Prevalence, Incidence, and Persistence of Postpartum Anxiety, Depression, and Comorbidity: A Cohort Study Among Women in Havana Cuba.

OBJECTIVE: To estimate the prevalence, incidence, and persistence of postpartum anxiety, depression, and comorbid symptoms over the first 6 months postpartum in a cohort of Havana women and to evaluate the sensitivity, specificity, and predictive power of the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) at 4 weeks postpartum on depressive and anxiety symptoms at 12 and 24 weeks. METHOD: A cohort study with 273 women in Havana, Cuba. Participants were assessed at 4, 12, and 24 weeks postpartum for anxiety, depression, and comorbid symptoms. RESULTS: Prevalence rates were highest at 4 weeks postpartum: 20.0% women reported elevated levels of anxiety and 16.4% reported depressive symptoms. The prevalence of comorbid anxiety and depression was 5.8%. While rates of anxiety steadily decreased to 13.8% at 24 weeks, rates of depression persisted to 24 weeks postpartum with 14.5% still experiencing elevated symptoms. Comorbid anxiety and depression decreased across time. There were limited sensitivity and poor predictive values for both the STAI and the EPDS. CONCLUSION: This study is the first to examine perinatal mental illness in Cuba. While anxiety and depression rates found among Cuban women are lower than those reported in other low-income countries, the rates paralleled high-income countries.

Caracterización tisular miocárdica por ultrasonidos y detección de disfunción diastólica por Dopplerpulsado: ¿índices precoces de miocardiopatía diabética? / Cardiac tissue characterization with ultrasound and: a very early index of diabetic cardiomyopathy?

Fundamento: Existe una miocardiopatía relacionada intrínsicamente con la diabetes y probablemente producida por el incremento de colágeno en el miocardio. Objetivo: Valorar el papel de la caracterización tisular miocárdica por ultrasonido y la detección de disfunción diastólica por Doppler pulsado como índices precoces de miocardiopatía diabética. Métodos: Estudio transversal, prospectivo, controlado que analizó la función diastólica con Doppler pulsado en 60 pacientes diabéticos y un grupo control de 15 personas sanas; todos normotensos, con prueba ergométrica negativa y función sistólica normal; 40 presentaban complicaciones microvasculares. Los valores de magnitud de variación cíclica fueron determinados a nivel del septum y la pared posterior. Los ecocardiogramas se realizaron con el equipo ALOKA 5500 con un transductor multibanda de 2.5 MHZ utilizando el programa beta de manejo digital (DMS) y el power Doppler en vistas ecocardiográficas estándar. Resultados: Se obtuvo reducción de la variación cíclica en diabéticos respecto al grupo control a nivel del septum 2D (3.4±1.3 vs. 4.4 ± 0.4 dB; p<0.003) y pared posterior PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB; p< 0.000001). Se encontrócorrelación entre presencia de disfunción diastólica y magnitudes bajas de variación cíclica (p<0.001). Lacaracterización tisular fue más sensible para detectar cambios precoces del miocardio en pacientes diabéticos(p<0.001).Conclusiones: La diabetes mellitus es causa de miocardiopatías que originan alteraciones muy precoces en el miocardio de estos pacientes; estoscambios pueden ser descubiertos en fases muy tempranas por el Doppler pulsado detectando disfuncióndiastólica y la caracterización tisular por ultrasonidos. Esta última es más sensible para el diagnóstico de dichaentidad(AU)

Introduction: There is an intrinsec myocardiopaty related with the diabetes and probably produced for the increment of collagen in the myocardium. Objective: To value the paper of the tissular myocardial characterization by ultrasound and the detection of diastolic dysfunction by pulsated Doppler as precocious indexes of diabetic miocardiopaty. Methods: Transverse, prospective,and controlled study thatanalyzed the diastolic function with pulsated Doppler in 60 diabetic patients and a control group of 15 healthyindividuals; all with a normal pressure, with a negative ergometric test and normal systolic function; 40 presented microvascular complications. The securities of magnitude of recurrent variation were determined at thelevel of the septum and the posterior wall. The echocardiograms were carried out with the equipment ALOKA 5500 with a multiband transducer of 2.5 MHZusing the beta digital handling program (DMS) and thepower Doppler in ecocardiografic views . Results:Reduction of the recurrent variation was obtained in diabetics with respect to the control group at the level of the septum 2D (3.4 ±1.3 vs. 4.4 ± 0.4 dB; p <0.003) and the posterior wall PP2D (3.4 ± 1.3 vs. 6.2 ± 0.4 dB;p <0.000001). Was found a correlation between the presence of diastolic dysfunction and the low magnitudes of ciclic variation (p <0.001). The tissularcharacterization was more sensitive to detect precocious changes of the myocardium in diabetic patients (p<0.001). Conclusions: The diabetes mellitus is cause of myocardiopaties that originate very precocious alterations in the myocardium of these patients; thesechanges can be discovered in very early phases by the pulsated Doppler detecting diastolic dysfunction and the tissular characterization by ultrasounds. This last one is more sensitive for the diagnosis of this entity(AU)

Hiperglucemia y anormalidades acústicas del tejido miocárdico del paciente con diabetes mellitus / Hyperglycaemia and acoustic abnormalities of the myocardial tissue of the patient with diabetes mellitus

Se estudiaron 60 pacientes con diabetes mellitus para correlacionar las alteraciones ecocardiográficas del miocardio, mediante técnica de caracterización hística (variación cíclica), con los trastornos de la glucemia y la presencia de complicaciones microvasculares. Se detectó que existía asociación entre alteraciones de la variación cíclica y presencia de complicaciones microvasculares (p = 0,003). Se obtuvo una correlación lineal entre valores altos de HbA1 y alteraciones de caracterización hística al nivel del septum 2D (p<0,001; r = - 0,4), así como con hiperglucemia posprandial 2h (p < 0,01; r = - 0,3) y enayunas (p < 0,04; r = - 0,2). Igualmente, encontramos correlación lineal inversa entre el tiempo de evolución de la enfermedad y los valores de variación cíclica, tanto para septum 2D (p < 0,003; r = -0,4) y PP2D (p < 0,001; r = - 0,3). Se concluyó que la caracterización hística del miocardio permite detectar alteraciones precoces en diabéticos complicados con daño microvascular, traducidas por disminución de la variación cíclica, correlacionadas con descontrol glucémico y mayor tiempo de evolución de la enfermedad.

60 patients with diabetes mellitus were studied to correlate the echocardiographic alterations of the myocardium, by histic characterization technique (cyclical variation), with glycaemia disorders and the presence of microvascular complications. An association between the alterations of cyclical variation and the presence of microvascular complications was found (p = 0.003). It was obtained a lineal correlation between the high values of HbA1 and the histic characterization alterations at the level of the septum 2D (p< 0.001; r = - 0.4), as well as with postprandial hyperglycaemia 2h (p<0.01; r = - 0.3) and under fasting conditions (p<0.04; r = - 0.2). Likewise, it was observed an inverse lineal correlation between the time of evolution of the disease and the values of cyclical variation, both for septum 2D (p<0.003; r = -0.4) and PP2D (p < 0.001; r = - 0.3). It was concluded that the histic characterization of the myocardium allows to detect early alterations in diabetic patients complicated with microvascular damage, expressed by the decrease of the cyclical variation, correlated with glycaemia decontrol and a longer time of evolution of the disease.

Hiperglucemia y anormalidades acústicas del tejido miocárdico del paciente con diabetes mellitus / Hyperglycaemia and acoustic abnormalities of the myocardial tissue of the patient with diabetes mellitus

Se estudiaron 60 pacientes con diabetes mellitus para correlacionar las alteraciones ecocardiográficas del miocardio, mediante técnica de caracterización hística (variación cíclica), con los trastornos de la glucemia y la presencia de complicaciones microvasculares. Se detectó que existía asociación entre alteraciones de la variación cíclica y presencia de complicaciones microvasculares (p = 0,003). Se obtuvo una correlación lineal entre valores altos de HbA1 y alteraciones de caracterización hística al nivel del septum 2D (p<0,001; r = - 0,4), así como con hiperglucemia posprandial 2h (p < 0,01; r = - 0,3) y enayunas (p < 0,04; r = - 0,2). Igualmente, encontramos correlación lineal inversa entre el tiempo de evolución de la enfermedad y los valores de variación cíclica, tanto para septum 2D (p < 0,003; r = -0,4) y PP2D (p < 0,001; r = - 0,3). Se concluyó que la caracterización hística del miocardio permite detectar alteraciones precoces en diabéticos complicados con daño microvascular, traducidas por disminución de la variación cíclica, correlacionadas con descontrol glucémico y mayor tiempo de evolución de la enfermedad(AU)

60 patients with diabetes mellitus were studied to correlate the echocardiographic alterations of the myocardium, by histic characterization technique (cyclical variation), with glycaemia disorders and the presence of microvascular complications. An association between the alterations of cyclical variation and the presence of microvascular complications was found (p = 0.003). It was obtained a lineal correlation between the high values of HbA1 and the histic characterization alterations at the level of the septum 2D (p< 0.001; r = - 0.4), as well as with postprandial hyperglycaemia 2h (p<0.01; r = - 0.3) and under fasting conditions (p<0.04; r = - 0.2). Likewise, it was observed an inverse lineal correlation between the time of evolution of the disease and the values of cyclical variation, both for septum 2D (p<0.003; r = -0.4) and PP2D (p < 0.001; r = - 0.3). It was concluded that the histic characterization of the myocardium allows to detect early alterations in diabetic patients complicated with microvascular damage, expressed by the decrease of the cyclical variation, correlated with glycaemia decontrol and a longer time of evolution of the disease(AU)