Avaluació de l'esforç submàxim dels flexors dorsals i palmars de canell mitjançant dinamometria isocinètica

El SEC (Suma Excèntric- Concèntric) i sobretot el DEC (Diferència Excèntric-Concèntric) són paràmetres que, ja han sigut demostrats en la literatura, com a vàlids en diferents articulacions i accions, per a identificar esforços submàxims, és a dir, la possible falta de col·laboració, durant la realització de proves de força mitjançant dinamometria isocinètica. Aquest estudi, mitjançant una mostra de 20 individus sans, demostra que el DEC i el SEC són bones eines per detectar la falta de col·laboració en l'avaluació dels flexors dorsals i palmars de canell (articulació prèviament no estudiada) amb dinamometria isocinètica en subjectes sans.El SEC (Suma Excéntrico- Concéntrico) y sobre todo el DEC (Diferencia Excèntric-Concèntric) son parámetros que, ya han sido demostrados en la literatura, como válidos en diferentes articulaciones y acciones, para identificar esfuerzos submáximos, es decir, la posible falta de colaboración, durante la realización de pruebas de fuerza mediante dinamometría isocinética. Este estudio, mediante una muestra de 20 individuos sanos, demuestra que el DEC y el SEC son buenas herramientas para detectar la falta de colaboración en la evaluación de los flexores dorsales y palmares de muñeca (articulación previamente no estudiada) con dinamometría isocinética en sujetos sanos

Benefits of using exchangeable copper and the ratio of exchangeable copper in a real-world cohort of patients with Wilson disease

Wilson disease (WD) is a complex disease in which diagnosis and long-term metabolic copper control remains challenging. The absence of accurate biomarkers requires the combination of different parameters to ensure copper homeostasis. Exchangeable copper and its ratio (REC) have been suggested to be useful biomarkers in this setting. We aimed at introducing these measurements and evaluate their performance and accuracy in our real-world cohort of WD patients. Exchangeable copper and REC were measured in 48 WD patients and 56 control individuals by inductively coupled plasma-mass-spectrometry. Demographic and clinical characteristics were collected. REC was shown to be significantly higher among WD patients compared to controls and useful for WD identification by using the previously established cutoffs: 71.4% of WD patients with a recent diagnosis had REC ≥18.5% and 95.1% of long-term treated WD had REC ≥14%; only four patients of the cohort presented discordant levels. Moreover, REC values were below 15% in all the control individuals. Exchangeable copper was significantly higher in WD patients compared to controls and tended to be reduced among WD patients who were compliant to medication. This real-life study confirmed that exchangeable copper and REC are useful serum biomarkers that can be used as complementary tests to ensure WD diagnosis (REC) and copper homeostasis whithin time (exchangeable copper). The desirable target levels for this last objective still needs to be validated in prospective cohorts

Neonatal feeding trajectories in mothers with bipolar disorder taking lithium: pharmacokinetic data

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories. Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6–8, 7–8, and 53–60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively. Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.Peer ReviewedPostprint (published version

Clozapine use during pregnancy and lactation: A case-series report

The current prescription of clozapine in psychotic women of reproductive age makes it crucial to understand its pharmacokinetics during pregnancy and lactation as well as its risk profile for neonatal outcome. The aim of this case series was to provide new evidence on the pharmacokinetic features of clozapine that determine its passage through the placenta and amniotic fluid, as well as the neonatal clozapine elimination half-life (t1/2). This case series demonstrates for the first time that clozapine might show partial placental passage similar to other atypical antipsychotics. Clozapine levels decreased during the first few days in nursing infants. The half-life of clozapine in neonates was slightly higher than previously estimated. Clozapine use in pregnancy may be associated with diabetes mellitus, especially if there is a family history of this disease. Although no acute toxicological effects were observed in the intrauterine exposed newborn, close follow-up of pregnancy is recommended. However, these results must be taken with caution being a case series with small sample size

Clinical and Pharmacokinetic Profile of Lithium Monotherapy in Exclusive Breastfeeding. A Follow-Up Case Series

Background: Most guidelines advise that women taking lithium should not breastfeed. The variation in transfer is just one reason behind this advice. Objectives: To present clinical and pharmacokinetic data of nine mother-infant pairs exposed to lithium monotherapy during late pregnancy and exclusive breastfeeding at the Perinatal Psychiatric Unit (2006-2018). Methods: We obtained sociodemographic data, medical risk factors, obstetric variables, and family and personal psychiatric history by semi-structured interview, and assessed maternal psychopathology with the Hamilton Depression Rating Scale and Young Mania Rating Scale. A senior neonatologist reviewed neonatal outcomes at birth using the Peripartum Events Scale. Paired maternal and cord blood and infant venous blood samples were collected. During the breastfeeding period, we monitored serum lithium and creatinine concentrations in mother-infant pairs at delivery, and at days 1-5, 7-11, 30, and 60 postpartum, and monthly until 6-months. Results: Lithium equilibrated completely across the placenta [1.13 (0.10), range (1.02-1.30)]. No women presented symptoms of postpartum lithium intoxication, two of the neonates presented transient hypotonia (22%). Lithium exposure was significantly less during breastfeeding than during late pregnancy, and serum lithium concentrations decreased up to 44% overtime from delivery to the first-month, and up to 60% to the third-month postpartum. There was no growth or developmental delay in the follow-up period. One woman had a manic episode with psychotic features at 45 days postpartum. Conclusions: In carefully selected women with bipolar disorder, lithium therapy when breastfeeding can be an appropriate option if coupled with close monitoring of the mother-infant pair

The influence of CYP enzymes and ABCB1 on treatment outcomes in schizophrenia: association of CYP1A2 activity with adverse effects

Aim: Genetic variants on metabolic and transport enzymes are good candidates to explain inter-individual differences in response to antipsychotics. The aim of this study is to evaluate and compare the influence of the CYP2D6, CYPC19, CYP1A2 and ABCB1 variants on plasma levels, treatment response and side effects of antipsychotics. Methods: Twenty polymorphisms in selected genes were genotyped in 318 patients diagnosed with schizophrenia, schizoaffective or delusional disorder treated with antipsychotics (clozapine, olanzapine, paliperidone, risperidone, aripiprazole and quetiapine). Plasma drug levels were determined after 6 weeks of treatment. The Positive and Negative Symptoms Scale (PANSS) and UKU scale of side effects were recorded at baseline and after 12 weeks of treatment. The effect of gene variants on plasma drug levels, treatment response and adverse effects were examined by multinomial regression. Results:CYP1A2 was found to be associated with psychic side effects (P = 0.02), with variants predicting higher enzyme activity associated with lower adverse effects, and was the strongest predictor for this adverse effect of all the studied factors. Functional variants in CYP genes were associated with plasma level differences, with higher activity variants associated with lower plasma levels. No association with improvement of the condition, as measured by the PANSS score, was found in this study. Conclusion: The results suggest that increased CYP1A2 activity protects against psychic side effects. Few studies have evaluated the impact of genetic factors on treatment response or side effects, and only in relation to a selection of adverse reactions. These results are a step towards better understanding of the factors behind the different aspects of clinical outcomes, such as various adverse effects

Peripartum lithium management: early maternal and neonatal outcomes

© 2024 Published by Elsevier B.V.Background It has been suggested that a 30–50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes. Methods A retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post. Results Sixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028). Limitations It is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium. Conclusions Lithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects.Peer ReviewedPostprint (author's final draft

Gaia Data Release 3: Exploring and mapping the diffuse interstellar band at 862 nm

Diffuse interstellar bands (DIBs) are common interstellar absorption features in spectroscopic observations but their origins remain unclear. DIBs play an important role in the life cycle of the interstellar medium (ISM) and can also be used to trace Galactic structure. Here, we demonstrate the capacity of the Gaia-Radial Velocity Spectrometer (RVS) in Gaia DR3 to reveal the spatial distribution of the unknown molecular species responsible for the most prominent DIB at 862 nm in the RVS passband, exploring the Galactic ISM within a few kiloparsecs from the Sun. The DIBs are measured within the GSP-Spec module using a Gaussian profile fit for cool stars and a Gaussian process for hot stars. In addition to the equivalent widths and their uncertainties, Gaia DR3 provides their characteristic central wavelength, width, and quality flags. We present an extensive sample of 476.117 individual DIB measurements obtained in a homogeneous way covering the entire sky. We compare spatial distributions of the DIB carrier with interstellar reddening and find evidence that DIB carriers are present in a local bubble around the Sun which contains nearly no dust. We characterised the DIB equivalent width with a local density of 0.19±0.04 Angström/kpc and a scale height of 98.60+11.10−8.46 pc. The latter is smaller than the dust scale height, indicating that DIBs are more concentrated towards the Galactic plane. We determine the rest-frame wavelength with unprecedented precision ( λ0=8620.86±0.019 Angström in air) and reveal a remarkable correspondence between the DIB velocities and the CO gas velocities, suggesting that the 862 nm DIB carrier is related to macro-molecules

Recomanacions per a la realització d’estudis de contactes de malalts amb tuberculosi a Catalunya

Tuberculosi; Estudis de contactes; EpidemiologiaTuberculosis; Estudios de contactos; EpidemiologíaTuberculosis; Contact studies; EpidemiologyL’objectiu d’aquest document és desenvolupar un protocol eficient d’actuació en la investigació dels contactes dels malalts amb TB que sigui comú a tot el territori. El document s’adreça a tots aquells professionals sanitaris que treballen en la prevenció i el control de la TB des dels diferents nivells assistencials, els serveis de salut pública i les institucions penitenciàries. En primer lloc s’aborda el marc d’actuació dels estudis de contactes davant la situació epidemiològica actual de la TB a Catalunya. Posteriorment, es tracten aspectes metodològics i la política d’actuació en la realització d’aquests estudis i, posteriorment, es revisa l’ús i la interpretació de les proves diagnòstiques per avaluar els contactes, i el tractament de la infecció tuberculosa latent. Finalment, es dedica un capítol a aspectes organitzatius en la realització d’aquests estudis, amb l’objectiu de millorar la coordinació entre els diferents agents implicats.El objetivo de este documento es desarrollar un protocolo eficiente de actuación en la investigación de los contactos de los enfermos con TB que sea común a todo el territorio. El documento se dirige a todos aquellos profesionales sanitarios que trabajan en la prevención y el control de la TB desde los diferentes niveles asistenciales, los servicios de salud pública y las instituciones penitenciarias. En primer lugar se aborda el marco de actuación de los estudios de contactos ante la situación epidemiológica actual de la TB en Cataluña. Posteriormente, se tratan aspectos metodológicos y la política de actuación en la realización de estos estudios y, posteriormente, se revisa el uso y la interpretación de las pruebas diagnósticas para evaluar los contactos, y el tratamiento de la infección tuberculosa latente. Finalmente, se dedica un capítulo a aspectos organizativos en la realización de estos estudios, con el objetivo de mejorar la coordinación entre los diferentes agentes implicados.The objective of this document is to develop an efficient protocol for the investigation of the contacts of the patients with TB that is common throughout the territory. The document is aimed at all those health professionals who work on the prevention and control of TB from different levels of care, public health services and penitentiary institutions. In the first place, the framework for action of contact studies is addressed with the current epidemiological situation of TB in Catalonia. Later, they deal with methodological aspects and the policy of action in the realization of these studies and, later, the use and the interpretation of the diagnostic tests to evaluate the contacts, and the treatment of the latent tuberculous infection are reviewed. Finally, a chapter is devoted to organizational aspects in the conduct of these studies, with the aim of improving the coordination between the different agents involved