Rehabilitation of Patients with Arthrogenic Muscular Inhibition in Pathologies of Knee Using Virtual Reality.

Arthrogenic muscle inhibition (AMI) refers to muscular alterations that are generated, producing biomechanical motor control and movement problems, leading to deficiencies in strength and atrophy. Currently, there exist methods that involve virtual reality (VR) and have been well perceived by physiotherapists. The present research measured the potential benefits in terms of therapeutic adherence and speed of recovery, through a comparative analysis in a healthcare provider institution, in Medellín, Colombia, with and without the aid of VR. For this purpose, dynamometry, and surface electromyography (sEMG) signal acquisition tools were used. The treatment involved neuromodulation, ranges of motion and mobility work, strengthening and reintegration into movement, complemented with TENS, NMENS and therapeutic exercise, where the patient was expected to receive a satisfactory and faster adherence and recovery. A group of 15 people with AMI who include at least 15 min of VR per session in their treatment were compared with another group who received only the base treatment, i.e., the control group. Analyzing the variables individually, it is possible to affirm that VR, as a complement, statistically significantly improved the therapeutic adherence in 33.3% for CG and 37.5% for IG. Additionally, it increased strength with both legs, the symmetry between them, and decreased the level of pain and stiffness that is related to mobility.

Longitudinal Analysis of Neuraminidase and Hemagglutinin Antibodies to Influenza A Viruses after Immunization with Seasonal Inactivated Influenza Vaccines.

Neuraminidase (NA)-based immunity could reduce the harmful impact of novel antigenic variants of influenza viruses. The detection of neuraminidase-inhibiting (NI) antibodies in parallel with anti-hemagglutinin (HA) antibodies may enhance research on the immunogenicity and duration of antibody responses to influenza vaccines. To assess anti-NA antibodies after vaccination with seasonal inactivated influenza vaccines, we used the enzyme-linked lectin assay, and anti-HA antibodies were detected in the hemagglutination inhibition assay. The dynamics of the anti-NA antibody response differed depending on the virus subtype: antibodies to A/H3N2 virus neuraminidase increased later than antibodies to A/H1N1pdm09 subtype neuraminidase and persisted longer. In contrast to HA antibodies, the fold increase in antibody titers to NA after vaccination poorly depended on the preexisting level. At the same time, NA antibody levels after vaccination directly correlated with titers before vaccination. A difference was found in response to NA antigen between split and subunit-adjuvanted vaccines and in NA functional activity in the vaccine formulations.

Virtual Reality Game for Physical and Emotional Rehabilitation of Landmine Victims.

Landmine victims require an engaging and immersive rehabilitation process to maintain motivation and therapeutic adherence, such as virtual reality games. This paper proposes a virtual reality exercise game called Exogames, which works with Nukawa, a lower limb rehabilitation robot (LLRR). Together, they constitute the general Kina system. The design and development process of Exogames is reported, as well as the evaluation of its potential for physical and emotional rehabilitation. In an initial survey designed ad-hoc, 13 health professionals evaluated compliance with various requirements. They agreed that Exogames would help the user focus on rehabilitation by providing motivation; 92.3% said that the user will feel safe in the virtual world, 66.7% of them agreed or totally agreed that it presents characteristics that may enhance the physical rehabilitation of lower limbs for amputees, 83.3% stated that it would promote the welfare of landmine victims, and 76.9% responded that the graphical interface and data report are useful for real-time assessment, and would be helpful for four interventional areas in all rehabilitation stages. In a second evaluation, using standardized surveys, five physical therapists and one lower limb amputee tried the Kina system as users. They filled out the System Usability Scale (SUS), the Physical Activity Enjoyment Scale (PACES), and the Game Experience Questionnaire (GEQ). The usability of the Kina system overall score was 69 (66, 79) out of 100, suggesting an acceptable though improvable usability. The overall PACES score of 110 (108, 112) out of 126 suggests that users enjoyed the game well. Finally, users indicated a positive effect with a good sense of immersion and smooth of gameplay during the tests, as indicated by the GEQ results. In summary, the evaluations showed that Exogames has the potential to be used as a virtual reality game for the physical and emotional rehabilitation of landmine victims.

Synthesis and characterization of a silver nanoparticle-containing polymer composite with antimicrobial abilities for application in prosthetic and orthotic devices.

BACKGROUND: The presence of skin problems in patients using external lower limb prosthesis is recurrent. This has generated the need to develop interfaces for prosthesis with the ability to control microbial growth. Silver nanoparticles (AgNPs) have been implemented in the development of biomaterials because of their high antimicrobial activity. This article discusses the development of an AgNP-containing polymer composite with antimicrobial activity for developing prosthetic liners. METHODS: AgNPs were synthesized using a photochemical method and certain physicochemical properties were characterized. Furthermore, the antimicrobial activity of AgNPs against Staphylococcus aureus ATCC 25923 and methicillin-resistant Staphylococcus aureus (MRSA), was assessed on the basis of their minimum inhibitory concentrations (MICs). AgNPs were incorporated into a silicon elastomer to assess certain physicomechanical properties, antimicrobial activity and cytotoxic effect of the material. RESULTS: The maximum antimicrobial activity of the material against Staphylococcus aureus ATCC 25923 and MRSA was 41.58% ±2.97% at AgNP concentration of 32.98 µg/mL and 14.85% ±5.94% at AgNP concentration of 16.49 µg/mL, respectively. Additionally, the material exhibited tensile yield strength, rupture tensile strength, and tensile modulus of elasticity of 0.70 - 1.10 MPa, 0.71-1.06 MPa, and 0.20 - 0.30 MPa, respectively. The mechanical characteristics of the material were within the acceptable range for use in external lower limb prosthetic and orthotic interfaces. CONCLUSIONS: It was possible to incorporate the AgNPs in a silicone elastomer, finding that the composite developed presented antimicrobial activity against Staphylococcus aureus ATCC 25923 and MRSA when compared to non-AgNP material samples.

Myoelectric control algorithm for robot-assisted therapy: a hardware-in-the-loop simulation study.

BACKGROUND: A direct blow to the knee is one way to injure the anterior cruciate ligament (ACL), e.g., during a football or traffic accident. Robot-assisted therapy (RAT) rehabilitation, simulating regular walking, improves walking and balance abilities, and extensor strength after ACL reconstruction. However, there is a need to perform RAT during other phases of ACL injury rehabilitation before attempting an advanced exercise such as walking. This paper aims to propose a myoelectric control (MEC) algorithm for a robot-assisted rehabilitation system, "Nukawa", to assist knee movement during these types of exercises, i.e., such as in active-assisted extension exercises. METHODS: Surface electromyography (sEMG) signal processing algorithm was developed to detect the motion intention of the knee joint. The sEMG signal processing algorithm and the movement control algorithm, reported by the authors in a previous publication, were joined together as a hardware-in-the-loop simulation to create and test the MEC algorithm, instead of using the actual robot. EXPERIMENTS AND RESULTS: An experimental protocol was conducted with 17 healthy subjects to acquire sEMG signals and their lower limb kinematics during 12 ACL rehabilitation exercises. The proposed motion intention algorithm detected the orientation of the intention 100% of the times for the extension and flexion exercises. Also, it detected in 94% and 59% of the cases the intensity of the movement intention in a comparable way to the maximum voluntary contraction (MVC) during extension exercises and flexion exercises, respectively. The maximum position mean absolute error was [Formula: see text], [Formula: see text], and [Formula: see text] for the hip, knee, and ankle joints, respectively. CONCLUSIONS: The MEC algorithm detected the intensity of the movement intention, approximately, in a comparable way to the MVC and the orientation. Moreover, it requires no prior training or additional torque sensors. Also, it controls the speed of the knee joint of Nukawa to assist the knee movement, i.e., such as in active-assisted extension exercises.

Optimization of silver nanoparticle synthesis by chemical reduction and evaluation of its antimicrobial and toxic activity.

BACKGROUND: Chemical reduction has become an accessible and useful alternative to obtain silver nanoparticles (AgNPs). However, its toxicity capacity depends on multiple variables that generate differences in the ability to inhibit the growth of microorganisms. Thus, optimazing parameters for the synthesis of AgNPs can increase its antimicrobial capacity by improving its physical-chemical properties. METHODS: In this study a Face Centered Central Composite Design (FCCCD) was carried out with four parameters: A g N O 3 concentration, sodium citrate (TSC) concentration, N a B H 4 concentration and the pH of the reaction with the objective of inhibit the growth of microorganisms. The response variables were the average size of AgNPs, the peak with the greatest intensity in the size distribution, the polydispersity of the nanoparticle size and the yield of the process. AgNPs obtained from the optimization were characterized physically and chemically. The antimicrobial activity of optimized AgNPs was evaluated against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans and compared with AgNPs before optimization. In addition, the cytotoxicity of the optimized AgNPs was evaluated by the colorimetric assay MTT (3- (4,5- Dimethylthiazol- 2- yl)- 2, 5 - Diphenyltetrazolium Bromide). RESULTS: It was found that the four factors studied were significant for the response variables, and a significant model (p < 0.05) was obtained for each variable. The optimal conditions were 8 for pH and 0.01 M, 0.0 6M, 0.01 M for the concentration of TSC, A g N O 3, and N a B H 4, respectively. Optimized AgNPs spherical and hemispherical were obtained, and 67.66% of it had a diameter less than 10.30 nm. A minimum bactericidal concentration (MBC) and minimum fungicidal Concentration (MFC) of optimized AgNPs was found against Staphylococcus aureus, Escherichia coli, Escherichia coli AmpC resistant, and Candida albicans at 19.89, 9.94, 9.94, 2.08 µg/mL, respectively. Furthermore, the lethal concentration 50 (L C 50) of optimized AgNPs was found on 19.11 µg/mL and 19.60 µg/mL to Vero and NiH3T3 cells, respectively. CONCLUSIONS: It was found that the factors studied were significant for the variable responses and the optimization process used was effective to improve the antimicrobial activity of the AgNPs.

Valoración cuantitativa para la reincorporación ocupacional / Quantitative assessment for the occupational reintegration

Resumen El progreso de la bioingeniería ha permitido el desarrollo de herramientas tecnológicas para cuantificar las variables asociadas al examen físico. En este artículo se presenta la descripción, ventajas y limitaciones de tecnologías para la medición de fuerza, arcos de movimiento, equilibrio y estabilidad, coordinación y marcha. Se proponen también alternativas para uso de estas tecnologías como parte del proceso de valoración de pacientes complejos, ya sea porque se sospeche simulación o porque presenten lesiones graves en las que se requiera sugerir opciones en el proceso de rehabilitación o cierre de caso. En tales circunstancias se identifican alternativas para un diagnóstico más completo que disminuyan la subjetividad del terapeuta y con mayores posibilidades de monitoreo.

Abstract The progress of bioengineering has allowed the development of technological tools to quantify the variables associated to the physical assessment process. The description, advantages and limitations of technologies to measure the strength, range of motion, balance and stability, coordination and gait are shown. Some alternatives are proposed for using those technologies as part of the appreciation process in complex patients, either for any suspicion of simulation or because any serious injury can exist where some alternatives for rehabilitation process are required. In such cases, must be identified some options for a more complete diagnosis, decreasing the subjectivity of the therapist and with more monitoring possibilities.

Evaluación de un programa de Atención: Farmacéutica en pacientes con Diabetes Mellitus Tipo 2 / Evaluation of a Program of Pharmaceutical Care to Patients with Type 2 Diabetes Mellitus

Introducción: La Atención Farmacéutica es la provisión responsable de la farmacoterapia con el propósito de alcanzar resultados concretos que mejoren la calidad de vida de los pacientes. Objetivo: Evaluar el impacto de las intervenciones farmacéuticas en pacientes con Diabetes Mellitus Tipo 2. Para ello se analizan al inicio y final del estudio: glicemia, hemoglobina glicosilada, calidad de vida de los pacientes, el conocimiento sobre la diabetes y los medicamentos que consume y los PRM iniciales y resueltos durante el estudio. Metodología: Ensayo Clínico Aleatorizado, con medición de variables antes y después. No probabilístico. De conveniencia. Participaron 32 pacientes del grupo intervenido y 32 en grupo control. Se realizaron entrevistas mensuales en un periodo de intervención farmacéutica de 6 meses (desde octubre 2011 hasta junio 2012). Se registraron solo 3 abandonos. Resultados: La edad de los pacientes fue 55,6±10,6 años. Los pacientes del grupo intervenido mejoraron la glicemia en 34% donde 24 pacientes tenían el valor (≤ 130 mg/dL); la hemoglobina glicosilada mejoró 1,9% donde 15 pacientes lograron los parámetros deseados (≤ 6,5%). La calidad de vida del grupo intervenido fue de (56,3 a 71,3 %) en el grupo control disminuyó de (57,4 a 46,1 %). En el grupo intervenido se encontraron 80 PRM, en 27 pacientes, se resolvieron 59; al final del estudio 12 pacientes resolvieron todos los PRM; se realizaron 254 intervenciones farmacéuticas, el nivel de conocimiento de los pacientes sobre la enfermedad mejoro en 41%, el conocimiento sobre sus medicamentos mejoro en 53%. Conclusión: Las intervenciones farmacéuticas mejoraron la calidad de vida, los parámetros clínicos de glicemia, hemoglobina glicosilada, optimizaron el uso de medicamentos, disminuyeron los PRM, mejoraron la satisfacción de los pacientes

Introduction: Pharmaceutical Care is the responsible provision of pharmacotherapy for the purpose of achieving concrete results in order to improve the quality of life of patients. Objective: To evaluate the impact of pharmaceutical intervention in patients with Type 2 Diabetes Mellitus. With this aim, the following aspects were analyzed at the beginning and at the end of the study: glycemia, glycosylated hemoglobin, quality of life of the patients, their diabetes knowledge, current medications and initial medicine-related problems and the ones that were solved during the study. Methodology: It was carried out a random clinical trial in which some variables were measured before and after it. It was a non probabilistic and conveniently trial. 32 patients of the intervention group and 32 at a control group participated on it. Monthly interviews were performed in a period of 6 months of pharmaceutical intervention (from October 2011 to June 2012). In this period, only 3 dropouts were recorded. Results: The age of the patients was 55.6 ± 10.6 years. The patients of the intervention group improved glycemia in 34%; 24 patients showed a value of (≤ 130 mg/dL); glycosylated hemoglobin improved in 1.9%; 15 patients reached the desired parameters (≤ 6.5%). The life quality of the intervention group increased from 56.3 to 71.3%. On the contrary, in the control group it decreased from 57.4 to 46.1 %. Within the intervention group were found 80 drug-related problems in 27 patients. 59 were solved. At the end of the research, 12 patients solved all their drug-related problems. 254 pharmaceutical interventions were performed. The level of patients’ knowledge related to their disease improved by 41% and the knowledge about their medication improved by 53%. Conclusion: It was demonstrated that pharmaceutical interventions helped improving the life quality, the clinical parameters of glycemia, glycosylated hemoglobin and the use of medicines. On the other hand, they lowered drug-related problems and increased patien' satisfaction

Impacto de la Atención Farmacéutica en la calidad de vida de pacientes con Diabetes Mellitus Tipo 2 / Impact of pharmaceutical care in clinical outcomes and quality of life of patients with type 2 diabetes mellitus

Introducción: La calidad de vida relacionada a la salud, agrupa elementos propios del individuo y otros externos al mismo, pero que interaccionan con él y pueden llegar a cambiar su estado de salud. Abarca áreas de función física, somática, estado psicológico y relación social. Objetivo: Evaluar los parámetros clínicos y la calidad de vida de pacientes con Diabetes Mellitus Tipo 2, que forman parte de un programa de Atención Farmacéutica. Metodología: Ensayo Clínico Aleatorizado, con medición de variables antes y después. No probabilístico. De conveniencia. Participaron 32 pacientes del grupo intervenido y 32 en grupo control. Se realizaron entrevistas mensuales durante 6 meses (desde octubre 2011 hasta junio 2012). Resultados: La edad promedio de los pacientes fue 55,6±10,6 años. En su mayoría mujeres. La evolución de la enfermedad fue 8,96±8,13 años. La patología asociada más frecuente fue en 82% hipertensión arterial. Los pacientes intervenidos mejoraron la glicemia en 35% donde 24 pacientes tenían el valor (≤ 130 mg/dL); la hemoglobina glicosilada mejoró 22% donde 15 pacientes lograron los parámetros deseados (≤ 6,5%). La calidad de vida del grupo intervenido aumento de (56,3 a 71,3 %), mejorando en todas las dimensiones y registrando una disminución en dolor corporal del grupo intervenido, en cambio en el grupo control disminuyó de (57,4 a 46,1 %), registrándose un aumento en la dimensión de dolor corporal. Conclusión: Los parámetros clínicos y la Calidad de vida del paciente diabético se ve influenciada positivamente por la intervención del farmacéutico en Atención Farmacéutica

Introduction: The relationship between quality of life and health combines elements intrinsic of the individual as well as external ones that interact with him. They possess the ability of changing the state of health. It includes such areas as physical, somatic, psychological and social. Objective: To evaluate the clinical parameters and quality of life of patients with Type 2 Diabetes Mellitus, within a program of Pharmaceutical Care. Methodology: Randomized Clinical Trial with measurement of variables before and after the evaluation. Non probabilistic. Convenience. 32 patients participated in the intervention group; 32 in the control group. Monthly interviews were conducted for 6 months, from October 2011 to June 2012. Results: The average age of the patients was 55,6±10,6 years. They were mostly women. The evolution of the condition was 8,96±8,13 years. The most frequent associated pathology was high blood pressure in 82% of them. The glycemia levels of the patients improved 35%, where 24 of the patients showed an index ≤ 130 mg/dL; glycosylated hemoglobin level improved 22%, where 15 patients achieved desired parameters (≤ 6,5%). The quality of life of the intervened group improved from 56.3 % to 71.3% in all dimensions showing a decrease in body pain for the intervened group. Body pain levels for the control group decreased from 57.4 to 46.1 % showing an increase in the body pain dimension. Conclusion: Clinical parameters and quality of life of diabetic patients is positively influenced by the intervention of the pharmacist in pharmaceutical care

Randomized, proof-of-principle clinical trial of active transcranial magnetic stimulation in chronic migraine.

BACKGROUND: High-frequency repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex (rTMS-DLPFC) is an effective treatment for depression. Preliminary studies indicated beneficial effects of rTMS-DLPFC on pain relief in patients treated for depression, and in patients with chronic migraine. METHODS: In this randomized, double-blind, parallel-group, single-center, proof-of-principle clinical trial, we tested the hypothesis that 23 sessions of active rTMS-DLPFC delivered over eight weeks would be feasible, safe and superior to sham rTMS to decrease the number of headache days in 18 patients with chronic migraine without severe depression. Per-protocol analysis was performed. RESULTS: rTMS-DLPFC applied over eight weeks was feasible and safe in patients with chronic migraine. Contrary to our primary hypothesis, the number of headache days decreased significantly more in the sham group than in the group treated with active rTMS-DLPFC at eight weeks. Average decrease in headache days was >50% in the sham group, indicating a powerful placebo response. Pain intensity improved in both groups to a similar extent. CONCLUSIONS: Positive results of M1 stimulation in other studies, and the absence of significant benefits of active high-frequency rTMS of the DLPFC in the present study, point to M1 as a more promising target than the DLPFC, for larger trials of noninvasive brain stimulation in patients with chronic migraine.

An inactivated, adjuvanted whole virion clade 2.2 H5N1 (A/Chicken/Astana/6/05) influenza vaccine is safe and immunogenic in a single dose in humans.

In this study, we assessed in humans the immunogenicity and safety of one dose (7.5 or 15 µg of hemagglutinin [HA]) of a whole-virion inactivated prepandemic influenza vaccine adjuvanted with aluminum hydroxide. The vaccine strain was made by reverse genetics from the highly pathogenic avian A/Chicken/Astana/6/05 (H5N1) clade 2.2 strain isolated from a dead bird in Kazakhstan. The humoral immune response was evaluated after a single vaccination by hemagglutination inhibition (HI) and microneutralization (MN) assays. The vaccine was safe and immunogenic, inducing seroconversion in 55% of the evaluated patients, with a geometric mean titer (GMT) of 17.1 and a geometric mean increase (GMI) of 3.42 after a dose of 7.5 µg in the HI test against the vaccine strain. The rate of seroconversion increased up to 70% when the dose of 15 µg was used. The percentages of individuals achieving anti-HA titers of ≥1:40 were 52.5% and 57.5% for the 7.5- and 15-µg dose groups, respectively. Similar results were obtained when antibodies were analyzed in an MN test. Substantial cross-neutralization titers (seroconversion in 35% and 52.5% of subjects in the two dose groups, respectively) were detected against heterologous clade 1 strain NIBRG14 (H5N1). Thus, one dose of this whole-virion prepandemic vaccine adjuvanted with aluminum has the potential to be effective against H5N1 viruses of different clades.

Generalized anxiety disorder, subthreshold anxiety and anxiety symptoms in primary headache.

AIMS: The aim of the present study was to evaluate the association between generalized anxiety disorder, subthreshold anxiety (SubAnx) and anxiety symptoms in the prevalence of primary headache. METHODS: This cross-sectional study evaluated 383 people from a Brazilian low-income community. One-year prevalence rates of migraine, chronic migraine and tension-type headache were calculated. Anxiety symptoms were then separated into the following groups (based on DSM-IV criteria): no anxiety criteria; one anxiety criterion; two anxiety criteria; and generalized anxiety disorder (GAD). The control group (no headaches) was compared with headache sufferers for each anxiety group using an adjusted model controlled for confounding factors. RESULTS: GAD was present in 37.0% of participants and SubAnx in 16.6%. Those with SubAnx had a 2.28-fold increased chance of having migraine; 3.83-fold increased chance of having chronic migraine, a 5.94-fold increased chance of having tension-type headache and a 3.27-fold increased chance of having overall headache. Some anxiety criteria (irritability, difficulty with sleep, concentration problems, muscle tension and fatigue) had similar prevalence to International Classification of Headache Disorders (ICHD-II) headache criteria such as unilateral pain and nausea for migraine and chronic migraine. CONCLUSION: Headache sufferers seem to have a high prevalence of anxiety symptoms and SubAnx. In addition, the presence of two or more anxiety criteria (not necessarily fulfilling all the criteria for GAD) was associated with having a headache disorder.

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: what do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.

Cephalalgiaphobia: a possible specific phobia of illness.

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care. Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.

Phobias, other psychiatric comorbidities and chronic migraine / Fobias, outras comorbidades psiquiátricas e enxaqueca crônica

BACKGROUND: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. METHOD: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. RESULTS: Lifetime criteria for at least one mental disorder was found in 87.5 percent of the sample; 75 percent met criteria for at least one lifetime anxiety disorder and 60.7 percent of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. CONCLUSION: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.

INTRODUÇÃO: As comorbidades psiquiátricas das enxaquecas crônicas são bem conhecidas. As fobias, transtorno ansioso mais comum, são mais prevalentes entre enxaquecosos do que entre não enxaquecosos. O perfil clínico de fobias em uma população enxaquecosa nunca foi estudado. MÉTODO: Estudamos aspectos psiquiátricos de uma população de 56 pacientes com enxaqueca crônica. RESULTADOS: Usando o SCID I/P para o DSM-IV, critérios diagnósticos para ao menos algum transtorno psiquiátrico durante a vida foram preenchidos por 87,5 por cento de nossa amostra, 75 por cento para ao menos um transtorno ansioso e 60,7 por cento para condições fóbicas em algum momento de suas vidas. Os escores de ansiedade e humor foram maiores entre os fóbicos e o número de fobias teve correlação positiva com o grau de ansiedade e depressão. CONCLUSÃO: Fobias são comuns na enxaqueca crônica e seu reconhecimento poderia influenciar seu manejo e melhorar seu prognóstico.

Phobias, other psychiatric comorbidities and chronic migraine.

BACKGROUND: Comorbidity of chronic migraine (CM) with psychiatric disorders, mostly anxiety and mood disorders, is a well-recognized phenomenon. Phobias are one of the most common anxiety disorders in the general population. Phobias are more common in migraineurs than non-migraineurs. The clinical profile of phobias in CM has never been studied. METHOD: We investigated the psychiatric profile in 56 patients with CM using the SCID I/P interview. RESULTS: Lifetime criteria for at least one mental disorder was found in 87.5% of the sample; 75% met criteria for at least one lifetime anxiety disorder and 60.7% of our sample fulfilled DSM-IV criteria for lifetime phobic avoidant disorders. Mood and anxiety scores were higher in phobic patients than in non-phobic CM controls. Number of phobias correlated with higher levels of anxiety and depression. CONCLUSION: Phobias are common in CM. Its recognition may influence its management. Early treatment may lead to better prognosis.

Reperfusion arrhythmias: role of early afterdepolarizations studied by monophasic action potential recordings in the intact canine heart during autonomically denervated and stimulated states.

INTRODUCTION: The precise mechanism of reperfusion arrhythmias is not established. The role of early afterdepolarizations (EADs) and triggered activity in the genesis of reperfusion ventricular arrhythmia was investigated. METHODS AND RESULTS: Monophasic action potentials (MAPs) were recorded in the canine heart using Ag-AgCl contact electrodes from the left and right ventricular endocardium and the left ventricular epicardial border zone during 10 minutes of occlusion of the proximal left anterior descending coronary artery followed by 2 minutes of reperfusion. Ventricular arrhythmias during ischemia and reperfusion were studied in three autonomically varied groups. Group 1 (n = 8) had intact autonomic neural innervation; group 2 (n = 8) had bilateral transection of ansae subclavii and vagi; and group 3 (n = 8) underwent bilateral transection of ansae subclavii and vagi with bilateral ansae subclavii stimulation during reperfusion. Ventricular fibrillation (VF) on reperfusion occurred in 2, 3, and 5 animals in the innervated, denervated, and sympathetically stimulated groups, respectively. Rapid ventricular tachycardia during ansae subclavii stimulation, antecedent to VF, occurred in 4 of 5 episodes in the sympathetically stimulated group. The frequency of premature ventricular complexes, couplets, and triplets on reperfusion was not significantly different among the three groups. Phase 2 or phase 3 EADs were noted during the acute ischemic phase in 6 of 8, 7 of 8, and 7 of 8 animals in the three groups, respectively (and persisted during reperfusion in the majority). Thus, these EADs were not a de novo phenomenon during reperfusion. Of the 72 MAP recording sites, only one demonstrated de novo phase 2 EADs during reperfusion. EADs disappeared during reperfusion in 6 animals (prior to the onset of VF in 4), and 5 dogs developed reperfusion VF without EADs being recorded. There was no direct correlation between the presence of EADs during reperfusion and the development of VF. The prevalence and onset of reperfusion VF was not significantly different in the presence of sympathetic stimulation. CONCLUSION: This study demonstrates that EADs can be recorded in the majority of dogs during both ischemia and reperfusion and do not appear to be a major mechanism responsible for reperfusion ventricular tachycardia and VF.

Acute hypokalemia and inducibility of ventricular tachyarrhythmia in a nonischemic canine model.

Inducibility of sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) by programmed ventricular stimulation following acute hypokalemia was studied in 21 anesthetized dogs free of inducible ventricular tachyarrhythmias at baseline. The control mean serum potassium concentration of 3.65 mEq/L was decreased to 2.14 mEq/L by insulin and furosemide administration. Inducibility of arrhythmias was also assessed following isoproterenol infusion before and after induction of hypokalemia. None of the animals developed sustained VT. Only one animal developed VF following hypokalemia (p greater than 0.05). Two normokalemic animals and five hypokalemic animals developed VF following isoproterenol infusion; this difference was not significant (p greater than 0.05). In this study, hypokalemia did not predispose to the development of a substrate necessary for the genesis and maintenance of VT. The inducibility of VF following hypokalemia was not significantly enhanced and appears to be related to the "aggressive" stimulation protocol.

Two phase radiofrequency catheter ablation of isolated ventricular endomyocardium.

UNLABELLED: This report describes a two phase radiofrequency (TPRF) energy source producing two radiofrequency sinusoidal voltages of similar frequency but different phase angles between three points of wire. When delivered through an orthogonal electrode catheter array (OECA) TPRF energy produces a square-shaped lesion of the area covered by the five electrodes (0.8 cm2). The purposes of the study were: to create square-shaped lesions using TPRF energy; to compare the size of lesions created by single phase radiofrequency (SPRF) to that of TPRF energy; and to study the depth of such lesions and to create lesions of desired size by adjacent placement of the OECA using TPRF energy. Ablations were created in nine isolated bovine hearts using three power settings (10, 20, and 40 watts) and three pulse durations (5, 10, and 20 seconds). Pathological examination was performed to document the length, width, depth, and the microscopic changes of ablations. TPRF energy increases the size of lesion (P less than 0.001) and utilizes less power (P less than 0.008) at the same power setting and pulse duration compared to SPRF energy. This is possibly related to earlier rise in impedance with TPRF compared to SPRF ablations. The largest lesion for both SPRF (0.51 +/- 0.08 cm2) and TPRF (1.03 +/- 0.18 cm2) ablations were observed at 20 watts for 20 seconds. By adjacent placement of the OECA and TPRF energy desired size (6 cm2) lesions were created. There was no significant difference between the depth of SPRF versus TPRF ablations at comparable power setting and pulse duration. Pathological examination revealed the shape of lesions were elliptical or cross-shaped for SPRF and square for TPRF ablations. Microscopic examination revealed coagulation necrosis, edema, and few necrotic cardiac muscle strands. CONCLUSIONS: TPRF energy can cause 1.2 cm2 lesions. TPRF compared to SPRF energy causes larger lesions but depth of lesions are not different than SPRF energy at the same power setting and pulse duration. By adjacent placement of OECA and TPRF energy desired size lesion can be created (6 cm2).