The Cross-sectional and Longitudinal Association Between Thyroid Function and Depression: A Population-Based Study.

CONTEXT: An association of thyroid function with mood disorders has been widely suggested, but very few studies have examined this association longitudinally. OBJECTIVE: We assessed the cross-sectional and longitudinal association between thyroid function and depression in a population-based cohort. METHODS: A total of 9471 individuals were included in cross-sectional analyses, of whom 8366 had longitudinal data. At baseline, we assessed thyroid function using serum samples (thyrotropin [TSH], free thyroxine (FT4), and thyroid peroxidase antibodies) and depressive symptoms using the Centre for Epidemiologic Studies Depression (CES-D) scale. Incident depressive events (n = 1366) were continuously followed up with the CES-D and clinical interviews. We analyzed the cross-sectional association of thyroid function and thyroid disease with depressive symptoms using linear and logistic regression, and the longitudinal association with Cox proportional hazard models for depressive events. RESULTS: Lower TSH levels and lower and higher FT4 levels were cross-sectionally associated with more depressive symptoms with a B value of -0.07 per 1 unit increase of natural log-transformed TSH (95% CI -0.11; -0.04). Furthermore, hypothyroidism was cross-sectionally associated with less depressive symptoms and hyperthyroidism with more depressive symptoms. Longitudinally, there was a U-shaped association between FT4 and incident depressive events but only in euthyroid participants. CONCLUSION: We show a cross-sectional association between thyroid (dys)function with depressive symptoms, and a U-shaped association between FT4 and incident depressive events in euthyroid individuals. Our findings suggest an association of thyroid function with the risk of developing depression, albeit small. Reverse causation and additional underlying factors may also contribute to the association.

Thyroid Function and Physical Activity: A Population-Based Cohort Study.

Background: Thyroid hormones are important metabolic regulators exerting effects in multiple systemic functions including muscular and cardiorespiratory function. Thyroid hormones may influence physical activity levels. However, there are currently no studies evaluating the association between thyroid function and physical activity levels in the general population. Methods: In a population-based cohort study between 2006 and 2013, we assessed the cross-sectional and longitudinal (with a mean follow-up time of 5 years) association of serum thyrotropin (TSH) and free thyroxine (fT4) with physical activity (metabolic equivalent task [MET] hours per week). Information on physical activity was collected using a validated questionnaire (Longitudinal Aging Study Amsterdam, median 22.50 MET hours per week). The association of TSH and fT4 with physical activity was examined using linear regression models in the cross-sectional and longitudinal analyses, adjusted for age, sex, lifestyle factors, and cardiovascular disease. In sensitivity analyses, we examined the association between thyroid function and physical activity including only participants within the reference range of thyroid function. We additionally examined moderate and vigorous physical activity separately as outcomes. Results: We included 2470 participants for the cross-sectional analysis (mean age 57.3 years, 58% women) and 1907 participants for the longitudinal analysis (mean age 56.9 years). There was no association between TSH (mIU/L) or fT4 (ng/dL) and physical activity (ß = 0.65, 95% confidence interval [CI, -1.67 to 2.98] and ß = 2.76, [CI -7.15 to 12.66], respectively) on cross-sectional analysis. Similarly, in the longitudinal analyses, we observed no association of TSH (ß = 1.16, [CI -1.31 to 3.63]) or fT4 (ß = -6.63, [CI -17.06 to 3.80]) with physical activity. Conclusions: We did not observe an association between the endogenous thyroid hormone level and total physical activity. Further studies need to be performed to evaluate whether thyroid hormone replacement therapy is associated with physical activity.

Opciones terapéuticas frente a especies de Candida resistentes a las equinocandinas / Therapeutic options in the management of echinocandin resistant Candida species

Introducción: La infección por levaduras del género Candida representa la causa más común de infecciones fúngicas invasivas. Su alta incidencia y la creciente resistencia frente a los azoles y, recientemente, a las equinocandinas ha generado la necesidad de buscar nuevas alternativas farmacológicas. Esta revisión presenta las principales alternativas farmacológicas en estudio frente a Candida resistente a equinocandinas. Métodos: Se buscó literatura referente al tema en las bases de datos Bireme, Clinical Key, Embase, Cochrane, Lilacs, Pubmed y Scopus. Se incluyeron 15 artículos en esta revisión. Resultados: Se exploran diferentes alternativas, incluyendo el aumento de dosis de las equinocandinas, su combinación con otros medicamentos y nuevos compuestos en estudio. Conclusión: A pesar de que las infecciones por Candida resistente a equinocandinas aún representan un desafío, dos alternativas farmacológicas se presentan como promisorias: la combinación con medicamentos existentes como el diclofenaco y nuevos compuestos que se encuentran actualmente en fase II de estudios clínicos.

Introduction: Candida yeasts infections represent the most common cause of invasive fungal infections. Its high incidence and increasing resistance to azoles and, recently, to echinocandins has generated the need to find new therapeutic options. This review presents the main pharmacological alternatives in research against echinocandins resistant Candida. Methods: A search was conducted in the databases of Bireme, Clinical Key, Embase, Cochrane, Lilacs, Pubmed and Scopus. 15 articles were included in this review. Results: Several alternatives are explored, including increased doses of echinocandins, combination with other drugs and new compounds under study. Conclusion: Although resistant Candida infections still represent a challenge, two pharmacological approaches show promise: The combination with existing medicaments such as diclofenac, and new compounds that are currently in Phase II of clinical trials.