Assessment of the psychometric properties of the 17- and 6-item Hamilton Depression Rating Scales in major depressive disorder, bipolar depression and bipolar depression with mixed features.

Assessing therapeutic response in depression requires scales that adequately measure the core symptoms of depressive symptomatology. The main goal of this study was to assess the psychometric properties of the 17-item Hamilton Depression Rating Scale (HAM-D17) and the 6-item Hamilton Depression Rating Scale (HAM-D6) in patients with Major Depressive Disorder (MDD), bipolar depression and bipolar depression with mixed features. We conducted a reanalysis of a pragmatic clinical trial in an outpatient clinic for mood disorders that included eight weeks of follow-up. A Mokken analysis was performed to evaluate the unidimensionality of the HAM-D17 and HAM-D6, and the Spearman correlation was used to assess concurrent validity between the HAM-D17, the HAM-D6 and quality of life scale (SF-36 and WHOQOL-BREF) scores. A total of 237 patients with a mean age of 40.2 years (±11.7) were included. According to the DSM-IV criteria, 58 (24.5%) were diagnosed with MDD and 73 (30.8%) were diagnosed with bipolar depression. Bipolar depression with mixed features was diagnosed in 106 (44.7%) patients according to the DSM-IV and supplemented by the Cincinnati criteria. Only the HAM-D6 scale proved to be unidimensional, showing strong homogeneity for evaluating MDD, moderate homogeneity for bipolar depression and weak homogeneity for bipolar depression with mixed features. Both the HAM-D17 and the HAM-D6 had inverse, significant correlations at baseline with SF-36 and WHOQOL-BREF scores. This is the first study to include bipolar depression patients with mixed features in an assessment of HAM-D6 unidimensionality.

Evaluating response to mood stabilizers in patients with mixed depression: A study of agreement between three different mania rating scales and a depression rating scale.

BACKGROUND: The aim of the present study was to evaluate agreement between three pairs formed by one of three mania scales (Young Mania Rating Scale [YMRS], Bech-Rafaelsen Mania Scale [BRMS], or the Clinician-Administered Rating Scale for Mania [CARS-M]) and a single depression scale (21-item Hamilton Depression Rating Scale [21-HAM-D]) for evaluation of response to mood stabilizers in patients with mixed bipolar disorder. METHODS: Between 2010 and 2014, 68 consecutive bipolar type I and II outpatients with mixed depression as per DSM-IV-TR and Cincinnati criteria were included in this 8-week open-label trial to randomly receive carbamazepine, lithium carbonate, or valproic acid as monotherapy. RESULTS: Patterns of response (defined as a reduction of at least 50% in one of the mania scales and on the 21-HAM-D) were strikingly similar: 21-HAM-D+YMRS=22.1%, 21-HAM-D+BRMS=20.6%, and 21-HAM-D+CARS-M=23.5% (p<0.368). Assessment of agreement revealed very high kappa coefficients: 21-HAM-D+YMRS vs. 21-HAM-D+CARS-M, kappa=0.87; 21-HAM-D+YMRS vs. 21-HAM-D+BRMS, kappa=0.78; 21-HAM-D+CARS-M vs. 21-HAM-D+BRMS, kappa=0.91 (p<0.001). LIMITATIONS: The decision to combine a depression rating scale with any one mania rating scale to assess treatment response in patients with mixed depression is questionable. CONCLUSIONS: The present study suggests that any one of the three tested mania rating scales (YMRS, BRMS, and CARS-M) can be combined with the 21-HAM-D to assess treatment response in patients with mixed bipolar disorder. This should give clinicians an added measure of confidence in using this strategy until valid, and specific instruments are developed for assessment of mixed states.

Effects of intermittent high-intensity exercise and carbohydrate supplementation on IGF-1 and glycogen of Wistar rats.

OBJECTIVE: The aim of this study was to analyze the association between glucose infusion during intermittent physical exercise and its metabolic effects on rats. DESIGN: Forty male rats were divided into eight groups based on training (intermittent), exercise and carbohydrate intake (glucose 20%): TEC (trained exercised with carbohydrate), TES (trained exercised without carbohydrate), TNC (trained non-exercised with carbohydrate), TNS (trained non-exercised without carbohydrate), UEC (untrained exercised with carbohydrate), UES (untrained exercised without carbohydrate), UNC (untrained non-exercised with carbohydrate) and UNS (untrained non-exercised without carbohydrate). The training and/or exercise protocol consisted of the rats running on a treadmill for 1 min above the lactate threshold, or running below the lactate threshold for 30s, intermittently for 30 min. Blood was analyzed for glycemia, lactate and IGF-1. Muscle and liver glycogen were measured (T2). RESULTS: Glycemia was found to be different in T2 compared to T1 in the TEC, TNC, UEC and UNC groups. Lactate was higher in T2 than in T1, but remained within the lactate threshold. Glycogen showed higher concentrations in the trained groups and, whether trained or not, in the supplemented groups. IGF-1 levels were higher in exercised rats independent of supplementation or glycogen levels. Trained rats showed lower IGF-1 when exercising than did the untrained animals. CONCLUSIONS: We conclude that intermittent exercise is beneficial in preventing a trained lactate pool, and that, in association with glucose supplementation, intermittent exercise will be efficient both in preventing a trained lactate pool and in maintaining sufficient glycemia levels. Exercise raises IGF-1 levels, whereas training inverts this relationship.

Subcutaneous autologous testicle transplantation in Wistar rats.

OBJECTIVE: To assess the hormone secretion and viability of subcutaneous autotransplanted testicles in Wistar rats. STUDY DESIGN: Wistar rats were randomly divided into four groups: sham (group I, n = 4), bilateral orchiectomy (group II, n = 4), sliced autotransplantation group (group III, n = 4), and whole-testicle autotransplantation group (group IV, n = 4). Sexual behavior (genital sniffing, thrusting intromissions, mounts with pelvic thrusting frequency), serum testosterone levels, and body weight were measured eight weeks after the procedure. RESULTS: Subcutaneous autotransplantation elicited an increased number of mounts (P < 0.007) and intromissions (P < 0.009) and a significant reduction in the latency of these two behaviors (P < 0.034) compared with castrated animals. The frequency of sniffing of the bodies of sexually receptive females was not affected by castration (P = 0.326). Serum testosterone in whole autotransplantation group (219.23; 184.02-229.23) was higher than for the sliced autotransplantation group (0.74; 0.54-0.91) and bilateral orchiectomy group (0.59; 0.4-0.82; P < 0.05). We demonstrated that testicles transplanted without vascular anastomosis maintain their hormone secretion and exert neuroendocrine function on sexual behavior in rats. Autotransplantation could be an important alternative means of gonadal preservation for oncological patients considered for oncological therapies.

A prevalência de estresse em uma amostra de estudantes do curso de medicina da Universidade Federal do Rio Grande do Sul / Prevalence of stress in a sample of medical students of Universidade Federal do Rio Grande do Sul

Introdução: O ingresso na Faculdade de Medicina representa uma transição a um novo estilo de vida e maior grau de exigência curricular. O estresse pode influenciar o desempenho acadêmico e as habilidades para tomar decisões e estabelecer uma adequada relação médico-paciente. O presente estudo avaliou a prevalência de estresse e fatores associados em uma amostra de estudantes da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRGS) através do Inventário de Sintomas de Stress para Adultos de Lipp (ISLL). Métodos: Estudo transversal não controlado, amostra aleatória (168 alunos). Instrumentos: ISLL, questionário com dados demográficos, uso de álcool e outras substâncias e sintomas de ansiedade. Resultados: Encontrou-se uma prevalência de estresse de 51,3% (IC95% 40,2-62,2), com maior prevalência de sintomas físicos do que psíquicos. A partir do sexto semestre os alunos apresentaram maior prevalência de estresse (55,3%), sem diferença estatisticamente significativa entre os semestres. O uso regular de álcool (43,6%) e estimulantes foi semelhante entre os alunos com e sem estresse (P = 0,63). Entre os alunos com estresse, 40% afirmaram já ter experimentado sintomas de pânico, enquanto apenas 5,3% dos sem estresse referiram esses sintomas (P <0,001). Entre os alunos com estresse, 90% relataram presença de sintomas de ansiedade nos últimos 6 meses, enquanto apenas 39,5% dos sem estresse o referiram (P < 0,001). Conclusão: Nossos achados apontam para a necessidade de investigar as causas da alta prevalência de estresse encontrada, a fim de propor medidas preventivas e/ou oferecer apoio psicológico para os estudantes, proporcionando uma melhor formação médica.

Background: Entering Medical School represents a transition toward a new lifestyle and higher curricular standards. Stress can influence academic performance and decision-making skills and establish a proper physician-patient relationship. This study examined the prevalence of stress and associated factors in a sample of medical students of Universidade Federal do Rio Grande do Sul (UFRGS) using Lipp’s Adult Stress Symptoms Inventory (ASSI). Methods: This is a cross-sectional, uncontrolled study using a random sample (168 students). Instruments: ASSI, questionnaire with demographic data, use of alcohol and other substances and anxiety symptoms. Results: There was a prevalence rate of stress of 51.3% (95%CI 40.2-62.2), with higher prevalence of physical symptoms than psychological symptoms. From the sixth semester students had higher prevalence of stress (55.3%), with no statistically significant difference between semesters. Regular use of alcohol (43.6%) and stimulants was similar between students with and without stress (P= 0.63). Among students with stress, 40% reported having already experienced panic symptoms, while only 5.3% of those without stress reported such symptoms (P <0.001). Among students with stress, 90% reported presence of anxiety symptoms in the last 6 months, while such symptoms were present in only 39.5% of those without stress (P <0.001). Conclusion: These findings suggest the need to investigate the causes of high prevalence of stress to propose preventive measures and/or to provide psychological support for students, providing better medical training.

Quality of life in a Brazilian sample of patients with Parkinson's disease and their caregivers.

OBJECTIVE: Parkinson's disease is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. METHOD: A cross-sectional study was performed in which quality of life was assessed by the WHOQOL-BREF questionnaire in 21 patients with Parkinson's disease and their respective caregivers. RESULTS: Significant differences between patients and caregivers were found in physical (p < 0.001) and psychological (p = 0.002) domains. In the Parkinson's disease group there was a significant inverse correlation between the psychological domain and duration of disease (p = 0.01), as well as between social domain and severity of disease (p = 0.001). There was a positive correlation between physical domain scores and number of people living in the same house (p = 0.02). The only significant finding in the group of caregivers was an inverse correlation between the social domain and the patients' age (p = 0.04). CONCLUSION: Duration, severity of the disease and the number of people living in the same house were the most important predictors of quality of life of Parkinson's disease patients. The age of the patients was the only significant predictor found in the caregivers' quality of life. In order to complement our findings, further short-form questionnaires should be validated for Brazilian samples of Parkinson's disease.

Expressão dos protooncogenes c-fos, c-myc e c-jun em miométrio normal e mioma humanos / Expression of the protooncogenes c-fos, c-myc and c-jun in human normal miometrium and leiomyoma

OBJETIVO: Comparar a expressão gênica (mRNA) e protéica dos protooncogenes c-fos, c-myc e c-jun em miométrio normal e mioma humanos. MÉTODOS: Foi realizado um estudo do tipo caso-controle. O material foi coletado de 12 pacientes submetidas a histerectomia no Hospital de Clínicas de Porto Alegre. A expressão do mRNA específico para c-myc, c-fos, c-jun e beta-microglobulina foi avaliada pela técnica de RT-PCR, utilizando primers específicos para cada gene. A expressão protéica destes protooncogenes foi avaliada através de Western blot com anticorpos específicos. RESULTADOS: Não houve diferença significativa para expressão gênica desses protooncogenes entre miométrio normal e mioma (c-myc: 0,87 ± 0,08 vs 0,87 ± 0,08, p = 0,952; c-fos: 1,10 ± 0,17 vs 1,01 ± 0,11, p = 0,21; c-jun: 1,03 ± 0,12 vs 0,96 ± 0,09, p = 0,168, respectivamente). Não houve diferença significativa para expressão protéica desses protooncogenes entre miométrio normal e mioma (c-myc: 1,36 ± 0,48 vs 1,53 ± 0,29, p = 0,569; c-fos: 8,85 ± 5,5 vs 6,56 ± 4,22, p = 0,434; e c-jun: 6,47 ± 3,04 vs 5,42 ± 2,03, p = 0,266, respectivamente). CONCLUSÃO: A expressão gênica (transcrição) e a expressão protéica (tradução) dos protooncogenes c-myc, c-fos e c-jun em mioma e miométrio normal são semelhantes.

Uterine myomas are common benign tumors of the female genital tract. The expression of growth factor signal transduction cascade components including the protooncogenes c-myc, c-fos, and c-jun seem to be involved in the development of myomas. PURPOSE: To compare the gene (mRNA) and protein expression of the protooncogenes c-fos, c-myc, and c-jun in human normal myometrium and leiomyoma. METHOD: A case-control study was performed. Samples were collected from 12 patients submitted to hysterectomy at the Hospital de Clínicas at Porto Alegre. The expression of the specific mRNA for c-myc, c-fos, c-jun, and beta-microglobulin was assessed through the RT-PCR technique, using specific primers to each gene. The protein expression of these protooncogenes was evaluated through the Western blot technique with specific antibodies. RESULTS: No statistically significant difference was observed in the gene expression for these protooncogenes between normal myometrium and leiomyoma (c-myc: 0,87 ± 0,08 vs 0,87 ± 0,08, p = 0,952; c-fos: 1,10 ± 0,17 vs 1,01 ± 0,11, p = 0,21; c-jun: 1,03 ± 0,12 vs 0,96 ± 0,09, p = 0,168, respectively). No statiscally significant difference was observed for the protein expression of these protooncogenes between normal myometrium and leiomyoma (c-myc: 1,36 ± 0,48 vs 1,53 ± 0,29, p = 0,569; c-fos: 8,85 ± 5,5 vs 6,56 ± 4,22, p = 0,434; e c-jun: 6,47 ± 3,04 vs 5,42 ± 2,03, p = 0,266, respectively). CONCLUSION: No difference was observed in the gene expression (transcription) nor in the protein expression (translation) of the protooncogenes c-myc, c-fos, and c-jun between leiomyoma and myometrium.

Quality of life in a Brazilian sample of patients with Parkinson's disease and their caregivers / Qualidade de vida de uma amostra de pacientes brasileiros portadores da doença de Parkinson e seus cuidadores

OBJECTIVE: Parkinson's disease is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. METHOD: A cross-sectional study was performed in which quality of life was assessed by the WHOQOL-BREF questionnaire in 21 patients with Parkinson's disease and their respective caregivers. RESULTS: Significant differences between patients and caregivers were found in physical (p < 0.001) and psychological (p = 0.002) domains. In the Parkinson's disease group there was a significant inverse correlation between the psychological domain and duration of disease (p = 0.01), as well as between social domain and severity of disease (p = 0.001). There was a positive correlation between physical domain scores and number of people living in the same house (p = 0.02). The only significant finding in the group of caregivers was an inverse correlation between the social domain and the patients´ age (p = 0.04). CONCLUSION: Duration, severity of the disease and the number of people living in the same house were the most important predictors of quality of life of Parkinson's disease patients. The age of the patients was the only significant predictor found in the caregivers' quality of life. In order to complement our findings, further short-form questionnaires should be validated for Brazilian samples of Parkinson's disease.

OBJETIVO: A doença de Parkinson é uma enfermidade neurodegenerativa comum caracterizada por disfunção motora e níveis crescentes de dependência para atividades da vida diária, com conseqüente impacto sobre a qualidade de vida dos pacientes e seus cuidadores. MÉTODO: Foi realizado um estudo transversal avaliando qualidade de vida por meio do questionário WHOQOL-BREF em 21 pacientes com doença de Parkinson e seus respectivos cuidadores. RESULTADOS: Diferenças significativas entre pacientes e cuidadores foram encontradas nos domínios físico (p < 0,001) e psicológico (p = 0,002) do questionário WHOQOL-BREF. No grupo dos pacientes, houve uma significativa correlação inversa entre o domínio psicológico e duração da doença (p = 0,01), assim como entre domínio social e gravidade da doença (p = 0,001). Houve uma correlação positiva entre domínio físico e número de pessoas vivendo na mesma casa (p = 0,02). O único achado significativo no grupo dos cuidadores foi uma correlação inversa entre o domínio social e a idade do paciente (p = 0,04). CONCLUSÃO: Duração, gravidade e número de pessoas vivendo na mesma casa foram os fatores preditores mais importantes sobre a qualidade de vida dos pacientes com doença de Parkinson. A idade dos pacientes foi o único fator preditor encontrado sobre a qualidade de vida dos cuidadores. Outros questionários de aplicação curta devem ser validados para amostras brasileiras de pacientes com doença de Parkinson no sentido de complementar nossos achados.