Lucas Piccoli Conzatti

Association between primary headaches and depression in young adults in southern Brazil

OBJECTIVE To verify the association between depression and headache in young adults, as well as to identify the features of headache associated with depression and the influence of this mood disorder on headache-related disability. METHODS A cross-sectional study with self-administered questionnaires about headache and depression was conducted at the Universidade de Caxias do Sul. Beck Depression Inventory (BDI) and Migraine Disability Assessment (MIDAS) were used to evaluate depressive symptoms and headache-related disability, respectively. Depression was considered if BDI ≥ 15. RESULTS A thousand and thirteen young adults were included in the study. A clear relationship was observed between headache and depression among the participants. Multivariate analyses demonstrated that nausea or vomiting related to headache and higher headache-related disability scores were independent factors associated with depression. Migraine was more associated with depression than the other types of headache. CONCLUSION The results demonstrate an association between headache and depression. Depressive symptoms are more likely to be found in young adults with more disabling headaches.

A Prospective Study of Factors Related to Satisfaction in Patients with Open Discectomy to Lumbar Disc Herniation

Introduction The knowledge of prognostic factors related to good and poor surgical outcome is crucial to perform a proper patient selection and achieve a good surgical outcome. The patient satisfaction and quality of life has been considered one of the most important outcomes in spinal surgery. The objective is to report the prognosis factors related to satisfaction after an open discectomy procedure in LDH through a prospective study design. Materials and Methods Prospective cohort of adults with LDH associated with neurological impairment and sciatica who underwent open discectomy. The inclusion criteria was the presence of L4–L5 or L5–S1 LDH on magnetic resonance image, with clinical correlation. The patients were submitted to surgical procedure if persisted with sciatica after clinical treatment of 4 to 8 weeks or if presented progressive motor impairment despite conservative treatment. All patients were evaluated preoperatively and 1, 6, and 12 months postoperatively using a validated instruments were used to evaluate pain, disability, quality of life, anxiety, and depression and fear and beliefs related to work and physical activity. In the last evaluation, the patients answered the following question to determinate their satisfaction with the procedure: Would you have the same treatment to achieve the same result again? The patients who answered “definitively Yes” or “probably Yes” were considered satisfied with the procedure. The patients were considered dissatisfied when they answered, “do not know,” “probably would not,” or “definitively would not.” Results A total of 125 patients with one level discectomy in L4–L5 or L5–S1 were included in this study. Paired analyses demonstrated that open discectomy improved pain, function, quality of life, depression, and anxiety scores, and reduced fear-avoidance beliefs of patients with lumbar disc herniation. The satisfaction rate with treatment was 84.8 and 86.4% at 30 days and 1-year postoperative, respectively. Patients considered satisfied with treatment presented higher improvement in ODI (mean difference: −19.24, CI 95%: −9.00to −29.48; p = 0.001), PC–SF-36 (mean difference: 12.71; CI 95%: 6.68–18.74; p < 0.0001), and BDI (mean difference: −3.57, CI 95%: −0.22 to −6.92; p = 0.039). Regarding fear-avoidance beliefs, the satisfied group presented lower levels of FAB–PA (p = 0.051) at final follow-up. No difference was observed in the FAB-W during the periods of evaluation. The instruments related to depression and anxiety demonstrated that the levels of anxiety and depression in 1-year postoperative were higher in patients dissatisfied (BDI: p = 0.005, HADS: p = 0.038). Conclusion The cutoff value to distinguish between satisfaction and dissatisfaction after open discectomy to patients with LDH was a change score of 21 (sensitivity: 0.88, specificity: 0.60, LR + : 2.20, and LR − : 0.23) for the ODI, 8 (sensitivity: 0.85, specificity: 0.69, LR + : 2.74, and LR − : 0.21) for PC–SF-36, and 3.5 (sensitivity: 0.76, specificity: 0.52, LR + : 1.58, and LR − : 0.46) for BDI.

Motor Outcome and Histological Findings in a Clipping Model of Spinal Cord Injury: Comparison between Posterior and Lateral Clip Placement

Introduction Different types of spinal cord injury models in rats were described in the literature, including spinal cord clip compression. This type of procedure can be performed by placing the clip in two directions in relation to the spinal cord: lateral or posterior. Studies published in the literature usually do not describe the direction of the clip placement. It is assumed that the severity of neurological symptoms and the histological lesion are different from each other in these two models. The objective is to evaluate the locomotor and the histological impact on the spinal cord comparing lateral and posterior clip placement. Materials and Methods This study is a randomized experimental trial. A total of 20 female Wistar rats, ranging from 250 to 300 g, aged 12 to 14 weeks, were randomized in two groups by the direction of clip placement: lateral group (n = 10) and posterior group (n = 10). After exposing the thoracic segment of spine (T8–T10), a laminectomy was performed at the T9 level under microscope view. The spinal cord injury was made using a 5 mm long aneurismal clip with a closing pressure of 50 g. Locomotor behavior was evaluated by the Basso, Beattie, and Bresnahan scale at the 1st, 7th, 14th, 21st, and 28th day after surgery and the histological analysis of the injury area by computer software. Results The histological evaluation showed a greater lesion area in the lateral group, mean 2.3 ± 2 mm2, when compared with the posterior group, mean 4.8 ± 1 mm2 (p = 0.03). There was no overall difference between lateral and posterior locomotor scores from day 1 to 28 (p = 0.361). Conclusion The lesion area observed in the spinal cord histology after the lateral placement of a clip was significantly greater than in the posterior direction of the clip. There was no overall motor performance difference between lateral and posterior BBB scores.

Avoiding Infertility after Spinal Cord Injury by Hyperbaric Oxygenation Therapy

Introduction After a primary mechanical injury in the spinal cord, a cascade of inflammatory events is triggered leading to the degeneration and death of potentially viable neuronal tissue. Besides motor loss, the injured patients suffer from erectile and ejaculatory dysfunctions, and spermatogenesis deficiencies. The objective is to study the efficacy of hyperbaric therapy in the acute phase in rats with spinal cord injury (SCI) to recover spermatogenesis. Materials and Methods Experimental study approved by the ethics and research committee. Eighteen rats were submitted to T9 spinal cord trauma by a 25 g weight drop using the MASCIS Impactor. They were allocated randomly to the hyperbaric therapy (HBT) and control group. The rats submitted to HBT had 1 hour sessions daily at 2 atmospheres of oxygen for 7 days. Previous works by the authors of this study support the HBT protocol chosen. The control group had supportive treatment. Testicular biopsies were performed by median abdominal incision in all rats on the 1st and 28th day of study. The samples obtained were soaked in hypoosmotic solution to evaluate the concentration of sperm per mL, number of round cells per field, number of infectious cells per field (peroxidase-Endtz test), and sperm viability (HOS test). The data were analyzed using SPSS software v.20, described by mean and standard deviation, and compared using the Student t-test or Mann–Whitney U-test according to the parametricity of the variable. A p-value of < 0.05 was considered significant. Results The mean concentration of sperm per mL did not change in the HBT (p = 0.41) and control groups (p = 0.74) over the 28 days of the study. The number of round cells and inflammatory cells per field was significantly greater in both groups on the 28th day. Sperm viability from day 1 to day 28 diminished two times more in the control (p = 0.001) than in the HBT group (p = 0.017) and sperm viability was significantly greater on day 28 in the HBT group as compared with the control group (86.67 ± 5.59% vs. 48.75 ± 21.83%) (p < 0.001). The other variables analyzed did not present a statistically significant difference between the groups. Conclusion The SCI promote spermatogenesis deficiencies that can be partially recovered by the HBT performed in the acute phase of SCI. Sperm viability was two times greater in the HBT group when compared with the control group 28 days after the injury.