Short-term deceleration capacity of heart rate: a sensitive marker of cardiac autonomic dysfunction in idiopathic Parkinson's disease.

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.

Increased markers of cardiac vagal activity in leucine-rich repeat kinase 2-associated Parkinson's disease.

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.

Beyond shallow feelings of complex affect: Non-motor correlates of subjective emotional experience in Parkinson's disease.

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.

Intensive Imaging Surveillance of Survivors of Breast Cancer May Increase Risk of Radiation-induced Malignancy.

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.

Depresión en pacientes con diabetes mellitus y su relación con el control glucémico / Depression in patients with diabetes mellitus and its relationship with the glycemic control

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.

Short-term studies of heart rate variability: comparison of two methods for recording.

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.

Epidemiología del intento suicida en el Hospital Central de Nampula, Mozambique

Intento suicida constituye la mayoría 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 características 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, metodología y motivos, intentos previos, persistencia de la idea suicida, características del intento (impulsivo o no) y diagnóstico psiquiátrico. Resultados: Más de la mitad de los pacientes tenían entre 15 y 24 años de edad, hubo una proporción de 1.3 a 1 de mujeres vs. varones, la mayoría eran estudiantes y soltero(a)s. Conflictos interpersonales motivaron tres de cada cuatro intentos. La ideación suicida persistía en 35,5 % de los pacientes al momento de la entrevista. La mayoría efectuó el intento suicida de manera impulsiva contando con fácil acceso a un raticida de elevada letalidad, y 14,6 % tenía 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 behavior’s 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.

Trastornos depresivos y eventos vitales en pacientes con hipertensión arterial y su relación con la adherencia terapéutica / Depressive disorders and vital events in patients with arterial hypertension and its relationship with therapeutic adherence / Transtornos depressivos e eventos vitais em pacientes com hipertensão arterial e sua relação com a adesão Terapêutica

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.

Trastornos depresivos y eventos vitales en pacientes con hipertensión arterial y su relación con la adherencia terapéutica / Depressive disorders and vital events in patients with arterial hypertension and its relationship with therapeutic adherence

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 por ciento 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 por ciento. 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 por ciento de los hipertensos; los más frecuentes fueron la muerte de familiares queridos, padecer enfermedades físicas y los conflictos interpersonales. El 42,8 por ciento 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(AU)

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 percent of the worlds 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 percent. The most frequent diagnoses were major depressive disorder, dysthymic disorder and adaptive disorders with depressive mood. Current vital events affected 77.9 percent of hypertensive patients; the most frequent were the death of loved relatives, suffering from physical illnesses and interpersonal conflicts. 42.8 percent 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(EU)

Factores psicosociales en pacientes de un servicio de otorrinolaringología / Psychosocial factors in otorhinolaryngology outpatients

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.

Zolpidem arousing effect in persistent vegetative state patients: autonomic, EEG and behavioral assessment.

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.

Sintomatología depresiva en adictos a drogas ilegales / Depressive symptomatology in addicts to illegal drugs

Introducción: el consumo de sustancias es un importante problema de salud pública en el mundo y constituye uno de los grandes azotes de la época actual. Objetivo: identificar la presencia de síntomas depresivos y algunos factores relacionados, en una muestra de adictos venezolanos. Método: estudio descriptivo, transversal de corte con 174 adictos a drogas ilegales que ingresaron en Villa El Yarey. Se estudiaron la edad, sexo, sustancia que consume, antecedentes psiquiátricos familiares, síntomas depresivos actuales y comportamiento suicida. Se utilizaron porcentajes, media aritmética, rangos y como estadística inferencial la prueba de cuadrado para el análisis de los datos. Resultados: predominaron los hombres y el grupo de 25 a 34 años. La frecuencia de síntomas depresivos fue de 26,4 por ciento. La droga que mayormente consumen los adictos es el crack, seguido por heroína y cocaína, los pacientes con síntomas depresivos tienen más familiares de primer grado con alcoholismo y drogadicción que aquellos que no tienen sintomatología depresiva; la tentativa de suicidio anterior única o múltiple y la presencia de idea suicida actual es más frecuente en pacientes con síntomas depresivos. Conclusiones: los síntomas depresivos son frecuentes en adictos, sobre todo en los que consumen drogas depresoras, ellos tienen con frecuencia familiares con adicción y un riesgo suicida elevado(AU)

Introduction: the consumption of substances is an important public health problem in the world and constitutes one of the great scourges of the current era. Objective: to identify the presence of depressive symptoms and some related factors in a sample of Venezuelan addicts. Method: a cross-sectional descriptive study with 174 addicts to illegal drugs who were admitted to Villa El Yarey. We studied the age, sex, substance consumed, family psychiatric history, current depressive symptoms and suicidal behavior. Percentages, arithmetic mean, ranges were used and, as inferential statistics, the chi-squared test for the analysis of the data. Results: men and the group of 25 to 34 years predominated. The frequency of depressive symptoms was 26.4 percent. The drug that most addicts consume is crack, followed by heroin and cocaine, patients with depressive symptoms have more first-degree relatives with alcoholism and drug addiction than those who do not have depressive symptoms; the attempt of previous single or multiple suicides and the presence of current suicidal idea is more frequent in patients with depressive symptoms. Conclusions: depressive symptoms are frequent in addicts, especially in those who consume depressant drugs; they frequently have relatives with addiction and a high suicidal risk(EU)

Los factores psicosociales y la depresión / Psychosocial factors and depression

Introducción: La depresión constituye un serio problema de salud pública y una causa importante de discapacidad en el mundo. Objetivo: Identificar la relación entre la depresión y algunos factores psicosociales. Método: Investigación descriptiva, transversal con 114 pacientes deprimidos y 64 sujetos sanos mentalmente, que acudieron al Hospital Madre Obrera, en Llallagua, Bolivia, entre junio de 2006 y febrero de 2008. Se identificaron algunas variables demográficas y eventos adversos tempranos y actuales que los afectaron. Se utilizó el chi cuadrado y odds ratio para el análisis estadístico. Resultados: La depresión fue más frecuente en mujeres, la media de edad fue de 45,9 años; los factores de riesgo para deprimirse fueron ser analfabeto, estar desempleado, ser ama de casa, estar divorciado o viudo y tener 5 ó más hijos. Los eventos adversos tempranos son más frecuentes en pacientes deprimidos (74,6 por ciento) que en los sanos (53,1 por ciento). Casi la totalidad de los deprimidos (99,1 por ciento) refirió eventos negativos actuales; el promedio de eventos en ellos fue de 4,2 y en los sanos de 1,4. Conclusiones: Las experiencias traumáticas que acontecen en edades tempranas de la vida predisponen a la depresión en la adultez. Las personas deprimidas presentan más eventos vitales negativos actuales y parecen más susceptibles al efecto depresogénico de estos(AU)

Introduction: depression is a serious public health problem and a major cause of disability worldwide. Objective: to identify the relationship between depression and some psychosocial factors. Method: descriptive, transversal research of 114 depressed patients and 64 mentally sound who came to the hospital Madre Obrera, in Llallagua, Bolivia, between June 2006 and February 2008. Some demographic variables and early and current adverse events were identified. Chi square and odds ratio for statistical analysis wereused. Results: depression was more common in women, the mean age was 45.9 years; the risk factors for depression were the illiteracy, unemployment, being a housewife, being divorced or widowed and have 5 or more children. Early adverse events were more common in depressed patients (74.6 percent) than in healthy ones (53.1 percent). Almost all depressed persons (99.1 percent) referred current negative events; the average of events in them was 4.2 and 1.4 in the healthy. Conclusions: traumatic experiences that occur at early ages of life predispose to depression in adulthood. Depressed people have more current vital negative events and seem to be more susceptible to the depressant effect of them(AU)

Factores psicosociales en pacientes con fibromialgia / Psychosocial factors in patients with fibromyalgia

La fibromialgia es una enfermedad frecuente en la práctica médica y la etiología de la misma permanece aún oscura, relacionándose con factores emocionales. Se realizó un estudio transversal con pacientes fibromiálgicos del Centro Médico Ambulatorio del Hospital Carlos M. de Céspedes, con el objetivo de identificar los factores psicosociales que se presentan en ellos. Se estudiaron variables demográficas; presencia de depresión, desesperanza e ideación suicida, percepción del dolor y eventos vitales. Se utilizó el análisis estadístico mediante porcentajes y como estadística inferencial el test Chi Cuadrado. Predominaron las mujeres, con edades entre 35 y 44 años, que tenían un empleo y pareja estable. El 77,3 por ciento tenían depresión y 34,8 por ciento de los deprimidos manifestaron ideación suicida. Más de la mitad de la muestra tenía desesperanza. Las personas con fibromialgia y depresión presentan con más frecuencia dolor exagerado a la presión y mayor número de eventos vitales que los no deprimidos. Se concluye que la depresión tiene una elevada prevalencia en los pacientes fibromiálgicos, al parecer relacionado con mecanismos etiopatogénicos comunes, que hacen pensar que esta entidad es una forma enmascarada de depresión o que la depresión puede ser una reacción adaptativa a la fibromialgia(AU)

Fibromyalgia is a common disease in the medical practice and its etiology remains dark, relating to the emotional factors. It was performed a cross-sectional study in patients with fibromyalgia in the Medical Ambulatory Center at Carlos M. de Céspedes Hospital, with the aim to identify thepsychosocial factors that occur in them. There were studied some demographic variables, like the presence of depression, hope lessness and suicidal ideation, pain perception and vital events. The statistical analysis was used by percentages, and as inferential statistical, it was applied the Chi Square test. There was a prevalence of women about 35 and 44 years old, which had a job and a stable partner. 77.3 percent presented depression and 34.8 percent of the depressed patients expressed suicidal ideation. More than a half of the sample presented hopelessness. People with fibromyalgia and depression more often presented exaggerated pressure pain and a greatest amount of vital events than the non depressed patients. It is concluded that depression is highly prevalent in patients with fibromyalgia, apparently related to common ethiopathogenic mechanisms, which suggested that this entity is a disguised form of depression or that depression may be an adaptive response to fibromyalgia(EU)

Factores de riesgo psicosociales de hipertensión arterial en una comunidad venezolana / Psychosocial risk factors of hypertension in a Venezuelan community

ntroducción: 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 ×2 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(AU)

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(AU)

Factores de riesgo psicosociales de hipertensión arterial en una comunidad venezolana / Psychosocial risk factors of hypertension in a Venezuelan community

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.

Factores psicosociales asociados a la depresión en un grupo de mujeres venezolanas / Psychosocial factors related to depression on a group venezuelan women

Introducción: la depresión es un trastorno común que afecta alrededor de 121 millones de personas en el mundo y su incidencia es mayor en las mujeres. Objetivo: establecer la relación entre los factores psicosociales y la presencia de depresión en un grupo de mujeres.Métodos: se estudiaron 46 mujeres deprimidas y 69 que no tienen trastornos mentales que acudieron a un consultorio comunitario en el Estado Bolívar, Venezuela. Se determinaron las variables demográficas, antecedentes familiares de trastornos psiquiátricos; así como los eventos vitales tempranos y actuales que las afectaron. El análisis estadístico se realizó mediante porcentajes, Odds ratio y el test Chi cuadrado. Para el diagnóstico de depresión se utilizaron los criterios del DSM IV.Resultados: no se encontró asociación significativa entre la presencia de depresión y las variables edad, escolaridad, ocupación, estado conyugal e historia familiar de trastornos psiquiátricos; sin embargo tener familiares con trastornos neuróticos, abuso de drogas y conducta suicida se comportó como un factor de riesgo para deprimirse. Las deprimidas presentaron significativamente más eventos psicotraumatizantes en la niñez que las que no tienen depresión; el más frecuente fue la violencia intrafamiliar. Las mujeres que estuvieron expuestas a uno o varios eventos vitales en los últimos 12 meses tienen 8 veces más riesgo de deprimirse que aquellas que no los experimentan. Los más frecuentes fueron los conflictos con la familia y con la pareja. Conclusiones: la depresión en mujeres está relacionada con experiencias traumáticas que acontecen durante la niñez; ellas presentan más eventos vitales negativos actuales y parecen más susceptibles al efecto depresogénico de estos(AU)

Introduction: depression is a common disorder that has an affect on about 121 millions of persons in the world and its incidence is higher on women.Objective: to establish the relationship between psychosocial factors and the presence of depression on a group of women.Methods: forty-six depressed women and sixty-women without mental disorders that visited a communitarian medical office in the state of Bolívar, Venezuela were studied. Demographic variables, family history of mental disorders as well as present and vital early incidents that have an affect on them were studied. The statistical analysis was carried out by means of percentages, Odds Ratio and Chi test. For the depression diagnostic were used DSM IV criteria. Results: there were no significant findings among depression and the variables age, scholar degree, occupation, marital status, and psychiatric disorder mental history ; nevertheless to have relatives suffering from neurotic disorders, drug abuse and suicidal behavior was consider as a risk factor to suffer from depression. The depressed women had significantly more post traumatic incidents during the childhood than the ones that do not suffer from depression and the most frequent incident was the family violence. Women that were exposed to one or more vital incidents during the last twelve months have eight times more risk to suffer from depression that the women that do not experience them. The most frequent divergences were with the family and the couple. Conclusions: depression on women is related to traumatic experiences that take place during the childhood; these depressed women have more present negative vital incidents and look like to be more susceptible to the depresogenic effect of these incidents(AU)

Depresión: diferencias de género / Depression. Gender differences

La presente revisión aborda algunas teorías existentes en el ámbito científico que tratan de explicar las diferencias de género en la depresión. Se exponen los criterios y hallazgos de diversos investigadores; así como algunas explicaciones y limitaciones de los artículos publicados. Todos los investigadores coinciden en que las tasas de prevalencia son mayores en mujeres, pero no existe consenso para las tasas de recurrencia que parecen ser iguales en ambos sexos. Algunos factores biológicos, fundamentalmente genéticos y hormonales tratan de explicar estas diferencias. Las mujeres están expuestas a mayor cantidad de estresores psicosociales y parecen ser más vulnerables al efecto depresogénico de estos. La respuesta al tratamiento antidepresivo varía para ambos sexos; estudios recientes reportan que los hombres responden mejor a los antidepresivos tricíclicos; mientras las mujeres tienen respuestas más favorables a los inhibidores selectivos de la recaptación de serotonina(AU)

The current review deals with some theories and previous research to illustrate the varied explanations for the gender differences in depression. Therefore, the criteria and findings of several researchers are exposed, as well as some explanations and limitations of the published articles. All investigators think that the rates of prevalence of depression are higher in women, but there are no agreements for the rates of recurrence that seem to be equal in both sexes. Some biological factors, such as hormonal and genetic may contribute to the differences in depression. A greater exposure to stressors has been proposed as being part of the explanation for the female excess in the risk for depression. Women are also more vulnerable to the depressogenic effect of the stressors. The men and women respond differentially to antidepressants. More recent studies have suggested that while men respond better to tricyclic antidepressants, women show a superior response to selective serotonin reuptake inhibitors(EU)

La depresión / Depression

La depresión constituye un serio problema de salud pública y una causa importante de discapacidad en el mundo. Se realizó una revisión bibliográfica sobre algunos aspectos relacionados con la enfermedad. El trastorno es más frecuente en las mujeres con una frecuencia de 2:1 con respecto a los hombres. En su etiología intervienen factores biológicos, genéticos y psicosociales. Para el tratamiento se utilizan diferentes clases de antidepresivos; así como asociaciones terapéuticas con Terapia electroconvulsivante, liotironina, estabilizadores del estado de ánimo y neurolépticos; además diferentes modalidades de psicoterapia donde se destacan la interpersonal y cognitivo-conductual. Otras opciones terapéuticas están actualmente en investigación como son los agonistas de la melatonina, antidepresivos serotoninérgicos, antagonistas de los receptores de taquiquinina y medicamentos que actúan sobre el sistema hipófisis pituitaria adrenal. También opciones no medicamentosas como la estimulación magnética transcraneal y la estimulación del nervio vago. Investigaciones recientes están enfocadas al estudio del factor neurotrófico derivado del cerebro y otros factores relacionados con la neurogénesis en personas adultas, que pudieran contribuir al desarrollo futuro de nuevos medicamentos antidepresivos (AU)

Depression constitutes a serious public health problem and a major cause of disability in the world. It was carried out a review of some aspects related to the disease. The disorder is more common in women with a rate of 2:1 with respect to men. In its etiology are involved biological, genetic and psychosocial factors. For the treatment different classes of antidepressants are used, as well as therapeutic associations with Electroconvulsive Therapy, liothyronine, mood stabilizers and neuroleptics, plus different modalities of psychotherapy standing out interpersonal and cognitive-behavioral ones. Other therapeutic options are currently under investigation such as the melatonin agonists, serotonergic antidepressants, antagonists of tachykinin receptors and medicaments acting on the hypophysis-pituitary-adrenal system. Also non-drug options such as Transcranial Magnetic Stimulation and Vagus nerve stimulation. Recent researches focus the study of the brain-derived neurotrophic factor and other factors related to Adult Neurogenesis, which could contribute to future development of new antidepressant medicaments (AU)