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Introduction. Attention deficit hyperactivity disorder (ADHD) is one of the most frequent reasons for visits in daily clinical practice, with a prevalence rate of 1-7% in Spain. The effectiveness of stimulants for the treatment of ADHD has been widely demonstrated and methylphenidate (MPD) is the most commonly used. There are currently several different immediate-release or extended-release formulations of MPD on the market. Aims. To review the characteristics of the different formulations of MPD, with special attention paid to the studies on Equasym ®, an extended-release preparation soon to be made available in Spain. The article also includes recommendations for clinical practice and the choice of drugs. Development. Several studies have assessed the effectiveness of Equasym ® versus placebo or in comparison to other MPD formulations. The extended-release preparations have a therapeutic action that is similar to that of the immediaterelease versions, the difference between them being the plasma concentration profiles over time during the day, which are reflected in the pharmacodynamic effects. Equasym ® is more effective in the morning, whereas other formulations, such as Concerta ®, allow greater control of the symptoms in the afternoon. These differences are important when it comes to prescribing the treatment. Conclusions. One of the main advantages of having different formulations of MPD available is that it allows the professional to choose the drug that best suits the clinical features and needs of each patient. The individual response is the essential criterion in deciding on the most appropriate treatment. © 2012 Revista de Neurología. Source

Grandas F.,Hospital Universitario Gregorio Maranon
Handbook of Clinical Neurology | Year: 2011

Hemiballism is a relatively rare hyperkinetic movement disorder characterized by involuntary, violent, coarse and wide-amplitude movements involving ipsilateral arm and leg. Although classically related to lesions in the subthalamic nucleus, in clinical-radiological series of hemiballism most patients had lesions outside this nucleus, involving mainly other basal ganglia structures. It has been suggested that abnormal neuronal firing patterns in the internal segment of the globus pallidus may be related to the pathogenesis of hemiballism. Stroke is the most common cause, but in recent years an increasing number of patients with hemiballism associated with nonketotic hyperglycemia or with complications of human immunodeficiency virus (HIV) infection have been reported. Contrarily to what was stated in older literature, hemiballism has, in general, a relatively good prognosis. Depending on the underlying causes, many patients may experience spontaneous improvements or remissions. Treatment should be directed to the cause of hemiballism. Symptomatic treatment includes the use of drugs, particularly blockers of striatal D2 dopamine receptors and tetrabenazine. Surgical treatment, especially pallidotomy, is a therapeutic option for the minority of patients with severe persistent disabling hemiballism. © 2011 Elsevier B.V. Source

Jimenez D.,University of Alcala | De Miguel-Diez J.,Hospital Universitario Gregorio Maranon | Guijarro R.,University of Malaga | Trujillo-Santos J.,Santa Lucia Hospital | And 6 more authors.
Journal of the American College of Cardiology | Year: 2016

Background Despite advances in hospital management in recent years, it is not clear whether mortality after acute pulmonary embolism (PE) has decreased over time. Objectives This study describes the trends in the management and outcomes of acute symptomatic PE. Methods We identified adults with acute PE enrolled in the registry between 2001 and 2013. We assessed temporal trends in length of hospital stay and use of pharmacological and interventional therapies. Using multivariable regression, we examined temporal trends in risk-adjusted rates of all-cause and PE-related death to 30 days after diagnosis. Results Among 23,858 patients with PE, mean length of stay decreased from 13.6 to 9.3 days over time (32% relative reduction, p < 0.001). For initial treatment, use of low-molecular-weight heparin increased from 77% to 84%, whereas the use of unfractionated heparin decreased from 22% to 8.4% (p < 0.001 for trend for all comparisons). Thrombolytic therapy use increased from 0.7% to 1.0% (p = 0.07 for trend) and surgical embolectomy use doubled from 0.3% to 0.6% (p < 0.01 for trend). Risk-adjusted rates of all-cause mortality decreased from 6.6% in the first period (2001 to 2005) to 4.9% in the last period (2010 to 2013) (p = 0.02 for trend). Rates of PE-related mortality decreased over time, with a risk-adjusted rate of 3.3% in 2001 to 2005 and 1.8% in 2010 to 2013 (p < 0.01 for trend). Conclusions In a large international registry of patients with PE, improvements in length of stay and changes in the initial treatment were accompanied by a reduction in short-term all-cause and PE-specific mortality. © 2016 American College of Cardiology Foundation. Source

Quintavalle C.,University of Naples Federico II | Garofalo M.,Ohio State University | Zanca C.,University of Naples Federico II | Romano G.,Fondazione IRCCS SDN | And 7 more authors.
Oncogene | Year: 2012

Glioblastoma is the most frequent brain tumor in adults and is the most lethal form of human cancer. Despite the improvements in treatments, survival of patients remains poor. In order to identify microRNAs (miRs) involved in glioma tumorigenesis, we evaluated, by a miRarray, differential expression of miRs in the tumorigenic glioma LN-18, LN-229 and U87MG cells compared with the non-tumorigenic T98G cells. Among different miRs we focused our attention on miR-221 and-222. We demonstrated the presence of a binding site for these two miRs in the 3′ untranslated region of the protein tyrosine phosphatase μ(PTPμ). Previous studies indicated that PTPμ suppresses cell migration and is downregulated in glioblastoma. Significantly, we found that miR-221 and-222 overexpression induced a downregulation of PTPμ as analyzed by both western blot and real-time PCR. Furthermore, miR-222 and-221 induced an increase in cell migration and growth in soft agar in glioma cells. Interestingly, the re-expression of PTPμ gene was able to revert the miR-222 and-221 effects on cell migration. Furthermore, we found an inverse correlation between miR-221 and-222 and PTPμ in human glioma cancer samples. In conclusion, our results suggest that miR-221 and-222 regulate glioma tumorigenesis at least in part through the control of PTP protein expression. © 2012 Macmillan Publishers Limited All rights reserved. Source

Cano Martinez N.,Hospital Universitario Gregorio Maranon
Dermatology online journal | Year: 2011

We report the case of a 9-year-old girl with a lesion on the posterior aspect of the neck, which was clinically compatible with granuloma annulare. An incisional biopsy was performed and the result of the biopsy was consistent with a fibrohistiocytic proliferation. After the total excision of the lesion, the definitive diagnosis of dermatomyofibroma was determined. Dermatomyofibroma is a benign and rare proliferation of myofibroblasts of the skin. Dermatomyofibroma is a solitary and slowly growing tumor. It is more common in adolescents and young adults, with a female preponderance. Dermatomyofibroma presents clinically as a papule or nodule. It may be slightly hyperpigmented. It is usually located on the upper trunk, axilla, upper arm, or neck. The treatment of choice is complete excision and the prognosis is excellent. Source

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