Prenatal exposure to fluoxetine modulates emotionality and aversive memory in male and female rat offspring.

During pregnancy, women are prone to depression, for which selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are usually the first-line treatment. However, fluoxetine can cross the placental barrier and affect fetuses, causing changes in serotonin levels early in life. Long-term effects in the brain circuits that control cognitive and emotional behavior are related to early fluoxetine exposure during development. In this study, we aimed to investigate whether fluoxetine exposure (10 mg/kg/day) from the 13th gestational day (GD13) to GD21 may lead to behavioral emotional-cognitive changes in male and female rat offspring approximately 90 days postnatally (~PN90). We have analyzed the performance of individuals in the open field and in the plus-maze discriminative avoidance task, which assesses anxiety and learning/memory processing behaviors. We have found that prenatal (GD13-GD21) exposure to fluoxetine strengthened aversive memory and induced higher anxiety levels in males, and quick extinction of aversive memory in females. Taken together, these results suggest that early exposure to fluoxetine impairs the basal state of anxiety and the cognitive functions of rats during adulthood, which may be in a sex-specific manner because males appear more susceptible than females.

Retinorecipient areas in the common marmoset (Callithrix jacchus): An image-forming and non-image forming circuitry.

The mammalian retina captures a multitude of diverse features from the external environment and conveys them via the optic nerve to a myriad of retinorecipient nuclei. Understanding how retinal signals act in distinct brain functions is one of the most central and established goals of neuroscience. Using the common marmoset (Callithrix jacchus), a monkey from Northeastern Brazil, as an animal model for parsing how retinal innervation works in the brain, started decades ago due to their marmoset's small bodies, rapid reproduction rate, and brain features. In the course of that research, a large amount of new and sophisticated neuroanatomical techniques was developed and employed to explain retinal connectivity. As a consequence, image and non-image-forming regions, functions, and pathways, as well as retinal cell types were described. Image-forming circuits give rise directly to vision, while the non-image-forming territories support circadian physiological processes, although part of their functional significance is uncertain. Here, we reviewed the current state of knowledge concerning retinal circuitry in marmosets from neuroanatomical investigations. We have also highlighted the aspects of marmoset retinal circuitry that remain obscure, in addition, to identify what further research is needed to better understand the connections and functions of retinorecipient structures.

[Fibrinolysis in the therapy of cerebrovascular accident]. / A fibrinólise na terapêutica do acidente isquémico cerebral.

Thrombolytic therapy for acute ischemic stroke based on data reported from recent prospective clinical trials was discussed and analyzed. The author presents some conclusions and suggestions for effective stroke management therapy with rtPA, which he believes will be the future of medical treatment of ischemic stroke.

[The successes and failures in the primary prevention of coronary disease]. / Sucessos e insucessos da prevenção primária da doença coronária.

The modification of major behavioural and environmental risk factors has helped reduce coronary heart disease. It seems, however, that prevention results were not so good as expected. It is assumed that the major cause of this apparent unsuccessful data is basically due to world population ageing, as it is known that coronary heart disease is much more frequent in older people. Therefore the current life expectancy shows that the preventive measures have indeed been successful. From the analysis and discussion of the preventive epidemiological recommendations and the identification of new risk factors, the Authors suggest new strategies for health promotion and particularly for coronary heart disease reduction.

Polypharmacy and non-compliance in the hypertensive elderly patient.

BACKGROUND: Elderly patients are major consumers of prescription and nonprescription medications and the proper use of these agents can lead to more cost-effective strategies in reaching optimal health. The use of medications for the treatment of multiple co-morbid conditions in a single patient increases the risks of polypharmacy and non-compliance and raises the burden on the health care system and society. OBJECTIVES: To analyse the extent and nature of total and anti hypertensive, polypharmacy the most prevalent groups of drugs, the compliance rate and the costs related to polypharmacy in the hypertensive elderly. METHODS: A descriptive cross-sectional study was made of sixty-nine patients 65 years of age or older on follow-up for arterial hypertension at a central hospital in Lisbon. The study protocol consisted of a questionnaire performed by the physician. We calculated the monthly amount of individual prescription expense, after cost reduction from social insurance. RESULTS: The patients used an average of 4.4 prescribed medications with a corresponding average of 6.4 pills per day. Drug use was greater in women than men. Hypertensive therapy involved a mean of 2 drugs. Antiplatelet drugs, coronary vasodilators, bezodiazepines, glucose regulators and hypolipidemic agents were the other major groups of drugs. Non-compliance was identified in only 14% of the patients. The average of individual prescription expenses was 5,076 Portuguese escudos (PTE) per month, of which 2,226 PTE was the average cost of antihypertensive agents. CONCLUSIONS: With this study we were able to show the extent of poly-pharmacotherapy in a population of hypertensive elderly patients. We found a high rate of compliance, although the costs were frequently high.

[Polypharmacotherapy in the elderly hypertensive patient]. / Polifarmacoterapia no hipertenso idoso.

We asked 53 elderly hypertensives from our outpatient clinic which and how many drugs they took, and analysed factors that could have affected the intake, as sex, age and school instruction. The most frequent drug groups found were, in decreasing order, antihypertensives, benzodiazepines, nitrates and non-steroidal anti-inflammatory drugs. 53.3% of the patients took only angiotensin converting enzyme inhibitors and/or calcium-channel antagonists as antihypertensive drugs. Twenty four patients used occasional medications, sometimes as much as 6 different drugs, specially analgesics, antipyretics and anti-inflammatory agents. These patients took, in mean, 5.2 different drugs daily, 2.1 of which antihypertensive, in a total of 8.5 pills. Females took more drugs (9.4 +/- 3.6 pills per day against 7.1 +/- 3.0 in the male gender, Z < 0.03). Age and school instruction did not affect the intake.

[Sleep disturbances in elderly hypertensive patients]. / Alterações do sono em hipertensos idosos.

OBJECTIVE: To investigate the subjective and objective perturbations in the elderly hypertensive patients. SAMPLE: 32 individuals were studied with ages > or = 65 years, 14 men and 18 women, with controlled idiopathic high blood pressure, diagnosed over a year ago, and able to lead autonomous lives. METHODS: These outpatients were asked to answer sleep questionnaires adapted from Stanford's questionnaire, and a nocturnal sleep polygraphic register was kept. RESULTS AND CONCLUSIONS: This group of elderly hypertensive outpatients slept badly but never consulted a doctor due to sleeping problems. The most frequent complaints were fatigue, body pains, frequent interruptions of sleep during the night and sleepiness during the day. In the polysonographic register, we highlight insomnia, snoring, obstructive apnea and the periodic movements during sleep. These findings could explain the patient's complaints. Research must be continued on sleep apnea in the elderly hypertensive patients particularly in those with snoring.

[Hemorrheologic changes in the hypertensive elderly patient]. / Alterações hemorreológicas no hipertenso idoso.

The aim of this work is to make a review of the papers about hemorheology and hypertension on the aged. The paucity of the works did not allow any conclusions. However, some of the drugs frequently used have tight links with hemorheology, which must be in our minds when dealing with old people.

[Clinical significance of hypercholesterolemia in the elderly]. / Significado clínico da hipercolesterolemia no idoso.

Hypercholesterolemia is known as a cardiovascular risk factor for the non elderly man. But it still remains the controversy about the significance of dislipidemia on the aged. The authors discuss the problem and suggest a therapeutic approach following the European Consensus Conference Guidelines.

[Arterial hypertension in the elderly and renal function]. / Hipertensão arterial no idoso e função renal.

STUDY OBJECTIVE: to evaluate the effects of antihypertensive treatment on renal function, in an elderly population of 29 patients with arterial hypertension. DESIGN: retrospective study of the first six months follow-up. SETTING: outpatients clinic of arterial hypertension in the elderly at a central hospital. PATIENTS AND METHODS: twenty nine elderly (> or = 65 years old) patients with a mean age of 71.8 +/- 5.6 years, with arterial hypertension (> or = 160/95 mmHg) submitted to antihypertensive treatment. Fourteen males and fifteen females. The systolic, diastolic and mean blood pressure was determined with a DINAMAP 1846, previously and at the first, third and sixth month of antihypertensive treatment (diuretic, calcium antagonists and angiotensin converting enzyme inhibitors). The serum creatinine was evaluated in the beginning of treatment and six months later. Means (+/- standard deviation) were compared with Student's t-test (statistically significant findings < 0.05). MEASUREMENTS AND RESULTS: the initial mean arterial pressure was 127.0 +/- 17 mmHg; with the antihypertensive treatment, was 119.1 +/- 16 mmHg in the first month, 114.4 +/- 12 mmHg in the third and 117.6 +/- 12 mmHg in the sixth month. The serum creatinine was 1.26 +/- 0.75 mg/dl in the beginning of the study and the final result was 1.30 +/- 0.74 mg/dl (p-NS). CONCLUSIONS: the antihypertensive treatment was effective in reducing the blood pressure, without a significant increase in serum creatinine.

[Automatic measurement of arterial pressure. A new method for analysis, quantification and evaluation of hypertensive disease]. / A medição automática da pressão arterial. Novo método de análise, quantificação e valorização da doença hipertensiva.

The authors try to analyse the role of ambulatory 24 h blood pressure monitoring (ABP) in the diagnosis of hypertension, and review medical literature on this subject. They emphasized the quantification and definition value of normal results and circadian profiles in ABP. The accuracy of the device and the choice of a correct statistical parameter of prognosis is essential in all prospectives studies. In the future a better correlation is expected between blood pressure and organ damage when blood pressure is measured by ambulatory recordings then office method.

[Ambulatory monitoring of blood pressure. Validation of a method]. / Medicação ambulatória da pressão arterial. validação do método.

Before the routine use of our ambulatory blood pressure (ABP) device, we did the correlation analysis of 153 pairs of blood pressure measurements within the ABP and gold-standard sphygmomanometer. We got a good correlation but a systematic statistical error about less 7 mmHg on systolic measurement and 11 mmHg on diastolic measurement by the ABP device. The different qualities found among the devices that we have in the market, lead to the proposal of protocols of validation in the premarketing and periodic quality assessment by the clinics.

[Hyponatremia--new concepts and therapy. Apropos of a clinical case]. / Hiponatrémia--novos conceitos e terapêutica. A propósito de um caso clínico.

The therapeutic approach of hyponatremia is reviewed, and the authors describe their recent experience of a clinical case of a woman with acute hyponatremia. After analysing the main publications of the last years, they conclude that the way of correcting hyponatremia largely depends of its acute or chronic character. Chronic hyponatremia must be corrected with slow rate infusion of sodium chloride (0.5 mmol/l/h), and acute hyponatremia with a rapid (2 mmol/l/h) or intermediate (1-1.5 mmol/l/h) rate of infusion of the same solution. This is the current advisable approach, until a new better orientation will virtually be clarified by further prospective studies.

[Acute effects of tobacco and vascular risk modulated by genetic factors]. / Acções agudas do tabaco e risco vascular modulado por factores genéticos.

Most studies regarding the acute effects of cigarette smoking refer to the higher sympathetic and adrenomedullary activity as a result of sympathetic ganglia and adrenal medulla nicotinic receptor activation. Although it is reasonable to suppose that the renin-angiotensin system might be activated, this possible effect of nicotine has not been studied. We have studied the effects of cigarette smoking on blood pressure, cardiac output, pulse pressure, renin-angiotensin system, kinins-NO, oxidative stress and insulin. Also, we have investigated if the variability of the biochemical parameters was dependent on genetic polymorphisms of the angiotensin converting enzyme and the acute phase protein haptoglobin. 39 normotensive individuals, 18 males and 21 females, of mean age 35.4 +/- 8.9 years were included in this study. Oxidative stress was dependent on the ACE I/D and Hp1/2 polymorphisms, with the ACE DD genotype and the Hp2-2 phenotype not showing variation in the anti-oxidant defense systems, and the ACE II-ID genotypes and Hp1-1 + 2-2 phenotypes showing a higher anti-oxidant response, hence a lower cardiovascular risk being predictable in the latter individuals.

Nocturnal sleep quality and circadian blood pressure variation.

OBJECTIVE: To verify whether non-dipper behavior is associated with poor nocturnal sleep quality and a higher rate of obstructive sleep apnea than dipper behavior. METHODS: A sample of 36 subjects older than 50 years (mean age = 70 +/- 6.49 years), 8 males and 28 females, 27 (75%) hypertensive and 9 (25%) normotensive, was studied. Nocturnal polysomnography was carried out in the patients' homes. 24-hour ambulatory blood pressure was studied with Spacelabs 90,207 device. The statistical tests used were Student's t test, Pearson's correlation and the Chi-square test. RESULTS: In the overall sample, higher rates of apnea, higher rates of arousal and shorter duration of the REM (rapid eye movement) phase were linked to high levels of nocturnal diastolic blood pressure, with statistical significance (p < 0.01, p < 0.01, p < 0.05 respectively). Sleep fragmentation was associated with the lowest percentages of variation in daytime to nighttime systolic blood pressure (p < 0.03). Apnea rates were significantly higher in the hypertensive group compared to the normal blood pressure population (p = 0.04). We also observed that higher rates of nocturnal apnea corresponded to lower variations in daytime to nighttime systolic blood pressure (p = 0.015) and to a lower dipper index (p < 0.05). Higher indexes of arousal and lower REM latency were associated with higher nocturnal blood pressure, both systolic (p = 0.039 and p = 0.008, respectively) and diastolic (p = 0.003 and p = 0.029, respectively). Sleep efficiency was also negatively correlated with mean levels of nocturnal diastolic blood pressure (p = 0.038). CONCLUSIONS: The quality of nocturnal sleep seems to play an important role in blood pressure levels, particularly in the nocturnal blood pressure profile. A poor quality of nocturnal sleep and the rate of obstructive sleep apnea were associated with non-dipper behavior in the hypertensive population. Sleep evaluation is particularly useful in non-dipper subjects with hypertension.

[Blood glucose and insulin in arterial hypertension. The elderly hypertensive patient]. / Glicemia e insulinemia na hipertensão arterial. Em destaque o hipertenso idoso.

The clinical importance of relationship between insulin resistance, hyperinsulinemia and high blood pressure is not yet fully understood. The aim of this study was to evaluate the influence of age in the relation between hyperglycemia, hyperinsulinemia and hypertension (HT). Two groups of patients with moderate to severe essential hypertension, aged < 65 (n = 40) and > or = 65 (n = 55) were compared with two other groups of normotensive subjects (NT) matched for sex (n = 14) and age (n = 18). The radioimmunoassay method and glucose oxidase methods were used to evaluate plasma insulin and plasma glucose concentrations. The global analysis shows: The plasma glucose level was significantly lower (p < 0.02) in NT group (n = 32; glycemia: 67.52 +/- 44 mg/dl) than in the HT group (n = 95; glycemia: 86.25 +/- 34.7 mg/dl. Further more the plasma insulin level in NT (3.37 +/- 3.18 microU/ml) was also lower than in HT (4.29 +/- 3.08 microU/ml) although without statistical significance. The patients (HT) aged < 65 years old had higher glycemia (85.76 +/- 26.8 mg/dl) and insulinemia (4.92 +/- 3.56) than NT of same age (glycemia: 59.0 +/- 11.8 mg/dl, insulinemia: 2.86 +/- 1.86), respectively p < 0.001 and p < 0.05. In HT aged > or = 65 the glycemia (82.38 +/- (9.67 mg/dl) was higher than in the NT matched group (65.5 +/- 20.36 mg/dl), p < 0.01, but plasma insulin was not different in the two groups (3.88 +/- 2.63 and 3.80 +/- 2.27 microU/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute myocardial infarct: apropos a clinical case]. / Enfarte agudo do miocárdio: a propósito de um caso clínico.

The AA describe a clinical case of acute myocardial infarction (A.M.I.) with prodromal angina and an initial diagnosis based exclusively on clinical criteria; the patient was submitted to thrombolysis and had recurrent angina which led to the performance of rescue percutaneous coronary angioplasty (P.T.C.A.) that was successful. The clinical situations that may precede A.M.I. are discussed and the importance of the clinical presentation in its diagnosis are stressed. The indications and benefits of rescue P.T.C.A. are also discussed and the AA. conclude that the patients with prodromata of A.M.I. must be kept under clinical observation, so that prompt necessary therapeutic measures may be undertaken and that rescue P.T.C.A. is a therapeutic option of proven clinical benefit.

[The medical therapy of angina pectoris]. / A terapêutica médica da angina de peito.

The angina pectoris crisis should be treated with nitroglycerin S.L.. In our days as in the 19th century, the non pharmacological therapeutic approach for angina pectoris (per se and to improve the free interval between crises) is still the same. This consists of the reduction of mental and physical stress, to stop smoking, improve light exercise, reduce obesity, and control other risk factors for coronary disease. Beta blockers are the choice drugs followed by calcium antagonists and nitrates. It is recommended that no short action calcium antagonists be used. Nitrates must be given with free intervals of action to avoid tachyphylaxis. The anti-platelet therapy can not be forgotten with aspirin or ticlopidine. Patients with refractory angina pectoris should be coronariography for performed eventual revascularization process.

[Arterial hypertension in the elderly. Experience at a hospital service]. / A hipertensão arterial da terceira idade. Experiência de uma consulta hospitalar.

High blood pressure in the elderly population is currently one of the most important public health problems. In recent years, a dramatic increase in life expectancy has occurred and cardiovascular diseases are now one of the major causes of morbidity and mortality in this age group. Therefore, high blood pressure in the elderly has been the aim of many trials throughout the world. In Medicine Department 1 of St. Maria Hospital, we designed and implemented a special outpatient follow-up for elderly people (> or = 65 years old) with hypertensive disease. At the end of the first year, 61 patients (22 men and 39 women) with an average age of 71 years (SD +/- 5.3), with known of high blood pressure for an average of 10 years were treated with angiotensin converting enzyme inhibitor (11 patients), calcium channel blockers (6 patients), or a combination of both drugs. The mean blood pressure fell 15 mm Hg (SD +/- 19.6) without deterioration of the renal function. The echocardiographic evaluation showed reduction in the left ventricular dimensions without significant modifications of diastolic, systolic and cardiac output. In addition, there was a significant increase in attention/concentration and memory abilities, however the percentage of depressed patients was the same at the end of the first year of treatment for high blood pressure.