Contingent Negative Variation in the Evaluation of Neurocognitive Disorders Due to Possible Alzheimer's Disease.

The usefulness of Contingent Negative Variation (CNV) potential as a biomarker of neurocognitive disorders due to possible Alzheimer's disease, is based on its possible physiological correlates. However, its application in the diagnostic evaluation of these disorders is still incipient. The aim of this study is to characterize the patterns of cognitive processing of information in the domain of nonspecific global attention, by recording potential CNV in a group of patients with neurocognitive disorders due to possible Alzheimer's disease. An experimental study of cases and controls was carried out. The sample included 39 patients classified according to DSM-5 with a neurocognitive disorder subtype possibly due Alzheimer's disease, and a Control Group of 53 subjects with normal cognitive functions. CNV potential was registered using standard protocol. The analysis of variance obtained significant differences in mean values and confidence intervals of total CNV amplitude between the three study groups. The late CNV segment amplitudes makes it possible to discriminate between the level of mild and major dysfunction in the group of patients. The CNV total amplitudes of potential allows for effective discrimination between normal cognitive functioning and neurocognitive disorders due to possible Alzheimer's disease.

The Relationship between Paresthesia and the Presence of Cardiac Dysautonomia in Patients with Post-COVID-19 Syndrome: A Preliminary Observational Study.

INTRODUCTION: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac dysautonomia in patients with post-COVID-19 syndrome is the objective of this study. PARTICIPANTS AND METHODS: This observational study was carried out in the neurophysiology service wing of the Juan Bruno Zayas Hospital, Santiago de Cuba, in Cuba. The patients were recruited through a post-COVID-19 clinic at the same hospital. A variability study of cardiac frequency and a test of autonomic cardiovascular reflexes was carried out, which is composed of deep breathing, orthostatism, and the Valsalva maneuver. RESULTS: The variability parameters of the cardiac frequency, the expiration-inspiration ratio between deep breaths, and the Valsalva Index showed no statistically significant differences between healthy participants and those with post-COVID-19 syndrome. During the Valsalva maneuver, there was a greater cardiac frequency response in participants with post-COVID-19 syndrome than in healthy subjects. The difference in supine and standing blood pressure was significantly minor in patients with post-COVID-19 syndrome. The logarithm of high frequency (log HF) increased significantly in patients with paresthesia when compared to patients without paresthesia. CONCLUSIONS: In the autonomic function tests, no signs of dysautonomia were found in patients with post-COVID-19 syndrome. The presence of paresthesias is associated with differences in cardiac vagal activity, which may suggest that damage to peripheral sensory nerve fibers could be associated with an affectation to autonomic fibres.

Autonomic and Vascular Responses during Reactive Hyperemia in Healthy Individuals and Patients with Sickle Cell Anemia.

Background and Objectives: To compare autonomic and vascular responses during reactive hyperemia (RH) between healthy individuals and patients with sickle cell anemia (SCA). Materials and Methods: Eighteen healthy subjects and 24 SCA patients were subjected to arterial occlusion for 3 min at the lower right limb level. The pulse rate variability (PRV) and pulse wave amplitude were measured through photoplethysmography using the Angiodin® PD 3000 device, which was placed on the first finger of the lower right limb 2 min before (Basal) and 2 min after the occlusion. Pulse peak intervals were analyzed using time-frequency (wavelet transform) methods for high-frequency (HF: 0.15-0.4) and low-frequency (LF: 0.04-0.15) bands, and the LF/HF ratio was calculated. Results: The pulse wave amplitude was higher in healthy subjects compared to SCA patients, at both baseline and post-occlusion (p < 0.05). Time-frequency analysis showed that the LF/HF peak in response to the post-occlusion RH test was reached earlier in healthy subjects compared to SCA patients. Conclusions: Vasodilatory function, as measured by PPG, was lower in SCA patients compared to healthy subjects. Moreover, a cardiovascular autonomic imbalance was present in SCA patients with high sympathetic and low parasympathetic activity in the basal state and a poor response of the sympathetic nervous system to RH. Early cardiovascular sympathetic activation (10 s) and vasodilatory function in response to RH were impaired in SCA patients.

Discriminant Model for Insulin Resistance in Type 2 Diabetic Patients.

Introduction: Patients with type 2 diabetes mellitus tend to have insulin resistance, a condition that is evaluated using expensive methods that are not easily accessible in routine clinical practice. Objective: To determine the anthropometric, clinical, and metabolic parameters that allow for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not. Methods: A cross-sectional analytical observational study was carried out in 92 type 2 diabetic patients. A discriminant analysis was applied using the SPSS statistical package to establish the characteristics that differentiate type 2 diabetic patients with insulin resistance from those without it. Results: Most of the variables analyzed in this study have a statistically significant association with the HOMA-IR. However, only HDL-c, LDL-c, glycemia, BMI, and tobacco exposure time allow for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not, considering the interaction between them. According to the absolute value of the structure matrix, the variable that contributes most to the discriminant model is HDL-c (-0.69). Conclusions: The association between HDL-c, LDL-c, glycemia, BMI, and tobacco exposure time allows for the discrimination of type 2 diabetic patients who have insulin resistance from those who do not. This constitutes a simple model that can be used in routine clinical practice.

Reactive Hyperemia and Cardiovascular Autonomic Neuropathy in Type 2 Diabetic Patients: A Systematic Review of Randomized and Nonrandomized Clinical Trials.

Objective: This work aimed to determine the relationship between the autonomic nervous system and reactive hyperemia (RH) in type 2 diabetes patients with and without cardiovascular autonomic neuropathy (CAN). Methodology: A systematic review of randomized and nonrandomized clinical studies characterizing reactive hyperemia and autonomic activity in type 2 diabetes patients with and without CAN was performed. Results: Five articles showed differences in RH between healthy subjects and diabetic patients with and/or without neuropathy, while one study did not show such differences between healthy subjects and diabetic patients, but patients with diabetic ulcers had lower RH index values compared to healthy controls. Another study found no significant difference in blood flow after a muscle strain that induced reactive hyperemia between normal subjects and non-smoking diabetic patients. Four studies measured reactive hyperemia using peripheral arterial tonometry (PAT); only two found a significantly lower endothelial-function-derived measure of PAT in diabetic patients than in those without CAN. Four studies measured reactive hyperemia using flow-mediated dilation (FMD), but no significant differences were reported between diabetic patients with and without CAN. Two studies measured RH using laser Doppler techniques; one of them found significant differences in the blood flow of calf skin after stretching between diabetic non-smokers and smokers. The diabetic smokers had neurogenic activity at baseline that was significantly lower than that of the normal subjects. The greatest evidence revealed that the differences in RH between diabetic patients with and without CAN may depend on both the method used to measure hyperemia and that applied for the ANS examination as well as the type of autonomic deficit present in the patients. Conclusions: In diabetic patients, there is a deterioration in the vasodilator response to the reactive hyperemia maneuver compared to healthy subjects, which depends in part on endothelial and autonomic dysfunction. Blood flow alterations in diabetic patients during RH are mainly mediated by sympathetic dysfunction. The greatest evidence suggests a relationship between ANS and RH; however, there are no significant differences in RH between diabetic patients with and without CAN, as measured using FMD. When the flow of the microvascular territory is measured, the differences between diabetics with and without CAN become evident. Therefore, RH measured using PAT may reflect diabetic neuropathic changes with greater sensitivity compared to FMD.

Análisis de sentimiento de tweets sobre la vacuna contra el COVID-19 en países iberoamericanos hispanohablantes / Sentiment analysis of tweets about the COVID-19 vaccine in Spanish-speaking Ibero-American countries

Resumen Introducción: En este estudio se evalúa la emocionalidad asociada a la vacunación contra el COVID-19 a partir de la técnica de análisis de sentimientos de los tweets en países iberoamericanos hispanohablantes. Método: En enero de 2021 se realizó un estudio mixto observacional transversal de 41023 tweets procedentes de nueve países iberoamericanos hispanohablantes (Chile, El Salvador, Venezuela, Ecuador, Argentina, México, Panamá, Perú y España) con una fase cuantitativa y técnicas de análisis de sentimientos mediante algoritmos de inteligencia artificial y una fase cualitativa donde se realizó un análisis del discurso de los tweets cuya emocionalidad era en extremo positiva y negativa. Resultados: A partir del análisis de sentimiento de los tweets, se observó que los países presentan una emocionalidad negativa asociada a la vacunación contra el COVID-19, que se podría atribuir a la desconfianza hacia las autoridades y a la eficacia o seguridad de las vacunas, según el análisis del discurso en los tweets de emocionalidad en extremo negativa. Conclusiones: Las técnicas de análisis de sentimientos en combinación con el análisis del discurso de la emocionalidad extrema posibilitaron la monitorización de las opiniones negativas y sus posibles factores asociados en la vacunación contra el COVID-19 en los países iberoamericanos estudiados.

Abstract Introduction: This study evaluates the emotionality associated with vaccination against COVID-19 using the sentiment analysis technique of tweets in Spanish-speaking Ibero-American countries. Method: In January 2021 a mixed cross-sectional observational study of 41023 tweets from nine Spanish-speaking Ibero-American countries (Chile, El Salvador, Venezuela, Ecuador, Argentina, Mexico, Panama, Peru and Spain) was carried out with a quantitative phase and analysis techniques of feelings based on artificial intelligence algorithms and a qualitative phase where an analysis of the discourse of the tweets whose emotionality was extremely positive and negative was carried out. Results: From the sentiment analysis of the tweets, it was observed that the countries present a negative emotionality associated with the vaccination against COVID-19, which could be attributed to mistrust towards the authorities and the efficacy or safety of the vaccines, according to the analysis of the discourse in the extremely negative emotionality tweets. Conclusions: Sentiment analysis techniques in combination with extreme emotionality discourse analysis made it possible to monitor negative opinions and their possible associated factors in vaccination against COVID-19 in the Ibero-American countries studied.

Temporal inequality of RR intervals like a new psychophysiological indicator of mental stress / Desigualdad temporal de los intervalos RR como nuevo indicador psicofisiológico de estrés mental / Desigualdade temporal de intervalos RR como um novo indicador psicofisiológico de estresse mental

Introduction: Gini coefficient (Gini index or Gini ratio) is a parameter that is normally used in economy to measure the income distribution in a country or in the whole wide world, but it can be used to measure any kind of distribution. In the present study it is exposed an innovative proposal of application of the Gini coefficient to Heart Rate Variability (HRV) like a psychophysiological indicator of mental stress. Purpose: To assess the application of the Gini coefficient as a psychophysiological indicator of mental stress. Methods: The involved participants are 13 healthy individuals (age 19 ± 1.5 years). Heart rate was continuously recorded at rest (5 minutes) and during a mental stress (5 minutes). Linear and nonlinear methods of heart rate variability were assessed, and 2 new indicators (Sequential and Non-Sequential Gini) were calculated and proposed to measure HRV differences between states. Results: When comparing rest and mental stress conditions, a sensible decrease of the traditional indicators of the HRV was founded (p<0.05), an increase of the heart rate (p=0.004) and of the Sequential Gini (p=0.004) and Non-Sequential Gini (p=0.04). Conclusions: The results suggest that temporary inequality of the RR intervals analyzed from the Gini coefficient could be an adequate indicator of sympathetic activity present during the mental stress, with great potentialities with the objective to assess the consequences of psychosomatic affections and anxiety disorders.

Introducción: El coeficiente de Gini o índice de Gini es un parámetro que normalmente se usa en economía para medir la distribución del ingreso en un país o en todo el mundo, pero puede usarse para medir cualquier tipo de distribución. En el presente estudio se expone una propuesta innovadora de aplicación del coeficiente de Gini a la Variabilidad de la Frecuencia Cardíaca (VFC) como indicador psicofisiológico del estrés mental. Objetivo: Evaluar la aplicación del coeficiente de Gini como indicador psicofisiológico de estrés mental. Métodos: Los participantes involucrados son 13 individuos sanos (edad 19 ± 1,5 años). La frecuencia cardíaca se registró continuamente en reposo (5 minutos) y durante un estrés mental (5 minutos). Se evaluaron métodos lineales y no lineales de variabilidad de la frecuencia cardíaca, y se calcularon y propusieron 2 nuevos indicadores (Gini secuencial y no secuencial) para medir las diferencias de VFC entre estados. Resultados: Al comparar las condiciones de reposo y estrés mental, se encontró una sensible disminución de los indicadores tradicionales de la VFC (p<0,05), un aumento de la frecuencia cardiaca (p=0,004) y del Gini Secuencial (p=0,004) y Gini no secuencial (p=0,04). Conclusiones: Los resultados sugieren que la desigualdad temporal de los intervalos RR analizados a partir del coeficiente de Gini podría ser un indicador adecuado de la actividad simpática presente durante el estrés mental, con grandes potencialidades en la evaluación las consecuencias de afecciones psicosomáticas y trastornos de ansiedad.

Introdução: O coeficiente de Gini ou índice de Gini é um parâmetro normalmente usado em economia para medir a distribuição de renda em um país ou no mundo, mas pode ser usado para medir qualquer tipo de distribuição. No presente estudo, apresenta-se uma proposta inovadora de aplicação do coeficiente de Gini à Variabilidade da Frequência Cardíaca (VFC) como indicador psicofisiológico de estresse mental.Objetivo: Avaliar a aplicação do coeficiente de Gini como indicador psicofisiológico de estresse mental.Métodos: Os participantes envolvidos são 13 indivíduos saudáveis ​​(idade 19 ± 1,5 anos). A frequência cardíaca foi registrada continuamente em repouso (5 minutos) e durante o estresse mental (5 minutos). Métodos lineares e não lineares de variabilidade da frequência cardíaca foram avaliados e 2 novos indicadores (gini sequencial e não sequencial) foram calculados e propostos para medir as diferenças na VFC entre os estados.Resultados: Ao comparar as condições de repouso e estresse mental, foi encontrada diminuição significativa nos indicadores tradicionais da VFC (p<0,05), aumento da frequência cardíaca (p=0,004) e do Gini Sequencial (p= 0,004) e não - Gini sequencial (p=0,04).Conclusões: Os resultados sugerem que a desigualdade temporal dos intervalos RR analisados ​​a partir do coeficiente de Gini pode ser um indicador adequado da atividade simpática presente durante o estresse mental, com grande potencial na avaliação das consequências de condições psicossomáticas e transtornos de ansiedade.

Theil Entropy as a Non-Lineal Analysis for Spectral Inequality of Physiological Oscillations.

Theil entropy is a statistical measure used in economics to quantify income inequalities. However, it can be applied to any data distribution including biological signals. In this work, we applied different spectral methods on heart rate variability signals and cellular calcium oscillations previously to Theil entropy analysis. The behavior of Theil entropy and its decomposable property was investigated using exponents in the range of [-1, 2], on the spectrum of synthetic and physiological signals. Our results suggest that the best spectral decomposition method to analyze the spectral inequality of physiological oscillations is the Lomb-Scargle method, followed by Theil entropy analysis. Moreover, our results showed that the exponents that provide more information to describe the spectral inequality in the tested signals were zero, one, and two. It was also observed that the intra-band component is the one that contributes the most to total inequality for the studied oscillations. More in detail, we found that in the state of mental stress, the inequality determined by the Theil entropy analysis of heart rate increases with respect to the resting state. Likewise, the same analytical approach shows that cellular calcium oscillations present on developing interneurons display greater inequality distribution when inhibition of a neurotransmitter system is in place. In conclusion, we propose that Theil entropy is useful for analyzing spectral inequality and to explore its origin in physiological signals.

Effectiveness of hypnotherapeutic and pharmacological treatment in primary monosymptomatic enuresis / Efectividad del tratamiento hipnoterapéutico y farmacológico en la enuresis primaria monosintomática

Abstract: Background: In primary monosymptomatic enuresis, it is not clear what dynamic changes occur in the efficacy of hypnotherapeutic versus pharmacological treatment plan. Objective: Determine the changes over time in the effectiveness of hypnotherapy and a pharmacological treatment plan in primary monosymptomatic enuresis. Method: A prospective, longitudinal and analytical study (time series) was performed on a universe of 119 patients between 7 and 16 years old, with primary monosymptomatic enuresis. 40 patients treated with imipramine and 79 patients with 1 session/1 hour /week of hypnotherapy were evaluated on the frequency of temporal changes of enuretic episodes during 14 weeks of treatments at the Hypnosis Clinic. Results: A logarithmic scale of the distributions of temporal changes in the frequencies of enuretic episodes in hypnotherapeutic and pharmacological treatments is presented, with an enuretic plateau from week 3 to week 6 in hypnotherapy. Conclusions: The hypnotherapeutic treatment was more favorable, as it had an early and efficient response compared to treatment with imipramine.

Resumen: Antecedentes: En la enuresis monosintomática primaria, no está claro qué cambios dinámicos ocurren en la eficacia del plan de tratamiento hipnoterapéutico versus farmacológico. Objetivo: Determinar los cambios dinámicos a lo largo del tiempo en la efectividad de la hipnoterapia y un plan de tratamiento farmacológico en la enuresis infantil no orgánica. Método: Se realizó un estudio prospectivo, longitudinal y analítico (serie temporal) en un universo de 119 pacientes entre 7 y 16 años, con enuresis nocturna no orgánica. 40 pacientes tratados con imipramina y 79 pacientes con 1 sesión / 1 hora / semana de hipnoterapia fueron evaluados en la frecuencia de cambios temporales de episodios enuréticos durante 14 semanas de tratamientos en la Clínica de Hipnosis. Resultados: Se presenta un modelo logarítmico de las distribuciones de cambios temporales en las frecuencias de episodios enuréticos en tratamientos hipnoterapéuticos y farmacológicos, con una meseta enurética desde la semana 3 a la semana 6 en hipnoterapia. Conclusiones: El tratamiento hipnoterapéutico fue más favorable, ya que tuvo una respuesta temprana y eficaz en comparación con el tratamiento con imipramina.

Early cardiovascular sympathetic reflex activation is independent of occlusion time during reactive hyperemia / La activación temprana del reflejo simpático cardiovascular es independiente del tiempo de oclusión durante la hiperemia reactiva / A ativação precoce do reflexo simpático cardiovascular é independente do tempo de oclusão durante a hiperemia reativa

Purpose: The aim of the present study was to investigate the role of occlusion time in dynamic changes of autonomic activation during reactive hyperemia. Methods: Healthy subjects (n = 30) in the age range of 18­25 years participated in this study. Vascular reactivity was assessed by measuring the dynamic changes in finger pulse volume amplitude (PVA) and  pulse transit time relative to the RR intervals in the test (occluded arm) and control arm (contralateral non-occluded arm) during 1, 3 and 5 minute of occlusion using two separate Photoplethysmographic sensors. Heart Rate Variability was computed from a simultaneously acquired ECG signal to monitor the dynamic changes in cardiac autonomic nervous activity. Time-varying analysis of all signals were shown every 1 second in average response graphs. Results: Time-varying analysis of vascular and autonomic response during reactive hyperemia demonstrated the presence of a characteristic response pattern with an increase in the Sympathetic index and a decrease in Parasympathetic index at 8 to 10 seconds, an increase in heart rate at 20 seconds and a progressive increase in PVA during the first 60 seconds after occlusion regardless of the time spent in the procedure. Moreover, a decrease in pulse transits time relative to RR intervals,  followed by an increase regardless of the occlusion time was evidenced.  Conclusions: Early cardiovascular sympathetic activation is independent of occlusion time during reactive hyperemia, which suggests this is a vascular autonomic reflex response involved in the generation of the physiological phenomenon of reactive hyperemia.

Objetivo: El objetivo del presente estudio fue investigar el papel del tiempo de oclusión en los cambios dinámicos de la activación autónoma durante la hiperemia reactiva.Métodos: Participaron en este estudio sujetos sanos (n = 30) en el rango de edad de 18 a 25 años. La reactividad vascular se evaluó midiendo los cambios dinámicos en la amplitud del volumen del pulso del dedo (PVA) y el tiempo de tránsito del pulso en relación con los intervalos RR en la prueba (brazo ocluido) y el brazo de control (brazo contralateral no ocluido) durante 1, 3 y 5 minutos. de oclusión utilizando dos sensores fotopletismográficos separados. La variabilidad de la frecuencia cardíaca se calculó a partir de una señal de ECG adquirida simultáneamente para controlar los cambios dinámicos en la actividad nerviosa autónoma cardíaca. El análisis variable en el tiempo de todas las señales se mostró cada segundo en gráficos de respuesta promedio.Resultados: El análisis variable en el tiempo de la respuesta vascular y autonómica durante la hiperemia reactiva demostró la presencia de un patrón de respuesta característico con un aumento en el índice simpático y una disminución en el índice parasimpático a los 8 a 10 segundos, un aumento en la frecuencia cardíaca a los 20 segundos y un aumento progresivo de PVA durante los primeros 60 segundos después de la oclusión independientemente del tiempo transcurrido en el procedimiento. Además, se evidenció una disminución en el tiempo de tránsitos del pulso en relación con los intervalos RR, seguido de un aumento independientemente del tiempo de oclusión.Conclusiones: La activación simpática cardiovascular temprana es independiente del tiempo de oclusión durante la hiperemia reactiva, lo que sugiere que se trata de una respuesta refleja autonómica vascular involucrada en la generación del fenómeno fisiológico de hiperemia reactiva.

Objetivo: O objetivo do presente estudo foi investigar o papel do tempo de oclusão nas mudanças dinâmicas da ativação autonômica durante a hiperemia reativa.Métodos: Participaram deste estudo indivíduos saudáveis ​​(n = 30) na faixa etária de 18 a 25 anos. A reatividade vascular foi avaliada medindo as mudanças dinâmicas na amplitude do volume do pulso do dedo (PVA) e tempo de trânsito do pulso em relação aos intervalos RR no teste (braço ocluído) e braço controle (braço não ocluído contralateral) durante 1, 3 e 5 minutos de oclusão usando dois sensores fotopletismográficos separados. A variabilidade da frequência cardíaca foi calculada a partir de um sinal de ECG adquirido simultaneamente para monitorar as mudanças dinâmicas na atividade nervosa autonômica cardíaca. A análise variável no tempo de todos os sinais foi mostrada a cada 1 segundo em gráficos de resposta média.Resultados: A análise variável no tempo da resposta vascular e autonômica durante a hiperemia reativa demonstrou a presença de um padrão de resposta característico com um aumento no índice simpático e uma diminuição no índice parassimpático em 8 a 10 segundos, um aumento na frequência cardíaca em 20 segundos e aumento progressivo do PVA durante os primeiros 60 segundos após a oclusão, independentemente do tempo despendido no procedimento. Além disso, foi evidenciada uma diminuição no tempo de trânsito de pulso em relação aos intervalos RR, seguida de um aumento independente do tempo de oclusão.Conclusões: A ativação simpática cardiovascular precoce independe do tempo de oclusão durante a hiperemia reativa, o que sugere que se trata de uma resposta reflexa autonômica vascular envolvida na geração do fenômeno fisiológico de hiperemia reativa.

Dynamics of cardiac autonomic regulation during isometric sustained weight test in hypertensive patients

Background: The Sustained Weight Test (SWT) is an isometric exercise test that has great practical value for carrying out massive studies on hypertension, however, is insufficient knowledge of the dynamics of cardiac autonomic regulation during this test. The aim of this study was to determine variations in the dynamics of cardiac autonomic regulation and in hemodynamic response during SWT in hypertensive subjects. Methods: A quasi-experimental study was conducted on 15 hypertensive patients of both sexes, paired with 30 normotensive individuals, measuring arterial blood pressure, entropy sample and the Heart Rate Variability (HRV) in time-frequency with the Continuous Wavelet Transform Morlet-type (CWT  morlet) through the electrocardiographic signal of the polygraph AD Instruments in the functional states of Rest and SWT. Results: A significant increase in heart rate and blood pressure was found, as well as a decrease in sample entropy in the functional states of normotensive and hypertensive patients. In hypertensive patients, an early response pattern increased with multiple fluctuations during SWT in the time-frequency analysis of HRV with the CWT morlet. Conclusions: SWT produces an increase in blood pressure, which is more frequent and evident in hypertensive subjects. Cardiac autonomic regulation during SWT increases the sympathetic and decreases the parasympathetic components, manifesting itself in hypertensive patients with a pattern of imbalance in the regulation of both sympathetic and parasympathetic response.

Influence of the emotional alterations in the arterial stiffness index and cardiovascular risk of pre-hypertensive patients

Purpose: To determine the influence of emotional alterations in the arterial stiffness index and cardiovascular risk of pre-hypertensive patients.Methods: A cross-sectional study was carried out in 48 pre-hypertensive patients. Emotional alterations, global cardiovascular risk and arterial stiffness index were evaluated. The PPG technique was used to record the arterial pulse wave in the first finger of the lower right limb, using the ANGIODIN® digital plethysmograph.Results: Pre-hypertensive patients with emotional alterations had major Weight, Body Mass Index, systolic blood pressure, diastolic blood pressure and arterial stiffness index with respect to patients who did not find emotional alterations. In pre-hypertensive patients, 58.3% presented a positive Cornell test, 39.6% of them female, and 18.8% male. There was a significant relationship (p<0.001) between the presence of emotional disturbances and moderate cardiovascular risk.Conclusions: Emotional alterations in pre-hypertensive patients is associated with an increase in arterial stiffness and an increased global cardiovascular risk.

Respuesta autonómica cardiovascular al estrés mental inducido por la prueba de cálculo aritmético / Autonomic cardiovascular response to mental stress induced by the arithmetic computation test

Introducción: El estrés mental agudo, así como los estados de ansiedad inducidos para influenciar la reactividad psicofisiológica en jóvenes sanos, aportan cambios en los patrones nerviosos que pueden ser medidos mediante la variabilidad de la frecuencia cardiaca. Objetivo: Determinar las diferencias en los parámetros lineales del balance autonómico cardiovascular en individuos jóvenes en estado basal y durante la prueba de cálculo aritmético. Métodos: Se realizó un estudio cuasi-experimental, sin grupo control de tipo antes y después, en el Laboratorio de Ciencias Básicas Biomédicas de la Universidad de Ciencias Médicas de Santiago de Cuba. Población y muestra de 10 sujetos. Se registró el trazado electrocardiográfico (5 min) durante el reposo y luego durante la prueba de cálculo aritmético. Resultados: Existieron diferencias significativas entre ambos estados en las variables frecuencia cardiaca (p = 0,005); mínima (p = 0,007); máxima (p = 0,005); intervalo RR (p = 0,005); stress index (p = 0,028); índice simpático (p = 0,005); bajas frecuencias (p = 0,005); relación LF/HF (p = 0,005); RMSSD (p = 0,007); NN50 (p = 0,008); pNN50 (p = 0,005); índice parasimpático (p = 0,005) y altas frecuencias (p = 0,005). El estrés mental provocó una disminución parasimpática y un predominio simpático uniforme en todos los sujetos participantes en el estudio. Conclusiones: Durante el estrés mental inducido por la prueba de cálculo aritmético la dinámica lineal de la respuesta autonómica cardiovascular experimenta un aumento en la actividad simpática y una disminución del tono parasimpático, traduciendo una respuesta adaptativa en la regulación de la función cardiovascular por el sistema nervioso autónomo(AU)

Introduction: Acute mental stress and states of anxiety induced to influence psychophysiological reactivity in healthy young people, result in changes in nervous patterns which may be measured in terms of heart rate variability. Objective: Determine the differences in linear parameters for autonomic cardiovascular balance in young individuals at baseline and during the arithmetic computation test. Methods: A non-observational quasi-experimental before-after study without a control group was conducted at the Basic Biomedical Sciences Laboratory of the University of Medical Sciences of Santiago de Cuba. The study population and sample was 10 subjects. The electrocardiographic tracing (5 min) was recorded at rest and then during the arithmetic computation test. Results: Significant differences were found between the two states as to the variables heart rate (p = 0.005), minimum (p = 0.007), maximum (p = 0.005), RR interval (p = 0.005), stress index (p = 0.028), sympathetic index (p = 0.005), low frequencies (p = 0.005), LF/HF ratio (p = 0.005), RMSSD (p = 0.007), NN50 (p = 0.008), pNN50 (p = 0.005), parasympathetic index (p = 0.005) and high frequencies (p = 0.005). Mental stress caused a parasympathetic reduction and uniform sympathetic predominance in all the subjects participating in the study. Conclusions: During the mental stress induced by the arithmetic computation test, the linear dynamic of the autonomic cardiovascular response experiences an increase in sympathetic activity and a reduction in parasympathetic tone, displaying an adaptive response in cardiovascular function regulation by the autonomous nervous system(AU)

Cardiac vagal imbalance to the isometric sustained weight test in adolescents with emotional eating behavior.

PURPOSE: To assess the relationship between emotional eating behavior and heart rate variability in Spanish adolescents during an isometric exercise test. METHODS: Participants included 52 adolescents aged between 13 and 18 years old. Heart rate was continuously recorded at rest (2 minutes) and during the sustained weight test (2 minutes). Linear and nonlinear methods of heart rate variability were assessed and related to the emotional eating behavior divided in two clusters. RESULTS: Statistically significant differences were observed in linear and non-linear parameters of heart rate variability comparing rest and sustained weight test. An increase in the value of emotional eating in overweight adolescents was founded. During the sustained weight test, there were differences between the two emotional eating clusters regarding the variables peak high frequency power, normalized low frequency power, normalized high frequency power, low frequency/high frequency ratio, and sample entropy. A positive correlation between the emotional eating behavior and the peak high frequency power was observed, though the prediction capacity of the high frequency waves is low it is observed that there is a good fit to the regression line. CONCLUSION: Results of this study shows that there was a relationship between vagal tone and emotional eating behavior in adolescents during an isometric exercise, with excessive parasympathetic predominance and sympathetic withdrawal during a physical effort.

Regulación autonómica cardiovascular durante la prueba del peso sostenido en pacientes sanos y diabéticos tipo 2 / Autonomic cardiovascular regulation during the sustained weight test in healthy subjects and type 2 diabetic patients

Introducción: En la actualidad se hace imprescindible el estudio de la diabetes mellitus tipo 2 a partir de técnicas poco costosas en función de la carga sanitaria que representa, es entonces donde la prueba del peso sostenido gana valor como ejercicio isométrico estático cubano en el estudio de la variabilidad de la frecuencia cardíaca. Objetivo: Determinar las respuestas electrofisiológicas autonómicas y hemodinámicas en estado basal y durante la prueba del peso sostenido en pacientes sanos y con diabetes tipo 2. Métodos: Se realizó un estudio en la Universidad de Ciencias Médicas de Santiago de Cuba, no observacional, cuasi-experimental, de tipo antes-después con grupo control de 60 pacientes (30 sanos y 60 con diabetes mellitus tipo 2). Resultados: Los diabéticos presentaron mayor IMC (p = 0,004). En estado basal se experimentaron diferencias significativas entre pacientes sanos y diabéticos. En la mayoría, los parámetros de la variabilidad de la frecuencia cardíaca analizados y durante la prueba del peso sostenido, solo se observaron diferencias significativas en las variables TAS (p = 0,022), BF (p = 0,001) y AF (p = 0,015). Al realizar la prueba del peso sostenido se encontraron variaciones muy significativas (p < 0,001) de los parámetros hemodinámicos, y variaciones significativas de AF (p = 0,023) y BF/AF (p = 0,046) en pacientes sanos; y en diabéticos, diferencias significativas de las variables hemodinámicas. Conclusiones: Se determinó una menor respuesta en pacientes diabéticos con respecto a los sanos del sistema nervioso autónomo, lo que expresa un deterioro de este y una disminución de la actividad simpática y parasimpática(AU)

Introduction: At present it is indispensable to study type 2 diabetes mellitus with low-cost techniques due to the health load it represents. In this context the sustained weight test acquires great value as a Cuban static isometric exercise for the study of heart rate variability. Objective: Determine autonomic and hemodynamic electrophysiological responses at baseline state and during the sustained weight test in healthy subjects and type 2 diabetic patients. Methods: A non-observational quasi-experimental before-after study was conducted at the University of Medical Sciences of Santiago de Cuba based on a control group of 60 patients (30 healthy and 30 with type 2 diabetes mellitus). Results: Diabetics had a higher BMI (p = 0.004). At baseline state significant differences were found between healthy subjects and diabetic patients. In most of the heart rate variability parameters analyzed and during the sustained weight tests, the only variables that showed significant differences were SBP (p = 0.022), FB (p = 0.001) and FA (p = 0.015). The results obtained from the sustained weight test were the following: very significant variations of hemodynamic parameters (p < 0.001), significant FA (p = 0.023) and FB/FA (p = 0.046) variations in healthy subjects, and significant differences in hemodynamic variables in diabetic patients. Conclusions: A lower response by the autonomic nervous system was determined in diabetic patients versus healthy subjects, signaling deterioration of that system and reduced sympathetic and parasympathetic activity(AU)

Introduction of Application of Gini Coefficient to Heart Rate Variability Spectrum for Mental Stress Evaluation / Introdução da Aplicação do Coeficiente de Gini ao Espectro de Variabilidade da Frequência Cardíaca para Avaliação do Estresse Mental

Abstract Background: The Gini coefficient is a statistical tool generally used by economists to quantify income inequality. However, it can be applied to any kind of data with unequal distribution, including heart rate variability (HRV). Objectives: To assess the application of the Gini coefficient to measure inequality in power spectral density of RR intervals, and to use this application as a psychophysiological indicator of mental stress. Methods: Thirteen healthy subjects (19 ± 1.5 years) participated in this study, and their RR intervals were obtained by electrocardiogram during rest (five minutes) and during mental stress (arithmetic challenge; five minutes). These RR intervals were used to obtain the estimates of power spectral densities (PSD). The limits for the PSD bands were defined from 0.15 to 0.40 Hz for high frequency band (HF), from 0.04 to 0.15 Hz for low frequency band (LF), from 0.04 to 0.085 Hz for first low frequency sub-band (LF1) and from 0.085 to 0.15 Hz for second low frequency sub-band (LF2). The spectral Gini coefficient (SpG) was proposed to measure the inequality in the power distribution of the RR intervals in each of above-mentioned HRV bands. SpG from each band was compared with its respective traditional index of HRV during the conditions of rest and mental stress. All the differences were considered statistically significant for p < 0.05. Results: There was a significant decrease in HF power (p = 0.046), as well as significant increases in heart rate (p = 0.004), LF power (p = 0.033), LF2 power (p = 0.019) and LF/HF (p = 0.002) during mental stress. There was also a significant increase in SpG(LF) (p = 0.009) and SpG(LF2) (p = 0.033) during mental stress. Coefficient of variation showed SpG has more homogeneity compared to the traditional index of HRV during mental stress. Conclusions: This pilot study suggested that spectral inequality of Heart Rate Variability analyzed using the Gini coefficient seems to be an independent and homogeneous psychophysiological indicator of mental stress. Also, HR, LF/HF, SpG(LF) of HRV are possibly important, reliable and valid indicators of mental stress.

Resumo Fundamento: O coeficiente de Gini é um instrumento estatístico geralmente usado por economistas para quantificar a desigualdade de renda. No entanto, ele pode ser aplicado a qualquer tipo de dados com distribuição desigual, incluindo a variabilidade da frequência cardíaca (VFC). Objetivos: Avaliar a aplicação do coeficiente de Gini para medir a desigualdade na densidade espectral de potência de intervalos RR, e usar esta aplicação como um indicador psicofisiológico do estresse mental. Métodos: Treze indivíduos saudáveis (19 ± 1,5 anos) participaram deste estudo, e seus intervalos RR foram obtidos por eletrocardiograma durante repouso (cinco minutos) e durante estresse mental (desafio aritmético; cinco minutos). Esses intervalos RR foram utilizados para obter as estimativas de densidades espectrais de potência (PSD). Os limites para as bandas PSD foram definidos de 0,15 a 0,40 Hz para banda de alta frequência (HF), de 0,04 a 0,15 Hz para banda de baixa frequência (LF), de 0,04 a 0,085 Hz para a primeira sub-banda de baixa frequência (LF1) e de 0,085 a 0,15 Hz para a segunda sub-banda de baixa frequência (LF2). O coeficiente de Gini espectral (SpG) foi proposto para medir a desigualdade na distribuição de potência dos intervalos RR em cada uma das bandas de VFC mencionadas acima. O SpG de cada banda foi comparado com seu respectivo índice tradicional de VFC durante as condições de repouso e de estresse mental. Todas as diferenças foram consideradas estatisticamente significativas para p < 0,05. Resultados: Houve uma diminuição significativa no poder de FC (p=0,046), bem como aumentos significativos na frequência cardíaca (p = 0,004), potência da LF (p = 0,033), potência da LF2 (p = 0,019) e LF/HF (p = 0,002) durante estresse mental. Houve também um aumento significativo de SpG(LF) (p = 0,009) e SpG(LF2) (p = 0,033) durante estresse mental. O coeficiente de variação mostrou que o SpG tem mais homogeneidade em comparação com o índice tradicional de VFC durante o estresse mental. Conclusões: Este estudo piloto sugeriu que a desigualdade espectral da VFC analisada pelo coeficiente de Gini parece ser um indicador psicofisiológico independente e homogêneo de estresse mental. Além disso, FC, LF/HF, SpG(LF) da VFC são possivelmente indicadores importantes, confiáveis e válidos de estresse mental.

Indicadores antropométrico-nutricionales en la estratificación de riesgo cardiovascular en una población adulta / Anthropometric-nutritional indicators in cardiovascular risk stratification in an adult population

RESUMEN Introducción: las enfermedades cardiovasculares constituyen una de las causas más importantes de morbilidad, discapacidad y muerte prematura a nivel mundial. El control de los factores de riesgo es un elemento imprescindible para su prevención en la atención primaria, por lo cual es importante la estimación del riesgo. Objetivo: determinar el valor de indicadores antropométrico-nutricionales en la estratificación del riesgo cardiovascular en la población adulta. Métodos: se realizó un estudio observacional, descriptivo y transversal, la muestra estuvo conformada por 166 pacientes con edades comprendidas entre 35 y 74 años, pertenecientes al consultorio 22 del policlínico Carlos Juan Finlay de Santiago de Cuba, en el período septiembre a diciembre de 2017 donde se evaluó el índice de masa corporal, el índice cintura-cadera, índice de adiposidad corporal y riesgo cardiovascular global. Resultados: en los valores de los indicadores antropométricos-nutricionales en los diferentes grados de riego cardiovascular según sexo se muestra como en las mujeres el índice de masa corporal (p=0,002) y el índice de adiposidad corporal (p=0,007) permitieron diferenciar significativamente los grados de riesgo cardiovascular, no así el índice cintura-cadera (p=0,193); en cambio en los hombres se observaron diferencias significativas solamente en el índice de adiposidad corporal (p=0,042). Conclusiones: en la diferenciación de los niveles de riesgo cardiovascular global el índice de adiposidad corporal es útil para ambos sexos y el índice de masa corporal en las mujeres, no posibilitando esto el índice cintura-cadera.

ABSTRACT Introduction: cardiovascular disease is one of the leading causes of morbidity, disability and premature death worldwide. The control of risk factors is an essential element for their prevention in primary care, so it is important to estimate the risk. Objective: to determine the value of anthropometric-nutritional indicators in the stratification of cardiovascular risk in the adult population. Methods: an observational, descriptive and cross-sectional study was carried out. The sample consisted of 166 patients between 35 and 74 years old, belonging to the 22 consulting room at Carlos Juan Finlay polyclinic in Santiago de Cuba, from September to December 2017, where the body mass index, waist-hip index, body fat index and global cardiovascular risk were evaluated. Results: in the values of the anthropometric-nutritional indicators in the different degrees of cardiovascular risk according to gender, body mass index (p=0,002) and body adiposity index (p=0,007) allowed significantly differentiating the degrees of cardiovascular risk, but not the waist-hip index (p=0,193); in contrast, significant differences were observed in men only in the body adiposity index (p=0,042). Conclusions: in the differentiation of global cardiovascular risk levels, the body adiposity index is useful for both genders and the body mass index in women, not making the waist-hip index possible.

Introduction of Application of Gini Coefficient to Heart Rate Variability Spectrum for Mental Stress Evaluation.

BACKGROUND: The Gini coefficient is a statistical tool generally used by economists to quantify income inequality. However, it can be applied to any kind of data with unequal distribution, including heart rate variability (HRV). OBJECTIVES: To assess the application of the Gini coefficient to measure inequality in power spectral density of RR intervals, and to use this application as a psychophysiological indicator of mental stress. METHODS: Thirteen healthy subjects (19 ± 1.5 years) participated in this study, and their RR intervals were obtained by electrocardiogram during rest (five minutes) and during mental stress (arithmetic challenge; five minutes). These RR intervals were used to obtain the estimates of power spectral densities (PSD). The limits for the PSD bands were defined from 0.15 to 0.40 Hz for high frequency band (HF), from 0.04 to 0.15 Hz for low frequency band (LF), from 0.04 to 0.085 Hz for first low frequency sub-band (LF1) and from 0.085 to 0.15 Hz for second low frequency sub-band (LF2). The spectral Gini coefficient (SpG) was proposed to measure the inequality in the power distribution of the RR intervals in each of above-mentioned HRV bands. SpG from each band was compared with its respective traditional index of HRV during the conditions of rest and mental stress. All the differences were considered statistically significant for p < 0.05. RESULTS: There was a significant decrease in HF power (p = 0.046), as well as significant increases in heart rate (p = 0.004), LF power (p = 0.033), LF2 power (p = 0.019) and LF/HF (p = 0.002) during mental stress. There was also a significant increase in SpG(LF) (p = 0.009) and SpG(LF2) (p = 0.033) during mental stress. Coefficient of variation showed SpG has more homogeneity compared to the traditional index of HRV during mental stress. CONCLUSIONS: This pilot study suggested that spectral inequality of Heart Rate Variability analyzed using the Gini coefficient seems to be an independent and homogeneous psychophysiological indicator of mental stress. Also, HR, LF/HF, SpG(LF) of HRV are possibly important, reliable and valid indicators of mental stress.

Concepción de extensión universitaria desde las ciencias médicas en Santiago de Cuba / Conception of university extension from Santiago of Cuba medical sciences

RESUMEN El presente artículo está dirigido a sistematizar una concepción teórica y metodológica que sustente el proceso de extensión universitaria en la carrera de Medicina en Cuba. Entre los resultados se destaca el lugar y papel de la extensión universitaria en el sistema de la formación integral del profesional a la que se asigna una connotación especial, de marcado contenido axiológico, coherente con las necesidades y proyecciones sociales que facilita la formación del educando y fortalece la relación institución-comunidad. Es factible de ser aplicado pues puede devenir en una importante contribución a elevar el impacto social de la docencia médica en tanto atiendan aspectos como la preparación de los implicados en las diferentes instancias; la colaboración de los consejos populares y los factores de la comunidad que se manifiestan en el modo de actuación del profesional.

ABSTRACT The present article is directed to systematize a theoretical and methodological conception that sustains the process of university extension in the career of Cuban medicine. Among the results he/she stands out the place and paper of the university extension in the system of the integral formation from the professional to which a special connotation is assigned, of marked axiological contained, coherent with the necessities and social projections that it facilitates the formation of the educating and it strengthens the relationship institution-community. It is feasible of being applied then it can become in an important contribution to elevate the social impact of the medical teaching as long as they assist aspects like the preparation of those implied in the different instances; the collaboration of the popular advice and the factors of the community that are manifested in the way of the professional's performance.