Decreased oxytocin plasma levels and oxytocin receptor expression associated with aggressive behavior in aggressive-impulsive disorders.

INTRODUCTION: This study aims to enhance the understanding of the association between the phenotypic and endophenotypic characteristics of impulsive-aggressive disorders, through the study of plasma oxytocin (OXT) and oxytocin receptor (OXTR) levels in patients with borderline personality disorder (BPD) and patients with eating disorders (ED), as well as to examine the relationship of OXT system with aggressive behavior in these disorders. METHODS: 68 patients with BPD, 67 patients with ED and 57 healthy control subjects were examined for plasma oxytocin levels and protein expression of OXTR in blood mononuclear cells. Aggressive behavior was assessed using the State-Trait Anger Expression Inventory (STAXI-2). Other self and hetero-aggressive behaviors were also evaluated through interviews. RESULTS: BPD and ED patients exhibited significantly lower plasma oxytocin levels than control subjects. Furthermore, BPD patients demonstrated significantly reduced expression of OXTR compared to controls. Plasma oxytocin levels negatively correlated with verbal aggression, while OXTR expression was inversely associated with the STAXI trait subscale. CONCLUSIONS: The findings validate the existence of oxytocin system dysfunction in impulsive-aggressive disorders. They also support the link between low OXT levels in plasma and OXTR expression and the impulsive-aggressive behavior that characterizes these patients in both state and trait situations.

Demanda asistencial en un Servicio de Pediatría durante el estado de alarma secundario a la COVID-19 / Demand for care in a Pediatric Service during the state of alarm secondary to COVID-19

Antecedentes y objetivos. La COVID-19 es una enfermedad producida por el virus SARS-CoV-2. En España,entre el mes de marzo y junio de 2020 se declaró el primer Estado de Alarma con el fin de contener la pandemia.Nuestro objetivo es evaluar la demanda asistencial y lasenfermedades que acudieron a Urgencias Pediátricas y quefueron ingresadas durante el tiempo que duró el primer Estado de Alarma, comparando con los mismos meses delos años 2018 y 2019.Resultados. Existe una reducción del número de ingresosde 345 a 141, un incremento de la complejidad demostrada por una mayor duración de los ingresos hasta 7,3±12,4 días(6,2±8,6 días en 2018 y 4,8±6,9 en 2019). Las enfermedades infecciosas (principalmente las respiratorias) descendieron, permaneciendo estables los ingresos por neoplasias, patología psiquiátrica, apendicitis y enfermedades circulatorias. EnUrgencias Pediátricas, en los años 2018 y 2019 (de 1 marzoa 30 junio) se atendieron 9.075 y 8.525 pacientes, mientras que en el 2020 se atendieron 2.215, aumentando el porcentajede ingresos procedentes de urgencias del 3,6% y 3,4% al 6%en 2020. Las enfermedades que aumentaron de forma más importante fueron las lesiones traumáticas y las intoxicaciones. Tanto en los ingresos como en urgencias existe unincremento en la edad de los pacientes. Conclusiones. El Estado de Alarma influyó en la presión asistencial y en el tipo de enfermedades atendidas enel Servicio de Pediatría, con una disminución del número de Urgencias y de ingresos, un incremento de la edad y unamodificación del tipo de enfermedades atendidas.

Introduction and objectives. COVID-19 is a disease caused by the SARS-CoV-2 virus. In Spain, between March and June 2020, the first State of Alarm was declared in order to contain the pandemic. Our objective is to evaluate the health care demand and the diseases that came to the Pediatric Emergency Department and were admitted during the time that the first State of Alarm lasted, comparing with the same months of the years 2018 and 2019.Results. There is a reduction in the number of admissions from 345 to 141, an increase in complexity demonstrated by a longer duration of admissions to 7.3±12.4 days (6.2 ± 8.6 days in 2018 and 4, 8±6.9 in 2019). Infectious diseases (mainly respiratory) decreased, with admissions for neoplasms, psychiatric pathology, appendicitis and circulatory diseases remaining stable. In Pediatric Emergencies, in the years 2018 and 2019 (from March 1 to June 30), 9,075 and 8,525 patients were attended, while in 2020, 2,215 were attended, increasing the percentage of admissions from the emergency room of 3.6% and 3.4% to 6% in 2020. The diseases that increased most significantly were traumatic injuries and poisonings. Both in admissions and in emergencies there is an increase in the age of the patients. Conclusions. The State of Alarm influenced the care pressure and the type of diseases treated in the Pediatric Service, with a decrease in the number of Emergencies and admissions, an increase in age and a modification of the type of diseases treated (AU)

Anemia grave secundaria a sangrado vaginal en niña de 13 años que rechaza transfusión sanguínea / Severe anemia secondary to vaginal bleeding in a 13-year old girl who rejects blood transfusion

Introducción: El sangrado vaginal como causa de anemia grave no es frecuente en la edad pediátrica, pero cuando aparece suele ser secundario a una hemorragia uterina disfuncional. El tratamiento del mismo tiene como objetivo el establecimiento y/o mantenimiento de la estabilidad hemodinámica del paciente. La situación actual en España establece que toda actuación en el ámbito de la salud de un paciente necesita el consentimiento libre y voluntario del afectado, siendo necesario el consentimiento por representación por varias razones, de las que destacamos que el paciente sea menor de edad y no sea capaz intelectual ni emocionalmente de comprender el alcance de la intervención. El consentimiento informado por representación debe adoptarse atendiendo siempre al mayor beneficio para la vida o salud del paciente. Caso clínico. Presentamos un caso de sangrado vaginal con una hemoglobina de 5 g/L, en una niña de 13 años que rechaza la transfusión sanguínea por creencias religiosas. Ante la anemia grave y la negativa de la paciente y de los padres a administrar la transfusión, se decide como primera medida la administración de líquidos intravenosos y aporte de hierro intravenoso, solicitando autorización judicial para, en caso de fracaso del tratamiento inicial, poder trasfundir concentrado de hematíes, situación que no se produce dada su repuesta favorable. Conclusiones. La buena evolución de la paciente nos permite concluir que ante una causa que imposibilite la transfusión sanguínea se puede administrar hierro intravenoso con buena repuesta

Introduction: Vaginal bleeding as a cause of severe anemia is not frequent in the pediatric age. However when it appears, it is generally secondary to dysfunction uterine bleeding. The objective of its treatment is to establish and/ or maintain the hemodynamic stability of the patient. The current situation in Spain establishes that all action within the health care setting of a patient requires free and voluntary consent of the patient, consent by representation being necessary for several reasons, standing out among them that the patient is a minor and is not intellectually or emotional capable of understanding the scope of the intervention. Informed consent by representation should always be adopted considering the best benefit for the patient's life or health. Clinical case. We present a case of vaginal bleeding with 5 g/L hemoglobin in a 13-year old girl who rejected blood transfusion due to religious beliefs. In view of the severe anemia and rejection by the patient and her parents to administer the transfusion, it was decided as a first step to administer intravenous fluids and intravenous iron supply and to request court authorization in case of initial treatment failure to be able to make a concentration red blood cell transfusion, a situation which did not occur given her favorable response. Conclusions. The good evolution of the patient allowed us to conclude that when it is not possible to perform a blood transfusion, intravenous iron can be administered with good response

Paliperidone prevents brain toll-like receptor 4 pathway activation and neuroinflammation in rat models of acute and chronic restraint stress.

BACKGROUND: Alterations in the innate immune/inflammatory system have been proposed to underlie the pathophysiology of psychotic disease, but the mechanisms implicated remain elusive. The main agents of the innate immunity are the family of toll-like receptors (TLRs), which detect circulating pathogen-associated molecular patterns and endogenous damage-associated molecular patterns (DAMPS). Current antipsychotics are able to modulate pro- and anti-inflammatory pathways, but their actions on TLRs remain unexplored. METHODS: This study was conducted to elucidate the effects of paliperidone (1mg/Kg i.p.) on acute (6 hours) and chronic (6 hours/day during 21 consecutive days) restraint stress-induced TLR-4 pathway activation and neuroinflammation, and the possible mechanism(s) related (bacterial translocation and/or DAMPs activation). The expression of the elements of a TLR-4-dependent proinflammatory pathway was analyzed at the mRNA and protein levels in prefrontal cortex samples. RESULTS: Paliperidone pre-treatment prevented TLR-4 activation and neuroinflammation in the prefrontal cortices of stressed rats. Regarding the possible mechanisms implicated, paliperidone regulated stress-induced increased intestinal inflammation and plasma lipopolysaccharide levels. In addition, paliperidone also prevented the activation of the endogenous activators of TLR-4 HSP70 and HGMB-1. CONCLUSIONS: Our results showed a regulatory role of paliperidone on brain TLR-4, which could explain the therapeutic benefits of its use for the treatment of psychotic diseases beyond its effects on dopamine and serotonin neurotransmission. The study of the mechanisms implicated suggests that gut-increased permeability, inflammation, and bacterial translocation of Gram-negative microflora and HSP70 and HGMB1 expression could be potential adjuvant therapeutic targets for the treatment of psychotic and other stress-related psychiatric pathologies.

Ingestión de cáusticos: revisión de la casuística de un hospital de tercer nivel / Intake of caustics: review of the casuistics of a tertiary hospital

Objetivos: analizar las características clínicas, epidemiológicas y los factores que pueden predecir lesión esofágica en la población infantil que ingresó en nuestro hospital por ingestión de cáusticos. Material y métodos: se realiza un estudio retrospectivo de los pacientes que requirieron ingreso por ingestión cáustica en los últimos 6 años. Se recogen distintas variables de la historia clínica entre las que destacamos, edad, sexo, tipo de cáustico, pH del líquido, sintomatología, tiempo de evolución y realización de la endoscopia. Resultados: desde el año 2000 hasta el tercer trimestre del 2006 fueron ingresados en nuestro Hospital 35 niños con la sospecha de haber ingerido una sustancia cáustica. De ellos 19 eran varones y 16 eran mujeres. La edad media fue de 2,6 años. Diez de los pacientes venían derivados de hospitales de otras provincias. Los cáusticos ingeridos fueron lejía (40,0%), amoniaco (17,1%), sosa (11,4%) y lavavajillas industrial (11,4%). El 42,9% de los casos los familiares realizaron procedimientos que pueden agravar la lesión. Los síntomas más frecuentes fueron vómitos (11 pacientes), heridas en los labios (8 pacientes), lesiones en la mucosa geniana (9 pacientes), quemaduras en la lengua (12 pacientes). Se indicó la endoscopia en 23 pacientes, que se llevó a cabo a las 31,5 horas de media tras la ingestión. En el 26,3% de las endoscopias se objetivó lesión esofágica(tipo 2a, 10,5% y tipo 2b, 15,8%). Los cáusticos más agresivos fueron la sosa, el amoniaco, y el lavavajillas industrial. Se observa una tendencia a encontrar relación entre el número de síntomas presentes y la probabilidad de lesión endoscópica. Conclusiones: la lejía es el agente cáustico más implicado en este tipo de accidente. La sosa, el amoniaco y el lavavajillas industrial son los líquidos más peligrosos. Los familiares todavía siguen realizando procedimientos inadecuados tras la ingestión. El mejor tratamiento es una buena prevención (AU)

Objectives: analyze the clinical, epidemiological characteristics and the factors that may predict esophageal injuries in the child population admitted to our hospital due to intake of caustics. Material and methods: a retrospective study was done of the patients who required admission due to caustic intake in the last six years. Different variables were collected from the clinical history, the following standing out among them: age, gender, type of caustics, pH of the liquid, symptoms, evolution time and conduction of endoscopy. Results: since the year 2000 until the third quarter of 2006, 35 children were admitted to our hospital with the suspicion of having ingested a caustic substance. Of them,19 were male and 16 female. Mean age was 2.6 years. Ten of the patients had been referred from hospitals of other provinces. The caustics ingested were bleach (40.0%), ammonium (17.1%), soda (11.4%) and industrial dishwasher soap (11.4%). In 42.9% of the cases, the families rejected procedures that could worsen the injury. The most frequent symptoms were vomiting (11 patients), lip wounds (8 patients), genian mucosal lesions (9 patients), burns under tongue (12 patients). Endoscopy was indicated in 23 patients, that was carried out at a mean of 31.5 hours after intake. In 26,3 of the endoscopes, esophageal injuries were observed (type 2a 10.5% and type 2b 15.8%). The most aggressive caustics were soda, ammonium and industrial dishwashing soap. A tendency was observed to find a relationship between the number of symptoms present and the likelihood of an endoscopic lesion. Conclusions: bleach is the caustic agent most involved in this type of accident. Soda, ammonium and industrial dishwashing soap are the most dangerous liquids. Family members are continuing to perform inadequate procedures after intake. The best treatment is a good preventive one (AU)

[The seroepidemiology of the varicella-zoster virus in children and adolescents]. / Seroepidemiología del virus de la varicela zoster en niños y adolescentes.

OBJECTIVE: To know the sero-protection level existing of varicella-zoster virus in a population of children and adolescents from Madrid. METHODS: To carry out this work we have had a total 560 serum from children and adolescents between 1 and 15 years old. Later to detect the title of antibodies against the varicella zoster virus (IgG VZV), we used enzymo immuno-analysis (PLATEST). RESULTS: The 96.5% of them were positive. Distributing this percentage in a similar way for every age, we get 100% at 8, 9, 10, 11 and 15 years old; 97.5% at 5, 6, 7, 12 and 13 years; 95% at 14 years old; 92.5% at 4 years old and 85% at 1 years old and 84% at 2 years old. CONCLUSIONS: The prevalence gradually increases with the age, from 20% at 1 year old to 100% at 15, finding the smallest prevalence in 84% to reach rapidly 100%.

[Hepatitis B vaccination in children and adolescents]. / Vacunación contra la hepatitis B en niños y adolescentes.

OBJECTIVE: This study's main aim was to investigate the immunogenicity of genetic recombinant vaccine in children and adolescents in Madrid, with the intention of determining the length of protection according to the titer of antibodies. A second aim was that of finding the optimum vaccine dosage, in order to suggest possible courses of action leading to an adequate strategy of vaccination. DESIGN: Crossover study. SETTING: Three educational centres in Madrid. PATIENTS AND OTHERS PARTICIPANTS: 1,184 pupils between 5 and 17 years old. INTERVENTIONS: Each individual was given three doses of Engerix B recombinant vaccine in the deltoid area at 0, 1 and 6 months. The vaccine dosage was 10 micrograms for children under 12 and 20 micrograms for those aged 12 and over. MAIN MEASUREMENTS AND RESULTS: The pre-vaccination markers were determined. A month after completing the vaccination, the titer of antibodies was quantified using the Abbott laboratories' microenzyme-immunoanalysis technique. The overall seroprotection rate was 98.9%. The MGT of the titer of antibodies was 9,283.2 mUI/ml. The seroprotection rates were similar among children under 12. The rates were also similar among those who were 12 or over, with titers of antibodies showing significantly higher in the children aged 12 or over. CONCLUSIONS: Given the good results obtained, we consider that the children will be protected for about 10 years. We suggest that all children and/or adolescents should be vaccinated as a means of controlling Hepatitis B. The recommended dosage for children under 8 is 10 micrograms and for those aged 8 and over, 20 micrograms.

[Immunogenicity of the vaccine against hepatitis B virus in schoolchildren of Madrid]. / Inmunogenicidad de la vacuna contra el virus de la hepatitis B en escolares de Madrid.

We carried out a vaccine program against Hepatitis B in scholar population aged 5 to 17 educated in 3 institutions of Madrid city/ region. Those children who followed the vaccination criteria (negative HBsAg and Anti HBc markers) were vaccinated. The vaccination regimen (Engerix B recombinant DNA vaccine) was 0-1-6 months and dose was 10 and 20 ug i.m. for those aged 6 to 13 and 13 to 17 respectively. The postvaccine serologic results (anti-HBs titer) was evaluated one month after tha last dose, at 7th month from the beginning. The variables of study were age and sex for each individual. Corresponding to these variables both seroconversion rate (percentage of patients with 10 Ul/l of-anti-HBs) and the geometric mean titer of antibodies (GMT anti-HBs titer) were determined. The overall seroconversion rate at 7th month was 99%. There is not significant association neither regarding the sex nor mean age between "responders" and "no responders". The titer of anti-HBs antibodies, expressed using the G.M.T., which was reached at 7th month was 9.283.2 UI/I. Finally, there is not correlation between age and anti-HBs antibody titer.

[The immunogenicity of the vaccine against the HBV in the mentally retarded]. / Inmunogenicidad de la vacuna contra el VHB en deficientes mentales.

Our group carried out during 1989 a serological cross sectional study in 1,024 mentally handicapped patients (231 with Down's syndrome [DS] and 793 affected with other mental disturbances [OMD]), educated in seven institutions of the Madrid region. Those patients with negative HBsAg and anti-HBc markers were considered vaccination susceptible individuals. This group was constituted by 546 individuals. The regime of vaccination used was 0-1-6 m, and the dose, 20 micrograms i.m. The present study makes an evaluation of the postvaccine serologic results one month after the third dose. It was considered the age, sex and if he or she suffers from Down's syndrome or not. Corresponding with these variables the seroconversion rate (percentage of patients with greater than or equal to 10 IU/l of anti-HBs) was determined as well as the geometric mean titer (GMT) of antibodies. The seroconversion rate was 97.1% in the group affected with DS and 95.5% in the group with OMD, not being this difference statistically significant. There is not also significant association with regard to the sex, being the seroconversion rate in males (94.7%) and females (97.6%) very similar. However, it is significant difference between the mean age of the "responders" to the vaccine (24.6 years of age) and that of the "non responders" (33.3 years of age) (p less than 0.001). Thus, the age exerts a negative influence in the response to the vaccination. The titer of anti-HBs antibody, expressed using the GMT, has significant association with the sex (p less than 0.001) but not with the type of mental disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)