Implicaciones pronósticas de la hiperglucemia de estrés en el infarto agudo de miocardio con elevación del ST. Estudio observacional prospectivo / Prognostic implications of stress hyperglycemia in acute ST elevation myocardial infarction. Prospective observational study

Introducción y objetivos. La hiperglucemia al ingreso se asocia a mal pronóstico en pacientes con infarto agudo de miocardio. El objetivo es evaluar la asociación independiente entre la hiperglucemia de estrés y la mortalidad hospitalaria en pacientes con infarto agudo de miocardio con elevación del ST (IAMCEST). Métodos. Analizamos a 834 pacientes ingresados de forma consecutiva por IAMCEST en la Unidad Coronaria. La asociación entre la glucemia al ingreso y la mortalidad hospitalaria se evaluó mediante regresión de Cox. La capacidad discriminatoria del modelo multivariable se evaluó mediante el estadístico C de Harrell. Resultados. La mortalidad fue del 10,7% (89/834 pacientes). Mediante las curvas ROC se determinó como punto de corte óptimo para la mortalidad una glucemia >= 140mg/dl. La incidencia de arritmias fue más frecuente en pacientes con glucemias >= 140mg/dl, tanto para las arritmias ventriculares malignas (el 28 frente al 18%; p=0,001) como para los trastornos de conducción intraventricular (el 5 frente al 2%; p=0,005) y auriculoventricular (el 9 frente al 5%; p=0,05), al igual que ocurrió con la incidencia de muerte intrahospitalaria (el 15 frente al 5%; p<0,001). En el análisis multivariable, los pacientes con glucemia >= 140mg/dl presentaron el doble de mortalidad intrahospitalaria (intervalo de confianza del 95%, 1,2-3,5; p=0,008). El valor pronóstico de la glucemia (como variable continua y como variable dicotomizada) no varió significativamente según hubiera diabetes o no (para la interacción, p=0,487 y p=0,653 respectivamente). Conclusiones. La hiperglucemia de estrés al ingreso es un predictor de mortalidad y arritmias en pacientes con IAMCEST y se podría usar en la estratificación de riesgo de estos pacientes(AU)

Introduction and objectives: In patients with acute myocardial infarction, elevation of plasma glucose levels is associated with worse outcomes. The aim of this study was to evaluate the association between stress hyperglycemia and in-hospital mortality in patients with acute myocardial infarction with ST-segment elevation (STEMI). Methods: We analyzed 834 consecutive patients admitted for STEMI to the Coronary Care Unit of our center. Association between admission glucose andmortality was assessed with Cox regression analysis. Discriminative accuracy of the multivariate model was assessed by Harrell´s C statistic. Results: Eighty-nine (10.7%) patients died during hospitalization. Optimal threshold glycemia level of 140 mg/dl on admission to predict mortality was obtained by ROC curves. Those who presented glucose >=140 mg/dl showed higher rates of malignant ventricular tachyarrhythmias (28% vs. 18%, P = .001), complicative bundle branch block (5% vs. 2%, P = .005), new atrioventricular block (9% vs. 5%, P = .05) and in-hospital mortality (15% vs. 5%, P < .001). Multivariate analysis showed that those with glycemia >=140 mg/dl exhibited a 2-fold increase of in-hospital mortality risk (95% CI: 1.2-3.5, P = .008) irrespective of diabetes mellitus status (P-value for interaction = 0.487 and 0.653, respectively). Conclusions: Stress hyperglycemia on admission is a predictor of mortality and arrhythmias in patients with STEMI and could be used in the stratification of risk in these patients(AU)

Influencia de diferentes situaciones de estrés en la actividad enzimática muscular en bovino de lidia (bos taurus) / Influence of different stressful situations in the muscular enzymatic activity in bullfighting bulls (Bos taurus)

En este estudio se han utilizado 15 bóvidos de la raza de lidia (Bos taurus), divididos en tres grupos, con diferentes edades, características del transporte y condiciones de lidia (machos de 3-4 años lidiados en la plaza de tientas y en plaza portátil y animales de 4 años lidiados en plaza fija), para estudiar el posible efecto de diferentes situaciones de estrés y ejercicio en la liberación de diferentes enzimas musculares. Se tomaron muestras de sangre de todos los animales. En las analíticas sanguíneas se obtuvieron los valores de cortisol y de las enzimas CPK, LDH y AST. En relación con estas enzimas, hubo una mayor liberación de CPK y LDH en los novillos lidiados en plaza de toros portátil, aunque las diferencias no fueron estadísticamente significativas. El comportamiento de la enzima AST no fue el mismo que el de la CPK y la LDH, lo que indicaría según los datos obtenidos en este estudio, que esta enzima no sería un buen indicador del daño o fatiga muscular. Este mayor daño o fatiga muscular se detectó en los animales que se lidiaron en plazas de toros portátiles, sin descanso previo en los corrales. En estos mismos animales, hubo una correlación entre la liberación de cortisol y la de enzimas musculares(AU)

In order to check the possible effect of different stressful situations in the release of different muscular enzymes in fifteen fighting bulls (Bos taurus) divided in three groups according to age, transport characteristics and bullfighting conditions (young bulls fought in a trial bullring and in a portable bullring and bulls fought in a permanent bullring) were used in this study. Samples of blood were taken from all animals. Values of cortisol and CPK, LDH and AST enzymes were obtained from blood samples. A higher CPK and LDH release was detected in young bulls fought in a portable bullring, although statistical differences were not found. The behaviour of the enzyme AST was different from CPK and LDH enzymes, what would indicate, according with the data of the present study, that the values of AST would not be a good indicator of muscular damage or fatigue. This higher muscular damage or fatigue was detected in animals fought in a portable bullring which had not a rest period in pens before the bullfight. In these animals a correlation between the release of cortisol and muscular enzymes was detected(AU)

Disfunción eréctil de origen psicogénico / Psicogenic erectile dysfunction

OBJETIVO: Revisar los diferentes aspectos relacionados con la disfunción eréctil de tipo psicógeno.MÉTODO: Revisión de la bibliografía y experiencia personalCONCLUSIONES: La disfunción eréctil de origen psicógeno es más frecuente de lo que se cree en la actualidad y es posible que aumente en el futuro, sobre todo en hombres jóvenes, en relación con el actual estilo de vida. La causa más frecuente es la ansiedad de rendimiento ligada a diferentes circunstancias. Otras causas vienen dadas por una mala educación sexual, por experiencias sexuales traumáticas durante la infancia, por conflictos en la relación de pareja, por situaciones estresantes de cualquier naturaleza o por trastornos psiquiátricos como la depresión entre muchas otras.La DE psicógena puede asociarse con otros trastornos de la esfera sexual, suele presentarse de forma brusca y es fácil de diagnosticar cuando existen erecciones normales de tipo involuntario o en determinadas circunstancias(AU)

OBJECTIVES: To review the different as-pects of psychogenic erectile dysfunction (PED).METHODS: To review the bibliography and our personal experience.CONCLUSION: PED is more frequent than curren-tly thought and may grow in the future, especially in young men, linked to the present style of life. Performan-ce anxiety related to different circumstances is the most common cause of PED. Other causes are given by an inadequate sexual education, traumatic sexual experien-ces during childhood, a conflictive couple relationship, stressful situations of any nature or psychiatric disorders, like depression, among others.PED may be associated with other sexual disorders. Usually occurs abruptly and it is easy to diagnose when there are normal erections in any circumstances(AU)

Depresión y síndrome de Down / Depression and down syndrome

Las personas con síndrome de Down, como el resto de la población, presentan problemasde salud mental que se deben diagnosticar, tratar y también prevenir. El aumento dedepresiones en los últimos años resulta ser un tema preocupante que merece la atenciónde los profesionales y de las familias.En esta población el diagnóstico de depresión es complicado, ya que sus manifestacionespueden confundirse con otras patologías. En este artículo se defi ne la depresión, se destacala manifestación específi ca de los síntomas y se dan pautas para su diagnóstico ytratamiento. También se hace hincapié en la prevención (AU)

Like anyone else, people with Down syndrome can suffer mental health problems thatrequire diagnosis, treatment and prevention. The higher number of depressions seen inrecent years is a cause for concern and must be taken on by health professionals andfamilies.Depression is diffi cult to diagnose in people with Down syndrome as its symptoms can bemistaken with those of other conditions. This paper sets out to defi ne depression,highlight the specifi c manifestation of symptoms and give guidelines on how it can bediagnosed and treated. Importance is also placed on prevention (AU)

Stress and heart rate variability in surgeons during a 24-hour shift.

OBJECTIVE: To determine the specific effects of working long hours in surgery and potential cardiac stress in the individual surgeon by measuring heart rate variability (HRV). DESIGN, SETTING, AND PARTICIPANTS: This prospective study measured HRV before, during, and after a 24-hour shift in a standardized resting period of 10 minutes. Measurements were repeated over 10 shifts for each participant. Eight surgeons from a high-volume inner-city surgery department took part in the study. MAIN OUTCOME MEASURES: Time and frequency domain parameters of HRV as parameters of cardiac stress and correlations with perceived stress and fatigue on a visual analog scale. RESULTS: Perceived fatigue increased over 24 hours (P < .001), whereas stress levels decreased slightly (P = .06). Time domain parameters of HRV increased from before the shift to after the shift (standard deviation of normal to normal intervals, square root of the mean normal to normal interval, and percentage of adjacent pairs of normal to normal intervals differing by more than 50 milliseconds: all P < .01), denoting more cardiac relaxation. Both the low- and high-frequency components increased (P = .04 and P < .001, respectively), showing a heightened activity of the autonomic nervous system. CONCLUSIONS: Measurements of HRV during a 24-hour surgical shift did not show an increase in cardiac stress concerning time domain parameters despite intense workloads for a median of 20 hours. Frequency components increased in parallel, though, suggesting alterations in sympathovagal balance. Perceived stress levels correlated with HRV, whereas fatigue did not. Further studies on occupational stress and its cardiac effects in surgeons are needed.

Combat stress or hemorrhage? Evidence for a decision-assist algorithm for remote triage.

INTRODUCTION: In the setting of remote military triage, when physical access to the patient is not possible, traditional physiological measurements available to a combat medic may not differentiate between a wounded soldier and an active soldier. We tested the hypothesis that changes in high-frequency R-R interval spectral power (RRI HF) and pulse pressure (PP) would differ between progressive central hypovolemia (simulated hemorrhage) and exercise to evaluate their potential for remotely distinguishing active from bleeding soldiers. The RRI HF and PP were used because of their ability to track central hypovolemia. METHODS: There were 12 (8 female/4 male) healthy, normotensive, nonsmoking subjects (age 27 +/- 2 yr; height 169 +/- 3 cm; weight 68 +/- 5 kg) who were exposed to progressive lower body negative pressure (LBNP) and a supine cycle ergometer protocol. ECG and blood pressure were measured continuously. Exercise workloads were determined by matching the heart rate (HR) responses to each LBNP level. Data were analyzed in time and frequency domains. RESULTS: HR increased from 67 +/- 3 bpm at rest to 101 +/- 4 bpm by -60 mmHg LBNP and was matched within 5% during exercise. By the final stage, RRI HF decreased by a similar magnitude during both LBNP (-78 +/- 7%) and exercise (-85 +/- 6%). PP decreased by 30 +/- 4% with LBNP compared with an increase of 20 +/- 6% during exercise. CONCLUSION: Monitoring PP in combination with RRI HF would distinguish a bleeding from an active soldier. Technologies that incorporate telemetry to track these derived vital signs would provide a combat medic with remote decision support to assess soldier status on the battlefield.

Measurement of surgical stress in anaesthetized children.

BACKGROUND: The surgical stress index (SSI), derived from a combination of heart rate (HR) and photoplethysmographic amplitude (PPGA) time series, is a novel method for continuous monitoring of intraoperative stress and has been validated in adults. The applicability of SSI and its constituents to monitoring children has not been previously evaluated. METHODS: In this controlled trial, 22 anaesthetized patients, aged 4-17 yr, undergoing strabismus surgery were randomized into two groups, Group LL and Group BSS. Patients in Group LL received topical conjunctival anaesthesia with a 1:1 mixture of lidocaine 2% and levobupivacaine 0.75%, and patients in Group BSS received balanced salt solution. RESULTS: Endotracheal intubation (n=22) increased median (range) SSI from 39.2 (22.6-55.6) to 53.6 (35.8-63.3) (P<0.001), decreased PPGA from 5.62 (2.79-9.69) to 5.27 (2.59-7.54)% (P=0.001), and increased the difference of response entropy (RE) and state entropy (SE) of frontal biopotentials (RE-SE) from 3.1 (0.06-9.1) to 5.7 (0.6-9.4) (P=0.01). Conventional haemodynamic variables also increased, median (range) HR from 72.9 (56.7-113.8) to 84.2 (60.4-124.8) beats min(-1) (P<0.001), and systolic non-invasive arterial pressure (S-NIBP) from 87 (78-143) to 103 (79-125) (P=0.007). When 3 min baseline before surgery was compared with 12 min of surgery, median (range) SSI increased from 43.3 (31.2-58.0) to 49.9 (39.3-57.2) (P=0.042) vs from 46.6 (26.8-57.8) to 52.1 (31.7-60.1) (P=0.024) and PPGA decreased from 6.60 (3.10-8.24) to 5.80 (3.03-7.65)% (P<0.001) vs from 5.51 (3.25-9.84) to 5.06 (3.08-8.99)% (P=0.042), in Groups LL and BSS, respectively, but SSI or other indicators did not differ significantly between the groups. CONCLUSIONS: SSI, PPGA, HR, NIBP, RE, and RE-SE detect autonomic responses to nociceptive stimuli in anaesthetized children undergoing strabismus surgery.

Urinary catecholamine responses in F-15 pilots: evaluation of the stress induced by long-distance flights.

Included in the Cooperative Cope Thunder exercises from Japan to Alaska is one of the longest distance flight missions carried out by Japan Air-Self Defense Force F-15 pilots. The magnitude of the flight stress of these pilots is considered to be quite high. The purpose of this study was to evaluate the flight stress induced by the long-distance flights. The subjects were eight pilots who participated on a volunteer basis. Samples of urine were collected approximately 30 minutes before (preflight) and 20 minutes after (postflight) the flights. The ratios (post-:preflight) of noradrenaline levels were 1.20 +/- 0.09 (Japan-Alaska) and 1.32 +/- 0.12 (Alaska-Japan), and those of adrenaline were 4.03 +/- 1.06 and 3.68 +/- 0.98. These results strongly suggest that psychological stress during the long-distance flights is increased in the fighter pilots.

E-PASS for predicting postoperative risk with hip fracture: a multicenter study.

UNLABELLED: This multicenter study of 813 consecutive patients with hip fracture was performed to estimate the effectiveness and reproducibility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to assess postoperative risk in patients with hip fracture. E-PASS is comprised of a preoperative risk score, a surgical stress score, and a comprehensive risk score based on the preoperative risk score and surgical stress score. Postoperative complications developed in 163 patients (20.0%); 13 (1.6%) died. Hospital postoperative morbidity and mortality rates increased linearly with the preoperative risk score and comprehensive risk score; the correlation was significant. The severity of postoperative complications and the incidence of higher grades of complications increased significantly with rising preoperative risk score and comprehensive risk score. Each E-PASS score also was related significantly with the length of postoperative hospitalization and costs. These results suggest E-PASS is useful for predicting postoperative risk, estimating costs, and for comparing the outcome in patients having surgical treatment of hip fractures. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cuadros primarios de dolor musculoesquelético difuso. Estudio descriptivo y analítico frente a la fibromialgia convencional / Pritnarp spndrotnes of diffuse muscle-eskeletical pain. Descriptive study and versus to the conventional fibromialgia disease

Objetivo: Estudio y contrastación de unos cuadros clínicos primarios, similares a la Fibromiálgia (F.M.) pero sin presencia importante de puntos dolorosos. Pacientes y métodos: Diseño tipo casos y controles. Casos Pacientes con dolor musculo esquelético difuso/generalizado y persistente (>6 meses), pero con <5puntos de F.M. y exclusión de patologías contundentes. Controles Pacientes diagnosticados de F.M. por los criterios de Wolfe de 1994.Variables estudiadas A) Características clínicas. Se pasa un cuestionario sobre 46 variantes de la sintomatología. Dos muestras: de 26 mujeres en casos y 32mujeres en controles. B) Datos exploratorios y evolución. Puntos dolorosos de F.M. Estrés, ansiedad y depresión, por evaluación semicuantitativa. Tensión muscular, por evaluación semiobjetiva. Y evolución por autoevaluación a los 6 meses. Pruebas estadísticas Pruebas de Student-Fisher para la comparación de edades y número de puntos dolorosos, y las del chi cuadrado para la comparación de frecuencias. Resultados: Media de puntos dolorosos en casos=1.36 y en controles 10.32 (P<0.0001). Perfil clínico muy similar en casos y controles, incluida la evolución. Diferencias: dolor más vivo y en reposo, en casos (P<0.005); tensión muscular más frecuente en controles (P<0.01). Conclusión: Estos resultados relativizan la importancia diagnóstica y pronóstica de los puntos dolorosos (AU)

Objective: Study and contrast of primary clinical syndromes, similar to the Fibromyalgia (F.M.) but without important presence of Patient painful points. Methods: Design type cases and controls. Patient’s clinical cases with generalized and persistent diffuse muscle-eskeletical pain/(>6 months), but with<5 F.M points. and exclusión of forceful pathologies. Controls. Diagnosed patients of F.M. by the criteria of Wolfe of 1994.Studied variables. A) Clinical characteristics. A questionnaire goes over 46 variants of the symptoms. Two samples: of 26 wo-men in cases and 32 women incontrols. B) Painful exploratory data and evolution. F.M points. Stress, anxiety and depression, semi quantitative evaluation. Muscular tensión, by semiobjective evaluation. And evolution by autoevaluation to the 6 months. Statistical Tests Student-Fisher Tests for the comparison of ages and number of painful points, and those of chi square for the comparison of frequencies. Results: Average of painful points in cases = 1.36 and controls (10,32 P< 0,0001) very similar clinical profile in cases and controls, including the evolution. Differences: alive pain but and in rest, cases (P< 0,005); muscular tensión but frequents in controls (P< 0,01). Conclusion: These results relativist the importance diagnose and foretell of the painful points (AU)

Monitoring levels of stress and overtraining in an elite brazilian female volleyball athlete: case study

El sobreentrenamiento es el resultado de un desequilibrio entre el estrés y su recuperación, combinado concortos períodos de recuperación y determinados factores psicosociales. En este estudio de caso se ha empleado uncuestionario de estrés y recuperación en el deporte para analizar los niveles de sobreentrenamiento en una jugadorabrasileña de balonvolea de elite. Los resultados indican que las elevadas cargas físicas provocan cambios en el perfil de ladeportista, mostrando un incremento en las escalas de fatiga. Los períodos de recuperación se han mostrado comofundamentales para el restablecimiento de las capacidades físicas y psicológicas de la deportista. Finalmente, nuestrométodo de análisis ha evidenciado la existencia de modificaciones en el perfil de la deportista después de acontecimientospuntuales, tal como el observado después de una derrota inesperada. Se concluye que los cambios en el perfil de la curva,obtenidas por nuestro cuestionario, reflejan los distintos períodos de recogida de datos, lo que configuraría un indicador delos cambios de la sobrecarga estresante. De esta manera, la posibilidad de detección o de la monitorización de los factoresestresantes para ella deportista puede ser de gran valor para la mejora del rendimiento físico y psicológico de un equipo (AU)

Overtraining is the result of an imbalance between stress and recovery, in addition to short recovery time andpsychosocial events. In this case study, a questionnaire of stress and recovery in sports was used to assess the level ofovertraining of an elite female Brazilian volleyball player. The results showed that the heavy loads caused changes in theathlete’s profile, resulting in an increase in the fatigue scales. The recovery periods were fundamental to restore her physicaland psychological capacities. Finally, the method used detected changes in the athlete’s profile after acute events, such as anunexpected defeat. We concluded that changes in the profile of the curve, showed by the instrument, reflected the differentmoments of the collection, thus reflecting the change in the stress overload. Therefore, the detection or monitoring ofstressing factors might be valuable to improve the physical and psychological performance of a team (AU)

Stress and burnout in anaesthesia.

PURPOSE OF REVIEW: Recently, many researchers have been studying stress and burnout in anaesthesia. Some researchers have examined the effects of stress in the workplace. Others have identified some job characteristics that have an impact on anaesthetist's well-being. Yet, few studies use the same measure of stress and/or define the concept of stress in the same way, making comparison and aggregation of results difficult, and therefore minimizing the general impact of these research findings. RECENT FINDINGS: The following review focuses on the increasing recent research on stress and burnout in anaesthesia regarding the existing stress models and shows where the progress has been made, and where difference of opinion and divergence of approach remain. SUMMARY: From the referred studies, the review challenges the more practical problems of prevention of stress and burnout and provides some avenues for future investigations.

Parental response to children's pain: the moderating impact of children's emotional distress on symptoms and disability.

Parental responses play a central role in the development and maintenance of children's pain behavior. Previous studies examining the impact of parental responses on children's pain have focused mainly on protective or solicitous responses. This study examined the impact of parental responses, including protectiveness, minimization of pain, and encouraging and monitoring responses, on children's functional disability and somatic symptoms. Participants included 327 patients with chronic pain, ages 8-17, who completed measures of pain, disability, somatic symptoms, depression, and anxiety. Patients' parents completed a measure assessing parental responses to their children's pain. Results show that for children with higher levels of emotional distress, maladaptive parental responses to pain (e.g., criticism, discounting of pain, increased attention to pain, and granting of special privileges) were associated with increased disability and somatic symptoms. Results of this study demonstrate the important ways in which parents can influence how their children cope with and manage chronic pain. Children whose parents are overly protective or critical of their pain may experience more impairment or somatic symptoms, particularly those children who are already at risk for difficulties due to higher levels of emotional distress.

Correlation between immune and neuronal parameters and stress perception in allergic asthmatics.

BACKGROUND: Asthma is a chronic disease defined by airway inflammation, increased airway hyperresponsiveness and episodes of airway obstruction. Although there are abundant clinical and experimental data showing that stress may worsen asthma, the mechanisms linking stress to asthma are not well understood. By inducing a pro-inflammatory cytokine milieu, stress might enhance airway inflammation in bronchial asthma. We therefore investigated the correlation of stress perception and the cytokine profile of circulating lymphocytes in humans. METHODS: Allergic asthmatic patients and healthy controls were evaluated for perceived level of stress, demographic and lung function data. Whole blood cells were obtained and stimulated by mitogen to assess intracellular IL-4, IFN-gamma and TNF-alpha by flow cytometry. Neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were measured in serum. RESULTS: Asthmatic patients showed significantly higher percentages of TNF-alpha-producing T cells than healthy controls. Only in asthmatic patients was stress perception correlated with percentages of TNF-alpha-producing T cells and serum BDNF levels, while forced expiratory volume in 1 s (% predicted) was negatively correlated to BDNF. CONCLUSION: The results of our study support the hypothesis that stress deteriorates bronchial asthma by inducing a pro-inflammatory cytokine profile in allergic asthmatics. Stress management might provide a supplement therapy of allergic asthma.

Phenomenology of mixed states: a principal component analysis study.

OBJECTIVES: To contribute to the definition of external and internal limits of mixed states and study the place of dysphoric symptoms in the psychopathology of mixed states. METHODS: One hundred and sixty-five inpatients with major mood episodes were diagnosed as presenting with either pure depression, mixed depression (depression plus at least three manic symptoms), full mixed state (full depression and full mania), mixed mania (mania plus at least three depressive symptoms) or pure mania, using an adapted version of the Mini International Neuropsychiatric Interview (DSM-IV version). They were evaluated using a 33-item inventory of depressive, manic and mixed affective signs and symptoms. RESULTS: Principal component analysis without rotation yielded three components that together explained 43.6% of the variance. The first component (24.3% of the variance) contrasted typical depressive symptoms with typical euphoric, manic symptoms. The second component, labeled 'dysphoria', (13.8%) had strong positive loadings for irritability, distressing sensitivity to light and noise, impulsivity and inner tension. The third component (5.5%) included symptoms of insomnia. Median scores for the first component significantly decreased from the pure depression group to the pure mania group. For the dysphoria component, scores were highest among patients with full mixed states and decreased towards both patients with pure depression and those with pure mania. CONCLUSIONS: Principal component analysis revealed that dysphoria represents an important dimension of mixed states.

Tratamiento farmacológico del trastorno de estrés agudo con propanolol e hipnóticos / Pharmacological treatment of acute stress disorder with propranolol and hypnotics

Introducción. El tratamiento farmacológico de la patología asociada a los traumas no presenta ni la eficacia ni la especifidad deseada, por lo que se realizan intentos constantes de añadir nuevos fármacos al arsenal terapéutico, en este caso con propranolol e hipnóticos. Método. Se ofreció dicho tratamiento a las víctimas del atentado del 11 de marzo de 2004 recibidas la siguiente semana por causa psiquiátrica (n=21) que cumplieran criterios de trastorno de estrés agudo (TEA) (n=15) y que no presentaran contraindicaciones para ello (n = 3). Asimismo se evaluó la intensidad del trauma a través de la Escala de Intensidad de Horowitz (EIH) y se recogieron los datos clínicos principales de los pacientes. Resultados. Los pacientes tratados con propranolol presentaron remisión de los síntomas diana en el 63,6% de los casos, respuesta parcial en el 27,3 % y falta de respuesta en el 9,1 %. Por su parte, el tratamiento con hipnóticos presenta una remisión de los síntomas en el 61,5 % de los casos y una respuesta parcial en el 38,5 %. Se encuentran correlaciones significativas estadísticamente para la EIH al inicio con el tiempo de incapacidad y al mes con la respuesta al propranolol y a los hipnóticos en las distintas subescalas. Conclusiones. El tratamiento con propranolol y con hipnóticos resulta útil en la disminución de la sintomatología del TEA. La EIH resulta de gran interés como predictor de incapacidad, así como la mala respuesta a propranolol y a hipnóticos. Son necesarios más estudios al respecto queconfirmen los hallazgos de esta muestra

Introduction. Pharmacological treatment of traumarelated mobidity has neither the efficacy nor specificity desired. Thus, several attempts have been made to add new drugs to the usual treatments, in this case with propranolol and hypnotic drugs. Method. We offered this treatment to the victims of the March 11, 2004 terrorism attack who were attended within the first week of this attack for psychiatric reasons (n = 21) and who also fulfilled criteria for acute stress disorder (ASD) (n = 15) and had no contraindications for the treatment (n=3). Trauma intensity was measured with Horowitz Impact of Events Scale (IES). Significant clinical data were collected. Results. Propranolol treatment was associated with clinical remission of target symptoms in 63.6 % of the cases, partial response in 27.3 % and no response in 9.1%. Hypnotic treatment was also associated with clinical remission in 61.5 % and partial response in 38.5 %. Statistically significant correlations were found at the beginning for IES with disability, and after the first month with the propranolol and hypnotic responses. Conclusions. Propranolol and hypnotic treatments are useful in the decrease of ASD symptoms. IES is very useful to predict disability as well as poor response to propranolol or hypnotic drugs. More studies are needed to confirm the data obtained in our sample

Assessment of slow-breathing relaxation technique in acute stressful tasks using a multipurpose non-invasive beat-by-beat cardiovascular monitoring system.

Recently, several studies revealed that daily slow-breathing exercise lowered blood pressure and increased baroreflex sensitivity. With this interesting finding, we have been contemplating to design a compact breath-controllable device for relaxation to stress reaction during daily living for home as well as ambulatory use, as a final goal, towards reduction of cognitive hemodynamic disorders, hypertension, and acute stress-induced hemodynamic disorders. The present study thereby describes, as a first step, to design a prototype system combining a compact multipurpose non-invasive beat-by-beat cardiovascular monitor developed previously with a wrist-type vibrator to make a respiration rhythm, and to assess an effect of slow-breathing relaxation on the cardiovascular hemodynamics in response to acute stressful conditions. The cardiovascular hemodynamic monitor can measure beat-by-beat systolic (SBP), mean (MBP) and diastolic (DBP) pressure in a finger based on the volume-compensation method, cardiac output (CO) by the electrical admittance method and the other hemodynamic-related parameters (e.g., total peripheral resistance (TPR=MBP/CO), heart rate (HR), respiratory rate, pulse wave velocity, etc.). The wrist-type vibrator can give various breathing rhythms quietly to a subject using a small vibration motor. The stressful tasks loaded to healthy volunteers (3 males, 23-34 yrs.) in the experiments were cold pressor and arithmetic ones as a representative of daily passive and active coping tasks, respectively, under conditions with (respiratory rate of 6 1/min) and without breath control.. The results showed that the slow-breathing technique could have a significant effect on improvement of the hemodynamic changes following the acute stressful tasks, especially in the passive coping task.

The relationship between stress and hair cortisol in healthy pregnant women.

PURPOSE: Stress has been shown to cause a large range of adverse fetal effects. This pilot study is the first attempt to examine cortisol level in the hair of pregnant women and assess its potential as a biomarker of gestational stress. PATIENTS AND METHODS: Twenty-five healthy pregnant women, in whom hair cortisol levels and the Perceived Stress Scale (PSS) were measured and correlated. RESULTS: Maternal hair cortisol levels, ranging between 0.06 and 0.23 nmol/g of hair correlated positively and significantly with measures of perceived stress (ranging between 2-22); (Rs=0.47) (P < 0.05). CONCLUSIONS: Our findings corroborate recent primate studies with induced stress, and suggest that hair cortisol is a potential biomarker of chronic stress in pregnancy. This new long term biological marker may have important implications in research and clinical practice.