Cardiac Autonomic Neuropathy in Graves' Disease: Smoking and Age as Predictive Factors.

OBJECTIVES: Hypermetabolic state in Graves' disease (GD) has a great impact on heart homeostasis, acting directly on the heart muscle and modulating the autonomic nervous system. To characterize cardiac autonomic neuropathy (CAN) as a possible complication in patients with GD. METHODS: We evaluated euthyroid GD patients and a control group of healthy euthyroid people. CAN was assessed using autonomic tests of cardiovascular reflex and heart rate variability: respiratory, Valsalva, orthostatic and orthostatic hypotension tests, high frequency, low frequency, and very low-frequency bands. Transthoracic echocardiography was performed in GD patients. RESULTS: Sixty GD patients and 50 people in control group were assessed. CAN was diagnosed in 20% of GD and 14% in the control group. Among GD, 13.3% presented incipient, and 6.7% established CAN, while in the control group, it was verified incipient in 8% and established in 6% (P = .7479). All GD patients with CAN presented an alteration in the deep breathing test. Age and smoking were evidenced as factors associated with the presence of CAN, while higher TRAb values at diagnosis decreased the chance of CAN. CONCLUSIONS: The prevalence of CAN in euthyroid GD patients was 20%. Changes in the cardiac autonomic nervous system were identified, pointing to the importance of evaluating this complication in these patients. Smoking was a predictive factor for CAN, increasing its relationship with conditions that aggravate GD.

Resilience, quality of life, and clinical aspects of patients with epilepsy.

Clinical and psychosocial factors can influence the quality of life (QoL) of patients with epilepsy (PWE). OBJECTIVE: The aim of this study was to investigate the association between the Resilience Scale (RS) and the QOLIE-31 (Quality of Life in Epilepsy Inventory), Neurological Disorders Depression Inventory for Epilepsy, and clinical aspects of 137 PWE, at a significance level of p < 0.05. RESULTS: Seizure control, normal EEG (electroencephalographic) background activity, and antiepileptic drug (AED) monotherapy were associated with greater resilience. There was a correlation between resilience and depressive episodes (Pearson correlation: -0.462; p < 0.000) and performance in the MMSE (Mini-Mental State Examination) (0.221, p = 0.015). Improved QoL was associated with greater resilience, self-sufficiency, equanimity, and perseverance. Greater resilience was significantly related to the absence of depressive symptoms (p = 0.001), normal EEG background activity (p = 0.024), and AED monotherapy (p = 0.049) in the linear regression model. CONCLUSION: Clinical, cognitive, and EEG aspects were related to resilience. Depressive symptoms correlate negatively with resilience. Individuals with greater resilience perceive better QoL.