Structural and functional neuroimaging findings associated with the use of clozapine in schizophrenia: a systematic review

OBJECTIVE

Schizophrenia is one of the most severe psychiatric disorders, and its current treatment relies on antipsychotic medications with only partial effectiveness. Clozapine is an atypical antipsychotic with a specific profile of action indicated for treatment-resistant schizophrenia. Neuroimaging studies assessing the effects of clozapine could help shed light on the neural underpinnings of the effects of this drug in the brain. The objective of this study was to review the available literature on the structural and functional neuroimaging findings associated with use of clozapine.

METHOD

We conducted a systematic review of the indexed literature using the PubMed, BIREME, and ISI Web of Knowledge search engines and the following keywords: clozapine, neuroimaging, computed tomography, MRI, functional magnetic resonance, PET, SPECT, and DTI.

RESULTS

A total of 23 articles were included in the review. In structural studies, the use of clozapine was associated with volume reductions in the basal ganglia, especially the caudate nucleus, where functional neuroimaging studies also found decreased perfusion. In the frontal lobe, clozapine treatment was associated with increased gray matter volume and reduced perfusion.

CONCLUSION

The results of the studies reviewed suggest that the use of clozapine is associated with distinctive structural and functional neuroimaging findings that are not shared with other antipsychotics.

The Brazilian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ)

We report the cross-cultural adaptation and validation into Brazilian-Portuguese of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children regardless the underlying disease. The Brazilian CHAQ was revalidated, while the CHQ has been derived from the Portuguese version. A total of 471 subjects were enrolled: 157 patients with JIA (27% systemic onset, 38% polyarticular onset, 9% extended oligoarticular subtype, and 26% persistent oligoarticular subtype) and 314 healthy children. The CHAQ discriminated clinically healthy subjects from JIA patients, with the systemic, polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and lower overall well-being scores when compared to their healthy peers. Also the CHQ discriminated clinically healthy subjects from JIA patients, with the systemic onset, polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being score when compared to their healthy peers. In conclusion the Brazilian versions of the CHAQ-CHQ are reliable and valid tools for the combined physical and psychosocial assessment of children with JIA.

[Early-onset neonatal sepsis and late-appearing diaphragmatic hernia]

The interesting association between delayed presentation of right-sided diaphragmatic hernia and neonatal Group B streptococcal infections occurs rarely and its pathogenesis is still obscure. Two preterm newborn infants with early onset of neonatal sepsis (one due to Group B Streptococcus) followed by recognition of right-sided diaphragmatic hernia on the 9th and 25th day of life are reported. In both cases the course of neonatal sepsis and pneumonia was complicated due to the appearance of right-sided pleural effusion and atelectasis. On serial chest roentgenograms right-sided bowel gas was noticed and the liver shadow became gradually elevated. Diagnosis was confirmed by ultrasonography and computed tomography. Suspicion of associated diaphragmatic hernia should be raised in neonatal streptococcal infection whenever subsequent progressive respiratory deterioration ensues, requiring mechanical ventilation after initial clinical improvement or in the presence of right-sided pleural effusion.

An evaluation of the efficiency of enrichment media in the isolation process for Vibrio parahaemolyticus

An evaluation of the efficiency of seven enrichment media for Vibrio parahaemolyticus was effected, by means of material collected from the corporeal surface of 82 marine fish caught off the Brazilian coast. On the whole, 45 fish proved positive, from which 71 strains were taken. Among the culture media analyzed the best results were obtained with the new enrichment media represented by two of the nutrient broth (Difco) pH 8.3; one supplemented with 2 g % of NaCl and 500 mg % eosin Y, and another supplemented with 125 mg % metachrome yellow II RD. The combination of enrichment media plus selective-indicator media demonstrated the superiority of the binary association of alcaline broth eosin Y to TCBS agar, both in the number of isolations and serotypes detected.