Cost-effectiveness of therapeutic interventions in schizophrenia

Background: Various studies have reported that a decision-tree analysis is useful to evaluate different treatment strategies in real clinical practice. Objective: The main aim of this study was to research the clinical decisions regarding the treatment of patients who were diagnosed with schizophrenia. Method: Cost-effectiveness study of three different interventions to treat patients with schizophrenia were studied. Interventions were divided into the following categories: a) day hospital (psycho-educational treatment+psychiatric consultation+psychopharmacological treatment); b) therapy adherence clinic (psychopharmacological treatment with depot antipsychotic medication+psychiatric consultation); c) outpatient psychiatric care (psychopharmacological treatment+psychiatric consultation). For this purpose decision tree model was designed and three outcomes were measured (therapeutic compliance, non-compliance and rehospitalization). TreeAge software was used in order to estimate outcome probabilities and sensitivity analysis, distribution Beta for probabilities and Gamma for cost of interventions. Results: The probability of therapeutic compliance and average semestral cost of therapy adherence clinic, outpatient psychiatric care and day hospital are 0.594, 0.284, 2.393, and mean cost intervention US$ 2145.6, US$ 700.2 and US$ 1412.1 respectively (IC95%), according to Montecarlo analysis. Conclusions: According to the results, the clinical decision to treat patients in therapy adherence clinic improved therapeutic compliance, but the cost of treatment was higher. There were extra costs and risks to society and patient that are associated with therapeutic non-compliance. It is less expensive for the health care system to provide the patients outpatient psychiatric care, but perhaps in the long-term outpatient psychiatric care is more costly for the patient, their family, and society. According to the many important limitations of this study, further studies are needed to reject/confirm these strategies to be included in real clinical practice

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Sección de Endocrinología Pediátrica del Hospital General Universitario Gregorio Marañón. Unidad de seguimiento de endocrinopatías del plan de detección precoz de la Comunidad Autónoma de Madrid (CAM) / Pediatric Endocrinology Section of the Hospital General Universitario Gregorio Marañón. Monitoring unit of endocrine disorders early detection program of the Regional Community of Madrid (RCM)

La Sección de Endocrinología Pediátrica se caracteriza por una Cartera de Servicios completa en esta patología y por ser la única Unidad de Seguimiento de Endocrinopatías del Plan de Detección Precoz de Endocrinopatías de la Comunidad Autónoma de Madrid. Enmarcada en el Servicio de Pediatría, Hospital Materno—Infantil del Hospital General Universitario Gregorio Marañón, dispone de una larga trayectoria con profesionales altamente cualificados y ha sido reconocida como Unidad de referencia y prestigio por los trabajos clínicos, docentes v de investigación desarrollados tanto a nivel nacional como internacional (AU)

The Paediatric Endocrinology Section is characterized by a complete portfolio of the speciality and for being the only Unit of Precocious Diagnosis and Treatment of Endocrinopathies, Screening Plan of Endocrine and Metabolic Disorders of the Autonomous Community of Madrid. Included in the Department of Paediatrics, General University Hospital Gregorio Marañon, it has a long history with highly qualified professionals and has been recognized as reference and prestigious unit for clinical work, educational work and clinical research developed at national and international level (AU)

Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias / Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments

OBJETIVOS: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. PACIENTES Y MÉTODOS: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario≥40mmol/l, osmolaridad urinaria>500 mOsm/kg y densidad urinaria>1.020g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. RESULTADOS: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). CONCLUSIONES: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities

[Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments]. / Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias.

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.

Psoriasis inducida por infliximab en una adolescente con colitis ulcerosa / Infliximab-induced psoriasis in an adolescent with ulcerative colitis

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Ileocolic intussusception secondary to Hodgkin's lymphoma. Report of a case.

Intussusception is a rare condition in adults and represents 1% to 5% of the total cases of intestinal obstruction. Preoperative diagnosis occurs only in a few patients and most of the cases are diagnosed during surgery. A demonstrable etiology is found in 70% to 90% of cases in adult intussusceptions, and approximately 40% of them are caused by primary or secondary malignant tumors. We report the case of a 32 year old male patient with an ileocolic intussusception secondary to Hodgkin's lymphoma, as well as the surgical treatment, and outcome.

Neuromuscular electrical stimulation improves GLUT-4 and morphological characteristics of skeletal muscle in rats with heart failure.

AIM: Changes in skeletal muscle morphology and metabolism are associated with limited functional capacity in heart failure, which can be attenuated by neuromuscular electrical stimulation (ES). The purpose of the present study was to analyse the effects of ES upon GLUT-4 protein content, fibre structure and vessel density of the skeletal muscle in a rat model of HF subsequent to myocardial infarction. METHODS: Forty-four male Wistar rats were assigned to one of four groups: sham (S), sham submitted to ES (S+ES), heart failure (HF) and heart failure submitted to ES (HF+ES). The rats in the ES groups were submitted to ES of the left leg during 20 days (2.5 kHz, once a day, 30 min, duty cycle 50%- 15 s contraction/15 s rest). After this period, the left tibialis anterior muscle was collected from all the rats for analysis. RESULTS: HF+ES rats showed lower values of lung congestion when compared with HF rats (P = 0.0001). Although muscle weight was lower in HF rats than in the S group, thus indicating hypotrophy, 20 days of ES led to their recovery (P < 0.0001). In both groups submitted to ES, there was an increase in muscle vessel density (P < 0.04). Additionally, heart failure determined a 49% reduction in GLUT-4 protein content (P < 0.03), which was recovered by ES (P < 0.01). CONCLUSION: In heart failure, ES improves morphological changes and raises GLUT-4 content in skeletal muscle.

Acute epiploic appendagitis. Report of three cases.

Primary epiploic appendagitis is a very rare condition that results from acute inflammation of an epiploic appendix. Clinical presentation is non-specific, and many times can mimic acute abdomen. When the diagnosis of epiploic appendagitis is made, conservative treatment must be initiated to avoid unnecessary surgery. We report three cases of acute epiploic appendagitis which were diagnosed by imaging and were managed conservatively with good clinical outcome.

[Laparoscopic therapy of gastric volvulus associated with hiatal hernia in the elderly patient]. / Tratamiento laparoscópico del vólvulo gástrico asociado a hernia hiatal en el paciente de edad avanzada.

Gastric volvulus is an abnormal rotation of one portion of the stomach around itself that may lead to gastric obstruction or an impairment of the vascular supply to the stomach leading to strangulation. This may present acutely or with chronic intermittent symptoms. Acute gastric volvulus is an emergency situation in which there is a closed loop obstruction and vascular compromise that requires urgent treatment. In the chronic type, unspecific abdominal pain is common. Chronic gastric volvulus must be treated to avoid complications, but there is not a standard treatment for this condition. Minimally invasion techniques, either endoscopic or laparoscopic offer the best option for treatment reducing morbidity and mortality rates. We report two cases of chronic gastric volvulus treated laparoscopically in the elderly.

Toxic megacolon secondary to Clostridium difficile colitis. Case report.

The incidence and severity of Clostridium difficile colitis has markedly increased in recent years. The spectrum of Clostridium difficile infection ranges from asymptomatic colonization to fulminant colitis requiring immediate surgery. Medical therapy failure and the presence of toxic megacolon dictate urgent surgical treatment with unfortunate high mortality rates (35% to 57%). We broach herein a case of toxic megacolon secondary to colitis due to Clostridium difficile infection in which early diagnosis and prompt surgical treatment led to a successful outcome.

Evidence of heterogeneity in the antibody response against the platelet antigen 3a; recognition of an 11-mer peptide carrying the HPA-3a polymorphic determinant.

BACKGROUND: The immune processes involved in the development of alloantibodies against the human platelet antigens in alloimmune disorders remain unclear. Antibody recognition of the platelet antigens on their respective platelet glycoproteins has been shown to be dependent on glycoprotein conformation. Furthermore, the post-translational modification of glycoproteins adds complexity to the alloantigenic determinants. METHODS: Nine anti-HPA-3a sera along with several control sera were tested for reactivity to an 11-mer peptide straddling the HPA-3a/b polymorphism. Sera found to specifically recognize the 3a peptide were further assessed by platelet pre-exposure and immunoblotting. RESULTS: Three of the nine antisera were found to specifically recognize an 11-mer synthetic 3a peptide by ELISA. Further analysis of all anti-HPA-3a sera by Western blot showed that only those reactive to the 3a peptide were able to bind both reduced and non-reduced GPIIb. CONCLUSION: The results presented in this study provide the first known evidence for the identification of an antibody population capable of recognizing a linear and non-glycosylated form of the HPA-3a epitope.

[Descriptive analysis about a group of patients with recurrent acute pancreatitis]. / Análisis descriptivo de un grupo de enfermos con pancreatitis aguda recidivante.

BACKGROUND: Recurrent acute pancreatitis (RAP) represents a diagnostic and treatment challenge. Although it's real frequency is difficult to establish some works have reported 25-60% prevalence. In most, the etiology is recurrent biliary stones untreated or consumption of alcohol. The information we have about the RAP in our midst is scarce. AIM: To review the clinical characteristics and follow-up of a group of patients with RAP. METHODS: Clinical charts of all patients with AP admitted to our Institute from January 1, 1995 to December 31, 2005 were reviewed. The diagnosis of RAP was established when two o more episodes of AP were documented. In each case clinical, biochemical, imaging, treatment and follow-up until the last visit to our hospital was analyzed. RESULTS: The diagnosis of AP was established in 406 patients. Forty of them had RAP (9.8%). Mean age was 32 years old (13-63). The majority was male (72.5%). A mean of 3.5 episodes of AP was presented for each subject (2-14). High levels of triglycerides (n = 15), alcoholism (n = 11) and gallstones (n = 8) were the most frequent cause of RAP. In some cases more than one factor was presented. In 5 of the 15 subjects with RAP due to hypertriglyceridemia other causes of AP were identified (two alcohol consumption,two idiopathic chronic pancreatitis and one gallstone disease). In three patients with RAP supposedly secondary to alcohol, gallstone disease was diagnosed during the follow-up. All of them were operated on. One has had four events of AP after the cholecistectomy. Four of the 8 subjects submitted to cholecistectomy for RAP associated to gallstone disease have had new episodes of AP: 2 for triglycerides and in two a chronic pancreatitis was diagnosed by endoscopic ultrasound or MRI. Two patients died (5%). CONCLUSIONS: This series represents probably the first analysis that exists on PAR in Mexico. The frequency found was 9% and the most common causes were hypertriglyceridemia, chronic alcohol consumption and gallstones.

[Left paraduodenal hernia: an unusual cause of intestinal obstruction.]. / Hernia paraduodenal izquierda:una causa inusual de obstrucción intestinal.

Paraduodenal hernias are an unusual cause of small bowel obstruction. The clinical spectrum varies from episodes of partial, intermittent,small bowel obstruction, to those of acute, complete small bowel obstruction, with the potential risk of complications such as intestinal ischemia,perforation and abdominal sepsis. Reported here in is the case of a 53 year old man with complete small bowel obstruction secondary to a left paraduodenal hernia, in whom operative treatment consisted of reduction of the hernia content, small bowel decompression and closure of the hernia ring. The operation successfully resolved the acute event and has prevented recurrences during a 4 year follow-up.

Monitorización fonocardiográfica remota del segundo ruido cardiaco y aclimatación durante una escalada en el Karakorum / Remote phonocardiographic monitoring of the second heart sound and acclimatization during a climb in the Karakorum

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Ameloblastomas: a regional Latin-American multicentric study.

AIM: To classify 163 ameloblastoma cases according to the new WHO Classification of Odontogenic Tumours (2005) and analyse their clinical and microscopic features. METHODS: We studied the clinico-pathological features of 163 ameloblastoma cases from nine regional Latin-American institutions from Mexico and Guatemala. RESULTS: Ameloblastomas comprised 22.7% of all odontogenic tumours. The mean age was 41.4 years for solid ameloblastoma (SA) and 26.3 years for unicystic ameloblastoma (UA) (P < 0.001) and both sexes were almost equally affected. The mandible was mainly affected for both UA and SA. The mean size was 6.2 cm for SA and 6.3 cm for UA cases. The recurrence rate was 21.7% for SA and 12.6% for UA. UA was twice as more frequent than the solid variant. CONCLUSIONS: In this study we found that UA was frequently misdiagnosed as SA; however, there are enough clinical and microscopic features that allow for an accurate differentiation between both types of ameloblastoma that should be recognized for surgical and prognostic purposes. In this study, SA was not found in patients younger than 20 years, UA had a constant myxoid stroma while mature connective tissue was more frequently associated with the solid type.

Molecular and immunohistochemical analyses of cardiac troponin T during cardiac development in the Mexican axolotl, Ambystoma mexicanum.

The Mexican axolotl, Ambystoma mexicanum, is an excellent animal model for studying heart development because it carries a naturally occurring recessive genetic mutation, designated gene c, for cardiac nonfunction. The double recessive mutants (c/c) fail to form organized myofibrils in the cardiac myoblasts resulting in hearts that fail to beat. Tropomyosin expression patterns have been studied in detail and show dramatically decreased expression in the hearts of homozygous mutant embryos. Because of the direct interaction between tropomyosin and troponin T (TnT), and the crucial functions of TnT in the regulation of striated muscle contraction, we have expanded our studies on this animal model to characterize the expression of the TnT gene in cardiac muscle throughout normal axolotl development as well as in mutant axolotls. In addition, we have succeeded in cloning the full-length cardiac troponin T (cTnT) cDNA from axolotl hearts. Confocal microscopy has shown a substantial, but reduced, expression of TnT protein in the mutant hearts when compared to normal during embryonic development.

A new chloroquinolinyl chalcone derivative as inhibitor of inflammatory and immune response in mice and rats.

The synthetic chalcone derivative 1-(2,4-dichlorophenyl)-3-(3-(6,7-dimethoxy-2-chloroquinolinyl))-2-propen-1-one (ClDQ) was evaluated for its anti-inflammatory, analgesic and immunomodulatory efficacy in-vitro and in-vivo. ClDQ concentration-dependently inhibited the production of nitric oxide (NO) (IC50 4.3 microM) and prostaglandin E(2) (PGE(2)) (IC50 1.8 microM) in RAW 264.7 macrophages stimulated with lipopolysaccharide. Human mononuclear cell proliferation was significantly inhibited by 10 microM ClDQ. Oral administration of ClDQ (10-30 mg kg(-1)) in the 24-h zymosan-stimulated mouse air-pouch model produced a dose-dependent reduction of cell migration as well as NO and PGE(2) levels in exudates. ClDQ (20 mg kg(-1), p.o.) inhibited ear swelling and leucocyte infiltration in the delayed-type hypersensitivity response to 2,4-dinitrofluorobenzene in mice. In the rat adjuvant-arthritis model, this compound reduced joint inflammation as well as PGE(2) and cytokine levels. In addition, ClDQ displayed analgesic effects in the phenylbenzoquinone-induced abdominal constriction model in mice and in the late phase of the nociceptive response to formalin. Our findings indicated the potential interest of ClDQ in the modulation of some immune and inflammatory conditions.

1-(2,3,4-trimethoxyphenyl)-3-(3-(2-chloroquinolinyl))-2-propen-1-one, a chalcone derivative with analgesic, anti-inflammatory and immunomodulatory properties.

OBJECTIVE AND DESIGN: The synthetic chalcone derivative 1-(2,3,4-trimethoxyphenyl)-3-(3-(2-chloroquinolinyl))-2-propen-1-one (TQ) was evaluated for its immunomodulatory and anti-inflammatory efficacy in vitro and in vivo. MATERIAL AND SUBJECTS: Human neutrophils and lymphocytes from healthy volunteers and RAW 264.7 murine macrophages. Swiss mice and Lewis rats were randomly divided into groups of six animals. TREATMENT: TQ was orally administered in all in vivo assays (10-30 mg/kg). METHODS: Elastase, superoxide and LTB(4) release were assayed in human neutrophils, NO/PGE(2) production and NF-kappaB activation in RAW 264.7, and (3)H thymidine incorporation in human lymphocytes. Zymosan-stimulated air pouches, DNFB-DTH, PBQ-induced writhings and formalin-induced pain were assayed in mice. Adjuvant-induced arthritis was tested in rats. Dunnett's t-test was employed for statistical analysis. RESULTS: Human T-cell proliferation, neutrophil functions and NO/PGE(2) production in murine macrophages were inhibited by TQ (IC(50) in the microM range), which showed anti-inflammatory, immunomodulatory and analgesic effects. CONCLUSIONS: Our findings indicate the potential interest of TQ in the modulation of some immune and inflammatory responses probably by NF-kappaB inhibition.