SENTIA: a systematic online monitoring registry for children and adolescents treated with antipsychotics

INTRODUCTION: Despite drastic increases in antipsychotic prescribing in youth, data are still limited regarding their safety in this vulnerable population, necessitating additional tools for capturing long-term, real world data. METHODS: We present SENTIA (SafEty of NeurolepTics in Infancy and Adolescence; https://SENTIA.es), an online registry created in 2010 to track antipsychotic adverse effects in Spanish youth <18 years old currently taking or initiating with any antipsychotic treatment. SENTIA collects information on sociodemographic, diagnostic and treatment characteristics, past personal medical/psychiatric history, healthy lifestyle habits and treatment adherence. Additionally, efficacy and adverse effect data are recorded including the Children’s Global Assessment Scale; Clinical Global Impressions scale for Severity and Improvement, the Safety Monitoring Uniform Report Form, Simpson-Angus Scale, Abnormal Involuntary Movement Scale, vital signs, blood pressure, and EKG. Finally, fasting blood is drawn for hematology, electrolytes, renal, liver and thyroid function, glucose, insulin, lipid, prolactin and sex hormone levels. Initially, a diagnostic interview and several psychopathology scales were also included. Patients are assessed regularly and followed even beyond stopping antipsychotics. RESULTS: Since 01/17/2011, 85 youth (11.5 ± 2.9 (range = 4-17) years old, 70.6% male) have been included at one inaugural center. After a mean duration of 17 ± 11 (range = 1-34) months, 78.8% are still actively followed. For feasibility reasons, the diagnostic interview and detailed psychopathology scales were dropped. The remaining data can be entered in <30 minutes. Several additional centers are currently being added to SENTIA. CONCLUSIONS: Implementation of a systematic online pharmacovigilance system for antipsychotic adverse effects in youth is feasible and promises to generate important information

La investigación biomédica en España (II). Evaluación del Fondo de Investigación Sanitaria (FIS) a través de los proyectos de investigación financiados en el período 1988-1995 a centros de investigación, facultades y escuelas

En un trabajo previo, publicado en esta misma revista, los autores han estudiado los resultados generados por los proyectos de investigación financiados por el Fondo de Investigación Sanitaria (FIS) a las Instituciones Sanitarias Asistenciales (hospitales) y los procedentes de los cuestionarios de encuestas remitidos a los investigadores responsables de tales proyectos y a los directores gerentes de los hospitales en los que se realizaron los mismos. En el presente trabajo, se continúa el proceso de evaluación del FIS, centrándose la atención en la distribución de los proyectos de investigación concedidos a los centros de investigación, facultades y escuelas, y en los resultados obtenidos a través de los cuestionarios de encuesta cumplimentados por los investigadores principales pertenecientes a estas instituciones o entidades.La realización de este trabajo ha sido posible gracias a la financiación otorgada por el FIS al proyecto de investigación 96/1803.Peer reviewe

Estudio de las alteraciones endocrinas durante el uso de psicofármacos en la infancia y adolescencia a partir de una base de datos prospectiva en atención especializada del área VI

La prescripción de antipsicóticos en niños y adolescentes ha aumentado en los últimos 25 años. El uso de los medicamentos antipsicóticos en la población pediátrica es considerado relativamente nuevo comparado con el uso en los adultos. Simultáneamente con este incremento de uso también se observa que el uso “off label” de antipsicóticos en la población pediátrica se ha incrementado en los últimos años, a pesar de la falta de datos de seguridad, especialmente en estudios a largo plazo. Los niños y adolescentes tienen una mayor susceptibilidad de aparición de reacciones adversas a los medicamentos y el riesgo de ineficacia aumenta en comparación con los adultos. Los niños no son solo diferentes a los adultos, sino además difieren mucho entre grupos de edad. El uso de los antipsicóticos de segunda generación se asocia a efectos cardiometabólicos y endocrinos. La hiperprolactinemia puede producir supresión de la hormona liberadora de gonadotrofina e hipogonadismo. Con el aumento del uso de medicamentos psicotrópicos en la población pediátrica, es crucial la realización de una monitorización de su seguridad para proporcionar un análisis informado de riesgo-beneficio en esta población..

Disadvantages of living in a populous neighborhood for sit-andwait predators: Competition for space reduces pit-trap size in antlion larvae

The study of how trap design responds to biotic and abiotic conditions can help to understand the selective forces affecting the foraging of trap-building organisms. We experimentally tested whether pit design can be modified by intraspecific competition for space in larvae of Myrmeleon crudelis, a common sit-and-wait predator that digs conical pit traps in the soil to capture walking arthropods. In a tropical forest in Costa Rica, we measured pit dimensions, larval body size, and the level of competition (i.e., density of neighboring traps) in 40 antlion larvae. These larvae were then taken to the laboratory and allowed to build new traps in individual containers. We measured within-individual changes in the size of traps in the field and in the laboratory, and related these to the level of competition experienced in the field. Larvae with relatively high levels of competition in the field showed a greater increase in the size of their pits in the laboratory. This change was independent of larval size. Larvae with none or few neighbors in the field showed little change in their pit sizes, whereas those with higher competition levels increased their diameter and depth up to 1,400% and 1,000%, respectively. Our results demonstrate that, at least in high-density aggregations, pit design is restricted by competition in addition to the constraints imposed by body size. This work suggests that biotic interactions can play a role in the design of extended phenotypes in sit-and-wait predators that live in dense aggregationsEl estudio de cómo el diseño de las trampas responde a las condiciones bióticas y abióticas puede ayudar a comprender las fuerzas selectivas que afectan la búsqueda de alimento de los organismos constructores de trampas. Probamos experimentalmente si el diseño del pozo puede modificarse mediante la competencia intraespecífica por el espacio en las larvas de Myrmeleon crudelis, un depredador común que se sienta y espera que excava trampas cónicas en el suelo para capturar artrópodos que caminan. En un bosque tropical de Costa Rica, medimos las dimensiones del pozo, el tamaño del cuerpo de las larvas y el nivel de competencia (es decir, la densidad de las trampas vecinas) en 40 larvas de hormiga león. Luego, estas larvas se llevaron al laboratorio y se les permitió construir nuevas trampas en contenedores individuales. Medimos los cambios intraindividuales en el tamaño de las trampas en el campo y en el laboratorio, y los relacionamos con el nivel de competencia experimentado en el campo. Las larvas con niveles relativamente altos de competencia en el campo mostraron un mayor aumento en el tamaño de sus hoyos en el laboratorio. Este cambio fue independiente del tamaño de las larvas. Las larvas con pocos o nulos vecinos en el campo mostraron pocos cambios en el tamaño de sus fosas, mientras que aquellas con niveles de competencia más altos aumentaron su diámetro y profundidad hasta 1.400% y 1.000%, respectivamente. Nuestros resultados demuestran que, al menos en agregaciones de alta densidad, el diseño del pozo está restringido por la competencia además de las restricciones impuestas por el tamaño del cuerpo. Este trabajo sugiere que las interacciones bióticas pueden desempeñar un papel en el diseño de fenotipos extendidos en depredadores que se sientan y esperan que viven en densas agregaciones.Universidad Nacional del Comahue, ArgentinaUniversidad Nacional de Córdoba, ArgentinaUniversidad Nacional, Costa RicaUniversidade Federal de Pernambuco, BrasilInstituto de Ecología, MéxicoUniversidad Nacional de San Agustín, PerúMuseo de Historia Natural Noel Kempff Mercado, BoliviaEscuela de Ciencias Biológica

Antlion allometry suggests a greater importance of prey capture among first larval instars

First larval stages require adequate feeding to reach subsequent instars. However, the accumulation of reserves is also important in the last larval instar because it is vital to pupate and successfully perform metamorphosis into adulthood. We indirectly determined the presence of changes in the relative importance of prey capture through larval ontogeny in the antlion larvae (Neuroptera Myrmeleontidae), a sit-and-wait predator with three instar stages that capture preys that fall into their pit-traps. We used scaling relationships between the size of body parts directly related to prey capture (prothorax) versus those that are not (thorax + abdomen). The prothorax (neck, head, and mandibles) is used in the pit building, prey capture, and re-capture, and pit cleaning. We measured the body parts of 70 larvae of Myrmeleon crudelis in a tropical rain forest of Costa Rica. The prothorax showed negative allometry: it was proportionally larger in the first than in the last instars. These results support the growth hypothesis, which states that food acquisition is key in the earlier stages of larval development. First instars can be more food-limited than later instars because they build small pit-traps where only very small arthropods can fall; have smaller mandibles and relatively lower grab force, increasing the probability of the prey escaping; and have smaller fat reserves and thus, are unable to resist long periods of starvation. This illustrates the relevance of using scaling relationships to better understand how ecological pressures change along ontogeny, emphasizing the role of food acquisition at earlier ontogenetic stages.Fil: Farji Brener, Alejandro Gustavo. Universidad Nacional del Comahue. Centro Regional Universitario Bariloche; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Biodiversidad y Medioambiente. Universidad Nacional del Comahue. Centro Regional Universidad Bariloche. Instituto de Investigaciones en Biodiversidad y Medioambiente; ArgentinaFil: Juncosa Polzella, Agostina Silvia. Universidad Nacional de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Madrigal Tejada, Daniela. Universidad Nacional de Costa Rica; ArgentinaFil: Centeno Alvarado, Diego. Universidade Federal de Pernambuco; BrasilFil: Hernández Soto, Mariana. Instituto de Ecología; MéxicoFil: Soto Huaira, Mayori. Universidad Nacional de San Agustin de Arequipa. Museo de Historia Natural; PerúFil: Gutiérrez Cruz, Sebastián. Museo de Historia Natural Noel Kempff Mercado; Bolivi

Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study

[Background] Concerns have been raised about the possibility that inhibitors of the renin–angiotensin–aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19.[Methods] In this case-population study, we consecutively selected patients aged 18 years or older with a PCR-confirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437.[Findings] We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62–2·41) and risk factors (1·46, 1·23–1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77–1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64–1·00) or angiotensin-receptor blockers (1·10, 0·88–1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34–0·80). The adjusted ORs were similar across severity degrees of COVID-19.[Interpretation] RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19.This study was funded by a research grant from the Institute of Health Carlos III (COV20/00027).Peer reviewe

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care