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Around 30% of patients with schizophrenia are considered treatment resistant (TRS). Only around 40% of TRS patients respond to clozapine. Long acting injectable antipsychotics could be a useful augmentation strategy for nonresponders.
We conducted a multicenter, observational, naturalistic, retrospective, 6-month mirror-image study to evaluate the efficacy and tolerability of clozapine and paliperidone palmitate association in 50 patients with TRS and other psychotic disorders. Clinical outcomes and side effects were systematically assessed.
Six months after starting the combined treatment, participants showed a significant relief of symptoms, decreasing the Brief Psychiatric Rating Scale total score from 18.32 ± 7.71 to 7.84 ± 5.16 (p < 0.001). The number of hospitalizations, the length of hospital stays and the number of visits to emergency services also decreased, while an increase of the functionality was observed (Personal and Social Performance total score increased from 46.06 ± 118.7 to 60.86 ± 18.68, p < 0.001). There was also a significant decrease in the number and severity of side effects with the combination therapy, decreasing the Udvalg for Kliniske Undersogelser total score from 10.76 ± 8.04 to 8.82 ± 6.63 (p = 0.004).
This study provides the first evidence that combining clozapine with paliperidone palmitate in patients with TRS and other psychotic disorders could be effective and safe, suggesting further research with randomized controlled trials of augmentation strategies for clozapine nonresponder patients.
Policy Significance Statement:
Patients with psychotic disorders such as schizophrenia show a variable response to antipsychotic treatments. Around 30% of patients are considered treatment resistant, indicated by insufficient symptom control to at least two different drugs. In these resistant cases, clozapine should be indicated, as it has shown to be superior to other options. However, only 40% of patients respond to clozapine, being necessary to establish which treatments could best potentiate clozapine action. Combining clozapine with long acting injectable antipsychotics, and particularly paliperidone palmitate, could be a useful strategy. We conducted a multicenter study of 50 patients with treatment-resistant schizophrenia and other psychotic disorders comparing the efficacy and tolerability in the 6 month-period prior and after starting the clozapine and paliperidone palmitate association. Our study suggests that this combination could be effective and safer, laying the groundwork for future clinical trials with this combination.
DX Cha (HD 104237) is a southern, optically bright Herbig Ae star with an infrared excess, that is part of a small stellar group younger than 5 Myr. We used the APEX and ASTE submillimeter telescopes in Chile to search for continuum and gas emission around this system. Using LABOCA on APEX we detect strong continuum emission around HD104237-A and system component HD104237-E. Our ASTE spectrum detects a double-peaked 12CO(3-2) line profile towards the system, typical of a rotating disk. The new data are used as constraints with MCFOST to produce a disk model that fits the entire SED as well as the observed CO line profile.
Comparative analysis shows that while policy windows and policy entrepreneurs are important, they are insufficient to account for policy change. An understanding of the institutional setting is key to explaining the speed and the magnitude of policy dynamics. In both food safety and pharmaceutical policy in Spain, a redefinition of policy image has involved a transformation of the policy subsystem. In the case of food safety such a paradigm shift has represented a dramatic change, in the case of pharmaceuticals it has meant a gradual process that has developed over a decade. Periods of stability in the pharmaceutical sector reflect the ability of a closed policy community to control problem framing. By contrast, rapid changes in food safety policies are the result of crisis situations governed by a relatively loose policy network. The European Union has been a key policy venue that can transform an institutional framework towards one that is more pluralistic and expert oriented.
To analyze a method that identifies potentially preventable nosocomial infections, as a tool to evaluate the performance of infection control programs through quantification of their potential for reducing nosocomial infections.
The database of the Study of the Prevalence of Nosocomial Infections in Spain (EPINE) was reanalyzed. The method was based on the use of false negatives of the classification table obtained from application of a fixed multiple logistic regression model, as an estimator of the number of potentially preventable nosocomial infections.
The calculated number of patients with preventable infections was 7,493, which constituted 21.6% of the infected patients. Among hospital areas, intensive care had the lowest preventability rate (4.6%), whereas gynecology and obstetrics had the highest (40.6%). There was a significant inverse exposure-effect relationship between the proportion of preventable infections and the National Nosocomial Infections Surveillance (NNIS) System risk index. No correlation was observed between the prevalence of patients with nosocomial infection and the percentage of preventable infections.
This analysis suggests that fewer nosocomial infections may be preventable in Spanish hospitals than previously assumed.
ArF excimer laser pulses (193 nm, 20 ns, 150 mJ) have been focused on a hydroxyapatite (HA) target in similar conditions to those normally used for thin film deposition. Fast intensified CCD images of HA laser ablation plumes have been taken in vacuum and under different water vapor pressures ranging from 0.01 mbar to 1 mbar. Images of HA ablation in vacuum have shown a plume freely expanding at a constant velocity of 2.3 × 106 cm/s. HA ablation under a water vapor pressure of 0.01 mbar has revealed an expansion behavior very similar to that of ablation in vacuum. Images taken under a water vapor pressure of 0.1 mbar have shown the formation of a shock structure in the plume. Finally, HA ablation under a water vapor pressure of 1 mbar has revealed the development of some irregularities in the shape of the plume.
To ascertain the etiology and outcome of episodes of bacteremia and fungemia over a three-year period (1990-1992) in patients with hematological malignancies.
Hematology service of a 1,500-bed Spanish university hospital.
Of a total of 178 episodes of significant bacteremia or fungemia in 101 patients, 53% affected patients with acute leukemia. Grampositive microorganisms were found to be the cause in 70% of the monomicrobial episodes. The most frequently isolated microorganism was coag-ulase-negative Staphylococcus (35%), followed by Staphylococcus aureus (11%). Most bloodstream infections occurred during an episode of neutropenia (59%). A total of 34 patients died during hospitalization; in 14, infection was the cause of death.
A marked increase in the incidence of bacteremias caused by grampositive microorganisms has been observed in our hospital over the last 10 years, especially in patients with hematological malignancies. The mortality due to bacteremia is similar to that found by other authors in series of bacteremia in hematological patients, and we have not found significant differences in the mortality due to bacteremia between neutropenic and non-neutropenic patients.
The highest duty of an American diplomatic or consular officer is to protect citizens of the United States in lawful pursuit of their affairs in foreign countries. The document issued in authentication of the right to such protection is the passport.
Broadly speaking, the Department issues two kinds of passports — those for citizens and those for persons who are not citizens. Citizens’ passports are ordinary and special; aliens’ passports are for travel in the United States and for qualified protection abroad of those who have taken the first steps to become American citizens.
The citizen’s passport is the only document issued by the Department of State to authenticate the citizenship of an American going abroad. The Act of August 18, 1856, makes the issuance to one who is not a citizen a penal offense if it is committed by a consular officer. Before this law was passed the Department did not issue the document to aliens; but it was permitted to this government’s agents abroad sometimes to issue it to others than American citizens. The Personal Instructions to the Diplomatic Agents of the United States of 1853 said:
They sometimes receive applications for such passports from citizens of other countries; but these are not regularly valid, and should be granted only under special circumstances, as may sometimes occur in the case of foreigners coming to the United States.
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