Clinical outcomes and predictors of success with Impella weaning in cardiogenic shock: a single-center experience

Introduction

Cardiogenic shock (CS) is a severe syndrome with poor prognosis. Short-term mechanical circulatory support with Impella devices has emerged as an increasingly therapeutic option, unloading the failing left ventricle (LV) and improving hemodynamic status of affected patients. Impella devices should be used for the shortest time necessary to allow LV recovery because of time-dependent device-related adverse events. The weaning from Impella, however, is mostly performed in the absence of established guidelines, mainly based on the experience of the individual centres.

Methods

The aim of this single center study was to retrospectively evaluate whether a multiparametrical assessment before and during Impella weaning could predict successful weaning. The primary study outcome was death occurring during Impella weaning and secondary endpoints included assessment of in-hospital outcomes.

Results

Of a total of 45 patients (median age, 60 [51-66] years, 73% male) treated with an Impella device, 37 patients underwent impella weaning/removal and 9 patients (20%) died after the weaning. Non-survivors patients after impella weaning more commonly had a previous history of known heart failure (p = 0.054) and an implanted ICD-CRT (p = 0.01), and were more frequently treated with continuous renal replacement therapy (p = 0.02). In univariable logistic regression analysis, lactates variation (%) during the first 12-24 h of weaning, lactate value after 24 h of weaning, left ventricular ejection fraction (LVEF) at the beginning of weaning, and inotropic score after 24 h from weaning beginning were associated with death. Stepwise multivariable logistic regression identified LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning beginning as the most accurate predictors of death after weaning. The ROC analysis indicated 80% accuracy (95% confidence interval = 64%-96%) using the two variables in combination to predict death after weaning from Impella.

Conclusions

This single-center experience on Impella weaning in CS showed that two easily accessible parameters as LVEF at the beginning of weaning and lactates variation (%) in the first 12-24 h from weaning begin were the most accurate predictors of death after weaning.

Efficacy of bio- and neurofeedback for depression: a meta-analysis

BACKGROUND

For many years, biofeedback and neurofeedback have been implemented in the treatment of depression. However, the effectiveness of these techniques on depressive symptomatology is still controversial. Hence, we conducted a meta-analysis of studies extracted from PubMed, Scopus, Web of Science and Embase.

METHODS

Two different strings were considered for each of the two objectives of the study: A first group comprising studies patients with major depressive disorder (MDD) and a second group including studies targeting depressive symptomatology reduction in other mental or medical conditions.

RESULTS

In the first group of studies including patients with MDD, the within-group analyses yielded an effect size of Hedges' g = 0.717, while the between-group analysis an effect size of Hedges' g = 1.050. Moderator analyses indicate that treatment efficacy is only significant when accounting for experimental design, in favor of randomized controlled trials (RCTs) in comparison to non RCTs, whereas the type of neurofeedback, trial design, year of publication, number of sessions, age, sex and quality of study did not influence treatment efficacy. In the second group of studies, a small but significant effect between groups was found (Hedges' g = 0.303) in favor of bio- and neurofeedback against control groups. Moderator analyses revealed that treatment efficacy was not moderated by any of the sociodemographic and clinical variables.

CONCLUSIONS

Heart rate variability (HRV) biofeedback and neurofeedback are associated with a reduction in self-reported depression. Despite the fact that the field has still a large room for improvement in terms of research quality, the results presented in this study suggests that both modalities may become relevant complementary strategies for the treatment of MDD and depressive symptomatology in the coming years.

C-reactive protein in a naturalistic sample of inpatients with major depressive disorder, bipolar disorder and obsessive-compulsive disorder

Introduction

The relevance of inflammation to psychiatric disorders is well established. While inflammation was broadly investigated in mood disorders, obsessive-compulsive disorder (OCD) received little attention. C-reactive protein (CRP) is an inflammatory marker commonly assessed in clinical practice. Studies comparing CRP levels across mood disorders and OCD are lacking.

Objectives

We compared the prevalence of CRP-based low-grade inflammation (LGI) across major depressive disorder (MDD), bipolar disorder (BD) and OCD, taking into account multiple individual variables that may affect CRP levels.

Methods

Retrospective, observational cross-sectional study in a naturalistic sample of hospitalized patients with MDD or BD or OCD. Information was collected from electronic medical records. Based on serum CRP levels at admission, the following were defined: CRP: >3 mg/L and ≤10 mg/l, “yes” LGI; ≤3 mg/L, “no” LGI. Logistic regression models were applied.

Results

We included 156 patients with MDD, 135 with BD, and 97 with OCD. We found prevalence rates of CRP-LGI of 29.9%, 36.5%, and 47.4% in patients with OCD, MDD, and BD, respectively, without significant differences between groups. The entire set of individual variables considered (e.g., sex, body mass index, medication) explained only one-third of the observed variations in CRP-LGI.

Conclusions

CRP-LGI may be a transdiagnostic feature of a substantial portion of patients with MDD or BD or OCD, rather than being exclusive to a specific psychiatric disorder. The presence of LGI was not fully explained by individual confounding factors. Given the relevance of inflammation to psychiatric and medical outcome, routine measurements of CRP in psychiatric settings may be valuable.

Disclosure

No significant relationships.

Are anxiety disorders associated with accelerated ageing and cognitive decline? A multicenter italian study in middle aged and older patients and controls

Introduction

Anxiety Disorders (AnxDs) are highly prevalent in middle-aged and older individuals and are putative factors that might interfere with normal aging, by affecting cognitive functioning and neuroprogression.

Objectives

This study aims to assess whether current AnxD in middle-aged and older subjects are associated with 1) lower neuropsychological performance, 2) shorter telomere length/lower plasmatic Amyloid-Beta, and 3) brain connectivity alterations, compared to subjects without lifetime psychiatric disorders (HCs).

Methods

This is an ongoing multicentric cross-sectional study. We collected preliminary data on neuropsychological performance through a standardized battery, in 60 outpatients with current AnxDs (DSM-5 criteria), 24 with psychopharmacological treatments (AnxDs+) and 36 without (AnxDs-), compared to 76 HCs, all aged 50-75 years. This study was supported by Fondazione Cariplo, grant n° 2014:0664.

Results

AnxDs- patients showed poorer performance in the language domain, namely in semantic fluency (p=0.04), compared to HCs. No other significant differences were found between groups. Within the patients’ group, we found that a greater burden of psychiatric disorders or medical diseases, current use of benzodiazepines, or unhealthy lifestyle had significant detrimental effects on cognition, whereas current use of antidepressants, pharmacological treatments for medical conditions, and higher levels of physical activity exhibited the opposite effects.

Conclusions

We found only limited difference in cognitive performance between patients and controls. However, our preliminary results show that multiple factors influence cognitive performance in individuals with AnxDs, making these aspect important to monitor in clinical practice. So far, our results are provisional and further analyses in the final sample may provide more reliable conclusions.

New onset of mental disorders, lifestyle changes, and quality of relationships during COVID-19 in italian population

Introduction

The COVID-19 pandemic has been causing relevant public health and psychosocial consequences.

Objectives

To assess the impact of the COVID-19 pandemic on mental health, lifestyle and personal relationships in the Italian general population.

Methods

An online survey spread between May and June 2020 to collect socio-demographic, clinical, lifestyle, relationship, and mental health self-reported information. Mental disorder screening was performed by the Patient Health Questionnaire and PTSD Checklist for DSM-5.

Results

Participants were 2003, 1504 of which (75%) completed the entire questionnaire (1157 females, 77%). Among the completers who have not had any mental disorder before (n=524, 35%), 263 (51.7%) met cut-off scores for psychiatric diagnoses on the self-report psychiatric screeners during the pandemic (i.e., Major Depressive Disorder, 11.3%, with death thoughts in approximately half of the cases; Panic Disorder, 1.1%; Generalized Anxiety Disorder, 13%.3, Obsessive-Compulsive Disorder, 13.2%, Post-Traumatic Stress Disorder, 7.3%; Alcohol Abuse, 5.5%). In line with this, 39% of completers complained of insomnia, while 12% and 10% started using anxiolytics and antidepressants, respectively. Approximately 7-8 % of completers started/increased alcohol and/or nicotine consumption, 33% quitted/decreased physical activity, and 40% declared decreased sexual satisfaction. Approximately 21% and 38% declared worsening in relationship with partner and difficulty in child-caring, respectively.

Conclusions

The COVID-19 pandemic appears to be a risk factor for new onset of mental disorders and worsening in lifestyle and familial relationships in the Italian population. These results should be confirmed by clinical interviews, and may represent a starting point for further monitoring of the medium and long-term consequences of the COVID-19 pandemic.

Disclosure

No significant relationships.

Recognition of healthy and cancerous breast cells: Sensing the differences by dielectric spectroscopy

PURPOSE

The response of human cells to applied electrical signals depends on the cellular health status, because it is influenced by the composition and structure of the main cellular components. Therefore, electrical impedance-based techniques can be considered as sensitive tools to investigate healthy or disease state at cellular level. The goal of this study is to show that different types of in vitro cellular lines, related to different health status, can be differentiated using impedance spectra analysis.

METHODS

Three different types of human breast cell line, corresponding to healthy, cancerous, and metastatic adenocarcinoma cells, were measured by means of electrical impedance spectroscopy. By modeling the investigated cells with proper resistive and capacitive circuital elements, the magnitude of the cell electrical components and spectra of real and imaginary part of dielectric permittivity were obtained. The latter were subsequently examined with a commonly adopted mathematical model, in order to estimate the values of specific dielectric parameters for the three different cellular lines.

RESULTS

The relative variation of cellular capacitance with respect to that of the culture medium, estimated at 100 Hz, has a larger value for the two types of cancerous cells with respect to the noncancerous type. Furthermore, the ratio between the real and imaginary part of the dielectric permittivity function has larger values for metastatic cells with respect to the normal and nonmetastatic ones. Therefore, the mentioned relative capacitance allows to discriminate between normal and cancerous cells, whereas the results obtained for the dielectric function can discriminate between metastatic and nonmetastatic cells.

CONCLUSIONS

This study can be considered as an exploratory investigation of evaluating in vitro the health status of humans cells using selected electrical impedance parameters as potential markers. The obtained results highlight that a standard cultureware system, provided with interdigitated electrodes and appropriate impedance parameters, that is, cellular capacitance and the ratio between the imaginary and real part of cellular dielectric function, can be used to discriminate between healthy and cancerous breast cell lines, as well as different malignancy degrees.

Raman spectroscopy for the evaluation of the radiobiological sensitivity of normal human breast cells at different time points after irradiation by a clinical proton beam

Radiobiological effects occurring in normal human breast cells exposed to a low dose of a clinical proton beam are detectable by means of Raman spectra and the ratiometric analysis of Raman peak intensities.

Correction: Exposure to 1.8 GHz electromagnetic fields affects morphology, DNA-related Raman spectra and mitochondrial functions in human lympho-monocytes

[This corrects the article DOI: 10.1371/journal.pone.0192894.].

The revolution of personalized psychiatry: will technology make it happen sooner?

Personalized medicine (PM) aims to establish a new approach in clinical decision-making, based upon a patient's individual profile in order to tailor treatment to each patient's characteristics. Although this has become a focus of the discussion also in the psychiatric field, with evidence of its high potential coming from several proof-of-concept studies, nearly no tools have been developed by now that are ready to be applied in clinical practice. In this paper, we discuss recent technological advances that can make a shift toward a clinical application of the PM paradigm. We focus specifically on those technologies that allow both the collection of massive as much as real-time data, i.e., electronic medical records and smart wearable devices, and to achieve relevant predictions using these data, i.e. the application of machine learning techniques.

Exposure to 1.8 GHz electromagnetic fields affects morphology, DNA-related Raman spectra and mitochondrial functions in human lympho-monocytes

Blood is a fluid connective tissue of human body, where it plays vital functions for the nutrition, defense and well-being of the organism. When circulating in peripheral districts, it is exposed to some physical stresses coming from outside the human body, as electromagnetic fields (EMFs) which can cross the skin. Such fields may interact with biomolecules possibly inducing non thermal-mediated biological effects at the cellular level. In this study, the occurrence of biochemical/biological modifications in human peripheral blood lympho-monocytes exposed in a reverberation chamber for times ranging from 1 to 20 h to EMFs at 1.8 GHz frequency and 200 V/m electric field strength was investigated. Morphological analysis of adherent cells unveiled, in some of these, appearance of an enlarged and deformed shape after EMFs exposure. Raman spectra of the nuclear compartment of cells exposed to EMFs revealed the onset of biochemical modifications, mainly consisting in the reduction of the DNA backbone-linked vibrational modes. Respirometric measurements of mitochondrial activity in intact lympho-monocytes resulted in increase of the resting oxygen consumption rate after 20 h of exposure, which was coupled to a significant increase of the FoF1-ATP synthase-related oxygen consumption. Notably, at lower time-intervals of EMFs exposure (i.e. 5 and 12 h) a large increase of the proton leak-related respiration was observed which, however, recovered at control levels after 20 h exposure. Confocal microscopy analysis of the mitochondrial membrane potential supported the respiratory activities whereas no significant variations in the mitochondrial mass/morphology was observed in EMFs-exposed lympho-monocytes. Finally, altered redox homeostasis was shown in EMFs-exposed lympho-monocytes, which progressed differently in nucleated cellular subsets. This results suggest the occurrence of adaptive mechanisms put in action, likely via redox signaling, to compensate for early impairments of the oxidative phosphorylation system caused by exposure to EMFs. Overall the data presented warn for health safety of people involved in long-term exposure to electromagnetic fields, although further studies are required to pinpoint the leukocyte cellular subset(s) selectively targeted by the EMFs action and the mechanisms by which it is achieved.

Coralline algae in a naturally acidified ecosystem persist by maintaining control of skeletal mineralogy and size

To understand the effects of ocean acidification (OA) on marine calcifiers, the trade-offs among different sublethal responses within individual species and the emergent effects of these trade-offs must be determined in an ecosystem setting. Crustose coralline algae (CCA) provide a model to test the ecological consequences of such sublethal effects as they are important in ecosystem functioning, service provision, carbon cycling and use dissolved inorganic carbon to calcify and photosynthesize. Settlement tiles were placed in ambient pH, low pH and extremely low pH conditions for 14 months at a natural CO₂ vent. The size, magnesium (Mg) content and molecular-scale skeletal disorder of CCA patches were assessed at 3.5, 6.5 and 14 months from tile deployment. Despite reductions in their abundance in low pH, the largest CCA from ambient and low pH zones were of similar sizes and had similar Mg content and skeletal disorder. This suggests that the most resilient CCA in low pH did not trade-off skeletal structure to maintain growth. CCA that settled in the extremely low pH, however, were significantly smaller and exhibited altered skeletal mineralogy (high Mg calcite to gypsum (hydrated calcium sulfate)), although at present it is unclear if these mineralogical changes offered any fitness benefits in extreme low pH. This field assessment of biological effects of OA provides endpoint information needed to generate an ecosystem relevant understanding of calcifying system persistence.

Does the "Silver Bullet" Lose its Shine Over the Time? Assessment of Loss of Lithium Response in a Preliminary Sample of Bipolar Disorder Outpatients

Background:

Though often perceived as a “silver bullet” treatment for bipolar disorder (BD), lithium has seldom reported to lose its efficacy over the time.

Objective:

The aim of the present study was to assess cases of refractoriness toward restarted lithium in BD patients who failed to preserve maintenance.

Method:

Treatment trajectories associated with re-instituted lithium following loss of achieved lithium-based maintenance in BD were retrospectively reviewed for 37 BD-I patients (median age 52 years; F:M=17:20 or 46% of the total) over an 8.1-month period on average.

Results:

In our sample only 4 cases (roughly 11% of the total, of whom F:M=2:2) developed refractoriness towards lithium after its discontinuation. Thirty-three controls (F:M=15:18) maintained lithium response at the time of re-institution. No statistically significant difference between cases and controls was observed with respect to a number of demographic and clinical features but for time spent before first trial ever with lithium in life (8.5 vs. 3 years; U=24.5, Z=-2.048, p=.041) and length of lithium discontinuation until new therapeutic attempt (5.5 vs. 2 years; U=8, Z=-2.927, p=.003) between cases vs. controls respectively. Tapering off of lithium was significantly faster among cases vs. controls (1 vs. 7 days; U=22, Z=-2.187), though both subgroups had worrisome high rates of poor adherence overall.

Conclusion:

Although intrinsic limitations of the present preliminary assessment hamper the validity and generalizability of overall results, stating the clinical relevance of the topic further prospective research is warranted. The eventual occurrence of lithium refractoriness may indeed be associated with peculiar course trajectories and therapeutic outcomes ultimately urging the prescribing clinicians to put efforts in preserving maintenance of BD in the absence of any conclusive research insight on the matter.

An update of safety of clinically used atypical antipsychotics

INTRODUCTION

The atypical antipsychotic (APs) drugs have become the most widely used agents to treat a variety of psychoses because of their superiority with regard to safety and tolerability profile compared to conventional/'typical' APs.

AREAS COVERED

We aimed at providing a synthesis of most current evidence about the safety and tolerability profile of the most clinically used atypical APs so far marketed. Qualitative synthesis followed an electronic search made inquiring of the following databases: MEDLINE, Embase, PsycINFO and the Cochrane Library from inception until January 2016, combining free terms and MESH headings for the topics of psychiatric disorders and all atypical APs as following: ((safety OR adverse events OR side effects) AND (aripiprazole OR asenapine OR quetiapine OR olanzapine OR risperidone OR paliperidone OR ziprasidone OR lurasidone OR clozapine OR amisulpride OR iloperidone)).

EXPERT OPINION

A critical issue in the treatment with atypical APs is represented by their metabolic side effect profile (e.g. weight gain, lipid and glycaemic imbalance, risk of diabetes mellitus and diabetic ketoacidosis) which may limit their use in particular clinical samples. Electrolyte imbalance, ECG abnormalities and cardiovascular adverse effects may recommend a careful baseline and periodic assessments.

Hidden impacts of ocean acidification to live and dead coral framework

Cold-water corals, such as Lophelia pertusa, are key habitat-forming organisms found throughout the world's oceans to 3000 m deep. The complex three-dimensional framework made by these vulnerable marine ecosystems support high biodiversity and commercially important species. Given their importance, a key question is how both the living and the dead framework will fare under projected climate change. Here, we demonstrate that over 12 months L. pertusa can physiologically acclimate to increased CO2, showing sustained net calcification. However, their new skeletal structure changes and exhibits decreased crystallographic and molecular-scale bonding organization. Although physiological acclimatization was evident, we also demonstrate that there is a negative correlation between increasing CO2 levels and breaking strength of exposed framework (approx. 20-30% weaker after 12 months), meaning the exposed bases of reefs will be less effective 'load-bearers', and will become more susceptible to bioerosion and mechanical damage by 2100.

Discrimination of different degrees of oral squamous cell carcinoma by means of Raman microspectroscopy and atomic force microscopy

Two cellular types characterized by different degree of oral squamous cell carcinoma can be discriminated by Raman microspectroscopy and Atomic Force Microscopy, according to the content of nucleic acids and proteins as well as the membrane stiffness.

Alexithymia and its relationships with acute phase proteins and cytokine release: an updated review

The alexithymia construct is multidimensional and comprises several features: (a) difficulty in identifying and describing feelings, (b) difficulty in distinguishing feelings from the bodily sensations, (c) diminution of fantasy, and (d) concrete and poorly introspective thinking. Altered immune responses have been seen in some psychiatric disorders and several data suggest that analogous changes could also be observable in alexithymia. Hence, the aim of this review is to investigate the relationships between alexithymia and acute phase proteins and cytokines in psychiatric, psychosomatic and medical diseases. Several studies have reported an association between alexithymia and higher circulating levels of acute phase proteins, especially C-Reactive Protein. Moreover, in alexithymic subjects the pro-inflammatory and anti-inflammatory cytokine balance may be tuned toward a pro-inflammatory imbalance with a concomitant altered cell-mediated immunity. These findings may be consistent with the "“stress-alexithymia hypothesis"”. Therefore, the screening of alexithymic traits and the administration of appropriate psychological and psychotherapeutical interventions should be integral parts of disease management programs. Supplying such interventions will probably help with prevention of the development of the disease and/or its exacerbation by improving the quality of life of alexithymic individuals.

Is there a role for agomelatine in the treatment of anxiety disorders?A review of published data

Anxiety disorders (Ads) are the most common type of psychiatric disorders, Pharmacologic options studied for treating ADs may include benzodiazepines, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSA) and serotonin and noradrenaline reuptake inhibitors (SNRIs). Agomelatine, a new melatonergic antidepressant, has been shown effective in various types of mood disorders. Moreover, some evidence points towards a possible efficacy of such a drug in the treatment of ADs. Therefore, the aim of this review was to elucidate current (facts and views) data on the role of agomelatine in the treatment of ADs. The trials evaluating agomelatine in the treatment of generalized anxiety disorder are few but, overall, encouraging in regards to its efficacy. However, further randomized, placebo-controlled studies on larger samples use are needed. Apart from some interesting case reports, no large studies are, to date, present in literature regarding agomelatine in the treatment of other ADs, such as panic disorder, social anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder. Therefore, the clinical efficacy and the relative good tolerability of agomelatine in generalized anxiety (GAD) warrants further investigation in ADs.

Insomnia as a predictor of high-lethality suicide attempts

INTRODUCTION

Research has demonstrated that patients with insomnia are at an increased risk of experiencing suicidal ideation and/or making a suicide attempt.

OBJECTIVES

To evaluate the relation between insomnia and suicidal behaviour.

AIMS

To examine factors associated with a diagnosis of insomnia in patients admitted to an Emergency Department (ED) and assessed by the psychiatrist in charge.

METHODS

Participants were 843 patients consecutively admitted to the ED of Sant'Andrea Hospital in Rome, between January 2010 and December 2011. All patients admitted were referred to a psychiatrist. A clinical interview based on the Mini International Neuropsychiatric Interview (MINI) and a semi-structured interview was conducted. Patients were asked about 'ongoing' suicidal ideation or plans for suicide.

RESULTS

Forty-eight percent of patients received a diagnosis of bipolar disorder (BD), major depressive disorder (MDD) or an anxiety disorder; whereas, 17.1% were diagnosed with Schizophrenia or other non-affective psychosis. Patients with insomnia (compared to patients without insomnia) more frequently had a diagnosis of BD (23.9% vs. 12.4%) or MDD (13.3% vs. 9.5%; p < 0.001). Moreover, patients with insomnia less frequently had attempted suicide in the past 24 h (5.3% vs. 9.5%; p < 0.05) as compared with other patients, but those patients with insomnia who attempted suicide more frequently used a violent method (64.3% vs. 23.6%; p < 0.01) compared to other suicide attempters.

CONCLUSIONS

Our results do not support an association between insomnia and suicidal behaviour. However, suicide attempters with insomnia more frequently used violent methods, and this phenomenon should be taken into serious consideration by clinicians.

Laser Ablation of Highly Oriented Cdse Thin Films and Cdte/Cdse Multilayers on Silicon Substrate

Laser ablation technique has been successfully used for the deposition of CdSe and CdTe/CdSe multilayers on Si(100) and Si(l11) substrates. X-ray analysis showed that CdSe/Si films were highly oriented. Their orientation changed from (100) to (002) by varying the substrate temperature from 473 to 673K. High orientation was also obtained on multilayered polycrystalline structures of CdSe and CdTe on Si(lll). Photoluminescence experiments have also been carried out on the deposited films.

Clostridium perfringens Type A Food Poisoning II. Response of the Rabbit Ileum as an Indication of Enteropathogenicity of Strains of Clostridium perfringens in Human Beings

The effect of feeding human beings individual strains of Clostridium perfringens or culture filtrates thereof was examined. The strains selected for challenge included both those which had previously been shown to produce fluid accumulation in the ligated ileum or overt diarrhea when injected into the nonligated ileum of the rabbit, or had produced both, and those which did not regularly produce these responses. Challenge doses prepared by allowing each strain to grow in beef stew for 3 hr at 46 C resulted in a 61% incidence of diarrhea when rabbit-positive cells were used. No diarrhea occurred among the subjects fed rabbit-negative strains prepared in a similar manner. The procedures employed in preparing the challenge dose appeared to influence the results obtained. When cell-free filtrates were fed, 4 of 15 persons consuming filtrates from rabbit-positive strains developed diarrhea. All subjects fed filtrates from rabbit-negative strains remained free from diarrhea. Serological tests were carried out to compare the identity of the strains of C. perfringens consumed by the subjects and those excreted in the feces. Heat resistance measured as D(100) values varied greatly among the rabbit-positive strains.

Efficacy and safety of azithromycin 1 g once daily for 3 days in the treatment of community-acquired pneumonia: an open-label randomised comparison with amoxicillin-clavulanate 875/125 mg twice daily for 7 days

This randomised, open-label, non-inferiority study was designed to demonstrate that a 3-day course of oral azithromycin 1 g once daily was at least as effective as a standard 7-day course of oral amoxicillin-clavulanate 875/125 mg twice daily in the treatment of outpatients with community-acquired pneumonia (Fine class I and II). In total, 267 patients with clinically and radiologically confirmed community-acquired pneumonia were randomly assigned to receive either the azithromycin (n=136) or the amoxicillin-clavulanate (n=131) regimen. At screening, 60/136 (58.8%) and 61/131 (62.9%) respectively had at least one pathogen identified by sputum culture, PCR, or serology. The primary endpoint was the clinical response in the intent-to-treat population at the end of therapy (day 8 to 12). Clinical success rates were 126/136 (92.6%) for azithromycin and 122/131 (93.1%) for amoxicillin-clavulanate (treatment difference: - 0.48%; 95% confidence interval: - 5.66%; 4.69%). Clinical and radiological success rates at follow-up (day 22-26) were consistent with the end of therapy results, no patient reporting clinical relapse. Bacteriological success rates at the end of therapy were 32/35 (91.4%) for azithromycin and 30/33 (90.9%) for amoxicillin-clavulanate (treatment difference: 0.52%; 95% confidence interval - 10.81%; 11.85%). Both treatment regimens were well tolerated: the overall incidence of adverse events was 34/136 (25.0%) for azithromycin and 22/132 (16.7%) for amoxicillin-clavulanate. In both treatment groups, the most commonly reported events were gastrointestinal symptoms. Azithromycin 1g once daily for 3 days is at least as effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia.

Vestibular testing in patients with panic disorder and chronic dizziness

In order to investigate the relationship between chronic dizziness and vestibular function in patients with panic disorder, in the present study neurotologic findings in 15 patients with panic disorder and chronic dizziness were compared with those in 15 patients with chronic dizziness, without panic disorder. All underwent neurotologic screening for spontaneous, positional and positioning nystagmus with head-shaking and head-thrust tests, an audiometric examination and electronystagmography with bithermal stimulation according to Freyss. A significantly higher number of patients with panic disorder and chronic dizziness showed pathological neurotologic findings in comparison to subjects with chronic dizziness only (9 and 2 patients, respectively; p < 0.05). Most patients with panic disorder showed signs of peripheral vestibular disorders. These results suggest that the complaint of dizziness in patients with panic disorder may be linked to a malfunction of the vestibular system and vestibular disorders may play a role in the pathophysiology of panic disorder. Possible mechanisms underlying this finding are discussed. In patients with panic disorder and chronic dizziness between panic attacks, a careful neurotologic examination is warranted.

The melanogenic system of the liver pigmented macrophages of Rana esculenta L.--tyrosinase activity

The enzyme system responsible for Amphibian Kupffer Cell (KC) melanogenesis has not been entirely elucidated. This research demonstrates that the KC melanosomes of Rana esculenta L. possess a tyrosine-hydroxylase (TH) activity, showing that a tyrosinase is the enzyme involved in the melanogenesis. The TH reaction depends on catalytic Dopa as a cofactor and is not affected by catalase or H2O2, showing that it is catalysed by the tyrosinase and not by the peroxidase present in the melanosomes. The TH reaction is activated by Cu2+ ions but not by other tyrosinase activators such as limited proteolysis, protein ageing, and Sodium Dodecyl Sulphate (SDS). SDS inhibited the KC TH activity even below the critical micelle concentration. All these results suggest that the KC-tyrosinase differs in structure from other known tyrosinases. Using anti-KC-tyrosinase antobodies, we observed that the sites of the tyrosinase location within the cell are the same as those described in the melanocytes. In the immunoblots, the anti-KC-tyrosinase antibodies also recognised two protein bands, at the higher molecular weight ranges, in the protein electrophoretic pattern. Moreover, the tyrosinase activity was limited to the highest molecular weight band of about 260 kDa, suggesting that the enzyme activity could depend on a molecular aggregate. The melanin produced in the liver was found to be a 5,6-dihydroxyindole-rich eumelanin similar to the Sepia melanin.

Anxiety sensitivity in children of panic disorder patients

Anxiety sensitivity (AS), which refers to the tendency to interpret anxiety-related bodily sensations as having potentially harmful somatic, psychological or social consequences, has been proposed as a vulnerability factor for the development of panic disorder (PD). The current study examined the anxiety sensitivity levels in children of parents with panic disorder. Children of panic disorder patients (n = 68) and children of healthy parents (n = 68) filled out the Childhood Anxiety Sensitivity Index, while parents completed the Anxiety Sensitivity Index. Children of parents with panic disorder did not display higher levels of anxiety sensitivity than children of healthy parents. Furthermore, no association between anxiety sensitivity levels of parents with panic disorder and their children was found. Anxiety sensitivity is not clearly manifest in children of parents with panic disorder and might be a developing vulnerability factor that may increase towards late adolescence or early adulthood.

Comparison of the Treatment with Paroxetine and Reboxetine in Panic Disorder: A Randomized, Single-Blind Study

INTRODUCTION

Serotonergic agents have greater effectiveness than noradrenergic ones in the treatment of Panic Disorder (PD). However preliminary studies suggested that reboxetine might be effective in the treatment of PD. We compared the effectiveness and tolerability of reboxetine and paroxetine in the treatment of PD.

METHODS

Sixty-eight patients with PD were assigned to treatment groups in a single-blind, randomized design. Each patient was assessed at day 0 and 90 by the Panic Associated Symptoms Scale (PASS), the Sheehan Disability Scale (SDS) and the Fear Questionnaire (FQ). Side effects were also recorded.

RESULTS

Reduction of PASS scores was significantly greater in the paroxetine group than in the reboxetine one. Vice versa we did not find any significant differences for other outcome measures. Sexual dysfunction and weight gain were significantly less frequent in the reboxetine group.

CONCLUSIONS

The results showed a greater effect of paroxetine on panic attacks than reboxetine, while no differences for anticipatory anxiety and avoidance were found, suggesting a different role of noradrenaline and serotonin in the treatment of PD.

Panic disorder: the role of the balance system

Experimental evidences suggest that Panic Disorder (PD) is characterized by abnormalities in respiratory and vestibular functions. We studied balance system function in patients with PD and its relationships with CO(2) reactivity and clinical characteristics. Nineteen patients with PD with/without agoraphobia underwent static posturography and the 35% CO(2) challenge. The severity of clinical symptomatology was measured by standardized psychometric scales. Patients were free of psychotropic medications during the 2 weeks before the study. Different investigators blind to each other carried out the CO(2) challenge, static posturography and clinical assessment. Nineteen age and sex-matched healthy controls underwent static posturography. Body sway velocity and length were significantly higher in panic patients than in controls and patients showed high percentages of abnormal scores. Patients with two or more abnormal scores on static posturography were significantly more agoraphobic than those with less than two. Abnormal posturography scores under the eyes-opened was related to high anticipatory anxiety, whereas those under eyes-closed was related to phobic avoidance. Symptomatological reactivity to CO(2) was significantly correlated to abnormal functions of the balance system in the eyes-closed condition. Our findings suggest that (1) many patients with PD (5-42%) have abnormalities in their balance system function compared with healthy controls (0-5%), (2) symptomatological reactivity to CO(2) and balance system function in patients with PD are correlated only in the eyes-closed condition and (3) there is a significant link between agoraphobic avoidance and subclinical abnormal function of the balance system network.

The 35% CO2 hyperreactivity and clinical symptomatology in patients with panic disorder after 1 week of treatment with citalopram: an open study

The effect of a short treatment (7 days) with citalopram on the reactivity to inhalations of 35% CO2 and 65% oxygen and on clinical symptomatology was investigated in 15 patients with panic disorder who had a positive response to 35% CO2 inhalation. An open study design was applied. On day 0, before starting drug treatment, and after 1 week of treatment, each patient underwent the 35% CO2 challenge, and clinical symptomatology was evaluated with psychometric scales. The results showed a significant reduction of CO2 reactivity and of scores on the anticipatory anxiety subscale of Panic Associated Symptoms Scale. These results confirm that the serotonergic system plays an important role in the modulation of CO2 hyperreactivity and suggest an early anxiolytic effect of citalopram in patients who have panic disorder and are hyperreactive to CO2.

A comparison of citalopram and paroxetine in the treatment of panic disorder: a randomized, single-blind study

BACKGROUND

Serotonin Selective Re-uptake Inhibitors (SSRIs) are the drugs of choice for treating panic disorder (PD). In vitro studies have shown different pharmacodynamic profiles for SSRIs, but their clinical relevance is still unknown. Paroxetine, the SSRI with the strongest serotonergic effect, also shows significant cholinergic and noradrenergic activities. In this class of drugs, citalopram is the most selective for serotonin. We compared these two drugs and their effectiveness and tolerability in a sample of patients with PD in a two-month treatment course.

METHOD

Fifty-eight patients with PD were randomly assigned to either the paroxetine or the citalopram treatment group in a single-blind, randomized design. Each patient was assessed at days 0, 7 and 60 by the Panic Associated Symptoms Scale (PASS), the Sheehan Disability Scale (SDS) and the Fear Questionnaire (FQ). Primary outcome measures were the percentage of patients free of panic attacks, anticipatory anxiety and phobic avoidance in the last week of the trial and the percentage of good responders, as defined by a reduction of at least 50% from baseline of both PASS and SDS global scores at day 60.

RESULTS

At day 60, 86% of patients receiving citalopram and 84% of those receiving paroxetine responded well to treatment. No significant differences between the two drugs were found. Both were well tolerated, although sexual side effects and weight gain were frequent. Anticipatory anxiety decreased significantly after the first week of treatment, and no initial worsening in the panic attacks was observed.

CONCLUSION

Paroxetine and citalopram show similar anti-panic properties and a good tolerability profile. Our results support evidence that the serotonergic system plays a significant role in the anti-panic properties of these two SSRIs.