Doenças valvares sob a perspectiva do teste cardiopulmonar de exercício: uma revisão integrativa dos últimos 10 anos / Valvular diseases from the perspective of cardiopulmonary exercise testing: an integrative review of the last 10 years

OBJETIVO: Avaliar artigos científicos sobre o uso do Teste Cardiopulmonar de Exercício (TCPE)nas valvopatias com insuficiência ou estenose moderada a grave em pacientes oligo ou assintomáticos. MÉTODOS: Trata-se de uma revisão integrativa de literatura, com artigos publicados entre 2014 e 2024, sem restrição linguística, disponíveis online na íntegra. Utilizou-se como questão norteadora: "Quais as evidências sobre a realização do teste cardiopulmonar de exercício em pacientes portadores de valvopatias moderadas a graves e assintomáticos?". A pesquisa bibliográfica foi realizadaatravés das bases de dados PUBMED/MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Coleção BVS, por meio dos seguintes descritores em Ciências da Saúde (DeCS): Heart Valve Diseases; Cardiopulmonry Exercise Testing, com uso do operador booleano "AND". RESULTADOS: A amostra final foi composta por 09 artigos que seguiram os critérios de inclusão e exclusão previamente definidos. CONSIDERAÇÕES Finais: O TCPE está bem estabelecido na literatura como uma opção segura, acessível e objetiva, para avaliação dos pacientes com doença valvar, permitindo análise real do condicionamento aeróbico, associado ao comportamento dos sistemas cardiovascular, pulmonar e periférico, trazendo maior precisão da avaliação clínica do paciente.

Can I speak to the manager? The gender dynamics of decision-making in Kenyan maize plots.

Gender and social inclusion efforts in agricultural development are focused on making uptake of agricultural technologies more equitable. Yet research looking at how gender relations influence technology uptake often assumes that men and women within a household make farm management decisions as individuals. Relatively little is understood about the dynamics of agricultural decision-making within dual-adult households where individuals' management choices are likely influenced by others in the household. This study used vignettes to examine decision-making related to maize plot management in 698 dual-adult households in rural Kenya. The results indicated a high degree of joint management of maize plots (55%), although some management decisions-notably those related to purchased inputs-were slightly more likely to be controlled by men, while other decisions-including those related to hiring of labor and maize end uses-were more likely to be made by women. The prevalence of joint decision-making underscores the importance of ensuring that both men's and women's priorities and needs are reflected in design and marketing of interventions to support maize production, including those related to seed systems, farmer capacity building, and input delivery.

Making mentoring more impactful for URiM students.

Mentorship has been proven to be a valuable vehicle to fight the disparity of diverse representation in medicine. Given the numerous findings that a more diverse medical profession leads to better patient outcomes, we believe fostering mentorship of URiM medical students is in the best interest for patients and the field of medicine. In our manuscript, we illustrated tenets of mentorship that result in effective mentoring of URiM students by any physician regardless of race, ethnicity, or background. This piece reflects upon our personal experiences with structured mentorship programs, results of similar programs at other universities, and ties in a broader conversation of the value of institutional support of mentorship programs. Given the urgency to increase diversity and, ultimately, belonging in not only medical education but also our physician workforce, this piece is highly relevant. This piece is intended to inspire and increase more opportunities for more incoming URiM students to be mentored at the start of their medical journey.

Making an Impact with E.M.P.A.C.T. Engage, Mentor Prepare, Advocate, Cultivate, and Teach: An Innovative Pilot Mentoring Program Evaluation for Students Underrepresented in Medicine.

Purpose: Medicine has yet to increase the representation of historically excluded persons in medicine to reflect the general population. The lack of support and guidance in the medical training of these individuals is a significant contributor to this disparity. The Engage, Mentor, Prepare, Advocate for, Cultivate, and Teach (EMPACT) Mentoring program was created to address this problem by providing support for learners who are historically underrepresented in medicine (URiM) as they progress through medical school. Methods: The EMPACT Pilot Program was formed and conducted during the 2019-2020 academic year. A total of 19 EMPACT mentorship groups were created, each consisting of two mentors and four medical student mentees. Additionally, four professional development workshops were held along with a final Wrap-up and Awards event. Pre and post pilot program surveys along with surveys after each workshop and focus groups were conducted with a random selection of program participants. Results: When compared to data from before and after the implementation of the EMPACT program, there were statistically significant differences (p < 0.05) in EMPACT mentees reporting they agree or strongly agree they felt ready to handle their clinical rotations (28% to 65%), felt the need to have an advocate (85% to 47%), possessed insight on day-to-day activities of an attending (26% to 56%) and felt a sense of community (79% to 94%). Mentors revealed an increase in their awareness of the concepts of microaggressions and imposter phenomenon. Finally, both groups felt an increase in their support system and sense of community at the school of medicine. Conclusion: Despite COVID-19 limitations, the EMPACT program met its goals. We effectively supported URiM medical students through mentorship, networking, and community.

Subconfluent ARPE-19 Cells Display Mesenchymal Cell-State Characteristics and Behave like Fibroblasts, Rather Than Epithelial Cells, in Experimental HCMV Infection Studies.

Human cytomegalovirus (HCMV) has a broad cellular tropism and epithelial cells are important physiological targets during infection. The retinal pigment epithelial cell line ARPE-19 has been used to model HCMV infection in epithelial cells for decades and remains a commonly used cell type for studying viral entry, replication, and the cellular response to infection. We previously found that ARPE-19 cells, despite being derived from an epithelial cell explant, express extremely low levels of canonical epithelial proteins, such as E-cadherin and EpCAM. Here, we perform comparative studies of ARPE-19 and additional epithelial cell lines with strong epithelial characteristics. We find that ARPE-19 cells cultured under subconfluent conditions resemble mesenchymal fibroblasts, rather than epithelial cells; this is consistent with previous studies showing that ARPE-19 cultures require extended periods of high confluency culture to maintain epithelial characteristics. By reanalyzing public gene expression data and using machine learning, we find evidence that ARPE-19 cultures maintained across many labs exhibit mesenchymal characteristics and that the majority of studies employing ARPE-19 use them in a mesenchymal state. Lastly, by performing experimental HCMV infections across mesenchymal and epithelial cell lines, we find that ARPE-19 cells behave like mesenchymal fibroblasts, producing logarithmic yields of cell-free infectious progeny, while cell lines with strong epithelial character exhibit an atypical infectious cycle and naturally restrict the production of cell-free progeny. Our work highlights important characteristics of the ARPE-19 cell line and suggests that subconfluent ARPE-19 cells may not be optimal for modeling epithelial infection with HCMV or other human viruses. It also suggests that HCMV biosynthesis and/or spread may occur quite differently in epithelial cells compared to mesenchymal cells. These differences could contribute to viral persistence or pathogenesis in epithelial tissues.

Computer Numerical Control Micromilling of a Microfluidic Acrylic Device with a Staggered Restriction for Magnetic Nanoparticle-based Immunoassays.

Microfluidic systems have greatly improved immunoassay techniques. However, many microfabrication techniques require specialized, expensive, or complicated equipment, making fabrication costly and incompatible with mass production, which is one of the most important preconditions for point-of-care tests (POCT) to be adopted in low-resource settings. This work describes the fabrication process of an acrylic (polymethylmethacrylate, PMMA) device for nanoparticle-conjugated enzymatic immunoassay testing using the computer numerical control (CNC) micromilling technique. The functioning of the microfluidic device is shown by performing an immunoassay to detect a commercial antibody using lysozyme as a model antigen conjugated to 100 nm magnetic nanoparticles. This device integrates a physical staggered restriction of only 5 µm in height, used to capture magnetic microparticles that make up a magnetic trap by placing an external magnet. In this way, the magnetic force on the immunosupport of conjugated nanoparticles is enough to capture them and resist flow drag. This microfluidic device is particularly suitable for low-cost mass production without the loss of precision for immunoassay performance.

Immunomodulatory Effects of Allium sativum L. and its Constituents against Viral Infections and Metabolic Diseases.

BACKGROUND: Allium sativum L., or garlic, is one of the most studied plants worldwide within the field of traditional medicine. Current interests lie in the potential use of garlic as a preventive measure and adjuvant treatment for viral infections, e.g., SARS-CoV-2. Even though it cannot be presented as a single treatment, its beneficial effects are beyond doubt. The World Health Organization has deemed it an essential part of any balanced diet with immunomodulatory properties. OBJECTIVE: The aim of the study was to review the literature on the effects of garlic compounds and preparations on immunomodulation and viral infection management, with emphasis on SARS-CoV- -2. METHODS: Exhaustive literature search has been carried out on electronic databases. CONCLUSION: Garlic is a fundamental part of a well-balanced diet which helps maintain general good health. The reported information regarding garlic's ability to beneficially modulate inflammation and the immune system is encouraging. Nonetheless, more efforts must be made to understand the actual medicinal properties and mechanisms of action of the compounds found in this plant to inhibit or diminish viral infections, particularly SARS-CoV-2. Based on our findings, we propose a series of innovative strategies to achieve such a challenge in the near future.

Severe respiratory disease caused by human respiratory syncytial virus impairs language learning during early infancy.

Human respiratory syncytial virus infection is a leading cause of pediatric morbidity and mortality. A previous murine study showed that during severe acute respiratory infections the virus invades the central nervous system, and that infected animals evolve with long-lasting learning difficulties associated with long-term potentiation impairment in their hippocampus. We hypothesized here that human infants who presented a severe episode of respiratory syncytial virus infection before 6 months of age would develop long-term learning difficulties. We measured the acquisition of the native phoneme repertoire during the first year, a milestone in early human development, comprising a reduction in the sensitivity to the irrelevant nonnative phonetic information and an increase in the sensitivity to the information relevant for the native one. We found that infants with a history of severe respiratory infection by the human respiratory syncytial virus presented poor distinction of native and nonnative phonetic contrasts at 6 months of age, and remained atypically sensitive to nonnative contrasts at 12 months, which associated with weak communicative abilities. Our results uncover previously unknown long-term language learning difficulties associated with a single episode of severe respiratory infection by the human respiratory syncytial virus, which could relate to memory impairments.

Analyzing structural alterations of mitochondrial intermembrane space superoxide scavengers cytochrome-c and SOD1 after methylglyoxal treatment.

Mitochondria are quantitatively the most important sources of reactive oxygen species (ROS) which are formed as by-products during cellular respiration. ROS generation occurs when single electrons are transferred to molecular oxygen. This leads to a number of different ROS types, among them superoxide. Although most studies focus on ROS generation in the mitochondrial matrix, the intermembrane space (IMS) is also important in this regard. The main scavengers for the detoxification of superoxide in the IMS are Cu, Zn superoxide dismutase (SOD1) and cytochrome-c. Similar to ROS, certain reactive carbonyl species are known for their high reactivity. The consequences are deleterious modifications to essential components compromising cellular functions and contributing to the etiology of severe pathological conditions like cancer, diabetes and neurodegeneration. In this study, we investigated the susceptibility of SOD1 and cytochrome-c to in vitro glycation by the dicarbonyl methylglyoxal (MGO) and the resulting effects on their structure. We utilized experimental techniques like immunodetection of the MGO-mediated modification 5-hydro-5-methylimidazolone, differential scanning calorimetry, fluorescence emission and circular dichroism measurements. We found that glycation of cytochrome-c leads to monomer aggregation, an altered secondary structure (increase in alpha helical content) and slightly more compact folding. In addition to structural changes, glycated cytochrome-c displays an altered thermal unfolding behavior. Subjecting SOD1 to MGO does not influence its secondary structure. However, similar to cytochrome-c, subunit aggregation is observed under denaturating conditions. Furthermore, the appearance of a second peak in the calorimetry diagram indirectly suggests de-metallation of SOD1 when high MGO levels are used. In conclusion, our data demonstrate that MGO has the potential to alter several structural parameters in important proteins of energy metabolism (cytochrome-c) and antioxidant defense (cytochrome-c, SOD1).

Promiscuity analysis of a kinase panel screen with designated p38 alpha inhibitors.

Protein phosphorylation by kinases is of critical importance for the regulation of many cellular functions. When kinases are deregulated numerous biological processes are affected, which may cause a variety of diseases. Therefore, kinase inhibition plays an important role for therapeutic intervention. A number of kinase inhibitors have been approved as drugs, initially in oncology where promiscuous (multi-kinase) inhibitors were most efficacious. Exploring kinase inhibitor selectivity and promiscuity for therapy is among the most challenging aspects of kinase drug discovery. Herein, we thoroughly analyze a kinase profiling experiment in which 637 designated inhibitors of p38α MAP kinase (p38α) were tested against a panel of 60 kinases distributed across the human kinome. In this experiment, only 19% of the inhibitors were found to be promiscuous when the median p38α inhibition level was applied as an activity threshold. Promiscuous inhibitors had a median value of two targets per compound, and many of these inhibitors were only active against the p38α and closely related JNK3 enzymes. Promiscuity cliffs were identified and analyzed in a network representation revealing structural modifications that were implicated in triggering compound promiscuity. Taken together, the findings revealed a high degree of selectivity of designated p38α directed inhibitors although they target the ATP binding site that is largely conserved across the human kinome.

Cheminformatic characterization of natural products from Panama.

In this work, we discuss the characterization and diversity analysis of 354 natural products (NPs) from Panama, systematically analyzed for the first time. The in-house database was compared to NPs from Brazil, compounds from Traditional Chinese Medicine, natural and semisynthetic collections used in high-throughput screening, and compounds from ChEMBL. An analysis of the "global diversity" was conducted using molecular properties of pharmaceutical interest, three molecular fingerprints of different design, molecular scaffolds, and molecular complexity. The global diversity was visualized using consensus diversity plots that revealed that the secondary metabolites in the Panamanian flora have a large scaffold diversity as compared to other composite databases and also have several unique scaffolds. The large scaffold diversity is in agreement with the broad range of biological activities that this collection of NPs from Panama has shown. This study also provided further quantitative evidence of the large structural complexity of NPs. The results obtained in this study support that NPs from Panama are promising candidates to identify selective molecules and are suitable sources of compounds for virtual screening campaigns.

Chemoselective fluorination and chemoinformatic analysis of griseofulvin: Natural vs fluorinated fungal metabolites.

Griseofulvin is a fungal metabolite and antifungal drug used for the treatment of dermatophytosis in both humans and animals. Recently, griseofulvin and its analogues have attracted renewed attention due to reports of their potential anticancer effects. In this study griseofulvin (1) and related analogues (2-6, with 4 being new to literature) were isolated from Xylaria cubensis. Six fluorinated analogues (7-12) were synthesized, each in a single step using the isolated natural products and Selectflour, so as to examine the effects of fluorine incorporation on the bioactivities of this structural class. The isolated and synthesized compounds were screened for activity against a panel of cancer cell lines (MDA-MB-435, MDA-MB-231, OVCAR3, and Huh7.5.1) and for antifungal activity against Microsporum gypseum. A comparison of the chemical space occupied by the natural and fluorinated analogues was carried out by using principal component analysis, documenting that the isolated and fluorinated analogues occupy complementary regions of chemical space. However, the most active compounds, including two fluorinated derivatives, were centered around the chemical space that was occupied by the parent compound, griseofulvin, suggesting that modifications must preserve certain attributes of griseofulvin to conserve its activity.

Platform for Unified Molecular Analysis: PUMA.

We introduce a free platform for chemoinformatic-based diversity analysis and visualization of chemical space of user supplied data sets. Platform for Unified Molecular Analysis (PUMA) integrates metrics used to characterize compound databases including visualization of chemical space, scaffold content, and analysis of chemical diversity. The user's input is a file with SMILES, database names, and compound IDs. PUMA computes molecular properties of pharmaceutical relevance, Murcko scaffolds, and diversity analysis. The user can interactively navigate through the graphs and export image files and the raw data of the diversity calculations. The platform links two public online resources: Consensus Diversity Plots for the assessment of global diversity and Activity Landscape Plotter to analyze structure-activity relationships. Herein, we describe the functionalities of PUMA and exemplify its use through the analysis of compound databases of general interest. PUMA is freely accessible at the authors web-site https://www.difacquim.com/d-tools/ .

Scaffold Diversity of Fungal Metabolites.

Many drug discovery projects rely on commercial compounds to discover active leads. However, current commercial libraries, with mostly synthetic compounds, access a small fraction of the possible chemical diversity. Natural products, in contrast, possess a vast structural diversity and have proven to be an outstanding source of new drugs. Several chemoinformatic analyses of natural products have demonstrated their diversity and structural complexity. However, to our knowledge, the scaffold content and structural diversity of fungal secondary metabolites have never been studied. Herein, the scaffold diversity of 223 fungal metabolites was measured and compared to the diversity of approved drugs and commercial libraries for HTS containing natural, synthetic, and semi-synthetic compounds. In addition, the global diversity of the fungal isolates was assessed and compared to other reference data sets using Consensus Diversity Plots, a chemoinformatic tool recently developed. It was concluded that fungal secondary metabolites are cyclic systems with few ramifications and more diverse than the commercial libraries with natural products and semi-synthetic compounds. The fungal metabolites data set was one of the most structurally diverse, containing a large proportion of different and unique scaffolds not found in the other compound data sets including ChEMBL. Therefore, fungal metabolites offer a rich source of molecules suited for identifying diverse candidates for drug discovery.

Activity Landscape Plotter: A Web-Based Application for the Analysis of Structure-Activity Relationships.

Activity landscape modeling is a powerful method for the quantitative analysis of structure-activity relationships. This cheminformatics area is in continuous growth, and several quantitative and visual approaches are constantly being developed. However, these approaches often fall into disuse due to their limited access. Herein, we present Activity Landscape Plotter as the first freely available web-based tool to automatically analyze structure-activity relationships of compound data sets. Based on the concept of activity landscape modeling, the online service performs pairwise structure and activity relationships from an input data set supplied by the user. For visual analysis, Activity Landscape Plotter generates Structure-Activity Similarity and Dual-Activity Difference maps. The user can interactively navigate through the maps and export all the pairwise structure-activity information as comma delimited files. Activity Landscape Plotter is freely accessible at https://unam-shiny-difacquim.shinyapps.io/ActLSmaps /.

Consensus Diversity Plots: a global diversity analysis of chemical libraries.

BACKGROUND: Measuring the structural diversity of compound databases is relevant in drug discovery and many other areas of chemistry. Since molecular diversity depends on molecular representation, comprehensive chemoinformatic analysis of the diversity of libraries uses multiple criteria. For instance, the diversity of the molecular libraries is typically evaluated employing molecular scaffolds, structural fingerprints, and physicochemical properties. However, the assessment with each criterion is analyzed independently and it is not straightforward to provide an evaluation of the "global diversity". RESULTS: Herein the Consensus Diversity Plot (CDP) is proposed as a novel method to represent in low dimensions the diversity of chemical libraries considering simultaneously multiple molecular representations. We illustrate the application of CDPs to classify eight compound data sets and two subsets with different sizes and compositions using molecular scaffolds, structural fingerprints, and physicochemical properties. CONCLUSIONS: CDPs are general data mining tools that represent in two-dimensions the global diversity of compound data sets using multiple metrics. These plots can be constructed using single or combined measures of diversity. An online version of the CDPs is freely available at: https://consensusdiversityplots-difacquim-unam.shinyapps.io/RscriptsCDPlots/.Graphical AbstractConsensus Diversity Plot is a novel data mining tool that represents in two-dimensions the global diversity of compound data sets using multiple metrics.

Chemoinformatic expedition of the chemical space of fungal products.

AIM: Fungi are valuable resources for bioactive secondary metabolites. However, the chemical space of fungal secondary metabolites has been studied only on a limited basis. Herein, we report a comprehensive chemoinformatic analysis of a unique set of 207 fungal metabolites isolated and characterized in a USA National Cancer Institute funded drug discovery project. RESULTS: Comparison of the molecular complexity of the 207 fungal metabolites with approved anticancer and nonanticancer drugs, compounds in clinical studies, general screening compounds and molecules Generally Recognized as Safe revealed that fungal metabolites have high degree of complexity. Molecular fingerprints showed that fungal metabolites are as structurally diverse as other natural products and have, in general, drug-like physicochemical properties. CONCLUSION: Fungal products represent promising candidates to expand the medicinally relevant chemical space. This work is a significant expansion of an analysis reported years ago for a smaller set of compounds (less than half of the ones included in the present work) from filamentous fungi using different structural properties.

Estudo do efeito da corrente interferencial na tensãomuscular e na qualidade de vida em indivíduos portadores de disfunção temporomandibular / Impact of interferential current in muscle tension and quality of life in patients with temporomandibular disorders

As disfunções temporomandibulares (DTM) são classifi cadascomo a principal causa de dor não-dental na região orofacial.No tratamento destas disfunções, a efetividade da TENS é bemconhecida, o mesmo não ocorrendo com a corrente interferencial(CIV). O objetivo deste trabalho foi avaliar a infl uência da correnteinterferencial na diminuição da tensão dos músculos masseter etemporal fi bras anteriores, bem como a melhora da sintomatologiae qualidade de vida em portadores de DTM. Foram selecionadosnove indivíduos com diagnóstico de DTM há mais de seis meses deacordo com critérios de inclusão e exclusão bem defi nidos. Destesapenas dois concluíram o tratamento completo e foram incluídosneste estudo. A rotina de tratamento consistiu em aplicação da CIVem três sessões de 20 minutos para cada músculo bilateralmentedurante duas semanas. Os resultados foram avaliados através doquestionário de qualidade de vida SF-36 e da eletromiografi a desuperfície que foram aplicados no pré-tratamento, no dia seguintee 15 dias após o término das sessões para verifi carmos os efeitosimediatos e prolongados do tratamento. Nossos dados sugeremdiminuição da tensão RMS, após o término do tratamento, naposição de repouso mandibular sem contato oclusal, para ambosos indivíduos nos músculos masseter direito, masseter esquerdo etemporal direito e na posição de máxima contração isométrica voluntáriaem todos os músculos. Também foi notado aumento da tensãoRMS no músculo temporal esquerdo nos dois indivíduos...

Temporomandibular disorders (TMD) are classifi ed as the maincause of non-dental pain in the orofacial region. Th e eff ectivenessof TENS is well known, which did not occur with modular interferentialcurrent. Th e aim of this study was to evaluate the infl uenceof interferential current in decreasing tension of the masseter andtemporal anterior fi bers, as well as improvement in symptoms andquality of life in patients with TMD. We selected nine individualsdiagnosed with TMD for over six months according to inclusionand exclusion criteria clearly defi ned. Of these, only two completedthe full treatment and were included in this study. Treatment routineconsisted of application of VSD in three sessions of 20 minutesfor each muscle bilaterally during two weeks and the results wereassessed by questionnaire SF-36 and surface electromyography havebeen applied in pre-treatment, next day and 15 days after the endof the sessions to verify the immediate and prolonged eff ects oftreatment. Our data suggest a decrease in RMS tension after completionof treatment in mandibular rest position with no occlusalcontact for both individuals in the right masseter, left masseterand right temporal and location of maximum voluntary isometriccontraction in all muscles. It was also observed increased tensionin the left temporal muscle RMS in two individuals. Even withinthe limitations of this study mainly by the diffi culty of adherenceof patients to complete treatment and based on data obtained weconcluded that the modular interferential current showed resultscomparable to results reported in the literature for the eff ects ofTENS in reducing muscle tension, refl ecting improvement in thepain and consequently on the quality of life...

Subdiagnóstico de depresión en atención primaria, en pacientes del área sur-oriente de Santiago, 2006 / Depression underdiagnosis in the primary healthcare: a study of patient of south-western area of Santiago, during 2006

La depresión es altamente prevalente en Chile, sin embargo, muchos pacientes no son pesquisados por los médicos de atención primaria (MAP). El objetivo de esta estudio es analizarla concordancia entre el diagnóstico de depresión hecho por MAP, respecto a una entrevista clínica estructurada basada en criterios DSM-IV (Manual Diagnóstico y Estadístico de los Trastornos Mentales) para depresión, realizada en un centro de atención secundaria (CAS). Se estudiaron 174 pacientes (edad 57.6 15.1 años, 131 mujeres), derivados por diversas patologías distintas a la depresión, a un CAS, atendidos durante el último mes por MAP. Todos los pacientes fueron evaluados con la escala de ansiedad y depresión de Goldberg (E.A.D.G) y a los probables casos según el instrumento (puntaje 3, subescala depresión) se les realizó una entrevista clínica estructurada basada en criterios DSM-IV para depresión. Treinta y tres pacientes tenían diagnóstico de depresión hecho por MAP. Sin embargo, 103 pacientes (59.2 por ciento) tuvieron puntajes 3 en la E.A.D.G y 59 (33.9 por ciento) cumplieron criterios DSM-IV para depresión. La concordancia entre el diagnóstico de depresión hecho por MAP, respecto al diagnóstico según criterios DSM-IV, mediante el índice Kappa, fue 0.39 (acuerdo débil), existiendo coincidencia positiva sólo en 25 casos. Se observó baja concordancia entre el diagnóstico de depresión hecho por MAP y el realizado a través de una entrevista clínica estructurada, con importante subdiagnóstico, cercano al 60 por ciento. En forma adicional, la aplicación de un test de tamizaje, fue de utilidad para detectar casos previamente no diagnosticados.