The synthetic cannabinoids: JWH, four years of analysis

Introduction

Since 2004, herbal mixtures for smoking use have been sold under the generic brand “Spice”. Many of them contain synthetic cannabinoids (agonists of the cannabinoid receptors). JWH-018 was one of the first spice drugs. There is no scientific evidence of their effects on humans, except cases of intoxications and users opinions.

Objective

The present study describes the presence of the synthetic cannabinoids JWH's and their characteristics in the samples delivered for analysis to the harm reduction NGO Energy Control from 2010 to 2014 in Spain.

Methods

From 15,814 samples analyzed from 2010 to 2014, those containing synthetic cannabinoids JWH's were studied (n = 47). Analysis was done by gas chromatography–mass spectrometry.

Results

From these 47 samples containing JWH, 55% were delivered as “legal highs” (n = 21) and 44% as JWH. Most common presentations were powder 47% and herbals 32%. Samples containing JWH 45%(n = 21) were mixed with more than one kind of JWH or were adulterated and other active principles were found 28% (n = 13) JWH-018, 11% (n = 5) JWH-210, 8% (n = 4) JWH-081 and the 6% WH-250 (n = 3). Origin of the sample was Catalunya 23% (n = 11), other provinces of Spain 46% (n = 22); other EU countries 23% (n = 11) and internet-unknown country 8% (n = 8). From the (n = 47) samples, were delivered (n = 16) in 2012, (n = 12) in 2013, (n = 11) in 2011, (n = 3) in 2010 and (n = 3) in 2014.

Conclusion

JWH'S represent a low percentage of new psychoactive substances analyzed. Its presence in the market seems decreasing.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ethylone: A synthetic cathinone emerging in Barcelona

Introduction

Synthetic cathinones, the active component in “bath salts”, have surfaced as a popular alternative to other illicit drugs of abuse, such as cocaine, MDMA (ecstasy), and methamphetamine, due to their potent psychostimulant and empathogenic effects.

Objectives

To describe the presence of Ethylone in samples delivered to energy control from 2014 to 2015 in Spain.

Methods

The total number of samples analyzed from 2014 to 2015 was 8324. Only those samples containing ethylone were studied. They were analyzed by energy control, a Spanish harm reduction NGO that offers the possibility of analysing the substances that users report. Analysis was done by gas chromatography-mass spectrometry.

Results

From June 2014 to December 2015, 8324 samples were delivered to EC. From this samples 28 (0.336%) contained ethylone. Twelve (0.144%) were delivered as MDMA, representing a 0.783% of the samples delivered as such, and only one sample (0.012%) delivered as MDMA presented ethylene as an adulterant along with MDMA. Other 6 samples (0.072%) were delivered as ethylone and 10 samples (0.120%) were delivered as unknown pills.

Discussion

Ethylone consumption is found to be an emerging issue according to the results of our samples, an increase of such is found during 2015. This might be traduced as an increase of ethylone in the drug market, but a sample selection bias should be considered as samples were voluntary delivered by consumers. An alarming phenomenon is that in some occasions ethylone is sold as MDMA, but effects take longer to occur and last longer, which may lead to an overdose if used as MDMA.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Methylone consumption characterized through samples handled by users

Introduction

In recent years, the increasing use tendency of NPS has motivated both awareness and concern about their identification and potential harmfulness. Synthetic cathinones represent a significant proportion of the NPS available and methylone is one of the most frequently found in Europe.

Objectives

The aim of the present study is to determine methylone presence and characteristics from the samples analyzed by Energy Control between the years 2009 and 2015 in Spain.

Methods

From all 21,198 samples analyzed from august 2009 to august 2015, only those in which methylone was found are studied (n = 140). The samples have been analyzed by Energy Control, a spanish harm-reduction NGO that offers to users the possibility of analyzing the substances they intend to consume. The analysis is done by gas chromatography–mass spectrometry.

Results

From the 140 samples containing methylone, 87 were handled as methylone, 20 as MDMA, 8 as other synthetic cathinones and 25 as other substances. The peak of consume was registered in 2011 with 41 samples then the number decreased until 10 samples in 2015.

Conclusions

Results suggest that methylone is most frequently handled as methylone or as MDMA and that its consumption could be decreasing. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological studies should be conducted to enhance the knowledge not only about methylone consumption, but also about synthetic cathinones in general in order to assess their potential risk and study the complications and its management.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

PCP analogues in samples of Barcelona from 2009 to 2015

Introduction

Novel psychoactive substances (NPS) use is progressively increasing year on year. The new analogues of phencyclidine are frequently sold as legal dissociative anesthetic drug with hallucinogenic and sedative effects, a legal alternative to ketamine, acting as a high affinity and selective ligand of NMDA receptor antagonists.

Objectives

To describe the presence of 3- and 4-MeO-PCP in samples delivered to Energy Control from 2009 to 2015 in Spain.

Methods

A total of 21,198 samples were analyzed from august 2009 to august 2015. Only those samples containing 4-MeO-PCP or 3-MeO-PCP were studied. They were analyzed by Energy Control, a Spanish harm reduction NGO that offers the possibility of analyzing the substances that users report. Analysis was done by gas chromatography–mass spectrometry.

Results

All the samples resulted to be the acquired drug of the consumer. Three samples were adulterated with substances as tramadol, cocaine, acetone among others.

Conclusions

Three and 4-MeO-PCP consumption is not found to be an emerging issue according to the results of our samples. Even the potential harmful effects of these dissociative drugs, our indirect indicator seems to show that consumption has not increased. A more precise monitoring would make a better approach to the real consumption and the impact of these substances in our society.

Disclosure of interest

The authors declare that they have no competing interest.

25I-NBOMe: The legal LSD

Introduction

Novel psychoactive substances (NPS) use is progressively increasing year on year. A new group of phenethylamines sold as legal stimulants and hallucinogens is being reported increasingly since 2012. Within this group, 25I-NBOMe is an outstanding substance with powerful effects and high affinity with the serotonin 2a (5HT2a) receptor. Several toxicity cases have been reported so far.

Objectives

To describe the presence of 25I-NBOMe and its characteristics in samples delivered to Energy Control from 2009 to 2015 in Spain.

Methods

Among the samples, 21,198 analyzed from august 2009 to august 2015 and only those samples containing 25I-NBOMe were studied (n = 56). Samples were analyzed by Energy Control, a Spanish harm-reduction NGO that offers users the possibility of analyzing the substances they intend to consume. Analysis was done by Gas Chromatography–Mass Spectrometry.

Results

From 56 samples were 25I-NBOMe was found, 24 were bought as LSD (42.8%), 12 as 25I-NBOMe (21.4%), 4 as 25C-NBOMe (7.1%), 4 as 25I-NBOH (7.1%) and 12 as other substances (21.4%), gummy bears included. All samples were received from 2012 on, having the highest peak on 2013 (19 samples).

Conclusions

25I-NBOMe consumption represents an emerging issue with potential harmful effects, especially when the substance used is not the expected. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological researches should be conducted to deepen knowledge about 25I-NBOMe and the management of its possible toxic effects. Physicians should be aware of NPS, their increasing use and the clinical differences between them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The cat and the mouse game: Is there a shift towards more dangerous substances in the cathinone illicit market?

Introduction

After mephedrone's ban in March 2010 new cathinones proliferated widely, even a new branch of atypical derivatives was launched into the market, represented by MDPV. The cardiovascular and central nervous system toxicity draws attention to this new family of cathinones, also known as pyrovalerones. MDPV was scheduled in 2011, leading to the apparition of Alpha-PVP from which there is little information.

Objectives

The aim of the present study is to describe the evolution of different cathinones in the samples delivered for analysis to the harm reduction NGO energy control from March 2009 to March 2016 in Spain.

Methods

Energy control is a Spanish harm reduction NGO that offers to drug users the possibility of analyzing the substances they intend to consume. From March 2009 to March 2016 a total of 24,528 samples were analyzed by the NGO from which 760 contained cathinones. Substance analysis was done by gas chromatography–mass spectrometry.

Results

From 2009 to 2016, cathinones represented a 2.82% from all analyzed samples. From March 2009 to March 2010, only 5 different cathinones were detected, in this same period methylone (n = 16; 37.20%) and mephedrone (n = 17; 39.53%) represented 76% of analyzed cathinones (n = 43). From March 2015 to March 2016, 132 cathinones were detected: methylone and mephedrone represented only 19.69%, giving prominence to clephedrone (n = 25; 18.93%) and Alpha-PVP (n = 24; 18.18%).

Conclusions

The evolution of synthetic cathinones detected by energy control is consistent with the evolution described in the literature. From 2009 to 2016, the cathinones detected diversify and new substances with higher toxicity potential appear.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

What are sweet dreams made of? Analysis of psychoactive substances into “gummies”: A retrospective descriptive study

Introduction

Although psychoactive substances has a long history in recreational settings, research on its composition has focused only on tablets, crystal and powder, even though new formulation for new psychoactive substances are readily available for users.

Objectives

To describe the presence of psychoactive substances and its characteristics in new formulations which had not previously been found in samples delivered to Energy Control from 2014 to 2015 in Spain.

Methods

A total of 8324 samples were analysed from June 2014 to December 2015. Only those samples in gummy formulation were studied (n = 9). Samples were analyzed by energy control, a Spanish harm-reduction NGO that offers analysis of substances to users. Analysis was done by gas chromatography-mass spectrometry.

Results

From 9 samples of psychoactive substances in gummy formulation, the analysis detected that 55.5% contained multiple psychoactive substances: 6 samples contained 25N-NBOMe (66.7%), 1 2C-E (11.1%), 1 2C-D (11.1%). Two allylescaline (20%), 1 cocaine (11.1%), 1 THC (11.1%), 1 canabinol (11.1%), 1 ketamine (11.1%), 1 caffeine (11.1%), 1 MDMA (11.1%), 1 N-acetyl-MDMA (11.1%), 1 metoxetamine (11.1%), 1 N-acetyl-MDMA), 1 2C-N (11.1%). The only substance found in active dosage was 25N-NBOMe. Six samples (66.67%) did not contain the substance expected by the consumer.

Discussion

Incipient presence of gummies as new psychoactive formulation was found. The most prevalent drug was 25N-NBOMe; 66.7% did not contain the substance expected. This may pose a risk for potential harmful effects. All the gummies were known to be drug-carriers when bought. This could represent the presence of new formulations from June 2014 in the Spanish recreational market.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Insight and Social Cognition in First Episode of Psychosis

Introduction

Impairment of insight in psychotic disorder is associated with adverse impact in treatment compliance, outcome and social functioning although its underlying mechanisms are still unknown. Social cognition and more specifically Theory of mind have been proposed to be correlated to insight. However, the relationship between both factors is still not well defined.

Aims

To study the association between social cognition and insight into mental illness in individuals with early psychosis included in the first episode of psychosis program of Hospital del Mar.

Methods

From the 94 patients included in the first psychotic episode program between January 2011 and January 2016, thirty-eight patients were evaluated six months after the episode. The three initial items of SUMD (Scale Unawareness of Mental Disorder) were used to measure insight and MSCEIT (Mayer-Salovey-Caruso Emotional Intelligence Test) was used to assess social cognition. Linear correlation analysis by Pearson correlation was conducted.

Results

Insight results of SUMD six months after the first episode of psychosis were significantly associated with several subsections of MSCEIT, such as experiential area total punctuation (r = –0.574; P = 0.025), emotional facilitation section (r = –0.633; P = 0.011) and the facial emotion perception task (r = –0.572; P = 0.026).

Conclusions

Results suggest an association between insight and emotional perception and facilitation performance in first episode patients, which may suggest a role of social cognition in psychosis insight impairment. Further research to better define the participation of social cognition in insight into psychosis alteration is mandatory to understand the etiology of insight, define treatment targets and consequently improve the disorder prognosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

CB1-5-HT2A heteromers in schizophrenia patients: Human studies in pro-neurons of the olfactory epithelium

Introduction

Despite multiple clinical and preclinical studies investigating schizophrenia, the neurobiological basis of this disease is still unknown. The dysregulation of the serotonergic system, in particular the 5-HT2A receptor and the endocannabinoid system have been postulated as possible causes of schizophrenia.

Objectives

The aim of this study is to evaluate the expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium in schizophrenia patients and control subjects.

Methods

We recruited a group of 10 healthy volunteers and 10 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, were clinically stable and had an illness duration range from 1 up to 15 years. The patients were diagnosed with schizophrenia from the medical record and confirmed by the structured clinical interview for DSM disorders. The expression of CB1-5-HT2A receptor heteromers in primary cultures of pro-neurons from the olfactory epithelium was quantified using proximity ligation assays and confocal microscopy.

Results

Olfactory epithelium pro-neurons were viable and expressed the neuronal marker, III-β tubulin. We also established the presence and the functionality of CB1-5-HT2A receptor heteromers in these cells using the proximity ligation and cAMP activity assays, respectively. Heteromer expression was significantly increased in schizophrenia patients with respect to controls.

Conclusions

This highly innovative methodology will allow the noninvasive, low-cost study of new biomarkers for schizophrenia in a model closely related to the central nervous system.

Disclosure of interest

The authors have not supplied their declaration of competing interest.Acknowledgments

This work was supported by grants from DIUE-Generalitat-de Catalunya (2014SGR 680), Instituto de Salud Carlos III (PI14/00210) and (PI10/01708) FIS-FEDER-Funds. LG is supported by the Instituto-de Salud Carlos III through a “Río Hortega” (CM14/00111).

Immunologic responses to the major allergen of Olea europaea in local and systemic allergic rhinitis subjects

OBJECTIVE

To evaluate the in vivo and in vitro responses to nOle e 1 in allergic rhinitis (AR) and local allergic rhinitis (LAR) patients sensitized to olive tree pollen (OL) confirmed by nasal allergen provocation test (NAPT).

METHODS

Twelve subjects with AR, 12 with LAR and 12 subjects as control group (CG) were selected. Skin testing and NAPT with nOle e 1 were performed. Eosinophilic cationic protein (ECP) and tryptase were measured in nasal lavages before and after NAPT. Serum IgE to OL allergens was measured by ELISA. Basophil activation tests (BAT) with OL and nOle e 1 and dendritic cell maturation/proliferation studies were carried out.

RESULTS

All AR (12/12) and 10/12 (83%) of LAR had a +NAPT to nOle e 1. ECP levels in nasal lavages were significantly increased after NAPT in both AR and LAR compared with CG at 15 min (P < 0.05). Serum IgE was positive only in AR. All AR had +BAT responses to OL and 10/12 to nOle e 1 (83%); 8/12 LAR (66.6%) had a +BAT to OL and 4/12 (33%) to nOle e 1, with only one subject of the CG with a +BAT to both OL and nOle e 1 (8%). Dendritic cell proliferation to nOle e 1 was increased in AR compared to LAR and CG (P = 0.019 and P = 0.001, respectively).

CONCLUSION

Both AR and LAR had a similar in vivo response to nOle e 1 with release of inflammatory mediators. Specific basophil activation with OL and nOle e 1 was observed in LAR confirming previous data obtained with dust mites.

Validation of an Argentine version of Lupus Quality of Life questionnaire

OBJECTIVE

To determine reproducibility and validity of an Argentine version of the Lupus Quality of Life questionnaire (LupusQoL) and to determine cut-off values in the questionnaire.

MATERIALS AND METHODS

One hundred and forty-seven systemic lupus erythematosus patients (American College of Rheumatology 1982/1997) were assessed from April 2014 to July 2014. Demographic and socioeconomic variables were collected, as well as SELENA/SLEDAI, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index Score, comorbidities and treatment data. Patients completed LupusQoL-Argentine version and European Quality of Life Questionnaire (EuroQoL-5D). Internal consistency and reliability were examined. Convergent validity with EuroQoL-5D was assessed through analysis of latent classes, which established homogeneous categories from the responses of each domain of LupusQoL and for the total.

RESULTS

Out of 147 patients, 93.2% were female, mean age 36.4 ± 11.1 years, mean disease duration 2.7 ± 9 years, mean SELENA/SLEDAI 2.7 ± 3 points. The cut-off point that defined good or bad quality of life was 0.739 for EuroQoL 5D and 63 for LupusQoL. Cut-off values for each LupusQoL domain were also defined, creating two classes in each of them. There was moderate to high concordance to classify quality of life (Kappa = 0.74, 95% confidence interval = 0.54, 0.95).

CONCLUSION

The Argentine version of LupusQoL is a valid, reliable and reproducible instrument to assess quality of life. In this study, cut-off points that allow the classification of patients regarding whether they have good or bad quality of life are established for the first time.

Efficacy and safety of D. pteronyssinus immunotherapy in local allergic rhinitis: a double-blind placebo-controlled clinical trial

The effects of allergen immunotherapy (AIT) on local allergic rhinitis (LAR) are largely unknown. We conducted the first randomized, double-blind, placebo-controlled (DBPC), phase II trial of D. pteronyssinus (DP) subcutaneous AIT (DP-AIT) on LAR (clinicaltrials.gov identifier: NCT02123316). Thirty-six LAR patients received Pangramin PLUS DP or placebo for 24 months. The primary endpoints were symptoms, medication scores, and medication-free days. The secondary included skin test, serum specific IgE and IgG4, nasal allergen provocation test (NAPT), and adverse events. AIT-DP produced significant improvements in both primary and secondary endpoints vs placebo. After 12 months of AIT-DP, we detected a significant and marked increase in allergen tolerance with negative NAPT in 50% of patients, and significant increases of serum sIgG4. Immunotherapy was well tolerated; no systemic reactions were reported. This study demonstrated that AIT-DP is a safe and clinically effective treatment for LAR, confirming that LAR is a new indication for AIT.

Instrumentation for Multi-modal Spectroscopic Diagnosis of Epithelial Dysplasia

Reflectance and fluorescence spectroscopies have shown great promise for early detection of epithelial dysplasia. We have developed a clinical reflectance spectrofluorimeter for multimodal spectroscopic diagnosis of epithelial dysplasia. This clinical instrument, the FastEEM, collects white light reflectance and fluorescence excitation-emission matrices (EEM's) within a fraction of a second. In this paper we describe the FastEEM instrumentation, designed for collection of multi-modal spectroscopic data. We illustrate its performance using tissue phantoms with well defined optical properties and biochemicals of known fluorescence properties. In addition, we discuss our plans to develop a system that combines a multi-spectral imaging device for wide area surveillance with this contact probe device.

Prefrontal cortical thickness related to negative symptoms in antipsychotic-naive, first-episode psychotic patients

Introduction

A significant cortical thinning has been repeatedly observed in adult-onset first-episode schizophrenia patients compared to healthy controls, mostly in medial and inferior prefrontal cortices. However, it is yet unclear whether all these replicated alterations are related to any particular clinical feature.

Objectives

This study aimed to investigate differences of cortical thickness in a sample of first-episode, drug-naive psychotic patients and age- and gender-matched healthy controls and explore clinical correlates of these parameters regarding negative symptoms.

Methods

High-resolution T1-weighted images were acquired from 23 antipsychotic-naive, first-episode psychotic patients and 26 age-matched healthy comparison subjects. Clinical features were measured with the negative subscale of the Positive and Negative Syndrome Scale (PANSS) at baseline and after a 2-month follow-up period.

Results

No differences were found regarding age or gender when comparing patients and controls. We found a significant cortical thinning in the left medial orbitofrontal cortex and in the right lateral orbitofrontal cortex in patients compared to healthy age- and gender-matched controls. Regarding clinical performance, no correlation was found at baseline between left medial orbitofrontal nor right lateral ortitofrontal cortical thickness and scores of the negative subscale of the PANSS. However, at the 2-month evaluation clinical performances were significantly associated to the left medial orbitofrontal cortical thickness values.

Conclusions

Cortical thickness alterations in prefontal cortex appear to be present at disease onset and these alterations may relate to clinical outcome. However, our findings must be considered just as exploratory. Larger longitudinal studies may help characterize, replicate and consolidate these findings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Evolution of bipolar disorder over 12 years in a psychiatric hospital

Introduction

Bipolar disorder is a leading cause of hospitalization in psychiatric hospitals. It is known that early detection of bipolar disorder is associated with a better prognosis.

Objectives

The aim of this study is to conduct a demographic analysis of patients hospitalized for bipolar disorder in a single center between 2003 to 2014.

Methods

Retrospective cohort study of 1230 patients admitted with bipolar disorder diagnosis from 2003 to 2014 at Centre Assistencial Emili Mira i López of Parc Salut Mar of Barcelona. We divided the study in two periods: 2003–2008 and 2009–2014. We analyzed the following variables: frequency of admissions, age, sex and days of hospital stay, comparing both periods. Chi-square test for categorical variables and Student t test for quantitative variables were applied.

Results

The mean ages at the first and second period are 52 and 47, respectively (P < 0.001). There are no significant differences in sex and days of hospitalization. The frequency of admissions on the first and third trimesters is higher than in the second and fourth, although the differences are not statistically significant.

Conclusions

Despite the large number of patients in the study, there are limitations, such as being a retrospective study and not being adjusted for confounding factors. The average age of patients in the second period is lower than in the first. This could suggest an improvement in early detection of bipolar disorder in the last years. Further research is needed to confirm this hypothesis.

Disclosure of interest

LG is funded by the Instituto de Salud Carlos III(CM14/00111).

Abnormal connectivity in dorsolateral prefrontal cortex in schizophrenia patients and unaffected relatives

Objectives

The aim of this study is to explore connectivity of the left dorsolateral prefrontal cortex (LDLPC) by functional magnetic resonance imaging during resting state, in subjects affected by schizophrenia and unaffected relatives.

Methods

We recruited a group of 29 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, who are and were clinically stable in the last 6 months and had an illness duration range from 5 up to 15 years. We also recruited a group of 23 unaffected relatives, without history of other mental, neurological or somatic disease and a group of 37 healthy volunteers. No subject in any of the three groups met criteria for substance use disorders.

All three groups were clinically evaluated, and a functional magnetic resonance during Resting State was performed.

Functional images were reoriented to the first scan, normalized to the MNI EPI template and smoothed with an 8 mm Gaussian kernel, with SPM. The CONN-FMRI Toolbox v1.2 was used to create individual subject seed-to-voxel connectivity maps, to the corresponding seeds of the default mode network.

Results

Fig. 1.

Conclusions

Our results show a significant increase in connectivity between LDLPC and anterior prefrontal cortex, dorsolateral prefrontal cortex and somatosensory association areas, especially between patients and controls. It is noteworthy to mention that we found a significant decrease in connectivity between LDLPC and supramarginal gyrus, superior temporal gyrus and somatosensory association areas between unaffected relatives and controls.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Are there more mechanical restraint in patients admitted for substance use disorder?

Introduction and objectives

Mechanical restraint is a therapeutic procedure commonly applied in acute units in response to psychomotor agitation. Its frequency is between 21 and 59% of patients admitted. These patients represent a risk to both themselves and for health workers. There is a myth that patients with substance use disorder (SUD) are more aggressive and require more forceful measures. There are not clinical studies that compared if there are differences of the frequency of mechanical restrain in patients with SUD.

The aim of this study is to explore the differences of frequency of mechanical restraint on patients with SUD in the psychiatry acute and dual pathology units and others psychiatric diagnostics.

Material and methods

We reviewed retrospectively the informatics record of all the mechanical restraints made and the total discharges of the three acute care units and dual disorders of Neuropsychiatry and Addictions Institute (INAD) of the Parc de Salut Mar de Barcelona, between January 2012 and January 2015. For every discharge the presence of at least one mechanical restraint and the DSM-IV diagnostic were coded. Then was calculated the frequency and proportion of mechanical retrains in every diagnostic group.

Results

The number of discharges analyzed was 4659 from which 838 had an episode of mechanical restraint. The 37% of patients with SUD of cocaine had an episode of mechanical restrain. The patients with SUD of alcohol only the 4%, and there no one case on patients with SUD of Cannabis. Thirty percent of patients with schizophrenia and 28% of bipolar disorder.

Acknowledgements

L. Galindo is a Rio-Hortega-fellowship-(ISC-III;CM14/00111).

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The agitated patient; need for mechanical restraint and prevention measures in relation to psychiatric diagnosis

Introduction

Psychomotor agitation is a common psychiatric emergency in our environment that can occur in a wide clinical spectrum. Both the agitation itself as the procedures for their control, carry an implicit risk to patient safety and health workers.

Objective

To describe the prevention measures used in patients requiring mechanical restraint in relation to diagnosis of psychiatric disorders.

Material and methods

This is a naturalistic descriptive study. Mechanical restraints made in brief psychiatric hospitalization units of “Hospital del Mar” between January of 2013 to March of 2015, were analyzed by diagnosis. Proportions of the prevention intervention performed by nurses in each episode were compared. The groups of prevention interventions done were: “verbal approach”, “environmental measures”, “psychopharmacological intervention”, “observation increase” and “inability for applying any measure because unpredictability”.

Results

A total of 2986 mechanical restraints were done in brief hospitalization units. Among the results, we find that verbal approach measure was use in 77.23% of patient with personality disorders. Environmental measures were used in 40% of the total of restraints. The most of psychopharmacological intervention was done in alcohol intoxication (50%) and then in psychotic spectrum (42.01%). The inability for applying measures was greater in alcohol intoxication (45.4%).

Conclusion

Some of the results of this study are interesting and consistent with clinical practice (for example, effectivity of pharmacological intervention in psychosis and bipolar disorders, as well verbal approach in anxiety, etc.), we can predict the usefulness of measures applied to prevent a mechanical restraint. Further research is needed in this topic.

Disclosure of interest

L. Galindo is a Rio-Hortega-fellowship – (ISC-III; CM14/00111).

Evolution of diagnostic frequency in schizophrenia spectrum disorders in Acute Psychiatric Unit in Barcelona

Introduction

Several studies have suggested variations in the prevalence of schizophrenia spectrum disorders diagnosis across time. This could be due to a change in diagnostic practice motivated either for changes in DSM criteria as for local culture factors. The aim of this study is to explore the evolution of the schizophrenia spectrum disorders. We hypothesize that we would observe a transference from the schizophrenia diagnosis to psychosis not otherwise specified.

Methods

A retrospective review of all psychiatric discharges in acute unit in the INAD of Parc de Salut Mar of Barcelona, between 2002 and 2014 was performed, relating each discharge to its axis I psychiatric diagnostic. An ANOVA analysis was used to calculate the differences between the months and the frequency of the diagnosis.

Conclusion

We have not been able to observe any transference between diagnoses across years. We observe a decrease of the proportion of schizophrenic spectrum disorders in its prevalence at discharge from 2012 to 2014. The proportion of not otherwise specified psychosis remains quite constant as a third of the schizophrenia diagnoses.

Disclosure of interest

The authors report no conflict of interest in this study. LG is funded by the Instituto.de.Salud.Carlos.III (CM14/00111).

Cortical and subcortical morphology deficits in cerebral gray matter in patients with schizophrenia and not affected siblings

Objective

Explore the basis of cortical morphometry in patients with schizophrenia and non-affected siblings by Magnetic Resonance Structural analyzing cortical thickness.

Methods

Twenty-nine patients with schizophrenia treated with atypical antipsychotics and clinically stable in the last 6 months were recruited. Twenty-three not affected siblings of patients with schizophrenia and 37 healthy volunteers were recruited. Magnetic Resonance Structural was performed. FreeSurfer the brain imaging software package for analysis of Cortical Thickness is used. In the analysis of group differences in cortical thickness (CT) with the general linear model (GLM), the P-value was established in 0003 following the Bonferroni correction to control for multiple comparisons (seven regions of interest a priori in each hemisphere).

Results

Significant differences in cortical thickness between patients and healthy controls. Differences between groups were calculated by general linear model (GLM) with age and sex as covairables (Table 1).

Conclusions

In applying the correction for multiple comparisons, differences in bilateral-lateral orbitofrontal, medial orbitofrontal-right and left temporal transverse frontal cortex are significant. Our study replicates previous findings and provides further evidence of abnormalities in the cerebral cortex, particularly in the frontal and temporal regions, being characteristic of schizophrenia.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Acknowledgements

L. Galindo is a Rio-Hortega-fellowship-(ISC-III; CM14/00111).

Prevalence and clinical relevance of local allergic rhinitis

BACKGROUND

Evidence demonstrates the existence of local allergic rhinitis (LAR) in nonatopic patients, although its prevalence in the rhinitis population remains unknown. The aim, therefore, of this study was to evaluate the prevalence, clinical characteristics, and severity of LAR in a Spanish rhinitis population, compared with patients having classical allergic rhinitis (AR) with systemic atopy or nonallergic rhinitis (NAR).

METHODS

A group of 452 adult rhinitis patients were randomly selected from a total of 3860 who attended our allergy service over 1 year. A clinical questionnaire, skin prick test (SPT), spirometry, and serum total and specific IgE (sIgE) were evaluated. A nasal allergen provocation test with multiple aeroallergens (NAPT-M), including Dermatophagoides pteronyssinus, pollens, alternaria, and dog epithelia, was performed in patients with negative SPT and serum sIgE.

RESULTS

A total of 428 patients completed the study; 24 were excluded because of nasal hyper-reactivity. LAR was diagnosed in 25.7%, AR in 63.1%, and NAR in 11.2%. The LAR and AR patients had a similar clinical profile: a nonsmoking woman with severe, persistent perennial rhinitis frequently associated with conjunctivitis and asthma. More than 36% of LAR patients reported rhinitis onset in childhood. NAPT-M detected aeroallergen polysensitization in 37.3% of the LAR patients. Dermatophagoides pteronyssinus was the main sensitizing aeroallergen in LAR and AR (60% vs 54%, P > 0.05).

CONCLUSIONS

Local allergic rhinitis is a prevalent entity in patients evaluated with rhinitis. Persistent and severe symptoms associated with conjunctivitis and/or asthma and polysensitization were likely to be detected in LAR and AR.

Liver cirrhosis in HIV-infected patients: prevalence, aetiology and clinical outcome

Liver disease is frequently seen in HIV+ patients as a result of coinfection with hepatitis B (HBV) or C (HCV) viruses, alcohol abuse and/or exposure to hepatotoxic drugs. The aim of this study was to assess the prevalence of liver cirrhosis, its main causes and clinical presentation in HIV+ patients. Observational, cross-sectional, retrospective study of all HIV+ individuals followed at one reference HIV outpatient clinic in Madrid. Liver fibrosis was measured in all cases using transient elastometry (FibroScan). All 2168 HIV+ patients on regular follow-up (76% males, 46% injecting drug users) were successfully examined by FibroScan) between October 2004 and August 2006. Liver cirrhosis was recognized in 181 (overall prevalence, 8.3%), and the main aetiologies were HCV, 82.3%; HBV, 1.6%; dual HBV/HCV, 2.8%; and triple HBV/HCV/ hepatitis delta virus (HDV) infection, 6.6%. The prevalence of cirrhosis differed among patients with distinct chronic viral hepatitis: HCV, 19.2%; HBV, 6.1%; HBV/HCV, 41.7%; and HBV/HCV/HDV, 66.7%. In 12 patients with cirrhosis (6.7%), no definite aetiology was recognized. Overall, cirrhotics had lower mean CD4 counts than noncirrhotics (408 vs 528 cells/microL respectively; P = 0.02), despite similar proportion of subjects with undetectable viraemia on highly active antiretroviral therapy. Clinical manifestations of liver cirrhosis were: splenomegaly, 61.5%; oesophageal varices, 59.8%; ascites, 22.6%; encephalopathy, 12.1%; and variceal bleeding, 6.1%. Liver cirrhosis and hepatic decompensation events are relatively frequent in HIV+ individuals. Chronic HCV and alcohol abuse, but not chronic HBV, play a major role. Transient elastometry may allow the identification of a significant number of HIV+ individuals with asymptomatic liver cirrhosis.

[Effects of hyposalinity in Thalassia testudinum (Hydrocharitaceae) from Parque Nacional Morrocoy, Venezuela]

The year 1996 had a high pluviosity in Morrocoy National Park (western coastal zone, Venezuela) and low salinity in December 1996 affected the seagrass beds, dominated by Thalassia testudinum. Patches without T. testudinum were observed in localities of the park that used to have very dense populations of this plant. Sampling was done at Las Luisas to determine leaf productivity, turnover rate, short shoot density and relative biomass of plant sections, in order to compare with data obtained in September 1996, previous to the event. Green leaves, roots and rhizomes were the most affected parts. Mean green leaf biomass decreased in January and February 1997 to 5% of the plant's total biomass; mean root biomass decreased in March to 40% and mean rhi zome biomass decreased in February to 30%. The density of the active short shoots decreased to a minimum in February, but in April it reached a value similar to that of September 1996. The density of the inactive short shoots decreased to a minimum in March, and they dissappeared in April, matching the increasing density of the active short shoots between these two months. In February 1997, 56% of the inactive short shoots showed evidence of leaf initiation. In January 1997 the leaf productivity and turnover rate values (2.72 +/- 0.35 g/m2/d and 2.15% leaf DW/d) were similar to the annual mean previously determined from Las Luisas (2.35 +/- 0.72 g/m2/d and 1.96% leaf DW/d). Nevertheless, the values of productivity and turnover rate detected at Las Luisas in April 1997 (4.88 +/- 2.14 g/m2/d and 4.66% leaf DW/d) were higher than those values previously reported for this location. In response to the mortality episode, the leaf productivity and turnover rate of T. testudinum increased and the leaf initiation was activated in the inactive short shoots.

Effect of blood metabolites, body condition and pasture management on milk yield and postpartum intervals in dual-purpose cattle farms in the tropics of the state of Veracruz, Mexico

Research was conducted on typical smallholder farms with dual-purpose cattle (DPC) (Bos indicus x B. taurus) in the coastal north-central area of Veracruz, Mexico. The study was divided into two phases. The aim of the first phase was to investigate the effect of blood metabolities, body condition and pasture management on milk yield and postpartum intervals, in order to investigate if the former are suitable indicators of the reproductive and nutritional status of DPC. One hundred and sixty-five calvings of crossbred cows were recorded from January 1992 to November 1994 on 12 small farms. Milk samples were collected twice a week for progesterone analysis. Blood samples and BCS were taken once a month. However, in Phase II emphasis was placed on the effect of pasture management upon reproductive and productive performance of DPC. Records of four farms were obtained from June 1995 to November 1996. Stocking rates were 0.40, 0.87, 0.35 and 1.5 cows/ha for farms A, B, C and D, respectively. Farms A and C used a slow rotation while B and D used a rapid rotation. In Phase I, the changes in BCS during the last month of pregnancy and first month postpartum did not correlate (p > 0.05) with milk yield or reproductive performance. Blood the metabolite profiles were not consistently related to productive or reproductive variables. The effect of farm and season was significant (p < 0.05) on most of the response variables and low productivity on overstocked farms lead to the conclusion that the low reproductive performance of DPC was linked to poor pasture management. During Phase II, farms A (FA) and D (FD) produce more milk than the others. Days to first service, days open, and calving interval were similar for farms B (FB) and C (FC), highest for Farm A, and lowest for Farm D. The forage availability mean was above the critical range of 6-8 kg of dry matter per 100 kg of liveweight (kg DM/100 kg LW) in all farms (range from 6.1 +/- 5.0 to 21.1 +/- 11.2 kg DM/100 kg LW). Farm D had the highest stocking rate (1.5 cows/ha), a rapid rotation (10 paddocks), a good forage availability (7.1 +/- 3.9 kg DM/100 kg LW) with a good quality for a tropical pasture (11.6 +/- 2.4% crude protein), and an economic energy supplementation. These results suggest this type of management could be more widely employed to improve the productivity of DPC on smallholder farms in the Mexican tropics.

Amiodarone-associated hemoptysis

Amiodarone is a benzofuran derivative with a chemical structure similar to thyroxine. Originally introduced to treat angina pectoris, amiodarone was found to have antiarrhythmic properties, and in 1985, was approved in the United States for treatment of life-threatening ventricular arrhythmias. It is now used for various ventricular and supraventricular arrhythmias refractory to conventional first-line medications, and as a result, side effects have been observed with increased frequency. The most severe and potentially life-threatening of these side effects is the development of pulmonary toxicity. Typically, amiodarone pulmonary toxicity (APT) is manifested by acute pneumonitis and chronic fibrosis. Amiodarone-associated hemoptysis (AAH) is a rare occurrence. The authors describe a case of AAH successfully treated with cessation of drug and steroid therapy.

Primary Ki-1 (anaplastic large cell) lymphoma of the brain and spinal cord

The authors report a case of primary Ki-1 lymphoma of the brain. The patient was a 4 1/2-year-old black girl who presented with a 4- and 5-day history of headaches, nausea, vomiting, neck stiffness, and difficulty in walking. Computed tomography (CT) scan of the brain showed two discrete densities in the left occipital lobe and in the brain stem. Magnetic resonance imaging (MRI) showed multiple densities scattered over the brain surface and brain stem. Microscopically, the tumor was an anaplastic neoplasm that diffusely infiltrated brain parenchyma. The neoplastic cells were large with amphophilic cytoplasm, large nuclei with irregular nuclear contours and prominent nucleoli. A high mitotic rate including atypical mitotic figures was noted. Immunohistochemical stains showed diffuse strong positivity for CD30 and moderate focal staining for epithelial membrane antigen. Leukocyte common antigen, cytokeratin, neuron specific enolase, monocyte/macrophage and B- and T-marker stains were negative. The histology was characteristic for Ki-1 large cell lymphoma. Cytologic examination of cerebrospinal fluid (CSF) demonstrated similar neoplastic cells. This is one of the first reports of this variant in the pediatric population.

Prognostic factors in laryngeal carcinoma. A multifactorial study of 416 cases

The prognostic significance of 20 clinical and histologic parameters was evaluated in a series of 416 laryngeal carcinomas treated between 1969 and 1981 at the Hospital de Santa Cruz y San Pablo, Barcelona, Spain. Clinical follow-up ranged from 2 to 13 years. The variables considered were: age, smoking habits, previous laryngeal disease, duration of clinical symptoms, motility of vocal cords, interval between diagnosis and treatment, postoperative infection, topographic location of the tumor, previous tracheostomy, ulceration, tumor size, resection margins, histologic grading, patterns of growth, types of invasion, mitotic index, depth of invasion, positive lymph nodes, T categories and N categories. Fourteen parameters were found to be significantly related to survival. After a multifactorial study using Cox's life table regression model, 5 of those 14 parameters were found to influence survival independently. The five variables ordered according to prognostic significance were: (1) positive lymph nodes, (2) T categories, (3) histologic grading, (4) ulceration, and (5) location.

Parietal cell volume, hypergastrinemia, and gastric acid hypersecretion after small bowel resection. Experimental study

One hundred and fifty male Sprague-Dawley rats were divided into six groups: control, antrectomy, truncal vagotomy with pyloroplasty, intestinal resection, antrectomy with intestinal resection, and truncal vagotomy with pyloroplasty and intestinal resection. In the control group gastric acid secretion and plasma levels of gastrin were calculated. In the other five groups the same calculations were made 3 months after the corresponding operations. In all animals samples of the gastric wall were taken after specific dyeing of the parietal cells of these samples. In all samples prepared in this way, the variables of parietal cell volume per unit of muscularis mucosa were obtained by a morphometric method. The statistical survey using the levels of gastric acidity, gastrinemia, and parietal volumes of the six groups of animals showed that there is no relation between gastrinemia and gastric acid secretion, nor between gastrinemia and parietal volume, but that there is a significant correlation between gastric acid secretion and parietal volume. Those results suggest that the parietal cell volume in the rat decreases when the secreting capacity of the mucosa is decreased, and that the plasma levels of gastrin do not have a direct trophic effect on the parietal cells of gastric mucosa.

Hepatic tumors of long duration with eventual metastases. Two cases of leiomyosarcomatosis possibly arising from hamartomas of liver

The cases of two patients who had hepatic tumors of long duration interpreted as hamartomas in whom, after many years, widespread metastases of malignant smooth muscle cells developed in a pattern of "carcinomatous lymphangitis" in the lungs are described. In one of the cases calcification of the hepatic nodules was prominent. The smooth muscle origin of the malignant cells was established only on electron microscopic examination. These cases appear similar to others variously reported as mixed tumors, hepatic cell carcinomas, and mesotheliomas.