Supplemental progesterone during early pregnancy exerts divergent responses on embryonic characteristics in sows and gilts.

Progesterone (P4) plays a key role in pregnancy establishment and maintenance; during early pregnancy, P4 stimulates the production and release of uterine secretions necessary for conceptus growth prior to implantation; therefore, exogenous P4 supplementation may improve embryo development. This study evaluated the effects of supplementation during early pregnancy with long-acting injectable progesterone or altrenogest on embryonic characteristics of sows and gilts. Thus, a total of 32 sows and 16 gilts were used. On day 6 of pregnancy sows and gilts were allocated to one of the following groups: non-supplemented; supplemented with 20 mg of altrenogest, orally, from days 6 to 12 of pregnancy; supplemented with 2.15 mg/kg of long-acting injectable progesterone on day 6 of pregnancy. Animals were killed on day 28 of pregnancy, and ovulation rate, embryo survival, embryo weight, crown-to-rump length, uterine glandular epithelium and endometrial vascularization were assessed. Treatments had no effect on pregnancy rate, embryo survival or endometrial vascular density (P > 0.05). Non-supplemented gilts presented larger and heavier embryos compared to gilts from supplemented groups (P < 0.05). Sows in the altrenogest group presented larger and heavier embryos compared to non-supplemented sows and sows supplemented with long-acting injectable progesterone. In conclusion, supplementation of sows and gilts with progestagen from day 6 of pregnancy can be used as a means to improve embryo survival without deleterious effects.

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy.

In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case-control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

Immunoexpression of tryptase-positive mast cells in periapical granulomas and radicular cysts.

AIM: To evaluate and compare the immunoexpression of tryptase in samples of periapical granulomas (PGs) and radicular cysts (RCs) correlating it with the type of lesion, localization, intensity of the inflammatory infiltrate and thickness of the cystic epithelial lining, in order to gain insight into the phlogistic role of these cells in the lesions studied. METHODOLOGY: Twenty-five PGs and twenty-five RCs obtained from human teeth without endodontic treatment were submitted to morphological and immunohistochemical analysis using anti-tryptase antibody. Mast cells were identified and counted in three regions: intra-epithelial, central/superficial and deep portions. The data were analysed using the Mann-Whitney U-test (P < 0.05). RESULTS: In comparison with RCs, PGs exhibited higher immunoexpression of tryptase-positive mast cells located in both central/superficial and deep regions (P < 0.001 and P < 0.001, respectively). When considering the total number of mast cells and disregarding the location, the number of tryptase-positive mast cells increased gradually from RCs to PGs (P < 0.001). Lesions with inflammatory infiltrate grade III had greater number of tryptase-positive mast cells located in both central/superficial and deep regions than lesions with inflammatory infiltrates grade II (P = 0.045 and P = 0.025). When the location was ignored, the lesions with inflammatory infiltrate grade III also exhibited higher immunostaining of tryptase-positive mast cells (P = 0.01). CONCLUSIONS: Tryptase-positive mast cells were present in chronic periapical lesions in a larger number in periapical granulomas than in radicular cysts, in both central/superficial and deep regions.

Proteomic analysis of Porphyromonas gingivalis exposed to nicotine and cotinine.

BACKGROUND AND OBJECTIVE: Smokers are more predisposed than nonsmokers to infection with Porphyromonas gingivalis, one of the most important pathogens involved in the onset and development of periodontitis. It has also been observed that tobacco, and tobacco derivatives such as nicotine and cotinine, can induce modifications to P. gingivalis virulence. However, the effect of the major compounds derived from cigarettes on expression of protein by P. gingivalis is poorly understood. Therefore, this study aimed to evaluate and compare the effects of nicotine and cotinine on the P. gingivalis proteomic profile. MATERIAL AND METHODS: Total proteins of P. gingivalis exposed to nicotine and cotinine were extracted and separated by two-dimensional electrophoresis. Proteins differentially expressed were successfully identified through liquid chromatography-mass spectrometry and primary sequence databases using MASCOT search engine, and gene ontology was carried out using DAVID tools. RESULTS: Of the approximately 410 protein spots that were reproducibly detected on each gel, 23 were differentially expressed in at least one of the treatments. A particular increase was seen in proteins involved in metabolism, virulence and acquisition of peptides, protein synthesis and folding, transcription and oxidative stress. Few proteins showed significant decreases in expression; those that did are involved in cell envelope biosynthesis and proteolysis and also in metabolism. CONCLUSION: Our results characterized the changes in the proteome of P. gingivalis following exposure to nicotine and cotinine, suggesting that these substances may modulate, with minor changes, protein expression. The present study is, in part, a step toward understanding the potential smoke-pathogen interaction that may occur in smokers with periodontitis.

Effects of discontinuous Percoll gradient centrifugation on the quality of bovine spermatozoa evaluated with computer-assisted semen analysis and fluorescent probes association.

The objective of this study was to evaluate the quality of bovine frozen-thawed sperm cells after Percoll gradient centrifugation. Frozen semen doses were obtained from six bulls of different breeds, including three taurine and three Zebu animals. Four ejaculates per bull were evaluated before and after discontinuous Percoll gradient centrifugation. Sperm motility was assessed by computer-assisted semen analysis and the integrity of the plasma and acrosomal membranes, as well as mitochondrial function, were evaluated using a combination of fluorescent probes propidium iodide, fluorescein isothiocyanate-conjugated Pisum sativum agglutinin and 5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolcarbocyanine iodide. The procedure of Percoll gradient centrifugation increased the percentage of total and progressive sperm motility, beat frequency, rectilinear motility, linearity and rapidly moving cells. In addition, the percentage of cells with intact plasma membrane and mitochondrial membrane potential was increased in post-centrifugation samples. However, the percentage of sperm cells with intact acrosomal membrane was markedly reduced. The method used selected the motile cells with intact plasma membrane and higher mitochondrial functionality in frozen-thawed bull semen, but processing, centrifugation and/or the Percoll medium caused damage to the acrosomal membrane.

A brain-specific isoform of mitochondrial apoptosis-inducing factor: AIF2.

Apoptosis-inducing factor (AIF) has important supportive as well as potentially lethal roles in neurons. Under normal physiological conditions, AIF is a vital redox-active mitochondrial enzyme, whereas in pathological situations, it translocates from mitochondria to the nuclei of injured neurons and mediates apoptotic chromatin condensation and cell death. In this study, we reveal the existence of a brain-specific isoform of AIF, AIF2, whose expression increases as neuronal precursor cells differentiate. AIF2 arises from the utilization of the alternative exon 2b, yet uses the same remaining 15 exons as the ubiquitous AIF1 isoform. AIF1 and AIF2 are similarly imported to mitochondria in which they anchor to the inner membrane facing the intermembrane space. However, the mitochondrial inner membrane sorting signal encoded in the exon 2b of AIF2 is more hydrophobic than that of AIF1, indicating a stronger membrane anchorage of AIF2 than AIF1. AIF2 is more difficult to be desorbed from mitochondria than AIF1 on exposure to non-ionic detergents or basic pH. Furthermore, AIF2 dimerizes with AIF1, thereby preventing its release from mitochondria. Conversely, it is conceivable that a neuron-specific AIF isoform, AIF2, may have been 'designed' to be retained in mitochondria and to minimize its potential neurotoxic activity.

Aligning Physical Therapy practice with Brazil's leading Health priorities: a "call to action" in the 21st century: [review] / Direcionando a prática da Fisioterapia com as principais prioridades de Saúde no Brasil: uma "chamada para ação" no século XXI: [revisão]

INTRODUCTION: This article serves as a "call to action" for physical therapists in the 21st century with special attention to the needs of Brazilians. Compared with evidence-based practice supporting the use of specific interventions, practice that is informed by contemporary societal and Health priorities has seriously lagged behind over recent decades. "The First Physical Therapy Summit on Global Health" held at the 2007 World Congress of the World Confederation of Physical Therapy (WCPT) in Canada highlighted the discrepancy between current practice trends globally and contemporary definitions of Physical Therapy (that subsume words such as health, well-being, quality of life, health promotion and prevention); the leading Health priorities within the WCPT regions; the proportions of physical therapists practicing in these priority areas; and the proportions of entry-level Physical Therapy professional education devoted to them. In the 20th century, the profession strived to align itself with societal needs, for example the world wars and poliomyelitis epidemics. Over the past 50 years, lifestyle conditions including ischemic heart disease, smoking-related conditions, hypertension, stroke, obesity, diabetes and cancer have predominated. Despite a remarkable shift from communicable diseases to non-communicable conditions over the past century, the profile of lifestyle conditions within professional practice and education remains low and disproportional to need. This is particularly striking given the unequivocal data in the literature that supports the cost-benefit relationship of noninvasive interventions (primarily Health education and exercise) over the short and long-term, with regard to their prevention, "cure" and management. Often the outcomes from these simple inexpensive interventions for lifestyle conditions are superior to drugs and surgery, which are largely used to mitigate signs and symptoms rather than to address underlying...

INTRODUÇÃO: O presente artigo é uma "chamada para ação" aos fisioterapeutas no século XXI, com especial atenção às necessidades dos brasileiros. Em comparação com a prática baseada em evidências, com o apoio do uso de determinadas intervenções, a prática em uso pela sociedade contemporânea considerando as prioridades de Saúde se mostra atrasada nas últimas décadas. "O Primeiro Encontro de Fisioterapia em Saúde Global", realizado no Congresso Mundial da Confederação Mundial de Fisioterapia (WCPT), em 2007, no Canadá, enfatizou a discrepância entre as tendências globais da prática atual e as definições contemporâneas da fisioterapia (que agrupa palavras como saúde, bem estar, qualidade de vida, promoção de saúde e prevenção); as principais prioridades de Saúde nas regiões do WCPT; a proporção de fisioterapeutas trabalhando nestas áreas de prioridade e a proporção de cursos de graduação profissional dedicados a tais áreas. No século XX, a profissão visava alinhamento com as necessidades sociais, como por exemplo, as guerras mundiais e a epidemia de poliomielite. Nos últimos 50 anos, predominaram as condições relacionadas ao estilo de vida, incluindo doença cardíaca isquêmica, doenças relacionadas ao fumo, hipertensão, acidente vascular cerebral, obesidade, diabetes e câncer. Apesar da marcante mudança de padrão de doenças contagiosas para doenças não contagiosas no último século, a inclusão do perfil das condições de estilo de vida na prática profissional permanece baixo e desproporcional à real necessidade. Isto é particularmente notável quando os dados inequívocos da literatura são considerados, apoiando a relação custo-benefício das intervenções não invasivas (principalmente educação em Saúde e exercícios) tanto em curto quanto em longo-prazo, considerando a prevenção, "cura" e cuidados. Freqüentemente, os desfechos destas intervenções simples e baratas no estilo de vida são superiores aos medicamentos e às cirurgias, que são amplamente...

Practical techniques for bovine sperm simultaneous fluorimetric assessment of plasma, acrosomal and mitochondrial membranes.

This experiment was performed to develop and validate practical techniques for simultaneous evaluation of the integrity of plasma and acrosomal membranes, as well as mitochondrial function in bovine spermatozoa using associations of fluorescent probes. Four protocols of fluorescent probes association were defined: protocol 1: propidium iodide (PI), fluorescein isothiocyanate-conjugated Pisum sativum agglutinin (FITC-PSA) and rhodamine 123; protocol 2: PI, FITC-PSA and MitoTracker Green FM (MITO); protocol 3: PI, Hoechst 33342 (H342), FITC-PSA and CMXRos; and protocol 4: PI, H342, FITC-PSA and JC-1. Three ejaculates from each of the four bulls (n = 12) were utilized, showing sperm motility >/=80% and abnormal morphology

Fluorescent stain method for the simultaneous determination of mitochondrial potential and integrity of plasma and acrosomal membranes in boar sperm.

The purpose of this study was to validate a technique for simultaneous evaluation of the plasma, acrosomal and mitochondrial membranes in boar spermatozoa, using an association of fluorescent probes: Propidium iodide (PI), fluorescein isothiocyanate-conjugated Pisum sativum agglutinin (FITC-PSA) and JC-1. Three ejaculates from each of four different boars, all showing motility >or=80% and abnormal morphology

Estudo comparativo entre os sistemas de umidificação aquoso aquecido e trocador de calor e de umidade na via aérea artificial de pacientes em ventilação mecânica invasiva / Comparative study between heated water humidifiers and hygroscopic heat and moisture exchangers in artificial airways for patients undergoing invasive mechanical ventilation

CONTEXTO: Nos pacientes recebendo suporte ventilatório invasivo através de tubos endotraqueais é essencial o uso de umidificadores. OBJETIVO: avaliar os níveis de temperatura (TºC) e de umidade relativa (UR) do gás administrado ao paciente em ventilação mecânica através da umidificação aquosa aquecida (UAA) e do filtro trocador de calor e de umidade (FTCU). MÉTODO: Este foi um estudo prospectivo, randomizado, onde foram estudados 20 pacientes divididos em dois grupos: um grupo usou a UAA (n=10) e o outro grupo (n=10) usou FTCU Hygrobac "S", marca Mallinckrodt®. As variáveis analisadas foram: níveis de temperatura (T) e umidade relativa (UR) do gás, volume minuto (VM), volume corrente (VC) e volume de condensação. RESULTADOS: Verificou-se que o sistema de umidificação aquosa aquecida atingiu temperaturas mais baixas que o filtro trocador (29,01 ± 1,33 ºC, versus 30,14 ± 1,24 ºC; p<0,001). A umidade relativa foi maior na UAA do que no FTCU (97,45 ± 5,22 por cento, versus 89,87 ± 11.04 por cento, p < 0,021). O volume de condensação do circuito do grupo usando UAA foi maior que o do grupo usando o FTCU (p < 0,05). CONCLUSÃO: Os resultados demonstram que ambos os sistemas, UAA e o FTCU forneceram umidades absolutas abaixo do valor recomendado, sendo que o sistema de UAA ofereceu uma umidade relativa maior, enquanto que o aquecimento do gás com o FTCU obteve um melhor desempenho.

BACKGROUND: In patients receiving invasive mechanical ventilation through endotracheal tubes, the use of humidifiers is essential. OBJECTIVE: To evaluate temperature and relative humidity levels in the gas administered to patients undergoing mechanical ventilation by means of heated water humidifiers (HWH) and hygroscopic heat and moisture exchangers (HHME). METHOD: This was a prospective randomized study on 20 patients divided into two groups: one group using HWH (n=10) and the other using the Hygrobac "S" model of HHME, made by Mallinckrodt® (n=10). The variables analyzed were: temperature and relative humidity levels of the gas, minute volume (MV), tidal volume (V T) and condensation volume. RESULTS: It was found that HWH attained lower temperatures than did HHME (29.01 ± 1.33 ºC versus 30.14 ± 1.24 ºC; p<0.001). The relative humidity was higher in HWH than in HHME (97.45 ± 5.22 percent versus 89.87 ± 11.04 percent; p<0.021). The condensation volume in the ventilator circuit for the group using HWH was greater than for the HHME group (p<0.05). CONCLUSION: The results demonstrate that both systems (HWH and HHME) supplied absolute humidity that was below recommended values, while the HWH offered higher relative humidity. On the other hand, HHME produced better performance regarding gas heating.

Avaliação da qualidade de vida pos-cirurgia cardiaca na fase I da reabilitação atraves do questionario MOS SF-36 / Quality of life assessment following heart surgery, during phase I reabilitation, Through MOS SF-36 questionnarie

O questionario de qualidade de vida Medical Outcome Study Short From -36 (MOS SF-36) permite monitorar condicao de saude antes e apos o tratamento instituido, sendo sencivel a melhora clinica. O objetivo desse estudo foi avaliar a qualidade de vida de pacientes submetidos a cirurgia de revascularizacao do mocardio e que participaram de um programa de reabilitacao cardiaca, atraves da aplicacao do questionario MOS SF-36. Metodologia: foram incluidos nesse estudo 24 individuos de ambos os sexos (15 homens e 9 mulheres) na faixa etaria entre 23 e 77 anos (idade media 58+-6 anos) submetidos a cirurgia de revascularizacao do miocardio, com quadro clinico estavel e que participem de uma programa de reabilitacao cardiaca fase I. O questionario foi aplicado em tres momentos antes, no 5º dia do pos-operatorio e 2 meses apos a cirurgia. Para analise estatistica foi utilizado o teste de wilcoxon para amostras pareadas. Resultados Observou-se queda dos seguintes parametros Funcionamento do Organismo (p=0,000), Limitacao por Disturbios fisicos (p=0,002), vitalidade (p=0,003) e dor (p=0,000) apos a cirurgia, havenso recuperacao significativa 2 meses apos (p=0,008, p=0,000,p=0,000 e p=0,000 respectivamente).Este estudo sugere que o questionario MOS SF-36 permite avaliar os beneficios da reabilitacao cardiaca fase I a qual propocionou autoconfianca e retorno as atividades diarias

Avaliação da forca muscular respiratoria no terceiro trimestre de gestação / Respiratory muscle force assessment in the final three months of pregnancy

Durante a gravidez, o sistema respiratorio sofre adaptacoes importantes que sao responsaveis pelas alteracoes nos volumes a nas capacidades pulmonares. Acredita-se que, com o crescimento uterino, as modificacoes na posicao de repouso do diafragama e na configuracao da parede toracica interfiram na forca dos musculos respiratorios inspiratorios e expiratorios. Objetivo: este estudo visa a correlacionar os valores de volume corrente, volume minuto e a presenca de dispneia pos-esforco com a pressao inspiratoria maxima (PImax) e correlacionar a diastase dos musculos retos abdominais (DMRA) com a pressao expiratoria maxima (PEmax) durante o terceiro trimestre de gestacao. Metodo: foram estudadas 10 mulheres primiparas entre a 28ª e a 38ª semana de gestacao, com faixa etaria de 16 a 35 anos, indice de massa corporea abaixo de 40 kg/m2 e sem historico de doenca pulmonar. Conclusao: este estudo mostrou que as mudancas fisiologicas ocorridas no sistema respiratorio durante o terceiro trimestre de gestacao nao ocasionaram alteracoes nos mecanismos das forcas musculares inspiratorias e expiratoria. O estudo nao encontrou correlacoes significativas entre as variaveis estudadas

Guidelines for neurosurgical trauma in Brazil.

This chapter emphasizes some aspects of the Brazilian Guidelines for the Assessment of Head Injury Patients, written based on the experience of the Emergency Service, Neurosurgical Division of the University of São Paulo Medical School Hospital, and sponsored by the Brazilian Society of Neurosurgery. These guidelines approach the management of head-injury patients from their initial assessment in the Emergency Room until the final suggested clinical or surgical management. The Brazilian Guidelines represents our efforts to provide the basis for a common unified data collection system, which may allow cooperative studies in the future.

Use of DNA-based diagnostic methods for human leishmaniasis in Minas Gerais, Brazil.

DNA hybridisation was used to type 26 samples from lesions of human patients from the Rio Doce Valley (Minas Gerais, Brazil) clinically diagnosed as having cutaneous leishmaniasis, using kinetoplast DNA (kDNA) cloned mini-circle probes specific for the Leishmania mexicana and Leishmania braziliensis complexes. All samples were found to belong to the L. braziliensis complex. When biopsies were pressed directly onto touch blot membranes 38.5% of the samples were positive. The positivity and specificity obtained were both 100% when cultured blotted parasites were used. The results were confirmed by polymerase chain reaction (PCR) analysis using primers specific for the L. mexicana and L. braziliensis complexes.

Spontaneous migration of a bullet in the cerebellum--case report.

A 15-year-old boy presented with a gunshot wound in the left cerebellar hemisphere. He was confused and left cerebellar signs were noted. The patient underwent the first surgery for debridement of the entry wound in the left parietal region and second surgery to remove the bullet. However, the bullet could not be located via a left unilateral suboccipital craniectomy in the park bench position, because it had migrated to the opposite side due to the effects of gravity in just a few hours. Skull radiography obtained just before the third surgery showed that the bullet had returned to the left side, and it was removed easily via the previous craniectomy in the sitting position. The clinical course suggests that in removing a bullet, skull radiography or computed tomography should be obtained just before surgery, or even intraoperatively, and that those findings should be the basis for the surgical procedure and operative position.

Spontaneous epidural hematoma following a shunt in an infant with congenital factor X deficiency. Case report and literature review.

The authors describe a case of an infant with congenital factor X deficiency. The patient presented with a central nervous system hemorrhage followed by hydrocephalus. He underwent a ventriculoperitoneal shunt and, during the postoperative period, developed a spontaneous epidural hematoma, which was evacuated. The clinical and pathophysiological aspects of this case are discussed based on a literature review.

Use of the inhalant lança by Brazilian medical students.

In a recent epidemiological survey of more than 700 Brazilian medical students, we found new evidence on a previously reported pattern of the "lança perfume" inhalant drug use. With multiple logistic regression used to hold constant an array of suspected correlates, we found a moderately strong association between the use of marijuana and the use of lança (adjusted odds ratio, OR = 5.6; p < .01). We also found that lança is almost never used by students who have never consumed alcoholic beverages. This pattern of associations can be used to guide the planning of programs to reduce the occurrence of illicit use of pharmaceutical compounds by medical students in Brazil.

The effect of respiration on the performance of the total artificial heart.

An electromechanical driven pusher plate type total artificial heart (TAH) has been developed in the Department of Surgery at Baylor College of Medicine. The control of this TAH is based upon Frank-Starling's law, and the output is likely to be affected by the respiration cycle. The necessity of an averaging system for the pumping to avoid this drifting of the output has been discussed in several papers. In this study, the effect of respiration on the performance of the TAH was evaluated in both in vitro and in vivo conditions. This TAH was driven without an averaging system in its control system. The results indicated that the mean output pressure was stable with minute changes in both the heart rate and outflow. This verifies that the electromechanical driven pusher plate type TAH, which is under development in our laboratory, compensated for the effect of respiration without an averaging system.

Immunoperoxidase for the detection of antibodies in cerebrospinal fluid in neurocysticercosis: use of Cysticercus cellulosae and Cysticercus longicollis particles fixed on microscopy slides.

The ORF strain of Cysticercus longicollis represents an important model for the study of heterologous antigens in the immunodiagnosis of neurocysticcreosis (NC). The immunoperoxidase (IP) technique was standardized using a particulate antigen suspension of Cysticercus longicollis (Cl) and Cysitcercus cellulosae (Cc). Cerebrospinal fluid (CSF) samples were incubated on the antigen fixed to microscopy slides; the conjugate employed was anti-IgG-peroxidase and the enzymatic reaction was started by covering the slides with chromogen solution (diaminobenzidine/H2O2). After washing with distilled water, the slide was stained with 2% malachite green in water. Of the CSF samples from 21 patients with NC, 19 (90.5%) were positive, whereas the 8 CSF samples from the control group (100%) were negative. The results of the [P-C] test applied to 127 CSF samples from patients with suspected NC showed 28.3% reactivity as opposed to 29.1% for the IP-Cc test. The agreement index for the IP test (Cl x Cc) was 94.2%, with no significant difference between the two antigens.

Respuestas multihormonales a una serie de pruebas neuroendocrinas en psiquiatría: una aproximación multivariada / Multihormonal responses to a series of neuroendocrine challenges in psychiatry: a multivariate approach

Mediante una batería neuroendocrina que incluye la prueba de supresión por dexamotasona, la prueba de estimulación con TRH y respuestas hormonales a apomorfina (PRL, GU, ACTH y cortisol) se estudian 86 pacientes hospitalizados, sin medicación, con los diagnósticos según DSM-IV con Depresión Mayor, esquizofrenia y trastorno esquizoafectivo y 18 controles. Se establecen las diferencias hormonales de los diversos grupos clínicos mediante el análisis factorial de correspondencia, lo que permite formular las posibles procesos fisiopatológicos subyacentes y la identificación de terapias farmacológicas apropiadas. Los resultados sugieren una disregulación cronobiológica del eje hipotálamo-hipófisis-tiroides en la depresión y una disregulación dopaminérgica en presencia de síntomas psicóticos productivos