Risk factors for mild depression in older women with overactive bladder syndrome-A cross sectional study.

BACKGROUND: Studies demonstrate an association between severe depression and overactive bladder syndrome (OAB). However, mild depression is constantly overlooked. The aim of this study was to evaluate the clinical and sociodemographic factors associated with mild depression in women with OAB. METHODS: Cross-sectional study involving 241 women over 60 years old in Brasilia, Brazil. All patients were subjected to an interview followed by questionnaires and physical examination. The clinical and sociodemographic variables analyzed were age, body mass index, physical activity level, OAB symptoms, presence of gynecological surgery, fecal incontinence, systemic arterial hypertension, Diabetes Mellitus, anxiety (Beck Anxiety Scale). The Geriatric Depression Scale-15 (GDS-15) was used to identify depression. Univariate logistic regression was used to assess the correlation between mild depression and the variables chosen. Variables with a p-value less than 0.2 were included in the multivariate logistic regression analysis. The level of confidence was set at 95%. RESULTS: 121 volunteers suffered from mild depression. The multivariate analysis demonstrated that gynecological surgery (p < .001) and anxiety (p < .001) are factors associated with mild depression. Older women with a history of gynecological surgery and a GDS-15 score of 2.04 were 1.08 times more likely to develop mild depression compared to older women with no history of gynecological surgery. CONCLUSION: Anxiety and a history of gynecological surgery are factors that need to be taken into account and may influence the development of mild depression in older women with OAB. Psychological treatment should be considered an important adjunct in the treatment of women with symptoms of Overactive Bladder Syndrome.

Neuromuscular electrical stimulation combined with exercise decreases duration of mechanical ventilation in ICU patients: A randomized controlled trial.

BACKGROUND: Early mobilization can be employed to minimize the duration of intensive care. However, a protocol combining neuromuscular electrical stimulation (NMES) with early mobilization has not yet been tested in ICU patients. Our aim was to assess the efficacy of NMES, exercise (EX), and combined therapy (NMES + EX) on duration of mechanical ventilation (MV) in critically ill patients. METHODS: The participants in this randomized double-blind trial were prospectively recruited within 24 hours following admission to the intensive care unit of a tertiary hospital. Eligible patients had 18 years of age or older; MV for less than 72 hours; and no known neuromuscular disease. Computer-generated permuted block randomization was used to assign patients to NMES, EX, NMES + EX, or standard care (control group). The main endpoint was duration of MV. Clinical characteristics were also evaluated and intention to treat analysis was employed. RESULTS: One hundred forty-four patients were assessed for eligibility to participate in the trial, 51 of whom were enrolled and randomly allocated into four groups: 11 patients in the NMES group, 13 in the EX group, 12 in the NMES + EX group, and 15 in the control group (CG). Duration of MV (days) was significantly shorter in the combined therapy (5.7 ± 1.1) and NMEN (9.0 ± 7.0) groups in comparison to CG (14.8 ± 5.4). CONCLUSIONS: NMES + EX consisting of NMES and active EXs was well tolerated and resulted in shorter duration of MV in comparison to standard care or isolated therapy (NMES or EX alone).

Maximal Inspiratory Pressure: Does the Choice of Reference Values Actually Matter?

BACKGROUND: Single-point measurements of maximal inspiratory pressure (MIP) are frequently used to suggest muscle weakness in clinical practice. Although there is a large variability in "mean" predicted MIP depending on the chosen reference values, it remains unclear whether those discrepancies actually impact on the prevalence of weakness, that is, MIP below the lower limit of normal. METHODS: A total of 1,729 subjects (50.1% men, aged 20 to 94 years) who underwent MIP measurements in a clinical laboratory comprised the study group. MIP was predicted according to the most frequently cited regression equations as of August 2015. Pretest probability of weakness was defined by a cluster of clinical and physiologic variables. RESULTS: Prevalence of weakness ranged from 33.4 to 66.9%. Set 2 equations agreed well in indicating weakness (κ [95% CI] ranging from 0.81 [0.79-0.83] to 0.83 [0.81-0.85]; P < .01). There was closer agreement between higher pretest probability of weakness and low MIP according to set 2 equations compared with set 1 equations. Thus, a significant fraction of subjects with abnormal MIP according to set 1 equations but preserved MIP according to set 2 equations had higher pretest probability of weakness (P < .05). CONCLUSIONS: The choice of MIP reference values strongly impacts on the prevalence of weakness. Some specific equations relate better to clinical and physiologic indicators of weakness, suggesting that they might be particularly useful to screen subjects for advanced respiratory neuromuscular assessment.

Oral N-acetylcysteine and exercise tolerance in mild chronic obstructive pulmonary disease.

Heightened oxidative stress is implicated in the progressive impairment of skeletal muscle vascular and mitochondrial function in chronic obstructive pulmonary disease (COPD). Whether accumulation of reactive oxygen species contributes to exercise intolerance in the early stages of COPD is unknown. The purpose of the present study was to determine the effects of oral antioxidant treatment with N-acetylcysteine (NAC) on respiratory, cardiovascular, and locomotor muscle function and exercise tolerance in patients with mild COPD. Thirteen patients [forced expiratory volume in 1 s (FEV1)-to-forced vital capacity ratio < lower limit of normal (LLN) and FEV1 ≥ LLN) were enrolled in a double-blind, randomized crossover study to receive NAC (1,800 mg/day) or placebo for 4 days. Severe-intensity constant-load exercise tests were performed with noninvasive measurements of central hemodynamics (stroke volume, heart rate, and cardiac output via impedance cardiography), arterial blood pressure, pulmonary ventilation and gas exchange, quadriceps muscle oxygenation (near-infrared spectroscopy), and estimated capillary blood flow. Nine patients completed the study with no major adverse clinical effects. Although NAC elevated plasma glutathione by ~27% compared with placebo (P < 0.05), there were no differences in exercise tolerance (placebo: 325 ± 47 s, NAC: 336 ± 51 s), central hemodynamics, arterial blood pressure, pulmonary ventilation or gas exchange, locomotor muscle oxygenation, or capillary blood flow from rest to exercise between conditions (P > 0.05 for all). In conclusion, modulation of plasma redox status with oral NAC treatment was not translated into beneficial effects on central or peripheral components of the oxygen transport pathway, thereby failing to improve exercise tolerance in nonhypoxemic patients with mild COPD.NEW & NOTEWORTHY Acute antioxidant treatment with N-acetylcysteine (NAC) elevated plasma glutathione but did not modulate central or peripheral components of the O2 transport pathway, thereby failing to improve exercise tolerance in patients with mild chronic obstructive pulmonary disease (COPD).

Effect of transcutaneous electrical nerve stimulation on peripheral to central blood pressure ratio in healthy subjects.

PURPOSE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on the arterial stiffness in healthy young adult and middle-aged men using the augmentation index (AI-x) and hemodynamic measures. METHODS: Twenty-four men (12 aged 27·25 ± 5·53 years and 12 aged 54·83 ± 5·10 years) were randomly allocated to two subgroups: TENS or placebo in ganglion region for 45 min. The AI-x and hemodynamic measures [late systolic blood pressure (SBP), central blood pressure (CBP), difference between P1 and P2 (ΔP) and tension time index (TTI)] were determined before and after protocols. RESULTS: TENS resulted in reduction of SBP in younger adults (TENSpre: 111 ± 2; post: 105 ± 2·2 mm Hg; PLACEBOpre: 113 ± 1·8; post: 114 ± 2·5 mm Hg; GEE, P<0·01), whereas no difference was found in middle-aged group. TENS also resulted in reduction of AI-x younger adults group (TENSpre: 56 ± 2·8; post: 53 ± 2%; PLACEBOpre: 55 ± 3; post: 58 ± 2·5%; GEE, P<0·01). ΔP and TTI were significantly decreased after the application of TENS in both groups, but significantly greater reductions in TTI and the SBP/CBP ratio were found in the group of younger adults. CONCLUSIONS: The acute application of ganglion TENS attenuated arterial stiffness in younger adults as well as hemodynamic measures in the middle-aged group. This method could emerge as effective therapy for the management of arterial blood pressure.