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Rodriguez-Martinez A.,Centro Forum | Quilo C.G.,Janssen Cilag
Clinical Drug Investigation | Year: 2013

Pharmacologic management strategies for schizophrenia, a relatively common psychotic disorder, include the use of typical and atypical antipsychotic drugs. In general, typical (or conventional) antipsychotics have a proven track record in effectively managing the positive symptoms of schizophrenia but sometimes lack efficacy in treating negative symptoms. The conventional agents are also associated with adverse neurologic effects such as extrapyramidal symptoms (EPS). The development of atypical antipsychotics has partly ameliorated the issue of EPS induced by typical antipsychotics. However, several of these atypical antipsychotic agents have been associated with adverse metabolic effects, including weight gain, dyslipidemia, and increased serum glucose levels. Paliperidone (9-hydroxy-riperidone) extended-release (ER) is an atypical antipsychotic indicated for the treatment of schizophrenia which utilizes a patented oral osmotic system technology that provides constant drug delivery over the course of the day. The efficacy and safety of paliperidone ER in patients with schizophrenia have been established. This review focuses on the metabolic safety of paliperidone ER in patients with schizophrenia. Clinical trials have demonstrated a lack of significant change in lipid profiles with paliperidone ER; furthermore, reported incidences of glucose-related adverse events in clinical trials were very low and similar to those seen with placebo. While dose-related increases in bodyweight of 1-2 kg have been observed with paliperidone ER, there are few reports of clinically relevant increases in bodyweight during treatment. Placebo-controlled trials indicate that the risk of developing metabolic disorders with paliperidone ER is low and similar to that seen with placebo. Furthermore, the ER formulation of paliperidone may offer potential advantages over atypical antipsychotics such as risperidone, particularly with regard to side effects and compliance, but comparative studies are needed. © 2013 Springer International Publishing Switzerland. Source


Puente de la Vega Costa K.,University of Bern | Gomez Perez M.A.,Hospital Del Mar | Gomez Perez M.A.,Autonomous University of Barcelona | Roqueta C.,Autonomous University of Barcelona | And 2 more authors.
Autonomic Neuroscience: Basic and Clinical | Year: 2016

Background: The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). Objectives: We wanted to know more about the effects of SGB on cardiovascular parameters. Methods: We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3 mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). Results: At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73 ± 8.61 to 73.53 ± 11.10, p = 0.015; on the left side from 70.66 ± 13.01 to 77.93 ± 10.40, p = 0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. Conclusions: Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB. © 2016 The Authors. Source


De Jaime E.,Centro Forum | De Jaime E.,Autonomous University of Barcelona | Vazquez O.,Centro Forum | Rodriguez M.L.,Centro Forum | And 7 more authors.
European Geriatric Medicine | Year: 2013

Purpose: To ascertain whether admission to a geriatric day hospital (GDH) modifies health self-perception and quality-of-life (QOL) dimensions using the Nottingham Health Profile (NHP) instrument, and to evaluate possible sex differences in these health dimensions. Methods: Longitudinal study including all patients admitted to and discharged from GDH. Evaluated parameters at admission and discharge were: Barthel and Lawton indexes, Folstein's Mini-Mental State Exam (MMSE), Charlson index, Geriatric Depression Scale (GDS), Timed Up&Go test, Tinetti walking test and NHP. Results: One hundred and ten of a total of 183 patients were included in the study (21 were excluded for different reasons and NHP was not registered at the time of discharge in 52); Barthel index, MMSE, GDS, Timed Up&Go and Tinetti walking test all improved significantly after the GDH intervention. A significant improvement was found in NHP scores (admission: 36.3 ± 22.7 vs. discharge: 31.3 ± 20.8, P = 0.044), physical mobility (49.5 ± 31.1 vs. 39.8 ± 28.5, P = 0.002) and emotional dimensions (36.4 ± 29.1 vs. 29.4 ± 25.7, P = 0.042). Among women, NHP analysis revealed an improvement in physical mobility (48.7 ± 32.9 vs. 37.2 ± 27.1, P = 0.008) and emotional dimensions (44.5 ± 29.8 vs. 33.3 ± 2.58, P = 0.02), while only an improvement in pain dimension was observed (25.7 ± 23.7 vs. 16.7 ± 18.8, P = 0.03) among men. Conclusions: Global health perception and QOL improved after admission to a GDH, particularly physical mobility and emotional dimensions. Women improved in physical mobility and emotion whereas men only improved in pain perception. © 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. Source


Gonzalez-Avila B.,Centro Forum | Roqueta C.,Autonomous University of Barcelona | Alvaro M.,Centro Forum | Roig A.,Centro Forum | And 2 more authors.
Revista Espanola de Geriatria y Gerontologia | Year: 2016

Objective: To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait. Patients and methods: A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5. ±. 8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids). Results: The stoppers group of patients had a mean age 82.2. ±. 8.7; Barthel index 64.6. ±. 20.7; MMSE 21.6. ±. 5.1; Charlson index 1.8. ±. 1.7, and the non-stoppers 78.5. ±. 7.6 (P = .024), 86.0. ±. 18.1 (P <. .001), 24.3. ±. 4.0 (P = .004), and 1.3. ±. 1.6 (P = .130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P = .002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P <. 0.009). Of the 63 patients with TUG. >. 20. seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20. seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG. <. 10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P <. 0.0001). The score of Tinetti test in the stoppers group was 15.4. ±. 5.2, and in non-stoppers 23.9. ±. 4.6 (P <. 0.001). Conclusions: Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG. © 2016 SEGG. Source


Roig T.,Servicio de Geriatria | Marquez M.T.,Centro Forum | Hernandez E.,Centro Forum | Pineda I.,Centro Forum | And 3 more authors.
Revista Espanola de Geriatria y Gerontologia | Year: 2013

Introduction and objectives: Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. Material and methods: Prospective study of 101. patients (mean age, 85.9. ±. 6.3. years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. Results: In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI] = 1.03 [1.01-1.06]; P = .040) and higher number of re-admissions (OR [95%CI] = 3.53 [1.19-10.44]; P = .023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI] = 0.15 [0.04-0.59]; P = .007). Conclusions: Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF. © 2013 SEGG. Source

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