciplinary, and biopsychosocial clinical approach that includes coping strategies and psychosocial support to address the socioemotional challenges associated with chronic kidney disease.

Central relaxin-3 receptor (RXFP3) activation increases ERK phosphorylation in septal cholinergic neurons and impairs spatial working memory.

The medial septum/diagonal band (MS/DB) is a relay region connecting the hypothalamus and brainstem with the hippocampus, and both the MS/DB and dorsal/ventral hippocampus receive strong topographic GABA/peptidergic projections from the nucleus incertus of the pontine tegmentum. The neuropeptide relaxin-3, released by these neurons, is the cognate ligand for a Gi/o-protein-coupled receptor, RXFP3, which is highly expressed within the MS/DB, and both cholinergic and GABAergic neurons in this region of rat brain receive relaxin-3 positive terminals/boutons. Comprehensive in vitro studies have demonstrated that the cell signaling pathways altered by RXFP3 stimulation, include inhibition of forskolin-activated cAMP levels and activation of ERK phosphorylation. In this study we investigated whether intracerebroventricular (icv) injection of RXFP3-A2, a selective relaxin-3 receptor agonist, altered ERK phosphorylation levels in the MS/DB of adult male rats. We subsequently assessed the neurochemical phenotype of phosphorylated (p) ERK-positive neurons in MS/DB after icv RXFP3-A2 administration by dual-label immunostaining for pERK and neuronal markers for cholinergic and GABAergic neurons. Central RXFP3-A2 injection significantly increased levels of pERK immunoreactivity (IR) in MS/DB at 20 and 90 min post-injection, compared to vehicle and naive levels. In addition, RXFP3-A2 increased the number of cells expressing pERK-IR in the MS/DB at 90 (but not 20) min post-injection in cholinergic (but not GABAergic) neurons, which also expressed putative RXFP3-IR. Moreover, icv injection of RXFP3-A2 impaired alternation in a delayed spontaneous T-maze test of spatial working memory. The presence of RXFP3-like IR and the RXFP3-related activation of the MAPK/ERK pathway in MS/DB cholinergic neurons identifies them as a key target of ascending relaxin-3 projections with implications for the acute and chronic modulation of cholinergic neuron activity and function by relaxin-3/RXFP3 signaling.

The effect of abscisic acid chronic treatment on neuroinflammatory markers and memory in a rat model of high-fat diet induced neuroinflammation.

BACKGROUND: Western diet and lifestyle are associated with overweight, obesity, and type 2 diabetes, which, in turn, are correlated with neuroinflammation processes. Exercise and a healthy diet are important in the prevention of these disorders. However, molecules inhibiting neuroinflammation might also be efficacious in the prevention and/or treatment of neurological disorders of inflammatory etiology. The abscisic acid (ABA) is a phytohormone involved in hydric-stress responses. This compound is not only found in plants but also in other organisms, including mammals. In rodents, ABA can play a beneficial role in the regulation of peripheral immune response and insulin action. Thus, we hypothesized that chronic ABA administration might exert a protective effect in a model of neuroinflammation induced by high-fat diet (HFD). METHODS: Male Wistar rats were fed with standard diet or HFD with or without ABA in the drinking water for 12 weeks. Glucose tolerance test and behavioral paradigms were performed to evaluate the peripheral and central effects of treatments. One-Way ANOVA was performed analyzed statistical differences between groups. RESULTS: The HFD induced insulin resistance peripherally and increased the levels of proinflammatory markers in in the brain. We observed that ABA restored glucose tolerance in HFD-fed rats, as expected. In addition, chronic ABA treatment rescued cognitive performance in these animals, while not affecting control diet fed animals. Moreover, it counteracted the changes induced by HFD in the hypothalamus; microglia activations and TNFα mRNA levels. CONCLUSION: These results suggest that ABA might become a new therapeutic molecule improving the neuroinflammatory status and insulin resistance.

[Candida parapsilosis: a major cause of bloodstream infection in a tertiary care hospital in Costa Rica]. / Candida parapsilosis: principal causa de candidemia en un hospital de referencia para adultos de Costa Rica.

BACKGROUND: Invasive Candida bloodstream infections are frequent and display high mortality in clinical practice. There is scarce published on this topic in Central America. OBJECTIVE: To characterize the epidemiology of candidemia in a hospital setting in Costa Rica. METHODS: 210 cases of nosocomial candidemia were analyzed in patients over 17 years of age, admitted to Hospital Mexico, between 2007 and 2011. Descriptive and temporary analyses were performed and the risk factors associated with C. parapsilosis and survival were evaluated. RESULTS: The incidence rate of candidemia was 1.47 cases per 1,000 admissions. The non-albicans Candida represented 62% of the isolated yeasts. Except for 2009, C. parapsilosis was the most commonly isolated species in four out of the five years reviewed, followed by C. albicans. There was a strong association between C. parapsilosis, the presence of a central venous catheter (OR: 4.8, CI 95%: 1.8-14.6, p < 0.001) and the use of parenteral nutrition (p: 0.008). The 30-day mortality was 50%. Candida albicans displayed the highest mortality and C. parapsilosis the lowest. Patients who did not receive anti-fungal treatment showed a significantly higher probability of death. CONCLUSIONS: The high incidence of candidemia from C. parapsilosis is directly related to the use of central venous catheters and parenteral nutrition. There is a need for creating local guidelines addressing the use of central venous catheters and parenteral nutrition, as well as implementing hand hygiene protocols.

Candida parapsilosis: principal causa de candidemia en un hospital de referencia para adultos de Costa Rica / Candida parapsilosis: a major cause of bloodstream infection in a tertiary care hospital in Costa Rica

Background: Invasive Candida bloodstream infections are frequent and display high mortality in clinical practice. There is scarce published on this topic in Central America. Objective: To characterize the epidemiology of candidemia in a hospital setting in Costa Rica. Methods: 210 cases of nosocomial candidemia were analyzed in patients over 17 years of age, admitted to Hospital Mexico, between 2007 and 2011. Descriptive and temporary analyses were performed and the risk factors associated with C. parapsilosis and survival were evaluated. Results: The incidence rate of candidemia was 1.47 cases per 1,000 admissions. The non-albicans Candida represented 62% of the isolated yeasts. Except for 2009, C. parapsilosis was the most commonly isolated species in four out of the five years reviewed, followed by C. albicans. There was a strong association between C. parapsilosis, the presence of a central venous catheter (OR: 4.8, CI 95%: 1.8-14.6, p < 0.001) and the use of parenteral nutrition (p: 0.008). The 30-day mortality was 50%. Candida albicans displayed the highest mortality and C. parapsilosis the lowest. Patients who did not receive anti-fungal treatment showed a significantly higher probability of death. Conclusions: The high incidence of candidemia from C. parapsilosis is directly related to the use of central venous catheters and parenteral nutrition. There is a need for creating local guidelines addressing the use of central venous catheters and parenteral nutrition, as well as implementing hand hygiene protocols.

Introducción: Las infecciones invasoras por Candida son frecuentes y de alta mortalidad. Existe poca información publicada de la región centroamericana. Objetivo: Caracterizar la epidemiología de la candidemia en un hospital de Costa Rica. Métodos: Se analizaron 210 episodios de candidemia nosocomial en pacientes sobre 17 años de edad, entre los años 2007 y 2011. Se realizó un análisis descriptivo y temporal de la serie y evaluación de las características clínicas asociadas haciendo énfasis en C. parapsilosis. Resultados: La incidencia acumulada de candidemia fue 1,47 casos/1.000 admisiones. Las especies de Candida no albicans constituyeron 62% de las levaduras aisladas. Exceptuando el año 2009, C. parapsilosis fue la especie predominante en cuatro de los cinco años estudiados, seguida por C. albicans. Se demostró una fuerte asociación entre C. parapsilosis, la presencia de catéter venoso central (OR: 4,8, IC 95%: 1,8-14,6, p < 0,001) y el uso de nutrición parenteral (p: 0,008). La mortalidad a 30 días fue de 50%. Candida albicans mostró la mortalidad más alta y C. parapsilosis la más baja. Los pacientes que no recibieron tratamiento antifúngico presentaron un aumento significativo en la mortalidad. Conclusiones: La incidencia elevada de candidemia por C. parapsilosis está relacionada con los catéteres venosos centrales y la administración de nutrición parenteral. Para su control es necesario establecer guías locales para uso de los catéteres venosos centrales y la nutrición parenteral, así como implementar estrategias para promocionar la higiene de las manos.

Acute oral administration of low doses of methylphenidate targets calretinin neurons in the rat septal area.

Methylphenidate (MPD) is a commonly administered drug to treat children suffering from attention deficit hyperactivity disorder (ADHD). Alterations in septal driven hippocampal theta rhythm may underlie attention deficits observed in these patients. Amongst others, the septo-hippocampal connections have long been acknowledged to be important in preserving hippocampal function. Thus, we wanted to ascertain if MPD administration, which improves attention in patients, could affect septal areas connecting with hippocampus. We used low and orally administered MPD doses (1.3, 2.7 and 5 mg/Kg) to rats what mimics the dosage range in humans. In our model, we observed no effect when using 1.3 mg/Kg MPD; whereas 2.7 and 5 mg/Kg induced a significant increase in c-fos expression specifically in the medial septum (MS), an area intimately connected to the hippocampus. We analyzed dopaminergic areas such as nucleus accumbens and striatum, and found that only 5 mg/Kg induced c-fos levels increase. In these areas tyrosine hydroxylase correlated well with c-fos staining, whereas in the MS the sparse tyrosine hydroxylase fibers did not overlap with c-fos positive neurons. Double immunofluorescence of c-fos with neuronal markers in the septal area revealed that co-localization with choline acethyl transferase, parvalbumin, and calbindin with c-fos did not change with MPD treatment; whereas, calretinin and c-fos double labeled neurons increased after MPD administration. Altogether, these results suggest that low and acute doses of methylphenidate primary target specific populations of caltretinin medial septal neurons.

[Effects of methylphenidate on anxiety]. / Efectos del metilfenidato sobre la ansiedad.

The attention deficit disorder with hyperactivity (ADDH) is a widely recognized disorder of unknown etiology. Methylphenidate administration is one of the most commonly used treatments to improve symptoms associated with ADDH. Although it is generally a well tolerated drug, several secondary effects may occur. In particular, this paper will focus on the effects on anxiety, in humans and experimental animal models. It has been shown that acute administration of methylphenidate in adults reduces anxiety, in both animal models and humans. On the other hand, chronic treatment during early ages (postnatal and young subjects) results in higher anxiety in adults. In some cases this effect appears together with higher susceptibility of drug consumption. Thus, we find that, in the literature, methylphenidate is capable of inducing different and opposite effects. Thus, further experiments would be required to elucidate the mechanisms by which methylphenidate exert its actions.

Efectos del metilfenidato sobre la ansiedad / Effects of methylphenidate on anxiety

El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno neurológico ampliamente reconocido de etiología desconocida. La administración de metilfenidato es uno de los tratamientos más utilizados para la mejora sintomática del TDAH. Aunque es un medicamento en general muy bien tolerado por los pacientes, existen algunos efectos secundarios ajenos a los síntomas de la hiperactividad. En particular, esta revisión se centra en revisar los efectos que la administración aguda o crónica del metilfenidato induce en síntomas de ansiedad en humanos y en modelos animales experimentales. Tanto en modelos animales como en humanos, la administración aguda en adultos tiene un efecto ansiolítico. Por otro lado, en modelos animales, la administración crónica en el período posnatal y adolescentes genera estados de ansiedad en el adulto, aumentando, además, en algunos casos, aunque no en todos, la propensión a la drogodependencia de otras sustancias. Existe disparidad de resultados y serían necesarios más estudios para elucidar los mecanismos por los cuales el metilfenidato ejerce su acción (AU)

The attention deficit disorder with hyperactivity (ADDH) is a widely recognized disorder of unknown etiology. Methylphenidate administration is one of the most commonly used treatments to improve symptoms associated with ADDH. Although it is generally a well tolerated drug, several secondary effects may occur. In particular, this paper will focus on the effects on anxiety, in humans and experimental animal models. It has been shown that acute administration of methylphenidate in adults reduces anxiety, in both animal models and humans. On the other hand, chronic treatment during early ages (postnatal and young subjects) results in higher anxiety in adults. In some cases this effect appears together with higher susceptibility of drug consumption. Thus, we find that, in the literature, methylphenidate is capable of inducing different and opposite effects. Thus, further experiments would be required to elucidate the mechanisms by which methylphenidate exert its actions (AU)