The Absence of Caspase-8 in the Dopaminergic System Leads to Mild Autism-like Behavior

In the last decade, new non-apoptotic roles have been ascribed to apoptotic caspases. This family of proteins plays an important role in the sculpting of the brain in the early stages of development by eliminating excessive and nonfunctional synapses and extra cells. Consequently, impairments in this process can underlie many neurological and mental illnesses. This view is particularly relevant to dopamine because it plays a pleiotropic role in motor control, motivation, and reward processing. In this study, we analyze the effects of the elimination of caspase-8 (CASP8) on the development of catecholaminergic neurons using neurochemical, ultrastructural, and behavioral tests. To do this, we selectively delete the CASP8 gene in cells that express tyrosine hydroxylase with the help of recombination through the Cre-loxP system. Our results show that the number of dopaminergic neurons increases in the substantia nigra. In the striatum, the basal extracellular level of dopamine and potassium-evoked dopamine release decreased significantly in mice lacking CASP8, clearly showing the low dopamine functioning in tissues innervated by this neurotransmitter. This view is supported by electron microscopy analysis of striatal synapses. Interestingly, behavioral analysis demonstrates that mice lacking CASP8 show changes reminiscent of autism spectrum disorders (ASD). Our research reactivates the possible role of dopamine transmission in the pathogenesis of ASD and provides a mild model of autism

Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study

To obtain an adequate view of the whole small intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting is recommended. However, intestinal content can hamper vision in spite of these measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation. PATIENTS AND METHODS: This was a prospective, multicenter, randomized, controlled study. Two-hundred ninety-one patients underwent one of the following preparations: 4 L of clear liquids (CL) (group A; 92 patients); 90 mL of aqueous sodium phosphate (group B; 89 patients); or 4 L of a polyethylene glycol electrolyte solution (group C; 92 patients). The degree of cleanliness of the small bowel was classified by blinded examiners according to four categories (excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit times, and diagnostic yield were measured. RESULTS: The degree of cleanliness did not differ significantly between the groups (P = 0.496). Interobserver concordance was fair (k = 0.38). No significant differences were detected between the diagnostic yields of the CE (P = 0.601). Gastric transit time was 35.7 +/- 3.7 min (group A), 46.1 +/- 8.6 min (group B) and 34.6 +/- 5.0 min (group C) (P = 0.417). Small-intestinal transit time was 276.9 +/- 10.7 min (group A), 249.7 +/- 13.1 min (group B) and 245.6 +/- 11.6 min (group C) (P = 0.120). CL was the best tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C (P = 0.008). CONCLUSIONS: A clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of preparation

Immunology of multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) leading to demyelination, axonal damage, and progressive neurologic disability. The development of MS is influenced by environmental factors, particularly the Epstein-Barr virus (EBV), and genetic factors, which include specific HLA types, particularly DRB1*1501-DQA1*0102-DQB1*0602, and a predisposition to autoimmunity in general. MS patients have increased circulating T-cell and antibody reactivity to myelin proteins and gangliosides. It is proposed that the role of EBV is to infect autoreactive B cells that then seed the CNS and promote the survival of autoreactive T cells there. It is also proposed that the clinical attacks of relapsing-remitting MS are orchestrated by myelin-reactive T cells entering the white matter of the CNS from the blood, and that the progressive disability in primary and secondary progressive MS is caused by the action of autoantibodies produced in the CNS by ­meningeal lymphoid follicles with germinal centers

Perfil de los pacientes que acuden al médico internista para valoración de osteoporosis: registro OSTEOMED

Producción CientíficaAntecedentes y objetivo: La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteración de la resistencia ósea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales características clínicas de los pacientes que acuden a la consulta de los médicos internistas en Espa˜na. Conocer estas características podría facilitar la puesta en marcha de planes de actuación para mejorar la atención de estos pacientes de manera más eficaz y eficiente. Material y métodos: A través del análisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales características clínicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios espa˜noles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitométricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados: En total se evaluó a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ± 12,1 a˜nos (mujeres, 64,7 ± 11,5 a˜nos; hombres, 61,2 ± 14,2 a˜nos). No hubo diferencia entre sexos en la historia de caídas recientes (9,1-6,7%), mientras que sí se apreció en la ingesta diaria de calcio de lácteos (553,8 ± 332,6 mg en mujeres vs. 450,2 ± 303,3 mg en hombres; p < 0,001) y en causas secundarias de osteoporosis(13% de hombres vs. 6,5% de mujeres; p < 0,001). En la muestra se observaron un total de 404fracturas (20%), destacando el número de fracturas vertebrales confirmadas (17,2%, 35,6% enhombres vs. 15,2% de las mujeres; p < 0,001). Una gran parte de los pacientes no recibía eltratamiento indicado y presentaba bajos niveles de actividad física y exposición solar. Un por-centaje importante de pacientes presentó comorbilidades asociadas, siendo las más frecuentesla hipertensión (32%) y la dislipidemia (28%).Conclusiones: Estos resultados definen el perfil del paciente con osteoporosis que acude a laconsulta de Medicina Interna en Espa˜na. Además, ponen de manifiesto el carácter multisistémicode esta entidad que junto con su elevada prevalencia determinan que las consultas específicasde Medicina Interna dedicadas a su manejo son el lugar adecuado para la atención de estos pacientes

Pattern of degeneration of the rat inferior olivary complex after the early postnatal axotomy of the olivocerebellar projection

Neuronal death of inferior olivary neurons after early axotomy of the olivocerebellar tract was studied in newborn (Pl) hemicerebellectomized rats during the first six days after lesion. The degeneration of the inferior olive showed a topographic pattem from one (P2) to six days after axotomy (P7), after which this complex had almost completely disappeared. The first degenerative changes were observed in the principal olive (P2), while the media1 accessory olive was the later-degenerated area (P5). The analysis of these degenerative changes provides a reference for future experimental studies. Furthermore, the topographic study of the degenerative process demonstrated that: i) the most vulnerable neurons were dorsolaterally located, whereas the most resistant ones occupied the media1 aspect of the inferior olivary complex, ii) the comparison between the topographical arrangement of the inferior olivary neurons according to their birth dates, and the rate of degenerative changes observed after hemicerebellectomy, open the possibility that the neurona1 generation date and the response to the axotomy of the inferior olivary neurons could be related

The bad compliance to the antipsycotic therapy: the role the nurse.

Gracias a la aparición de nuevos tratamientos dirigidos a la patología psicótica, se ha experimentado un gran avance en la lucha contra la Esquizofrenia, pero a pesar de ello, sigue existiendo actualmente un alto porcentaje de pacientes diagnosticados de este Trastorno Mental que no cumplen con el tratamiento, con las consiguientes recaídas y nuevos ingresos. Según datos del Ministerio de Sanidad, aproximadamente de un 4 a 12% de los pacientes con Trastornos Mentales, siguen de forma rigurosa su tratamiento farmacológico; el resto prefiere no ingerir fármaco alguno, ya sea porque cree no necesitarlos o porque dejan de tomarlos después de sufrir síntomas indeseables a causa de los efectos colaterales, por lo que creemos que el principal factor de contribución para el control efectivo de este tipo de enfermedades es la adherencia del paciente al tratamiento y la concienciación de la necesidad del mismo. De ahí que la puesta en marcha por equipos profesionales de Enfermería de programas, de aceptación, conocimiento y manejo de fármacos antipsicóticos, ya sean desde las unidades de agudos, subagudos, o cualesquiera de los diferentes dispositivos extrahospitalarios, son vitales para asegurar un mínimo de cumplimiento terapéutico.ABSTRACT: Thanks to the availability of new antipsychotic treatments, the fight against schizophrenia has obtained promising results. But, to date, there are still a percentage of people who do not adhere to the treatment. Obviously, all this leadsto a recurrence of the disorder and to an increase of the hospital admissions. According to the Ministry of Health figures, from 4 to 12% of patients take the treatment exactly as prescribed, while the others prefer not to take any medication, both, because they think they do not need them or because they experience sideeffects. We deem necessary good treatment compliance, as it may be the most important factor to improve the control rates psychotic illnesses. For this reason, the implementation by nurses of education programs to motivate patients to comply (in acute, subacute or outpatient psychiatric units) is deemed to be of high importance to improve patient adherence to treatments

Taking care of the caregivers: family care

El cuidado de la persona que padece alguno de los diferentes Trastornos Mentales plantea una serie de desafíos importantes en el entorno familiar. Esto hace que muchas de las familias que desempeñan el rol de cuidador experimenten situaciones estresantes y de sobrecarga, situaciones que a menudo afectan a la salud física y mental, produciendo todo tipo de desajustes emocionales. En el presente trabajo haremos referencia a la situación familiar que se produce tras el ingreso de uno de sus miembros en una Unidad de Agudos y una reflexión sobre las actuaciones que Enfermería en Salud Mental puede y debe realizar. Esta atención a familias, incluye una serie de acciones destinadas a acompañar en el proceso de enfermedad, informar sobre los cuidados, clarificar dudas y reajustar expectativas, todo esto en un clima de acercamiento familia-enfermera. El objetivo principal sería por lo tanto el acercamiento a la familia como unidad de atención, utilizando instrumentos que ayuden a abordar y conocer la estructura familiar, los factores estresores y en definitiva el tratar a la familia en el contexto hospitalario, detectando posibles disfunciones desadaptativas.ABSTRACT: The primary care of a psychiatric patient represents a real challenge for the family environment, this situation causes that many of the families that play the caregiver role experience stressing and overwhelming feelings that can directly evoke physical and mental problems causing several types of emotional distress. In this communication named “Taking care of the caregivers: Family Care” we will make reference to the situation that emerges after the hospitalization of one of the family members in a psychiatric emergency unit and a thought about the actions that the psychiatrical nurses can and should take. This family atention includes a series of actions with a common goal: to be with the family in the disease process, to inform about the cares that have to be given to the patient, to clarify the doubts and adjust their expectances among a warm and kind family-nurse realtionship. The principal objective is the aproaching to the patient family as the primary attention focus by means of instruments that can help this aproach, the knowledge of the family structure, the most probable stressing factors and definitely to treat the whole family in a hospital scenario in order to detect the posible disfunctions