[Effectiveness results of olanzapine in acute psychotic patients with agitation in the emergency room setting: results from NATURA study]

INTRODUCTION

Patterns of use of antipsychotics are not well described in emergency units. The objective of this study was to describe the effectiveness and safety of use of olanzapine in patients with acute psychosis and agitation in the emergency rooms.

METHODS

In this prospective observational study 278 patients with acute psychosis and agitation were consecutively admitted in 16 psychiatric emergency wards and treated with any oral psychopharmacology treatment, including olanzapine, according to investigators clinical criteria. Data were collected prospectively including demographics, diagnosis, concomitant medications, utilization of mechanical restraints, and severity of agitation. Clinical evolution during emergency room stay was assessed with PANSS-Excitement Component, CGI-S and Agitation and Calmness Evaluation Scale (ACES) at baseline, before any re-intervention (if needed) and at discharge from the emergency room. Safety was also evaluated.

RESULTS

Olanzapine alone was used in 148 (53.2%) patients. Most of them (77.7 %) were diagnosed of Schizophrenia and related psychoses. Up to 38 patients (25.7 %) required mechanical restraints. Mean change (confidence interval [CI] 95 %) from baseline to discharge was significant in all rating scales; PANSS-EC: -7.46 (-8.2, -6.7); CGI-S: -1.82 (-2, -1.6) ACES: 1.28 (1.1, 1.5). At discharge 70.3% of patients went to inpatient units. Five patients (3.4%) reported adverse events including: bradycardia, dry mouth, sedation, hypertension, hypotension, and orthostatic hypotension. None of them was serious.

CONCLUSIONS

The utilization of olanzapine alone decreased agitation in psychotic patients in emergency room settings. Incidence of adverse events was low and it was well tolerated.

Patterns of drug treatment for manic episode in the clinical practice. Outcomes of the Spanish sample in the EMBLEM Study

INTRODUCTION

Although treatment for mania has been studied extensively in randomized clinical trials, there are few data that address how these patients are truly managed in clinical, functional, and economic terms in the psychiatric practice in Spain.

OBJECTIVE

To determine prescribing patterns in Spain on the basis of the Spanish sample of bipolar patients in manic or mixed phase included as part of the pan-European EMBLEM Study.

METHOD

The EMBLEM Study recruited 3,681 patients, 312 of whom (8.47%) were included in Spain. Patients had to be adults with a diagnosis of bipolar disorder who were initiating treatment for a manic phase. They underwent evaluation using the Spanish versions of scales that measure severity of mania (the Young Mania Rating Scale, CGI-BP and the Hamilton Scale) and functional level (LCM, SLICE of LIFE). Information was collected regarding drug and treatment adherence variables.

RESULTS

Prior to being admitted into the study, 42% of the patients were receiving polytherapy, 35% were on monotherapy, and 23% were not taking any medication whatsoever. Forty percent of the patients presented partial or total non-compliance with the treatment prescribed. During the first stage of the study, in the case of single-drug treatment, acute management for mania consisted of mean daily doses of 25 mg of olanzapine, 6.6 mg of risperidone, 9.5 mg of haloperidol, 165 mg of lamotrigine, 938.5 mg of valproate, and 909 mg of lithium, whereas when combined therapy was used, the following doses were used: olanzapine, 22.1 mg; risperidone, 7.3 mg; haloperidol, 12.3 mg; lamotrigine, 1,75.1 mg; valproate, 1,038.4 mg, and lithium, 1012.6 mg. Of those patients who were on monotherapy at the beginning of the study 51% were treated with a single drug, whereas 48% were receiving polytherapy. Among the participants who were receiving combined treatment when they began the study, almost all of them, 94%, were prescribed combined treatment. In the case of the hospitalized patients who made up 88% of the sample, the vast majority, 92%, had improved by the time the study was completed. Mean time to release from hospital was 24 days.

DISCUSSION

In Spain, treatment for mania is essentially based on combined treatments, hospitalization, and antimania drugs that are prescribed at somewhat higher doses than those recommended in the corresponding prescribing information documents, which indicates that the clinical reality of this entity is far more complex than clinical trials conducted in experimental conditions suggest.

[Prefrontal dysfunction in schizophrenia: implication is associative recognition]

OBJECTIVE

We used an event related functional magnetic resonance imaging (fMRI) method to examine the neural basis of associative recognition memory deficit in schizophrenia.

METHODS

Fifteen people with schizophrenia and 18 healthy control subjects were scanned with fMRI while performing a memory task (coding and recognition) of visual objects. During coding, the subjects studied items and pairs of items. During recovery, the subjects had to recognize items (old/new decisions) and recognize associations (intact/rearranged decisions). The study design was based on a random effect model and the fMRI analysis was restricted to correct items only.

RESULTS

At the behavioral level, both groups performed equally well on item recognition, whereas people with schizophrenia demonstrated poorer performance on associative recognition. At the brain level, comparison between associative and item recognition tasks revealed greater left dorsolateral prefrontal and right inferior prefrontal activations in the control group relative to the schizophrenia group.

CONCLUSIONS

The findings of this fMRI study suggest the prefrontal cortex as the basis for the selective memory deficit for associative recognition observed in schizophrenia.

A leishmaniosis surveillance system among stray dogs in the region of Madrid: ten years of serodiagnosis (1996–2006)

Two seroepidemiological surveys on canine leishmaniosis in stray dogs were performed annually in the Madrid region for 10 years (November 1996-April 2006). The presence of anti-Leishmania antibodies was detected by immunofluorescence antibodies test (cut off 1:100). The overall seroprevalence found in the 1,803 dogs studied was 7.8% (141 positive dogs). Seropositivity was not associated with either breed or sex. Statistical analysis revealed greater seroprevalence in groups of older dogs, indicating that the probability of exposure to the bite of sand flies infected with Leishmania infantum increased with age. The most important result was a high proportion of seropositivity for leishmaniosis (79.5%) among dogs without clinical signs of canine leishmaniosis. These data are very important because stray dogs can play an important role in the epidemiology of this zoonotic disease. Furthermore, the stray population could be useful sentinels to follow the progress of the disease in endemic areas.

On-line determination of 3,5,6-trichloro-2-pyridinol in human urine samples by surface plasmon resonance immunosensing

An immunochemical method for the analysis of 3,5,6-trichloro-2-pyridinol (TCP), a major urinary metabolite of chlorpyrifos, is developed using a surface plasmon resonance (SPR)-based biosensor. The stability of the assay was assessed by covalently linking the analyte derivative to a thin, gold-modified sensor surface. For optimization of analyte derivative immobilization, sensor chips were activated via alkanethiol monolayers with terminal amine or carboxyl groups. Binding inhibition tests were performed in untreated urine samples and compared to those obtained in distilled water and PBS was used as control. In all cases, similar detection limits, at the micrograms per litre level (0.1-0.24 microg L(-1)), were attained for TCP assays independently of the dilution buffer. Reproducibility of measurements was studied throughout more than 130 regeneration cycles, which allowed the repeated use of the same immunosensor surface without significant variation of the SPR signal. All measurements were developed in real-time in only 10 min, using a SPR portable system. The device could be applied as a valuable analytical method to both environmental screening and clinic diagnostics.

Optical immunosensor for fast and sensitive detection of DDT and related compounds in river water samples

A surface plasmon resonance (SPR) based immunosensor has been developed for the monitoring of environmentally persistent pollutants like DDT, its metabolites and analogues in real water samples. A reusable immunosurface is provided via the covalent attachment of the analyte derivative to a self-assembled alkanethiol monolayer formed onto the SPR gold-thin layer. The regeneration of the sensor surface allowed the performance of 270 assay cycles within an analysis time of 20 min for each assay cycle. Immunoassays based on a binding inhibition format were performed by using two monoclonal antibodies (MAbs) with different selectivity. Low limits of detection (LODs), in the sub-nanogram per litre range, were attained for DDT-selective (15 ng L-1) and DDT group-selective immunoassays (31 ng L-1). Both assays were carried out in spiked river water samples without significant effect of the matrix. SPR measurements were validated using gas-chromatography-mass spectrometry. The comparison between methods was in good agreement showing an excellent correlation coefficient (r2=0.995). The SPR analysis of DDT proved to be three times more sensitive than colorimetric ELISAs without the need of labelling and a much lower time of response. Our SPR biosensor portable platform (beta-SPR) is already commercialised by the company SENSIA, S.L. (Spain).

Multi-analyte SPR immunoassays for environmental biosensing of pesticides

Multi-analyte detection of environmentally relevant pesticides is performed by using a two-channelled surface plasmon resonance (SPR) biosensor. The special design of the SPR instrument allows the determination of several analytes (DDT, chlorpyrifos and carbaryl) via different immobilization formats. First, simultaneous pesticide monitoring is possible by flowing chlorpyrifos, carbaryl or DDT samples separately over each channel of the SPR system, wherein their corresponding recognition element was previously immobilized. The second approach is based on the multiple and combined immobilization of several analyte recognition elements on the sensing surface of one individual flow cell. In this format, the analysis time for all three pesticides varied from 40 to 60 min depending on the number of regeneration cycles. In most cases, similar detection limits were attained for the target analyte irrespective of the assay format, with sensitivity values at the nanogram per litre level (18-50 ng L(-1)). The assay reproducibility was proved through the repeated use of the same sensor surface for over more than 200 assay cycles, whereas the absence of biosensor response to non-related analytes showed the specificity and reliability of the analysis. The SPR instrument, including optics, electronics and microfluidics, is already commercialised by the company SENSIA, SL.

Determination of carbaryl in natural water samples by a surface plasmon resonance flow-through immunosensor

The analysis of carbaryl in natural water samples was accomplished using a portable immunosensor based on surface plasmon resonance (SPR) technology. The assay was based on a binding inhibition immunoassay format with the analyte derivative covalently immobilized on the sensor surface. An alkanethiol self-assembled monolayer (SAM) was formed onto the gold-coated sensor surface to allow the reusability of the same sensing surface during 220 regeneration cycles. Reproducibility was evaluated by performing three independent assays in triplicate on 3 different days. The batch-assay variability was also calculated using three different gold-coated sensor surfaces. The intra- and inter-day relative standard deviation were 8.6 and 15.3%, respectively, whilst a variation of 7.4% in assay sensitivity was obtained by employing different sensor chips. The lowest detection limit, calculated as the concentration providing a 10% decrease of the blank signal, was of 1.38 microg L(-1). Matrix effects were also evaluated in different water types, showing I50 values (carbaryl concentrations that produced a 50% decrease of the blank signal) within the range of carbaryl standard curves in distilled water (2.78-3.55 microg L(-1)). The carbaryl immunoassay performance was validated with respect to conventional high-performance liquid chromatography-mass spectrometry (HPLC-MS). The correlation between methods was in good agreement (r2 = 0.998, 0.999 and 0.999) for the three types of natural water samples tested. A complete assay cycle, including regeneration, is accomplished in 20 min. All measurements were carried out with the SPR sensor system (beta-SPR) commercialised by the company SENSIA, SL (Spain). The small size and low-time of response of the beta-SPR platform would allow its utilization in real contaminated locations.

Specific IgG antibody response against antigens of Dirofilaria immitis and its Wolbachia endosymbiont bacterium in cats with natural and experimental infections

Sera from three groups of cats under different experimental conditions were studied by ELISA to assess the host's immune response against synthetic peptides derived from Dirofilaria immitis (Dipp) and against the surface protein of its endosymbiont, Wolbachia (WSPr). In experimentally infected cats (Group 1), an increase of IgG antibody against both Dipp and WSPr was observed from 2 months post-infection until the end of the study, 6 months post-infection. In experimentally infected cats, treated against infective larvae (Group 2), anti-Dipp IgG decreased dramatically from 4 months post-infection (3 months post treatment), showing very low values till the end of the study (6.5 months from infection, 5.5 months from treatment), while anti-WSP IgG increased constantly till the end of the study. Of 49 outdoor, asymptomatic cats exposed to a high risk of natural infection (Group 3), 9 were positive for anti-Dipp IgG and for a validated, in-clinic commercial antibody diagnostic kit for cats. Two cats were also found positive for circulating antigens of adult female worm. Anti-WSPr IgG were found in five of nine anti-Dipp IgG-positive sera and from eight ELISADipp-negative sera. Our results confirm the strong IgG response in heartworm infected cats and demonstrate the involvement of the Wolbachia endosymbiont in the immune reaction to the parasite both in experimentally infected cats and in cats exposed to a high risk of natural infection.

Influence of eye closing on the cardiovascular response to stand test on stable and unstable platforms

Check if the stimulation of the leg muscles and neuro-sensorial system during stand test influence the cardiovascular response to stand test pre and post a 7 d HDT (4 subjects).

METHODS

After 20 min supine, the subject stood for 10 min, and closed the eyes for 1 min. Then he stayed 2 min stand up on ant-posterior or lateral unstable platform and closed the eyes for 30 sec. The cerebral and lower limb flow were assessed by Doppler (skin fixed sensors) and also the cerebral to femoral flow ratio (CFR).

RESULTS

All 4 subjects were tolerant, CFR increased similarly pre and post HDT. Post HDT eye closing increased leg muscle activity, and femoral flow increased more than pre HDT, on ant-post unstable platform. The trace of the body foot pressure point was much longer post HDT on the ant-post platform.

CONCLUSION

Post HDT neuro-sensorial disadaptation may contribute to reduce the orthostatic tolerance at least in absence of visual references.

Traditional knowledge about mushrooms in a Nahua community in the state of Tlaxcala, Mexico

This paper describes the traditional mycological knowledge of the Nahua of San Isidro Buensuceso, on the slopes of La Malinche Volcano National Park, in the state of Tlaxcala, México. The results described in this paper were obtained through interviews with villagers selected at random; a free-listing technique was used to determine the cultural significance of the mushrooms of the region. A total of 48 species, which had 65 Náhuatl names and 40 in Spanish, were identified. Although San Isidro villagers consider mushrooms to be a natural resource mainly used for food, they also use them for medicine, insecticides and trade. This paper presents traditional information on the morphology, ecology, fenology and consistency of the mushrooms found around San Isidro. It proposes that, from a cultural perspective, Gomphus flocossus, Ramaria spp. and Boletus spp. are the most important species of the region.

Validation of a monoclonal enzyme immunoassay for the determination of carbofuran in fruits and vegetables

The N-methylcarbamate pesticide carbofuran is a very important insecticide used worldwide. In the present work, the validation of a monoclonal antibody-based enzyme immunoassay (ELISA) to determine this compound in fruits and vegetables is described. The immunoassay is a competitive heterologous ELISA in the antibody-coated format, with an I(50) value for standards in buffer of 740 ng/L and with a dynamic range between 200 and 3100 ng/L. For recovery studies, peppers, cucumbers, strawberries, tomatoes, potatoes, oranges, and apples were spiked with carbofuran at 10, 50, and 200 ppb. After liquid extraction, analyses were performed by ELISA on extracts purified on solid-phase extraction (SPE) columns and crude, nonpurified extracts. Depending on the crop, mean recoveries in the 43.9--90.7% range were obtained for purified samples and in the 90.1--121.6% range for crude extracts. The carbofuran immunoassay performance was further validated with respect to high-performance liquid chromatography (HPLC) with postcolumn derivatization and fluorescence detection (EPA Method 531.1). Samples were spiked with carbofuran at several concentrations and analyzed as blind samples by ELISA and HPLC after SPE cleanup. The correlation between methods was very good (y = 0.90x + 2.66, r(2)() = 0.958, n = 25), with HPLC being more precise than ELISA (mean coefficients of variation of 4.1 and 11.5%, respectively). The immunoassay was then applied to the analysis of nonpurified extracts of the same samples. Results also compared very well with those obtained by HPLC on purified samples (y = 1.02x + 10.44, r(2)() = 0.933, n = 29). Therefore, the developed immunoassay is a suitable method for the quantitative and reliable determination of carbofuran in fruits and vegetables even without sample cleanup, which saves time and money and considerably increases the sample throughput.

Monoclonal enzyme immunoassay for the analysis of carbaryl in fruits and vegetables without sample cleanup

The N-methylcarbamate pesticide carbaryl is one of the most important insecticides used worldwide. In the present work, the validation of a monoclonal antibody-based enzyme immunoassay (ELISA) for the determination of this compound in fruits and vegetables is described. The immunoassay is a competitive heterologous ELISA in the antibody-coated format, with an I(50) value for standards in buffer of 101.0 +/- 26.9 ng/L and with a dynamic range between 31.6 and 364.0 ng/L. For recovery studies, peppers, cucumbers, strawberries, tomatoes, potatoes, oranges, and apples were spiked with carbaryl at 10, 50, and 200 ppb. After liquid extraction, analyses were performed by ELISA on both extracts purified on solid-phase extraction (SPE) columns and crude, nonpurified extracts. Depending on the crop and the fortification level, recoveries in the 59.0--120.0% range were obtained for purified samples and in the 70.0--137.7% range for crude extracts. The carbaryl immunoassay performance was further validated with respect to high-performance liquid chromatography (HPLC) with postcolumn derivatization and fluorescence detection (EPA Method 531.1). Samples were spiked with carbaryl at several concentrations and analyzed as blind samples by ELISA and HPLC after SPE cleanup. The correlation between methods was excellent (y = 1.04x + 0.71, r(2) = 0.992, n = 33), with HPLC being more precise than ELISA (mean coefficients of variation of 5.2 and 12.0%, respectively). The immunoassay was then applied to the analysis of nonpurified extracts of the same samples. Results also compared very well with those obtained by HPLC on purified samples (y = 1.28x - 0.59, r(2) = 0.987, n = 33) while maintaining similar precision. Therefore, the developed immunoassay is a suitable method for the quantitative and reliable determination of carbaryl in fruits and vegetables even without sample cleanup, which saves time and money and considerably increases sample throughput.

Determination of thiabendazole in fruit juices by a new monoclonal enzyme immunoassay

A competitive, indirect enzyme-linked immunosorbent assay (ELISA) for thiabendazole has been developed and applied to the analysis of fruit juices spiked with this fungicide. The immunoassay is based on a new monoclonal antibody derived from a hapten functionalized at the nitrogen atom in the 1-position of the thiabendazole structure. To our knowledge, such a structure has not been previously used to obtain antibodies to thiabendazole. The I50 value and the detection limit of the ELISA for standards were 0.2 and 0.05 ng/mL, respectively. Fruit juices were analyzed by diluting samples in assay buffer, without extraction or cleanup. Samples were not even centrifuged or filtered to remove fruit pulp. Under these conditions, the immunoassay was able to accurately determine thiabendazole down to 1 ng/mL in orange and grapefruit juices, down to 5 ng/mL in banana juice, and down to 20 ng/mL in apple and pear juices. Sensitivity differences of the ELISA were caused by the minimum dilution required by each juice to minimize matrix effects: 1/10 for orange and grapefruit juices, 1/50 for banana juice, and 1/100 for apple and pear juices. In an attempt to further increase the sensitivity of the immunoassay for matrixes showing the strongest interferences, apple and pear juices spiked with thiabendazole at low levels (1-20 ng/mL) were extracted with ethyl acetate before analysis. This simple procedure entailed a significant reduction of matrix effects, which in fact allowed us to determine accurately as low as 5 ng/mL thiabendazole in apple and pear juices. Irrespective of whether samples were analyzed by the direct dilution method or after extraction, the simplicity, sensitivity, and sample throughput of this monoclonal immunoassay makes it a very convenient method for the routine monitoring of thiabendazole residues in fruit juices.

Production of monoclonal antibodies to the N-methylcarbamate pesticide propoxur

Monoclonal antibodies (MAbs) to the pesticide propoxur were produced from haptens with carboxylic spacer arms of different lengths introduced at the carbamate group of the analyte structure. MAbs were subsequently characterized in the conjugate-coated format using these immunizing haptens and newly synthesized compounds as homologous and heterologous assay conjugates, respectively. Appropriate combinations of immunoreagents resulted in competitive enzyme immunoassays (ELISA) with I(50) values in the low nanomolar range (6.5-17.9 nM). A modification of the conjugate-coated format consisting of the simultaneous incubation of the MAb and the peroxidase-labeled secondary antibody in the presence of the analyte resulted in an assay with an I(50) value of 4.4 nM. This one-step conjugate-coated ELISA format is as simple and fast as the antibody-coated format but without the need of synthesizing enzyme-hapten conjugates. Major N-methylcarbamate pesticides were not recognized by the MAb. This immunoassay should reasonably allow the rapid, low-cost, and sensitive determination of propoxur in food, soils, and the environment at levels of regulatory and practical importance.

Lung transplantation for advanced bronchioloalveolar carcinoma confined to the lungs

BACKGROUND

Bronchioloalveolar carcinoma (BAC) is a well-differentiated lung adenocarcinoma that has a tendency to spread chiefly within the confines of the lung by aerogenous and lymphatic routes and may therefore be amenable to local therapy. However, a high rate of local recurrence after lung transplantation was recently reported. We describe two patients with unresectable and recurrent extensive BAC limited to the lung parenchyma who underwent lung transplantation with curative intent.

METHODS

Patients were chosen to receive lung transplants for BAC if they met the following criteria: (1) recurrent or unresectable BAC limited to the lung parenchyma without nodal involvement and (2) suitable candidate for lung transplantation.

RESULTS

The first patient relapsed in the lungs at 9 months after transplantation. The pattern of disease suggested contamination of the new lungs at the time of implantation. Repeat lung transplantation was performed, with cardiopulmonary bypass and irrigation of the remaining upper airway. This patient has had no evidence of local or systemic tumor recurrence at more than 4 years since the second transplantation. The second patient underwent transplantation using the modified technique and expired 16 months after transplantation of other causes. An autopsy showed no evidence of recurrent BAC in the lungs or of metastatic lesions at any site.

CONCLUSIONS

Lung transplantation may be an option for unresectable or recurrent BAC confined to the lungs. Isolation of the diseased lungs and the use of cardiopulmonary bypass during surgery may be important in this disease and should be studied further.