Viral infections of the central nervous system in Spain: a prospective study

The aim of the study was to determine the incidence of viruses causing aseptic meningitis, meningoencephalitis, and encephalitis in Spain. This was a prospective study, in collaboration with 17 Spanish hospitals, including 581 cases (CSF from all and sera from 280): meningitis (340), meningoencephalitis (91), encephalitis (76), febrile syndrome (7), other neurological disorders (32), and 35 cases without clinical information. CSF were assayed by PCR for enterovirus (EV), herpesvirus (herpes simplex [HSV], varicella-zoster [VZV], cytomegalovirus [CMV], Epstein-Barr [EBV], and human herpes virus-6 [HHV-6]), mumps (MV), Toscana virus (TOSV), adenovirus (HAdV), lymphocytic choriomeningitis virus (LCMV), West Nile virus (WNV), and rabies. Serology was undertaken when methodology was available. Amongst meningitis cases, 57.1% were characterized; EV was the most frequent (76.8%), followed by VZV (10.3%) and HSV (3.1%; HSV-1: 1.6%; HSV-2: 1.0%, HSV non-typed: 0.5%). Cases due to CMV, EBV, HHV-6, MV, TOSV, HAdV, and LCMV were also detected. For meningoencephalitis, 40.7% of cases were diagnosed, HSV-1 (43.2%) and VZV (27.0%) being the most frequent agents, while cases associated with HSV-2, EV, CMV, MV, and LCMV were also detected. For encephalitis, 27.6% of cases were caused by HSV-1 (71.4%), VZV (19.1%), or EV (9.5%). Other positive neurological syndromes included cerebellitis (EV and HAdV), seizures (HSV), demyelinating disease (HSV-1 and HHV-6), myelopathy (VZV), and polyradiculoneuritis (HSV). No rabies or WNV cases were identified. EVs are the most frequent cause of meningitis, as is HSV for meningoencephalitis and encephalitis. A significant number of cases (42.9% meningitis, 59.3% meningoencephalitis, 72.4% encephalitis) still have no etiological diagnosis.

Psychometric properties of the Spanish version of the diagnostic interview for depressive personality

The aim of this study was to evaluate the reliability and validity of the Spanish-language version of the diagnostic interview for depressive personality (DIDP). The DIDP was administered to 328 consecutive outpatients and the test-retest and inter-rater reliability were assessed. Factor analysis was used in search of factors capable of explaining the scale and a cutoff point was established. The DIDP scales showed adequate Cronbach's α values and acceptable test-retest and inter-rater reliability coefficients. Convergent and discriminant validity were explored, the latter with respect to avoidant and borderline personality disorders. The results of the factor analysis were consistent with the four-factor structure of the DIDP scales. The receiver operating characteristic (ROC) analysis revealed the area under the curve to be 0.848. We found 30 to be a good cutoff point, with a sensitivity of 74.5% and a specificity of 78.5%. The DIDP proved to be a reliable and valid instrument for assessing depressive personality disorder, at least among our outpatients. The psychometric properties of the DIDP support its clinical usefulness in assessing depressive personality.

[Laparoscopic radical cystectomy with extracorporeal creation of a "Y" shaped orthotopic ileal neobladder using non-reabsorbable mechanical suture (Fontana)]

INTRODUCTION

We describe the technique and present the preliminary results of the laparoscopic radical cystectomy technique with the extracorporeal creation of a "y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture (Fontana).

MATERIALS AND METHOD

We describe the technique step by step and we present a series of 15 patients that underwent this surgery between November 2005 and August 2009, with special emphasis on the duration of the surgery, urinary diversion time, intraoperative and postoperative complications, daytime and night time continence and the frequency of postoperative micturition.

RESULTS

The mean follow-up of the series was 24 months (6-32). The mean duration of surgery was 280 (range 210-345) minutes and the mean urinary diversion time was 54.5 (range 40-75) minutes. There were no intraoperative complications and the average hospitalization time was 7 (range 5-15) days. During the follow-up, there were 5 late postoperative complications, 2 cases of urinary infection with good response to antibiotic treatment and 3 uretero-neovesical anastomosis strictures, which were treated with percutaneous balloon dilation, with a good functional result. No lithiasis was found in the neobladder. Complete daytime continence was obtained in 13/14 patients (92.9%) and complete night time continence in 6/14 (42.9%). One patient (6.7%) required clean intermittent self-catheterization as the patient did not micturate spontaneously.

CONCLUSIONS

The creation of a "Y" shaped ileal orthotopic neobladder using non-absorbable mechanical suture is a feasible, fast and safe technique and it provides promising functional results. Further follow-up is required to determine its long-term results.

Clinical improvement at Day 3 as factor influencing length of hospital stay and discharge of patients with schizophrenia

Introduction

The type of treatment used for patients with schizophrenia and an improvement at Day 3 can affect the length of stay and symptom outcome.

Objectives

To determine the influence of improvement at Day 3 in the lenght of hospital stay and hospital discharge in the case of patients with schizophrenia admitted to acute units.

Methods

A multicenter, naturalistic, retrospective study evaluating medical intervention in 1346 patients with schizophrenia in acute units in Spain.

Results

The mean of hospital stay days was 23.3 (range 1–260 days). 49.5% of patients with improvement at Day 3 had a shorter length of hospital stay. 78.7% received treatment with antipsychotics prior to admission. The most common drugs were risperidone, olanzapine and quetiapine. 99.8% and 99.7% were treated during hospital stay and on discharge, respectively. The drugs most commonly used were paliperidone ER, risperidone and olanzapine. 99.8% of patients with improvement measured by GCI at Day 3 and 100% with improvement at Day 5 had improved at discharge. The percentage of patients requiring use of benzodiazepines or physical/mechanical restriction decreased as the days passed.

Conclusions

The three most commonly used drugs during admission were effective, but the action of paliperidone ER is to be noted (its use increased from 4% prior to admission to 43% and 44% during hospital stay and on discharge, respectively). The results of this study appear to confirm that symptom improvement should be obtained as early as the first week of treatment to achieve a shorter hospital stay.

Correlation between clinical outcome in the first 5 Days of treatment and on hospital discharge in patients with schizophrenia

Introduction

In patients with acute clinical symptoms, a short hospital stay and prevalent therapeutic objectives aimed at controlling symptoms overcome the clinician's concern for the functionality levels that will be even more significant after discharge.

Objectives

To establish the clinical condition of patients admitted to acute/short-stay units in the first five days of hospital stay and on hospital discharge.

Methods

A multicenter, naturalistic, retrospective, observational study to evaluate clinical assessment (CGI) obtained in patients with schizophrenia after treatment at the time of admission and on hospital discharge.

Results

The mean score of the CGI questionnaire decreases from 5.3 recorded on admission to 4.3 on Day 5 and 3 on discharge. On Day 5 of hospital stay, symptoms had improved in 57.3% of cases. In 30.9% of cases there were no changes and in 1.7% symptoms had worsened. In 86.3% of patients symptoms had improved at discharge. 100% of patients with clinical improvement at Day 5 had a clinically significant improvement on hospital discharge.

Conclusions

Clinical improvement in the first five days after hospital admission appears to lead to a better clinical prognosis on hospital discharge. Hospital discharge should be scheduled from admission, so treatment choice should be geared to looking to control symptoms in the first few days and allow for better social and personal functioning after discharge.

[Management of hemorrhagic radiation cystitis with hyperbaric oxygen therapy]

INTRODUCTION AND OBJECTIVES

hemorrhagic cystitis (HC) after pelvic radiotherapy occurs in 2-8% of patients. A variety of treatments have been described, most of them with uncertain results. We assessed the efficacy of hyperbaric oxygen therapy (HBOT) in HC cases.

PATIENTS AND METHODS

retrospective analysis of patients with HC after pelvic radiotherapy receiving HBOT at our center between January 2002 and January 2010. Our protocol included 40 sessions of HBOT in a multiplace hyperbaric chamber with 90minutes of 100% oxygen breathing at 2.2 atm. Success was evaluated in terms of total or partial stop of bladder bleeding. Telephone follow-up was updated at the time of submission in all cases.

RESULTS

twenty-five patients were treated (21 male, 4 female); the mean age was 66.7 years. Twenty men were irradiated for prostate cancer and one for bladder cancer. Three women had cervix cancer and one endometrial cancer. In all cases previous conservative treatment had failed and HBOT was considered only after other measures failed. All the patients responded to HBOT and none recurred after end of treatment at a mean follow-up of 21.2 months. There were no serious complications.

CONCLUSION

HBOT is a highly effective and safe, non-invasive therapy for HC secondary to pelvic radiation; it should be considered as first line alternative in these difficult cases.

Laboratory paradigms of impulsivity and alcohol dependence: a review

Impulsivity can be defined as choosing a smaller, immediate reward over a larger, delayed reward. From this perspective, addictive behaviors such as substance abuse and pathological gambling reflect a series of impulsive choices. However, impulsivity is not a homogeneous construct. Laboratory measures of impulsivity reflect two types of processes. The first is related to behavioral inhibition and refers to an individual's ability to appropriately inhibit thoughts or actions. The second is the delay of reward dimension, namely the degree to which immediate (rewarding) consequences have more control over an individual's behavior than consequences that are delayed. In this review, we describe how alcohol is associated with significant impairments in these paradigms. We also suggest that they may have a role in the development of alcohol dependence. These results are in agreement with a model in which delay of gratification might be a marker for early use and/or abuse of alcohol, whereas impairment in behavioral inhibition might be a marker for maintained use in time and, therefore, for progression towards alcohol dependence.

Zonisamide versus diazepam in the treatment of alcohol withdrawal syndrome

INTRODUCTION

Anticonvulsant drugs have been used in the treatment of alcohol detoxification. The purpose of the present study was to evaluate the efficacy and safety of zonisamide in a sample of patients presenting alcohol withdrawal syndrome.

METHOD

In this 3-week, randomized, flexible-dose trial, 40 inpatients with alcohol dependence disorder received zonisamide or diazepam for detoxification. Zonisamide was started at a dose of 400-600 mg/day (week 1), tapering to a minimum dose of 100-300 mg/day (week 3). Diazepam was administered using a similar regimen (from 130-50 mg/day tapering to 5-15 mg/day). Subjects were treated initially (weeks 1 and 2) in an inpatient unit and for the final week in an outpatient facility. During the inpatient period, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was used to assess the efficacy of each substance. During the outpatient period the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and a craving scale were used.

RESULTS

All subjects completed the study. During the inpatient period both drugs reduced alcohol withdrawal symptoms, but the decrease was more marked in the zonisamide group. At the end of the study (week 3) participants treated with zonisamide showed lower CIWA-Ar scores than subjects receiving diazepam. Also, individuals in the zonisamide group had less craving for alcohol, less anxiety, and less daytime sedation compared with participants treated with diazepam.

CONCLUSION

Zonisamide can be a valuable alternative to benzodiazepines in the prevention of alcohol withdrawal syndrome.