Posibles mecanismos de acción de la terapia electroconvulsiva en trastornos afectivos: revisión de la evidencia disponible en investigación con seres humanos

The mechanisms of action (MA) of electroconvulsive therapy (ECT) in affective disorders are poorly understood. We synthesized and discussed the evidence provided by primary studies and systematic reviews in humans. There are differences in the methylation of candidate genes involved in the response to ECT. Functioning of the hippocampal serotonin receptor 5-HT1B is associated with the response in patients with major depressive disorder (PMDD), while the striatal dopamine transporter would participate in the response of PMDD and in patients with bipolar disorders (BD). The only neurotrophic factor associated with ECT response was vascular endothelial growth factor. In BD, some oxidative stress metabolites had a clinical correlation, while tryptophan metabolism showed a clinical association in BD and PMDD. Furthermore, in PMDD, some neurodegeneration markers were implicated in the MA of ECT. There were no other biological dimensions associated with BD. In PMDD, multiple inflammatory mediators were associated with the clinical response (natural killer cells, tumor necrosis and growth factors, and interleukins 1, 4, 6, 10,1β). Likewise, some structures and circuits consistently involved at the morphological and functional level are the default mode network, cognitive control networks, frontal, temporal, cingulate, occipital and temporal cortices, frontal, temporal, precentral, fusiform and left angular gyri, hippocampus, thalamus and amygdala. Investigations are mostly focused on PMDD, are observational, and their samples limited, but they show relatively consistent results with clinical significance.

Posibles mecanismos de acción de la terapia electroconvulsiva en esquizofrenia: revisión de la evidencia disponible en investigación con seres humanos / A review about the putative mechanisms of action of electroconvulsive therapy in schizophrenia in human research

Electroconvulsive therapy (ECT) has multiple uses in psychiatry, but its mechanisms of action (MA) in patients with schizophrenia (PS) are poorly understood. We synthesize and discuss the available evidence in this regard. We conducted a search for primary human studies and systematic reviews searching MA of ECT in PS published in PubMed/Medline, SciELO, PsycInfo, and the Cochrane Library, including 24 articles. Genetic findings are scarce and inconsistent. At the molecular level, the dopaminergic and GABAergic role stands out. The increase in brain derived neurotrophic factor (BDNF) after ECT, is a predictor of positive clinical outcomes, while the change in N-acetyl aspartate levels would demonstrate a neuroprotective role for ECT. This intervention would improve inflammatory and oxidative parameters, thereby resulting in a symptomatic improvement. ECT is associated with an increase in functional connectivity in the thalamus, right putamen, prefrontal cortex and left precuneus, structures that play a role in the neural default mode network. A decrease in connectivity between the thalamus and the sensory cortex and an enhanced functional connectivity of the right thalamus to right putamen along with a clinical improvement have been reported after ECT. Moreover a volumetric increase in hippocampus and insula has been reported after ECT. These changes could be associated with the biochemical pathophysiology of schizophrenia. Most of the included studies are observational or quasi-experimental, with small sample sizes. However, they show simultaneous changes at different neurobiological levels, with a pathophysiological and clinical correlation. We propose that the research on ECT should be carried out from neurobiological dimensions, but with a clinical perspective.

Fibromatosis musculoaponeurótica agresiva: presentación de un caso / Muscleneuropatic agressive fibromatosis: a case presentation

Resumen Paciente masculino de 40 años, consulta por dolor en región glútea izquierda, asociado a masa de crecimiento progresivo; inicialmente valorado por ortopedia, donde le realizan radiografía y gammagrafía sin diagnóstico definitivo; revalorado por ortopedia y traumatología, luego de resonancia magnética y biopsia del glúteo comprometido se diagnostica fibromatosis glútea, la cual fue tratada con una resección del tejido invasivo y posteriormente radioterapia complementaria con acelerador lineal. Conclusión: Los tumores desmoides son infrecuentes y representan 0,03 % de todas las neoplasias y < 3 % de todos los tumores de tejidos; la cirugía ha sido tradicionalmente el pilar terapéutico debido a la variabilidad en el curso clínico y la importancia del sitio involucrado se asocia al tratamiento y aplicación de radioterapia.

Abstract 40 year old male patient complains about pain in left gluteal region, associated with progressive growing mass; initially valued by orthopedics, which performed x-ray scan and gammagraphy without a definitive diagnosis. He was reassessed by orthopedics and traumatology, through magnetic resonance imaging and biopsy of the committed gluteal, and was diagnosed with gluteal fibromatosis, which was treated with invasive tissue resection and subsequently additional accelerator radiotherapy. Conclusions: Desmoid tumors are rare and account for 0.03 % of all malignancies and <3 % of all tumors of tissues. Surgery has traditionally been the therapeutic mainstay due to variability in the clinical course and importance of the site of involvement is associated with the treatment and application of radiation therapy.

Playful Interventions Increase Knowledge about Healthy Habits and Cardiovascular Risk Factors in Children: The CARDIOKIDS Randomized Study / Intervenções Lúdicas Aumentam o Conhecimento sobre Hábitos Saudáveis e Fatores de Risco Cardiovasculares em Crianças: Estudo Clínico Randomizado CARDIOKIDS

Abstract Background: Childhood obesity is an important health problem worldwide. In this context, there is a need for the development and evaluation of innovative educational interventions targeting prevention and formation of health habits. Objectives: To ascertain the impact of ludic workshops on children's knowledge, self-care, and body weight. Methods: This was a randomized, clinical study with 79 students aged 7-11 years, conducted from March to November 2012. Anthropometric measurements were collected and two questionnaires (Typical Day of Physical Activities and Food Intake, in Portuguese, and the CARDIOKIDS, a questionnaire of knowledge about cardiovascular risk factors) were applied at baseline, at the end of intervention, and three months thereafter. The intervention consisted of eight playful workshops, which involved the presentation of a play. Results: Seventy-nine students were randomized to the intervention (n = 40) or the control group (n = 39). Mean age was 10.0 ± 1.1 years. After eight weeks, the intervention group showed significant improvement in the knowledge score (p < 0.001). There was an increase in physical activity scores in both groups, but with no difference between the groups at the end of intervention (p = 0.209). A reduction in the BMI percentile was observed in the intervention group, but there was no significant statistical difference between the two groups after the intervention. Conclusions: Playful interventions may improve knowledge and physical activity levels in children and, when combined with other strategies, may be beneficial to prevent child obesity and improve self-care.

Resumo Fundamento: A obesidade infantil é um importante problema de saúde no mundo. Nesse contexto, há uma necessidade para o desenvolvimento e a avaliação de intervenções educativas inovadoras que objetivem a prevenção e a formação de hábitos saudáveis. Objetivo: Avaliar o impacto de workshops lúdicos sobre o conhecimento, autocuidado, e peso corporal de crianças. Métodos: Esse foi um estudo clínico randomizado, com 79 estudantes com idade entre 7 e 11 anos. Medidas antropométricas foram coletadas, e dois questionários (DAFA, Dia Típico de Atividades Físicas e de Alimentação e o CARDIOKIDS, um questionário de conhecimento sobre fatores de risco cardiovasculares) foram aplicados no basal, ao final da intervenção, e três meses depois. A intervenção consistiu em oito workshops lúdicos, que incluiu a apresentação de uma peça de teatro. Resultados: Setenta e nove estudantes foram randomizados para o grupo intervenção (n = 40) ou para o grupo controle (n = 39). A idade média foi 10 ± 1,1 anos. Após oito semanas, o grupo intervenção mostrou uma melhora significativa no escore de conhecimento (p < 0,01). Houve um aumento nos escores de atividade física em ambos os grupos, mas sem diferença entre os grupos no final da intervenção (p=0,209). Observou-se uma redução no percentil do IMC no grupo intervenção, mas não houve diferença estatística entre os grupos após a intervenção. Conclusões: Intervenções lúdicas podem melhorar o conhecimento e níveis de atividade física em crianças e, quando combinadas com outras estratégias, podem ser benéficas na prevenção da obesidade e melhoria do autocuidado.

Insatisfação da imagem corporal e estado nutricional em crianças de 7 a 11 anos: estudo transversal / Dissatisfaction of body image and nutritional status in children 7-11 years old: Cross-sectional study

A insatisfação com a imagem corporal pode ser um agravante no desenvolvimento de distúrbios psíquicos e físicos. O objetivo deste estudo é avaliar a frequência de insatisfação corporal e distorção da imagem corporal em crianças de baixa renda e descrever diferenças quanto ao gênero e estado nutricional. Métodos: Foram estudados todos os 79 indivíduos de 7 a 11 anos de uma instituição filantrópica que atende crianças de famílias de baixa renda cujos pais concordaram na inclusão dos filhos no estudo. A insatisfação corporal foi avaliada comparando a imagem desejada com a imagem percebida, de acordo com escala de silhuetas de Tiggemann e Wilson-Barret, enquanto a distorção foi avaliada pela diferença entre a imagem percebida e o estado nutricional avaliado de acordo com os critérios da Organização Mundial da Saúde. Resultados: Verificou-se que 37,5% das crianças estavam acima do peso. A insatisfação corporal atingiu 75,6% dos meninos e 76,2% das meninas, sendo que 45,9% dos meninos e 52,4% das meninas desejavam ser mais magros. Nas crianças eutróficas, o percentual de insatisfação foi de 66%, nas crianças com sobrepeso foi de 69% e nos obesos de 100% (p <0, 001). A distorção da imagem corporal foi de 12,2% nos eutróficos, 30,8% nos com sobrepeso e 42,1% nos obesos (p <0,001). Conclusão: A insatisfação com a imagem corporal e distorção da percepção em relação ao estado nutricional atual foram elevadas em nossa amostra de crianças de 7 a 11 anos, o que corrobora achados de pesquisas com adolescentes e é relevante à luz das potenciais consequências para o desenvolvimento psíquico...

Dissatisfaction with one’s body image may be related to the development of physical and psychological disturbances. The objective of the study is to evaluate the frequency of body dissatisfaction and distortion in children from low-income families, describing differences in terms of gender and nutritional status. Methods: The subjects were 79 individuals aged 7-11 years, from a philanthropic institution in Porto Alegre, Brazil, which receives children from low-income families whose parents agreed with the inclusion of their children in the study. Body dissatisfaction was evaluated comparing the desired image with the perceived image, according to Tiggemann & Wilson-Barret’s children’s figure rating scale. The nutritional status was categorized according to the criteria of the World Health Organization. Results: Of 37.5% of children were overweight. Body dissatisfaction affected 75.6% of boys and 76.2% of girls, with 45.9% of the boys and 52.4% of the girls wanting to be thinner. The percentage of subjects dissatisfied with their body image was 66% in normal weight children, 69% in overweight children, and 100% in obese children (p<0.001). Image distortion was observed in 12.2% of normal weight children, 30.8% of overweight children, and 42.1% in obese children (p<0.001). Conclusion: Body image dissatisfaction and distortion were elevated in children from 8 to 11 years old, which is in agreement with studies on adolescents, and may be relevant given the potential consequences on psychological development...

Lesiones anorrectales en pacientes HIV positivo y con SIDA: 12 años de experiencia clínica / Anorectal injuries in VIH seropositive and AIDS patients: 12 years of clinical experience

Se presenta grupo de 45 pacientes seropositivos al virus de la inmunodeficiencia humana, portadores anorrectal, que fueron separados en dos grupos: los HIV + (42,2 por ciento) y los con SIDA clínico (57,8 por ciento). Todos fueron de sexo masculino, jóvenes (edad promedio 32,2 años), siendo los factores de riesgo más frecuentes la homosexualidad (66,6 por ciento) y bisexualidad (22,2 por ciento). En los HIV+ la lesión más frecuente fue la considerada dentro de la de tipo común (47,3 por ciento), mientras que en los pacientes con SIDA clínico fue la ocasionada por inmunosupresión (50 por ciento). La patología común más frecuente en ambos grupos fue la enfermedad hemorroidaria. La enfermedad de transmisión sexual, también en ambos grupos, más frecuente fueron los condilomas. La respuesta al tratamiento en el grupo HIV+ fue óptima y/o buena en todos los casos. En los pacientes con SIDA clínico se observó evolución regular y mala, cuestión que resultó más frecuente en los sometidos a manejo quirúrgico (60 por ciento) que en los manejo médico (10 por ciento)

Técnica de marsupialización en quiste pilonidal: 7 años de experiencia / Marsupialization technique in pilonidal cyst: 7 years of experience

Se presenta trabajo retrospectivo, en 64 pacientes portadores de quiste pilonidal en los que se realizó la técnica de marsupialización. La mayoría eran mujeres (56,2 por ciento), con el promedio de edad de 22,8 años. El tiempo de evolución previo a la consulta fue de 24 meses en promedio y la sintomatología más frecuente fue el aumento de volumen (92,1 por ciento) y dolor (65,6 por ciento). No hubo morbilidad post-operatoria. El seguimiento se logró en el 87 por ciento de los pacientes. La cicatrización completa se observó como promedio a los 25 días y la recidiva ffue de 3,1 por ciento a los 12 y 20 meses. En nuestra experiencia la marsupialización en quistes pilonidales, simples o complejos, resulta ser una técnica sencilla y con buenos resultados