Factores relacionados con la incidencia temprana de trastorno depresivo en pacientes con un primer episodio de psicosis

ABSTRACT: Introduction: although depression has been thoroughly studied in chronic psychosis, we do not have a full grasp of the role of depression during a first episode of psychosis (FEP). Objective: identifying the predisposing factors of depression in FEP and how they relate to an early onset, as well as the clinical consequences in terms of outcome, functioning and suicide. Method: a review of the existing literature on depression in FEP was performed by an online search in Uptodate, Medline and Embase databases, in addition to the on-going clinical trials included in Clinicaltrial.gov. The articles selected were examined with the advice of a doctor specialized in the subject. Results: the prevalence of depression during FEP is high. Prodromal and acute depression are now emerging as key factors in the development of future depression, with post-psychotic depression rarely happening on its own. While demographic factors are not associated with depression, the association between depression and other factors such as gender, substance use, duration of untreated psychosis, and the severity of positive symptoms is contradictory. Some predisposing factors that are significantly linked to depression during all stages of the illness are insight and suicide risk. Although a worse outcome and functioning are associated with post-psychotic and persistent depression, such relationship is not present in prodromal or baseline depression. Conclusion: since the prevalence of depression during FEP is high, an early detection and management are needed in order to improve patient outcome. However, more research into this subject is required to have better knowledge of depression in FEP.RESUMEN: Introducción: aunque la depresión se ha estudiado más a fondo en la psicosis crónica, el papel de la depresión durante un primer episodio de psicosis (PEP) no se comprende completamente. Objetivo: identificar los factores predisponentes de la depresión en PEP y cómo se relacionan con un inicio temprano, así como las consecuencias clínicas en cuanto a resultados, funcionamiento y suicidio. Método: se realizó una revisión de la literatura existente sobre la depresión en PEP mediante una búsqueda en las bases de datos de Uptodate, Medline y Embase, además de los ensayos clínicos en desarrollo incluidos en Clinicaltrial.gov. Los artículos seleccionados fueron examinados con el asesoramiento de un médico especializado en el tema. Resultados: la prevalencia de depresión durante PEP es alta. La depresión en las fases prodrómica y aguda está emergiendo como factor clave en el desarrollo de depresión en el futuro, mientras que la depresión post-psicótica rara vez ocurre por sí sola. Si bien no se han encontrado factores demográficos asociados con la depresión, la asociación entre la depresión y otros factores como el género, el uso de sustancias, la duración de la psicosis no tratada y la gravedad de los síntomas positivos es contradictoria. Algunos factores predisponentes que están significativamente asociados con la depresión durante todas las etapas de la enfermedad son la percepción y el riesgo de suicidio. A pesar de que un peor resultado y funcionamiento están asociados con la depresión post-psicótica y persistente, tal relación no está presente en la depresión prodrómica o aguda. Conclusión: dado que la prevalencia de depresión durante PEP es alta, se necesita una detección y manejo tempranos para mejorar el resultado del paciente. Sin embargo, se requiere más investigación sobre este tema para tener un mejor conocimiento de la depresión en PEP.Grado en Medicin

Cooling, Physical Scales and Topology

We develop a cooling method controlled by a physical cooling radius that defines a scale below which fluctuations are smoothed out while leaving physics unchanged at all larger scales. We apply this method to study topological properties of lattice gauge theories, in particular the behaviour of instantons, dislocations and instanton--anti-instanton pairs. Monte Carlo results for the SU(2) topology are presented. We find that the method provides a means to prevent instanton--anti-instanton annihilation under cooling. While the instanton sizes are largely independent from the smoothing scale, the density and pair separations are determined by the particular choice made for this quantity. We discuss the questions this raises for the "physicality" of these concepts.Comment: 25 pages, 8 figures, minor corrections, references adde

A numerical test of the continuum index theorem on the lattice

The overlap formalism of chiral fermions provides a tool to measure the index, Q, of the chiral Dirac operator in a fixed gauge field background on the lattice. This enables a numerical measurement of the probability distribution, p(Q), in Yang-Mills theories. We have obtained an estimate for p(Q) in pure SU(2) gauge theory by measuring Q on 140 independent gauge field configurations generated on a 12^4 lattice using the standard single plaquette Wilson action at a coupling of beta=2.4. This distribution is in good agreement with a recent measurement [8] of the distribution of the topological charge on the same lattice using the same coupling and the same lattice gauge action. In particular we find =3.3(4) to be compared with = 3.9(5) found in [8]. The good agreement between the two distributions is an indication that the continuum index theorem can be carried over in a probabilistic sense on to the lattice.Comment: 17 pages, 5 figures, plain TeX, uses eps

Craniosynostosis surgery: workflow based on virtual surgical planning, intraoperative navigation and 3D printed patient-specific guides and templates

Craniosynostosis must often be corrected using surgery, by which the affected bone tissue is remodeled. Nowadays, surgical reconstruction relies mostly on the subjective judgement of the surgeon to best restore normal skull shape, since remodeled bone is manually placed and fixed. Slight variations can compromise the cosmetic outcome. The objective of this study was to describe and evaluate a novel workflow for patient-specific correction of craniosynostosis based on intraoperative navigation and 3D printing. The workflow was followed in five patients with craniosynostosis. Virtual surgical planning was performed, and patient-specific cutting guides and templates were designed and manufactured. These guides and templates were used to control osteotomies and bone remodeling. An intraoperative navigation system based on optical tracking made it possible to follow preoperative virtual planning in the operating room through real-time positioning and 3D visualization. Navigation accuracy was estimated using intraoperative surface scanning as the gold-standard. An average error of 0.62 mm and 0.64 mm was obtained in the remodeled frontal region and supraorbital bar, respectively. Intraoperative navigation is an accurate and reproducible technique for correction of craniosynostosis that enables optimal translation of the preoperative plan to the operating room. © 2019, The Author(s).This work has been supported by Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, project “PI18/01625”, co-funded by European Regional Development Fund (ERDF), “A way of making Europe”

Early detection of chronic kidney disease: multidisciplinary document

El aumento de la prevalencia de pacientes con Enfermedad Renal Crónica (ERC), la ha convertido en un problema de Salud Pública mundial, no sólo por el requerimiento de tratamiento sustitutivo renal, sino porque el desarrollo de enfermedad cardiovascular constituye la primera causa de muerte en estos pacientes. La creatinina plasmática (Crp) no siempre resulta un marcador precoz, pues su valor en sangre se eleva por encima del límite superior del intervalo de referencia cuando el Índice de Filtrado Glomerular (IFG) disminuye a la mitad. La medición del IFG con marcadores exógenos es el mejor indicador para evaluar la función renal (FR), aunque su uso en la práctica clínica se reserva para situaciones especiales. El Índice de depuración de creatinina (IDC) puede presentar errores por causa de una mala recolección de orina. Además, sobreestima el IFG debido a que la creatinina, además de ser excretada, se secreta a nivel tubular. La utilización de fórmulas asociadas a Crp está recomendada por la mayoría de las sociedades científicas. La ecuación MDRD-4 se adoptó por consenso "IFGe (mL/min/1,73 m2)= 186 x (Crp) -1.154 x (edad) -0.203 x (0,742 mujer) x (1,212 raza negra)". El factor inicial es 175 cuando el resultado de Crp es trazable a Espectrometría de Masa con Dilución Isotópica (EM-DI). Esta fórmula no es aplicable en casos de embarazadas, hospitalizados, menores de 18 o mayores de 70 años, amputados, etc. Dado que la medición de Crp es la mayor fuente de error para el cálculo de IFGe, el laboratorio debe validar su procedimiento analítico para determinar creatinina. El Error Total no debe superar el 8% para que no produzca un aumento mayor del 10% en la estimación del IFG. Para la detección de ERC se recomienda: 1) Estimar la VFG utilizando la ecuación MDRD-4 asociada a Crp (fuerza de recomendación C). 2) Informar valores de más de 60 mL/min/1,73 m2 sólo como "mayor de 60" y los valores menores de 60, como el número exacto obtenido; 3) Excluir en sistemas con cálculos automáticos las situaciones que limitan el uso de la ecuación.The increase in prevalence of patients with Chronic Kidney Disease (CKD) has turned it a worldwide public health problem not only due to its requirement of a kidney replaceable treatment, but also because cardiovascular disease is now the main cause of death among these patients. Plasma Creatinine (Crp) is not always an early marker, due to the fact that its blood levels exceed the highest limit of the reference range when the Glomerular Filtration Rate (GFR) decreases to a half. GFR measurement with exogenous markers is the best indicator to test renal function (RF), although its use in the clinical practice is only restricted to special situations. Creatinine Clearance (CC) may have errors caused by an inadequate urine collection. Moreover, it overestimates the GFR considering that creatinine is not only excreted but also secreted at the tubular level. The utilization of formulas associated to Crp is recommended by most of the Scientific Societies. The MDRD-4 equation has been adopted by consensus "eGFR (mL/min/1.73 m2)= 186 x (Crp) -1.154 x (age) -0.203 x (0.742 woman) x (1.212 black people)". When the creatinine results are traceable to isotope Dilution/Mass Spectrometry reference method, the initial factor is 175. This formula does not apply to pregnant women, hospitalized patients, people under 18 or older than 70 years old, amputees, etc. Given that the measurement of Crp is the biggest cause of error for the calculation of eGFR, the lab should validate the analytical procedure to determine creatinine. The Total Error should not exceed 8% in order not to yield an increase over 10% of GFR estimation. For CKD detection, it is recommended as follows: 1) Estimate the GFR using MDRD-4´s equation associated to Crp. (Strength of Recommendation C); 2) Report values over 60 mL/min/1.73 m2 only as "over 60" and values under 60 as the exact number obtained; 3) Exclude from automatic calculation systems, situations that limit the use of the equation.Fil: Alles, Alberto. Sociedad Argentina de Nefrología; ArgentinaFil: Fraga, Adriana Raquel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Sociedad Argentina de Nefrología; Argentina. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Houssay. Instituto de Investigaciones Medicas; ArgentinaFil: García, Roberto Daniel. Fundación Bioquímica Argentina; ArgentinaFil: Gómez, Alejandra. Asociación Bioquímica Argentina; ArgentinaFil: Greloni, Gustavo. Sociedad Argentina de Nefrología; ArgentinaFil: Inserra, Pablo Ignacio Felipe. Sociedad Argentina de Nefrología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mazziotta, Daniel. Fundación Bioquímica Argentina; ArgentinaFil: Torres, María Lía. Fundación Bioquímica Argentina; ArgentinaFil: Villagra, Alberto. Asociación Bioquímica Argentina; Argentin

QCD vacuum structure

Several issues related to the structure of the QCD vacuum are reviewed. We concentrate mostly on results concerning instantons and center vortices.Comment: Lattice 2000 (Plenary), 8 pages, 2 figures; typos corrected, hep-numbers of references updated, one figure replaced by black and whit

Topology of the SU(2) vacuum: a lattice study using improved cooling

We study the topological structure of the SU(2) vacuum at zero temperature: topological susceptibility, size, shape and distance distributions of the instantons. We use a cooling algorithm based on an improved action with scale invariant instanton solutions. This algorithm needs no monitoring or calibration, has an inherent cut off for dislocations and leaves unchanged instantons at physical scales. The physical relevance of our results is checked by studying the scaling and finite volume dependence. We obtain a susceptibility of (200(15) MeV)^4. The instanton size distribution is peaked around 0.43fm, and the distance distribution indicates a homogeneous, random spatial structure.Comment: 45 pages, Latex, 19 figures. Improvements and some new remarks added in sections 3.4, 3.5, 4. and figures 14, 16, 17 and 18 (concerning mostly I-A interactions and density-density correlations). New references adde

Phosphoenolpyruvate carboxylase dentified as a key enzyme in erythrocytic Plasmodium falciparum carbon metabolism

Phospoenolpyruvate carboxylase (PEPC) is absent from humans but encoded in thePlasmodium falciparum genome, suggesting that PEPC has a parasite-specific function. To investigate its importance in P. falciparum, we generated a pepc null mutant (D10Δpepc), which was only achievable when malate, a reduction product of oxaloacetate, was added to the growth medium. D10Δpepc had a severe growth defect in vitro, which was partially reversed by addition of malate or fumarate, suggesting that pepc may be essential in vivo. Targeted metabolomics using 13C-U-D-glucose and 13C-bicarbonate showed that the conversion of glycolytically-derived PEP into malate, fumarate, aspartate and citrate was abolished in D10Δpepc and that pentose phosphate pathway metabolites and glycerol 3-phosphate were present at increased levels. In contrast, metabolism of the carbon skeleton of 13C,15N-U-glutamine was similar in both parasite lines, although the flux was lower in D10Δpepc; it also confirmed the operation of a complete forward TCA cycle in the wild type parasite. Overall, these data confirm the CO2 fixing activity of PEPC and suggest that it provides metabolites essential for TCA cycle anaplerosis and the maintenance of cytosolic and mitochondrial redox balance. Moreover, these findings imply that PEPC may be an exploitable target for future drug discovery

Famílies botàniques de plantes medicinals

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia, Assignatura: Botànica Farmacèutica, Curs: 2013-2014, Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són els recull de 175 treballs d’una família botànica d’interès medicinal realitzats de manera individual. Els treballs han estat realitzat per la totalitat dels estudiants dels grups M-2 i M-3 de l’assignatura Botànica Farmacèutica durant els mesos d’abril i maig del curs 2013-14. Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pel professor de l’assignatura i revisats i finalment co-avaluats entre els propis estudiants. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica