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Augmentation treatment has been the subject of several studies in treatment-resistant obsessive compulsive disorder (OCD). We hypothesized that medications with a dual action on the melatoninergic and serotoninergic systems may be of use in treatment-resistant OCD.
In this open label study we investigated the efficacy and safety of agomelatine augmentation in treatmentresistant OCD.
Twelve patients, aged 18–50, fulfilling OCD criteria, with no response to a 16-week or longer treatment with a selective serotonine reuptake inhibitor (SSRI) at the indicated dose, were assigned to receive agomelatine augmentation. Subjects were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and were screened for treatmentemergent side effects at baseline, week 8 and week 12 of treatment.
The overall Y-BOCS score fell during the duration of the study (all comparisons among baseline, 8th week and 16th week were statistically significant, p < 0.01). On the obsession Y-BOCS scale a drop was noted, which led to statistical significance at the 16th week of the study (p < 0.05). Regarding the compulsion Y-BOCS scale a drop was also noted, particularly from baseline to the 8th week of the study (p < 0.01). Dizziness (16.6%) and headache (8.4%) were the most often reported side effects of treatment.
Agomelatine could be efficacious and well tolerated as an augmenting agent in refractory to treatment OCD. Further controlled studies are warranted to explore the efficacy of agomelatine, as well as the potential role of circadian rhythm modulation both in the pathophysiology and treatment of OCD.
Fifteen percent of patients with diabetes mellitus (DM) meet the criteria for comorbid major depression. To maximize response of both depression and diabetic disorder, one should consider antidepressant treatment.
The present study compared the efficacy of agomelatine and sertraline in the treatment of symptoms of depression/anxiety, diabetes self-care, and metabolic control in a sample of depressed patients with non-optimally controlled type 2 DM.
This was an observational study of 40 depressed patients with DM who were randomly assigned to receive either agomelatine or sertraline, and were assessed over a 4-month period for depression, anxiety, self care, fasting plasma glucose, haemoglobin A1c and body weight.
HDRS scores fell at the end of the study for both treatment groups; significantly lower HARS scores were noted at the last assessment for the agomelatine group. Body weight increased slightly in the sertraline group. Although an improvement in fasting plasma glucose was observed in the final assessment in both treatment groups glycated hemoglobin showed a tendency towards lower values in the agomelatine group. Both groups had better SCI scores at the end of the study; the changes in the agomelatine group were higher. Both antidepressants were well tolerated and none of the patients dropped-out of the study.
The main finding of the present study was that agomelatine had a more positive effect than sertraline on symptoms of depression and anxiety, as well as metabolic parameters and health-related behaviors, in depressed patients with type 2 DM.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
CLINICAL TRIALS IDENTIFIER
ClinicalTrials.gov. Identifier: NCT01764490.
Infect Control Hosp Epidemiol 2018;39:660–667
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