Enduring attenuation of norepinephrine synaptic availability and augmentation of the pharmacological and behavioral effects of desipramine by repeated immobilization stress.

Here we provide evidence that repeated immobilization stress (RIS) in rats induces a persistent increase in noradrenergic activity in the anterior aspects of the anterolateral bed nucleus of the stria terminalis (alBNST). This increase in noradrenergic activity results from both enhanced synthesis and reuptake of norepinephrine (NE). It leads to a decrease in the synaptic availability of NE, which elicits an augmented noradrenergic response to the inhibitors of NE reuptake (NRIs), such as desipramine (DMI), an antidepressant. The enduring depression-like behavior and the augmentation of the climbing behavior seen in repeatedly stressed rats following subchronic administration of DMI in the forced swimming test (FST) might be explained by a dysregulation of noradrenergic transmission observed in alBNST. Taken together, we propose that dysregulation of noradrenergic transmission such as the one described in the present work may represent a mechanism underlying major depressive disorders (MDD) with melancholic features in humans.

Factores asociados a mortalidad en pacientes con infarto cerebral del Instituto Nacional de Ciencias Neurológicas: Enero 2008 - diciembre 2009 / Factors associated to mortality in patients with cerebral infarction at the Instituto Nacional de Ciencias Neurólogicas: January 2008 - December 2009

Objetivos: Explorar los factores asociados a mortalidad en pacientes con infarto cerebral que fueron hospitalizados en el Instituto Nacional de Ciencias Neurológicas. Material y Métodos: Se revisaron las historias clínicas de pacientes con diagnóstico de infarto cerebral hospitalizados en el Instituto Nacional de Ciencias Neurológicas, durante Enero del 2008 hasta Diciembre del 2009. Se describen las variables demográficas y clínicas de los pacientes, además se utilizó el modelo de regresión logística para explorar los factores asociados a mortalidad en los pacientes. Resultados: Se analizaron 461 historias clínicas de pacientes con infarto cerebral. El promedio de edad fue de 67 años, el 56% fueron hombres. La mortalidad fue del 7,6%, IC 95% (5,3-10,4); los factores asociados a mortalidad que tuvieron significancia estadística fueron: el déficit sensitivo OR=2,7, cefalea OR=2,75, trastorno de conciencia OR=12, escala NIHSS al ingreso OR=1,25 y el territorio vascular anterior OR=2,65. Conclusiones: en éste estudio exploratorio los factores asociados a mortalidad intrahospitalaria por infarto cerebral fueron la presencia de déficit sensitivo, cefalea, pérdida de conciencia, déficit neurológico severo y territorio vascular de la circulación anterior.

Objectives: To explore associated factors to mortality of patients with cerebral infarction. Methods: We reviewed clinical records of patients with diagnosis of cerebral infarction hospitalized at the Instituto Nacional de Ciencias Neurologicas, January 2008 to December 2010. We describe the demographic and clinical variables. In addition, the logistic regression model was used to determine the factors associated with mortality in these patients. Results: We reviewed clinical records of 461 patients with brain infarction. The median age was 67 years and 56% were men. We calculated a ratio of 7.6% dead, 95% IC (5.3-10.4); the factors significantly associated are the sensitive deficit OR = 2.7, headache OR = 2.75, consciousness disorder OR = 12, NIHSS scale OR = 1.25 and anterior vascular territory OR = 2.65. Conclusions: in this exploratory study factors associated with mortality by cerebral infarction were the presence of sensitive deficit, headache, loss of consciousness, severe neurological deficit and vascular territory of the anterior circulation.

Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country.

BACKGROUND: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. METHODS: We conducted a large population-based survey of women aged 18-29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure. RESULTS: Of 8242 eligible women, 7992 (97.0%) agreed to participate. The prevalence of reported induced abortions was 11.6% (95% confidence interval [CI] 10.9%-12.4%) among the 7962 women who participated in the survey. It was 13.6% (95% CI 12.8%-14.5%) among the 6559 women who reported having been sexually active. The annual incidence of induced abortion was 3.1% (95% CI 2.9%-3.3%) among the women who had ever been sexually active. In the multivariable analysis, risk factors for induced abortion were higher age at the time of the survey (odds ratio [OR] 1.11, 95% CI 1.07-1.15), lower age at first sexual intercourse (OR 0.87, 95% CI 0.84-0.91), geographic region (highlands: OR 1.56, 95% CI 1.23-1.97; jungle: OR 1.81, 95% CI 1.41-2.31 [v. coastal region]), having children (OR 0.82, 95% CI 0.68-0.98), having more than 1 sexual partner in lifetime (2 partners: OR 1.61, 95% CI 1.23-2.09; > or = 3 partners: OR 2.79, 95% CI 2.12-3.67), and having 1 or more sexual partners in the year before the survey (1 partner: OR 1.36, 95% CI 1.01-1.72; > or = 2 partners: OR 1.54, 95% CI 1.14-2.02). Overall, 49.0% (95% CI 47.6%-50.3%) of the women who reported being currently sexually active were not using contraception. INTERPRETATION: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer-sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.

Handheld computers for self-administered sensitive data collection: a comparative study in Peru.

BACKGROUND: Low-cost handheld computers (PDA) potentially represent an efficient tool for collecting sensitive data in surveys. The goal of this study is to evaluate the quality of sexual behavior data collected with handheld computers in comparison with paper-based questionnaires. METHODS: A PDA-based program for data collection was developed using Open-Source tools. In two cross-sectional studies, we compared data concerning sexual behavior collected with paper forms to data collected with PDA-based forms in Ancon (Lima). RESULTS: The first study enrolled 200 participants (18-29 years). General agreement between data collected with paper format and handheld computers was 86%. Categorical variables agreement was between 70.5% and 98.5% (Kappa: 0.43-0.86) while numeric variables agreement was between 57.1% and 79.8% (Spearman: 0.76-0.95). Agreement and correlation were higher in those who had completed at least high school than those with less education. The second study enrolled 198 participants. Rates of responses to sensitive questions were similar between both kinds of questionnaires. However, the number of inconsistencies (p = 0.0001) and missing values (p = 0.001) were significantly higher in paper questionnaires. CONCLUSION: This study showed the value of the use of handheld computers for collecting sensitive data, since a high level of agreement between paper and PDA responses was reached. In addition, a lower number of inconsistencies and missing values were found with the PDA-based system. This study has demonstrated that it is feasible to develop a low-cost application for handheld computers, and that PDAs are feasible alternatives for collecting field data in a developing country.