Stages of hyperglycemia and common mental disorders in adults - The Brazilian Study of Adult Health (ELSA-Brasil) / Estágios de hiperglicemia e transtornos mentais comuns em adultos - Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

ABSTRACT CONTEXT AND OBJECTIVE: Diabetes mellitus and depressive disorders frequently coexist. However, this relationship has been little evaluated across stages of hyperglycemia and for a broad range of common mental disorders (CMDs). The objective here was to investigate the association between CMDs and stages of glycemia. DESIGN AND SETTING: Cross-sectional study conducted among civil servants aged 35-74 years participating in the ELSA-Brasil cohort. METHODS: CMDs were classified using the Clinical Interview Schedule - Revised (CIS-R). Glycemia was classified in stages as normal, intermediate hyperglycemia, newly classified diabetes or previously known diabetes, based on oral glucose tolerance testing, glycated hemoglobin (HbA1c), self-reported diabetes and medication use. Blood glucose control was assessed according to HbA1c. RESULTS: CMDs were most prevalent in individuals with previously known diabetes. After adjustments, associations weakened considerably and remained significant only for those with a CIS-R score ≥ 12 (prevalence ratio, PR: 1.15; 95% confidence interval, CI: 1.03-1.29). Intermediate hyperglycemia did not show any association with CMDs. For individuals with previously known diabetes and newly classified diabetes, for every 1% increase in HbA1c, the prevalence of depressive disorders became, respectively, 12% and 23% greater (PR: 1.12; 95% CI: 1.00-1.26; and PR: 1.23; 95% CI: 1.04-1.44). CONCLUSION: Individuals with previously known diabetes had higher CIS-R scores. Among all individuals with diabetes, worse blood glucose control was correlated with depressive disorder. No relationship between intermediate hyperglycemia and CMDs was observed, thus suggesting that causal processes relating to CMDs, if present, must act more proximally to diabetes onset.

RESUMO CONTEXTO E OBJETIVO: Diabetes mellitus e transtornos depressivos frequentemente coexistem. No entanto, essa relação tem sido pouco avaliada nos estágios hiperglicêmicos e em uma amplitude maior de transtornos mentais comuns (TMCs). O objetivo foi investigar a associação entre TMCs e estágios de glicemia. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado com funcionários públicos com idade entre 35-74 anos participantes da coorte ELSA-Brasil. MÉTODOS: TMCs foram classificados usando o instrumento Clinical Interview Schedule - Revised (CIS-R). Para a classificação dos estágios de glicemia, foi utilizado o teste de tolerância a glicose, hemoglobina glicada (HbA1c), relato pessoal de diabetes e uso de medicamentos. A glicemia foi categorizada como: normal, hiperglicemia intermediária, classificação nova de diabetes, e diabetes prévio. Controle glicêmico foi avaliado pela HbA1c. RESULTADOS: TMCs foram mais prevalentes nos pacientes com diabetes prévio. Após ajustes, as associações foram consideravelmente enfraquecidas, permanecendo significativas somente para aqueles com escore do CIS-R ≥ 12 (razão de prevalência, RP: 1,15; intervalo de confiança de 95%, IC: 1,03-1,29). Hiperglicemia intermediária não teve associação com CMDs. Para aqueles com diabetes prévio e classificação nova de diabetes, para cada aumento de 1% na HbA1c, a prevalência de transtorno depressivo foi, respectivamente, 12% e 23% maior (RP: 1,12; IC: 1,00-1,26 e RP: 1,23; IC: 1,04-1,44). CONCLUSÃO: Aqueles com diabetes prévio tiveram escore do CIS-R mais elevado. Entre todos com diabetes, o controle glicêmico pior foi relacionado ao transtorno depressivo. Não foi observada relação entre hiperglicemia intermediária e TMCs, sugerindo que a relação causal relacionada aos TMCs, se presente, deve agir de forma mais próxima ao início de diabetes.

Variation of plasma cortisol levels in patients with depression after treatment with bilateral electroconvulsive therapy / Variação de cortisol plasmático em pacientes deprimidos após tratamento com eletroconvulsoterapia bilateral

Introduction: More than 60 years after the introduction of modern psychopharmacology, electroconvulsive therapy (ECT) continues to be an essential therapeutic modality in the treatment of mental disorders, but its mechanism of action remains unclear. Hormones play an essential role in the development and expression of a series of behavioral changes. One aspect of the influence of hormones on behavior is their potential contribution to the pathophysiology of psychiatric disorders and the mechanism of action of psychotropic drugs and ECT. Objective: We measured blood levels of the hormone cortisol in patients with unipolar depression according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and compared results with levels found in healthy adults. Method: Blood cortisol levels were measured before the beginning of treatment with ECT, at the seventh session, and at the last session, at treatment completion. Depression symptoms were assessed using the Beck Depression Inventory (BDI). Results: Cortisol levels remained stable in both men and women between the seventh and the last sessions of ECT; values ranged from 0.686±9.6330 g/dL for women, and there was a mean decrease of 5.825±6.0780 g/dL (p = 0.024). Mean number of ECT sessions was 12. After the seventh and the last ECT sessions, patients with depression and individuals in the control group had similar cortisol levels, whereas BDI scores remained different. Conclusion: Cortisol levels decreased during ECT treatment. ECT seems to act as a regulator of the hypothalamic-pituitaryadrenal axis. .

Introdução: Mais de 60 anos após a introdução da moderna psicofarmacologia, a eletroconvulsoterapia (ECT) continua essencial para o tratamento de distúrbios mentais, mas seu mecanismo de ação ainda não é totalmente conhecido. Certos hormônios têm um papel fundamental no desenvolvimento e expressão de uma série de alterações comportamentais. Um aspecto da influência dos hormônios nos comportamentos é sua contribuição potencial para a patofisiologia dos distúrbios psiquiátricos e o mecanismo de ação de psicotrópicos e da ECT. Objetivo: Os níveis do hormônio cortisol no sangue foram medidos em pacientes com depressão unipolar classificados de acordo com a 4ª edição do Manual Estatístico e Diagnóstico de Transtornos Mentais (DSM-IV), e os resultados foram comparados com os níveis encontrados em adultos saudáveis. Métodos: Os níveis de cortisol no sangue foram medidos antes do início do tratamento com ECT, na sétima e na última sessão, após a conclusão do tratamento. Os sintomas de depressão foram avaliados usando o Inventário de Depressão de Beck (BDI). Resultados: Os níveis de cortisol permaneceram estáveis tanto nos pacientes masculinos quanto femininos entre a sétima e a última sessão de ECT; os valores variaram 0,686±9,6330 g/ dL entre as pacientes femininas, e houve uma diminuição de 5,825±6,0780 g/dL (p = 0,024). O número médio de sessões de ECT foi 12. Após a sétima e a última sessão de ECT, os níveis de cortisol nos pacientes com depressão e nos indivíduos no grupo controle foram semelhantes, enquanto os resultados da escala BDI permaneceram diferentes. Conclusão: Os níveis de cortisol diminuíram durante o tratamento com ECT. A ECT parece atuar como reguladora do eixo hipotalâmico-hipofisário-adrenal. .

Degeneración quística de la arteria poplítea: Presentación de caso clínico / Cystic degeneration of the popliteal artery: Report of one case

Cystic degeneration of the popliteal artery is an uncommon cause of intermittent claudication. We report a 52 years old male consulting for intermittent claudication referred to the calf. The angiography showed a 93% stenosis in segment of 45 mm length of the left popliteal artery with a smooth surface, suggesting an extrinsic compression. A CT angiography of the lower limb suggested the presence of a cystic degeneration. The patient was operated and the middle third of the popliteal artery was excised. The pathological study of the surgical piece was informed as artery media cystic degeneration.

Surgical management of cystic dilatation bile ducts in adults / Tratamento cirúrgico da dilatação cística das vias biliares em adultos

BACKGROUND: The cystic dilatation of the biliary tract is a rare disease and uncertain origin. It is recognized more frequently in children; however, its incidence comes increasing in adults, representing 20% of the cases. AIM: To evaluate morbimortality rates, evolution and handing of patients with cystic dilatation bile ducts in adults. METHODS: Were evaluated, retrospectively, five adults who had the diagnosis of choledochal cyst and that had been submitted to some surgical procedure. RESULTS: Abdominal pain was the commonest complain to all patients. Jaundice was present in 80%. Ultrasound scanning was done in all the cases as initial examination. CT scan, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography were also done in some patients; however, the diagnosis was established intra-operatively in all cases. The cyst resection with reconstruction of the biliary tract was done in 60%; the cystojejunostomy in 20%; and in 20% biliary tract drainage. CONCLUSIONS: Biliary tract cystic dilatation is a rare disease. However, its incidence is increasing in the adult population, so, it must be thought as differential diagnosis when facing obstructive jaundice. .

RACIONAL: A dilatação cística da via biliar é uma patologia rara e de origem incerta. É diagnosticada mais frequentemente em crianças, porém sua incidência vem aumentando em adultos, representando 20% dos casos. OBJETIVO: Demonstrar a experiência dos autores no tratamento cirúrgico, e no manejo da evolução, dos pacientes com dilatação cística das vias biliares. MÉTODO: Foram avaliados, retrospectivamente, cinco adultos que tiveram o diagnóstico de cisto de colédoco e que foram submetidos a algum procedimento cirúrgico no Hospital da Restauração, PE, entre março de 2003 e junho de 2004. RESULTADOS: Dor abdominal foi a queixa comum a todos os pacientes. Icterícia esteve presente em 80% dos casos. A ultrassonografia foi realizada em todos os casos como exame inicial. Tomografia computadorizada, ressonância magnética e colangiopancreatografia retrógada endoscópica também foram realizadas em alguns pacientes, porém o diagnóstico foi estabelecido no intra-operatório em todos os casos. O tratamento cirúrgico variou de acordo com a experiência do cirurgião e o quadro clínico do paciente. A ressecção do cisto com reconstrução da via biliar foi realizada em 60%, a cistoduodenostomia em 20% e a drenagem da via biliar em 20% dos casos. CONCLUSÃO: A dilatação cística da via biliar é doença rara, principalmente em nosso meio. Porém, sua incidência vem aumentando na população adulta, devendo estar sempre presente no diagnóstico diferencial das icterícias obstrutivas. .

Endogenous depression; total triiodothyronine [T3] levels in patients with first episode

The aim of this study to determine the levels of Total triiodothyronine [T3] in patients with first episode of Endogenous depression [prior to medical treatment] and in matched controls. Punjab Institute of Mental Health. Between Jan. and Dec.2011. 100 newly diagnosed depressive patients in the age range of 18-65 years were included in the study. 60 healthy controls were taken from dermatological clinic. Total triiodothyronine [T3] was estimated using enzyme - immune assay. The results obtained were analyzed using Statistical package of social sciences, Version 7.0 [SPSS 7.0]. No significant difference in levels of Total triiodothyronine [T3] was found in depressive patients and control. Lower levels of T3 in depressive patients could lead to subclinical hypothyroidism and refractiveness. Therefore, thyroid profile in refractive patients is suggested

Niveles de ácidos grasos poliinsaturados omega-3 en membranas de eritrocitos de mujeres con depresión / Omega-3 polyunsaturated fatty acids in red blood cell membranes from depressed female patients

There is a hypothesis that lack ofn-3 polyunsaturated fatty acids (n-3 PUFA) is of etiological importance in depression. Docosahexaenoic acid (DHA), a member of the n-3 PUFA family, is a crucial component of synaptic cell membranes. Objective: The aim of this study was to measure red blood cell (RBC) membrane n-3 fatty acids in a group of depressed female patients relative to a matched healthy control group. Methods: We measured the fatty acid composition of membranes from RBC of 9 female depressive patients and 6 healthy controls subjects. Results: There was a significant depletion of RBC membrane n-3 PUFAs in the depressed subjects. This result agrees with the international evidence and opens a new line of investigation on etiology of the depression.

Actualmente existe una hipótesis que vincula la disminución de ácidos grasos poliinsaturados omega-3 (AGPI n-3), en diversos tejidos, con la depresión. El ácido docosahexaenoico (DITA), uno de los miembros más importantes de los AGPI n-3, cumple importantes funciones en las membranas sinápticas. Objetivo: evaluar si pacientes con depresión presentan niveles disminuidos de ácidos grasos omega-3. Sujetos y métodos: se seleccionaron 9 pacientes mujeres en tratamiento por depresión de un consultorio de Puente Alto y 6 controles pareados por edad y sexo, a quienes se midió el perfil de ácidos grasos en membrana de eritrocitos. Resultados y conclusiones: Se demostró una disminución significativa de los niveles de AGPI n-3 en las membranas de eritrocitos de las depresivas. Este resultado concuerda con la evidencia expuesta en la literatura internacional y fomenta la investigación en este nuevo campo sobre una posible etiología de la depresión.

Depressive symptoms and C-reactive protein in a Brazilian urban community

Psychological depression is an independent risk factor for coronary artery disease. C-reactive protein has been implicated as a mediator of the effect of psychological depression. Several studies have found that individuals, especially men, who report higher levels of psychological depression also have higher levels of C-reactive protein. The current study was undertaken to replicate these results in a Brazilian population, in which there is a much wider range of variation in both background characteristics (such as socioeconomic status) and coronary artery disease risk factors. A sample of 271 individuals was interviewed using the Center for Epidemiological Studies Depression Scale. Fasting blood samples were obtained and evaluated for C-reactive protein (assessed by a turbidimetric immunoassay using a Dade Behring kit) analysis in a subsample (N = 258) of individuals. The mean ± SD C-reactive protein for the entire sample was 0.43 ± 0.44, with 0.42 ± 0.48 for men and 0.43 ± 0.42 mg/L for women. Data were analyzed using multiple regression analysis, controlling for age, sex, body mass index, socioeconomic status, tobacco use, and both total cholesterol and low-density lipoprotein cholesterol. Higher reported depressive symptoms were correlated with higher C-reactive protein for men (partial r = 0.298, P = 0.004) and with lower C-reactive protein for women (partial r = -0.154, P = 0.059). The differences in the associations for men and women could be a result of differential effects of sex hormones on stress reactivity and immune response. On the other hand, this difference in the associations may be related to gender differences in the disclosure of emotion and the effect that self-disclosure has on physical health and immune response.

Estudios sobre la Feniltilamina en Orina y el Acido Fenilacético en sangue y orina en pacientes depresivos / Phenylethylamine in urine and phenylacetic acid in blood and urine in depressive patients

Se pasa una revista general a valores de fenetilamina(FEA) en ratas y sus cambios luego de la administración de diferentes drogas. Se presentam valores de FEA urinaria en 4710 pacientes psiquiátricos con sintomatología depresiva. Se comparam valores de FEA en orina de 24h con los de su metabolito, el ácido fenilacético total (AFAT) en orina de 24h. Se hace un estudio comparativo de valores urinarios y plasmáticos de AFAT concluyéndose que en pacientes depresivos se encuentra una disminuición de AFAT en urina y que la determinación de AFAT en plasma bien puede usarse como marcador de enfermedades depresivas

Levels of copper and zinc in depression.

The study was undertaken to estimate plasma copper and zinc in thirty-five depressed patients. Two blood samples were drawn from each patient, one before starting treatment and the second after recovery from depression. The results were compared with the thirty-five normal healthy individuals. The mean plasma copper in controls, depressed patients and in patients after recovery were 106.82, 122.14 and 104.22 micrograms/dl, respectively. The copper levels in patients when depressed were significantly higher as compared to controls and after recovery from depression. The mean plasma zinc levels in controls, depressed patients and after recovery were 115.80, 107.62 and 125.68 micrograms/dl, respectively. No significant difference could be obtained between control and depressed patients. However, the values were significantly higher in recovered patients compared to patients with depression.

Receptores a neurotransmisores y suicidio. Revisión / Neurotransmitters receptor and suicide. A review

Los estudios epidemiológicos muestran una relación muy estrecha entre depresión y suicidio, ya que se ha observado que un porcentaje elevado de los suicidios han sido diagnosticados previamente como deprimidos; sin embargo, los mecanismos etiológicos involucrados en estos dos tipos de trastornos todavía no son bien conocidos. En los últimos años se ha postulado que la alteración del metabolismo de los neutransmisores monoamínicos presentes en el cerebro es responsable de los desórdenes depresivos. Esta hipótesis se ha convertido en el principal centro de atracción de las investigaciones bioquímicas. Además de la noradrenalina, serotonina y dopamina, también se han estudiado otros neurotransmisores, tales como la acetilcolina y el ácido gamma aminobutírico. Se han analizado sus concentraciones y la de sus metabolitos en orina, plasma y líquido cefalorraquídeo, así como sus receptores en diferentes regiones del cerebro de suicidas o de individuos deprimidos muertos por causas naturales