The mean time to peak absorption of cyclosporine (CsA) in liver transplant patients is approximately 2 hours, but in some patients the peak occurs later. The goal of this study was, therefore, to investigate the incidence of delayed absorption in 27 de novo liver transplant recipients receiving CsA >10 mg/kg/day (C 2 monitoring) and in 15 maintenance patients. Patients were categorized as 'normal' absorbers (C 2 exceeding C 4 and C 6 ) or 'delayed' absorbers (C 4 or C 6 exceeding C 2 ), and as 'good' (>800 ng/mL at C 0 , C 2 , C 4 , or C 6 ) or 'poor' absorbers (C 0 , C 2 , C 4 and C 6 <800 ng/mL) on the day of study. Among de novo patients, 15 (56%) had 'normal' CsA absorption and 12 (44%) 'delayed' absorption. Good CsA absorption occurred in 16 patients (59%) and poor absorption in 11 (41%). The proportion of poor absorbers was similar in patients with normal (6 / 15, 40%) or delayed (5 / 12, 42%) absorption. Among the 12 delayed absorbers, 11 had peak CsA concentration at C 4 . Mean C 0 level was significantly higher in delayed absorbers (282 ؎ 96 ng/mL) than in normal absorbers (185 ؎ 88ng/mL; P ‫؍‬ .01). Delayed absorbers reverted to normal absorption (C 2 > C 4 ) after a median of 6 days from the day of study, and no cases of delayed absorption were found among maintenance patients. In conclusion, almost 50% of the patients had delayed CsA absorption early posttransplant; around half of these exhibited normal CsA exposure. Measurement of C 4 in addition to C 2 differentiates effectively between delayed and poor absorbers of CsA such that over-or underimmunosuppression can be avoided. (Liver Transpl 2005;11:167-173.)

Nutrition is fundamental for brain development, but relatively little is known about water-soluble vitamin (WSV) levels and the effect of supplementation on psychiatry symptoms in children and adolescents (CAD) with psychiatric disorders. Our team systematically reviewed all studies concerning WSV abnormalities or supplementation in CAD with any psychiatric disorder. We searched for original studies published between 1990 and 15/05/2020 which were not based on retrospective chart review and which included WSV blood level measurements or investigated the effect of WSV supplementation on psychiatric symptoms in psychiatric patients aged 18 or under. Forty-two articles were included, 69% of which (N=29) examined Autism Spectrum Disorders (ASD), with most of these assessing folate or vitamin B12 supplementation (N=22, 75.9% of ASD studies). Meta-analyses showed significantly lower vitamin B12 levels in ASD and ADHD patients vs. healthy controls (HC), while folate levels were higher in ADHD patients vs. HC. Most of the studies (9/10, 90%) showed a decrease in symptoms as measured by clinical scales after supplementation. There was significant heterogeneity between the studies, however many found different types of vitamin abnormalities in CAD with psychiatric disorders.

Introducción: A pesar de que diferentes déficits nutricionales como el de ácido fólico se han asociado a la esquizofrenia y a otros trastornos psiquiátricos, se sabe poco sobre los posibles déficits de ácido fólico y vitamina B12 en niños y adolescentes con trastornos psiquiátricos. Objetivo: Describir los valores y posibles déficits de ácido fólico y vitamina B12 en niños y adolescentes hospitalizados por un trastorno psiquiátrico y comparar las posibles diferencias existentes según diagnóstico. Método: Se revisaron de forma retrospectiva las historias clínicas de los pacientes ingresados durante el 2015 en el Servicio de Psiquiatría y Psicología del Hospital Clinic de Barcelona. Se midieron los niveles de ácido fólico y vitamina B12 al ingreso, se registraron los datos sociodemográficos y la categoría diagnóstica, según criterios DSM-IV-TR. Resultados: Se incluyeron 278 pacientes, de edad media: 14,8 años y 64% chicas. Los niveles medios de vitamina B12 fueron: 420.5±152.4 pg/mL, significativamente menores en adolescentes que en niños y en chicos que en chicas. Se observaron diferencias significativas entre pacientes con un trastorno depresivo (381.3±107.5 pg/mL) vs. Trastornos de la conducta alimentaria (TCA) (523.1 ±229.6 pg/mL) (p=0.002). La media de ácido fólico fue: 8±4.8 ng/mL, significativamente menor en adolescentes que en niños. Los pacientes con trastornos psicóticos (5,9±2.2ng/mL) presentaron niveles significativamente menores que los pacientes con TCA (8.1±3.6ng/mL) (p=0.019). 11,2% de los pacientes tenían un déficit de uno o de ambos nutrientes. Conclusiones: Alrededor de un 11% de la muestra presentaba un déficit de vitamina B12, de ácido fólico o de ambos, con diferencias significativas en algunas categorías diagnósticas. Sería interesante poder estudiar mejor estos déficits, debido a la importancia y posible repercusión clínica de los mismos en niños y adolescentes.

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