Hipomagnesemia secundária ao uso crônico de Inibidores de Bomba de Prótons: Relato de Caso

Modelo do Estudo: Relato de Caso. Objetivos: Apresentar um caso de hipomagnesemia sintomática associada a hipocalcemia induzido pelo uso de Omeprazol por cerca de 6 anos, com respectiva revisão de literatura. Métodos: Estudo dos achados clínicos e laboratoriais, associado à discussão da origem multifatorial do problema em questão. Relato de Caso: Paciente apresentou, há 2 meses, um episódio de convulsão e tremores, e outra convulsão à admissão, além de outros sinais clínicos de deficiência de magnésio, como parestesias, tremores e cãibras. Exames sanguíneos de acompanhamento de internação revelaram baixos valores séricos de cálcio (8,0 mg/dL) e magnésio (0,94 mg/dL), e níveis de sódio, potássio, uréia, creatinina e vitamina D dentro da normalidade. Dentre os medicamentos dos quais fazia uso, o Omeprazol era utilizado em regime de cronicidade, estando presente à admissão e nos 6 anos anteriores. A reposição de magnésio resultou em aumento parcial da concentração sérica (1,30 mg/dL) e melhora parcial da sintomatologia apresentada. Após a retirada do Omeprazol, os valores séricos de magnésio voltaram ao padrão de normalidade (2,50 mg/dL), ocorrendo remissão total dos sintomas. Importância: A Hipomagnesemia induzida pelo uso crônico de inibidores da bomba de prótons (IBP) é uma condição que pode levar a consequências clínicas graves, e tal situação pode ser revertida pela simples suspensão da medicação, medida capaz de restaurar o equilíbrio homeostático do magnésio.Design of the study: Case report. Objectives: To present, through a case report, a framework of symptomatic hypomagnesaemia associated with hypocalcemia induced by the use of Omeprazole for a long period of time. Methods: Study of clinical and laboratory findings associated with the discussion of the multifactorial origin of the problem in question. Results: The patient depicted in this study showed clinical signs of magnesium depletion or deficiency, evidenced by seizures, tremors, cramps and paresthesias. Blood tests for monitoring of admission revealed low levels of calcium (8,0 mg/dL) and magnesium (0,94 mg/dL), with values of sodium, potassium, urea, creatinine and vitamin D within normal limits. The patient was using Omeprazole at admission. After the withdrawal of Omeprazole, serum magnesium returned to normal range and clinical ceased. Relevance: Hypomagnesaemia is a clinical condition of difficult to diagnose and rarely appears as a differential diagnosis. Chronic administration of proton pump inhibitors represents one of the possible genesis of this change of magnesium and should be considered as a potential cause of harm and should be promptly identified and treated with the suspension of the inhibitor

Lack of effects of typical and atypical antipsychotics in DARPP-32 and NCS-1 levels in PC12 cells overexpressing NCS-1

<p>Abstract</p> <p>Background</p> <p>Schizophrenia is the major psychiatry disorder, which the exact cause remains unknown. However, it is well known that dopamine-mediated neurotransmission imbalance is associated with this pathology and the main target of antipsychotics is the dopamine receptor D₂. Recently, it was described alteration in levels of two dopamine signaling related proteins in schizophrenic prefrontal cortex (PFC): Neuronal Calcium Sensor-1 (NCS-1) and DARPP-32. NCS-1, which is upregulated in PFC of schizophrenics, inhibits D₂internalization. DARPP-32, which is decreased in PFC of schizophrenics, is a key downstream effector in transducing dopamine signaling. We previously demonstrated that antipsychotics do not change levels of both proteins in rat's brain. However, since NCS-1 and DARPP-32 levels are not altered in wild type rats, we treated wild type PC12 cells (PC12 WT) and PC12 cells stably overexpressing NCS-1 (PC12 Clone) with antipsychotics to investigate if NCS-1 upregulation modulates DARPP-32 expression in response to antipsychotics treatment.</p> <p>Results</p> <p>We chronically treated both PC12 WT and PC12 Clone cells with typical (Haloperidol) or atypical (Clozapine and Risperidone) antipsychotics for 14 days. Using western blot technique we observed that there is no change in NCS-1 and DARPP-32 protein levels in both PC12 WT and PC12 Clone cells after typical and atypical antipsychotic treatments.</p> <p>Conclusions</p> <p>Because we observed no alteration in NCS-1 and DARPP-32 levels in both PC12 WT and Clone cells treated with typical or atypical antipsychotics, we suggest that the alteration in levels of both proteins in schizophrenic's PFC is related to psychopathology but not with antipsychotic treatment.</p

J-PLUS : a catalogue of globular cluster candidates around the M 81/M 82/NGC 3077 triplet of galaxies

Globular clusters (GCs) are proxies of the formation assemblies of their host galaxies. However, few studies exist targeting GC systems of spiral galaxies up to several effective radii. Through 12-band Javalambre Photometric Local Universe Survey (J-PLUS) imaging, we study the point sources around the M 81/M 82/NGC 3077 triplet in search of new GC candidates. We develop a tailored classification scheme to search for GC candidates based on their similarity to known GCs via a principal component analysis projection. Our method accounts for missing data and photometric errors. We report 642 new GC candidates in a region of 3.5 deg2 around the triplet, ranked according to their Gaia astrometric proper motions when available. We find tantalizing evidence for an overdensity of GC candidate sources forming a bridge connecting M 81 and M 82. Finally, the spatial distribution of the GC candidates (g − i) colours is consistent with halo/intra-cluster GCs, i.e. it gets bluer as they get further from the closest galaxy in the field. We further employ a regression-tree-based model to estimate the metallicity distribution of the GC candidates based on their J-PLUS bands. The metallicity distribution of the sample candidates is broad and displays a bump towards the metal-rich end. Our list increases the population of GC candidates around the triplet by threefold, stresses the usefulness of multiband surveys in finding these objects, and provides a testbed for further studies analysing their spatial distribution around nearby (spirals) galaxies

Genome-wide association study of patient and clinician rated global impression severity during antipsychotic treatment

Examine the unique and congruent findings between multiple raters in a genome-wide association studies (GWAS) in the context of understanding individual differences in treatment response during antipsychotic therapy for schizophrenia

Genotype-Based Ancestral Background Consistently Predicts Efficacy and Side Effects across Treatments in CATIE and STAR*D

Only a subset of patients will typically respond to any given prescribed drug. The time it takes clinicians to declare a treatment ineffective leaves the patient in an impaired state and at unnecessary risk for adverse drug effects. Thus, diagnostic tests robustly predicting the most effective and safe medication for each patient prior to starting pharmacotherapy would have tremendous clinical value. In this article, we evaluated the use of genetic markers to estimate ancestry as a predictive component of such diagnostic tests. We first estimated each patient’s unique mosaic of ancestral backgrounds using genome-wide SNP data collected in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) (n = 765) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) (n = 1892). Next, we performed multiple regression analyses to estimate the predictive power of these ancestral dimensions. For 136/89 treatment-outcome combinations tested in CATIE/STAR*D, results indicated 1.67/1.84 times higher median test statistics than expected under the null hypothesis assuming no predictive power (p<0.01, both samples). Thus, ancestry showed robust and pervasive correlations with drug efficacy and side effects in both CATIE and STAR*D. Comparison of the marginal predictive power of MDS ancestral dimensions and self-reported race indicated significant improvements to model fit with the inclusion of MDS dimensions, but mixed evidence for self-reported race. Knowledge of each patient’s unique mosaic of ancestral backgrounds provides a potent immediate starting point for developing algorithms identifying the most effective and safe medication for a wide variety of drug-treatment response combinations. As relatively few new psychiatric drugs are currently under development, such personalized medicine offers a promising approach toward optimizing pharmacotherapy for psychiatric conditions

Recommendations For The Treatment Of Migraine Attacks - A Brazilian Consensus

In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.74326227

Recomendações para o tratamento da crise migranosa - Um consenso brasileiro

In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.Neste artigo um grupo de especialistas no tratamento de cefaleia da Sociedade Brasileira de Cefaleia através de um consenso elaborou medidas estratérgicas para tratar uma crise de migrânea tanto na criança como no adulto. Uma enfase particular foi dada no tratamento da migranea na mulher, incluindo gravidez, lactação e período perimenstrual.74326227

Extracellular matrix and vascular dynamics in the kidney of a murine model for Marfan syndrome

Fibrillin-1 is a pivotal structural component of the kidney’s glomerulus and peritubular tissue. Mutations in the fibrillin-1 gene result in Marfan syndrome (MFS), an autosomal dominant disease of the connective tissue. Although the kidney is not considered a classically affected organ in MFS, several case reports describe glomerular disease in patients. Therefore, this study aimed to characterize the kidney in the mgΔlpn-mouse model of MFS. Affected animals presented a significant reduction of glomerulus, glomerulus-capillary, and urinary space, and a significant reduction of fibrillin-1 and fibronectin in the glomerulus. Transmission electron microscopy and 3D-ultrastructure analysis revealed decreased amounts of microfibrils which also appeared fragmented in the MFS mice. Increased collagen fibers types I and III, MMP-9, and α-actin were also observed in affected animals, suggesting a tissue-remodeling process in the kidney. Video microscopy analysis showed an increase of microvessel distribution coupled with reduction of blood-flow velocity, while ultrasound flow analysis revealed significantly lower blood flow in the kidney artery and vein of the MFS mice. The structural and hemodynamic changes of the kidney indicate the presence of kidney remodeling and vascular resistance in this MFS model. Both processes are associated with hypertension which is expected to worsen the cardiovascular phenotype in MFS

Recomendações para o tratamento da crise migranosa - um consenso brasileiro

In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period743262271Neste artigo um grupo de especialistas no tratamento de cefaleia da Sociedade Brasileira de Cefaleia através de um consenso elaborou medidas estratérgicas para tratar uma crise de migrânea tanto na criança como no adulto. Uma enfase particular foi dada no tratamento da migranea na mulher, incluindo gravidez, lactação e período perimenstrua