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Affective disorders in Parkinson's disease (PD) concern several components of emotion. However, research on subjective feeling in PD is scarce and has produced overall varying results. Therefore, in this study, we aimed to evaluate the subjective emotional experience and its relationship with autonomic symptoms and other non-motor features in PD patients. We used a battery of film excerpts to elicit Amusement, Anger, Disgust, Fear, Sadness, Tenderness, and Neutral State, in 28 PD patients and 17 healthy controls. Self-report scores of emotion category, intensity, and valence were analyzed. In the PD group, we explored the association between emotional self-reported scores and clinical scales assessing autonomic dysregulation, depression, REM sleep behavior disorder, and cognitive impairment. Patient clustering was assessed by considering relevant associations. Tenderness occurrence and intensity of Tenderness and Amusement were reduced in the PD patients. Tenderness occurrence was mainly associated with the overall cognitive status and the prevalence of gastrointestinal symptoms. In contrast, the intensity and valence reported for the experience of Amusement correlated with the prevalence of urinary symptoms. We identified five patient clusters, which differed significantly in their profile of non-motor symptoms and subjective feeling. Our findings further suggest the possible existence of a PD phenotype with more significant changes in subjective emotional experience. We concluded that the subjective experience of complex emotions is impaired in PD. Non-motor feature grouping suggests the existence of disease phenotypes profiled according to specific deficits in subjective emotional experience, with potential clinical implications for the adoption of precision medicine in PD. Further research on larger sample sizes, combining subjective and physiological measures of emotion with additional clinical features, is needed to extend our findings.
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Doença de Parkinson , Humanos , Doença de Parkinson/psicologia , Emoções/fisiologia , Medo , Ira , TristezaRESUMO
PURPOSE: Cardiac autonomic dysfunction in idiopathic Parkinson's disease (PD) manifests as reduced heart rate variability (HRV). In the present study, we explored the deceleration capacity of heart rate (DC) in patients with idiopathic PD, an advanced HRV marker that has proven clinical utility. METHODS: Standard and advanced HRV measures derived from 7-min electrocardiograms in 20 idiopathic PD patients and 27 healthy controls were analyzed. HRV measures were compared using regression analysis, controlling for age, sex, and mean heart rate. RESULTS: Significantly reduced HRV was found only in the subcohort of PD patients older than 60 years. Low- frequency power and global HRV measures were lower in patients than in controls, but standard beat-to-beat HRV markers (i.e., rMSSD and high-frequency power) were not significantly different between groups. DC was significantly reduced in the subcohort of PD patients older than 60 years compared to controls. CONCLUSIONS: Deceleration-related oscillations of HRV were significantly reduced in the older PD patients compared to healthy controls, suggesting that short-term DC may be a sensitive marker of cardiac autonomic dysfunction in PD. DC may be complementary to traditional markers of short-term HRV for the evaluation of autonomic modulation in PD. Further study to examine the association between DC and cardiac adverse events in PD is needed to clarify the clinical relevance of DC in this population.
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Doença de Parkinson , Disautonomias Primárias , Sistema Nervoso Autônomo , Desaceleração , Frequência Cardíaca , Humanos , Doença de Parkinson/complicaçõesRESUMO
Introducción: Algunos estudios resaltan la presencia de manifestaciones psiquiátricas en pacientes con diabetes mellitus. La depresión es el trastorno mental más frecuente en diabéticos; se considera que 1 de cada 3 pacientes con diabetes tienen depresión y, a su vez, el riesgo de tener un trastorno depresivo es 2 veces mayor que en la población general. Objetivo: Identificar algunos factores asociados con la depresión en pacientes diabéticos y su efecto en el control glucémico. Métodos: Se realizó un estudio descriptivo y transversal de 457 pacientes diabéticos, atendidos en el Hospital Central de Nampula, Mozambique, desde marzo de 2014 hasta diciembre de 2016. Como principales variables figuraron: frecuencia de los síntomas de depresión, trastornos depresivos, características sociodemográficas, eventos vitales actuales y control glucémico. Se utilizó el porcentaje como medida de resumen y como estadística inferencial la prueba de X2 de independencia y odds ratio, con un intervalo de confianza de 95 %. Resultados: La frecuencia de síntomas de depresión y de trastornos depresivos en la consulta externa fue de 32,3 y 24,3 %, respectivamente. Los factores mayormente asociados con la depresión fueron: el sexo femenino, estar viudo o divorciado y ser ama de casa. Por otra parte, experimentar 2 o más eventos vitales actuales incrementó la probabilidad de depresión y esta última se asoció con un mal control glucémico (p<0,05). Conclusiones: La frecuencia de depresión en pacientes diabéticos es elevada y está asociada con algunas variables sociodemográficas, con eventos vitales actuales y con un mal control glucémico.
Introduction: Some studies emphasize the presence of psychiatric signs in patients with diabetes mellitus. The depression is the most frequent mental disorder in diabetic patients; it is considered that 1 out of 3 patients with diabetes have depression and, in turn, the risk of having a depressive disorder is 2 times higher than in the general population. Objective: To identify some factors associated with the depression in diabetic patients and their effect in the glycemic control. Methods: A descriptive and cross-sectional study of 457 diabetic patients, assisted in the Central Hospital of Nampula, Mozambique, was carried out from March, 2014 to December, 2016. As main variables we can mention: frequency of the depression symptoms, depressive disorders, sociodemographic characteristics, current vital events and glycemic control. The percentage was used as summary measure and as inference statistics the chi-squared test of independence and odds ratio, with a 95 % confidence interval. Results: The frequency of depression symptoms and depressive disorders in the outpatient service was 32.3 and 24.3 %, respectively. The factors mostly associated with the depression were: the female sex, being widower or divorced and being a housewife. On the other hand, to experience 2 or more current vital events increased the depression probability and the latter was associated with a poor glycemic control (p <0.05). Conclusions: The frequency of depression in diabetic patients is high and it is associated with some sociodemographic variables, with current vital events and with a poor glycemic control.
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Depressão/epidemiologia , Diabetes Mellitus , Controle Glicêmico/métodos , MoçambiqueRESUMO
RESUMEN Introducción: la hipertensión arterial (HTA) es uno de los grandes desafíos de la medicina moderna, por su elevada prevalencia, constituye probablemente, el problema de salud más importante en los países desarrollados y subdesarrollados. Afecta a alrededor de mil millones de personas adultas y según proyecciones para el 2025 habrá 1,5 millones de personas con la enfermedad, que equivale a 30 % de la población mundial. Objetivo: identificar la presencia de trastornos depresivos y eventos vitales en pacientes con hipertensión arterial y su relación con la adherencia a la terapia antihipertensiva. Método: se realizó un estudio descriptivo, transversal con 222 pacientes hipertensos del Hospital Central de Nampula, Mozambique. Se estudiaron algunas variables sociodemográficas, sintomatología depresiva, diagnóstico psiquiátrico, eventos vitales actuales y adherencia terapéutica. Se hicieron análisis bivariados para correlacionar la adhesión al tratamiento con la presencia de síntomas psicológicos, tratamiento psicofarmacológico, eventos vitales y diagnóstico de enfermedad depresiva. Resultados: la frecuencia de síntomas depresivos fue de 40,5 %. Los diagnósticos más frecuentes fueron trastorno depresivo mayor, trastorno distímico y trastornos adaptativos con estado de ánimo depresivo. Los eventos vitales actuales afectaron a 77,9 % de los hipertensos; los más frecuentes fueron la muerte de familiares queridos, padecer enfermedades físicas y los conflictos interpersonales. El 42,8 % tenía una pobre adherencia a la medicación antihipertensiva, la que se asoció significativamente (p<0,05) con la presencia de síntomas depresivos, necesidad de un tratamiento psicofarmacológico, ser afectado por 3 o más eventos vitales actuales y tener diagnóstico de un trastorno depresivo. Conclusiones: la frecuencia de depresión es elevada en hipertensos y los pacientes deprimidos tienen una pobre adherencia terapéutica. Los eventos vitales actuales influyen negativamente en el cumplimiento del tratamiento antihipertensivo.
ABSTRACT Introduction: arterial hypertension (hypertension) is one of the great challenges of modern medicine, due to its high prevalence, it is probably the most important health problem in developed and underdeveloped countries. It affects about one billion adults and according to projections by 2025 there will be 1.5 million people with the disease, which is equivalent to 30% of the world's population. Objective: to identify the presence of depressive disorders and vital events in patients with arterial hypertension and their relationship with adherence to antihypertensive therapy. Method: a descriptive, cross-sectional study was conducted with 222 hypertensive patients from the Central Hospital of Nampula, Mozambique. Some sociodemographic variables, depressive symptomatology, psychiatric diagnosis, current vital events and therapeutic adherence were studied. Bivariate analyzes were performed to correlate adherence to treatment with the presence of psychological symptoms, psychopharmacological treatment, vital events and diagnosis of depressive illness. Results: the frequency of depressive symptoms was 40.5%. The most frequent diagnoses were major depressive disorder, dysthymic disorder and adaptive disorders with depressive mood. Current vital events affected 77.9% of hypertensive patients; the most frequent were the death of loved relatives, suffering from physical illnesses and interpersonal conflicts. 42.8% had poor adherence to antihypertensive medication, which was significantly associated (p <0.05) with the presence of depressive symptoms, need for psychopharmacological treatment, being affected by 3 or more current life events and having Diagnosis of a depressive disorder. Conclusions: the frequency of depression is high in hypertensive patients and depressed patients have poor therapeutic adherence. Current vital events negatively influence compliance with antihypertensive treatment.
RESUMO Introdução: a hipertensão arterial (hipertensão) é um dos grandes desafios da medicina moderna, devido à sua alta prevalência, é provavelmente o problema de saúde mais importante nos países desenvolvidos e subdesenvolvidos. Afeta cerca de um bilhão de adultos e, segundo as projeções até 2025, haverá 1,5 milhão de pessoas com a doença, o que equivale a 30% da população mundial. Objetivo: identificar a presença de distúrbios depressivos e eventos vitais em pacientes com hipertensão arterial e sua relação com a adesão à terapia anti-hipertensiva. Método: estudo descritivo, transversal, com 222 pacientes hipertensos do Hospital Central de Nampula, Moçambique. Foram estudadas algumas variáveis sociodemográficas, sintomatologia depressiva, diagnóstico psiquiátrico, eventos vitais atuais e adesão terapêutica. Análises bivariadas foram realizadas para correlacionar a adesão ao tratamento com a presença de sintomas psicológicos, tratamento psicofarmacológico, eventos vitais e diagnóstico de doença depressiva. Resultados: a frequência de sintomas depressivos foi de 40,5%. Os diagnósticos mais frequentes foram transtorno depressivo maior, distúrbio distímico e distúrbios adaptativos com humor depressivo. Os eventos vitais atuais afetaram 77,9% dos pacientes hipertensos; os mais frequentes foram a morte de parentes queridos, sofrendo de doenças físicas e conflitos interpessoais. 42,8% apresentaram baixa adesão à medicação anti-hipertensiva, que foi significativamente associada (p <0,05) à presença de sintomas depressivos, necessidade de tratamento psicofarmacológico, sendo afetada por três ou mais eventos atuais da vida e tendo Diagnóstico de um distúrbio depressivo. Conclusões: a frequência de depressão é alta em pacientes hipertensos e os deprimidos apresentam baixa adesão terapêutica. Os eventos vitais atuais influenciam negativamente a adesão ao tratamento anti-hipertensivo.
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PURPOSE: Cardiac autonomic dysfunction manifests as reduced heart rate variability (HRV) in idiopathic Parkinson's disease (PD), but no significant reduction has been found in PD patients who carry the LRRK2 mutation. Novel HRV features have not been investigated in these individuals. We aimed to assess cardiac autonomic modulation through standard and novel approaches to HRV analysis in individuals who carry the LRRK2 G2019S mutation. METHODS: Short-term electrocardiograms were recorded in 14 LRRK2-associated PD patients, 25 LRRK2-non-manifesting carriers, 32 related non-carriers, 20 idiopathic PD patients, and 27 healthy controls. HRV measures were compared using regression modeling, controlling for age, sex, mean heart rate, and disease duration. Discriminant analysis highlighted the feature combination that best distinguished LRRK2-associated PD from controls. RESULTS: Beat-to-beat and global HRV measures were significantly increased in LRRK2-associated PD patients compared with controls (e.g., deceleration capacity of heart rate: p = 0.006) and idiopathic PD patients (e.g., 8th standardized moment of the interbeat interval distribution: p = 0.0003), respectively. LRRK2-associated PD patients also showed significantly increased irregularity of heart rate dynamics, as quantified by Rényi entropy, when compared with controls (p = 0.002) and idiopathic PD patients (p = 0.0004). Ordinal pattern statistics permitted the identification of LRRK2-associated PD individuals with 93% sensitivity and 93% specificity. Consistent results were found in a subgroup of LRRK2-non-manifesting carriers when compared with controls. CONCLUSIONS: Increased beat-to-beat HRV in LRRK2 G2019S mutation carriers compared with controls and idiopathic PD patients may indicate augmented cardiac autonomic cholinergic activity, suggesting early impairment of central vagal feedback loops in LRRK2-associated PD.
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Doença de Parkinson/complicações , Doença de Parkinson/genética , Doença de Parkinson/fisiopatologia , Disautonomias Primárias/etiologia , Idoso , Feminino , Frequência Cardíaca/fisiologia , Humanos , Serina-Treonina Proteína Quinase-2 com Repetições Ricas em Leucina/genética , Masculino , Pessoa de Meia-Idade , Mutação , Nervo Vago/fisiopatologiaRESUMO
Intento suicida constituye la mayorÃa de pacientes con lesiones autoinfligidas que acuden al servicio de urgencias. Su costo económico y social es elevado en términos de utilización de servicios de salud y el impacto que tiene en el individuo y la familia. Objetivo: Identificar algunas caracterÃsticas epidemiológicas de casos de intento suicida vistos en el Hospital Central de Nampula, Mozambique. Material y Métodos: Estudio descriptivo, transversal y porcentual de 93 pacientes con historia de intento suicida atendidos entre mayo de 2014 y diciembre de 2016. Se identificaron algunas variables sociodemográficas, metodologÃa y motivos, intentos previos, persistencia de la idea suicida, caracterÃsticas del intento (impulsivo o no) y diagnóstico psiquiátrico. Resultados: Más de la mitad de los pacientes tenÃan entre 15 y 24 años de edad, hubo una proporción de 1.3 a 1 de mujeres vs. varones, la mayorÃa eran estudiantes y soltero(a)s. Conflictos interpersonales motivaron tres de cada cuatro intentos. La ideación suicida persistÃa en 35,5 % de los pacientes al momento de la entrevista. La mayorÃa efectuó el intento suicida de manera impulsiva contando con fácil acceso a un raticida de elevada letalidad, y 14,6 % tenÃa historia de intentos previos. Los diagnósticos psiquiátricos más frecuentes fueron trastornos de la personalidad y trastornos depresivos. Conclusiones: Conflictos interpersonales como factor desencadenante, fácil disponibilidad de un agente letal, conducta impulsiva y diagnósticos de trastornos de la personalidad y depresión son hallazgos descriptivos fundamentales de este estudio en Mozambique.
Suicidal attempt constitutes the majority of patients with self-inflicted injuries seen at hospital emergency departments. The economic and social costs are high in terms of utilization of health services and the behaviorâs impact on the individual and his/her family. Objective: To identify some epidemiological characteristics of suicide attempts at Nampula Central Hospital in Mozambique. Material and Method: Descriptive, cross-sectional study on 93 patients who attempted suicide between May 2014 and December 2016. Sociodemographic variables, suicidal method, reasons for the attempt, previous attempts, persistence of suicidal ideation, psychiatric diagnosis and whether the attempt was impulsive or not were identified, data, quantified through percent figures. Results: Over half of the patients were in the 15-24, not-married, and students with a female/male ratio of 1.3. Interpersonal conflicts were the reason in ¾ parts of the attempts. Suicidal ideation persisted in 35.5 % of the patients. Most of the suicide attempts were impulsive acts, facilitated by the availability and easy access to a rodenticide called ratex, and 14.6 % of the patients had had previous attempts. The most frequent psychiatric diagnoses were personality and depressive disorders. Conclusions: Interpersonal conflicts, availability of a lethal agent, impulsive behaviour and diagnoses of personality disorders and depression were the main descripotive findings of this study in Mozambique.
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BACKGROUND: Current clinical guidelines recommend mammography as the only imaging method for surveillance in asymptomatic survivors of early breast cancer (EBC). However, non-recommended tests are commonly used. We estimated the imaging radiation-induced malignancies (IRIM) risks in survivors of EBC undergoing different imaging surveillance models. MATERIALS AND METHODS: We built 5 theoretical models of imaging surveillance, from annual mammography only (model 1) to increasingly imaging-intensive approaches, including computed tomography (CT) scan, positron emission tomography-CT, bone scan, and multigated acquisition scan (models 2 through 5). Using the National Cancer Institute's Radiation Risk Assessment Tool, we compared the excess lifetime attributable cancer risk (LAR) for hypothetical survivors of EBC starting surveillance at the ages of 30, 60, or 75 years and ending at 81 years. RESULTS: For all age groups analyzed, there is a statistically significant increase in LAR when comparing model 1 with more intensive models. As an example, in a patient beginning surveillance at the age of 60 years, there is a 28.5-fold increase in the IRIM risk when comparing mammography only versus a schedule with mammography plus CT scan of chest-abdomen and bone scan. We found no differences when comparing models 2 through 5. LAR is higher when surveillance starts at a younger age, although the age effect was only statistically significant in model 1. CONCLUSION: Non-recommended imaging during EBC surveillance can be associated with a significant increase in LAR. In addition to the lack of survival benefit, additional tests may have significant IRIM risks and should be avoided.
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Neoplasias da Mama/diagnóstico por imagem , Sobreviventes de Câncer/estatística & dados numéricos , Mamografia/efeitos adversos , Programas de Rastreamento/métodos , Neoplasias Induzidas por Radiação/etiologia , Tomografia por Emissão de Pósitrons/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Adulto , Idoso , Neoplasias da Mama/terapia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Imagem Molecular/efeitos adversos , Neoplasias Induzidas por Radiação/diagnóstico , Vigilância da População , Prognóstico , Doses de Radiação , Exposição à Radiação/efeitos adversos , Cintilografia/efeitos adversos , Medição de Risco/métodos , Fatores de RiscoRESUMO
Resumen Introducción: Los síntomas psicológicos están presentes en pacientes con manifestaciones otorrinolaringológicas, según reportes de algunas investigaciones. Objetivo: Describir algunos factores psicosociales en pacientes de un servicio de otorrinolaringología. Método: Estudio transversal con 138 pacientes provenientes del Departamento de Otorrinolaringología del Hospital Central de Nampula. Se identificaron las manifestaciones físicas y psicológicas, los eventos vitales y el diagnóstico psiquiátrico. Se utilizó Chi cuadrado para determinar si existía asociación entre ansiedad, síntomas depresivos y algunos síntomas otorrinolaringológicos. Resultados: Los motivos de consulta en otorrinolaringología fueron dolor de oídos, dolor en la garganta, hipoacusia, zumbido de oídos y sensación de cuerpo extraño faríngeo. El examen físico fue negativo en 73,2% de los pacientes. La mayoría tenían manifestaciones psiquiátricas, predominando los síntomas depresivos y ansiedad, que se asociaron significativamente con el dolor de oídos y garganta. Más de la mitad fueron afectados por múltiples eventos vitales. Conclusiones: Los problemas de salud mental son frecuentes en pacientes con síntomas de otorrinolaringología sin causa orgánica aparente.
Background: The psychological symptoms are present at patients with otorhinolaryngologic manifestations according to reports of some investigations. Objective: To describe the psychosocial factors in otorhinolaringology outpatients. Methods: It is a cross-sectional study with 138 outpatients who visited the department of otorhinolaryngology in Nampula Central Hospital. We studied physical and psychological manifestations, stressful life events and, psychiatric diagnosis. The chi-squared test to determine association between anxiety, depressive symptoms and the otorhinolaryngologic symptoms were used. Result: The motive of otorhinolaryngology consultation was ear pain, sore throat, partial deafness, tinnitus and sensation of a foreign body in the throat. The physical examination was negative in 73,2% of the patients. The majority of patients had psychiatrics manifestations and the depressive symptoms and anxiety predominated, which was associated with the ear pain and sore throat. More than half of patients experienced several stressful life events. Conclusions: The mental health problems are frequents in otorhinolaryngology patients without organic apparent disease.
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Humanos , Masculino , Feminino , Otolaringologia , Psicologia , Saúde Mental , Transtornos Mentais , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Introducción: la hipertensión arterial constituye un importante problema de salud. En el mundo aproximadamente 7,6 millones de muertes prematuras y 92 millones de años de vida ajustados por discapacidad son atribuidas a esta afección. Objetivo: identificar la asociación de la hipertensión arterial con algunos factores de riesgo psicosociales. Métodos: se efectuó un estudio transversal (de corte) de 197 pacientes (74 hipertensos y 123 sin hipertensión arterial) que acudieron al Consultorio UD-140 de la urbanización 25 de Marzo, perteneciente al municipio de Caroní, en el Estado Bolívar de Venezuela, desde enero del 2004 hasta noviembre del 2005. Se identificaron las variables demográficas, los antecedentes personales y familiares de trastornos psiquiátricos, así como los eventos vitales que afectaron a los pacientes. En el análisis estadístico se emplearon el porcentaje, la prueba de la ײ y la oportunidad relativa. Resultados: en la serie predominaron las mujeres, el grupo etario de 55 y más años, la escolaridad primaria, las amas de casa y las víctimas de maltrato físico o psicológico, o ambos. Los pacientes hipertensos tuvieron mayor probabilidad de presentar familiares de primer grado con trastornos psiquiátricos, así como de padecer enfermedades físicas y experimentar conflictos con su pareja. Conclusiones: algunas variables demográficas se convierten en estresores que se asocian a la hipertensión; también algunos eventos vitales son causa más probable de estrés en las personas hipertensas.
Introduction: hypertension constitutes an important health problem. Approximately 7,6 million of premature deaths and 92 million of years adjusted to life due to disabilities are attributed to this disorder. Objective: to identify the association of hypertension with some psychosocial risk factors. Methods: a cross-sectional study of 197 patients, (74 with hypertension and 123 without it) who visited the doctor's office UD-140 of the urbanization 25 de marzo, belonging to Caroní municipality, in the State of Bolivar, Venezuela was carried out from January, 2004 to November, 2005. The demographic variables, personal and family history of psychiatric disorders, as well as vital events affecting the patients were identified. In the statistical analysis the percentage, the Chi squared test and the relative opportunity were used. Results: women, the age group 55 and more, the primary school level, the housewives and the victims of physical and psychological abuse, or both, prevailed in the series. The hypertensive patients had higher probabilities of having first generation relatives with psychiatric dysfunctions, as well as of suffering physical diseases and of experiencing conflicts with their couples. Conclusions: some demographic variables become stressors associated to hypertension; some vital events are also more probable the cause of stress in hypertensive patients.
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Fatores Sociais , Hipertensão , Estresse Psicológico , VenezuelaRESUMO
OBJECTIVE: To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records. METHODS: We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days. The first 30 minutes of the session were considered the basal record, and then Zolpidem was administered. All participants were evaluated clinically, by EEG, and by HRV during the basal record, and for 90 minutes after drug intake. RESULTS: We found in all patients, time-related arousing signs after Zolpidem intake: behavioral (yawns and hiccups), activation of EEG cortical activity, and a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. CONCLUSIONS: We demonstrated time-related arousing signs after Zolpidem intake. We discussed possible mechanisms to explain these patho-physiological findings regarding EEG cortical activation and an autonomic vagolytic drug effect. As this autonomic imbalance might induce cardiocirculatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that this arousing Zolpidem effect might be certainly related to brain function improvement, it should be particularly considered for the development of new neuro-rehabilitation programs in PVS cases. According to the literature review, we claim that this is the first report about the vagolitic effect of Zolpidem in PVS cases.
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Sistema Nervoso Autônomo/efeitos dos fármacos , Eletroencefalografia , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/tratamento farmacológico , Piridinas/farmacologia , Piridinas/uso terapêutico , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/fisiopatologia , Adulto Jovem , ZolpidemAssuntos
Nível de Alerta/efeitos dos fármacos , Sistema Nervoso Autônomo/efeitos dos fármacos , Ondas Encefálicas/efeitos dos fármacos , Estado Vegetativo Persistente/tratamento farmacológico , Estado Vegetativo Persistente/fisiopatologia , Piridinas/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Eletroencefalografia/métodos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Análise Espectral , Adulto Jovem , ZolpidemRESUMO
Objetivo: Estudiar las características epidemiológicas de las personas que asistieron por intento suicida a un hospital de Potosí, Bolivia. Material y métodos: Se realizó un estudio con 56 personas que acudieron al Hospital Madre Obrera de Llallagua (Potosí, Bolivia) que tuvieron un intento suicida entre el 6 de junio de 2006 y el 31 de octubre de 2007. Mediante entrevistas individuales se determinaron las variables demográficas, métodos y motivos del intento suicida, antecedentes personales y familiares de conducta suicida, diagnóstico psiquiátrico y factores inherentes a la tentativa actual. Resultados: La razón mujeres/varones fue 2:1. El grupo de edad más afectado fue el de 15 a 24 años (55,4%). Entre los hombres, predominaron los solteros (72,2%) y los estudiantes (50%); y entre las mujeres, las que tenían pareja (50%) y las amas de casa (42,1%). El método suicida más utilizado fue la ingestión de organofosforados (67,8%), en tanto que los motivos más frecuentes fueron los conflictos con la pareja (42,6%) y con la familia (37%). En 25% de la muestra persistía la ideación suicida; 21,4% tenía familiares con conducta suicida y 16,1% había realizado tentativas anteriores. El 83,9% realizó el intento suicida de manera impulsiva y 51,8% estaba bajo los efectos del alcohol. Los diagnósticos psiquiátricos más frecuentes fueron los trastornos de la personalidad y la depresión. Conclusiones: Quienes intentan suicidarse son jóvenes, mujeres, estudiantes, amas de casa, hombres solteros y mujeres con pareja. La conducta suicida personal y en familiares, la ingestión de bebidas alcohólicas, así como tener un trastorno de personalidad son características frecuentes.
Objective: To study the epidemiological characteristics of 56 patients arriving to the ôMadre Obreraõ Hospital in Llallagua, Potosí, Bolivia. Material and method: 56 patients arriving to the ôMadre Obreraõ Hospital in Llallagua, Potosí, Bolivia for suicide attempts during the period June/2006 and October/2007 was studied. Information about demographic variables; the method and motive of the suicide attempt, personal and family history of suicidal behavior, psychiatric diagnosis and related factors to the current tentative was collected by interviewing patients. Results: We found a female/male ratio of 2:1. Fifty four percent of patients were between 15 and 24 years old. Among males, 72.2% were single and 50% were students; and among women, 50% had partner and 42.1% were housewives. The most frequently suicide method used was organic phosphate insecticides ingestion (67.8%). The cause of suicide attempts were couple conflicts (42.6%) followed by family conflicts (37%). A total of 25% of the participants maintained the suicidal ideation, 21.4% had a positive family history of suicide behavior and 16.1% had previously suicidal attempt, 83.9% were impulsive suicidal attempts and 51.8% were under the influence of alcohol.The most frequent psychiatric diagnoses were personality disorders and depression. Conclusion: Those who attempt suicide are young, female, students, housewives, single men and married women. History of family and personal suicidal behavior, alcohol ingestion and personality disorders were frequent features.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Depressão , Epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , SuicídioRESUMO
Objetivo: describir la experiencia de los últimos 7 años con fijadores articulados utilizados en el manejo del trauma severo de codo, posterior a la liberación de contracturas articulares y en luxaciones abandonadas. Materiales y métodos: se realizó un estudio descriptivo retrospectivo tipo serie de casos de pacientes a quienes se les colocó un fijador articulado de codo entre los años 2000 y 2007. Se revisaron las historias clínicas de 20 pacientes y se registraron los datos en un formulario diseñado para tal fin. Al final del tratamiento se aplicó el índice funcional para codo de la Clínica Mayo para realizar una evaluación objetiva. Resultados: el tiempo promedio con el fijador fue de 3,2 meses (0,7 a 9). Once pacientes asistieron al último control y se les aplicó el índice funcional encontrando los siguientes resultados: excelente en el 63,6% de los casos, bueno en el 27,2% y regular en el 9%. Los arcos de movilidad articular pasaron en promedio de 35,4 a 84,8º y de 70,8º a 133º en flexoextensión y en pronosupinación respectivamente. Trece pacientes requirieron uno o varios procedimientos complementarios durante la colocación del fijador. En 7 pacientes (35%) se presentaron complicaciones; la más frecuente fue la infección en el tracto de los clavos (osteítis). Conclusiones: el fijador articulado de codo proporciona una alternativa viable para el manejo de lesiones complejas agudas o crónicas y como protección de los tejidos blandos cuando se realiza liberación de contracturas. La ventaja del fijador, al tener un diseño acorde con la biomecánica de la articulación, es que permite un inicio temprano de la movilidad.
Assuntos
Cotovelo , Fixadores Externos , Instabilidade Articular , Luxações ArticularesRESUMO
Objetivo: describir la artrodesis de rodilla con un alargamiento óseo simultáneo usando fijadores externos como un procedimiento adecuado de salvamento. Materiales y métodos: se realizó un estudio descriptivo retrospectivo tipo serie de casos con pacientes manejados en el Hospital Universitario del Valle y el Centro Médico Imbanaco, a quienes se les practicó una artrodesis de rodilla empleando fijadores externos entre los años 2001 y 2007. Se seleccionaron las historias clínicas de 18 pacientes que presentaron defectos óseos mayores de 5 cm que requirieron alargamiento o transporte óseo simultáneo para recuperar la longitud de la extremidad. Los pacientes llenaron la encuesta SF-36 v2 en español, para evaluar funcionalidad y calidad de vida al final del tratamiento. Resultados: la fusión ósea de la artrodesis se alcanzó en todos los pacientes (100%); en 2 pacientes se suspendió el alargamiento óseo porque no toleraron la fijación externa. El tiempo promedio con el fijador fue de 11 meses. El promedio de alargamiento fue de 7,8 cm (1-13 cm). El índice de consolidación del regenerado fue de 1,2 meses/cm (0,8-3). Con el SF-36 v2 se obtuvieron valores por encima de 50 puntos en 4 de las 8 dimensiones, en especial en la salud general y el dolor corporal. Conclusiones: la artrodesis de rodilla con alargamiento óseo simultáneo es un procedimiento de salvamento adecuado ante lesiones complejas del miembro inferior y se convierte en una alternativa a la amputación. La osteogénesis por distracción es útil cuando se realiza una artrodesis de rodilla porque permite tener una extremidad con una longitud óptima y funcional, mejorando la calidad de vida de los pacientes.
Assuntos
Amputação Cirúrgica , Artrodese , Alongamento Ósseo , Fixadores Externos , Articulação do Joelho , Extremidade Inferior , Osteogênese por Distração , ColômbiaRESUMO
Se describe un sistema de fijación externa desarrollado en la Universidad del Valle que ofrece una gran versatilidad para diferentes tipos de fracturas, es de costo muy competitivo y cumple los requisitos de estabilidad y rigidez. La base del sistema consiste en una prensa de seis grados de libertad que permite construir configuraciones de doble barra, que brindan buena estabilidad. El sistema está complementado por anillos de aluminio y otros accesorios que permiten configurar desde fijadores monoplanares para fracturas diafisarias hasta fijadores híbridos para tratar fracturas complejas como las del pilón tibial. Se presentan los componentes del sistema, algunas configuraciones típicas, sus caractericas mecánicas realizadas mediante procedimientos computacionales validados experimentalmente en el laboratorio, buscando la matriz de flexibilidad ínterfragmentaria. Los resultados indicaron una rigidez y una estabilidad comparables con las de otros fijadores internacionalmente probados y aceptados, en nuestro medio. Desde el punto de vista biomecánico el sistema está listo para ser probado clínicamente.
Assuntos
Fenômenos Biomecânicos , Fixação de FraturaRESUMO
Heart rate variability (HRV) is often analysed using short-term studies. Our objective was to compare two of them in a group of diabetic patients (reduced HRV) and in a control group. From the same 10 min surface electrocardiogram (ECG) two recordings were obtained. In one of them the whole signal was acquired through an A/D converter (post-event method). In the other (real-time method), an interface between the electrocardiograph and a parallel port of a computer was used to perform real-time processing of the ECG signal. The R-R intervals were measured after a visual validation in the post-event method. In the real-time method, the stored R-R intervals were automatically filtered. For both methods HRV indexes were calculated using the same software. The values of mean R-R intervals for each subject were almost identical regardless of the method. Accordingly, we found a high correlation between HRV indexes obtained from both methods (all Spearman values > or = 0.9441 and P < 0.0001). In addition, we found similar P values in the comparisons between the diabetic and control groups. We conclude that both methods are suitable for HRV analysis. Therefore, the selection of method can be based on other considerations such as the capability to store the ECG of the post-event method or the speed of analysis and lower cost of the real-time one.
Assuntos
Algoritmos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diagnóstico por Computador/métodos , Eletrocardiografia/métodos , Frequência Cardíaca , Armazenamento e Recuperação da Informação/métodos , Adulto , Idoso , Sistemas Computacionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão/métodos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Se estudiaron 94 pacientes que acudieron a la consulta de psiquiatría de Cauto Cristo, Granma, Cuba, por un síndrome depresivo, con el objetivo de describir algunas de sus características clínico epidemiológicas. A todos los sujetos se les realizó una entrevista estructurada para conocer datos demográficos, características clínicas, eventos vitales, conducta suicida en el individuo y sus familiares y diagnóstico nosológico; éste último según los criterios del DSM IV. Predominaron las mujeres, el grupo de 35 a 54 años y los que tenían pareja. Los diagnósticos más frecuentes fueron trastorno distímico, trastorno adaptativo con estado de ánimo depresivo y trastorno depresivo mayor. La edad de inicio de los cuadros depresivos se sitúa en la tercera y cuarta década de la vida. El 28,5 porciento de los deprimidos ha tenido un intento suicida actual o anterior, y fue frecuente esa conducta en sus familiares. Las mujeres tuvieron más eventos vitales que los hombres, y los más frecuentes fueron los conflictos con la pareja y otros miembros de la familia, presentándose los síntomas de forma similar en ambos sexos. El humor depresivo, la falta de interés y disfrute en las actividades y la sensación de pérdida de energía o fatiga fueron los síntomas más frecuentemente referidos por los enfermos