Novel Pharmacological Targets of Post-Traumatic Stress Disorders

Post-traumatic stress disorder (PTSD) is a psychopathological condition with a heteroge- neous clinical picture that is complex and challenging to treat. Its multifaceted pathophysiology still remains an unresolved question and certainly contributes to this issue. The pharmacological treatment of PTSD is mainly empirical and centered on the serotonergic system. Since the therapeutic response to prescribed drugs targeting single symptoms is generally inconsistent, there is an urgent need for novel pathogenetic hypotheses, including different mediators and pathways. This paper was conceived as a narrative review with the aim of debating the current pharmacological treatment of PTSD and further highlighting prospective targets for future drugs. The authors accessed some of the main databases of scientific literature available and selected all the papers that fulfilled the purpose of the present work. The results showed that most of the current pharmacological treatments for PTSD are symptom-based and show only partial benefits; this largely reflects the limited knowledge of its neurobiology. Growing, albeit limited, data suggests that the hypothalamic-pituitary-adrenal axis, opioids, glutamate, cannabinoids, oxytocin, neuropeptide Y, and microRNA may play a role in the development of PTSD and could be targeted for novel treatments. Indeed, recent research indicates that examining different pathways might result in the development of novel and more efficient drugs

Quality improvement in ammonium nitrate production using Six Sigma methodology

Six sigma has been used in different industries to reach operational excellence. However, in the chemical industry, the application of this methodology is limited. This research presents an implementation of the six sigma method for ammonium nitrate (AN) content optimization in condensate production for a fertilizer company in Colombia. The paper aims to determine the levels for input variables in the process, to meet desirable standards for condensate quality in terms of ammonium nitrate content. Based on the DMAIC steps implementation, it was possible to establish the main variables affecting the condensate quality and their optimal levels to reach an ammonium nitrate content below 15,000 ppm. These results demonstrate the impact that a six sigma project may have on operational effectiveness and quality improvement for meeting the customer requirements

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

The microbiota/microbiome and the gut–brain axis: How much do they matter in psychiatry?

The functioning of the central nervous system (CNS) is the result of the constant integration of bidirectional messages between the brain and peripheral organs, together with their connections with the environment. Despite the anatomical separation, gut microbiota, i.e., the microorganisms colonising the gastrointestinal tract, is highly related to the CNS through the so-called “gut–brain axis”. The aim of this paper was to review and comment on the current literature on the role of the intestinal microbiota and the gut–brain axis in some common neuropsychiatric conditions. The recent literature indicates that the gut microbiota may affect brain functions through endocrine and metabolic pathways, antibody production and the enteric network while supporting its possible role in the onset and maintenance of several neuropsychiatric disorders, neurodevelopment and neurode-generative disorders. Alterations in the gut microbiota composition were observed in mood disorders and autism spectrum disorders and, apparently to a lesser extent, even in obsessive-compulsive disorder (OCD) and related conditions, as well as in schizophrenia. Therefore, gut microbiota might represent an interesting field of research for a better understanding of the pathophysiology of common neuropsychiatric disorders and possibly as a target for the development of innovative treatments that some authors have already labelled “psychobiotics”

Relationship between BDNF and oxytocin

Converging, albeit scattered data mainly gathered in animals indicate that the neurotrophin brain-derived neurotrophic factor (BDNF) and the nonapeptide oxytocin (OT) interact in a cooperative way.Data in humans are really limited and indirect. Therefore, the aim of the present study was to explore the possible existence of a link between OT and BDNF in humans, by means of two peripheral markers, the plateletpoor-plasmatic-BDNF (PPP-BDNF) and the platelet BDNF (PLT-BDNF) and OT levels.Twenty-six young healthy controls of both sexes who volunteered for the study were included in the study. Fifty ml of peripheral venous blood were drawn from one-night fasting subjects between 8.00 and 9.00 a.m. The BDNF and OT assays were carried out according to common methods. Comparisons for continuous variables were performed by the Student's t-test for variables that follow a normal distribution, and by the Wilcoxon-MannWhitney test for variables not normally distributed. The correlations between biological markers were explored by calculating the Pearson's correlation coefficient or Spearman's rank correlation.The results showed that PLT-BDNF (pg/mg proteins, mean +/- SD) and PPP-BDNF (pg/ml, mean +/- SD) were 1546 +/- 1844 and 10111 +/- 1892, respectively. The OT levels (pg/ml, mean +/- SD) were 13.92 +/- 4.54. The OT levels were significantly higher in women than in men. The Spearman's analysis revealed a statistically significant and negative correlation between OT levels and PLT-BDNF (R = -0.543, p = 0.004).The findings of this study highlight the presence of a significant and negative correlation between OT and PLTBDNF in a small group of healthy controls of both sexes. In any case, despite all the limits of peripheral biomarkers, they suggest that this reciprocal influence might have a downstream homeostatic function dampening one activity when the other is activated or no longer necessary, maybe at the level of the stress and/or immune systems

Perspectivas filosóficas do uso da tecnologia no cuidado de enfermagem em terapia intensiva

O contexto de assistência à saúde vem sendo influenciado por mudanças produzidas no âmbito da tecnologia o que tem gerado diversas inquietações e indagações acerca dos benefícios, riscos e das relações construídas entre trabalhadores, doentes e a utilização de máquinas como instrumentos imprescindíveis ao cuidado. O objetivo deste artigo foi refletir sobre o uso da tecnologia no cuidado de enfermagem ao doente crítico em terapia intensiva. Espera-se com estas reflexões minimizar arestas que permeiam os ambientes tecnologizados como a terapia intensiva e as concepções de cuidado de enfermagem que neste campo da assistência em saúde envolve o uso de máquinas e equipamentos que oferecem suporte avançado de vida.The context of health assistance has been influenced by changes which are produced in the dimension of technology. They have triggered a lot of inquietude and questioning regarding benefits, risks, and relations constructed among workers and sick, and the use of machines as indispensable tools for care. This paper aims at reflecting on the use of technology in nursing care given to the critical sick in the intensive care unit. It is expected that this reflection can minimize doubts which permeate technological environments, such as the intensive care unit, and the conceptions of nursing care since it involves the use of machines and equipment which provide advanced life support in this field of health assistance.El contexto de atención a la salud viene siendo influenciado por cambios producidos en el ámbito de la tecnología lo que tiene generando diversas inquietudes e indagaciones acerca de los beneficios, riesgos y de las relaciones construidas entre trabajadores, enfermo y la utilización de máquinas como instrumentos imprescindibles al cuidado. El objetivo de este artículo fue reflexionar sobre el uso de la tecnología en el cuidado de enfermería al enfermo crítico en terapia intensiva. Se espera con estas reflexiones minimizar aristas que permean los ambientes tecnologizados como la terapia intensiva y las concepciones de cuidado de enfermería que en este campo de la asistencia en salud envuelve el uso de máquinas y equipamientos que ofrecen soporte avanzado de vida