Serum Kynurenines Correlate With Depressive Symptoms and Disability in Poststroke Patients: A Cross-sectional Study.

BACKGROUND: Poststroke depression (PSD) is related to adverse functional and cognitive prognosis in stroke patients. The participation of kynurenine pathway metabolites in depression has been previously proposed; however, there are few studies on its role in PSD and disability in stroke. OBJECTIVE: To investigate if there is a correlation between serum kynurenines levels with poststroke anxiety and depression symptoms and disability scales. METHODS: A cross-sectional case-control study was conducted in patients with first stroke, of >1 month and <1 year of evolution, with no history of previous psychiatric or neurological disorders; the Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA), functional evaluations (Barthel index, Functional Independence Measure [FIM]) were applied and serum kynurenines (Kyns) were determined. RESULTS: Sixty patients were included; significant depressive symptoms were found in 63% of the cases; a significant and positive correlation was obtained between levels of 3-hydroxykynurenine (3-HK) with HADS-T (r = 0.30, P = .025) and HADS-D (r = 0.28, P = .039). Depressed patients showed significantly higher levels of 3HK (P = .048) and KYNA (P = .0271) than nondepressed patients; the 3HK levels were inversely correlated with functional scales: Barthel index (r = -0.31, P = .02), FIM (r = -0.40, P = .01); in addition, serum 3HK levels were significantly higher in patients with poor sleep quality (P = .0190). CONCLUSIONS: Serum Kyns show correlation with the presence and severity of depressive symptoms and with the disability and sleep quality. Kyns may be a potential marker of depression risk and disability in stroke in future.

Trastornos del sueño: ¿qué son y cuáles son sus consecuencias? / Sleep disorders: what are they and what are their consequences?

Resumen Desde hace décadas, el ritmo de la vida moderna ha generado múltiples cambios en nuestra conducta y hábitos. Especialmente, los hábitos alimenticios y de ejercicio se han modificado de manera importante, pero uno de los cambios más evidentes ha ocurrido en el sueño. En la actualidad, el tiempo dedicado a este ha disminuido drásticamente, pero no solo se trata de la cantidad, sino también de la calidad del sueño que se ha visto afectada de forma relevante en todos los grupos de edad, en especial en la población joven. Desde hace algunos años se sabe que el sueño juega un papel muy importante para el óptimo funcionamiento físico y mental del ser humano, pero solo recientemente hemos comenzado a conocer y entender las consecuencias que una mala calidad del sueño puede tener sobre la salud a mediano y largo plazo. En esta revisión se incluyen los trastornos del sueño más comunes o representativos, los estudios que se utilizan para su diagnóstico y, finalmente, se da un panorama general sobre las consecuencias de estos trastornos en la salud a largo plazo.

Abstract For decades, the rhythm of modern life has generated multiple changes in our behavior and habits. Especially, the way we eat and our exercise habits have changed significantly but one of the most evident effects is regarding sleep behavior. Nowadays, sleep has decreased dramatically, but not only in quantity. The quality of sleep has been affected in a significant way on all age groups, especially in the young population. For several years, we've known that sleep plays an essential role for an optimal physical and mental performance in the human being. Only recently we've begun to discover and understand the consequences that sleep disturbances can have on health in the long term. In the present article we include a general review of the most common or representative sleep disorders, the studies used for their diagnosis and finally we made an overview of the consequences of these disorders on health.

Exploración neurológica básica para el médico general / Basic neurological examination for the general practitioner

Resumen La exploración neurológica (EN) es la herramienta clínica más importante con que se cuenta en medicina para la detección y diagnóstico de las enfermedades del sistema nervioso. Como en muchas áreas de la medicina, la integración de los datos clínicos obtenidos mediante la EN con los conocimientos neuroanatómicos y neurofisiológicos resulta de vital importancia para la correcta interpretación de la EN. Para el estudiante de medicina, con frecuencia la EN, y en general las materias relacionadas con las neurociencias, son conceptualizadas como muy extensas, difíciles y áridas, por lo que resulta importante realizar de manera sencilla la enseñanza de las distintas disciplinas neurocientíficas al estudiante de medicina y al médico en general. En este sentido, el objetivo del presente artículo es proponer un esquema para la realización de una exploración neurológica básica (ENB) que le permita al médico de primer contacto identificar eficazmente posibles alteraciones neurológicas (sobre todo las más frecuentes o graves), para así poder brindar un tratamiento inicial adecuado o establecer criterios de referencia oportuna a otro nivel de atención.

Abstract The neurological examination (NE) is the most important clinical tool in medicine for the detection and diagnosis of nervous system diseases. In several medical areas, the integration of clinical data with neuroanatomical and neurophysiological knowledge is of vital importance for the correct utilization and interpretation of NE. Frequently for the medical students, the NE and other subjects related to neuroscience are conceptualized as lengthy, difficult and boring; so it is important to teach these subjects to the medical students and general practitioners in a simple and comprehensive manner. Hence, the main objective of this paper is to propose a scheme for performing a basic neurological examination (BNE) that will allow the primary care physician to readily identify possible neurological disorders (especially the most frequent or severe), in order to provide adequate initial treatment or establish opportune reference criteria to another level of medical assistance.