Uremia and insulin resistance: N-carbamoyl-asparagine decreases insulin-sensitive glucose uptake in rat adipocytes.

BACKGROUND: In uremia, urea-derived cyanate reacts with amino groups irreversibly forming carbamoyl amino acids (C-AA) and carbamoyl proteins. Carbamoylated molecules can affect binding and trafficking and alter metabolic pathways. The C-AA role in insulin-sensitive glucose transport has not been explored and may contribute to insulin resistance in uremia. METHODS: Insulin-stimulated glucose uptake by cultured rat adipocytes was measured using both 3-minute and 3-second assays. Adipocytes were incubated for 24 hours in medium containing 0.5 micromol/mL of 15 different C-AA. 125I-insulin binding studies were done. C-asparagine in plasma from 10 uremic patients on continuous ambulatory peritoneal dialysis (CAPD) was measured using high-performance liquid chromatography (HPLC). RESULTS: Insulin-sensitive glucose uptake was reduced 34% by N-carbamoyl-l-asparagine, (N-C-Asn), in a dose-dependent manner with a half-maximally effective concentration of 0.15 micromol/mL. Fourteen other N-carbamoyl-amino acids as well as 0.5 micromol/mL of asparagine did not affect insulin sensitive glucose uptake. N-C-Asn, l-asparagine, and the other N-carbamoyl amino acids (0.5 micromol/mL) had no effect on basal glucose uptake. These data suggest that that N-C-Asn affects the insulin sensitive glucose transporter system. 125I-insulin binding studies demonstrated that N-C-Asn did not alter insulin binding. Glucose uptake measured using a 3-second assay showed that the glucose affinity of the transporter and glucose phosphorylation were not affected. In uremic patients managed by CAPD, the mean free N-C-Asn plasma level was 1.33 micromol/mL. CONCLUSION: These data suggest that N-C-Asn concentration may contribute to the insulin resistance seen in uremia.

Comparación psicométrica transcultural de la depresión mayor entre Chile y Alemania / Cross cultural psychometric comparison of major depression in inpatients from Chile and Germany

Background: Depressive symptoms and personality features of patients with mood disorders are supposed to have a strong variability in cross cultural studies. The clinical profile, the outcome and the treatment response seem to be different across the world. Aim: To investigate the differences and similarities of major depressive disorders in Chile and Germany. Material and methods: Sixty seven Chilean and German depressive inpatients, without comorbidity on axis I or II were studied. Diagnosis of depression was based on DSM IV and ICD 10 criteria for major depression. Symptomatology was assessed using the self reporting questionnaire (SRQ-20), the Symptom checklist-90-revisited (SCL 90-R), the Beck inventory for Depression (BDI), and the Hamilton scale for depression (HAM-D). Personality was assessed with the Munich Personality Scale. Results: Only the SRQ-20 shows significantly higher tendency towards depression among Chilean patients. At the personality level, Chileans exhibited higher scores in extroversion, neuroticism, esoteric and isolating tendencies. Conclusions: These results help to understand differences and similarities between depressive syndromes across cultures. They suggest that the relation between symptomatology, some personality traits and severe major depression has little variability across cultures

Um encontro com Heidelberg: diagnósticos fenomenológicos e criteriológicos: diferentes ou complementares? / Phenomenological and criteriological diagnostics: different or complementary?

Diversas escolas fenomenológicas se dedicaram à diferenciação entre fenômeno/sintoma e característica/critério, permitindo, respectivamente, uma diferenciação entre um diagnóstico fenomenológico orientado para uma abordagem holística do paciente enquanto uma pessoa e um diagnóstico sintomatológicoðcriteriológico orientado para a doença. São indicadas diferenças entre ambos métodos com respeito a suas características no tocante ao relacionamento entre o diagnosticador e o paciente, a seus horizontes de experiência e fundamentos científicos e, finalmente, com respeito a seus significados para formas pessoais e biológicas de terapia

Um encontro com Heidelberg: diagnosticos fenomenologicos e criteriologicos: diferentes ou complementares?

Diversas escolas fenomenologicas se dedicaram a diferenciacao entre fenomeno/sintoma e caracteristica/criterio, permitindo, respectivamente, uma diferenciacao entre um doagnostico fenomenologico orientado para uma abordagem holistica do paciente enquanto uma pessoa e um diagnostico sintomatologico-criteriologico orientado para a doenca. Sao indicados diferencas entre ambos metodos com respeito a suas caracteristicas no tocante ao relacionamento entre o diagnosticador e o paciente, a seus horizontes de experiencia e fundamentos cientificos e, finalmente, com respeito a seus significados para formas pessoais e biologicas de terapia.

Aspectos rol - teóricos de las psicosis endógenas / Role-theoretic aspects of endogenous psychoses

Mientras las enfermedades somáticas son secundarías a pertubaciones de las funciones primarias, las psicosis endógenas podrían considerarse desde el punto de vista psicosocial como la expresión de una falla en la realización de los roles. El análisis rol-teorético del comportamiento social de los maníaco-depresivos, caracterizado por nosotros como "hipernómico" (de "nomos" que significa ley, regla, normal), permite descubrir en ellos una forma específica de constitución de su identidad. Esta está caracterizada por una "sobre-identificación" con los roles sociales la que se acompaña de un desplazamiento de la relación dialéctica entre "identidad del yo" e "identidad del rol" en favor de esta última. Las psicosis depresivas que se producen en situaciones de cambio, pérdida o colisión de roles podrían ser entonces concebidas como "crisis de identidad", desde la perspectiva de esa estructura de la identidad propuesta. Este modelo permitiría también comprender ciertas particularidades de las psicosis depresivas en lo que respecta a la edad de comienzo y al tipo de evolución. A diferencia de la "sobreidentificación" con el rol que observamos en el depresivo, en las psicosis esquizofrénicas encontramos una verdadera incapacidad para asumir roles. Los hebefrénicos son incapaces de orientar su conducta según el tema y la zona de relevancia de una situación, mientras el esquizofrénico paranoide cae con frecuencia en interpretaciones engañosas sobre su entorno desde su falta de participación en la definición de una situación intersubjetiva determinada