Oxidative stress parameters and antioxidants in adults with unipolar or bipolar depression versus healthy controls: Systematic review and meta-analysis.

BACKGROUND: To study differences in oxidative stress markers and antioxidants among patients with bipolar depression (BPD) and unipolar depression (UPD). METHODS: Data sources. Electronic MEDLINE/PubMed/Cochrane Library/Scopus/TripDatabase database search until 30/06/2021. STUDY SELECTION: Included were articles comparing antioxidant or oxidative stress markers between adults with BPD or UPD and healthy controls (HCs). DATA EXTRACTION: Two authors extracted data independently. Random effects meta-analysis, calculating standardized mean differences for results from ≥3 studies. RESULTS: Oxidative stress markers reported in 40 studies -1 published repeatedly- (UPD, studies = 30 n = 3072; their HCs, n = 2856; BPD, studies = 11 n = 393; their HCs, n = 540; with 1 study reporting on both UPD and BPD) included thiobarbituric acid reactive substances (TBARS), antioxidant uric acid and antioxidant-enhancing enzymes superoxide dismutase (SOD), catalase (CAT) and glutathione-peroxidase (GPX). Compared with HCs, UPD and BPD were associated with significantly higher levels of TBARS, without differences between UPD and BPD (P = 0.11). Compared with HCs, UPD and BPD did not differ regarding the activity of the CAT (P = 0.28), SOD (P = 0.87) and GPX (P = 0.25) enzymes. However, uric acid levels were significantly higher vs HCs in BPD than in UPD among adult patients (P = 0.004). Results were heterogenous, which, for some parameters, decreased after stratification by the blood source (serum, plasma red blood cells, whole blood). LIMITATIONS: The main limitations are the small number of studies/participants in the BPD subgroup, and heterogeneity of the results. SUMMATIONS: Both BPD and UPD may be associated with an impaired oxidative stress balance, with significantly higher uric acid levels vs. HCs in UPD than in BPD.

Oxidative stress parameters and antioxidants in patients with bipolar disorder: Results from a meta-analysis comparing patients, including stratification by polarity and euthymic status, with healthy controls.

OBJECTIVE: To investigate oxidative stress markers and antioxidants in bipolar disorder (BD). METHODS: Electronic MEDLINE/PubMed/Cochrane-Library/Scopus/TripDatabase search until 06/30/2019 for studies comparing antioxidant or oxidative stress markers between BD and healthy controls (HCs). Standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated for ≥3 studies. RESULTS: Forty-four studies (n = 3,767: BD = 1,979; HCs = 1,788) reported on oxidative stress markers malondialdehyde (MDA), thiobarbituric acid reactive substances (TBARS), and total nitrites; antioxidants glutathione (GSH), uric acid, and zinc; or antioxidantenhancing enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX), and GSH-transferase (GST). Compared with HCs, BD was associated with higher GST (P = .01), CAT (P = .02), nitrites (P < .0001), TBARS (P < .0001), MDA (P = .01), uric acid (P < .0001), and lower GSH (P = .006), without differences in SOD, GPX, and zinc. Compared to HCs, levels were higher in BD-mania for TBARS (P < .0001) and uric acid (P < .0001); in BD-depression for TBARS (P = .02); and BD-euthymia for uric acid (P = .03). Uric acid levels were higher in BD-mania vs BD-depression (P = .002), but not vs BD euthymia. TBARS did not differ between BD-mania and BD-depression. Medication-free BD-mania patients had higher SOD (P = .02) and lower GPX (P < .0001) than HCs. After treatment, BD did not differ from HCs regarding SOD and GPX. CONCLUSIONS: Beyond a single biomarker of oxidative stress, the combination of several parameters appears to be more informative for BD in general and taking into account illness polarity. BD is associated with an imbalance in oxidative stress with some phase-specificity for uric acid and TBARS and possible treatment benefits for SOD and GPX. Future studies should take into account confounding factors that can modify oxidative stress status and simultaneously measure oxidative stress markers and antioxidants including different blood sources.

Educación inclusiva en contextos inéditos: la implementación de la Pedagogía Hospitalaria / Inclusive education in new contexts: the implementation of Hospital Pedagogy / Educação inclusiva em novos contextos: a implemantação da Pedagogia Hospitalar

El objetivo de este trabajo es analizar los beneficios de la Pedagogía Hospitalaria en las Unidades de Salud Mental que reciben pacientes en edad escolar que permanecen largos períodos ingresados. Esto los aparta del sistema escolar ordinario. Esta investigación la hemos desarrollado durante diez años con una metodología mixta. En la contextualización del marco teórico, estudiamos la evolución de esta disciplina y los factores que intervienen. Destacamos que el alumnado valora positivamente superar su curso académico con éxito, la enseñanza personalizada de los docentes del Aula Hospitalaria, y la posibilidad de evadirse del medio hospitalario. Estas conclusiones demandan una mayor implicación y formación del profesorado para un trabajo coordinado, y el uso de las TIC en conexión con los centros educativos, para propiciar una educación inclusiva.

The aim of this study is to analyze the benefits of hospital pedagogy in mental health units that treat long‒term school‒age patients, causing them to miss a samount of time in the regular education system. The research took place over a period of ten years and is eclectic in its approach. As part of the contextualization of the theoretical framework, the development of this discipline and various intervening factors are studied. The results show that students view successful completion of their academic level, the personalized teaching from hospital school teachers and the ability to get away from the hospital environment in a positive light. These conclusions demonstrate the need for a greater level of teacher involvement and training that will result in work that is more coordinated between high schools and the hospital school and the use of ICT in education centers to promote inclusive education

O objetivo deste trabalho é analisar os benefícios da Pedagogia Hospitalar em Unidades de Saúde Mental que tratam de pacientes de longa permanência em idade escolar,os afastando do sistema de ensino regular. A pesquisa se desenvolve durante um período de dez anos e é eclética em sua abordagem. Na contextualização do quadro teórico, é estudada a evolução dessa disciplina e os diversos fatores intervenientes. Destaca‒se que os alunos acreditam que irão concluir de maneira bem‒sucedida seu ano acadêmico, valorizam o ensino personalizado por professores da escola do hospital e, assim, poderão sair do ambiente hospitalar. Essas conclusões exigem um maior nível de envolvimento e da formação do professor, para que haja um trabalho mais coordenado de IES/Sala de Aula Hospitalar e o uso das TIC em conexão com os centros de educação, de forma a promover a educação inclusiva