ABSTRACT
Nuestro país ha avanzado con la incorporación del tratamiento de la depresión unipolar a todo paciente, con acceso universal y garantías de tratamiento con oportunidad y calidad. Como resultado de esto el manejo de la depresión en la atención primaria ha mejorado en la última década. Diversos estudios han mostrado que alrededor de un 25 por ciento de los pacientes correspondería a las depresiones en trastornos en el espectro bipolar, cifra que aumenta al 40 por ciento en depresión recurrente. Se hace necesario diseñar un enfrentamiento clínico rápido para el reconocimiento de características indicadoras de un trastorno afectivo bipolar (TAB), considerando que estos pacientes no responden bien al tratamiento con antidepresivos, se deterioran más, o son más refractarios a tratamiento, con mayor riesgo de suicidio, incluso con el riesgo de gatillar episodios maniacos o hipomaniacos. El estudio presenta una breve revisión sobre bipolaridad y desarrolla un método clínico, basado en un cuestionario breve diseñado a partir de pruebas de tamizaje estándares, para poder reconocer con mayor facilidad a pacientes que estén con mayor riesgo de presentar un trastorno afectivo bipolar.
In the last decade, Chile has improved its primary care service by providing timely and good quality assistence to all patients treated with mayor depression. Different studies show that 25 percent of patients treated with depression are within the spectrum of bipolar affective disorders (TAB), figure that rises up to 40 percent in recurrent depression. These patients did not respond to the treatment with antidepressant, or more refractory to treatment, and have a higuer rate of suicide, even with the risk of triggering manic or hypomanic episodes. Therefore, it is necessary to design fast clinical clues to recognize features that may be indicative of TAB. Based on a standard screening tests, this study presents a brief review about bipolarity disorders and develops a clinical method to suspect patients that are at risk of presenting TAB in an easier way.
Subject(s)
Humans , Mass Screening , Primary Health Care , Bipolar Disorder/diagnosis , Surveys and QuestionnairesABSTRACT
Pre-eclampsia is a hypertensive disorder of pregnancy in which enzymatic antioxidant defenses fail and tissues are injured. This prospective case-control study evaluated whether pre-eclamptic women and their newborns show higher degrees of oxidative stress than normal pregnancies and sought to determine if this stress is related to clinical severity. Forty-four pre-eclamptic and thirty healthy pregnant women attending two hospitals in Valparaíso, Chile, were studied. The following plasmatic variables of antioxidant capacity were evaluated: glutathione peroxidase activity (GPx), total antioxidant capacity measured by oxidation of ABTS substrate (2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid), and superoxide dismutase activity (SOD). malondialdehide (MDA) was measured to evaluate lipoperoxidation. The evaluation was performed at diagnosis of pre-eclampsia, delivery, 30 days and 120 days post delivery. Newborns were studied at delivery through umbilical cord blood samples. Our analysis shows that antioxidant enzyme activity (SOD, GPx, ABTS) was significantly decreased, while lipoperoxidation (MDA) was increased in both pre-eclamptic groups compared to normal pregnant women (p<0.01). Statistically significant difference was found between mild and severe pre-eclamptic groups (p<0.01), for all biochemical markers studied. Therefore, the clinical severity of this pathology is closely related to the degree of oxidative stress.