Risk and protective factors for release in outpatients with schizophrenia

eposterWe aim to determine risk and protective factors influencing relapse incidence in outpatient with schizophrenia. A longitudinal, observational study was done with outpatients with schizophrenia (F20) or schizoaffective disorder (F25)(DMS-IV and ICD-10), without hospitalization during the previous 6 months. The patients were consecutively included into the study to received oral (O-A) or long-acting injectable (depot-A) antipsychotics. Clinical stage evolution, compliance, efficacy and safety assessments (including PANSS, CGI-SSI, hospitalization rates, and adverse events) were recorded before and after 6 and 12 months of treatment. Results: 60 outpatients (aged 34.5±8.9, male 73%), 75% schizophrenia and 25% schizoaffective disorder diagnosis, 68.3% fewer than 15 years of schizophrenia evolution, 76.7% fewer than 5 times previous hospitalizations were treated with O-A (41.7%) or depot-A (58.3%) antipsychotics for at least one year. Depot-A treated patients showed a significant higher compliance compared to O-A patients during the all following time, lower PANSS (total, positive and negative) scores and CGI-SSI score (p<0.01), and a delayed relapse incidence and re-hospitalization to more than 1 year in the 48% of patients (relapse % depot/% oral) after 6 months 22.9%/52.0%, and after 12 months 48.6%/4.0%. Conclusion: There were protective factors which delayed relapse incidence in schizophrenia: Use of sustained-release preparations, family support. There were risk factors for occurrence of relapse in schizophrenia: cocaine, heroin and alcohol consumption, absence of family support, greater severity of patients assessed through CGI-SI, male sex, age older than 25 years and long-term evolution of the disorder.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Avatars and Cartoons reduce anxiety in pediatric inpatients

Avatars and Cartoons reduce anxiety in pediatric inpatients I Bellido1, MV Bellido2, A Gomez-Luque3. 1University of Malaga, Pharmacology and Clinical Therapeutics, Spain, 2Regional University Hospital, Malaga, Surgery Service, Spain, 3Virgen de la Victoria University Hospital, Malaga, Anaesthesia Service, Spain Background and aim: Pain induces fear, stress and anxiety in young children. Avatars and cartoons explaining analgesic and sedative drugs administration routes may reduce children’s anxiety in young children. We quantify the possible antianxiety effect of avatars and cartoons explaining analgesic and sedative drug’s administration routes to inpatients children. Methods: A prospective, aleatorized, controlled study (blinded for the analyser) in inpatients children (< 6 years old) was done. Clinical stage, diagnostic, surgery, anaesthesia and all treatment procedures were recorded. Anxiety (STAIC test) was recorded before and 5 h and 24 h after drugs administration. A 15 minutes movie with avatars and cartoons explaining how the analgesic and sedative drugs were going to be administered was use in 120 children (movie group) and was compared to other group that could not see the movie (control group n=120). Results: Children, N=240, aged 3-6 years, 4.5±1 years old, 55% male, treated in emergency 50%, surgery (31.3%) and intensities care unit (18.8%) were enrolled. The drugs routes administration were oral (25%), intramuscular (29.6%), intravenous (39.6%), inhalatory (3.8%), others (2.1%). Children saw part or the full movie an average of 5.2±2.1 times. At 24 h of follow-up anxiety was higher in control than in movie group (8.5±3 vs. 4.3±1.6, p<0.05, Student t test). Children of the control group wept, complained, and called their parents during more time than movie group. Conclusion: The use of avatars and cartoons to explain analgesics and sedative drugs routes administration to inpatients young children reduced children’s anxiety.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Flipped classroom based on objective structured clinical examinations analysis by undergraduate students of Pharmacology course from the Podiatry Degree improve their learning and assessment communication skills about medicines

Comunicación cartel con defensa oralWe aim to evaluate the impact of the individual and in-group analysis of OSCEs (filmed by other students) looking for correct and incorrect behaviours and contents in their learning of pharmacology. Summary of work and outcomes: A 5-year prospective study in which students of Pharmacology course from the Podiatry Degree analysed filmed OSCEs individually and in a group in a flipped classroom. Each group (max 5 students) analysed along 1 week a filmed OSCE, prepare a summary of correct and incorrect items related to clinical events, medicines uses, and people behaviours. The students presented their analysis results to the rest of the class. After each presentation, the other students of the class were encouraged to ask questions and after that, the students voluntarily answered a satisfaction survey. Result and Discussion: 405 students, 65.2% female, 20±5.3 years old were included. Students spend 13.4±5.4 h on making the filmed-OSCE analysis. The percentage of students satisfied with this way of studying pharmacology was 96.5%. OSCEs analysis by students increased their percentage of success in the final assessment in both OSCEs-related and OSCEs-non-related questions (+18.5% and +10.1%). Conclusion: Filmed Objective Structured Clinical Examinations analysis by undergraduate students on the Pharmacology course of Podiatry Degree improved their knowledge about medicines use and their communication skills during the assessment.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Propofol induce higher amnesic effect than sevoflurane and isoflurane anaesthesia in the rat

Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

The antidepressant effect of hypericum perforatum extract Ze 117 is associated with reduced possibilities of drug interactions than hypericum perforatum extract LI 160.

Hypericum perforatum (HP) is the most extensively investigated medicinal herbs with antidepressant effect. Differences showed by HP extracts in their antidepressant effect and their clinical consequence of HP-drug interactions have been related with HP extract different composition, particularly regarding to their primary ingredients hyperforin and hypericin content. Experimental data and clinical trials have shown that low-hyperforin-content HP has a comparable antidepressant efficacy in the treatment of mild/moderate depression (1) (2). However, hyperforin is responsible for CYP3A4 induction via activation of a nuclear steroid/pregnane and xenobiotic receptor (SXR/PXR) and hypericin is a P-glycoprotein inducing compound (3), which are the main origin of HP-drug interactions. Changes in cytochrome P-450 (CYP-450) activity could modulate the effect of different drugs. Some of the reported interactions are based on findings from in vitro studies but the clinical importance of which remain to be demonstrated. Two different hypericum extracts, Ze 117 and LI 160, which are differently composed, Ze 117 (0.15-0.25% hypericin, 0.5% hyperforin) and LI 160 (0.3% hypericin, 4-6% hyperforin) were checked regarding their antidepressant-like activity vs. classical antidepressants with and without liver CYP 450 enzyme activity modulation by cimetidine. Experimental procedures followed the ECC Directives and were approved by local authorities. Male Wistar rats (n=6 per group, 6 months old, weight 314±25 g, Charles River-Spain) were injected (i.p. once a day) with Ze 117 (20 mg/kg, Zeller AG), LI 160 (20 mg/kg, Lichtwer Pharma AG), imipramine (IMI) (10.9 mg/kg, Novartis SL), fluoxetine (FLU) (5 mg/kg, Lilly and Dista) or saline (SAL), in presence and absence of cimetidine (CIM) (50 mg/kg, Rimsa) during 20 days. The forced swim test (4) was used for the evaluation of the antidepressant-like effect. The opend-field test was used for the evaluation of the motor activity. The total CYP 450 content of the liver was measure using spectrophotometry methods in liver microsomes. Results are expressed as mean±sem and were compared by Student t test and ANOVA test followed by Bonferroni post-test. The drugs antidepressant effect (reduction of the immobility time) ranking order was: i) without cimetidine’s CYP-450 inhibition: IMI 109±33s >Ze 117 163±21s =FLU165±29s >LI 160 201±234s >SAL 224±17s, pLI 160 144±13s >FLU 171±21s >Ze 117 188±10 >SAL 219±20s, pLI 160 >Ze 117 >SAL, p<0.05). LI 160 significantly reduced the liver CYP-450 total content with respect to SAL (-43.3%, p<0.05) while Ze 117 had lower effect (-25.9%, p<0.05). In conclusion, hypericum perforatum extract Ze 117 shows higher antidepressant effect and lower inhibitory effect of the total CYP 450 liver content than hypericum perforatum extract LI 160. Liver CYP 450 inhibition by cimetidine increased the antidepressant of LI 160 but did not modify the antidepressant effect of Ze 117. (1)Fiebich BL, Knörle R, Appel K et al. (2011) Fitoterapia 82(3):474-480. (2)Singer A, Schmidt M, Hauke W et al. (2011) Phytomedicine 18(8-9):739-742. (3)Mannel M. (2004) Drug Saf 27(11):773-797. (4)Castagné V, Moser P, Roux S et al. (2011) Curr Protoc Neurosci 55:8.10A.1-8.10A.14.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Chlamydomonas reinhardtii, an Algal Model in the Nitrogen Cycle

Nitrogen (N) is an essential constituent of all living organisms and the main limiting macronutrient. Even when dinitrogen gas is the most abundant form of N, it can only be used by fixing bacteria but is inaccessible to most organisms, algae among them. Algae preferentially use ammonium (NH4+) and nitrate (NO3−) for growth, and the reactions for their conversion into amino acids (N assimilation) constitute an important part of the nitrogen cycle by primary producers. Recently, it was claimed that algae are also involved in denitrification, because of the production of nitric oxide (NO), a signal molecule, which is also a substrate of NO reductases to produce nitrous oxide (N2O), a potent greenhouse gas. This review is focused on the microalga Chlamydomonas reinhardtii as an algal model and its participation in different reactions of the N cycle. Emphasis will be paid to new actors, such as putative genes involved in NO and N2O production and their occurrence in other algae genomes. Furthermore, algae/bacteria mutualism will be considered in terms of expanding the N cycle to ammonification and N fixation, which are based on the exchange of carbon and nitrogen between the two organisms

Towards a life cycle sustainability assessment method for the quantification and reduction of impacts of buildings life cycle

The construction and building sectorsare one of the highestconsumersof resourcesand energy. Literature evidences the potentialities of the design phase towardsthe improvement of environmental, economic and social performance of buildings. Thus, the Life Cycle Sustainability Assessment (LCSA) approach is recognized as suitable method. It isbased on the “triple bottom line”principle, to calculate environmental, economic, social impacts produced by buildings during itslife cycle. The present paper aims to present a methodological framework based on anLCSA, used during design stages of buildings and integrated into a building’s design technology such as Building Information Modeling (BIM). A conceptual approach to conduct the data integration and a possible workflow to integrate the LCSA into BIMis proposed. The value of the present approach is the possibility to conductquantitative environmental, economic and social assessment of buildings to guide designers to measure and predict the building’s performanc

Detecting and Characterizing Mg II absorption in DESI Survey Validation Quasar Spectra

In this paper we will present findings on the detection of Magnesium II (MgII, lambda = 2796 {\AA}, 2803 {\AA}) absorption systems observed in data from the Early Data Release (EDR) of the Dark Energy Spectroscopic Instrument (DESI). DESI is projected to obtain spectroscopy of approximately 3 million quasars (QSOs), of which over 99% are anticipated to be found at redshifts greater than z < 0.3, such that DESI would be able to observe an associated or intervening Mg II absorber illuminated by the background QSO. We have developed an autonomous supplementary spectral pipeline that detects such systems through an initial line-fitting process and then confirms line properties using a Markov Chain Monte Carlo (MCMC) sampler. Based upon both a visual inspection and the reanalysis of coadded observations, we estimate this sample of absorption systems to have a completeness of 82.56% and purity of 99.08%. As the spectra in which Mg II systems are detected are the result of coadding multiple observations, we can determine the sensitivity, and therefore completeness, of the sample by searching for known Mg II systems in coadded data with fewer observations (and therefore lower signal-to-noise). From a parent catalog containing 83,207 quasars, we detect a total of 23,921 Mg II absorption systems following a series of quality cuts. Extrapolating from this occurrence rate of 28.75% implies a catalog at the completion of the five-year DESI survey that contains over eight hundred thousand Mg II absorbers. The cataloging of these systems will enable significant further research as they carry information regarding circumgalactic medium (CGM) environments, the distribution of intervening galaxies, and the growth of metallicity across the redshift range 0.3 < z < 2.5.Comment: 12 pages, 7 figure

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group