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La evaluación y el tratamiento de los trastornos psiquiátricos son cruciales en los padecimientos al final de la vida. La depresión y los trastornos de ansiedad son altamente prevalentes y no deben ser tomados como parte de la normalidad en los pacientes en cuidados paliativos, ya que están asociados a disminución de la calidad de vida, así como mayor morbilidad y mortalidad. Las herramientas de tratamiento farmacológico de estos padecimientos incluyen a los antidepresivos tricíclicos o a los inhibidores selectivos de la recaptura de serotonina que pudiesen no ser los más adecuados por sus efectos adversos e interacciones medicamentosas. Uno de los fármacos que se ocupa relativamente poco en estos contextos es la mirtazapina. La mirtazapina es un fármaco aprobado para el tratamiento de la depresión que se ha probado tiene un inicio de acción más rápido y mayor efectividad que diversos otros antidepresivos. Su mecanismo de acción es distintivo, pues tiene al antagonismo del receptor alfa-2 adrenérgico y el antagonismo del receptor 5-HT2a y c como sus principales actividades sin involucrar a la inhibición del transportador de serotonina. Además cuenta con el bloqueo del receptor 1 de histamina y del receptor 5-HT3 dentro de sus afinidades que le proporcionan actividad como hipnótico-sedante, antiemético y orexigénico. Por su mecanismo noradrenérgico y serotoninérgico también tiene efectos sobre el dolor crónico. Estos factores pueden ser potencialmente útiles en los pacientes tratados en unidades de cuidados paliativos y generarían una reducción de la polifarmacia o del uso de fármacos que pudiesen generar efectos adversos indeseables en esta población. Esta revisión tiene la finalidad de presentar la evidencia del uso de este fármaco en diversos contextos relacionados con la atención de los pacientes en cuidados paliativos, principalmente aquellos que se encuentran al final de la vida, así como establecer su perfil de seguridad en comparación con los antidepresivos clásicamente utilizados (AU)

Evaluation and treatment of psychiatric disorders is crucial in palliative care patients at the end of life. Depression and anxiety disorders are highly prevalent and should not have been taken as normal in palliative care patients, as they are associated with decreased quality of life and increased morbidity and mortality. The pharmacological treatment of these disorders include selective serotonin reuptake inhibitors and tricyclic antidepressants that should not be the most suitable options because adverse effects and drug interactions associated with them. One of the drugs that is not used often in these contexts is mirtazapine. Mirtazapine is an approved drug for the treatment of depression that has proven to have a faster onset of action and greater effectiveness than several other antidepressants. Its mechanism of action is distinctive because alpha2 adrenergic receptor antagonism and 5-HT2a-c receptor antagonism are the main antidepressant mechanism without involving inhibition of the serotonin transporter. It also has activity as an antagonist of the histamine 1 and the 5-HT3 receptors which produce its hypnotic-sedative, antiemetic and orexigenic properties. By its noradrenergic and serotonergic mechanism also has effects on chronic pain. This factors may be potentially useful in patients treated in palliative care units and also, could reduce polypharmacy or the use of drugs that are likely to generate undesirable adverse effects. The purpose of this review is to show evidence of the use of this drug in various contexts related to palliative care patients, mainly those at the end of life, as well as to establish their safety profile in comparison with tipically used antidepressants (AU)

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Ammonium nitrate is one of the most widespread contaminants related with the viability of natural amphibian populations. In this study we have evaluated in terms of mortality and total length the effects that a previous sublethal pulse to ammonium nitrate generates in Epidalea calamita. Experiments were divided in two phases. In the first one, tadpoles were exposed to two different treatments, with and without a low ammonium nitrate concentration (22 mg NH(4)NO(3) L(-1)). The second phase consisted in static toxicity experiments from both origin treatments with five different nominal concentrations (0, 22, 45, 90 and 180 mg NH(4)NO(3) L(-1)). Results showed that tadpoles that had experienced a previous sublethal exposure showed a negative effect on survival (57% of reduction in the LC(50) value) and total length, throughout an increase in their sensitivity. These results could help us to understand the situation of amphibian populations inhabiting aquatic ecosystems exposed to discontinuous and variable pulses of pollutants.

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Intraspecific and interspecific variations have been observed across many taxa with respect to resistance to natural environmental stressors. It has already been well documented that amphibians are sensitive to habitat degradation and are regarded as bioindicators of aquatic and agricultural ecosystems. In southern Spain, different toxic substances, including copper sulphate, which is used to control Cycloconium oleaginum (Fungi, Ascomycota, Venturiaceae) during spring and autumn, are used in intensive olive tree agriculture. In this context, many wetlands are affected by a diffuse pollution process. Thus, toxicological studies using different species living in wetlands surrounded by agricultural activity are needed to understand the alterations suffered by these ecosystems. To achieve this understanding, individuals of five amphibian species (Bufo bufo, Epidalea calamita, Discoglossus jeanneae, Pelobates cultripes, and Pelophylax perezi) at Gosner developmental stages 19 and 25 were exposed to different copper sulphate concentrations in 96 h acute toxicity tests. Exposure to copper sulphate had a negative effect on total larval length reached at the end of the experimental period and generated approximately 30% of growth reduction respect to control treatments. P. perezi was the most tolerant species studied and showed no mortality at the maximum concentration tested (0.20 mg Cu L(-1)), whereas the most sensitive species (B. bufo, E. calamita, and D. jeanneae) showed approximately 90% mortality at the same concentration. These results indicates that the sole presence in wetlands of P. perezi, the most abundant species in southeast of Iberian Peninsula, might be correlated with its high tolerance to agrochemicals.

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Epidalea calamita embryos at Gosner stages 3 and 19, and larvae at Gosner stage 25, were exposed to different copper sulfate concentrations, ranging from 0.05 to 0.40 mg Cu L(-1), in 96-h acute toxicity tests. Embryonic and larval mortality, development, growth, and larval escape behavior were evaluated. LC(50) at 96 h obtained at Gosner stages 3, 19, and 25 were 0.22, 0.08, and 0.11 mg Cu L(-1), respectively. Embryonic and larval developments were delayed after 96 h of copper sulfate exposure. Growth was also affected and individuals in control treatments grew to twice the size of those exposed to copper concentrations over 0.2 mg Cu L(-1) during the experiments initiated at Gosner stage 19. Escape behavior was altered after 96 h of copper sulfate exposure; larvae showed shorter distances moved and abnormal displacement types. However, after 4 days of recovery process, most of the larvae showed normal escape behavior. For amphibians that develop in temporary wetlands, increased development time, lower size, and altered escape behavior might have repercussions on the number of individuals that can successfully complete metamorphosis and, consequently, on recruitment.

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We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was based on the confirmation of an IgE-mediated aetiology by an oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloyl G and V, amoxicillin, ampicillin and cefaclor < 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroxime axetil.

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We present 10 cases (6 males and 4 females) of children aged 4 to 12 years, who were diagnosed with allergy to clavulanic acid (CL) and treated in the Paediatric Allergy Section of the University Hospital Dr. Peset in Valencia from 2000 to 2005. The children reported symptoms of urticaria and angio-oedema after receiving orally-administered amoxicillin/clavulanic acid (A-CL) for an infection. Diagnosis was basedon the confirmation of an IgE-mediated aetiology byan oral challenge test with amoxicillin-clavulanic acid. Following negative skin test results and CAP for penicilloy lG and V, amoxicillin, ampicillin and cefaclor< 0.35 KU/l, those patients who were allergic to clavulanic acid (positive oral challenge test) were shown to be tolerant to orally-administered Cefuroximeaxetil

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El síndrome de Van der Woude se caracteriza por la presencia de hoyuelos (pits) o fístulas labiales, asociados a hendiduras labiales y/o palatinas. También se han asociado otras anomalías congénitas, como defectos cardiacos y anomalías en los miembros. Es un trastorno genético con herenciaa utosómica dominante, con penetrancia casi completa y expresividad variable, estando implicados dos locus génicos. En este artículo repasamos la prevalencia, la etiología y los aspectos clínicos característicos de este síndrome, además de presentar el caso de un recién nacido varón con labio leporino bilateral y apéndices mucosos en el labio inferior. Insistimos en la importancia de la asociación de las hendiduras faciales junto a los pits, por el patrón hereditario del síndrome, así como el diagnóstico diferencial de distintos cuadros clínicos que presentan hoyuelos mucosos

Van der Woude syndrome is characterized by labial pits and/or fistulas, associated with labial and/or palatal cleft. Other congenital anomalies, involving arms, legs or heart, can also te present. It is a genetic disorder with autosomal dominant inheritance nearly complete penetrance and highly variable expressivity. Two genetic loci have been identified. We review the prevalence o etiology and clinical features of this syndrome, and report a case in a male infant with bilateral cleft lips and pits in lowerlip. We stress the importance of the association of facial clefts and pits due to the hereditary pattern of this syndrome, and discuss the differential diagnosis with respect to other syndromes involving pits

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