Catatonia Secondary to Sudden Clozapine Withdrawal: A Case with Three Repeated Episodes and a Literature Review

A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5). The Liverpool Adverse Drug Reaction (ADR) Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is described with three catatonic episodes which (1) occurred after sudden discontinuation of clozapine in the context of decades of follow-up, (2) had ≥3 of 12 DSM-5 catatonic symptoms and serum creatinine kinase elevation, and (3) required medical hospitalization and intravenous fluids. Clozapine may be a gamma-aminobutyric acid (GABA) receptor agonist; sudden clozapine withdrawal may explain a sudden decrease in GABA activity that may contribute to the development of catatonic symptoms in vulnerable patients. Based on the limited information from these cases, the pharmacological treatment for catatonia secondary to sudden clozapine withdrawal can include benzodiazepines and/or restarting clozapine

Three Patients Needing High Doses of Valproic Acid to Get Therapeutic Concentrations

Valproic acid (VPA) can autoinduce its own metabolism. Cases requiring VPA doses \u3e4000 mg/day to obtain therapeutic plasma concentrations, such as these 3 cases, have never been published. Case 1 received VPA for seizures and schizophrenia and had \u3e50 VPA concentrations in 4 years. A high dose of 5,250 mg/day of VPA concentrate was prescribed for years but this dose led to an intoxication when switched to the enterocoated divalproex sodium formulation, requiring a normal dose of 2000 mg/day. VPA metabolic capacity was significantly higher (t = -9.6; df = 6.3, p \u3c 0.001) during the VPA concentrate therapy, possibly due to autoinduction in that formulation. Case 2 had VPA for schizoaffective psychosis with 10 VPA concentrations during an 8-week admission. To maintain a VPA level ≥50 μg/mL, VPA doses increased from 1500 to 4000 mg/day. Case 3 had tuberous sclerosis and epilepsy and was followed up for \u3e4 years with 137 VPA concentrations. To maintain VPA concentrations ≥50 μg/mL, VPA doses increased from 3,375 to 10,500 mg/day. In Cases 2 and 3, the duration of admission and the VPA dose were strongly correlated (r around 0.90; p \u3c 0.001) with almost no change after controlling for VPA concentrations, indicating progressive autoinduction that increased with time

Catatonia Secondary to Sudden Clozapine Withdrawal: A Case with Three Repeated Episodes and a Literature Review

A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5). The Liverpool Adverse Drug Reaction (ADR) Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is described with three catatonic episodes which (1) occurred after sudden discontinuation of clozapine in the context of decades of follow-up, (2) had ≥3 of 12 DSM-5 catatonic symptoms and serum creatinine kinase elevation, and (3) required medical hospitalization and intravenous fluids. Clozapine may be a gamma-aminobutyric acid (GABA) receptor agonist; sudden clozapine withdrawal may explain a sudden decrease in GABA activity that may contribute to the development of catatonic symptoms in vulnerable patients. Based on the limited information from these cases, the pharmacological treatment for catatonia secondary to sudden clozapine withdrawal can include benzodiazepines and/or restarting clozapine

Development of “DECOAM” Eco-Friendly Detergent that Minimizes Eutrophication

Abstract. During the First and Second World Wars, there was a significant in- crease in wastewater from animal and vegetable fats treated with newly produced detergents. However, these detergents are still conventional and contain in their composition chemical and harmful compounds that affect the aquatic environ- ment. Faced with this problem, it was proposed to develop a biodegradable detergent with low concentrations of phosphorus and nitrogen to minimize eutrophication. The "DECOAM" detergent was made with organic products, its main component being orange peel, which replaces the surfactants contained in conventional de- tergents. In order to contrast the efficiency of the eco-friendly detergent with conventional detergents, two dirty garments (covered with mud and ash) were washed, one with the conventional detergent and the other with the biodegradable detergent, where both garments were impeccable. Immediately afterward, the samples of each wastewater were taken and the results obtained from the laboratory were: the wastewater from the conventional detergent had the following concentrations: pH (11.15), T° (12.8 °C), Conductivity (11 550 uS/cm), Phosphorus (4. 310 mg/L) and Total Nitrogen (20.24 mg/L); and for the wastewater from the eco- friendly detergent "DECOAM" were: pH (7.01), T° (12.5 °C), Conductivity (448 uS/cm), Phosphorus (0.316 mg/L) and Total Nitrogen (< 1.00 mg/L). Finally, it was concluded that the biodegradable detergent has the same efficiency as the conventional detergent in removing the dirt; on the other hand, the concen- tration of phosphorus and nitrogen were significantly lower compared to the con- ventional detergent, thus reducing eutrophication in the surface water bodies

Resistencia axial de columna cervical en Scrofa Landrace machos de 6 a 8 meses de nacido, en comparación con estudios en humanos

La columna cervical humana es una región del esqueleto axial que presenta un alto grado de lesión traumática por estar expuesta a gran movilidad. Existen medios científicos dedicados a la búsqueda de los posibles avances tecnológicos en aparatos de estabilización y de reemplazo de vertebras pertenecientes a la región cervical de uso corriente denominados prótesis. El proyecto se hizo con el objetivo de medir la resistencia de la compresión axial de los cuerpos vertebrales y las unidades funcionales cervicales de Scrofa Landrace (porcino) machos entre 6 y 8 meses de nacido, compararlas con datos bibliográficos humanos y proponerlo como modelo biomecánico de experimentación y como una opción de xenoinjerto para patologías de lesión vertebral o discal en humanos; para ello se realizó un estudio cuasi-experimental, descriptivo y comparativo, en el que se efectuaron ensayos de compresión axial en unidades de cuerpo anterior (UCA) vertebrales cervicales de 20 especímenes y Unidades funcionales (UF) vertebrales cervicales de 20 especímenes, los datos recolectados incluían tanto la máxima carga, como máximo desplazamiento, y a partir de estos se halló el coeficiente de rigidez y el coeficiente de flexibilidad de los distintos segmentos cervicales. Los resultados obtenidos de las experiencias arrojaron para UCA una máxima carga promedio para el segmento C5 (2590 N) y en UF en el segmento C4 – C5 (3813 N), esto debido la pronunciación de la lordosis en C4 – C5, lo cual hace que se encuentre el cambio de angulación soportando así el mayor peso. Con respecto al coeficiente de rigidez, las UF superaron ampliamente los valores de las UCA, esto explicado por la función estática de pilar anterior del disco intervertebral en la columna cervical. En comparación con estudios en humanos, estos fueron menores a los resultados obtenidos en este proyecto, siendo la proporción coeficiente de rigidez y máxima carga soportada mayor en la columna porcina; los datos de este proyecto superaron los datos encontrados en los estudios en humanos explicando la mayor densidad de las vértebras de porcinos

Necesidades de las familias de niños con deficiencia auditiva en las áreas de educación y salud

14 páginas.​El objetivo de esta investigación fue develar las necesidades de las familias de niños y niñas con deficiencia auditiva en las áreas de educación y salud, llevando a cabo un acercamiento a su realidad y las particularidades de los grupos familiares. Se utilizó una metodología cualitativa y un estudio de tipo descriptivo. Se encontró que las familias de los niños han tenido dificultades para el acceso a la atención en salud que requieren, lo cual ha incidido en que los padres acudan a la acción de tutela para garantizar que el niño acceda a los servicios que requiere, de igual manera se identificó que pocos niños reciben atención especializada en salud para la evaluación de su deficiencia auditiva y/o implantes cocleares de tenerlos. En el área de educación se estableció que los niños han participado de procesos de educación inclusiva, en los cuales se ha promovido su vinculación al aula regular. Se recomienda que para futuras investigaciones se continúen explorando las necesidades de las familias de niños con deficiencia auditiva y otro tipo de deficiencia, así como, la investigación con otros grupos etáreos con este tipo de deficiencias. De igual forma, se sugiere llevar a cabo estudios con metodología cuantitativa que den cuanta de otras dimensiones del fenómeno.The objective of this research was to uncover the needs of families of children with hearing impairment in the areas of education and health, carrying out an approach to the reality of these and the particularities of family groups. A qualitative methodology and descriptive study was used. It was found that the families of the children have had difficulty accessing the health care they need, which has stressed that parents attend the tutela to ensure that the child access the services required, just identified so few children receive specialized health for assessment of his hearing impairment and / or cochlear implants to have them attention. In education area, it was established that the children have participated inclusive process of education, which has promoted its relationship to the regular classroom. It is recommended that future research will continue to explore the needs of families of children with hearing impairment and other deficiencies and work in another age group with such shortcomings. Similarly, conducting studies with quantitative methodology to give as much of the other dimensions of this phenomenon

Uso de Anticonceptivos Orales y Percepción del Papel del Farmacéutico Comunitario entre Adolescentes: un estudio observacional

Introduction: Unintended pregnancies in adolescents have serious consequences both for the adolescents themselves and their babies and for the use of health system resources. One of the reasons is the low use of oral contraceptive pills (OCPs) among this population, mainly due to lack of information or non-adherence to the medication. The aim of this study was to describe the information adolescents receive about OCPs and their use, as well as their perception of the role of the community pharmacist in this field. Method: A cross-sectional observational study was carried out by means of a survey applied to women aged 12-19 years living in Spain, regardless of whether or not they had used OCPs, during April 2021. Different social networks were used to disseminate the survey. Different Spanish associations dedicated to family planning and adolescent sexual health counselling were also contacted. Results: 81.7% (n=76) of respondents had not taken OCPs, although 35.5% (n=33) had had sex. The 6% (n=1) who were taking or had taken OCPs reported adherence. 88% (n=82) thought that the pharmacist is knowledgeable about medicines; however, only 19.4% (n=18) would consult them for OCP questions. Conclusions: To solve the problems of lack of information about OCPs and adherence in adolescent women, the community pharmacist is an accessible professional who can contribute to this by taking an active role and using different forms of educational materials.Introducción: Los embarazos no deseados en adolescentes tienen graves consecuencias tanto para las propias adolescentes y sus bebés como para el uso de los recursos del sistema sanitario. Una de las razones es el escaso uso de píldoras anticonceptivas orales (ACO) entre esta población, debido principalmente a la falta de información o a la no adherencia a los medicamentos. El objetivo de este estudio fue describir la información que reciben las adolescentes sobre los ACO y su uso, así como su percepción del papel del farmacéutico comunitario en este campo. Método: Se realizó un estudio observacional transversal mediante encuesta, aplicada a mujeres entre 12-19 años residentes en España, independientemente de si habían utilizado o no ACO, durante abril de 2021. Para la difusión de esta encuesta se utilizaron diferentes redes sociales. Asimismo, se contactó con diferentes asociaciones españolas dedicadas a la orientación de la planificación familiar y la salud sexual en adolescentes. Resultados: El 81,7% (n=76) de los encuestados no había tomado ACO, aunque el 35,5% (n=33) sí había mantenido relaciones sexuales. El 6% (n=1) que tomaba o había tomado ACO informó que eran adherentes. El 88% (n=82) pensaba que el farmacéutico tiene conocimientos sobre medicamentos; sin embargo, sólo el 19,4% (n=18) les consultaría para resolver dudas sobre ACO. Conclusiones: Para resolver los problemas de falta de información sobre ACO y de adherencia en mujeres adolescentes, el farmacéutico comunitario es un profesional accesible que puede contribuir a ello adoptando una actitud activa y utilizando diferentes formas de material educativo

Synthesising quantitative evidence in systematic reviews of complex health interventions

Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America : the ESTAMPA screening study protocol

Q1Q1Introduction Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. Methods and analysis Women aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number NCT01881659Revista Internacional - Indexad