Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy.

BACKGROUND: Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS: Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS: A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION: The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.

Clinical Validation of the Comprehensive Complication Index as a Measure of Postoperative Morbidity at a Surgical Department: A Prospective Study.

OBJECTIVE: Using clinical outcomes, to validate the comprehensive complication index (CCI) as a measure of postoperative morbidity in all patients undergoing surgery at a general surgery department. BACKGROUND: The Clavien-Dindo classification (CDC) is the most widely used system to assess postoperative morbidity. The CCI is a numerical scale based on the CDC. Once validated, it could be used universally to establish and compare the real postoperative complications of each surgical procedure. METHODS: Observational prospective cohort study. All patients who underwent surgery during the 1-year study period were included. All the complications graded with the CDC and related to the initial admission, or until discharge if the patient was readmitted within 90 days of surgery, were included. Surgical procedures were classified according to the operative severity score (OSS) as minor, moderate, major, or major+. The clinical validation of the CCI was performed by assessing its correlation with 4 different clinical outcomes. RESULTS: A total of 1850 patients were included: 513 (27.7%) presented complications and 101 (5.46%) were readmitted. In the multivariate analysis, the CCI and CDC were associated with postoperative stay, prolongation of postoperative stay, readmission, and disability in all OSS groups (P < 0.001). The CCI was superior to the CDC in all models except for prolongation of stay for OSS moderate and major+. CONCLUSIONS: The CCI can be applied in all the procedures carried out at general surgery departments. It is able to determine the morbidity and allows the comparison of the outcomes at different services.

Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review.

INTRODUCTION: Surgery for primary hyperparathyroidism (PHPT) is traditionally deemed to be successful if serum calcium levels return to normal 6 months after parathyroidectomy. Regular monitoring of serum calcium and parathyroid hormone (PTH) in the follow-up of patients after parathyroidectomy for PHPT has drawn attention to the presence of a normocalcemic group of patients with elevated PTH (NCePTH) during the post-operative period. The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study. MATERIALS AND METHODS: We conducted an unlimited PubMed search updated on March 31, 2017, which yielded 1628 results. We selected 37 articles, 33 of which included cases of NCePTH in their series and 23 performed statistical studies to assess factors associated with NCePTH. RESULTS: The maximum mean prevalence of NCePTH in the various series was 23.5%, ranging from 3 to 46%. Many factors were associated with NCePTH. The most important were higher pre-operative PTH, low pre-operative 25 (OH) D3, lower pre-operative creatinine clearance and greater adenoma weight. The origin of NCePTH may be multifactorial, since several factors were implicated in the etiology. NCePTH does not seem to be related to an increase in PHPT recurrence, although this possibility should not be dismissed. Vitamin D deficiency should be corrected. Treatment with calcium supplements seems to be clearly beneficial. CONCLUSION: The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

Establishment of Mimosa biuncifera (Fabaceae) inoculated with arbuscular mycorrhizal fungi in greenhouse and field drought conditions.

Mexico is dominated by arid or semi-arid ecosystems, predominantly characterized as xeric shrublands. These areas are frequently deteriorated due to agriculture or over-grazing by livestock (sheep and goats). The vegetation type mainly consists of thorny plant species, and among these, the dominant one in overgrazed areas is catclaw (Mimosa biuncifera). This is a nurse plant that facilitates establishment of other vegetation and promotes plant succession. Catclaw plants form a mutualistic association with arbuscular mycorrhizal fungi (AMF), which improves uptake of nutrients and water. The objective of this study was to determine the effect of inoculating catclaw plants with native AMF and starting their growth under a low water availability treatment in a greenhouse, and later transplanting them to field conditions of drought and deterioration. Field plants were evaluated according to their survivorship and growth. The seeds of catclaw plants and soil with AMF spores were collected in the Mezquital Valley of Hidalgo State, in Central Mexico. Seedlings were grown in individual pots in a greenhouse. The experimental design consisted of two levels of pot irrigation, wet (W) and dry (D), as well as the presence (M+) or absence (M-) of AMF inoculum, with 20 replicates for each treatment. The following plant parameters were recorded every week: height, number of leaves and pinnae, and mean diameter of coverage. After 20 weeks in the greenhouse, determination was made of fresh and dry biomass, relative growth rate (RGR), root/shoot ratio, real evapotranspiration (RET), water-use efficiency (WUE), and percentage of mycorrhizal colonization. The remaining plants growing under the dry treatment (M+ and M-) were then transplanted to a semi-arid locality in the Mezquital Valley. During one year, monthly records were kept of their height, number of leaves, mean diameter of coverage and survival. Results showed that compared to greenhouse plants under other treatments, those under the wet mycorrhizal (WM+) treatment were taller, had more pinnae, and were characterized by greater coverage, faster RGR, and greater fresh and dry biomass. Moreover, inoculated plants (WM+ and DM+) showed higher WUE than those uninoculated (WM- and DM-, respectively). After one year in field conditions, there was a higher survival rate for previously inoculated versus uninoculated plants. Hence, mycorrhization of M. biuncifera with native AMF inoculum increased plant efficiency in biomass production, thus favoring establishment and survival in field conditions. We concluded that inoculation of catclaw plants is recommendable for revegetation programs in deteriorated semi-arid zones.

Neurological Adverse Effects of Antipsychotics in Children and Adolescents.

OBJECTIVE: The aim of this study was to evaluate demographic, clinical, and treatment factors that may impact on neurological adverse effects in naive and quasi-naive children and adolescents treated with antipsychotics. METHODS: This was a 1-year, multicenter, observational study of a naive and quasi-naive pediatric population receiving antipsychotic treatment. Two subanalyses were run using the subsample of subjects taking the 3 most used antipsychotics and the subsample of antipsychotic-naive subjects. Total dyskinesia score (DyskinesiaS) and total Parkinson score (ParkinsonS) were calculated from the Maryland Psychiatric Research Center Involuntary Movement Scale, total UKU-Cognition score was calculated from the UKU Side Effect Rating Scale. Risk factors for tardive dyskinesias (TDs) defined after Schooler-Kaine criteria were studied using a logistic regression. RESULTS: Two hundred sixty-five subjects (mean age, 14.4 [SD, 2.9] years) with different Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders were recruited. DyskinesiaS (P < 0.001) and ParkinsonS (P < 0.001) increased at 1-year follow-up. Risperidone was associated with higher increases in DyskinesiaS compared with quetiapine (P < 0.001). Higher increases in ParkinsonS were found with risperidone (P < 0.001) and olanzapine (P = 0.02) compared with quetiapine. Total UKU-Cognition Score decreased at follow-up. Findings were also significant when analyzing antipsychotic-naive subjects. Fifteen subjects (5.8%) fulfilled Schooler-Kane criteria for TD at follow-up. Younger age, history of psychotic symptoms, and higher cumulative exposure time were associated with TD at follow-up. CONCLUSIONS: Antipsychotics increased neurological adverse effects in a naive and quasi-naive pediatric population and should be carefully monitored. Risperidone presented higher scores in symptoms of dyskinesia and parkinsonism. Quetiapine was the antipsychotic with less neurological adverse effects. Younger subjects, psychosis, and treatment factors predicted an increased risk of TD.

[To find out the life habits and risk factors of adolescents seen in the Health Centres of two semi-urban populations using a structured open response clinical interview]. / Conocer los hábitos de vida y factores de riesgo de los adolescentes atendidos por los centros de salud de dos poblaciones semiurbanas mediante una entrevista clínica estructurada con respuestas abiertas.

OBJECTIVE: To investigate the habits and risk factors of adolescents from two Health Centres in two semi-urban populations using a structured clinical interview with open questions. DESIGN: Cross-sectional descriptive study. SETTING: Two semi-urban populations from the Malaga area. PARTICIPANTS: Adolescents aged between 16 and 18 years old. We selected 5 medical clinics out of the 19 clinics in the Health Centres, using stratified random sampling. A total of 204 adolescents were included, with 62 (30.39%) of them not attending. OUTCOMES: 42.3% were overweight or obese. The BMI and MBP ratio was R=0.4 They ate fruit, vegetables or dairy products at least once a day 54.2%, 57.8% and 24.5%, respectively. 32.3% of the male teenagers and 63.5% of females did not exercise regularly. 21.8% were smokers, and this was related to a low socio-economical level (OR: 3.38 P=0.001 95% CI: 1.27 to 9) and with abandoning education (OR: 2.88 P=0.015 CI 95%. 1.20 to 6,86). 56.3% usually drink and this habit was also related to abandoning education. (OR: 3.5 95% CI: 1.43 to 8.94). 10.6% of the teenagers consumed illegal substances and their group of friends in 36.6% of the cases. 12.1% had unprotected sex. 12.4% and 13.4% did not use a crash helmet or seat belt, respectively. 24.2% have driven in a drunken state at some point. 20.4% have felt depressed at least once. CONCLUSIONS: Risk factors and life style habits prevalent in reference to weight, fruit, vegetables and dairy products consumption, sport, smoking, alcohol and depression problems have been similar to the ones found in other studies that have used anonymous surveys. Prevalence of substance abuse has been lower.

Evaluation of Preoperative Clinical and Serological Determinations in Complicated Acute Appendicitis: A Score for Predicting Complicated Appendicitis. / Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada.

BACKGROUND: To analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA). METHODS: This is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups. RESULTS: Three hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2-18.2), symptom duration 14.1hours (95% CI: 6.3-21.9), neutrophil percentage 5.0% (95% CI: 3.2-6.8), CRP 73.6mg/l (95% CI: 50.0-97.2) and hospital stay 2.2 days (95% CI: 1.4-3.0), with p<0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75-0.85). CONCLUSION: This model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis.

Obstetric and perinatal outcome in 200 infants conceived from vitrified oocytes.

Cryopreservation of oocytes by vitrification is a promising new technique for assisted human reproduction. Any new technical development must be accompanied with data concerning obstetric and perinatal outcome. This study analysed the obstetric and perinatal outcomes in 165 pregnancies and 200 infants conceived following oocyte vitrification cycles in three assisted reproduction centres. The results indicate that the mean birth weight and the incidence of congenital anomalies are comparable to that of spontaneous conceptions in fertile women or infertile women undergoing in-vitro fertilization treatment. These preliminary findings may provide reassuring evidence that pregnancies and infants conceived following oocyte vitrification are not associated with increased risk of adverse obstetric and perinatal outcomes.

Selective formal transesterification of fluorinated 2-(trimethylsilyl)ethyl alpha-imino esters mediated by TBAF.

The scope of the transesterification reaction between beta-fluorinated alpha-imino esters and various electrophiles in the presence of TBAF as fluorine source is described. The reaction is highly selective for alkyl iodides, bromides, and mesylates, while alkyl chlorides react at a significantly slower rate and tosylates do not react under the reaction conditions. This methodology represents a simple and useful alternative for the preparation of a wide variety of fluorinated alpha-imino esters.

Electroconvulsive therapy in the treatment of mixed states in bipolar disorder.

INTRODUCTION: Mixed bipolar states are not infrequent and may be extremely difficult to treat. Lithium, anticonvulsants including valproate and carbamazepine, and antipsychotics such as olanzapine, ziprasidone, and aripiprazole have been reported to be at least partially effective in controlled clinical trials, but many patients do not respond to pharmacological approaches. Electroconvulsive therapy has been tested to be efficacious for the treatment of both manic and depressive episodes, but much less evidence is available with regards to mixed states. The aim of the review was to report the available evidence for the use of electroconvulsive therapy in mixed bipolar states. METHODS: A systematic review of the literature on treatment of mixed states, focused on electroconvulsive therapy, was made, beginning in August 1992 and ending in March 2007. The key words were "electroconvulsive therapy" and "mixed bipolar". RESULTS: Only three studies met the required quality criteria and were included. This literature suggests that ECT is an effective, safe, and probably underutilized treatment of mixed states. Recent technical developments have made ECT more friendly, tolerable, and safe. Potential alternatives, such as vagus nerve stimulation, deep brain stimulation, or transcranial stimulation, are still far to be proved as effective as ECT.

Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication.

BACKGROUND: Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS: Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS: mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.

Metas internacionales de seguridad del paciente en centro de salud: un artículo de revisión bibliográfica / International goals of patient safety in health centers: a bibliographic review article

Las metas internacionales de seguridad del paciente fueron implementadas por la Joint Commision International (JCI), a nivel mundial, con la finalidad de reducir los eventos adversos en los centros de salud. El objetivo de esta revisión bibliográfica fue identificar las metas internacionales de seguridad del paciente (MISP) incorporadas en centros de salud en el marco de la cultura de seguridad y calidad de la atención. Se realizó una revisión bibliográfica narrativa sistematizada utilizando las bases de datos de PubMed y EBSCO Host, utilizando criterios de inclusión y exclusión para la selección de los artículos para análisis. Los ámbitos evaluados relacionados a las metas internacionales de seguridad, identificados en los artículos seleccionados fueron: i) cultura de seguridad, ii) calidad de la atención, iii) comunicación efectiva, iv) cirugía de alto riesgo, v) medicamentos de alto riesgo. Las metas internacionales de calidad están incorporadas en los diferentes centros de salud, algunos de ellos definidos explícitamente en los sistemas de evaluación de calidad y otros de manera implícita en ámbitos generales en los sistemas de evaluación.

The Joint Commission International (JCI) implemented international patient safety goals worldwide to reduce adverse events in health centers. The objective of this literature review was to identify the international patient safety goals (MISP) incorporated in healthcare facilities within the framework of safety culture and quality of care. A systematized narrative literature review was carried out using PubMed and EBSCO Host databases, using inclusion and exclusion criteria to select articles for analysis. The areas evaluated related to the international safety goals identified in the selected articles were: i) safety culture, ii) quality of care, iii) effective communication, iv) high-risk surgery, v) high-risk drugs. International quality goals are incorporated in the different health centers, explicitly defined in the quality evaluation systems and others in general areas in the evaluation systems.

Garengeot's hernia: two case reports with CT diagnosis and literature review.

Garengeot's hernia (GH) is defined as the presence of the appendix inside a femoral hernia. It occurs in 0.9% of femoral hernias and is usually an incidental finding during surgery. Its treatment is controversial and the aim of this article is to review the diagnostic methods and surgical considerations. We report two cases diagnosed preoperatively by contrast-enhanced computed tomography (CT) and discuss the treatment options based on a review of the literature published in PubMed updated on 1 December, 2015. Fifty articles reporting 64 patients (50 women, mean age 70 years) with GH were included in the analysis. Diagnosis was performed by preoperative CT in only 24 cases, including our two. The treatment of GH is emergency surgery. Several options are available laparoscopic or open approach: insertion of a mesh or simple herniorrhaphy, with or without appendectomy. CONSLUSION: The preoperative diagnosis with CT can guide the choice of treatment. Appendectomy and hernioplasty should be performed via inguinotomy, if there is no perforation or abscess formation.

Valoración de parámetros clínicos y analíticos preoperatorios en apendicitis aguda complicada. Score para predecir apendicitis complicada / Evaluation of Preoperative Clinical and Serological Determinations in Complicated Acute Appendicitis: A Score for Predicting Complicated Appendicitis

Introducción: Los parámetros clínicos y analíticos de la apendicitis aguda (AA) son la base diagnóstica. Se analiza la diferencia de sus valores según la histología para distinguir las AA simples de las complicadas. Métodos: Análisis observacional retrospectivo que incluye pacientes (>14 años) que ingresan con diagnóstico de AA desde el 1 abril 2014 al 31 julio 2016. Histopatológicamente se dividen en AA complicada (perforada y/o gangrenada) y AA no complicada (flemonosa). Entre los 2 grupos se compara sexo, edad, temperatura al ingreso, duración de sintomatología, recuento leucocitario preoperatorio (WBC), porcentaje de neutrófilos, volumen plaquetario medio (VPM), índice de distribución de plaquetas (PDW), proteína C-reactiva (PCR) y estancia hospitalaria. Resultados: Se analizan 335 pacientes y se incluyen 284, de los cuales 194 (68,3%) tienen AA no complicada (AAnc) y 90 (31,7%) AA complicada (AAc). La edad, la duración de sintomatología, el porcentaje de neutrófilos, la PCR y la estancia hospitalaria son mayores en la AAc (p<0,05). Las diferencias de las medias entre AAnc y AAc son: edad 13,2 años (IC 95%: 8,2-18,2), duración de sintomatología 14,1h (IC 95%: 6,3-21,9), porcentaje de neutrófilos 5,0% (IC 95%: 3,2-6,8), PCR 73,6mg/l (IC 95%: 50,0-97,2) y estancia hospitalaria 2,2 días (IC 95%: 1,4-3,0), con p<0,05. Un modelo basado en parámetros preoperatorios (edad, duración de sintomatología, porcentaje de neutrófilos y PCR) se calcula para predecir la posibilidad de AAc. El área bajo la curva del modelo es 0,80 (IC 95%: 0,75-0,85). Conclusiones: El modelo predice la posibilidad de desarrollar AAc, pero debe validarse de manera prospectiva. (AU)

Background: To analyze whether clinical and analytical parameters differ according to histopathology in cases of acute appendicitis (AA). Methods: This is a retrospective, observational study including patients (>14 years of age) admitted for suspicion of AA from 1 April 2014 to 31 July 2016. Histopathology was divided into complicated (including perforated and gangrenous AA) and uncomplicated appendicitis (phlegmonous). Sex, age, temperature of patients on admission to the Emergency Department, symptom duration, preoperative white blood cell (WBC) count, neutrophil percentage, mean platelet volume (MPV), platelet distribution width (PDW), C-reactive protein (CRP) and hospital stay were compared in the two groups. Results: Three hundred and thirty-five patients were analyzed, and 284 were included. Appendicitis was uncomplicated in 194 (68.3%) and complicated in 90 (31.7%). Age, symptom duration, neutrophil percentage, CRP and hospital stay were higher in the complicated AA group (P < .05). The mean differences between uncomplicated and complicated AA were: age 13.2 years (95% CI: 8.2-18.2), symptom duration 14.1hours (95% CI: 6.3-21.9), neutrophil percentage 5.0% (95% CI: 3.2-6.8), CRP 73.6mg/l (95% CI: 50.0-97.2) and hospital stay 2.2 days (95% CI: 1.4-3.0), with p<0.05 for all these variables. A model based on the preoperative parameters (age, symptom duration, neutrophil percentage and CRP) was calculated to predict the likelihood of complicated AA. The receiver operating characteristic (ROC) of the model had an area under the curve of 0.80 (95% CI 0.75-0.85). Conclusion: This model is able to diagnose complicated AA without the need for imaging techniques, although it must be validated with prospective analysis. (AU)

Bipolar I and II versus unipolar depression: clinical differences and impulsivity/aggression traits.

OBJECTIVE: To investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. METHODS: Six hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. RESULTS: Compared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. CONCLUSION: Our findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.