Neumonía recurrente adquirida en la comunidad en la edad pediátrica. ¿Factor de riesgo para el desarrollo de asma infantil?

ObjetivoDeterminar si la neumonía recurrente adquirida en la comunidad (NR) constituye un factor de riesgo para desarrollar asma infantil (AI), comparado con los niños que padecen un sólo un episodio de neumonía o neumonía no recurrente (NNR). Determinar si los pacientes con AI están más predispuestos a padecer NR.DiseñoEstudio de cohortes históricas.EmplazamientoAtención primaria.ParticipantesUn total de 80 episodios de neumonía identificados en 65 niños entre el 1 de enero de 1996 y el 30 de junio de 1999.Mediciones principalesRiesgo relativo (RR) y su intervalo de confianza (IC del 95%) de asma infantil en presencia de neumonía recurrente frente a neumonía no recurrente, y RR de neumonía recurrente en presencia de asma infantil.ResultadosDe 65 niños incluidos, 18 niños presentaron NR (27,7%; IC del 95%, 16,8-38,6). La prevalencia de AI fue del 49,2% (32 niños) (IC del 95%, 37,1-61,4). El diagnóstico en algún momento de AI fue superior en niños con NR (RR = 4,1; IC del 95%, 1,9-8,9). No hubo diferencias entre la incidencia de NR y NNR en niños previamente diagnosticados de AI (RR = 1,28; IC del 95%, 0,5-3).ConclusionesEs necesario realizar un seguimiento especial a todo niño diagnosticado de NR en atención primaria, ya que las posibilidades de presentar AI en el futuro son mayores en estos casos.ObjectiveTo determine if recurrent community acquired pneumonia (RP) is a risk factor for developing childhood asthma (CA), compared with those children who only suffer one episode of pneumonia or non-recurrent pneumonia (NRP).To determine if patients with CA are more disposed to suffer RP.DesignHistorical cohort study.SettingPrimary care.ParticipantsA total of 80 episodes of pneumonia identified in 65 infants between the 1st of February 1996 and 30th June 1999.Principal measurementsThe relative risk (RR) and confidence interval (95% CI) of childhood asthma in the presence of recurrent pneumonia as compared to non-recurrent pneumonia, and the RR of recurrent pneumonia in the presence of childhood asthma.ResultsOf the 65 children included, 18 had RP (27.7%; 95% CI, 16.8-38.6). The prevalence of CA was 49.2% (32 children) (95% CI, 37.1-61.4). The diagnosis of CA at any time was higher in children with RP (RR=4.1; 95% CI, 1.9-8.9). There were no differences between the incidence of RP and NRP in children previously diagnosed with CA (RR=1.28; 95% CI, 0.5-3.0).ConclusionsA special follow-up needs to be carried out on all children diagnosed with RP in primary care, since the possibility of presenting with CA is higher in these cases

Effects of hallucinogens on neuronal activity

Hallucinogens evoke sensory, perceptual, affective, and cognitive effects that may be useful to understand the neurobiological basis of mood and psychotic disorders. The present chapter reviews preclinical research carried out in recent years in order to better understand the action of psychotomimetic agents such as the noncompetitive NMDA receptor (NMDA-R) antagonists and serotonergic hallucinogens. Our studies have focused on the mechanisms through which these agents alter cortical activity. Noncompetitive NMDA-R antagonists, such as phencyclidine (PCP) and MK-801 (dizocilpine), as well as the serotonergic hallucinogens DOI and 5-MeO-DMT, produce similar effects on cellular and population activity in prefrontal cortex (PFC); these effects include alterations of pyramidal neuron discharge (with an overall increase in firing), as well as a marked attenuation of the low frequency oscillations (0.2–4 Hz) to which neuronal discharge is coupled in anesthetized rodents. PCP increases c-fos expression in excitatory neurons from various cortical and subcortical areas, particularly the thalamus. This effect of PCP involves the preferential blockade of NMDA-R on GABAergic neurons of the reticular nucleus of the thalamus, which provides feedforward inhibition to the rest of thalamic nuclei. It is still unknown whether serotonergic hallucinogens also affect thalamocortical networks. However, when examined, similar alterations in other cortical areas, such as the primary visual cortex (V1), have been observed, suggesting that these agents affect cortical activity in sensory and associative areas. Interestingly, the disruption of PFC activity induced by PCP, DOI and 5-MeO-DMT is reversed by classical and atypical antipsychotic drugs. This effect suggests a possible link between the mechanisms underlying the disruption of perception by multiple classes of hallucinogenic agents and the therapeutic efficacy of antipsychotic agents.Supported by the Innovative Medicines Initiative Joint Undertaking (IMI) under Grant Agreement N° 115008 (NEWMEDS). IMI is a public–private partnership between the European Union and the European Federation of Pharmaceutical Industries and Associations. Support from the following grants is also acknowledged: SAF 2015-68346-P (Ministry of Economy and Competitiveness and European Regional Development Fund), PI09/1245 and PI12/00156 (PN de I+D+I 2008–2011, ISCIII-Subdireccion General de Evaluación y Fomento de la Investigación cofinanced by the European Regional Development Fund. “Una manera de hacer Europa”) and Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (P82, 11INT3). Support from the Generalitat de Catalunya (SGR20093) is also acknowledged. MR is recipient of a IDIBAPS fellowship.Peer reviewe