The next psychoactive drugs: From imipramine to ketamine.

Since the 1950s, the therapeutic arsenal against depression has grown considerably. From the discovery of mono-amine oxidase inhibitors (MAOIs) to the antidepressant effect of ketamine, several pharmacological breakthroughs made the history of psychiatry. These discoveries oriented the research about the pathophysiology of depression, which is one of the most disabling diseases worldwide affecting 10 to 20% of general population. In this article, we offer a short historical review of the various therapeutic options developed over the past century and the consequences of these innovations. We then review the discovery of the antidepressant effects of ketamine (and its S-enantiomer, esketamine), the lastest development in depression treatment. Ketamine's effects are spectacular both in terms of their very short onset time, and because they are observed even in treatment-resistant depression. Just as MAOIs and tricyclic antidepressants allowed the "monoaminergic hypothesis of depression" to emerge, unravelling the mechanisms of ketamine's antidepressant effects should highlight the role of glutamatergic system and neuro-inflammation in the neurobiology of depression. Ketamine might also help to refine our understanding of the cognitive pathophysiology of depression and to deeply transform the clinical representations of depressive disorder.

Depuis les années 1950, l'arsenal thérapeutique permettant de lutter contre la dépression s'est considérablement enrichi. De la découverte des inhibiteurs de la mono-amine oxydase (IMAO) à celle de la kétamine, ces percées pharmacologiques ont marqué l'histoire de la psychiatrie et guidé la recherche sur la physiopathologie de la dépression, cette pathologie dévastatrice affectant entre 10 et 20 % de la population mondiale. Nous proposons dans cet article une courte revue historique des différentes options thérapeutiques développées au cours du siècle passé et des conséquences qu'ont eues ces innovations. Nous réalisons ensuite un état des lieux de la plus récente de ces découvertes, celle des effets antidépresseurs de la kétamine (et de son énantiomère S, l'eskétamine), spectaculaires de par leur délai d'action et leur efficacité même dans les formes les plus résistantes de dépression. De même que la découverte des IMAO et des tricycliques a permis de concevoir une théorie monoaminergique de la dépression, l'étude des mécanismes d'actions de la kétamine pourrait permettre de comprendre le rôle de la transmission glutamatergique ou de la neuro-inflammation dans la neurobiologie de cette pathologie, d'affiner nos connaissances sur sa physiopathologie cognitive, ou encore de transformer en profondeur les représentations des cliniciens sur cette maladie.

Imaging and Quantitation of a Succession of Transient Intermediates Reveal the Reversible Self-Assembly Pathway of a Simple Icosahedral Virus Capsid.

Understanding the fundamental principles underlying supramolecular self-assembly may facilitate many developments, from novel antivirals to self-organized nanodevices. Icosahedral virus particles constitute paradigms to study self-assembly using a combination of theory and experiment. Unfortunately, assembly pathways of the structurally simplest virus capsids, those more accessible to detailed theoretical studies, have been difficult to study experimentally. We have enabled the in vitro self-assembly under close to physiological conditions of one of the simplest virus particles known, the minute virus of mice (MVM) capsid, and experimentally analyzed its pathways of assembly and disassembly. A combination of electron microscopy and high-resolution atomic force microscopy was used to structurally characterize and quantify a succession of transient assembly and disassembly intermediates. The results provided an experiment-based model for the reversible self-assembly pathway of a most simple (T = 1) icosahedral protein shell. During assembly, trimeric capsid building blocks are sequentially added to the growing capsid, with pentamers of building blocks and incomplete capsids missing one building block as conspicuous intermediates. This study provided experimental verification of many features of self-assembly of a simple T = 1 capsid predicted by molecular dynamics simulations. It also demonstrated atomic force microscopy imaging and automated analysis, in combination with electron microscopy, as a powerful single-particle approach to characterize at high resolution and quantify transient intermediates during supramolecular self-assembly/disassembly reactions. Finally, the efficient in vitro self-assembly achieved for the oncotropic, cell nucleus-targeted MVM capsid may facilitate its development as a drug-encapsidating nanoparticle for anticancer targeted drug delivery.

Mood fluctuations shift cost-benefit tradeoffs in economic decisions.

Mood effects on economic choice seem blatantly irrational, but might rise from mechanisms adapted to natural environments. We have proposed a theory in which mood helps adapting the behaviour to statistical dependencies in the environment, by biasing the expected value of foraging actions (which involve taking risk, spending time and making effort to get more reward). Here, we tested the existence of this mechanism, using an established mood induction paradigm combined with independent economic choices that opposed small but uncostly rewards to larger but costly rewards (involving either risk, delay or effort). To maximise the sensitivity to mood fluctuations, we developed an algorithm ensuring that choice options were continuously adjusted to subjective indifference points. In 102 participants tested twice, we found that during episodes of positive mood (relative to negative mood), choices were biased towards better rewarded but costly options, irrespective of the cost type. Computational modelling confirmed that the incidental mood effect was best explained by a bias added to the expected value of costly options, prior to decision making. This bias is therefore automatically applied even in artificial environments where it is not adaptive, allowing mood to spill over many sorts of decisions and generate irrational behaviours.

Studying the Effect of Short Carbon Fiber on Fused Filament Fabrication Parts Roughness via Machine Learning.

Along with the characteristic staircase effect, short carbon fibers, added to reinforce Fused Filament Fabrication parts, can significantly worsen the resulting surface finishing. Concerning this topic, the present work intends to improve the existing knowledge by analyzing 2400 measurements of arithmetic mean roughness Ra corresponding to different combinations of six process parameters: the content by weight of short carbon fibers in polyethylene terephthalate glycol (PETG) filaments f, layer height h, surface build angle θ, number of walls w, printing speed s, and extruder diameter d. The collected measurements were represented by dispersion and main effect plots. These representations indicate that the most critical parameters are θ, f, and h. Besides, up to a carbon fiber content of 12%, roughness is mainly affected by the staircase effect. Hence, it would be likely to obtain reinforced parts with similar roughness to unreinforced ones. Different machine learning methods were also tested to extract more information. The prediction model of Ra using the Random Forest algorithm showed a correlation coefficient equal to 0.94 and a mean absolute error equal to 2.026 µm. In contrast, the J48 algorithm identified a combination of parameters (h = 0.1 mm, d = 0.6 mm, and s = 30 mm/s) that, independent of the build angle, provides a Ra < 25 µm when using a 20% carbon fiber PETG filament. An example part was printed and measured to check the models. As a result, the J48 algorithm correctly classified surfaces with low roughness (Ra < 25 µm), and the Random Forest algorithm predicted the Ra value with an average relative error of less than 8%.

Criterion-related validity and reliability of the 2-km walk test and the 20-m shuttle run test in adults: The role of sex, age and physical activity level.

OBJECTIVES: To analyze the criterion-related validity and the reliability of fitness field tests for evaluating cardiorespiratory fitness in adults, by sex, age, and physical activity level. DESIGN: Cross-sectional. METHODS: During 3 weeks, sociodemographic, anthropometric measurements, a treadmill maximal test, the 2-km walk test, and the 20-m SRT were performed in 410 adults aged 18-64 years. Measured and estimated VO2max (by Oja's and Leger's equations) were analyzed. RESULTS: Measured VO2max was associated with estimated VO2max by the 2-km walk test and 20-m SRT (r = 0.784 and r = 0.875, respectively; both p < 0.01). Bland-Altman analysis showed a mean difference of -0.30 ml* kg-1 * min-1 (p < 0.001, d = -0.141) in the 2-km walk test, and 0.86 ml* kg-1 * min-1 (p = 0.051) in the 20-m SRT. Significant mean differences between test and retest were found in the time to complete the 2-km walk test (-1.48 ±â€¯0.51 s, p = 0.004, d = -0.014) and in the final stage reached in the 20-m SRT (0.04 ±â€¯0.01, p = 0.002, d = 0.015). Non-significant differences were found between test and retest in the estimated VO2max by Oja's (-0.29 ±â€¯0.20 ml* kg-1 * min-1, p > 0.05) and Leger's eqs. (0.03 ±â€¯0.04 ml* kg-1 * min-1, p > 0.05). Moreover, both test results and estimated VO2max equations showed a high test-retest reliability. CONCLUSIONS: Both tests were valid and reliable for evaluating cardiorespiratory fitness in adults aged 18-64 years, regardless of sex, age, and physical activity level.

Mechanical disassembly of single virus particles reveals kinetic intermediates predicted by theory.

New experimental approaches are required to detect the elusive transient intermediates predicted by simulations of virus assembly or disassembly. Here, an atomic force microscope (AFM) was used to mechanically induce partial disassembly of single icosahedral T=1 capsids and virions of the minute virus of mice. The kinetic intermediates formed were imaged by AFM. The results revealed that induced disassembly of single minute-virus-of-mice particles is frequently initiated by loss of one of the 20 equivalent capsomers (trimers of capsid protein subunits) leading to a stable, nearly complete particle that does not readily lose further capsomers. With lower frequency, a fairly stable, three-fourths-complete capsid lacking one pentamer of capsomers and a free, stable pentamer were obtained. The intermediates most frequently identified (capsids missing one capsomer, capsids missing one pentamer of capsomers, and free pentamers of capsomers) had been predicted in theoretical studies of reversible capsid assembly based on thermodynamic-kinetic models, molecular dynamics, or oligomerization energies. We conclude that mechanical manipulation and imaging of simple virus particles by AFM can be used to experimentally identify kinetic intermediates predicted by simulations of assembly or disassembly.

Association Between Mild Neurocognitive Disorder Due to Alzheimer's Disease and Possible Attention-deficit/Hyperactivity Disorder: A Case Report.

Recent literature concerning attention-deficit/hyperactivity disorder (ADHD) underlines the persistence of this neurodevelopmental illness in older patients. Comorbidity with a neurodegenerative disease is thus possible. However, few studies have investigated this topic. To our knowledge, this is the first case report of such a possible association, which raises important questions about clinical presentation, symptoms, diagnosis, and treatment. A 72-year-old man, without any psychiatric history, presented with depression, subjective memory loss, and attention deficit and anxious symptoms, and was diagnosed with mild neurocognitive disorder due to Alzheimer's disease. However, the patient's attentional symptoms appeared to have been present since childhood. A formalized diagnostic interview assessing for ADHD did not allow for a clear diagnosis, possibly due to recall bias. The patient's anxiety symptoms also did not respond well to cognitive behavioral therapy coupled with different antidepressants. We hypothesized the presence of ADHD, with the symptoms balanced until now by the patient's high cognitive capacities, and we postulated that the onset of a neurogenerative process may have disrupted this balance. In this case report, we discuss symptom dimensionality, the interplay between neurodegenerative and neurodevelopmental diseases, and various treatment options. Attentional deficits and anxiety symptoms are frequent in mild neurocognitive disorders due to neurodegenerative illnesses. It is important to explore the time of onset of such symptoms since neurodegenerative processes can worsen neurodevelopmental conditions. Moreover, identification of a pre-existing neurodevelopmental condition can lead to alternative care and treatment options. In addition, the unexplained worsening of ADHD symptoms should prompt clinicians to assess for a neurodegenerative process.

Systematic analysis of biological roles of charged amino acid residues located throughout the structured inner wall of a virus capsid.

Structure-based mutational analysis of viruses is providing many insights into the relationship between structure and biological function of macromolecular complexes. We have systematically investigated the individual biological roles of charged residues located throughout the structured capsid inner wall (outside disordered peptide segments) of a model spherical virus, the minute virus of mice (MVM). The functional effects of point mutations that altered the electrical charge at 16 different positions at the capsid inner wall were analyzed. The results revealed that MVM capsid self-assembly is rather tolerant to point mutations that alter the number and distribution of charged residues at the capsid inner wall. However, mutations that either increased or decreased the number of positive charges around capsid-bound DNA segments reduced the thermal resistance of the virion. Moreover, mutations that either removed or changed the positions of negatively charged carboxylates in rings of acidic residues around capsid pores were deleterious by precluding a capsid conformational transition associated to through-pore translocation events. The results suggest that number, distribution and specific position of electrically charged residues across the inner wall of a spherical virus may have been selected through evolution as a compromise between several different biological requirements.

Amino Acid Side Chains Buried along Intersubunit Interfaces in a Viral Capsid Preserve Low Mechanical Stiffness Associated with Virus Infectivity.

Single-molecule experimental techniques and theoretical approaches reveal that important aspects of virus biology can be understood in biomechanical terms at the nanoscale. A detailed knowledge of the relationship in virus capsids between small structural changes caused by single-point mutations and changes in mechanical properties may provide further physics-based insights into virus function; it may also facilitate the engineering of viral nanoparticles with improved mechanical behavior. Here, we used the minute virus of mice to undertake a systematic experimental study on the contribution to capsid stiffness of amino acid side chains at interprotein interfaces and the specific noncovalent interactions they establish. Selected side chains were individually truncated by introducing point mutations to alanine, and the effects on local and global capsid stiffness were determined using atomic force microscopy. The results revealed that, in the natural virus capsid, multiple, mostly hydrophobic, side chains buried along the interfaces between subunits preserve a comparatively low stiffness of most (S2 and S3) regions. Virtually no point mutation tested substantially reduced stiffness, whereas most mutations increased stiffness of the S2/S3 regions. This stiffening was invariably associated with reduced virus yields during cell infection. The experimental evidence suggests that a comparatively low stiffness at S3/S2 capsid regions may have been biologically selected because it facilitates capsid assembly, increasing infectious virus yields. This study demonstrated also that knowledge of individual amino acid side chains and biological pressures that determine the physical behavior of a protein nanoparticle may be used for engineering its mechanical properties.

Definition of reference ranges for free T4, TSH, and thyroglobulin levels in healthy subjects of the Jaén Health District. / Definición de los rangos de referencia de T4 libre, TSH y tiroglobulina en sujetos sanos del Distrito Sanitario de Jaén.

BACKGROUND AND OBJECTIVES: The treatment guidelines for thyroid dysfunction recommend defining reference ranges for thyroid hormones in each area through assessment of local population data considering the iodine nutritional status. The aim of this study was to define the reference ranges of free thyroxine (FT4), TSH, and thyroglobulin levels in a general population from Jaen, an area of southern Spain with an adequate iodine nutritional status, and whether they were associated with urinary iodine levels. PATIENTS AND METHODS: A cross-sectional study was conducted in 1,003 subjects of the general population of the Jaen Health District. Levels of urinary iodine, FT4, TSH, thyroglobulin, and thyroid peroxidase (TPO) antibodies were measured according to age and sex. RESULTS: Median and mean urinary iodine levels were 110.59µg/L and 130.11µg/L respectively. Median TSH level was 1.83µIU/mL (p2.5=0.56µIU/mL, p97.5=4.66µIU/mL). Median FT4 level was 0.84ng/dL (p2.5=0.62ng/dL, p97.5=1.18ng/dL). TPO antibodies were detected in 5.7% of subjects. There was no correlation between urinary iodine levels and FT4, TSH or TPO antibodies. Subjects with positive TPO antibodies had higher TSH levels (3.34µIU/L versus 2.14µIU/mL, P=.001; odds ratio=2.42). CONCLUSIONS: Urinary iodine levels in Jaen are optimal according to World Health Organization standards. Reference ranges of FT4, TSH, and thyroglobulin do not differ from those reported in the literature and are no associated to urinary iodine levels. The prevalence of positive TPO antibodies was similar to that reported in other Spanish areas.

Quantitatively probing propensity for structural transitions in engineered virus nanoparticles by single-molecule mechanical analysis.

Viruses are increasingly being studied from the perspective of fundamental physics at the nanoscale as biologically evolved nanodevices with many technological applications. In viral particles of the minute virus of mice (MVM), folded segments of the single-stranded DNA genome are bound to the capsid inner wall and act as molecular buttresses that increase locally the mechanical stiffness of the particle. We have explored whether a quantitative linkage exists in MVM particles between their DNA-mediated stiffening and impairment of a heat-induced, virus-inactivating structural change. A series of structurally modified virus particles with disrupted capsid-DNA interactions and/or distorted capsid cavities close to the DNA-binding sites were engineered and characterized, both in classic kinetics assays and by single-molecule mechanical analysis using atomic force microscopy. The rate constant of the virus inactivation reaction was found to decrease exponentially with the increase in elastic constant (stiffness) of the regions closer to DNA-binding sites. The application of transition state theory suggests that the height of the free energy barrier of the virus-inactivating structural transition increases linearly with local mechanical stiffness. From a virological perspective, the results indicate that infectious MVM particles may have acquired the biological advantage of increased survival under thermal stress by evolving architectural elements that rigidify the particle and impair non-productive structural changes. From a nanotechnological perspective, this study provides proof of principle that determination of mechanical stiffness and its manipulation by protein engineering may be applied for quantitatively probing and tuning the conformational dynamics of virus-based and other protein-based nanoassemblies.

Assessment of iodine nutritional status in the general population in the province of Jaén.

BACKGROUND AND OBJECTIVE: Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. MATERIAL AND METHODS: A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. RESULTS: Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52µg/L vs 109.33µg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100µg/L, and 68% of women of childbearing age had levels less than 150µg/L. CONCLUSIONS: Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100µg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO.

Definición de los rangos de referencia de T4 libre, TSH y tiroglobulina en sujetos sanos del Distrito Sanitario de Jaén / Definition of reference ranges for free T4, TSH, and thyroglobulin levels in healthy subjects of the Jaén Health District

Antecedentes y objetivos: Las guías de tratamiento de disfunción tiroidea recomiendan definir los intervalos de referencia de las hormonas tiroideas de cada área mediante la evaluación de datos de población local considerando el grado de nutrición yódica de la misma. El objetivo de este estudio fue definir los rangos de referencia de la tiroxina libre (T4L), TSH y tiroglobulina en población general de Jaén, área con un nivel de nutrición yódica adecuado, y si estos estaban afectados por la yoduria. Material y métodos: Estudio descriptivo transversal realizado en 1.003 sujetos de población general en el Distrito Sanitario de Jaén. El yodo urinario, T4L, TSH, tiroglobulina y los anticuerpos antitiroperoxidasa (anti-TPO) fueron analizados en función de la edad y el sexo. Resultados: La mediana de yoduria fue 110,59μg/l y la media 130,11μg/l. La mediana de TSH fue 1,83μUI/ml (p2,5=0,56μUI/ml, p97,5=4,66μUI/ml). La mediana de T4L fue 0,84ng/dl (p2,5=0,62ng/dl, p97,5=1,18ng/dl). El 5,7% de los sujetos tenían anticuerpos anti-TPO positivos. No existía correlación entre los valores de T4L, TSH ni los anticuerpos anti-TPO con los niveles de yoduria. Los sujetos con anticuerpos anti-TPO positivos tenían una TSH más elevada (3,34μUI/ml frente 2,14μUI/ml; p=0,001; odds ratio=2,42). Conclusiones: El yodo urinario en Jaén está dentro de los valores recomendados por la Organización Mundial de la Salud. Los rangos de referencia de T4L, TSH y tiroglobulina no son diferentes a lo descrito en la literatura y no difieren según la yoduria. La prevalencia de anticuerpos anti-TPO positivos es semejante a la descrita en otras poblaciones de España (AU)

Background and objectives: The treatment guidelines for thyroid dysfunction recommend defining reference ranges for thyroid hormones in each area through assessment of local population data considering the iodine nutritional status. The aim of this study was to define the reference ranges of free thyroxine (FT4), TSH, and thyroglobulin levels in a general population from Jaen, an area of southern Spain with an adequate iodine nutritional status, and whether they were associated with urinary iodine levels. Patients and methods: A cross-sectional study was conducted in 1,003 subjects of the general population of the Jaen Health District. Levels of urinary iodine, FT4, TSH, thyroglobulin, and thyroid peroxidase (TPO) antibodies were measured according to age and sex. Results: Median and mean urinary iodine levels were 110.59μg/L and 130.11μg/L respectively. Median TSH level was 1.83μIU/mL (p2.5=0.56μIU/mL, p97.5=4.66μIU/mL). Median FT4 level was 0.84ng/dL (p2.5=0.62ng/dL, p97.5=1.18ng/dL). TPO antibodies were detected in 5.7% of subjects. There was no correlation between urinary iodine levels and FT4, TSH or TPO antibodies. Subjects with positive TPO antibodies had higher TSH levels (3.34μIU/L versus 2.14μIU/mL, P=.001; odds ratio=2.42). Conclusions: Urinary iodine levels in Jaen are optimal according to World Health Organization standards. Reference ranges of FT4, TSH, and thyroglobulin do not differ from those reported in the literature and are no associated to urinary iodine levels. The prevalence of positive TPO antibodies was similar to that reported in other Spanish areas (AU)

Evaluación del estado de nutrición yódica en población general en la provincia de Jaén / Assessment of iodine nutritional status in the general population in the province of Jaén

ANTECEDENTES Y OBJETIVO: En Jaén se conoce que existe una deficiencia de yodo (DY) de leve a moderada, y que afecta tanto a escolares como a mujeres embarazadas. Se sabe que la DY es una de las causas principales de disfunción tiroidea y bocio, habiéndose establecido que una yodoprofilaxis adecuada en zonas yododeficientes, tanto en forma de sal yodada, leche y sus derivados, o la toma de suplementos yodados, en caso de gestación, conlleva una mejoría significativa de estos problemas. El objetivo de este estudio es evaluar el grado de nutrición yódica en población general en una zona catalogada como yododeficiente y sin que se hayan llevado a cabo, por el momento, campañas institucionales de yodoprofilaxis. MATERIAL Y MÉTODOS: Estudio descriptivo de corte transversal. Se ha realizado determinación de la yoduria en población general en el distrito sanitario de Jaén, separando en grupos según la edad y el género, y se ha encuestado sobre del consumo de sal yodada. RESULTADOS: La mediana de yoduria fue de 110,59 μg/l y la media de 130,11 μg/l. Se encuentran diferencias estadísticamente significativas en los niveles de yoduria en los escolares con respecto al resto de grupos de edad, siendo la media de yoduria en este grupo de 161,52 μg/l vs 109,33 μg/l en los mayores de 65 años. Encontramos que el 43% de la población tiene una yoduria menor de 100 μg/l y que en las mujeres, en el grupo de edad fértil, hay un 66,8% con niveles de yoduria inferior a 150 μg/l. CONCLUSIONES: la situación nutricional de yodo indicaría que se encuentra dentro de lo que se considera una nutrición adecuada, si bien encontramos que el porcentaje de población que presenta yodurias por debajo de 100 μg/l es aún muy elevado, y que la prevalencia del consumo de sal yodada en hogares es del 30,9%, muy por debajo de las recomendaciones de la OMS

BACKGROUND AND OBJECTIVE: Iodine deficiency affecting both pregnant women and schoolchildren has been reported in Jaén. Iodine deficiency is one of the leading causes of thyroid dysfunction and goiter, and adequate iodine prophylaxis with iodized salt, milk, and dairy products, or iodine supplementation have been shown to significantly improve iodine status in pregnancy. The purpose of this study was to assess iodine nutritional status in the general population of a iodine-deficient area with no previous institutional campaigns of iodine prophylaxis. MATERIAL AND METHODS: A descriptive, cross-sectional study. Urinary iodine levels were measured in subjects from the Jaén healthcare district. The data were stratified by sex and age groups, and a survey was conducted on iodized salt consumption. RESULTS: Median and mean urinary iodine levels were 110.59 mcg/L and 130.11 mcg/L respectively. Urinary iodine levels were significantly higher in schoolchildren as compared to other age groups (161.52 μg/L vs 109.33 μg/L in subjects older than 65 years). Forty-three percent of the population had urinary iodine levels less than 100 μg/L, and 68% of women of childbearing age had levels less than 150 μg/L. CONCLUSIONS: Iodine nutritional status appears to be adequate, but the proportion of the population with urinary iodine levels less than 100 μg/L is still very high, and iodized salt consumption is much less common than recommended by the WHO

Riesgo cardiovascular global en una población adulta mayor del área rural, Cantón de Garabito, Puntarenas / Global cardiovascular risk on an elderly population in a rural area in Garabito, Puntarenas, Costa Rica

Objetivo: determinar el riesgo cardiovascular global en las personas adultas mayores que asisten al Centro Diurno de Ancianos Josefina Ugalde, de Quebrada Ganado, Puntarenas. Métodos: estudio de tipo analítico y prospectivo, de una población adulta mayor que asiste al centro diurno. Entre agosto de 2012 y febrero de 2014, se recolectaron los datos demográficos, clínicos, biológicos y de gabinete. Se aplicó la escala de Framingham. Resultados: se estudió 61 personas (67% mujeres), con edad promedio de 75,7 años, sin diferencia estadística por sexo (p=0,199). La prevalencia de factores de riesgo cardiovascular fue: hipertensión arterial 68%; obesidad abdominal 59%; LDL elevado 48%; HDL bajo 39%; diabetes mellitus 37%; tabaquismo 32% y antecedentes cardiovasculares 18%. En los controles a los 12 y 18 meses, solamente demostraron una reducción significativa (p<0,001) en los niveles de LDL elevado (32%) y en el perímetro abdominal (40%). Los otros parámetros no se modificaron. A los 18 meses el riesgo cardiovascular global fue del 14%, distribuido de la siguiente manera: el 21,4% presentó riesgo cardiovascular bajo; el 47,6%, riesgo cardiovascular moderado, y el 31%, riesgo cardiovascular alto. Conclusión: los factores de riesgo cardiovascular clásicos de enfermedad aterosclerótica, son frecuentes y tratados de forma subóptima en la población estudiada, lo que se asocia a un riesgo cardiovascular global elevado.

Purpose: To determine the global cardiovascular risk of an elderly population attending the Josefina Ugalde Day-care Center for the Elderly in Quebrada Ganado, Puntarenas, Costa Rica. Methods: A prospective and analytical study of an elderly population that attends the day-care center. Between August 2012 and February 2014 demographic, clinical, biological and complementary studies were collected. The Framingham scale was used to determine cardiovascular risk. Results: A total of 61 persons were studied (67% female), the mean age of this population was 75.7 years; there was no statistical difference regarding gender (p=0.199). Cardiovascular risk factor prevalence was as follows: hypertension 68%, altered abdominal circumference 59%, elevated LDL cholesterol 48%, low HDL cholesterol 39%, diabetes mellitus 37%, smoking 32% and prior cardiovascular events 18%. Patient follow-up at 12 and 18 months revealed a relevant reduction (p< 0.001) in elevated LDL (32%) and abdominal circumference (40%). All other parameters remained unaltered. After 18 months, global cardiovascular risk was 14%, distributed as follows: 21.4% had low risk; 47.6% had moderate risk and 31% had high risk. Conclusion: The classic risk factors for atherosclerotic disease are frequent and treated in a suboptimal manner in the population studied. This is associated with a high global cardiovascular risk.