Fármacos anticonvulsionantes analgésicos y conducta suicida

El suicidio es una causa de muerte cada vez más frecuente; en el mundo ocurren alrededor de un millón de suicidios al año. Por encima de estas cifras, entre 10 y 20 millones de individuos manifiestan conductas suicidas de modo repetitivo, principalmente quienes ya han tenido intentos suicidas y quienes padecen algunas enfermedades psiquiátricas y médicas. A lo largo de los años, ha habido múltiples definiciones y descripciones de este fenómeno. Edwin Shneidman definió el suicidio como "el acto consciente de autoaniquilación, que se entiende como un malestar pluridimensional en un individuo que percibe este acto como la mejor solución". Stengel en 1961, diferenció entre el intento y la tentativa de suicidio. En el intento, hay intención autolítica, pero por impericia o fallos en el método no se ha logrado. En la tentativa, conducta parasuicida o comúnmente llamado gesto autolítico, no existe la voluntad de morir, sino que más bien es una forma de pedir ayuda o un intento de modificar situaciones para lograr un beneficio secundario. No obstante, hay conductas parasuicidas que han acabado en suicidios consumados.Departamento de Biología Celular, Histología y FarmacologíaMáster en Investigación en Ciencias de la Salu

Medication and suicidal behaviour. A case-control study

El suicidio es un importante problema de Salud Pública. Numerosos fármacos han sido relacionados con el comportamiento suicida. El objetivo del estudio fue analizar la posible asociación entre el uso de ciertos medicamentos y la aparición de un intento de suicidio. Diseñamos un estudio de casos y controles retrospectivo. Consideramos casos a aquellos pacientes hospitalizados tras un intento de suicidio; para cada caso, se seleccionaron dos controles, emparejados por edad y sexo. Se consideraron los factores de exposición y se incluyeron determinas variables relacionadas con la patología y los tratamientos farmacológicos. Se recurrió a una regresión logística para analizar los factores relacionados con el intento de suicidio y el uso de los medicamentos de interés. Se concluyó que prestar atención a situaciones como el aislamiento social, el consumo de cocaína y cannabis, el uso de ISRS y a patologías que cursan con dolor podría prevenir el comportamiento suicida.Suicide is a major public health problem. Numerous drugs have been related to suicidal behavior. The objective of the study was to analyze the possible association between the use of certain medications and the appearance of a suicide attempt. We designed a retrospective case-control study. We consider cases to those hospitalized patients after a suicide attempt; for each case, two controls were selected, matched by age and sex. Exposure factors were considered and certain variables related to pathology and pharmacological treatments were included. A logistic regression was used to analyze the factors related to the suicide attempt and the use of the medications of interest. It was concluded that paying attention to situations such as social isolation, cocaine and cannabis use, the use of SSRIs and pathologies that occur with pain could prevent suicidal behavior.Departamento de Biología Celular, Histología y Farmacologí

Realidade virtual como ferramenta motivadora ao processo de aprendizado

Este trabalho reporta os resultados do desenvolvimento de aplicações computacionais utilizando técnicas de realidade virtual, para fins de ensino e divulgação científica. O objetivo é desenvolver aplicações que possam facilitar o aprendizado, com o uso de recursos computacionais que o tornem uma atividade lúdica e mais agradável para os alunos, de forma a melhorar o envolvimento destes com os temas abordados, para que os conhecimentos possam ser melhor absorvidos. São mostrados os resultados das aplicações desenvolvidas, com as perspectivas de sua utilização através de apresentações em laboratórios das duas Instituições envolvidas

Evidencias empíricas del CAPM en el mercado español de capitales

The aim of this paper consists mainly of analyzing if the aggregated behaviour ofinvestors in the Spanish capital market corresponds with the risk-return relationshiphypothesized by CAP models. In our country little empirical work has been done usinggrouping of assets in portfolios. Different tests using two altemative rnethodologies arecanied out: the already mentioned "approach using grouping of portfolios" (Black-Jensen-Scholes, 1972) and the "perspective of individual assets" as raised by Litzemberger-Ramaswamy (1979). El objetivo del presente trabajo consiste fundamentalmente en analizar si la conductaagregada de los inversores en el mercado de capitales español concuerda con las relaciones de equilibrio rentabilidad-riesgo hipotetizadas por el CAPM. En nuestro país, se han efectuado pocas pruebas empíricas diferentes a las desarrolladas en la perspectiva de agrupamiento de activos en carteras de valores. En este trabajo se plantean los distintos tests desde dos metodologías alternativas: la ya mencionada "aproximación de agrupamiento de carteras (Black-Jensen-Scholes, 1972) y la "perspectiva de activos individuales" planteada por Litzemberger-Ramaswamy (1979).

How to Assess Diabetic Kidney Disease Progression? From Albuminuria to GFR

Malaltia renal crònica; Diabetis mellitus; Malaltia renal diabèticaEnfermedad renal crónica; Diabetes mellitus; Enfermedad renal diabéticaChronic kidney disease; Diabetes mellitus; Diabetic kidney diseaseDiabetic kidney disease (DKD) is one of the most relevant complications of type 2 diabetes and dramatically increases the cardiovascular risk in these patients. Currently, DKD is severely infra-diagnosed, or its diagnosis is usually made at advanced stages of the disease. During the last decade, new drugs have demonstrated a beneficial effect in terms of cardiovascular and renal protection in type 2 diabetes, supporting the crucial role of an early DKD diagnosis to permit the use of new available therapeutic strategies. Moreover, cardiovascular and renal outcome trials, developed to study these new drugs, are based on diverse cardiovascular and renal simple and composite endpoints, which makes difficult their interpretation and the comparison between them. In this article, DKD diagnosis is reviewed, focusing on albuminuria and the recommendations for glomerular filtration rate measurement. Furthermore, cardiovascular and renal endpoints used in classical and recent cardiovascular outcome trials are assessed in a pragmatic way.The authors are current recipients of research grants from the Fondo de Investigación Sanitaria-Feder—Instituto de Salud Carlos III (PI17/00257) and REDinREN (RD16/0009/0030)

Uncontrolled donation after circulatory death: A cohort study of data from a long‐standing deceased‐donor kidney transplantation program.

Despite good long-term outcomes of kidney transplants from controlled donation after circulatory death (DCD) donors, there are few uncontrolled DCD (uDCD) programs. This longitudinal study compares outcomes for all uDCD (N = 774) and all donation after brain death (DBD) (N = 613) kidney transplants performed from 1996 to 2015 at our center. DBD transplants were divided into those from standard-criteria (SCD) (N = 366) and expanded-criteria (N = 247) brain-dead donors (ECD). One-, 5-, and 10-year graft survival rates were 91.7%, 85.7%, and 80.6% for SCD; 86.0%, 75.8%, and 61.4% for ECD; and 85.1%, 78.1%, and 72.2% for uDCD, respectively. Graft survival was worse in recipients of uDCD kidneys than of SCD (P = .004) but better than in transplants from ECD (P = .021). The main cause of graft loss in the uDCD transplants was primary nonfunction. Through logistic regression, donor death due to pulmonary embolism (OR 4.31, 95% CI 1.65-11.23), extrahospital CPR time ≥75 minutes (OR1.94, 95%CI 1.18-3.22), and in-hospital CPR time ≥50 minutes (OR 1.79, 95% CI 1.09-2.93) emerged as predictive factors of primary nonunction. According to the outcomes of our long-standing kidney transplantation program, uDCD could help expand the kidney donor pool.post-print1,71 M

Prevalence of attention deficit hyperactivity disorder in detention settings: A systematic review and meta-analysis

© 2018 Baggio, Fructuoso, Guimaraes, Fois, Golay, Heller, Perroud, Aubry, Young, Delessert, Gétaz, Tran and Wolff. Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD. Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining "ADHD" and "prison" keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses. Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7-29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9-47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics. Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis

DIAGNÓSTICO DE BEM-ESTAR DE BOVINOS EM DOIS MATADOUROS ESTADUAIS NA REGIÃO SUL DO BRASIL

O objetivo desse trabalho foi diagnosticar o grau de bem-estar de bovinos em dois matadouros de inspeção estadual no estado de Santa Catarina por meio da identificação da incidência de pontos críticos. Planilhas utilizadas para auditoria interna de bem-estar animal em matadouros foram adaptadas. Durante a condução foram observados 156 animais e para a avaliação dos hematomas 128 carcaças. Dos 156 animais, 104 (66,6%) receberam choques elétricos, 38 (24,3%) escorregaram, nove (5,7%) caíram e 20 (12,8%) vocalizaram. Para a insensibilização dos animais foi utilizada pistola com dardo cativo penetrante, por vezes adicionado de golpes de marreta no matadouro A e de choupa nos matadouros A e B. Observou-se que apenas 11 (7,0%) bovinos apresentaram indicadores de inconsciência. Apenas três (1,9%) animais foram sangrados até no máximo um minuto após a insensibilização. Foram quantificadas 294 lesões, indicando uma média de mais de duas lesões por bovino. Conclui-se que as instalações apresentaram pontos críticos e que o impacto dos procedimentos de insensibilização sobre o grau de bem-estar dos animais estudados foi severo, necessitando melhorias para atendimento tanto de questões de bem-estar animal como regulamentares. A adoção de manejo humanitário e o monitoramento dos pontos críticos de bem-estar podem promover aumento de rendimentos e avanço ético para todos os envolvidos

Direct-acting Antivirals for the Treatment of Kidney Transplant Patients With Chronic Hepatitis C Virus Infection in Spain: A Long-term Prospective Observational Study

Background: Direct-acting antivirals (DAA) allow effective and safe eradication of hepatitis C virus (HCV) in most patients. There are limited data on the long-term effects of all-oral, interferon-free DAA combination therapies in kidney transplant (KT) patients infected with HCV. Here we evaluated the long-term tolerability, efficacy, and safety of DAA combination therapies in KT patients with chronic HCV infection. Methods: Clinical data from KT patients treated with DAA were collected before, during, and after the treatment, including viral response, immunosuppression regimens, and kidney and liver function. Results: Patients (N = 226) were mostly male (65.9%) aged 56.1 +/- 10.9 years, with a median time from KT to initiation of DAA therapy of 12.7 years and HCV genotype 1b (64.6%). Most patients were treated with sofosbuvir-based therapies. Rapid virological response at 1 month was achieved by 89.4% of the patients and sustained virological response by week 12 by 98.1%. Liver function improved significantly after DAA treatment. Tacrolimus dosage increased 37% from the beginning of treatment (2.5 +/- 1.7 mg/d) to 1 year after the start of DAA treatment (3.4 +/- 1.9 mg/d, P < 0.001). Median follow-up was 37.0 months (interquartile range, 28.4-41.9) and death-censored graft survival was 91.1%. Adverse events resulting from DAA treatment, especially anemia, were reported for 31.0% of the patients. Conclusions: Chronic HCV infection can be treated efficiently and safely with DAA therapy in KT patients. Most patients retained stable kidney function and improved liver function. Tacrolimus dose had to be increased in most patients, potentially as a result of better liver function