Prevalence and Association Between Cognition, Anxiety, and Depression in Patients Hospitalized with Heart Failure

Abstract Background Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established. Objectives The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge. Methods This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls. Results This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days. Conclusions Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days.

A presença de fármacos e cafeína em água superficial e destinada ao consumo humano / The presence of pharmaceuticals and caffeine in surface and treated water

Com um intenso consumo, e graças ao surgimento de novas técnicas analíticas, a presença de fármacos e cafeína tem sido detectada em meios aquáticos por todo o mundo, mesmo que em baixas concentrações. No entanto, os impactos que podem ocasionar à saúde e ao ambiente ainda não são bem compreendidos. Dessa forma, o objetivo deste trabalho foi avaliar a presença dos fármacos atenolol, carbamazepina, clonazepam, fluoxetina, haloperidol, ibuprofeno, paracetamol, sinvastatina e venlafaxina e da cafeína em água bruta e tratada por uma estação de tratamento convencional, caracterizar as águas de acordo com as características físico-químicas e microbiológicas e verificar as conformidades com os padrões legais, e avaliar os impactos dos compostos detectados nas amostras para o ambiente aquático. As análises foram realizadas por cromatografia líquida acoplada à espectrometria de massas sequencial. As coletas das amostras foram realizadas nos períodos chuvoso e seco. As características físico-químicas analisadas foram cor aparente, turbidez, condutividade e pH. Para a caracterização microbiológica foram quantificados os coliformes totais e Escherichia coli. O impacto dos contaminantes foi avaliado com base em teste de toxicidade aguda, pela coleta de dados na literatura cientifica acerca dos efeitos subletais para organismos aquáticos e pela avaliação de risco, realizada de acordo com o cálculo do quociente de risco. O método analítico mostrou-se adequado em suas figuras de mérito para a análise dos contaminantes. A carbamazepina, a fluoxetina, a venlafaxina e a cafeína, presentes na água bruta foram removidas pelo tratamento da água. As características físico-químicas e microbiológicas da água bruta e da tratada enquadraram-se nos valores estabelecidos pela Resolução Conama nº 357 e pela Portaria de Consolidação nº 5, respectivamente. Os compostos identificados neste estudo podem ocasionar danos a organismos não-alvos e risco ao ambiente aquático.

With an intense consumption, and thanks to the emergence of new analytical techniques, the presence of pharmaceuticals and caffeine has been detected in aquatic environments all over the world, even in low concentrations. However, the impacts they can have on health and the environment are still not well understood. Thus, the objective of this work was to evaluate the presence of the pharmaceuticals atenolol, carbamazepine, clonazepam, fluoxetine, haloperidol, ibuprofen, paracetamol, simvastatin and venlafaxine and caffeine in raw water and treated by a conventional treatment plant, to characterize the waters according to the physical-chemical and microbiological characteristics and check the compliance with legal standards, and evaluate the impacts of the compounds detected in the samples for the aquatic environment. The analyses were performed by liquid chromatography coupled with sequential mass spectrometry. Sample collections were carried out in the rainy and dry periods. The physical-chemical characteristics analyzed were apparent color, turbidity, conductivity and pH. For microbiological characterization, total coliforms and Escherichia coli were quantified. The impact of contaminants was assessed based on an acute toxicity test, by collecting data in the scientific literature on sublethal effects for aquatic organisms and by assessing risk, carried out according to the calculation of the risk quotient. The analytical method proved to be adequate in its figures of merit for the analysis of contaminants. Carbamazepine, fluoxetine, venlafaxine and caffeine, present in raw water, were removed by water treatment. The physical-chemical and microbiological characteristics of raw and treated water were in line with the values established by Conama Resolution nº 357 and Consolidation Ordinance nº 5, respectively. The compounds identified in this study can cause damage to non-target organisms and risk to the aquatic environment.

Development of a new test cell to measure cumulative permeation of water-insoluble pesticides with low vapor pressure through protective clothing and glove materials.

A collaborative approach, involving resources and expertise from several countries, was used to develop a test cell to measure cumulative permeation by a solid-state collection technique. The new technique was developed to measure the permeation of pesticide active ingredients and other chemicals with low vapor pressure that would otherwise be difficult to test via standard techniques. The development process is described and the results from the final chosen test method are reported. Inter-laboratory studies were conducted to further refine the new method and determine repeatability and reliability. The revised test method has been approved as a new ISO/EN standard to measure permeation of chemicals with low vapor pressure and/or solubility in water.

In vitro and ex vivo anticholinesterase activities of Erythrina velutina leaf extracts.

CONTEXT: Erythrina velutina (EV) Willd (Fabaceae-Faboideae) is a medicinal tree that is commonly used in Brazil for the treatment of several central nervous system disorders. OBJECTIVE: The anticholinesterase activity of EV is described in this work. METHODS: Concentration-response curves (0-1.6 mg/mL) for EV leaf aqueous extract (AE) and alkaloid-rich extracts (AKEs) were performed in vitro. Cholinesterase inhibition was examined in mouse brains, as the cholinesterase source, and in pure acetylcholinesterase (AChE) or butyrylcholinesterase (BuChE). Mice were treated with AE or AKE (100, 200, and 400 mg/kg, p.o.) and their brains were used for the measurement of cholinesterase activity (CA) ex vivo. RESULTS: CA was inhibited by AE (IC(50) = 0.57 [0.43-0.75] mg/mL) and AKE (IC(50) = 0.52 [0.39-0.70] mg/mL) in brain homogenates in a concentration-dependent manner. The ex vivo experiments indicated that AE (400 mg/kg, p < 0.05, 32.2 ± 3.9% of inhibition) and AKE (all doses: p < 0.05-p < 0.001, 29.6 ± 3.2% as the maximum inhibition) significantly inhibited CA in the central nervous system after oral administration. AE and AKE inhibited AChE and BuChE activities in a concentration-dependent manner (AE: IC(50AChE) = 0.56 [0.38-0.81] mg/mL, IC(50BuChE) = 2.95 [1.51-5.76] mg/mL, AKE: IC(50AChE) = 0.87 [0.60-12.5] mg/mL, IC(50BuChE) = 2.67 [0.87-8.11] mg/mL). DISCUSSION AND CONCLUSIONS: These data indicated that AE and AKE crossed the blood-brain barrier to inhibit CA in the brain. AE and AKE also exhibited a dual inhibitory action on acetyl- and BuChE.

Mobility and accessibility in historic cities.

The historic cities of Brazil, despite its colonial structure, don't fail to go through transformations that affect contemporary cities, which is the main source of problems, leading to new approaches to urban issues such as mobility and accessibility. The uncontrolled growth of tourism in the historic cities can be considered as a big problem, because at the same time, they have committed to the conservation of its built heritage and demand control of the activities that occur in their areas without harm. Then, a permanent dialogue between conservatives and planners could be accomplished by joining the various sectoral policies. The study of urban mobility in historical sites was in fact the focus of this work because of their peculiarities, such as its specific characteristics of urban structure, morphology and occupation. In fact, the development of tourism in historic centers generates specific demands, such as adaptation to new uses of the houses, intensive movement of people and vehicles, illegal parking, among others. Beyond threatening the city preservation, does not provide mobility and accessibility to tourists, because these cities were not designed for the tourism conditions and needs of contemporary life. Characteristic features of Brazilian baroque cities, such as topography , the narrow streets, narrow or nonexistent sidewalks, steep turns and ramps strong, are not suitable for heavy vehicles, traffic and pedestrian circulation. Thus, studies concerning conservation urban integrated are aimed at an approach to interaction between historic preservation of the environment with the dynamic socio-economic of the local.

Vitamin E ameliorates high dose trans-dehydrocrotonin-associated hepatic damage in mice.

trans-Dehydrocrotonin (t-DCTN), the diterpenoid from Croton cajucara Bentham, exhibits hypoglycemic and hypolipidemic activities, but in high doses is associated with a discrete hepatotoxicity. In the search for measures to mitigate this, pretreatment with the antioxidants N-acetylcysteine and vitamin E has been examined. Mice that received a high dose t-DCTN (100 mg/kg) manifested hepatic damage, as evidenced by significant elevations in serum ALT and AST, and hepatic GSH, and histological alterations, which could be obliterated by pretreatment with vitamin E, but not with N-acetylcysteine, possibly by creating an effective antioxidant balance.

Gastroprotective effect of lupeol on ethanol-induced gastric damage and the underlying mechanism.

The effect of lupeol, a natural pentacyclic triterpene on ethanol-induced gastric damage in mice was evaluated. The gastroprotection was assessed by determination of changes in mean gastric lesion area, quantification of mucosal non-protein sulfhydryls (NP-SH), and characterized using drugs that influence the endogenous prostaglandins, alpha(2)-adrenoceptors, nitric oxide, K(ATP)-channels, and intracellular calcium. Orally administered lupeol (3, 10, and 30 mg/kg) significantly and dose-dependently attenuated the ethanol-induced gastric damage by 39-69%, whereas the positive control N-acetylcysteine (NAC, 300 mg/kg, i.p.) afforded 32% protection. Both lupeol and NAC restored the NP-SH depleted by ethanol but the lupeol effect was only marginal. Lupeol gastroprotection was attenuated by indomethacin and L-NAME, the respective COX and NO-synthase inhibitors and was weakly sensitive to alpha(2)-adrenergic antagonist yohimbine and K(ATP)-channel blocker glibenclamide, but more profoundly to calcium blocker verapamil. These pharmacological effects of lupeol may synergistically contribute to alleviating the ethanol-associated gastric damage, which is multifactorial.

Evidence of the mechanism of action of Erythrina velutina Willd (Fabaceae) leaves aqueous extract.

ETHNOPHARMACOLOGICAL RELEVANCE: Erythrina velutina is traditionally used for sleepiness, convulsions and nervous system excitation in Brazil. Although central effects have been reported for Erythrina velutina, little is known about its mechanism of action. AIM OF THE STUDY: To investigate the pharmacological evidences of mechanism of action of Erythrina velutina leaves aqueous extract (AE). MATERIALS AND METHODS: Terminal segments of the guinea-pig ileum (n=5-8) were mounted in an organ bath and isotonic contractions were recorded. Phytochemical screening was carried out on AE. RESULTS: AE (0.025-2.50 mg/ml) produced contractile response in the guinea-pig ileum, yielding typical concentration-response curves (EC50=0.63 mg/ml). Electrically evoked contractions were significantly increased in the presence of AE. AE-elicited contractions were significantly reduced by bicuculline, tetrodotoxin, atropine, verapamil or incubation in low calcium-high potassium solution. Atropine along with verapamil abolished AE contractile response. Alkaloids, catechins, steroids, flavonols, flavononols, flavonoids, phenols, saponins, tannins, triterpenoids, and xanthones were detected in AE. CONCLUSIONS: AE contains important constituents for pharmacological activities. AE-induced contractions seem to involve GABAA receptor activation, acetylcholine release, muscarinic receptor activation, augmentation of Ca2+ entry through L-type calcium channels, and calcium release from the intracellular stores. These findings provide further support for Erythrina velutina traditional uses.

Gastroprotective mechanisms of centipedic acid, a natural diterpene from Egletes viscosa LESS.

This study was aimed to clarify the mechanisms of gastroprotection by centipedic acid (CPA), a natural diterpene from Egletes viscosa LESS. (Asteraceae) using ethanol-induced gastric mucosal damage in mice and gastric secretion in 4-h pylorus-ligated rats as model systems. In mice, intragastrically administered CPA (25, 50, 100 mg/kg) greatly reduced the mucosal lesions induced by 96% ethanol (0.2 ml, p.o.) by 18, 53, and 79%, respectively, whereas N-acetylcysteine (NAC, 300 mg/kg, i.p.), the reference compound produced a 50% inhibition. In 4-h pylorus-ligated rats, CPA (50 mg/kg) applied intraduodenally decreased both gastric secretory volume and total acidity. Similar to NAC, the plant diterpene effectively prevented the ethanol associated decrease in non-proteic sulfhydryls (NP-SH) and the elevated thiobarbituric acid-reactive substances (TBARS) in gastric tissue, suggesting that these compounds exert an antioxidant effect. Pretreatment of mice with indomethacin, the cyclooxygenase inhibitor but not with capsazepine, the transient receptor potential vanilloid-1 (TRPV1)-receptor antagonist greatly suppressed the gastroprotective effect of CPA. Furthermore, CPA gastroprotection was significantly attenuated in mice pretreated with L-NAME or glibenclamide the respective inhibitors of nitric oxide synthase and K(+)(ATP) channel activation. These data suggest that CPA affords gastroprotection by different and complementary mechanisms, which include a sparing effect on NP-SH reserve, and roles for endogenous prostaglandins, nitric oxide, and TRPV1-receptor and K(+)(ATP) channel activation.

Idéias, crenças e valores que as mulheres grávidas têm a respeito da própria sexualidade / Ideas, beliefs and values that pregnants women have regarding the proper sexuality

Estudo exploratório descritivo, de abordagem qualitativa, realizado em um Hospital Escola Público Federal de Recife, com oobjetivo principal de analisar idéias, crenças e valores que as gestantes têm sobre a sua sexualidade. A população constituiusede gestantes atendidas no Pré-Natal da referida instituição e três gestantes que espontaneamente verbalizaram seussentimentos relacionados com a sexualidade constituíram a amostra. Este estudo teve a aprovação pelo Comitê de Ética emPesquisa do Centro de Ciências da Saúde da Universidade Federal de Pernambuco. As informações foram coletadas por meiode discussão em grupo, utilizando-se um formulário semi-estruturado onde foi utilizada a entrevista não estruturada e aobservação participativa após elaborar as seguintes questões norteadoras: Como eu penso a questão do sexo? Que sentimentovem quando estou junto ao meu companheiro? Como eu gestante sinto prazer? Como é a sensação do prazer no meu corpo?.Para a análise das informações foi realizada a transcrição das fitas gravadas, com identificação das participantes pela letrainicial de seus nomes, mantendo sigilo de suas identidades. Foi realizada leitura minuciosa de cada transcrição e identificadaas temáticas sexualidade na gestação e sexualidade no puerpério. Ao proceder com a discussão pôde-se observar que ossentimentos das gestantes relacionados com sua sexualidade foram divergentes no que dizem respeito à freqüência dasrelações sexuais, satisfação pessoal, experiência em gestação anterior, invasão de limites do companheiro, sensaçõesuterinas durante e após coito, sentir parceiro e bebê durante o ato sexual, dentre outros; e semelhantes quando se refere aomedo de machucar o bebê, preocupação com a dor, recusa do homem que leva a insegurança feminina...

Gastroprotective effect of mangiferin, a xanthonoid from Mangifera indica, against gastric injury induced by ethanol and indomethacin in rodents.

In search of novel gastroprotective agents, mangiferin, a naturally occurring glucosylxanthone from Mangifera indica L. (Anacardiaceae), was evaluated in mice on gastric injury induced by ethanol and indomethacin. The effects of mangiferin on gastric mucosal damage were assessed by determination of changes in mean gastric lesion area or ulcer score in mice and on gastric secretory volume and total acidity in 4-h pylorus-ligated rats. Mangiferin (3, 10 and 30 mg/kg, P. O.) significantly attenuated the gastric damage induced by ethanol by 30, 35, and 63 %, and of indomethacin by 22, 23 and 57 %, respectively. N-Acetylcysteine (750 mg/kg, I. P.) and lansoprazole (30 mg/kg, P. O.) used as positive controls in these ulcerogenic models resulted in 50 % and 76 % suppression of gastric injury, respectively. In 4-h pylorus-ligated rats, intraduodenally applied mangiferin (30 mg/kg) caused significant diminutions in gastric secretory volume and total acidity. In addition, like N-acetylcysteine, a donor of sulfhydryls, mangiferin effectively prevented the ethanol-associated depletion of gastric mucosal non-protein sulfhydryl content in mice, suggesting an antioxidant action. These findings provide evidence that mangiferin affords gastroprotection against gastric injury induced by ethanol and indomethacin most possibly through the antisecretory and antioxidant mechanisms of action.