Epidemiology and outcome in renal failure

Acute renal failure (ARF) in the ICU patient usually occurs as part of a wider multiple organ dysfunction, and is associated with mortality rates of around 50%. Differences in definitions make comparing study populations difficult and moves are being made to improve uniformity, and to recognize that ARF is not a single event but a continuous process from mild renal dysfunction through to complete organ failure requiring renal replacement therapy. In this review we will discuss the epidemiology of ARF within the limitations imposed by comparing studies that use different definitions and focus on different patient populations.     

GFAP expression in astrocytes of suprachiasmatic nucleus and medial preoptic area are differentially affected by malnutrition during rat brain development

The aim of the present study was investigate, in young rats, the effects of malnutrition on astrocyte distribution of two hypothalamic regions, the circadian pacemaker suprachiasmatic nucleus (SCN) and the medial preoptic area (MPA). Control rats were born from mothers fed on commercial diet since gestation and malnourished rats from mothers fed on multideficient diet, from the beginning of gestation (GLA group) or from the onset of lactation (LA group). After weaning, pups received ad libitum the same diet as their mothers, and were maintained under a 12/12 h light/dark cycle. The animals were analyzed either at 30-33, or 60-63 days of life. Brain coronal sections (50 microm) were processed to visualize glial fibrillary acidic protein (GFAP) immunoreactivity. Compared to control rats, both malnourished groups of 30 and 60 days exhibited a reduced number of GFAP-immunoreactive astrocytes in the SCN. The total GFAP-immunoreactive area in the SCN of the GLA group differed from the control group at both age ranges analyzed. The GFAP expression as measured by the relative optical density (ROD) exhibited a 50-60% reduction in the MPA in both malnourished groups, compared to controls. The results suggest that malnutrition early in life leads to alterations in gliogenesis or glial cell proliferation in both nuclei, being these alterations greater in the MPA. Compensatory plasticity mechanisms in the GFAP-expression seem to be developed in the astrocyte differentiation process in the SCN, especially when the malnutrition is installed from the lactation.     

Effect of curriculum reform on graduating student performance

With the aim of evaluating the efficacy of a new curriculum implemented in the Faculty of Medicine of Ribeir?o Preto (University of S?o Paulo, Brazil), a yearly objective assessment of both cognitive and practical skills of undergraduate (sixth year) students was performed. All graduating student underwent a multiple-choice questions (MCQs) test and groups of 18-20 students were randomly assigned to OSCEs for either clinical (real and standardized patients) or procedure (manikins) skills. The average MCQs score for the students graduating in the new curriculum (63.1, SD = 8.9, n = 261) was significantly higher (p < 0.001) than for the previous curriculum (55.3, SD = 8.1, n = 222). Results for practical exams showed that the new curriculum was associated with significantly improved performance in five out of the six stations for procedure skills, but in only two of the 10 clinical skills stations. Final evaluation of graduating students revealed deficiencies in the local curriculum and may serve as a guide to take measures to correct them.     

The role of genetics in alcohol dependence

In this article we examined the heritability of alcohol dependence. A review of family, twin and adoption studies, allowed us to support the thesis of an important genetic component in this dependence. The transmission of this heritability occurs through a biological vulnerability associated to environmental factors, in a model called epigenetic. We also discussed the relationship between biological vulnerability and high-risk phenotypes for alcohol dependence. In the end, we briefly comment on the molecular genetic studies associated with this disorder.     

Olanzapine in the treatment of refractory migraine and chronic daily headache

BACKGROUND: Olanzapine, a thienobenzodiazepine, is a new "atypical" antipsychotic drug. Olanzapine's pharmacologic properties suggest it would be effective for headaches, and its propensity for inducing acute extrapyramidal reactions or tardive dyskinesia is relatively low. We thus decided to assess the value of olanzapine in the treatment of chronic refractory headache. METHODS: We reviewed the records of 50 patients with refractory headache who were treated with olanzapine for at least 3 months. All previously had failed treatment with at least four preventative medications. The daily dose of olanzapine varied from 2.5 to 35 mg; most patients (n = 19) received 5 mg or 10 mg (n = 17) a day. RESULTS: Treatment resulted in a statistically significant decrease in headache days relative to baseline, from 27.5 +/- 4.9 before treatment to 21.1+/-10.7 after treatment (P <.001, Student t test). The difference in headache severity (0 to 10 scale) before treatment (8.7+/-1.6) and after treatment (2.2 +/- 2.1) was also statistically significant (P <.001). CONCLUSION: Olanzapine may be effective for patients with refractory headache, including those who have failed a number of other prophylactic agents. Olanzapine should receive particular consideration for patients with refractory headache who have mania, bipolar disorder, or psychotic depression or whose headaches previously responded to other neuroleptic medications.