Seguridad de los antipsicoticos en embarazo en pacientes con psicosis. Revisión sistemática

Enfermedades mentales de tipo psicótico en gestantes se han asociado con mayor número de resultados negativos. Los síntomas psicóticos durante el embarazo se presentan aproximadamente 7.1 por 100.000 casos. Dentro de las consecuencias se incluye mayor riesgo de parto pretérmino, bajo peso al nacer, alteraciones placentarias, malformaciones congénitas de predominio cardiovascular y mayor tasa de muertes perinatales. Como abordaje terapéutico son frecuentes los antipsicóticos de primera generación, aceptados como seguros pero en menor grado se han considerados los antipsicóticos de segunda generación pues ha sido escasamente evaluada su seguridad durante la gestación. Aún existe controversia sobre los potenciales efectos secundarios de algunos antipsicóticos dado los resultados contradictorios. Métodos: Revisión sistemática de la literatura de artículos que proporcionaron mejor evidencia para determinar cuáles antipsicóticos de elección durante la gestación en pacientes con esquizofrenia de acuerdo a su perfil de seguridad. Se evaluó calidad metodológica reconociendo particularidades y resultados de los estudios incluidos. Resultados: De 39 estudios seleccionados, cinco fueron incluidos en esta revisión, clasificándose como nivel de evidencia IIa y evaluados según su calidad metodológica con escala NOS. Se evaluó paso placentario de antipsicóticos, malformaciones fetales, complicaciones obstétricas como parto pretérmino, bajo y alto peso fetal, complicaciones respiratorias, diabetes gestacional, aborto espontáneo, entre otros. Discusión: Se debe sopesar el riesgo-beneficio, la significancia estadística, la significancia clínica y las particularidades de las pacientes a tratar. Conclusión: Los estudios analizados evaluaron diferentes medicamentos antipsicóticos, dificultando consolidación de información en especial en conclusiones solidas ante algunas premisas como fármacos de elección.

Índice de pulsatilidad de arteria cerebral media como predictor para desenlaces desfavorables en fetos pequeños para la edad gestacional

Introducción: La aparición de vasodilatación aislada de la arteria cerebral media en fetos pequeños para la edad gestacional sin otros cambios en el doppler puede interpretarse como fisiológica o podría ser la manifestación inicial de una restricción de crecimiento intrauterino de inicio tardío. Se pretende evaluar la asociación de la disminución del índice de pulsatibilidad de la arteria cerebral media, como predictor de desenlaces perinatales adversos, en fetos con bajo peso para edad gestacional. Metodología: Se realizó un estudio de cohorte analítica de temporalidad histórica para determinar si el hallazgo de disminución de la pulsatibilidad en el doppler de arteria cerebral media se asocia con el pronóstico perinatal adverso, en fetos pequeños para edad gestacional mediante un muestreo no probabilístico. Resultados: Se recolectaron un total de 325 flujometría doppler de fetos pequeños para edad gestacional. El riesgo de parto pretérmino fue RR 2.6 IC95% 1.6-4.1, de hospitalización fue RR 1.4 IC95%1.1-1.9 y de muerte fue 2.1 IC95%1.5-3.2 cuando hay índice de pulsatilidad alterada en la arteria cerebral media. La regresión logística mostró que el riesgo de desenlaces desfavorables con alteraciones en la arteria cerebral media fue de RR 4.2 IC95% 2.5-7.1 ajustado por edad materna, edad gestacional y bajo peso al nacer. Discusión Los pacientes expuestos presentan mayor riesgo de desenlaces desfavorables con diferencias significativas, no así en otros estudios publicados. El presente estudio muestra asociaciones significativas que debe ser evaluada con estudios más amplios.

Factores perinatales para riesgo de sobrepeso y obesidad en niños de 4 a 5 años en Colombia 2010.

Introducción: La OMS revela que en 2010 alrededor de 43 millones de niños menores de 5 años presentan sobrepeso. En Colombia según la Encuesta Nacional de Situación Nutricional en Colombia en su versión 2005, mostraba una prevalencia general de sobrepeso de 3.1% niños de 0 a 4 años. Es una condición de salud de origen multifactorial en la que interviene factores genéticos, ambientales, maternos y perinatales. Objetivo: Establecer la asociación de riesgo entre el bajo peso al nacer y el desarrollo de sobrepeso y obesidad en niños de 4 a 5 años. Metodología: Se realizó un estudio observacional descriptivo retrospectivo de corte transversal con los datos nutricionales, maternos y perinatales de la Encuesta Nacional de Demografía en Salud del año 2010 en Colombia. Se analizó la asociación entre la variable independiente bajo peso al nacer con el desenlace sobrepeso y obesidad en menores de 4 a 5 años, usando como medida el IMC según la edad. Se realizaron análisis univariados, bivariados y de regresión logística con un modelo de riesgo según las variables que inciden en el desenlace y la variable independiente. Resultados: La muestra obtenida para el estudio fue de 2166 niños de 4 a 5 años de edad quienes cumplían los criterios de inclusión. La prevalencia de sobrepeso u obesidad en la primera infancia fue de 21.8% (472) y el bajo peso al nacer. Los resultados sugieren la asociación de bajo peso y sobrepeso u obesidad es de ORajustado= 0.560 (0.356 – 0.881). Conclusiones: Los resultados sugieren que existe una asociación como factor protector entre el bajo peso y el sobrepeso u obesidad en la primera infancia. Sin embargo, debido al comportamiento de las variables consideradas en la muestra no hay suficiente información para rechazar completamente la hipótesis nula.

Characterisation of an s-type low molecular weight glutenin subunit of wheat and its proline and glutamine-rich repetitive domain

The low molecular weight glutenin subunits (LMW-GS) are major components of the glutenin polymers which determine the elastomeric properties of wheat (Triticum aestivum L.) gluten and dough. They comprise a complex mixture of components and have proved to be difficult to purify for detailed characterisation. The mature LMW subunit proteins comprise two structural domains, with one domain consisting of repeated sequences based on short peptide motifs. DNA sequences encoding this domain and a whole subunit were expressed in Escherichia coli and the recombinant proteins purified. Detailed comparisons by spectroscopy (CD, FT-IR) and dynamic light scattering indicated that the repetitive and non-repetitive domains of the proteins formed different structures with the former having an extended conformation with an equilibrium between poly-L-proline II-like structure and type II’ b-turns, and the latter a more compact globular structure rich in a-helix. Although the structures of these two domains appear to form independently, dynamic light scattering of the whole subunit dissolved in trifluoroethanol(TFE) suggested that they interact, leading to a more compact conformation. These observations may have relevance to the role of the LMW-GS in gluten structure and functionality.

Low molecular weight heparin significantly reduces embolisation after carotid endarterectomy - a randomised controller trial

Objectives The administration of unfractionated heparin (UFH) prior to carotid clamping during carotid endarterectomy (CEA) transiently increases the platelet aggregation response to arachidonic acid (AA) despite the use of aspirin. We hypothesized that this phenomenon might be reduced by using low molecular weight heparin (LMWH) resulting in fewer emboli in the early post-operative period. Methods 183 aspirinated patients undergoing CEA were randomised to 5000 IU UFH (n = 91) or 2500 IU LMWH (dalteparin, n = 92) prior to carotid clamping. End-points were: transcranial Doppler (TCD) measurement of embolisation, effect on bleeding and platelet aggregation to AA and adenosine 5′-diphosphate (ADP). Results Patients randomised to UFH had twice the odds of experiencing a higher number of emboli in the first 3 h after CEA, than those randomised to LMWH (p = 0.04). This was not associated with increased bleeding (mean time from flow restoration to operation end: 23 min (UFH) vs. 24 min (LMWH), p = 0.18). Platelet aggregation to AA increased significantly following heparinisation, but was unaffected by heparin type (p = 0.90). The platelets of patients randomised to LMWH exhibited significantly lower aggregation to ADP compared to UFH (p < 0.0001). Conclusions Intravenous LMWH is associated with a significant reduction in post-operative embolisation without increased bleeding. The higher rate of embolisation seen with UFH may be mediated by increased platelet aggregation to ADP, rather than to AA.

Low molecular weight organogelators from self-assembling synthetic tripeptides with coded amino acids: morphological, structural, thermodynamic and spectroscopic investigations

A series of self-assembling terminally blocked tripeptides (containing coded amino acids) form gels in various aromatic solvents including benzene, toluene, xylenes at low concentrations. However these tripeptides do not form gels in aliphatic hydrocarbons like n-hexane, cyclohexane, n-decane etc. Morphological studies of the dried gel indicate the presence of an entangled fibrous network, which is responsible for gelation. Differential scanning calorimetric (DSC) studies of the gels produced by peptide 1 clearly demonstrates thermoreversible nature of the gel and tripeptide-solvent complex may be produced during gel formation. FT-IR and H-1 NMR studies of the gels demonstrate that an intermolecular hydrogen-bonding network is formed during gelation. Single crystal X-ray diffraction studies for peptides 1, 2 and 3 have been performed to investigate the molecular arrangement that might be responsible for forming the fibrous network of these self-assembling peptide gelators. It has been found that the morph responsible for gelation of peptides 1, 2 and 3 in benzene is somewhat different from that of its xerogel.

Low-molecular-weight gelators: Elucidating the principles of gelation based on gelator solubility and a cooperative self-assembly model

This paper highlights the key role played by solubility in influencing gelation and demonstrates that many facets of the gelation process depend on this vital parameter. In particular, we relate thermal stability (T-gel) and minimum gelation concentration (MGC) values of small-molecule gelation in terms of the solubility and cooperative self-assembly of gelator building blocks. By employing a van't Hoff analysis of solubility data, determined from simple NMR measurements, we are able to generate T-calc values that reflect the calculated temperature for complete solubilization of the networked gelator. The concentration dependence of T-calc allows the previously difficult to rationalize "plateau-region" thermal stability values to be elucidated in terms of gelator molecular design. This is demonstrated for a family of four gelators with lysine units attached to each end of an aliphatic diamine, with different peripheral groups (Z or Bee) in different locations on the periphery of the molecule. By tuning the peripheral protecting groups of the gelators, the solubility of the system is modified, which in turn controls the saturation point of the system and hence controls the concentration at which network formation takes place. We report that the critical concentration (C-crit) of gelator incorporated into the solid-phase sample-spanning network within the gel is invariant of gelator structural design. However, because some systems have higher solubilities, they are less effective gelators and require the application of higher total concentrations to achieve gelation, hence shedding light on the role of the MGC parameter in gelation. Furthermore, gelator structural design also modulates the level of cooperative self-assembly through solubility effects, as determined by applying a cooperative binding model to NMR data. Finally, the effect of gelator chemical design on the spatial organization of the networked gelator was probed by small-angle neutron and X-ray scattering (SANS/SAXS) on the native gel, and a tentative self-assembly model was proposed.

In vitro fermentation and prebiotic potential of novel low molecular weight polysaccharides derived from agar and alginate seaweeds

Fermentation properties and prebiotic potential of novel low molecular weight polysaccharides (LMWPs) derived from agar and alginate bearing seaweeds was investigated. Ten LMWPs were supplemented to pH, temperature controlled anaerobic batch cultures inoculated with human feces from three donors, in triplicate. Microbiota changes were monitored using Fluorescent in-situ hybridization and short chain fatty acids, the fermentation end products were analysed using gas chromatography. Of the ten LMWPs tested, Gelidium seaweed CC2253 of molecular weight 64.64 KDa showed a significant increase in bifidobacterial populations from log(10) 8.06 at 0 h to log(10) 8.55 at 24 h (p = 0.018). For total bacterial populations, alginate powder CC2238 produced a significant increase from log(10) 9.01 at 0 h to log(10) 9.58 at 24 h (p = 0.032). No changes were observed in the other bacterial groups tested viz. Bacteroides, Lactobacilli/Enterococci, Eubacterium rectale/Clostridium coccoides and Clostridium histolyticum. The polysaccharides also showed significant increases in total SCFA production, particularly acetic and propionic acids, indicating that they were readily fermented. In conclusion, some LMWPs derived from agar and alginate bearing seaweeds were fermented by gut bacteria and exhibited potential to be used a novel source of prebiotics.

Development and validation of a parent report measure for detection of cognitive delay in infancy

Aim To develop a brief, parent-completed instrument (‘ERIC’) for detection of cognitive delay in 10-24 month-olds born preterm, or with low birth weight, or with perinatal complications, and to establish its diagnostic properties. Method Scores were collected from parents of 317 children meeting ≥1 inclusion criteria (birth weight <1500g; gestational age <34 completed weeks; 5-minute Apgar <7; presence of hypoxic-ischemic encephalopathy) and meeting no exclusion criteria. Children were assessed for cognitive delay using a criterion score on the Bayley Scales of Infant and Toddler Development Cognitive Scale III1 <80. Items were retained according to their individual associations with delay. Sensitivity, specificity, Positive and Negative Predictive Values were estimated and a truncated ERIC was developed for use <14 months. Results ERIC detected 17 out of 18 delayed children in the sample, with 94.4% sensitivity (95% CI [confidence interval] 83.9-100%), 76.9% specificity (72.1-81.7%), 19.8% positive predictive value (11.4-28.2%); 99.6% negative predictive value (98.7-100%); 4.09 likelihood ratio positive; and 0.07 likelihood ratio negative; the associated Area under the Curve was .909 (.829-.960). Interpretation ERIC has potential value as a quickly-administered diagnostic instrument for the absence of early cognitive delay in preterm or premature infants of 10-24 months, and as a screen for cognitive delay. Further research may be needed before ERIC can be recommended for wide-scale use.

Evidence for sex differences in fetal programming of physiological stress reactivity in infancy

Associations between low birth weight and prenatal anxiety and later psychopathology may arise from programming effects likely to be adaptive under some, but not other, environmental exposures and modified by sex differences. If physiological reactivity, which also confers vulnerability or resilience in an environment-dependent manner, is associated with birth weight and prenatal anxiety, it will be a candidate to mediate the links with psychopathology. From a general population sample of 1,233 first-time mothers recruited at 20 weeks gestation, a sample of 316 stratified by adversity was assessed at 32 weeks and when their infants were aged 29 weeks (N = 271). Prenatal anxiety was assessed by self-report, birth weight from medical records, and vagal reactivity from respiratory sinus arrhythmia during four nonstressful and one stressful (still-face) procedure. Lower birth weight for gestational age predicted higher vagal reactivity only in girls (interaction term, p = .016), and prenatal maternal anxiety predicted lower vagal reactivity only in boys (interaction term, p = .014). These findings are consistent with sex differences in fetal programming, whereby prenatal risks are associated with increased stress reactivity in females but decreased reactivity in males, with distinctive advantages and penalties for each sex.

The role of root exuded low molecular weight organic anions in facilitating petroleum hydrocarbon degradation: current knowledge and future directions

Rhizoremediation is a bioremediation technique whereby enhanced microbial degradation of organic contaminants occurs within the plant root zone (rhizosphere). It is considered an effective and affordable ‘green technology’ for remediating soils contaminated with petroleum hydrocarbons (PHCs). This paper critically reviews the potential role of root exuded compounds in rhizoremediation, with emphasis on commonly exuded low molecular weight aliphatic organic acid anions (carboxylates). The extent to which remediation is achieved shows wide disparity among plant species. Therefore, plant selection is crucial for the advancement and widespread adoption of this technology. Root exudation is speculated to be one of the predominant factors leading to microbial changes in the rhizosphere and thus the potential driver behind enhanced petroleum biodegradation. Carboxylates can form a significant component of the root exudate mixture and are hypothesised to enhance petroleum biodegradation by: i) providing an easily degradable energy source; ii) increasing phosphorus supply; and/or iii) enhancing the contaminant bioavailability. These differing hypotheses, which are not mutually exclusive, require further investigation to progress our understanding of plant–microbe interactions with the aim to improve plant species selection and the efficacy of rhizoremediation.

Características clínicas e da saturação transcutânea de oxigênio em lactentes hospitalizados com diagnóstico de bronquiolite viral aguda em oxigenoterapia por cateter extranasal

Objetivos – Descrever as características clínicas de crianças entre 1 e 12 meses hospitalizadas com diagnóstico de bronquiolite viral aguda (BVA), nos primeiros dias de internação, e verificar se o tempo de dessaturação de oxigênio (TD) tem valor prognóstico nesses pacientes. Metodologia – Estudo de coorte realizado de maio a outubro de 2001 com 111 pacientes entre 1 e 12 meses de idade internados no Hospital da Criança Santo Antônio, de Porto Alegre (RS), com diagnóstico de BVA na admissão, com saturação transcutânea de oxigênio da hemoglobina (SatHb) menor que 95% e em oxigenoterapia por cateter extranasal há menos de 24 horas. A gravidade foi verificada através do tempo de internação, tempo de oxigenoterapia e tempo para saturar 95% em ar ambiente (desfechos). Foram realizadas avaliações clínicas duas vezes ao dia (manhã e tarde), durante o período em que o paciente necessitou de oxigênio suplementar (até atingir saturação transcutânea de oxigênio de 95% em ar ambiente), com limite de dez avaliações. Os pacientes tiveram o oxigênio adicional retirado. Foi verificado, então, o tempo necessário para a saturação decrescer até 90% (TD90) e 85% (TD85), limitando-se a medida em no máximo cinco minutos. Foi constituído um escore de gravidade com os sinais clínicos anotados. Utilizou-se o teste do qui-quadrado ou teste exato de Fischer para comparar entre si os grupos de variáveis categóricas e o teste t ou MannWhitney para variáveis numéricas. Foi utilizada a correlação de Spearman para avaliar associações entre variáveis contínuas de distribuição assimétrica (escore de gravidade, tempo de internação, tempo de oxigenoterapia total e tempo para saturar acima ou igual a 95% em ar ambiente). Considerou-se alfa crítico de 5% em todas as comparações, exceto nas correlações em que foi utilizada a correção de Bonferroni para comparações múltiplas (30 correlações: p= 0,002; 10 correlações: p= 0,005). Os dados relativos ao peso e estatura para a idade foram digitados e analisados no programa específico do EpiInfo que utiliza o padrão NCHS (EpiNut). Resultados – Houve leve predomínio do sexo masculino (54%), predominância de idade inferior a quatro meses (61,3%), prevalência maior nos meses de junho e julho, freqüência elevada de história de prematuridade (23%) e de baixo peso de nascimento (14%). As manifestações clínicas prévias à hospitalização (falta de ar, chiado no peito, febre e parar de respirar) ocorreram, na sua maioria, nos três dias anteriores. Da população estudada, 45% tinha história de sibilância prévia, a maioria com um ou dois episódios relatados (31,5%). Esses pacientes foram analisados separadamente e tiveram resultados semelhantes ao grupo com BVA. A freqüência de desnutrição moderada e grave, excluídos os pacientes com história de prematuridade, foi de 26 pacientes (23%). Todos os pacientes utilizaram broncodilatador inalatório; 20% do grupo com BVA receberam corticosteróides sistêmicos e 47% de toda população, antibióticos. A mediana do uso de oxigênio em pacientes com BVA foi de 4,4 dias (IIQ 70,2-165,2) e o tempo de oxigenoterapia até saturar 95% em ar ambiente foi de 3,4 dias (IIQ 55-128). A mediana do tempo de internação hospitalar foi de 7 dias (IIQ 5-10,5) entre os pacientes com BVA; neste aspecto, apresentou diferença (p = 0,041) em relação ao grupo com sibilância prévia, que teve um tempo de internação mais longo (9 dias, IIQ 5-12). Observou-se pouca variabilidade clínica no período estudado, através da aplicação do escore clínico. Não se encontraram correlações estatisticamente significativas entre os escores clínicos e os TDs com os desfechos. Conclusões – Os TDs como elementos auxiliares na avaliação de pacientes em oxigenoterapia não foram clinicamente úteis neste estudo. É possível, no entanto, que, avaliando pacientes com maiores diferenças clínicas entre si, essas aferições possam mostrar-se importantes.

A new and improved strategy combining a dispersive-solid phase extraction-based multiclass method with ultra high pressure liquid chromatography for analysis of low molecular weight polyphenols in vegetables

This paper reports on the development and optimization of a modified Quick, Easy, Cheap Effective, Rugged and Safe (QuEChERS) based extraction technique coupled with a clean-up dispersive-solid phase extraction (dSPE) as a new, reliable and powerful strategy to enhance the extraction efficiency of free low molecular-weight polyphenols in selected species of dietary vegetables. The process involves two simple steps. First, the homogenized samples are extracted and partitioned using an organic solvent and salt solution. Then, the supernatant is further extracted and cleaned using a dSPE technique. Final clear extracts of vegetables were concentrated under vacuum to near dryness and taken up into initial mobile phase (0.1% formic acid and 20% methanol). The separation and quantification of free low molecular weight polyphenols from the vegetable extracts was achieved by ultrahigh pressure liquid chromatography (UHPLC) equipped with a phodiode array (PDA) detection system and a Trifunctional High Strength Silica capillary analytical column (HSS T3), specially designed for polar compounds. The performance of the method was assessed by studying the selectivity, linear dynamic range, the limit of detection (LOD) and limit of quantification (LOQ), precision, trueness, and matrix effects. The validation parameters of the method showed satisfactory figures of merit. Good linearity (View the MathML sourceRvalues2>0.954; (+)-catechin in carrot samples) was achieved at the studied concentration range. Reproducibility was better than 3%. Consistent recoveries of polyphenols ranging from 78.4 to 99.9% were observed when all target vegetable samples were spiked at two concentration levels, with relative standard deviations (RSDs, n = 5) lower than 2.9%. The LODs and the LOQs ranged from 0.005 μg mL−1 (trans-resveratrol, carrot) to 0.62 μg mL−1 (syringic acid, garlic) and from 0.016 μg mL−1 (trans-resveratrol, carrot) to 0.87 μg mL−1 ((+)-catechin, carrot) depending on the compound. The method was applied for studying the occurrence of free low molecular weight polyphenols in eight selected dietary vegetables (broccoli, tomato, carrot, garlic, onion, red pepper, green pepper and beetroot), providing a valuable and promising tool for food quality evaluation.