Memantina: el valor de la terapia combinada / Memantine: the value of combined therapy

El tratamiento sintomático de la enfermedad de Alzheimer se realiza en la actualidad a través de una doble aproximación terapéutica: con los inhibidores de la acetilcolinesterasa, cuyo mecanismo de acción se basa en la inhibición selectiva de ésta, y con la memantina, que actúa bloqueando la activación tónica patológica de los receptores NMDA. Ambos fármacos han sido aprobados para el tratamiento de la enfermedad de Alzheimer y presentan un espectro de indicación terapéutica que es compartido en la fase moderada (MMSE: 10-20). Dado que ambas aproximaciones terapéuticas presentan mecanismos de acción complementarios y comparten indicación terapéutica en un espectro sintomático amplio de la enfermedad, el objetivo de este artículo es revisar la evidencia existente sobre la efi cacia de la terapia combinada para poder inferir su utilidad desde el inicio del tratamiento (AU)

The symptomatic treatment of Alzheimer’s disease is currently carried out using a twofold therapeutic approach involving acetylcholinesterase inhibitors, whose mechanism of action is based on the selective inhibition of this enzyme, and memantine, which acts by blocking the pathological tonic activation of NMDA receptors. Both drugs have been approved for the treatment of Alzheimer’s disease and present a therapeutic indication spectrum that is shared in the moderate phase (MMSE: 10-20). Since both therapeutic approaches off er the same complementary mechanisms of action and share the same therapeutic indication over a wide symptomatic disease spectrum, the aim of this article is to review the existing evidence on the eff ectiveness of combined therapy so as to be able to discern its usefulness from the moment treatment begins (AU)

¿Será un trastorno bipolar? Controversia acerca de los trastornos bipolares infanto-juveniles / No disponible

Revisamos el trastorno bipolar (TB) infantil y juvenil:diagnóstico, epidemiología, etiología (factores genéticosy ambientales), comorbilidades, curso, suicidio, tratamiento,prevención e investigación futura en el TBpediátrico. El TB de inicio infantil y de la primera adolescenciapuede ser una forma más severa del trastornoque el de inicio en el final de la adolescencia o en laadultez, los subtipos del TB infanto-juvenil puedenentenderse como fenotipos en un continuo o espectrobipolar. Su prevalencia puede estar subestimada. El cursodel trastorno es grave con alto consumo de recursosmédicos y educativos, severo deterioro psicosocial yuna estrecha relación con el fenotipo adulto más grave.A pesar de su carga genética, los factores ambientalesinfluyen decisivamente en la gravedad de la psicopatologíay el curso. El tratamiento combinado con fármacos,psicoeducación y psicoterapia mejora el pronóstico.Se requieren criterios más específicos para los niñosque recojan mejor su fenomenología

We review bipolar disorder (BD) in childhood and adolescence: diagnostic, epidemiology, aetiology(genetic and environmental factors), comorbidities,course, suicide, treatment, outcome and future researchabout pediatric BD. Bipolar disorder with childhood orfirst adolescent onset could be a more severe form ofdisorder than adult or late-adolescence onset BD and wefound that the subtypes of the childhood and adolescentBD could be phenotypes on a continuum or bipolarspectrum. The prevalence may be underestimated. Thecourse of BD is severe with high use of medical andeducational resources and severe psychosocial impairmentand it is also related with the most severe adultphenotype. In spite of its genetic load, the environmentalfactors influence decisively in the severity of thepsychopathology and the course. Combined treatmentwith pharmacotherapy, psychoeducational and psychotherapyapproach improves the outcome. More specificdiagnostic criteria are needed for the children thatbetter fulfill this phenomenology

Perfil de personalidad en una muestra de adolescentes en tratamiento ambulatorio. Estudio preliminar con el MMPI-A / Personality Profile in a sample adolescent outpatients: a prelimnary

Objetivo: Se examina el perfil de personalidad asociado a diferentes diagnósticos clínicos en una muestra de pacientes ambulatorios del Centro de Salud Mental Infanto-Juvenil. Material y métodos: 77 adolescentes entre 13 y 17 años fueron evaluados con el MMPI-A. Hemos realizado un análisis retrospectivo de las historias clínicas para obtener los datos sociodemográficos y clínicos (edad, sexo, cronicidad y diagnóstico CIE-10 y CFTMIA). Mostramos el perfil global y por diagnóstico, los estadísticos descriptivos y comparamos las medias para los diferentes diagnósticos (test de Kruskal- Wallis, Median test, Kolmogorov- Smirnov y test de Mann Whitney) y edades (correlaciones divariadas de Pearson, test de Kruskal- Wallis y test de Mann Whitney). Resultados: El total de la muestra presenta elevaciones moderadas en las escalas de depresión y desviación psicopática. Se asocian diferentes perfiles a cada diagnóstico edad. Los trastornos psicóticos y los trastornos mixtos de la conducta y las emociones muestran un perfil más psicopatológico en las escalas clínicas y mayor deterioro psicosocial reflejado en las escalas de contenido. Los adolescentes más mayores (edades de 16 y 17) tienen puntuaciones más altas que los adolescentes jóvenes (13 a 15 años) en depresión e introversión. Discusión: Los estudios revisados sugieren que hay un sustancial grado de asociación entre el inicio de los trastornos del eje I y la psicopatología del eje II en el final de la adolescencia y el inicio de la primera adultez. Comentamos nuestros resultados y discutimos la asociación entre trastornos mentales en la infancia y adolescencia y alteraciones de la personalidad. Conclusiones: Identificar y tratar con éxito los trastornos en la infancia puede ayudar a reducir el riesgo de desarrollar un trastorno de personalidad adulto. Se necesita más investigación para desarrollar recomendaciones de evaluación y tratamiento para las manifestaciones tempranas de las alteraciones de la personalidad (AU)

Objective: We examined the personality profile associated to diferents diagnoses in a sample of outpatients of the Mental Health Center for Children and adolescents. Method: 77 adolescents with ages from 13 to 17 were assessed with the MMPI-A. We made a prospective analysis of each clinical report to obtain sociodemographic and clinical data (age, gender, cronicity, diagnostic with CIE- 10 and CFTMA).We show the profiles of both the total sample and of each diagnostic cathegory using descriptive statistics and compared means for the diffe- 201 rent diagnoses (using Kruskal- Wallis test, Median test, Mann-Whitney test and Kolmogorov- Smirnov test) and for ages (using Pearson bivariate correlations, Kruskal- Wallis test and Mann- Whitney test). Results: All the sample show moderate elevations in Depression and Psychopatic deviation. Differents profiles are associated to each diagnosis and age: psychotic and mixed disorders of conduct and emotions show more severe psychopathology profile in clinical scales and more psychosocial impairment reflected in content scales. Older adolescents (age 16 and 17) have more elevated and significative scores than younger adolescents (age 13 to 15) in depression and introversion. Discussion: Studies revised suggest a substantial degree of association between early onset axis I disorders and axis II psychopathology in late adolescence and young adults. We comment our results and discuss the association between mental disorders in childhood and adolescence and personality disfunction. Conclusions: Identification and successful treatment of childhood disorders and severe early impairment, may help to reduce the risk of subsequent development of an adult personality disorder. More research is needed to develop assessment and treatment recommendations addressing the early manifestations of personality disturbance (AU)

Personalidad y trastornos de la conducta alimentaria: uso del Mini-Mult en la valoración de pacientes externas con trastorno alimentario / Personality and eating disorders: use of mini -mult in the outpatient assesment of patients with eating disorders

Examinamos características de personalidad de 32 adolescentes con trastorno alimentario (según criterios de la CIE-10) al inicio del tratamiento en el Centro de Salud Mental Infanto-Juvenil. En la admisión se les aplicaron los siguientes cuestionarios: Mini-Mult, EDI, EAT-40, BITE. Analizamos los datos usando el SPSS versión 9.0. Los cuatro grupos muestran perturbaciones importantes demostradas por elevaciones en las escalas 2(D) y 4 (Pd). Las pacientes bulímicas puntúan más alto en las escalas del Mini-Mult. Se discuten los resultados en relación a la investigación revisada (AU)

Absence of Fas (CD95) and FasL (CD95L) immunohistochemical expression suggests Fas/FasL-mediated apoptotic signal is not relevant in cutaneous Kaposi's sarcoma lesions.

It has been suggested that Fas ligand (FasL), expressed by several neoplastic cell lines and some tumors in vivo, is able to trigger the apoptotic process in activated T-lymphocytes and may constitute a key element of the immunological escape mechanisms used by many types of neoplasia. In order to evaluate the possible role of Fas-mediated apoptosis in Kaposi's sarcoma (KS), we have studied the immunocytochemical expression of Fas and FasL in biopsy specimens showing different histopathological stages of classic KS (C-KS) and AIDS-associated KS (AIDS-KS), as well as in cultured cells derived from C-KS lesions. KS biopsy tissue failed to show Fas expression in all epidemiologic forms and histopathologic stages studied, while FasL positivity was present in a small number of cells in just a few cases. Double immunostaining ruled out the lymphocytic nature of these cells, whose morphology in adjacent sections stained with hematoxylin and eosin was consistent with KS cells. In contrast, cultured KS cells exhibited strong immunocytochemical cytoplasmic expression of both Fas and FasL. These findings indicate that the Fas-FasL system does not play a major role as a trigger of apoptosis in KS cells in vivo and that the upregulation of these molecules observed in KS cells in vitro probably is the result of cell stress induced by growth in culture.

Induction of proliferating cell nuclear antigen and Ki-67 expression by cytomegalovirus infection.

With the goal of facilitating viral reproduction, cytomegalovirus (CMV) induces changes in the host cell replication machinery. Very little information is available, however, on the effects brought about by CMV on proliferating cell nuclear antigen (PCNA) and Ki-67 expression in infected cells. Fifty-five paraffin-embedded tissue samples (43 gastrointestinal, 10 skin, and 2 kidney biopsies) with both histological and immunohistochemical evidence of CMV infection were investigated for PCNA and Ki-67 expression by the avidinbiotin-peroxidase method. Of the 55 cases studied, 47 were positive for PCNA and 46 for Ki-67. PCNA and Ki-67 immunostaining was more striking in CMV-immunoreactive, inclusion-free cell nuclei, whereas cell nuclei exhibiting well-developed CMV inclusions either showed a weak peripheral signal for both proliferation markers, or were completely negative. Enhanced PCNA and Ki-67 expression appears to be among the changes induced by CMV infection in host cells. Moreover, this induction seems to reach its peak during the earlier phases of CMV infection and abate as the infection proceeds to its inclusion-forming phases, when a sufficiently high viral load would have been attained.