Are exercise programs relevant in psychiatric wards?

Introduction

About 3% of the general population suffers from Severe Mental Illness (SMI), including schizophrenia spectrum, bipolar and major depressive disorders. In this group, the rates of cardiovascular disease, diabetes mellitus and metabolic syndrome are approximately twice as high as the general population and the life expectancy is 13-30 years inferior compared to age and sex matched controls, greatly due to medical comorbidities. Low levels of physical activity (PA) and low fitness are likely to play a role.

Objectives

To review the evidence about the effects of PA on physical health markers and psychiatric clinical symptoms of SMI patients.

Methods

We performed a literature review on the impact of exercise programs in physical and mental health of SMI patients using the PubMed and Google Scholar databases.

Results

Several studies demonstrate that PA improves a variety of physical health markers in SMI patients, such as body weight, body mass index, waist circumference, body fat percentage, cardiorespiratory fitness, systolic blood pressure and HDL cholesterol. In parallel, there is evidence to support the benefit of PA in mental health, especially due to its effect on mood. Furthermore, PA promotes cognitive functioning, sleep quality, quality of life, self-esteem and fosters social interaction. Moreover, in patients with schizophrenia, exercise seems to decrease negative symptoms.

Conclusions

Implementation of regular physical activities in psychiatric wards should be considered whenever possible, due to its positive effects on physical and mental health. The adoption of structured exercise programs in psychiatric wards is feasible, safe, and well-received by patients.

Disclosure

No significant relationships.

Risk factors and prevention of posttraumatic stress disorder in Intensive Care Unit patients

Introduction

Post-traumatic stress disorder (PTSD) is associated with exposure to an actual death or serious injury threatening event , as is the example of an Intensive Care Unit (ICU) patient, and it is characterized by dissociative, avoidance, cognitive and mood symptoms. (1) It is known that ICU patients may develop PTSD with an incidence rate of 10%. (2)

Objectives

Comprehend the correlation between PTSD development and ICU care and its risk factors and ways of prevention.

Methods

The authors conducted a literature review by searching the Pubmed database using the keywords PTSD; ICU; Risk Factors; Prevention.

Results

The studies show that the risk factors are associated to: Intensive care like mechanic ventilation, sedation (like using midazolam, lorazepam or opioid); individual’s characteristics like being younger than 50 years old, personal history of depression, feminine gender and lower levels of cortisol, and experiencing cognitive alterations, as hallucinations, delirium, amnesia and delirant memory, or anxiety while under ICU care. (1,3,4,5) As a form of prevention non pharmacological measures are the most consensual. Pharmacologic hypothesis should be applied in the first 6 hours of trauma and could be hydrocortisone, as it is thought to be a protective factor for memory consolidation, but the conclusions are not consistent.(6)

Conclusions

There are a lot of people that develop PTSD in the ICU context who are not diagnosed and therefore not treated. In this way, it is necessary to identify the patients with more risk factors, apply the non-pharmacological measures and evaluate the person after discharge.

Disclosure

No significant relationships.

That song in my head: a review on Musical Hallucinations

Introduction

Hearing music inside our heads is frequent, however some hear it more vividly, constantly and involuntarily. Musical Hallucinations (MH), first described by Baillarger in 1846, are a complex type of auditory hallucination characterized by perception of melodies, music, or songs.

Objectives

This work aims to review the literature considering MH.

Methods

Pubmed and Google Scholar search using MeSH term “musical hallucinations”

Results

MH occurs in 0.16% of the population. They´re usually perceived as frightening or annoying. Proposed mechanisms include spontaneous activity triggered by sensory deprivation from hearing impairment, like in visual hallucinations in Charles Bonnet syndrome, and some authors even include MH as a subtype of this syndrome. Indeed, 60% of all patients with MH have hearing impairment or deafness. Other less frequent causes include focal brain lesions involving the auditory pathway and cortex, temporal epilepsy, metabolic or drug intoxication. Psychiatric conditions are uncommon but not impossible, especially in affective disorders. MH most frequently consist in familiar tunes, sometimes of personal significance, religious songs (especially in older patients), childhood songs, folk and popular songs from the radio - suggesting that musical perception is never unlearned but represents a “parasitic memory”, an unchangeable memory feature which can be experienced by relevant neuronal circuit stimulation. Most patients with MH were reported to have no extraordinary musical skills.

Conclusions

MH are rare and strongly associated with hearing loss, though investigation of other causes should be sought. Treating the underlying cause is important but remission is not guaranteed.

Disclosure

No significant relationships.

Effect of exercise training on amyloid-like protein aggregates among patients with heart failure

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): MG and CS were supported by a PhD FCT grant (SFRH/BD/128893/2017) and by an individual grant from CAPES [BEX 0554/14-6], respectively. This work was financially supported by the project POCI-01-0145-FEDER-030011, funded by FEDER, through COMPETE2020-POCI, and by national funds, through FCT/MCTES (PTDC/MEC-CAR/30011/2017). iBiMED is a research unit supported by the Portuguese Foundation for Science and Technology (REF: UID/BIM/04501/2020) and FEDER/Compete2020 funds).

Introduction

Amyloid-like protein aggregates play a decisive role in the pathology of heart failure. Alterations in protein homeostasis, in particular, the clearance of toxic amyloid-like aggregates are emerging therapeutic targets in cardiovascular medicine. The clinical benefits of cardiac rehabilitation and exercise training are widely accepted in heart failure; however, little is known about the potential benefit of exercise training in amyloid-like protein aggregates.

Purpose

To assess the effects of a moderate-intensity exercise training program on amyloid-like protein aggregates levels among patients with heart failure with reduced ejection fraction.

Methods

Eighteen subjects participated in the study; eight patients (age: 66.6 ± 5.9 years; FEVE: 38.4 ± 8.9%) with heart failure with reduced ejection fraction participated in a 3-month exercise training program (2 x 60 min sessions per week of moderate-intensity aerobic and resistance exercise). Ten healthy subjects (age: 68. 4 ± 3.1 years) were recruited to an age-matched reference group.  Amyloid-like protein aggregates were assessed before and after 3 months of exercise training. Clinical data, medication, anthropometrics, and cardiorespiratory fitness were also assessed. Thioflavin T (ThT) dye fluorescence was used to quantify the plasma levels of amyloid-like aggregates and the Fourier transform infrared spectroscopy (FTIR) was applied to evaluate the conformation of cross-β-sheet structures characteristic of amyloid protein aggregates.

Results

Exercise program improved cardiorespiratory fitness by 14.0 ± 17.1% (17.4 ± 3.2 to 19.7 ± 2.9 ml/kg/min) and reduced NT-proBNP levels by 16.5% (34.2) (median concentration of 632 pg/mL (720.8) to 517.5 pg/mL (707.0)) in the heart failure patients. A slight decrease of amyloid-like aggregates levels was observed in post-exercise training samples (a reduction of 3.1%); interestingly, after the exercise training program, the heart failure patients showed levels of amyloid-like aggregates similar to the reference group (1132.0 ± 114.2 vs. 1094.8 ± 132.9 a.u.). Additionally, the PLS-R multivariate analysis of the amide I region of the FTIR spectra revealed enrichment of antiparallel β-sheets (1693 cm-1) assigned to amyloid-like oligomers in the samples of heart failure patients before, but not after, the exercise program. Of note, oligomeric species, as intermediates of amyloid assembly, can contribute to the increase of amyloid burden, but also, some have been reported to be highly reactive and toxic to cells, being key elements of amyloid pathogenesis.

Conclusions

 Our preliminary results indicate that 3 months of exercise training may have significant effects on amyloid-like oligomers, and start hindering the formation of the larger ThT-positive aggregates among patients with heart failure.

Abstract Figure.

To fast or not to fast

Introduction

Ramadan happens in the ninth month of the Muslim lunar calendar. The cycle of the sun marks the beginning and the end of fasting. Its duration varies depending on the season: approximately 18 h in the summer to approximately 12 h during winter. The obligation to eat only during the night leads to an important change in the circadian rhythm There are certain psychiatric illnesses wherein people are very sensitive to this circadian disruption, bipolar disorder in particular. We know that a regulated circadian rhythm with adequate sleep are essential for symptom regulation and mood stability, with the risk of relapse or worsening symptoms. Additionally, some medications have to be maintained at a specific therapeutic index, namely lithium, a common mood stabilizer used to treat bipolar disorder.

Objectives

To review the impact of Ramadan on patients with bipolar disorder

Methods

Pubmed and Google Scholar search using the keywords Bipolar disorder, Ramadan, circadian rhythm, fasting, sleep deprivation

Results

All physiologic parameters are influenced by the circadian rhythm, which is influenced in its turn by the food rhythm. Studies on the effects of Ramadan on mood and mental health in the general population provide contradicting evidence. The inability to take medications during the day, dehydration and other somatic changes that necessitate dosing modification may lead to psychiatric symptom exacerbation.

Conclusions

Patients with bipolar disorder might be particularly sensitive to circadian rhythm disturbances and could require increased monitoring of their symptoms during this month.

Disclosure

No significant relationships.

Cotard syndrome in a patient with multiple sclerosis: A case report

Introduction

“Cotard syndrome” is a rare condition characterized by a constellation of clinical features, including hypochondriac and nihilistic delusions, the most characteristic of which are the ideas that one is dead or that their organs do not exist. It is more commonly associated with psychotic depression and schizophrenia but can also be found in several neurological disorders. In the clinical practice it generally appears as an “incomplete Cotard”, reduced to hypochondriac delusions attributed to the malfunction or occlusion of the organs, usually the digestive tract and abdominal viscera. Consequently it is common for these patients to reject food or medications. In literature it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II.

Objectives

Literature review on Cotard Syndrome and its link with Multiple Sclerosis, based on a clinical case.

Methods

Pubmed and Google Scholar search using the keywords Cotard Syndrome, Multiple Sclerosis.

Results

Hereby we present a clinical case of a 53-year-old female patient, with multiple sclerosis, who presented with hypochondriac and nihilistic delusions and refusal of food and medication. The patient was treated with olanzapine with rapid remission of delusional activity.

Conclusions

Multiple sclerosis is an immunemediated chronic disease, affecting predominantly the sensory and motor function. In addition, psychiatric comorbidity is very frequent with up to 50 % lifetime risk of depression. While various neurological disorders have been described in association with Cotard syndrome, its link with multiple sclerosis has been scarcely reported.

Disclosure

No significant relationships.

The worms that invade your brain

Introduction

Neurocysticercosis is a parasitic infection of the central nervous system and caused by the pork tapeworm Taenia solium. Humans become infected after consuming undercooked food or water contaminated with tapeworm eggs, or through poor hygiene practices. The clinical manifestations of neurocysticercosis (NCC) largely depend on the number, type, size, localization, and stage of development of cysticerci, as well as on the host immune response against the parasite. Seizures are the most common manifestations of NCC (70–90%) of patients, followed by headache (38%), focal deficits (16%) and signs of intracranial hypertension (ICH) (12%), but psychiatric symptoms can also be seen.

Objectives

Literature review on neuropsychiatric manifestations of neurocysticercosis, based on a clinical case.

Methods

Pubmed search using the keywords neurocysticercosis, psychiatric comorbidity, neuropsychiatric manifestations.

Results

We present a clinical case of a 29-year-old male patient, with history of an epilepsy, that immigrated to Portugal with his family from Cape Verde for specialized medical care. He presented to the ER with an acute psychotic episode characterized by disorientation, persecutory ideation, psychomotor agitation and violent behavior. Brain CT scan showed multiple calcifications in cerebral parenchyma and CSF was positive for antibodies against T. solium.

Conclusions

The polymorphous symptomatology seen in NCC is mimicked only by neuro-tuberculosis and neurosyphilis in developing countries, and multiple sclerosis in the Western countries. Psychiatric symptoms are a part of the clinical presentation of infectious diseases. It is important to consider NCC in endemic areas presenting with psychiatric symptoms, especially those showing poor response to the standard treatment and in those with history of seizures.

Disclosure

No significant relationships.

Transfusion transmissible pathogens are prevalent in healthy cats eligible to become blood donors

OBJECTIVES

This study aims to determine the prevalence of subclinical infectious agents considered core pathogens for worldwide screening in healthy, client-owned, indoor cats eligible to become blood donors in Spain and Portugal.

MATERIALS AND METHODS

Blood samples of healthy, indoor, domestic cats selected to be potential blood donors were tested for feline leukaemia virus antigens, feline immunodeficiency virus antibodies and polymerase chain reactions for Mycoplasma haemofelis, Candidatus Mycoplasma haemominutum, Candidatus Mycoplasma turicensis, feline leukaemia virus provirus, Leishmania spp. and Bartonella spp. Not all donors were tested for all agents.

RESULTS

Overall, 5105 healthy indoor cats were tested and 8.1% (414/5105) had at least one subclinical infectious agent that is transmissible through blood product transfusion. 1.5% (77/5105) were positive for feline leukaemia virus antigens and 2.9% (148/5105) were positive for feline immunodeficiency virus antibodies, therefore they were excluded as donors. The overall prevalence of haemoplasmas in feline leukaemia virus and feline immunodeficiency virus SNAP-negative feline blood donors was 3.7% (181/4880) [1.3% (63/4880) were positive for Mycoplasma haemofelis; 2.3% (112/4880) to Candidatus Mycoplasma haemominutum and 0.12% (6/4880) to Candidatus Mycoplasma turicensis]. The prevalence of feline leukaemia provirus was 5.2% (9/173) and of Bartonella spp. was 0.2% (2/1122). None of the 173 cats were positive for Leishmania spp.

CLINICAL SIGNIFICANCE

The prevalence of many transfusion transmissible pathogens was relatively high in this healthy, client-owned, indoor cats eligible to become blood donors. Performing an extended screening panel that includes at least polymerase chain reactions for Mycoplasma haemofelis, Candidatus Mycoplasma haemominutum, Candidatus Mycoplasma turicensis, feline leukaemia virus provirus, and Bartonella spp., in addition to feline leukaemia virus antigens and feline immunodeficiency virus antibodies, is recommended in pet blood banks from analogous regions.

Diabetes and pre-infarct angina. Time to rethink comorbidities in the reperfusion-injury phenomenon?

Background

Pre-infarct angina (PIA) has been shown to reduce reperfusion injury and infarct size in patients with ST-elevation myocardial infarction (STEMI) and currently represents the most efficient form of myocardial conditioning yet discovered. The role of diabetes on ischemic preconditioning remains controversial – while some pre-clinical studies suggest that diabetes blunts ischemic conditioning, clinical studies are lacking.

Methods

We retrospectively evaluated consecutive patients with STEMI admitted in our hospital from January 2008 to August 2018 who underwent primary angioplasty (PCI). PIA was defined as chest, arm or jaw pain during the preceding 48h before STEMI diagnosis. Peak creatine kinase and peak Troponin T levels were used as a surrogate of infarct size. Ischemic time (IT) was defined as the time between the onset of symptoms to the restoration of flow after either guidewire passage, thrombus aspiration or first balloon inflation.

Results

Of the 1143 included patients, 74% (n=845) were male and mean age was 62.6±13.1 years. A quarter of STEMI-patients had diabetes (25%, n=285). Almost a third of the patients (32%, n=359) had a history of angina in the preceding 48h before STEMI (PIA). The proportion of PIA was similar between diabetic and non-diabetic patients. In patients with diabetes, PIA was associated with lower creatine kinase (CK) (1144 [500–2212] vs 1715 [908–3309] U/L, p=0.0029) and Troponin T (TnT 3.30 [1.90–6.58] vs 4.88 [2.50–9.58] ng/mL, p=0.0022) despite similar IT as compared to those without PIA (328 [200–554] vs. 258 [180–530] minutes, p=0.1365). In non-diabetic patients, PIA was not significantly associated with infarct size (TnT 3.74 [2.23–7.11] vs 4.56 [2.44–7.77] ng/mL, p=0.1945; CK 1549 [910 - 2909] vs 1793 [996 - 3078] U/L, p=0.0653) even after adjustment for the increased ischemic time (240 [150–550] vs. 210 [140–405] minutes, p=0.0128) (β=−0.12, p=0.085 for CK and β=−0.11, p=0.183 for TnT). A significant interaction was observed between the existence of PIA and diabetes on peak TnT (p=0.026 for interaction) and CK (p=0.047 for interaction), which was independent of the culprit vessel and IT. During a median follow-up period of 18.0 [12.1–25.5] months, 268 (24.0%) MACE events have occurred (165 deaths, 27 strokes, 46 myocardial infarctions and 26 target vessel revascularization). PIA was associated with a significant reduction in the incidence of MACE (HR 0.66 (95% CI: 0.48–0.89)) driven by a reduction on mortality (HR 0.44 (95% CI: 0.28–0.70)). Diabetes was associated with an increased incidence of MACE (HR 1.42 (95% CI: 1.07–1.89)). No interaction was found between diabetes and PIA on their effect on MACCE events.

Conclusion

PIA is a strong predictor of favourable outcomes in the setting of STEMI. The effect of PIA on myocardial protection in patients with STEMI undergoing primary PCI seems to be modulated by the presence of diabetes.

Distribution of Peak CK and Peak TnT

Funding Acknowledgement

Type of funding source: None

Translating research findings into clinical practice: a systematic and critical review of neuroimaging-based clinical tools for brain disorders

A pivotal aim of psychiatric and neurological research is to promote the translation of the findings into clinical practice to improve diagnostic and prognostic assessment of individual patients. Structural neuroimaging holds much promise, with neuroanatomical measures accounting for up to 40% of the variance in clinical outcome. Building on these findings, a number of imaging-based clinical tools have been developed to make diagnostic and prognostic inferences about individual patients from their structural Magnetic Resonance Imaging scans. This systematic review describes and compares the technical characteristics of the available tools, with the aim to assess their translational potential into real-world clinical settings. The results reveal that a total of eight tools. All of these were specifically developed for neurological disorders, and as such are not suitable for application to psychiatric disorders. Furthermore, most of the tools were trained and validated in a single dataset, which can result in poor generalizability, or using a small number of individuals, which can cause overoptimistic results. In addition, all of the tools rely on two strategies to detect brain abnormalities in single individuals, one based on univariate comparison, and the other based on multivariate machine-learning algorithms. We discuss current barriers to the adoption of these tools in clinical practice and propose a checklist of pivotal characteristics that should be included in an "ideal" neuroimaging-based clinical tool for brain disorders.

Effect of Chlorhexidine Treatment Prior to Fiber Post Cementation on Long-Term Resin Cement Bond Strength

The purpose of this study was to evaluate the push-out bond strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation in simulated, long-term service (thermocycling) when the root canal is treated with chlorhexidine before cementation. One hundred twenty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation (n=120). The specimens were randomly placed into one of 12 groups (10 specimens each) according to cement (T = total-etch RelyX ARC or S = self-adhesive RelyX Unicem), treatment with chlorhexidine (N or Y: without or with), and number of thermal cycles (00, 20, or 40: 0, or 20,000 or 40,000 cycles): 1. TN00, 2. TN20, 3. TN40, 4. TY00, 5. TY20, 6. TY40, 7. SN00, 8. SN20, 9. SN40, 10. SY00, 11. SY20, 12. SY40. The root of each specimen was cut perpendicular to the vertical axis, yielding six 1.0 mm-thick sections. A push-out bond strength test was performed followed by statistical analysis using a factorial analysis of variance. Pairwise comparisons of significant factor interactions were adjusted using the Tukey test. Significant differences of push-out bond strengths were found in the four main effects (resin cement [ p<0.0001], treatment with chlorhexidine [ p<0.0001], number of cycles [ p<0.0001], and root third [ p<0.0001]) and all interactions ( p<0.05 for all). Both resin cements produced higher bond strength in the cervical third followed by the middle third, and lower values were detected in the apical third. Additionally, the results suggest that the use of an additional disinfection treatment with chlorhexidine before the cement application produced the highest push-out bond strength regardless of root third. Further, the thermocycling simulation decreased the bond strength for both resin cements long-term when the chlorhexidine was not applied before cementation. However, when the root canal was treated with chlorhexidine and the fiber post was cemented with self-adhesive cement, the bond strength increased after 0, 20,000 and 40,000 cycles.

Push-Out Bond Strength Evaluation of Glass Fiber Posts With Different Resin Cements and Application Techniques

The purpose of this study was to evaluate the push-out strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation using two different techniques (microbrush and elongation tip) of cement application. In addition, this study evaluated the effect of total-etch conditioning before the use of a self-adhesive cement. Sixty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation. The specimens were randomly placed into one of six groups according to the cement and technique used: RelyX ARC (ARC): ARC + microbrush, ARC + elongation tip; RelyX Unicem (RU): RU + microbrush, RU + elongation tip; or RelyX Unicem + 37% phosphoric acid (RUE): RUE + microbrush, RUE + elongation tip. Each specimen root was cut perpendicular to the vertical axis yielding six 1.0-mm-thick sections. Push-out strength test was performed, followed by statistical analysis using three-way analysis of variance and the Games-Howell test (p<0.05). Statistically significant differences between the groups were found (p< 0.05). The cervical third of the roots had the highest mean push-out strength values, while the apical third had the lowest mean values regardless of the technique used. The elongation technique produced higher mean push-out strength values compared to the microbrush technique. The self-etch adhesive cement had the highest mean push-out strength value in all thirds. The addition of a conditioning step before the self-etch adhesive cementation appears to be effective in enhancing push-out strength with GFPs.

Three axis vector magnet set-up for cryogenic scanning probe microscopy

We describe a three axis vector magnet system for cryogenic scanning probe microscopy measurements. We discuss the magnet support system and the power supply, consisting of a compact three way 100 A current source. We obtain tilted magnetic fields in all directions with maximum value of 5T along z-axis and of 1.2T for XY-plane magnetic fields. We describe a scanning tunneling microscopy-spectroscopy (STM-STS) set-up, operating in a dilution refrigerator, which includes a new high voltage ultralow noise piezodrive electronics and discuss the noise level due to vibrations. STM images and STS maps show atomic resolution and the tilted vortex lattice at 150 mK in the superconductor β-Bi2Pd. We observe a strongly elongated hexagonal lattice, which corresponds to the projection of the tilted hexagonal vortex lattice on the surface. We also discuss Magnetic Force Microscopy images in a variable temperature insert.

Thermal Properties of Alcaline-Earth-Oxides / III. Analysis of Anharmonic Effects

Experimental heat capacity data for the alcaline-earth-oxides have been used to analyse by a new method the high temperature thermodynamic properties of these crystals in terms of quasi-harmonic and explicit anharmonic contributions.

The explicit anharmonic contribution ΔC is consistent with theoretical predictions; ΔC is proportional to T in a first order approximation. The factor of anharmonicity A is negative for MgO, A = (-0.4 + 0.4) · 10-5 K-1 , for SrO A= (-2.8±1) · 10-5 K-1 and for BaO A=(-3.9±1) ·10-5 K-1 , but positive for CaO A = (2.3 ± 1.2) · 10-5 K-1.

Comparison with the results of analysis of the anharmonic effects in the alcaline-halides shows that the alcaline-earth-oxides may be treated by the same models valuable for the alcaline-halides. The results suggest that the type of anharmonic forces is determined in the alcaline-halides as well as in the alcaline-earth-oxides primarily by the cation of the salt.

Topological superconducting state of lead nanowires in an external magnetic field

Superconductors with an odd number of bands crossing the Fermi energy have topologically protected Andreev states at interfaces, including Majorana states in one-dimensional geometries. We propose here that repeated indentation of a Pb tip on a Pb substrate can lead to nanowires such that the resulting superconducting system has novel topological properties. We have analyzed a number of conductance curves obtained in different nanowires, and observe, in a few cases, very peculiar dependence of the critical current on magnetic field. In these cases, the form of multiple Andreev reflections observed at finite voltages are compatible with topological superconductivity. The nanowires give a low number of 1D channels, large spin orbit coupling, and a sizable Zeeman energy, provided that the applied magnetic field is higher than the Pb bulk critical field.

Temperature dependent tunneling spectroscopy in the heavy fermion CeRu2Si2 and in the antiferromagnet CeRh2Si2

CeRu(2)Si(2) and CeRh(2)Si(2) are two similar heavy fermion stoichiometric compounds located on the two sides of a magnetic quantum critical phase transition. CeRh(2)Si(2) is an antiferromagnet below T(N) = 36 K with moderate electronic masses whereas CeRu(2)Si(2) is a paramagnetic metal with particularly heavy electrons. Here we present tunneling spectroscopy measurements as a function of temperature (from 0.15 to 45 K). The tunneling conductance at 0.15 K reveals V-shaped dips around the Fermi level in both compounds, which disappear in CeRu(2)Si(2) above the coherence temperature, and in CeRh(2)Si(2) above the Néel temperature. In the latter case, two different kinds of V-shaped tunneling conductance dips are found.