La depresión con ideas suicidas presenta disfunciones corticales prefrontales que favorecen significativamente el intento suicida / Depression with suicidal ideas presents prefrontal cortical dysfunctions that significantly favor suicidal intent

Se realiza una revisión de estudios de resonancia magnética integral y funcional, así como estudios bioquímicos en pacientes con y sin ideas suicidas. Estos estudios en pacientes con alto riesgo de suicidio presentan una disminución de volúmenes corticales en la corteza prefrontal dorso y ventrolateral. Lo importante de estos estudios es que resultan de la comparación con pacientes deprimidos con bajo riesgo de suicidio. Los estudios de resonancia magnética funcional mostraron una hipofuncionalidad del lóbulo prefrontal en los pacientes depresivos con ideas suicidas severas, que se observa como una disminución del flujo sanguíneo cerebral en las áreas lateral y ventral. Se observa una disminución del metabolismo de serotonina, en clara relación con la severidad de las ideas de muerte, también con un foco en la región lateroventral prefrontal. Dado que las funciones de la corteza prefrontal afirman al individuo en su perspectiva vital, disfunciones como las descritas debilitan la coordinación y organización del apego a la vida, quedando, por el contrario, la posibilidad de la búsqueda de la muerte. Se concluye que los pacientes depresivos con ideas suicidas tienen una alta vulnerabilidad para el intento de suicidio por la afectación de las zonas prefrontales.

A review of functional integral magnetic resonance and biochemical data from patients with and without suicidal ideation is presented. Patients with high suicidal risk show a decrease in cortical volume in ventrolateral and dorsal prefrontal cortex. These studies are compared to those of depressed patients with low suicidal risk. Functional magnetic resonance in depressed patients with severe suicidal ideation show an hypo functional prefrontal lobe, seen as a decrease in blood flow in lateral and ventral areas. There is a decrease in serotonin metabolism, clearly related to the severity of suicidal ideation, also in ventrolateral prefrontal cortex. As prefrontal cortex functions enhance vital perspectives, such dysfunctions weaken coordination and organization of attachment to life, making search for death a possibility. Authors conclude that depressed patients with suicidal ideation have a high vulnerability for suicidal intent due to changes in prefrontal areas.

How do stress, sleep quality, and chronotype associate with clinically significant depressive symptoms? A study of young male military recruits in compulsory service

Objective: Although studies have shown an association between poor sleep and chronotype with psychiatric problems in young adults, few have focused on identifying multiple concomitant risk factors. Methods: We assessed depressive symptoms (Beck Depression Inventory [BDI]), circadian typology (Morningness-Eveningness Questionnaire [MEQ]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), perceived stress (Perceived Stress Scale [PSS]), social rhythm (Social Rhythm Metrics [SRM]), and salivary cortisol (morning, evening and night, n=37) in 236 men (all 18 years old). Separate analyses were conducted to understand how each PSQI domain was associated with depressive symptoms. Results: Depressive symptoms were more prevalent in individuals with higher perceived stress (prevalence ratio [PR] = 6.429, p < 0.001), evening types (PR = 2.58, p < 0.001) and poor sleepers (PR = 1.808, p = 0.046). Multivariate modeling showed that these three variables were independently associated with depressive symptoms (all p < 0.05). The PSQI items subjective sleep quality and sleep disturbances were significantly more prevalent in individuals with depressive symptoms (PR = 2.210, p = 0.009 and PR = 2.198, p = 0.008). Lower levels of morning cortisol were significantly associated with higher depressive scores (r = -0.335; p = 0.043). Conclusion: It is important to evaluate multiple factors related to sleep and chronotype in youth depression studies, since this can provide important tools for comprehending and managing mental health problems.

Decreased expression of microRNA-17 in hippocampal tissues and blood from mice with depression up-regulates the expression of PAI-1 mRNA and protein

This study determined the expression of plasminogen activator inhibitor-1 (PAI-1) and microRNA (miR)-17 in a mouse depression model. Forty male mice were divided evenly into control and depression groups. A chronic unpredictable mild stress (CUMS) model was constructed. qRT-PCR was used to determine the expression of PAI-1 mRNA and miR-17. Western blotting and ELISA were used to determine expression of PAI-1 protein. Dual luciferase reporter assay was carried out to identify direct interaction between miR-17 and PAI-1 mRNA. The mice with depression had elevated PAI-1 mRNA and protein in hippocampal tissues and blood. Expression of miR-17 was decreased in hippocampal tissues and blood from mice with depression. miR-17 bound with the 3′-UTR of PAI-1 mRNA to regulate its expression. This study demonstrated that miR-17 expression in hippocampal tissues and blood from mice with depression was decreased while expression of PAI-1 mRNA and protein was up-regulated. miR-17 participated in depression in mice by regulating PAI-1.

miR-22 and cerebral microbleeds in brainstem and deep area are associated with depression one month after ischemic stroke

In this study, we aimed to explore the relationship among miR-22, deep cerebral microbleeds (CMBs), and post-stroke depression (PSD) 1 month after ischemic stroke. We consecutively recruited 257 patients with first-ever and recurrent acute cerebral infarction and performed PSD diagnosis in accordance with the Diagnostic and Statistical Manual IV criteria for depression. Clinical information, assessments of stroke severity, and imaging data were recorded on admission. We further detected plasma miR-22 using quantitative PCR and analyzed the relationship among miR-22, clinical data, and PSD using SPSS 23.0 software. Logistic regression showed that deep (OR=1.845, 95%CI: 1.006-3.386, P=0.047) and brain stem CMBs (OR=2.652, 95%CI: 1.110-6.921, P=0.040), as well as plasma miR-22 levels (OR=2.094, 95%CI: 1.066-4.115, P=0.032) were independent risk factors for PSD. In addition, there were significant differences in baseline National Institutes of Health Stroke Scale scores (OR=1.881, 95%CI: 1.180-3.011, P=0.007) and Widowhood scores (OR=1.903, 95%CI: 1.182-3.063, P=0.012). Analysis of the receiver operating curve (AUC=0.723, 95%CI: 0.562-0.883, P=0.016) revealed that miR-22 could predict PSD one month after ischemic stroke. Furthermore, plasma miR-22 levels in brainstem and deep CMBs patients showed an upward trend (P=0.028) relative to the others. Patients with acute ischemic stroke, having brainstem and deep cerebral microbleeds, or a higher plasma miR-22 were more likely to develop PSD. These findings indicate that miR-22 might be involved in cerebral microvascular impairment and post-stroke depression.

Antidepressant effects of Kai-Xin-San in fluoxetine-resistant depression rats

This study aimed to investigate the antidepressant effect and the mechanism of action of Kai-Xin-San (KXS) in fluoxetine-resistant depressive (FRD) rats. Two hundred male Wistar rats weighing 200±10 g were exposed to chronic and unpredictable mild stresses (CUMS) for 4 weeks and given fluoxetine treatment simultaneously. The rats that did not show significant improvement in behavioral indexes were chosen as the FRD model rats. These rats were randomly divided into four groups: FRD model control; oral fluoxetine and aspirin; oral KXS at a dose of 338 mg·kg-1·day-1; and oral KXS at a dose of 676 mg·kg-1·day-1. Rats continued to be exposed to CUMS and underwent treatment once a day for 3 weeks, then cytokine (COX-2, IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-10, TGF-β, and TNF-α) levels in the hippocampus and serum, and organ coefficients were measured. Both doses of KXS improved the crossing and rearing frequencies, sucrose-preference index, and body weight in FRD rats. KXS at a dose of 338 mg·kg-1·day-1reduced COX-2, IL-2, IL-6, TNF-α levels, increased IL-10 level in the hippocampus, and reduced IL-2 and TNF-α levels in serum. KXS at a dose of 676 mg·kg-1·day-1reduced TNF-α level in the hippocampus, reduced IL-2 and TNF-α levels in serum, and increased IFN-γ and IL-10 levels in the hippocampus and serum. There were no significant differences in organ-coefficients of the spleen among and between groups. The results suggested that oral administration of KXS in FRD rats was effective in improving behavior disorders by influencing various inflammatory pathways.

Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study / Desequilíbrio na proporção salivar diurna de testosterona/cortisol em homens com apneia obstrutiva do sono grave: um estudo observacional

ABSTRACT INTRODUCTION: The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. OBJECTIVE: The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C). METHODS: Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities. RESULTS AND CONCLUSION: The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.

Resumo Introdução: A relação complexa entre os distúrbios do sono e os hormônios pode levar a alterações na produção de cortisol e testosterona em pacientes com Apneia obstrutiva do sono (AOS). Objetivo: O objetivo deste estudo foi determinar as curvas diurnas de testosterona e cortisol livres na saliva e sua proporção (razão T/C). Método: Dez indivíduos recém-diagnosticados com AOS com base na avaliação por polissonografia noturna e sonolência diurna excessiva e sete controles pareados foram recrutados, consecutivamente. Cortisol e testosterona foram medidos em amostras de saliva coletadas ao acordar, ao meio-dia e à noite. A avaliação psicométrica dos distúrbios de ansiedade/depressão e função sexual mencionados foi realizada para detectar a presença de comorbidades neuropsicológicas. Resultados: O achado principal foi que os indivíduos com AOS apresentam hipocortisolismo ao acordar e uma redução significante na concentração de testosterona à noite, em comparação com o grupo controle, que manteve a variação fisiológica diurna de testosterona e cortisol com concentrações hormonais mais elevadas pela manhã e concentrações mais baixas durante a noite. O uso de dados de várias mensurações diurnas, em vez de uma única mensuração, permitiu detectar as alterações na razão T/C de sinais opostos no início e no final do dia: os indivíduos com AOS apresentaram razão T/C maior que os controles na parte da manhã, enquanto que a razão T/C foi significantemente inferior à dos controles durante a noite. Conclusão: Os desequilíbrios no balanço anabólico-catabólico diurno sugerem que a AOS está associada a uma desregulação dos eixos hipotálamo-hipófise-adrenal e hipotálamo-hipófise-gonadal, potencialmente a causa subjacente de algumas das comorbidades neuropsicológicas observadas em pacientes com AOS.

Cortisol, DHEA, and depression in the elderly: the influence of physical capacity / Cortisol, DHEA e a depressão no idoso: a influência da capacidade física

ABSTRACT Objective Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. Method Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. Results Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. Conclusions The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.

RESUMO Objetivo A depressão maior tem sido associada a alterações nos níveis de cortisol e dehidroepiandrosterona (DHEA) em pacientes idosos depressivos. O presente estudo objetivou investigar a associação entre depressão, cortisol e DHEA, corrigindo por variáveis intervenientes, incluindo a capacidade física. Além disso, a associação entre os níveis hormonais e a capacidade física nos dois grupos experimentais também foi analisada. Método Pacientes idosos depressivos (n = 32) e idosos controles saudáveis (n = 31), pareados pela idade foram analisados. Os sujeitos foram submetidos a uma avaliação da capacidade física, incluindo níveis de atividade física, testes de capacidade funcional e escalas de equilíbrio. Resultados Os pacientes depressivos mostraram níveis significativamente menores de cortisol, os quais tornaram-se não significantes após controlados pela capacidade física. Uma correlação positiva foi observada entre os níveis de cortisol e a capacidade física. Resultados não significativos foram observados para DHEA, possivelmente devido a inclusão de pacientes depressivos e uma única coleta de amostra. Conclusão Os dados sugerem que a capacidade física modula a relação entre depressão e os níveis de cortisol e deve ser considerada em futuras investigações.

Anesthesia for EXIT procedure (ex utero intrapartum treatment) in congenital cervical malformation - a challenge to the anesthesiologist / Anestesia para procedimento EXIT (tratamento extraútero intraparto) em malformação congênita cervical - um desafio para o anestesiologista

The ex utero intrapartum treatment (EXIT) procedure consists of partial externalization of the fetus from the uterine cavity during delivery, allowing the maintenance of placental circulation. It is indicated in the presence of congenital malformation when difficulty in fetal airway access is anticipated, allowing it to be ensured by direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. Anesthesia for EXIT procedure has several special features, such as the appropriate uterine relaxation, maintenance of maternal blood pressure, fetal airway establishment, and maintenance of postpartum uterine contraction. The anesthesiologist should be prepared for the anesthetic particularities of this procedure in order to contribute to a favorable outcome for the mother and particularly the fetus.

O procedimento EXIT (tratamento extraútero intraparto) consiste na exteriorização parcial do feto da cavidade uterina durante o parto para permitir a manutenção da circulação fetoplacentária. Está indicado na presença de malformações congênitas em que se antecipa a dificuldade no acesso da via aérea fetal e permite que essa seja assegurada por laringoscopia direta, broncoscopia, traqueostomia ou intervenção cirúrgica. A anestesia para procedimento EXIT apresenta várias particularidades. O relaxamento uterino adequado, a manutenção da pressão arterial materna, o estabelecimento de via aérea fetal e a manutenção da contração uterina pós-parto são alguns exemplos. O anestesiologista deve estar preparado para as particularidades anestésicas desse procedimento, de modo a contribuir para um desfecho favorável para a mãe e particularmente para o feto.

Prueba de basculación (Tilt Table Testing): Comparación de dos protocolos: isoproterenol versus nitroglicerina / Comparison of the use of isoproterenol or nitroglycerine during the Tilt test

Background: There is debate about the advantages of different protocols usefulness of tilt test for the diagnosis of vasovagal collapse. Aim: To compare the sensitivity, specificity, adverse reactions, complications and time requirements of two different Tilt test protocols. Material and Methods: A Tilt test using isoproterenol in progressive doses (2 μg for 10 min and 5 μg for 5 min posteriorly was performed in 159 patients aged 9 to 84 years (59 males). Another Tilt test using sublingual nitroglycerine in doses of 0.3 mg was performed in 201 patients aged 8 to 87 years (62 males). Also, 20 healthy volunteers were tested. Results: The positivity rates of the tests using isoproterenol and nitroglycerin were 75.5 and 77.6% respectively (NS). The figures for sensitivity were 98.4 and 99.3% (NS). The figures for specificity were 93.2 and 98.4% (NS). The test using isoproterenol requires 15 more minutes. As adverse reactions, 38% of participants experienced palpitations with isoproterenol and 22% experienced headache with nitroglycerin. Conclusions: The Tilt test with nitroglycerin is shorter, simpler, painless, with less personnel involved and has the same diagnostic accuracy than the test with isoproterenol.

Weight loss and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation / Perda ponderal e presença de anemias carenciais em pacientes submetidos à bypass gástrico em Y-de-roux em uso de suplementação de vitaminas e mine

BACKGROUND: Obesity is a chronic disease with high growth in population and bariatric surgery is currently considered the most effective treatment for weight reduction; on the other hand, nutritional deficiencies are observed after this procedure. AIM: To analyze weight loss progression and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation. METHODS: Retrospective analysis of 137 patients of both sexes, aged between 18-60 years, using supplemental multivitamins and minerals, were included; personal information, anthropometric and laboratory data in the preoperative, 12, 24, 36 and 48 months postoperatively were collected. RESULTS: Postoperatively, in both sexes, occurred weight loss compared to the pre-operative weight gain at 48 months and maintenance of body mass index. There was a decrease in the percentage of excess weight loss at 48 months postoperatively compared to the time of 12, 24 and 36 months in men and decreased at 48 postoperative months compared to the time of 24 months in females. There was a decreased in serum ferritin in both sexes and increased serum iron at 48 months postoperatively in males. There was a decreased in vitamin B12 and folic acid increased serum at 48 postoperative months in females. CONCLUSIONS: Surgical treatment was effective for reducing weight, body mass index reduction and achievement of success in the late postoperative period along with multivitamin and mineral supplementation on prevention of serious nutritional deficiencies and anemia. .

RACIONAL: A obesidade é doença crônica com elevado crescimento na população. A cirurgia bariátrica é considerada o tratamento mais efetivo para redução de peso; por outro lado, deficiências nutricionais são observadas após esse procedimento. OBJETIVO: Avaliar a evolução da perda ponderal e a presença de anemias carenciais em pacientes submetidos ao bypass gástrico em Y-de-Roux em uso de suplementação de vitaminas e minerais. MÉTODOS: Análise retrospectiva de 137 pacientes de ambos os sexos, com idade entre 18-60 anos, em uso de suplementação de polivitaminas e minerais incluindo informações pessoais, dados antropométricos e laboratoriais nos períodos pré-operatório, 12, 24, 36 e 48 meses de pós-operatório. RESULTADOS: No pós-operatório, em ambos os sexos, ocorreu perda de peso em relação ao pré-operatório, ganho de peso aos 48 meses e manutenção do índice de massa corporal. Houve diminuição do percentual de perda de excesso de peso aos 48 meses pós-operatórios comparado com os tempos 12, 24 e 36 meses em homens e diminuição aos 48 meses pós-operatórios em relação aos 24 meses no sexo feminino. Houve diminuição da ferritina sérica em ambos os sexos e aumento do ferro sérico aos 48 meses pós-operatório no sexo masculino. Houve diminuição da vitamina B12 e aumento do ácido fólico séricos aos 48 meses do pós-operatório no sexo feminino. CONCLUSÕES: O tratamento cirúrgico mostrou-se eficaz para redução de peso, redução do índice de massa corporal e alcance do sucesso no pós-operatório tardio juntamente com a suplementação de polivitamínico e minerais na prevenção de deficiências nutricionais importantes e anemias. .

Changes in tau phosphorylation levels in the hippocampus and frontal cortex following chronic stress

Studies have indicated that early-life or early-onset depression is associated with a 2- to 4-fold increased risk of developing Alzheimers disease (AD). In AD, aggregation of an abnormally phosphorylated form of the tau protein may be a key pathological event. Tau is known to play a major role in promoting microtubule assembly and stabilization, and in maintaining the normal morphology of neurons. Several studies have reported that stress may induce tau phosphorylation. The main aim of the present study was to investigate possible alterations in the tau protein in the hippocampus and frontal cortex of 32 male Sprague-Dawley rats exposed to chronic unpredictable mild stress (CUMS) and then re-exposed to CUMS to mimic depression and the recurrence of depression, respectively, in humans. We evaluated the effects of CUMS, fluoxetine, and CUMS re-exposure on tau and phospho-tau. Our results showed that a single exposure to CUMS caused a significant reduction in sucrose preference, indicating a state of anhedonia. The change in behavior was accompanied by specific alterations in phospho-tau protein levels, but fluoxetine treatment reversed the CUMS-induced impairments. Moreover, changes in sucrose preference and phospho-tau were more pronounced in rats re-exposed to CUMS than in those subjected to a single exposure. Our results suggest that changes in tau phosphorylation may contribute to the link between depression and AD.

Trastornos psiquiátricos y cognitivos de la hepatitis C y su tratamiento con interferón / Psychiatric and cognitive problems associated to hepatitis C and its treatment with interferon

This article is a literature search about the psychopathology related to hepatitis C and its treatment with interferon. An overview of the methodology of the available studies is presented. New theories for a better understanding and diagnosis of the psychiatric alteration associated to hepatitis C or interferon treatment are proposed, to improve future research. We discuss neurobiological aspects, clinical manifestations, psychosocial features and pharmacotherapy of the psychiatric manifestations of hepatitis C and its treatment with interferon.

Exploração farmacológica do sistema endocanabinoide: novas perspectivas para o tratamento de transtornos de ansiedade e depressão? / Pharmacological exploitation of the endocannabinoid system: new perspectives for the treatment of depression and anxiety disorders?

OBJETIVO: Este artigo revisa o sistema endocanabinoide e as respectivas estratégias de intervenções farmacológicas. MÉTODO: Realizou-se uma revisão da literatura sobre o sistema endocanabinoide e a sua farmacologia, considerando-se artigos originais ou de revisão escritos em inglês. DISCUSSÃO: Canabinoides são um grupo de compostos presentes na Cannabis Sativa (maconha), a exemplo do Δ9-tetraidrocanabinol e seus análogos sintéticos. Estudos sobre o seu perfil farmacológico levaram à descoberta do sistema endocanabinoide do cérebro de mamíferos. Este sistema é composto por pelo menos dois receptores acoplados a uma proteína G, CB1 e CB2, pelos seus ligantes endógenos (endocanabinoides; a exemplo da anandamida e do 2-araquidonoil glicerol) e pelas enzimas responsáveis por sintetizá-los e metabolizá-los. Os endocanabinoides representam uma classe de mensageiros neurais que são sintetizados sob demanda e liberados de neurônios pós-sinápticos para restringir a liberação de neurotransmissores clássicos de terminais pré-sinápticos. Esta sinalização retrógrada modula uma diversidade de funções cerebrais, incluindo ansiedade, medo e humor, em que a ativação de receptores CB1 pode exercer efeitos dos tipos ansiolítico e antidepressivo em estudos préclínicos. CONCLUSÃO: Experimentos com modelos animais sugerem que drogas que facilitam a ação dos endocanabinoides podem representar uma nova estratégia para o tratamento de transtornos de ansiedade e depressão.

OBJECTIVE: The present review provides a brief introduction into the endocannabinoid system and discusses main strategies of pharmacological interventions. METHOD: We have reviewed the literature relating to the endocannabinoid system and its pharmacology; both original and review articles written in English were considered. DISCUSSION: Cannabinoids are a group of compounds present in Cannabis Sativa (hemp), such as Δ9-tetrahydrocannabinol, and their synthetic analogues. Research on their pharmacological profile led to the discovery of the endocannabinoid system in the mammalian brain. This system comprises at least two G-protein coupled receptors, CB1 and CB2, their endogenous ligands (endocannabinoids; e.g. the fatty acid derivatives anandamide and 2-arachydonoyl glycerol), and the enzymes responsible for endocannabinoid synthesis and catabolism. Endocannabinoids represent a class of neuromessengers, which are synthesized on demand and released from post-synaptic neurons to restrain the release of classical neurotransmitters from pre-synaptic terminals.This retrograde signalling modulates a variety of brain functions, including anxiety, fear and mood, whereby activation of CB1 receptors was shown to exert anxiolytic-and antidepressant-like effects in preclinical studies. CONCLUSION: Animal experiments suggest that drugs promoting endocannabinoid action may represent a novel strategy for the treatment of depression and anxiety disorders.

Determinación de los niveles de cortisol salival en una muestra de sujetos de Santiago de Chile / Salivary cortisol among subjects with and without Cushing syndrome

Background: Salivary cortisol measurement is recommended as a screening mea-sure when a Cushing Syndrome is suspected. Theproposed cut-offpointfor aprobable diagnosis is 0.16 ug/dL. Aim: To determine salivary cortisol concentrations during the day inpatients with and without Cushing syndrome and with depression. Material and Methods: Salivary cortisol was measured by competitive enzyme immuno assay (EIA), in samples obtained at 8:00,15:00 and 23:00 h in 78 patients without Cushing syndrome, aged 40 ± 15years (28 males), 30 patients with depression aged 40 ± 12years (nine males) and four jemales with Cushing syndrome aged 42 ± 17 years. Results: Salivary cortisol was higher among patients with Cushing syndrome than the rest of patients. A salivary cortisol over the cut-off value of O.16 ug/dL was found in 42 percent of subjects without Cushing syndrome and in 33 percent of patients with depression. Median values among patients without Cushing syndrome, depression and with Cushing syndrome were 0.21 (range < 0.1-1.42), 0.2 (range 0,12-0.9) and 0.58 (range 0.37-1.1) ug/dL, respectively Conclusions: Salivary cortisol measured by EIA method was higher among patients with Cushing syndrome but there was a great overlap with values obtained in subjects without the syndrome.

Morphological aspects of the embryonic development of the TMJ in rats (Rattus norvegicus albinus) treated with fluoxetine / Aspectos morfológicos del desarrollo embrionario de la ATM en ratas (Rattus norvegicus albinus) tratadas con fluoxetina

The TMJ has been to the Dental community a key point in the search of knowledge, being it part of the temporomandibular joint complex and of the estomatognathic system which are in charge of the mastication, speech, swallowing, as well as participation in breathing and taste perception. For the majority of the women in serious state of depression, which do not respond psychotherapeutic treatment, pharmacological treatment it's applied. The antidepressants serotonin selective reuptake inhibitors (SSRIs) are the most recommended in these cases. The teratogenic effect of the SSRIs is considered controversial, studies done with women who used these drugs during the pregnancy showed that the respiratory and central nervous systems are the most affected, was also recorded a deficit of body growth and the decrease of the encephalon and skull measures. In the present study, our goal was to assess whether the administration of Fluoxetine during the pregnancy modified the embryology and morphology of the TMJ of rats. For that, 16 Wistar female rats from the Nutrition Department of the UFPE vivarium were selected; 8 for the control group, which received daily 0.9 percent of saline in subcutaneous dose of 10ml/g, with schedules previously established after daily weighing and 8 for the experimental one that were treated with fluoxetine hydrochloride with the dose of 10mg/Kg in a volume 10ml/g of weight, were injected subcutaneously with the same standards established for the control group. It was observed, with this dose that the embryological development of the TMJ, especially of the mandibular condyle, does not present any difference between the degree of maturation of the tissue that forms the TMJ, especially of the condyle between the treated and control groups.

La ATM ha sido para la comunidad odontológica un punto clave en la búsqueda del conocimiento, dado que forma parte del complejo articular temporomandibular y del sistema estomatognático, los cuales se encargan de la masticación, fonación y deglución, así como la participación en la respiración y de la percepción gustativa. Para la mayoría de las mujeres con cuadros graves de depresión, que no responden al tratamiento psicoterapéutico, el tratamiento farmacológico es aplicado. Los antidepresivos del grupo de los Inhibidores Selectivos de Recaptación de Serotonina (ISRSs) son los más comúnmente recomendados en estos casos. El efecto teratogénico de los ISRSs es considerado controversial. Estudios realizados en mujeres que utilizaron estas drogas durante la gestación mostraron que los sistemas respiratorios y nervioso central son los más afectados, también fue constatado un déficit de crecimiento corporal, encefálico y disminución de las medidas craneales. En el presente estudio, nuestro objetivo fue evaluar si la administración de fluoxetina durante la gestación modifica la embriología y la morfología de la ATM de ratas de laboratorio. Para este fin, 16 ratas Wistar del bioterio de nutrición de la UFPE fueron seleccionadas: 8 para el grupo de control, las cuales recibieron diariamente solución fisiológica a 0,9 por ciento en aplicaciones subcutáneas en la dosis de 10ml/g, en horarios previamente establecidos después de pesaje diario y 8 para el experimental, las que fueron tratadas con clorhidrato de fluoxetina en la dosis de 10mg/kg, en un volumen de 10ml/g, inyectados por vía subcutánea en los mismos estándares establecidos para el grupo de control. Se observó, que con esta dosis el desarrollo embriológico de la ATM, especialmente del cóndilo mandibular, no presentó ninguna diferencia entre el grado de maduración de los tejidos que forman la ATM, especialmente del cóndilo, entre los grupos tratado y grupo control.

Bases neurobiológicas de la depresión / Neurobiology of depression

La depresión es uno de los trastornos mentales que presenta una gran prevalencia, ya que afecta a cerca del 16% de la población general. Actualmente, la mayoría de los estudios coinciden en que este trastorno se produce por una interacción entre algún tipo de predisponente genético y diversos factores ambientales. Es por ello que la investigación de los mecanismos que median dicha interacción cobra vital importancia para conseguir avanzar en la comprensión de los mecanismos etiopatogénicos que originan el trastorno depresivo, y por ende para lograr herramientas más eficaces para su tratamiento y prevención. Durante las últimas décadas gran parte de los estudios sobre las bases neurobiológicas de la depresión evolucionaron a partir de dos grandes hipótesis, la teoría monoaminérgica y la teoría neurotrófica. El objeto del presente artículo es hacer una revisión de los hallazgos científicos que avalan ambas teorías.

Evaluation of salivary cortisol and psychological factors in patients with oral lichen planus.

Background and Objectives: Lichen planus is a relatively common chronic inflammatory disease of oral mucosa and skin. Cortisol, also called as "stress hormone", has been used as an indicator in various stress evaluation studies. Salivary cortisol measurement is an indicator of free cortisol or biologically active cortisol in human serum and provides noninvasive and easy technique. Recent studies have been conflicting, and hence, in the present study, evaluation of salivary cortisol levels and psychosocial factors in oral lichen planus (OLP) patients was done. Materials and Methods: A total of 30 patients with clinically and histopathologically proven cases of OLP, along with the age and sex-matched healthy controls were included in the study. Samples of stimulated saliva were collected, centrifuged and analyzed for the level of cortisol with cortisol enzyme linked immunosorbent assay. Psychosocial factors of study and control groups were measured by depression anxiety and stress scale. Student's t-test was used to compare the psychological factors and salivary cortisol levels between patients with the OLP and the control group. Results: Irrespective of sex, significantly higher depression (83.4 ± 15.4%), anxiety (80.5 ± 11.3%), and stress (94.2 ± 6.2%) scores were observed in OLP patients compared to controls. Increased cortisol levels were observed among 17 (56.6%) OLP patients in the study group. A positive correlation was found between psychological factors and salivary cortisol levels in the OLP patients. The values of Pearson's correlation coefficient "r", between depression, anxiety, and stress with salivary cortisol was: +0.42,S; +0.27,NS; and +0.65,HS, respectively among the study group.

Função cognitiva e depressão em uma coorte de pacientessubmetidos a diálise peritoneal, avaliada pelo mini-mental (meem) ebdi – devemos incluí-los na memória / Cognitive function and depression in a cohort of patients onperitoneal dialysis, assessed by the mini-mental (mmse) andbdi – we should memorize them

Introdução: A depressão e a demência constituem duas das enfermidades mentais mais prevalentes em doenças crônicas. Objetivo: Avaliar a funçãocognitiva e a depressão em pacientes portadores de doença renal crônica em diálise peritoneal. Pacientes e Métodos: Estudo transversal realizado nosmeses de dezembro de 2005 e janeiro de 2006, em 23 pacientes submetidos à diálise peritoneal. Realizada uma bateria de testes: Miniexame do EstadoMental (MEEM), Teste de Fluência Verbal (TFV) e Inventário Beck de Depressão (BDI). Também foram coletados dados clínicos e laboratoriais dospacientes, bem como uso de medicações. Resultados: A média das idades foi de 60,6 anos e a maioria dos pacientes (56,6%) eram do sexo feminino,tendo sido a nefropatia diabética (50%) a principal causa da DRC. O teste MEEM mostrou que 60% dos pacientes apresentavam declínio cognitivo. O TFVrevelou que 40% dos pacientes apresentaram alteração na fluência verbal. O BDI mostrou que 56% dos pacientes apresentavam depressão leve oumoderada. Conclusão: Embora os nossos resultados devam ser considerados como preliminares, eles sugerem a necessidade de se realizar estudoslongitudinais com maior número de pacientes a fim de se confirmar ou não a ocorrência aumentada do declínio cognitivo em pacientes com doença renalcrônica em tratamento com diálise peritoneal.

Introduction: Depression and dementia are among the most frequent mental chronic diseases. Patients and methods: In this study the cognitive functionand depression evaluated by the Mini-Mental (MMSE) test and Beck Depression Inventory (BDI), were assessed, respectively in patients on peritonealdialysis. Clinical and laboratory data, as well as prescribed medication were obtained from the patients’ charts in the months of December, 2005 andJanuary, 2006. The results are expressed as mean ± standard deviation or percentage. Statistical difference was considered when the p value was <0.05.The software used was the SPSS version 10.0. Results: The mean age of the patients was 60.6 years, and the majority (56.6%) was female. Diabetickidney disease (50%) was the main cause of end stage renal disease. Mild, moderate or severe cognitive deficit was detected in 60% of the patients by theMMSE test. Mild or moderately severe depression was observed in 56% of patients by the BDI. Conclusion: Although our results should be interpreted aspreliminary, they suggest the need for more longitudinal studies with a larger number of patients in order to confirm or not the increased occurrence ofcognitive deficit in patients on peritoneal dialysis.

Estrés oxidativo y depresión: ¿un posible rol etiológico? / Oxidative stress and depression: a possible etiologic role?

La prevalencia de la depresión, como concepto general de enfermedad, ha aumentado en todo el mundo, convirtiéndose en un grave problema de salud. A pesar de esto, no se conoce su causa. Sin embargo, un posible rol etiológico puede ser adjudicado al estrés oxidativo, ya que la evidencia actual demuestra que pacientes con dicho diagnóstico tienen elevados niveles de lipoperoxidación y disminuidas las defensas antioxidantes, es decir, presentan estrés oxidativo; este último se asocia a una disminución de los ácidos grasos omega-3, hecho que ha demostrado estar significativamente asociado con las depresiones mayor, menor y post parto. Por consiguiente es posible plantear que el estrés oxidativo puede tener un rol en la etiología del subtipo de depresión que se relaciona con disminución de los ácidos grasos omega-3. El propósito de este trabajo es relacionar el rol etiológico que tendría el estrés oxidativo en aquellas depresiones relacionadas con el déficit de ácidos grasos omega-3.

Estrés y depresión: una mirada desde la clínica a la neurobiología / Stress and depression: a clinical to neurobiology view

La amplia difusión de los términos estrés y depresión obligan al clínico a precisar los conceptos médicos al respecto. La adecuada capacidad de adaptación de un organismo a un estímulo estresor se denomina eustrés y su opuesto, el distrés, constituye una respuesta que se traducirá en diversos síntomas y signos. El estrés puede facilitar la aparición de distintos cuadros psiquiátricos, particularmente en sujetos vulnerables. En este artículo se revisan los mecanismos neurobiológicos que subyacen al estrés y su relación con los trastornos depresivos. Actualmente se hace necesario estar familiarizado con el lenguaje de las neurociencias para una mejor comprensión de las hipótesis biológicas de la patología mental. Asimismo el progreso en esta área ha dado origen a una farmacoterapia más racional y específica basada en los mecanismos de acción de los fármacos y en los complejos eventos de la fisiología sináptica. Se revisan también algunos aspectos de la resiliencia y de la neuroplasticidad y su relación con los antidepresivos.