Long-term assessment of plasma lipids in transplant recipients treated with tacrolimus in relation to fatty liver.

Immunosuppression has improved graft and recipient survival in transplantation but is associated with possible adverse effects including cardiovascular diseases. The impact of tacrolimus on the lipidic profile has been debated for several years. Twenty-nine kidney transplant recipients on tacrolimus treatment were monitored for six years, and multiple laboratory parameters investigating the lipid asset, as well as glucose profile, were carried out. Tacrolimus has been responsible for significant changes in plasma lipid concentrations only for the first six months, but not for the remaining time of observation. Similarly, in the same periods, glycemic imbalance was highlighted. The liver enzyme activity showed a modest derangement during the tacrolimus treatment, suggesting the presence of lipid accumulation in the liver. Fatty liver reversed in the long term follow-up. Tacrolimus, although it is not a completely safe option in the first months of the immunosuppressive protocols in organ transplanted recipients, still retains a certain role in the long-term post-transplantation immunosuppressive approach with high cardiovascular risk

MARIJUANA LEGALIZATION: ETHICAL CHALLENGES

Nowadays, there is a global debate on recreational and medical marijuana legalization, but the facts show us that we know too little about its long term effects on human health. Thus far, there have not been enough large-scale clinical trials showing the benefits of the marijuana plant and its risks as potential medication. Many studies have reported about the detrimental effects of marijuana. Safety concerns, include cognitive impairment, increased risk of motor-vehicle accidents, increased risk of unsafe sexual behaviors, mood swings, severe anxiety, paranoia, psychosis, addiction, altered brain development, respiratory problems, vascular and heart damage. Unfortunately, these effects are not properly addressed by mass media. Conversely, the two main cannabinoids (THC and cannabidiol), found in varying ratios in the marijuana plant are of therapeutic interest. To date, many countries have approved pharmaceutical formulations of these extracts for several medical conditions and a growing body of literature supports their usefulness in many others. The actual restricting laws which consider marijuana an illegal substance and the pressure of marijuana legalization supporters makes it difficult to evaluate objectively the pros and cons of medical marijuana and of its active molecules. Considering, the responsibility physicians have in assuring public health, government funded research and more time are needed before making any claim. It is imperative to emphasize the importance of communication among all parties due to the possible side effects of treatment with marijuana and its potential to interact with other medications the patient may be taking. However, if physicians believe a law or the public information provided is unfair it\u2019s an ethical and professional responsibility to work and actively change things. Psychiatrists may have a role in these challenges

The importance of cognitive assessment in the management of psychiatric disorders

The rationale of this article is to emphasize the importance of cognitive assessment in the management of psychiatric syndromes. Many studies have investigated and have clearly shown the existence of cognitive dysfunction in most of the psychiatric disorders. These deficits occur with different severity wich seems to trace a dimensional continuum between the various clinical manifestations. Cognitive impairment is not merely a result of the damage caused during the time by the psychiatric symptoms but an integral part of the disorder itself. The alterations of different cognitive domains found in mental illnesses are often detectable as prodromal symptoms of the disease, showing indirectly a predisposition to the later development of the disorder, particularly schizophrenia. Considering the cognitive impairment is noto only a feature of schizophrenia but also of affective psychoses and bipolar disorder, some authors have suggested using the cognitive impairment as an endophenotype. Moreover, cognitive assessment is essential for the formulation of effective strategies capable also of recovery of cognitive functions through structured and specific rehabilitative strategies

Long-Term Assessment of Plasma Lipids in Transplant Recipients Treated with Tacrolimus in Relation to Fatty Liver

Immunosuppression has improved graft and recipient survival in transplantation but is associated with possible adverse effects including cardiovascular diseases. The impact of tacrolimus on the lipidic profile has been debated for several years. Twenty-nine kidney transplant recipients on tacrolimus treatment were monitored for six years, and multiple laboratory parameters investigating the lipid asset, as well as glucose profile, were carried out. Tacrolimus has been responsible for significant changes in plasma lipid concentrations only for the first six months, but not for the remaining time of observation. Similarly, in the same periods, glycemic imbalance was highlighted. The liver enzyme activity showed a modest derangement during the tacrolimus treatment, suggesting the presence of lipid accumulation in the liver. Fatty liver reversed in the long term follow-up. Tacrolimus, although it is not a completely safe option in the first months of the immunosuppressive protocols in organ transplanted recipients, still retains a certain role in the long-term post-transplantation immunosuppressive approach with high cardiovascular risks

Absence of pharmacokinetic interference of moxifloxacin on cyclosporine and tacrolimus in kidney transplant recipients

This study investigates the potential pharmacokinetic interactions between an antimicrobial agent, moxifloxacin, and 2 immunosuppressant drugs, cyclosporine and tacrolimus, in kidney transplant recipients. Twenty-two kidney transplant patients needing antibiotic therapy for urinary tract infections are enrolled. Eleven patients are under cyclosporine treatment and the other 11 patients are under tacrolimus treatment. Because the urinary tract infections are caused by gram-negative aerobes sensitive to moxifloxacin, this antibiotic is administered by oral route at a dose of 400 mg/d for 1 week; in each patient pharmacokinetic studies are carried out before and at the seventh day of therapy. For both immunosuppressors, none of the pharmacokinetic parameters investigated show statistically significant differences between values obtained before and during treatment with moxifloxacin. In fact, the concentration-time profiles of monoclonal cyclosporine, polyclonal cyclosporine, and tacrolimus are not significantly different before and during the antimicrobial therapy. The results of the present study rule out interference of moxifloxacin with both cyclosporine and tacrolimus kinetics and indicate that the concomitant administration of the fluoroquinolone and cyclosporine or tacrolimus does not require modifications of the dosages of 2 immunosuppressant drugs

Clinical insights by the presence of bipolar disorder in pseudohypoparathyroidism type 1A

Pseudohypoparathyroidism type 1A and its association with bipolar disorder (BD) have never been reported so far. We report a new case with both clinical entities and discuss the potential pathophysiological mechanisms of this association (protein kinase A hypoactivation, parathyroid hormone, hypocalcemia, protein kinase C activation, vitamin D deficiency). In this patient, the correction of the underlying calcium and vitamin D deficiencies leads to a better BD outcome and lower dosage of psychopharmacological agents. The conclusions might be generalized for a better understanding and management of these condition

Topiramate in Alcohol Use Disorders: Review and Update.

To date, a limited number of pharmacological agents exist to treat alcohol use disorders (AUDs), and there is growing interest in new therapeutic tools. In this framework, topiramate may represent a useful treatment option, although its use is not yet approved for AUDs. The main focus of this review is to discuss all the existing data supporting the use of topiramate in AUDs, with an emphasis on the most recent and relevant clinical implications. In addition, the profile of the alcoholic patient who may benefit more from the use of topiramate is outlined. In this regard, the authors conducted a PubMed search of clinical human studies published in English using the following key words: topiramate alcohol dependence, topiramate alcohol withdrawal and topiramate alcoholism. The evidence suggests that topiramate could be an effective treatment option for the management of AUDs, while there are limited results for its use to treat alcohol withdrawal syndrome. In particular, topiramate shows a greater beneficial effect in subjects with a typology of craving characterised by drinking obsessions and automaticity of drinking. Topiramate, within the dosage range of 75-300 mg/day, could be considered as a first-line treatment option for the management of AUDs. Its use appears to be safe and well-tolerated, especially in light of very recent findings