ABSTRACT
Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .
Subject(s)
Adult , Female , Humans , Male , Young Adult , Brain Injuries/psychology , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Psychiatric Status Rating Scales/standards , Age Factors , Area Under Curve , Confidence Intervals , Mass Screening/methods , Prospective Studies , Psychometrics , Surveys and Questionnaires/standards , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Sex FactorsABSTRACT
Currently, hospital infection is a serious public health problem, and several factors may influence the occurrence of these infections, including the presence of insects, which are carriers of multidrug-resistant bacterial species. The aim of this study was to isolate staphylococci carried by insects in two public hospitals of Vitoria da Conquista, Bahia and to identify the resistance profile, pathogenicity and efficacy of disinfection of the premises. A total of 91 insects were collected in 21 strategic points of these hospitals, and 32 isolated strains ofStaphylococcus aureus were isolated. Based on antibiogram and Minimum Inhibitory Concentration results, 95% of these strains were susceptible to oxacillin. These strains were also evaluated for the presence of resistance genes encoding resistance to oxacillin/methicillin by polymerase chain reaction, but the sample was negative for this gene. Pathogenicity tests were performed in vitro biofilm formation induced by glucose, where it was found that eight (27.58%) strains were classified as biofilm producers and 21 (72.4%) as stronger producers. In addition, we performed PCR for their virulence genes: Sea (enterotoxin A), SEB (B), Sec (C), PVL (Panton-Valentine Leukocidin), ClfA (clumping factor A) and Spa (protein A). Of these, Sea, Spa PVL were positive in 7 (21.8%), 2 (6.3%) and 1 (3.1%) samples, respectively. The analysis of cytokine induction in the inflammatory response of J774 macrophages by isolates from the two hospitals did not show statistical difference at the levels of IL-6, TNF-α, IL-1 and IL-10 production. In addition, we verified the antimicrobial activity of disinfecting agents on these strains, quaternary ammonium, 0.5% sodium hypochlorite, 1% sodium hypochlorite, 2% sodium hypochlorite, 2% glutaraldehyde, Lysoform®, 70% alcohol solution of chlorhexidine digluconate, 2% peracetic acid, and 100% vinegar. Resistance was seen in only for the following two disinfectants: 70% alcohol in 31 (96.8%) samples tested and vinegar in 30 (93.8%) samples. The study demonstrated the presence of resistant and pathogenic organisms conveyed by insects, thus suggesting improvement in efforts to control these vectors.
Subject(s)
Animals , Anti-Bacterial Agents/pharmacology , Disinfection/methods , Insecta/microbiology , Staphylococcus aureus , Brazil , Biofilms/growth & development , DNA, Bacterial/genetics , Genotype , Hospitals, Public , Insecta/classification , Microbial Sensitivity Tests , Methicillin Resistance/genetics , Polymerase Chain Reaction , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicity , Staphylococcus aureus/physiology , Virulence Factors/geneticsABSTRACT
Com o intuito de estudar a atividade eletrencefalográfica em vigilia da demência senil de tipo Alzheimer (DA) e da doença de Parkinson (DP) foi iniciado estudo prospectivo e controlado. Foram comparados 6 paciente com DA e 11 pacientes com DP, com um grupo controle composto por 12 pacientes com depressao maior crônica leve a moderada (DSM-III-R, 1987). Nos três grupos, através de análise espectral, foi obtida a mediana da frequência da energia da atividade dominante posterior. O grupo controle apresentou atividade posterior com frequência de 8,79 ñ O,52 (mñdp). No grupo com DA este valor foi 6,65 ñ O,8O (mñdp) e no grupo com DP 7,69 + 1,39 (mñdp). A hipótese experimental de que pacientes com DA e DP diferem dos controles em relaçao à atividade de fundo (definida como anormal sendo <8) foi confirmada pelo teste do qui quadrado (p=O,Ol) e no teste t a média das frequências da energia posterior foi significativamente menor nos pacientes com DA (p=O,O1) e DP (p=O,O5) do que nos controles. Os resultados indicam que esta anormalidade possa ser correlacionada com o grau de comprometimento cortical e a gravidade da evoluçao da DA e da DP.