Chronbiologically-based sub-groups in bipolar I disorder: A latent profile analysis.

BACKGROUND: Bipolar disorder presents with significant phenotypic heterogeneity. The aim of this study was to investigate whether bipolar disorder, type I (BDI) subjects could be meaningfully classified into homogeneous groups according to activity, sleep, and circadian characteristics using latent profile analysis (LPA). We hypothesized that distinct BDI sub-groups would be identified based primarily on circadian-associated markers. MATERIALS AND METHODS: 105 individuals with BDI were included in the study. Seventeen activity, sleep, and circadian characteristics were assessed via actigraphy and clinical assessments. LPA was conducted to stratify our sample into homogenous sub-groups. Differences between groups on demographic, clinical, activity, sleep, and circadian characteristics were explored. RESULTS: Two distinct groups were identified, a High Chronobiological Disturbance group (HCD) (56%, N = 59) and a Low Chronobiological Disturbance group (LCD) (41%; N = 46). Circadian variables were the defining characteristics in sub-group determination. Large effect sizes and magnitudes of association were noted in circadian variables between HCD and LCD sub-groups. Several circadian rhythm variables accounted for a large percentage of the variance between HCD and LCD sub-groups. No differences were noted between sub-groups on demographic characteristics and the psychiatric medications currently in use. Mood state did not significantly impact sub-group differences. LIMITATIONS: The protocol was cross-sectional in design. Longitudinal studies are required to determine the stability of the identified sub-groups. CONCLUSION: LPA was able to identify sub-groups in BDI with circadian variables being the most distinguishing factors in determining sub-group class membership. Future research should explore the role that circadian characteristics can play in defining sub-phenotypes of bipolar disorder.

Altered levels of interleukins and neurotrophic growth factors in mood disorders and suicidality: an analysis from periphery to central nervous system.

Interleukins and neurotrophins levels are altered in the periphery of patients with major depression and suicidal behavior, however it is not clear if similar abnormalities occur in the central nervous system. Our objective was to examine the association of IL-6, IL-1ß, BDNF, and GDNF levels between postmortem plasma, cerebrospinal fluid (CSF), and brain tissue in a heterogeneous diagnostic subject groups including normal controls, mood disorders only, mood disorders with AUD/SUD (alcohol abuse disorder, substance abuse disorder), and AUD/SUD without mood disorders. To address these questions we collected postmortem plasma (n = 29), CSF (n = 28), and brain (BA10) (n = 57) samples from individuals with mood disorder, mood disorder with AUD/SUD, AUD/SUD and normal controls. These samples were analyzed using a multiplex based luminex assay with a customized 4-plex cytokine/interleukins- IL-6, IL-1ß, BDNF, and GDNF human acute phase based on xMAP technology platform. Protein levels were determined using a Luminex 200 instrument equipped with Xponent-analyzing software. We observed IL-6 (p = 2.1e-07), and GDNF (p = 0.046) were significantly correlated between brain and CSF. In addition, IL-6 (p = 0.031), were significantly correlated between brain and plasma. Overall diagnostic group analysis showed a significant difference with brain GDNF, p = 0.0106. Pairwise comparisons showed that GDNF level is-39.9 ± 12 pg/ml, p = 0.0106, was significantly higher than in the brains derived from mood disorders compared to normal controls, -23.8 ± 5.5 pg/ml, p = 0.034. Brain BDNF was higher in suicide (p = 0.0023), males compared to females (p = 0.017), and psychiatric medication treated vs. non-treated (p = 0.005) individuals. Overall, we demonstrate that blood IL-6, GDNF and BDNF could be informative peripheral biomarkers of brain biology associated with mood disorders, substance disorders, and suicide.

The association between mood state and chronobiological characteristics in bipolar I disorder: a naturalistic, variable cluster analysis-based study.

BACKGROUND: Multiple types of chronobiological disturbances have been reported in bipolar disorder, including characteristics associated with general activity levels, sleep, and rhythmicity. Previous studies have focused on examining the individual relationships between affective state and chronobiological characteristics. The aim of this study was to conduct a variable cluster analysis in order to ascertain how mood states are associated with chronobiological traits in bipolar I disorder (BDI). We hypothesized that manic symptomatology would be associated with disturbances of rhythm. RESULTS: Variable cluster analysis identified five chronobiological clusters in 105 BDI subjects. Cluster 1, comprising subjective sleep quality was associated with both mania and depression. Cluster 2, which comprised variables describing the degree of rhythmicity, was associated with mania. Significant associations between mood state and cluster analysis-identified chronobiological variables were noted. Disturbances of mood were associated with subjectively assessed sleep disturbances as opposed to objectively determined, actigraphy-based sleep variables. No associations with general activity variables were noted. Relationships between gender and medication classes in use and cluster analysis-identified chronobiological characteristics were noted. Exploratory analyses noted that medication class had a larger impact on these relationships than the number of psychiatric medications in use. CONCLUSIONS: In a BDI sample, variable cluster analysis was able to group related chronobiological variables. The results support our primary hypothesis that mood state, particularly mania, is associated with chronobiological disturbances. Further research is required in order to define these relationships and to determine the directionality of the associations between mood state and chronobiological characteristics.

Experience in the use of non-pneumatic anti-shock garment (NASG) in the management of postpartum haemorrhage with hypovolemic shock in the Fundación Valle Del Lili, Cali, Colombia.

BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.

Doppler de arterias uterinas y preeclampsia: experiencia en el Hospital de San José / Prediction of pre-eclampsia by uterine artery Doppler - San José Hospital

Los cambios en la circulación uteroplacentaria mediante la evaluación de las arterias uterinas con Doppler ha despertado el interés de investigadores, convirtiéndose en el método de elección para el tamizaje de pacientes con alto riesgo de desarrollar preeclampsia. Objetivos: describir los hallazgos del DPau en cuanto a índice de resistencia arterial (IR) e índice de pulsatilidad (IP) en el segundo trimestre de gestación y su asociación con PRE-E y/o restricción del crecimiento intrauterino en una población seleccionada del servicio de ginecología y obstetricia del Hospital de San José en Bogotá, DC. Colombia. Materiales y métodos: asistieron 109 pacientes con edad gestacional de 22 a 25 semanas entre marzo 2004 y diciembre 2007, se indagaron factores de riesgo para PRE-E y se practicó DPau. Se realizó seguimiento en las semanas 28, 32 y 36 hasta obtener información del parto. Resultados: 43 presentaron alteración del Doppler, 15 (13%) se complicaron con PRE-E y 10 (2%) con RCIU. El IR se encontró alterado con mayor frecuencia en PRE-E y el IP en RCIU. Los antecedentes de PRE-E (60%), nuliparidad (33%) e hipertensión crónica (26%) fueron los factores de riesgo observados con mayor frecuencia en pacientes con PRE-E. Conclusiones: los resultados obtenidos nos permiten observar que las alteraciones del DPau junto con los factores de riesgo de la población, podrían tener algún tipo de relación con el desenlace de PRE-E y RCIU. Se esperan futuras investigaciones que ayuden a dilucidar con claridad la asociación del DPau y los factores de riesgo con el desarrollo de eventos obstétricos adversos.

The possibility to study changes in uteroplacental circulation using uterine artery Doppler has awakened researchers' interest, becoming the favorite screening method for women at high risk of pre-eclampsia. Objectives: to describe uterine artery Doppler findings related to artery resistance index (RI) and pulsatility index (PI) in the second trimester of pregnancy and its association with developing pre-eclampsia (PRE-E) and/or intrauterine growth restriction (IUGR) in a selected population at the Obstetrics and Gynecology Department of the San José Hospital in Bogotá, DC. Colombia. Materials and methods: 109 patients with 22 to 25 weeks of gestation, from March 2004 through December 2007, were included, PRE-E risk factors were considered and uterine artery Doppler was performed. Follow-up at 28, 32, and 36 weeks was conducted until delivery. Results: alterations were found in 43 patients, 15 (13%) developed PRE-E and 10 (2%) developed IUGR. Altered RI was more commonly found in PRE-E and altered PI in IUGR. The most frequently associated risk factors in PRE-E patients were previous PRE-E (60%), nulliparity (33%) and chronic hypertension (26%). Conclusions: these results revealed that uterine artery Doppler alterations and antecedents of risk factors in the studied population may have some relation with pre-eclampsia and intrauterine growth restriction outcomes. Further research helping to clarify association of uterine artery Doppler and risk factors of adverse obstetric events is required.