Activation of NOP receptor increases vulnerability to stress: role of glucocorticoids and CRF signaling.

RATIONALE: Recently, we demonstrated that the activation of the nociceptin/orphanin FQ (N/OFQ) receptor (NOP) signaling facilitates depressive-like behaviors. Additionally, literature findings support the ability of the N/OFQ-NOP system to modulate the hypothalamic-pituitary-adrenal (HPA) axis. OBJECTIVES: Considering that dysfunctional HPA axis is strictly related to stress-induced psychopathologies, we aimed to study the role of the HPA axis in the pro-depressant effects of NOP agonists. METHODS: Mice were treated prior to stress with the NOP agonist Ro 65-6570, and immobility time in the forced swimming task and corticosterone levels were measured. Additionally, the role of endogenous glucocorticoids and CRF was investigated using the glucocorticoid receptor antagonist mifepristone and the CRF1 antagonist antalarmin in the mediation of the effects of Ro 65-6570. RESULTS: The NOP agonist in a dose-dependent manner further increased the immobility of mice in the second swimming session compared to vehicle. By contrast, under the same conditions, the administration of the NOP antagonist SB-612111 before stress reduced immobility, while the antidepressant nortriptyline was inactive. Concerning in-serum corticosterone in mice treated with vehicle, nortriptyline, or SB-612111, a significant decrease was observed after re-exposition to stress, but no differences were detected in Ro 65-6570-treated mice. Administration of mifepristone or antalarmin blocked the Ro 65-6570-induced increase in the immobility time in the second swimming session. CONCLUSIONS: Present findings suggest that NOP agonists increase vulnerability to depression by hyperactivating the HPA axis and then increasing stress circulating hormones and CRF1 receptor signaling.

Self-Reported Mood and Lifestyle-Related Physical Activity of Young Adults With Major Depressive Disorder.

We investigated whether mood and lifestyle-related indicators of physical health are differentially expressed according to self-reported levels of depressive symptoms among young adults with a current episode of major depression. In a cross-sectional study, we recruited 94 young adults (females = 67, 71.3%; males = 27, 28.7%; aged 18-35 years) with a current episode of major depression. We assessed their mood with the Profile of Mood States (POMS), and Beck Anxiety Inventory-(BAI), sleep with the Pittsburgh Sleep Quality Index (PSQI), physical activity with the Simple Physical Activity Questionnaire (SIMPAQ), and their cardiorespiratory fitness. Participants' depression levels were classified as follows using established cut-points: (a) Mild Depressive Symptoms (MIDS, BDI-II 14-19 points, n = 17), (b) Moderate Depressive Symptoms (MODS, BDI-II 20-28 points, n = 37) or (c) Severe Depressive Symptoms (SEDS, BDI-II 29-63 points, n = 40). As expected, we found that young adults with SEDS, when compared to those with MODS and MIDS, showed higher depressive mood on the POMS, and they exhibited greater anxiety symptoms, lower reported 'vigor' on physical activity measures, worse sleep quality as expressed by their global score sleep; daytime dysfunction; and sleep disturbance, and they showed lower cardiorespiratory fitness. Those with moderate depressive symptoms only differed from those with mild symptoms with respect to hostility, fatigue and mood disturbance. Although there was a gradient whereby worse mental and physical health indicators were more closely related to the SEDS depression categorization, while healthier indicators were associated with the MIDS category, some parameters were not different between the MDD severity groups, particularly when comparing MIDS and MODS. Clinicians treating patients with MDD should consider these factors when designing lifestyle-based interventions.

Safety and tolerability of inhaled N,N-Dimethyltryptamine (BMND01 candidate): A phase I clinical trial.

Psychedelics are being increasingly examined for their therapeutic potential in mood disorders. While the acute effects of ayahuasca, psilocybin, and lysergic acid diethylamide (LSD) last over several hours, inhaled N,N-Dimethyltryptamine (DMT) effects last around 10 min, which might provide a cost- and time-effective alternative to the clinical application of oral psychedelics. We aimed at investigating the safety and tolerability of inhaled DMT (BMND01 candidate). We recruited 27 healthy volunteers to receive a first, lower dose and a second, higher dose (5/20 mg, 7.5/30 mg, 10/40 mg, 12.5/50 mg, or 15/60 mg) of inhaled DMT in an open-label, single-ascending, fixed-order, dose-response study design. We investigated subjective experiences (intensity, valence, and phenomenology), physiological effects (blood pressure, heart rate, respiratory rate, blood oxygen saturation, body temperature), biochemical markers (liver, kidney, and metabolic functions), and adverse events during the acute and post-acute effects of DMT. DMT dose-dependently increased intensity, valence and perceptual ratings. There was a mild, transient, and self-limited increase in blood pressure and heart rate. There were no changes in safety blood biomarkers and no serious adverse events. DMT dose-dependently enhanced subjective experiences and positive valence. Inhaled DMT might be an efficient, non-invasive, safe route of administration, which might simplify the clinical use of this substance. This is the first clinical trial to test the effects of inhaled DMT (BMND01 candidate).

Effects of Training Loads on Stress Tolerance and Mucosal Immunity in High-Intensity Functional Fitness Athletes.

Purpose: This study aimed to analyze the effects of training load on stress tolerance (ST) and secretory immunoglobulin A (SIgA) in male and female high-intensity functional fitness (HIFF) athletes during two different 10 and consecutive weekly training volume loads [higher (week 1) and lower volume (week 2)]. Methods: 14 athletes [7 males: 29.3 (±5.8) years; 86.3 (±8.2) kg and 176.8 (±3.8) cm and 7 females: 32.7 (±4.4) years; 60.0 (±6.7) kg and 162.5 (±5.9) cm] participated. The ST, assessed by Daily Analysis of Life Demand in Athletes questionnaire (DALDA) and Saliva sampling were performed in four time-points (pre (T1) and post (T2) week 1; pre (T3) and post (T4) week 2). Results: Female athletes showed a decrease in ST (symptoms of stress) from 15 T1 to T3 [F(3,36) = 7.184, p˂ 0.001, ηp2 = 0.374], without difference in male athletes (p > .05). There is a significant difference of SIgA concentration [F(3.36) = 3.551; p = .024; ηp2 = 0.228], with a significant decrease in female athletes group in T2 compared to T1 (p = .013) and T4 (p = .023). In addition, the different training volume loads did not impact mucosal immunity in male athletes (p > .05). Conclusion: The current findings suggest that higher HIFF volume results in decreased ST and SIgA concentration in female 20 athletes and a subsequent decrease in training volume loads contributed to restoring these variables.

Moderators of ayahuasca's biological antidepressant action.

Introduction: The understanding of biological responses to psychedelics with antidepressant potential is imperative. Here we report how a set of acute parameters, namely emotional (depressive symptoms), cognitive (psychedelic experience), and physiological (salivary cortisol), recorded during an ayahuasca dosing session, modulated serum brain-derived neurotrophic factor (BDNF), serum cortisol (SC), serum interleukin 6 (IL-6), plasma C-reactive protein (CRP), and salivary cortisol awakening response (CAR). Methods: Results were analyzed 2 days after the psychedelic intervention (ayahuasca) versus placebo in both patients with treatment-resistant depression and healthy volunteers. These measures were assessed as part of a randomized double-blinded, placebo-controlled trial (n = 72). Results: Results revealed that larger reductions of depressive symptoms during the dosing session significantly moderated higher levels of SC in patients. Whereas lesser changes in salivary cortisol levels during the ayahuasca intervention were related to higher BDNF levels in patients with a larger clinical response in the reduction in depressive symptoms. No moderator was found for patient's CAR, IL-6, and CRP responses to ayahuasca and for all biomarker responses to ayahuasca in healthy controls and in the placebo group. Discussion: In summary, some specific emotional and physiological parameters during experimental ayahuasca session were revealed as critical moderators of the improvement of major depression biomarkers, mainly BDNF and SC two days after ayahuasca intake. These findings contribute to paving the way for future studies investigating the biological antidepressant response to psychedelic therapy.

Analysis of stress tolerance, competitive-anxiety, heart rate variability and salivary cortisol during successive matches in male futsal players.

BACKGROUND: This study aimed to compare the stress tolerance, competitive anxiety, heart rate variability and salivary cortisol before and during successive futsal competitive matches (3 matches in 4 days) in young male futsal players. METHODS: 10 young male futsal players (16.9 ± 0.7 age; 71.0 ± 5.1 kg; 174.9 ± 4.3 cm) were monitored during one training session and across a competitive period with 3 successive matches. External load was determined by the PlayerLoad method, while session rating of perceived exertion was used to calculate the internal training and competitive load. The stress tolerance was examined using Daily Analysis of Life Demand in Athletes questionnaire and the Competitive State Anxiety Inventory was used to analyze the competitive anxiety. The Time and frequency monitoring parameters were used to analyze the vagal cardiac autonomic marker. sC was analyzed using enzyme-linked immunosorbent assay. RESULTS: A generalized estimating equation showed a significant difference for PlayerLoad from M1 to TS, M2 and M3, from M2 to M3 (p < 0.05), and for session rating of perceived exertion from M1 to Ts and M3 (p < 0.05). A difference for sources [χ2 (3) = 1.481, p = 0.68] or symptoms [χ2 (3) = 3.893, p = 0.27] was not found. There was no significant difference in any of the competitive anxiety [cognitive anxiety (F (1.644; 14.799) = 4.6, p = 0.73, ŋ2 p = 0.28), somatic anxiety (F (2,09; 18,85) = 26.07 p = 0.057; ŋ2p = 0.27) or self-confidence (F(2.07; 18.85) = 15.875 p = 0.152; ŋ2p = 0.18)] domains. The HRV parameters (time domain and frequency) and Salivary Cortisol (sC) (χ2 (3) = 4.320 p = 0.229) did not significantly change during the successive matches. CONCLUSION: The competitive scenario in which the players were evaluated did not significantly modify the stress tolerance, or the athletes' state of anxiety, which in turn was not able to promote changes in the cardiac vagal modulation or in the sC levels before the matches.

Impact of educational level and travel burden on breast cancer stage at diagnosis in the state of Sao Paulo, Brazil.

We describe the characteristics of cases of breast cancer among women assisted at hospitals affiliated to the public health system in the state of São Paulo (Brazil), analysing the effects of level of education and travel burden to point of treatment. We conducted a retrospective analysis of invasive breast cancer among women diagnosed between 2000 and 2015. Data were extracted from the hospital-based cancer registries of Fundação Oncocentro de São Paulo-FOSP. The outcome was clinical stage at diagnosis (stage III-IV versus I-II). The explanatory variables were educational level and travel burden. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. Multiple imputations were used for missing educational level (31%). The study included 81,669 women with invasive breast cancer diagnosed between 2000 and 2015. The mean age of patients at diagnosis was 56.8 years (standard deviation 13.6 years). 38% of patients were at an advanced stage at diagnosis (stage III-IV). Women with lower levels of education and those who received cancer care in municipalities other than where they lived were more likely to be diagnosed at an advanced stage. In conclusion, promotion of breast cancer awareness and improving pathways to expedite breast cancer diagnosis and treatment could help identify breast tumors at earlier stages.

A Congested Match Schedule Alters Internal Match Load and Affects Salivary Immunoglobulin A Concentration in Youth Soccer Players.

ABSTRACT: Mortatti, AL, Oliveira, RSCd, Pinto, JCBdL, Galvão-Coelho, NL, Almeida, RN, Aoki, MS, and Moreira, A. A congested match schedule alters internal match load and affects salivary immunoglobulin A concentration in youth soccer players. J Strength Cond Res 36(6): 1655-1659, 2022-The aim of this study was to analyze the effects of a congested match schedule (CMS) undertaken after a tapering week, on internal match load (IML) and salivary immunoglobulin A (SIgA) concentration in 12 youth soccer players (16.6 ± 0.5 years; 175 ± 8 cm; 65 ± 8 kg) who performed 4 official matches within a 4-day period. Internal match load was determined using the session-rating of perceived exertion method and the competitive strain (CS) and monotony index (MI) were also determined. Saliva sampling was conducted, before the last training day of a tapering week (training) preceding the CMS, 60 minutes before the first match (match-1), and 22 hours after match 4 (postmatch 4). Salivary immunoglobulin A was analyzed by ELISA. The results of the analysis of variance with repeated measures showed a significant difference for IML across the matches (p < 0.001). A significant reduction in SIgA was observed from prematch 1 to postmatch 4 (p = 0.019). Regarding the change in SIgA (ΔSIgA), 58.3% of the players presented values equal/higher than the minimal detectable change. A large within-individual correlation was observed between ΔSIgA and MI and CS (r = 0.71 and r = 0.72: p < 0.01, respectively). The current findings suggest that youth players participating in a CMS may present a decrease in mucosal immunity function. In addition, data suggest that the MI and CS may be used as valuable markers for monitoring competition load during CMS in youth soccer players.

The Effects of Successive Soccer Matches on the Internal Match Load, Stress Tolerance, Salivary Cortisol and Jumping Performance in Youth Soccer Players.

The study aim was to analyze the effects of successive matches on the internal match load, stress tolerance, salivary cortisol concentration and countermovement vertical jump height in twelve youth soccer players (16.6 ± 0.5 yr; 175 ± 8 cm; 65 ± 8 kg) who performed four official matches within a four day-period with a 24-h recovery interval between the matches. The internal match load, monotony index and competitive strain, as well as stress tolerance were examined. Saliva samples were collected and countermovement vertical jump height was assessed 60 min pre and 30 min post each match; delta of salivary cortisol and countermovement vertical jump height for each match were analyzed. Salivary cortisol was analyzed using an enzyme-linked immunosorbent assay. The results of ANOVA with repeated measures showed no differences between matches for the internal match load (p > 0.05). The scores of the monotony index and competitive strain were 4.3 (±2.3) and 8104 (±6795) arbitrary units, respectively. There was no difference for stress tolerance between matches (p > 0.05). Delta values of salivary cortisol were not different among the assessed matches (F(3,33) = 1.397, p = 0.351, η2: 0.09); however, delta of countermovement vertical jump height decreased from match 1 to match 4 (F(3,33) = 8.64, p < 0.001, η2: 0.44). The current findings suggest that participating in four successive matches, with 24-h of recovery in between, may not lead to changes in stress tolerance and salivary cortisol of youth players, but it may induce a decrease in players' jumping performance after the fourth match.

Reverse Myocardial Remodeling in Hypertrophic Cardiomyopathy: Little Explored Benefit of Exercise.

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease that causes myocardial remodeling. Physical exercise (PE) is a therapeutic resource used in Supervised Cardiac Rehabilitation (SCR) to improve Quality of Life (QL), reducing cardiovascular morbidity and mortality. Therefore, the aim of this study is to report how SCR using a personalized exercise prescription, promoted Reverse Myocardial Remodeling (RMR), improved functionality and QL of a patient with HCM. This is a case report of a 43-year-old sedentary female patient with a Body Mass Index (BMI) of 24.7 kg/m2. The patient was diagnosed with Septal Type Asymmetric HCM. Heart Failure (HF) grade III / IV, according to the New York Heart Association (NYHA), was initially treated with 40mg of Propranolol Hydrochloride twice a day, and presented with excessive fatigue, and angina. The echocardiogram showed a final diastolic volume (FDV) of 130 ml, a final systolic volume (FSV) of 44 ml, a left ventricular mass (LVM) of 236 g, interventricular septum thickness of 14 mm, left ventricular posterior wall (LVPW) thickness of 9 mm, left atrium diameter 46 mm, left ventricular end diastolic diameter of 52mm, septum/left ventricular wall ratio of 1.55 mm, and ejection fraction (EF) of 66% (Teicholz). It was obtained as a result of decreased FDV 130 vs. 102ml, decreased FSV 44 vs. 32 ml, decreased LVM 236 vs. 201 g, increased EF 66 vs. 69%, 26% improvement in QL, and 50% reduction in the dosage of Propranolol Hydrochloride. These results suggest that a personalized SCR program is an adjuvant treatment capable of promoting RMR and improving QL and functionality in a patient with HCM.

Potential biomarkers of major depression diagnosis and chronicity.

BACKGROUND: Molecular biomarkers are promising tools to be routinely used in clinical psychiatry. Among psychiatric diseases, major depression disorder (MDD) has gotten attention due to its growing prevalence and morbidity. METHODS: We tested some peripheral molecular parameters such as serum mature Brain-Derived Neurotrophic Factor (mBDNF), plasma C-Reactive Protein (CRP), serum cortisol (SC), and the salivary Cortisol Awakening Response (CAR), as well as the Pittsburgh sleep quality inventory (PSQI), as part of a multibiomarker panel for potential use in MDD diagnosis and evaluation of disease's chronicity using regression models, and ROC curve. RESULTS: For diagnosis model, two groups were analyzed: patients in the first episode of major depression (MD: n = 30) and a healthy control (CG: n = 32). None of those diagnosis models tested had greater power than Hamilton Depression Rating Scale-6. For MDD chronicity, a group of patients with treatment-resistant major depression (TRD: n = 28) was tested across the MD group. The best chronicity model (p < 0.05) that discriminated between MD and TRD included four parameters, namely PSQI, CAR, SC, and mBDNF (AUC ROC = 0.99), with 96% of sensitivity and 93% of specificity. CONCLUSION: These results indicate that changes in specific biomarkers (CAR, SC, mBDNF and PSQI) have potential on the evaluation of MDD chronicity, but not for its diagnosis. Therefore, these findings can contribute for further studies aiming the development of a stronger model to be commercially available and used in psychiatry clinical practice.

Pathophysiology of Major Depression by Clinical Stages.

The comprehension of the pathophysiology of the major depressive disorder (MDD) is essential to the strengthening of precision psychiatry. In order to determine the relationship between the pathophysiology of the MDD and its clinical progression, analyzed by severity of the depressive symptoms and sleep quality, we conducted a study assessing different peripheral molecular biomarkers, including the levels of plasma C-reactive protein (CRP), serum mature brain-derived neurotrophic factor (mBDNF), serum cortisol (SC), and salivary cortisol awakening response (CAR), of patients with MDD (n = 58) and a control group of healthy volunteers (n = 62). Patients with the first episode of MDD (n = 30) had significantly higher levels of CAR and SC than controls (n = 32) and similar levels of mBDNF of controls. Patients with treatment-resistant depression (TRD, n = 28) presented significantly lower levels of SC and CAR, and higher levels of mBDNF and CRP than controls (n = 30). An increased severity of depressive symptoms and worse sleep quality were correlated with levels low of SC and CAR, and with high levels of mBDNF. These results point out a strong relationship between the stages clinical of MDD and changes in a range of relevant biological markers. This can assist in the development of precision psychiatry and future research on the biological tests for depression.

Changes in inflammatory biomarkers are related to the antidepressant effects of Ayahuasca.

BACKGROUND: Ayahuasca is a traditional Amazon brew and its potential antidepressant properties have recently been explored in scientific settings. We conducted a double-blind placebo-controlled trial of ayahuasca with treatment-resistant depression patients (n = 28) and healthy controls (n = 45). AIMS: We are evaluating the blood inflammatory biomarkers: C-reactive protein and interleukin 6, as a potential consequence of ayahuasca intake and their correlation with serum cortisol and brain-derived neurotrophic factor levels. Blood samples were collected at pre-treatment and 48 hours after substance ingestion to assess the concentration of inflammatory biomarkers, together with administration of the Montgomery-Åsberg Depression Rating Scale. RESULTS: At pre-treatment, patients showed higher C-reactive protein levels than healthy controls and a significant negative correlation between C-reactive protein and serum cortisol levels was revealed (rho = -0.40, n = 14). C-reactive protein in those patients was not correlated with Montgomery-Åsberg Depression Rating Scale scores. We observed a significant reduction of C-reactive protein levels across time in both patients and controls treated with ayahuasca, but not with placebo. Patients treated with ayahuasca showed a significant correlation (rho = + 0.57) between larger reductions of C-reactive protein and lower depressive symptoms at 48 hours after substance ingestion (Montgomery-Åsberg Depression Rating Scale). No significant result with respect to interleukin 6 and brain-derived neurotrophic factor was found. Furthermore, these biomarkers did not predict the antidepressant response or remission rates observed. CONCLUSIONS: These findings enhance the understanding of the biological mechanisms behind the observed antidepressant effects of ayahuasca and encourage further clinical trials in adults with depression.

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression.

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.

A descoberta pré-natal da fissura labiopalatina do bebê: principais dúvidas das gestantes / Prenatal discovery of baby's cleft lip and palate: pregnant women's main doubts / El descubrimiento prenatal de la fisura labial y palatina del bebé: principales dudas de las embarazadas

Objetivo: identificar as principais dúvidas de gestantes com diagnóstico pré-natal do bebê de fissura de lábio e/ou palato. Método: estudo descritivo, retrospectivo, quantitativo. A amostra foi composta por 15 de gestantes atendidas na consulta de enfermagem, em 2016, numa instituição pública paulista. Para a coleta de dados, utilizou-se instrumento institucional após aprovação do projeto por Comitê de Ética em Pesquisa. As dúvidas foram categorizadas como alimentação, higiene, protocolo cirúrgico, hipótese diagnóstica, pós-operatório e sofrimento/bullying. Os resultados foram submetidos à análise estatística descritiva. Resultados: idade média materna de 30 anos (±5,9), paterna de 31 anos (±10,4). Predomínio das seguintes características: classificação socioeconômica média inferior ­ 8 (53%); escolaridade dos progenitores, ensino superior completo ­ 15 (52%); bebês do sexo masculino ­ 11 (73%); diagnósticos de Fissura Transforame Unilateral Esquerda ­ 7 (47%). Salientaram-se dúvidas sobre: alimentação ­ 15 (100%) e higiene ­ 9 (60%). Conclusão: as principais dúvidas das gestantes foram sobre alimentação e higiene. Identificá-las permitiu direcionar as orientações para as necessidades reais dessa clientela.

Objective: to identify pregnant women's main doubts at prenatal diagnosis of baby's cleft lip and/or palate. Method: this retrospective, quantitative, descriptive study considered a sample of 15 pregnant women attending nursing appointments in 2016 at a public institution in São Paulo. After the project was approved by the research ethics committee, data were collected using an institutional instrument. Doubts were categorized into feeding, hygiene, surgical protocol, diagnostic hypothesis, postoperative care and suffering/bullying. The results were subjected to descriptive statistical analysis. Results: the mothers' mean age was 30 (±5.9) years, the fathers' mean was 31 (±10.4) years. The following features predominated: low mean socioeconomic position ­ 8 (53%); higher education ­ 15 (52%); male babies ­ 11 (73%); left unilateral transforaminal cleft ­ 7 (47%). Doubts were raised on: food ­ 15 (100%) and hygiene ­ 9 (60%). Conclusion: the pregnant women's main doubts were about food and hygiene. Identifying them made it possible to adjust guidelines to this clientele's real needs.

Objetivo: identificar las principales dudas de mujeres embarazadas con diagnóstico prenatal del bebé de fisura de labio y/o palatina. Método: estudio descriptivo, retrospectivo, cuantitativo. La muestra se compuso de 15 mujeres embarazadas atendidas en la consulta de enfermería, en 2016, en una institución pública de São Paulo. Para la recolección de datos se utilizó un instrumento institucional después de la aprobación del proyecto por el Comité de Ética en Investigación. Las dudas se categorizaron como alimentación, higiene, protocolo quirúrgico, hipótesis diagnóstica, postoperatorio y sufrimiento/bullying. Los resultados se sometieron al análisis estadístico descriptivo. Resultados: promedio de edad materna de 30 años (±5,9), paterna de 31 años (±10,4). Predominio de los siguientes aspectos: clasificación socioeconómica media inferior ­ 8 (53%); escolaridad de los progenitores, enseñanza universitaria completa ­ 15 (52%); bebés de sexo masculino ­ 11 (73%); diagnósticos de Fisura Transforamen Unilateral Izquierda ­ 7 (47%). Se destacaron dudas sobre: alimentación ­ 15 (100%) e higiene ­ 9 (60%). Conclusión: las principales dudas de las embarazadas se basaron en alimentación e higiene. Identificarlas permitió consucir las orientaciones hacia las necesidades reales de esa clientela.

Questions of informal caregivers of children regarding the postoperative period of cochlear implant.

OBJECTIVE: To identify the main questions of informal caregivers of children with hearing impairments on the postoperative care of cochlear implant. METHOD: Cross-sectional study developed in a public and tertiary hospital of the state of São Paulo, Brazil. The sample consisted of 48 informal caregivers who were monitoring children subjected to cochlear implant. Data collection took place during the preoperative nursing consultation, by structured interview, between September 2016 and July 2017. The questions identified were categorized by similarity. RESULTS: The questions were related to: rest, dressing, feeding, length of stay, system activation time, infection, removal of stitches, bleeding, medicines, immediate sound stimulation, and pain. CONCLUSION: The prevalent questions were about rest, dressing, and feeding, and identifying them made it possible to plan and implement a nursing care aimed at the caregiver needs, as well as prepare them for care maintenance after hospital discharge.

Questions of informal caregivers of children regarding the postoperative period of cochlear implant / Dudas de cuidadores informales de niños en torno al posoperatorio de implante coclear / Dúvidas de cuidadores informais de crianças referentes ao pós-operatório de implante coclear

ABSTRACT Objective: To identify the main questions of informal caregivers of children with hearing impairments on the postoperative care of cochlear implant. Method: Cross-sectional study developed in a public and tertiary hospital of the state of São Paulo, Brazil. The sample consisted of 48 informal caregivers who were monitoring children subjected to cochlear implant. Data collection took place during the preoperative nursing consultation, by structured interview, between September 2016 and July 2017. The questions identified were categorized by similarity. Results: The questions were related to: rest, dressing, feeding, length of stay, system activation time, infection, removal of stitches, bleeding, medicines, immediate sound stimulation, and pain. Conclusion: The prevalent questions were about rest, dressing, and feeding, and identifying them made it possible to plan and implement a nursing care aimed at the caregiver needs, as well as prepare them for care maintenance after hospital discharge.

RESUMEN Objetivo: Identificar las principales dudas de cuidadores informales de niños con discapacidad auditiva en torno a los cuidados posoperatorios de implante coclear. Método: Estudio transversal realizado en un hospital público y terciario del interior de São Paulo, Brasil. La muestra constó de 48 cuidadores informales que acompañaban a niños sometidos a implante coclear. La recolección de datos se hizo durante la consulta de enfermería preoperatoria, por medio de entrevista estructurada realizada entre septiembre de 2016 y julio de 2017. Las dudas identificadas se categorizaron por similitud. Resultados: Las dudas estuvieron relacionadas con: el reposo, el vendaje, la alimentación, el tiempo de internación, el tiempo de activación del sistema, la infección, la retirada de puntos, el sangrado, las medicaciones, el estímulo sonoro inmediato y el dolor. Conclusión: Las dudas más predominantes fueron en torno al reposo, al vendaje y a la alimentación, e identificarlas posibilitó planificar e implementar una asistencia de enfermería orientada a las necesidades de la clientela, además de prepararla para mantener los cuidados tras el alta hospitalaria.

RESUMO Objetivo: Identificar as principais dúvidas de cuidadores informais de crianças com deficiência auditiva sobre os cuidados pós-operatórios de implante coclear. Método: Estudo transversal desenvolvido em um hospital público e terciário do interior de São Paulo, Brasil. A amostra constou de 48 cuidadores informais que se encontravam acompanhando crianças submetidas a implante coclear. A coleta de dados ocorreu durante a consulta de enfermagem pré-operatória, por meio de entrevista estruturada, entre setembro de 2016 e julho de 2017. As dúvidas identificadas foram categorizadas por similaridade. Resultados: As dúvidas relacionaram-se a: repouso, curativo, alimentação, tempo de internação, tempo de ativação do sistema, infecção, retirada de pontos, sangramento, medicações, estímulo sonoro imediato e dor. Conclusão: As dúvidas prevalentes relacionaram-se ao repouso, curativo e alimentação e identificá-las possibilitou planejar e implementar uma assistência de enfermagem voltada às necessidades da clientela, além de prepara-los para manutenção dos cuidados após a alta hospitalar.

Modulation of Serum Brain-Derived Neurotrophic Factor by a Single Dose of Ayahuasca: Observation From a Randomized Controlled Trial.

Serotonergic psychedelics are emerging as potential antidepressant therapeutic tools, as suggested in a recent randomized controlled trial with ayahuasca for treatment-resistant depression. Preclinical and clinical studies have suggested that serum brain-derived neurotrophic factor (BDNF) levels increase after treatment with serotoninergic antidepressants, but the exact role of BDNF as a biomarker for diagnostic and treatment of major depression is still poorly understood. Here we investigated serum BDNF levels in healthy controls (N = 45) and patients with treatment-resistant depression (N = 28) before (baseline) and 48 h after (D2) a single dose of ayahuasca or placebo. In our sample, baseline serum BDNF levels did not predict major depression and the clinical characteristics of the patients did not predict their BDNF levels. However, at baseline, serum cortisol was a predictor of serum BDNF levels, where lower levels of serum BDNF were detected in a subgroup of subjects with hypocortisolemia. Moreover, at baseline we found a negative correlation between BDNF and serum cortisol in volunteers with eucortisolemia. After treatment (D2) we observed higher BDNF levels in both patients and controls that ingested ayahuasca (N = 35) when compared to placebo (N = 34). Furthermore, at D2 just patients treated with ayahuasca (N = 14), and not with placebo (N = 14), presented a significant negative correlation between serum BDNF levels and depressive symptoms. This is the first double-blind randomized placebo-controlled clinical trial that explored the modulation of BDNF in response to a psychedelic in patients with depression. The results suggest a potential link between the observed antidepressant effects of ayahuasca and changes in serum BDNF, which contributes to the emerging view of using psychedelics as an antidepressant. This trial is registered at http://clinicaltrials.gov (NCT02914769).

Cortisol Modulation by Ayahuasca in Patients With Treatment Resistant Depression and Healthy Controls.

Major depression is a highly prevalent mood disorder, affecting about 350 million people, and around 30% of the patients are resistant to currently available antidepressant medications. Recent evidence from a randomized controlled trial (RCT) supports the rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression. The aim of this study was to explore the effect of ayahuasca on plasma cortisol and awakening salivary cortisol response, in the same group of treatment-resistant patients (MD) and in healthy volunteers (C). Subjects received a single dose of ayahuasca or placebo (dosing session), and both plasma and awakening salivary cortisol response were measured at baseline (before dosing session) and 48 h after the dosing session. Baseline assessment (D0) showed blunted awakening salivary cortisol response and hypocortisolemia in patients, with respect to healthy controls. Salivary cortisol was also measured during dosing session, and we observed higher increases for both C and MD that ingested ayahuasca than placebo. After 48 h from the dosing session with ayahuasca, patients' awakening salivary cortisol response is similar to the ones detected in controls. No significant changes in plasma cortisol levels were observed 48 h after the sessions. Therefore, these findings point to new evidence on the modulation of salivary cortisol levels as a result of an ayahuasca session, both in healthy and depressive volunteers. Considering that cortisol acts in regulation of distinct physiological pathways, emotional and cognitive processes, it is assumed to be critically involved to the etiology of depression and its regulation seems to be important for the treatment and remission of major depression, ayahuasca use as antidepressant should be further investigated. Moreover, this study highlights the importance of psychedelics in the treatment of human mental disorders.

Nursing diagnoses and interventions in children submitted to cochlear implantation.

OBJECTIVE: Identifying the main nursing diagnoses and interventions in children submitted to cochlear implant in the immediate postoperative period. METHOD: A cross-sectional study conducted between February and April 2016, considering nursing history (anamnesis and physical examination) and nursing diagnoses (NANDA - International) with their respective interventions (Nursing Intervention Classification - NIC). Descriptive statistical analysis was used to construct the results. RESULTS: A total of 19 children participated in this study. The main nursing diagnoses listed were: impaired verbal communication, impaired skin integrity, risk for infection, risk for falls, and risk for bleeding (n=19; 100%). Regarding the nursing interventions, the following prevailed: Improvement in communication: auditory deficit, Skin surveillance, Protection against infection, Prevention of falls and Precautions against bleeding (n=19; 100%). CONCLUSION: Nursing diagnoses and interventions related to the cochlear implant postoperative period were related to communication, bleeding control, surgical wound care, infection prevention, comfort and well-being. OBJETIVO: Identificar os principais diagnósticos e intervenções de enfermagem em crianças submetidas a implante coclear em pós-operatório imediato. MÉTODO: Estudo transversal realizado entre fevereiro e abril de 2016. Foram considerados o histórico de enfermagem (anamnese e exame físico) e os diagnósticos de enfermagem (NANDA - Internacional) com suas respectivas intervenções (Nursing Intervention Classification - NIC). Para construção dos resultados utilizou-se da análise estatística descritiva. RESULTADOS: Participaram do presente estudo 19 crianças. Os principais diagnósticos de enfermagem elencados foram: Comunicação verbal prejudicada, Integridade da pele prejudicada, Risco de infecção, Risco de queda e Risco de sangramento (n=19; 100%). Quanto às intervenções de enfermagem, prevaleceram: Melhora na comunicação: deficit auditivo, Supervisão da pele, Proteção contra infecção, Prevenção de quedas e Precauções contra sangramento (n=19; 100%). CONCLUSÃO: Os diagnósticos e as intervenções de enfermagem referentes ao pós-operatório de implante coclear relacionaram-se com comunicação, controle de sangramento, cuidados com a ferida operatória, prevenção de infecção, conforto e bem-estar.