Posttraumatic epilepsy: Integrating clinical, inflammatory, and genetic profiles in traumatic brain injury patients.

OBJECTIVE: This study aims to assess the clinical, inflammatory, and genetic profiles of traumatic brain injury (TBI) patients over a 2-year follow-up period, focusing on the development of posttraumatic epilepsy (PTE). METHODS: Fifty-nine patients with acute TBI were recruited in the emergency unit of a hospital in Brazil. Clinical data and blood samples were collected after 10 days of hospitalization for posterior genetic profile (Apolipoprotein E- ApoE and Glutamic Acid Descarboxylase-GAD sequencing) analyses. A subset of 19 patients were assessed for cytokine markers (mRNA expression). The development of PTE was investigated for two years following TBI. Statistical analyses including univariate analysis, multiple correspondence analysis, and Mann-Whitney test were performed. RESULTS: Analysis revealed an association between severe TBI and requirement for neurosurgery and polytrauma (p<0.05), as well as the development of PTE over a two-year follow-up period (p<0.05). Multiple correspondence analysis identified two distinct profiles associated with PTE and Non-PTE outcomes. The PTE profile showed a higher prevalence of the ApoE genotype E3/E3 and GAD1 SNP (rs769391) genotype AA in our study, while the Non-PTE profile showed a higher presence of E3/E4. mRNA expression analysis demonstrated acute elevated levels of TNF-α in the PTE group as compared to Non-PTE patients (6.70±1.53 vs 5.31 ±0.33, p<0.01). SIGNIFICANCE: Our findings underscore the multifactorial nature of aspects potentially contributing to PTE. It is unlikely that any single factor might in isolation have a strong causative influence over the development of epilepsy after TBI. Our results provide a suggestion of potential clustering that might be relevant as prognostic factors for PTE.

Associations among physical activity, comorbidities, depressive symptoms and health-related quality of life in type 2 diabetes.

OBJECTIVE: To investigate associations between physical activity, comorbidity severity, depressive symptoms, and health-related quality of life in type 2 diabetes mellitus. SUBJECTS AND METHODS: All individuals, 200 patients and 50 controls, aged from 40 to 60 years, were investigated by interview, and all variables were measured concurrently. Physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ), Health-Related Quality of Life (HRQL) by the Short-Form Health Survey (SF-36), comorbidity severity by the Charlson Comorbidity Index (CCI), and depressive symptoms by the Beck Depression Inventory (BDI-II > 16). Single and multiple regression analysis evaluated the effects of independent variables on physical activity. RESULTS: The patients had more depressive symptoms and greater comorbidity severity (p < 0.005). Diabetic patients showed better activity levels (IPAQ) (p < 0.005). Functional Capacity, General State of Health, and Physical Limitation were the most affected subscales in the SF-36 evaluation of the HRQL. Sedentary diabetic patients had higher waist circumference, waist-to-hip ratios, more depressive symptoms, and worse HRQL. Functional capacity (p = 0.000), followed by General State of Health (p = 0.02), were the health status measure subscales independently associated with physical activity. CONCLUSIONS: The findings suggest that increasing patient independence and treating depressive symptoms can promote physical activity for type 2 diabetes mellitus patients. It is suggested that group activities and caregivers/family support might compensate for the patient dependence, and increase adherence to exercise programs in those that are less active.

Associations among physical activity, comorbidities, depressive symptoms and health-related quality of life in type 2 diabetes / Associações entre atividade física, comorbidades, sintomas depressivos e qualidade de vida relacionada à saúde em diabéticos tipo 2

OBJECTIVE: To investigate associations between physical activity, comorbidity severity, depressive symptoms, and health-related quality of life in type 2 diabetes mellitus. SUBJECTS AND METHODS: All individuals, 200 patients and 50 controls, aged from 40 to 60 years, were investigated by interview, and all variables were measured concurrently. Physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ), Health-Related Quality of Life (HRQL) by the Short-Form Health Survey (SF-36), comorbidity severity by the Charlson Comorbidity Index (CCI), and depressive symptoms by the Beck Depression Inventory (BDI-II > 16). Single and multiple regression analysis evaluated the effects of independent variables on physical activity. RESULTS: The patients had more depressive symptoms and greater comorbidity severity (p < 0.005). Diabetic patients showed better activity levels (IPAQ) (p < 0.005). Functional Capacity, General State of Health, and Physical Limitation were the most affected subscales in the SF-36 evaluation of the HRQL. Sedentary diabetic patients had higher waist circumference, waist-to-hip ratios, more depressive symptoms, and worse HRQL. Functional capacity (p = 0.000), followed by General State of Health (p = 0.02), were the health status measure subscales independently associated with physical activity. Conclusions: The findings suggest that increasing patient independence and treating depressive symptoms can promote physical activity for type 2 diabetes mellitus patients. It is suggested that group activities and caregivers/family support might compensate for the patient dependence, and increase adherence to exercise programs in those that are less active.

OBJETIVO: Investigar as associações entre atividade física, gravidade das comorbidades, sintomas depressivos e qualidade de vida relacionada à saúde em pacientes com diabetes mellitus tipo 2. SUJEITOS E MÉTODOS: Todos os indivíduos, 200 pacientes e 50 controles, com idades entre 40 e 60 anos, foram analisados por entrevistas, e todas as variáveis foram medidas neste mesmo momento. A atividade física foi avaliada pelo International Physical Activity Questionnaire (IPAQ); a qualidade de vida relacionada à saúde (QVRS), pelo Short-Form Health Survey (SF-36); a gravidade das comorbidades, pelo Índice de Comorbidade de Charlson (CCI); e os sintomas depressivos foram avaliados pelo Inventário de Depressão de Beck (BDI-II > 16). A análise de regressão simples e múltipla avaliou os efeitos das variáveis independentes sobre a atividade física. RESULTADOS: Os pacientes apresentaram mais sintomas depressivos e maior gravidade das comorbidades (p < 0,005). Os pacientes diabéticos apresentaram melhores níveis de atividade (IPAQ) (p < 0,005). A Capacidade Funcional, a Condição Geral de Saúde e a Limitação Física foram as subescalas mais afetadas na avaliação da QVRS no SF-36. Os pacientes diabéticos sedentários apresentaram maior circunferência da cintura, proporção cintura-quadril, mais sintomas depressivos e pior QVRS. A Capacidade Funcional (p = 0,000), seguida pela Condição Geral de Saúde (p = 0,02), foram as subescalas de medida de condição de saúde associadas independentemente com a atividade física. CONCLUSÕES: Os achados sugerem que a independência dos pacientes e o tratamentos dos sintomas depressivos podem pro-mover a atividade física para pacientes com diabetes mellitus tipo 2. Sugere-se que atividades em grupo e o apoio da família/cuidadores podem compensar a dependência do paciente e aumentar a aderência ao programa de exercícios nos pacientes menos ativos.

The relationship between physical activity, restless legs syndrome, and health-related quality of life in type 2 diabetes.

To evaluate the relationship between physical activity with co morbidities and health-related quality of life in type 2 diabetic patients with and without restless legs syndrome (RLS). This is an observational study, set at tertiary care diabetic outpatient clinic, where 200 consecutive type 2 diabetic patients and 47 controls participated. Physical activity level was established by the International Physical Activity Questionnaire (IPAQ) and RLS diagnosis and RLS severity were established using the criteria defined by the International Restless Legs Syndrome Study Group; excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale, quality of sleep by the Pittsburgh Sleep Quality Index and Health-Related Quality of Life by the Short-Form Health Survey (SF-36). Depressive symptoms were investigated by Beck Depression Inventory (BDI- II). Among all diabetic patients (58 % women, mean age 52.7 ± 5.7), disease duration varied from 1 to 30 years (11.7 ± 7.5). Diabetic patients had more hypertension (76 %), peripheral neuropathy (65 %), and depressive symptoms (31 %) than controls; no gender differences were found between cases with and without depressive symptoms. RLS patients (72 % female) had worse quality of sleep. With regards to the quality of life domains, more active RLS diabetic patients had better perception of functional capacity, physical limitation, pain, and general health state (p < 0.05). RLS symptom severity did not vary according to physical activity (IPAQ level). This study shows that the physical activity is associated with a better perception of functional capacity, physical limitation, and pain in diabetic patients with RLS; thus a more active lifestyle should be encouraged.