Lucilia Domingues Casulari da Motta

Depressed mood and poor quality of life in male patients with chronic renal failure undergoing hemodialysis

OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialitico, correlacionar as alteracoes observadas no humor com os diferentes dominios do questionario de qualidade de vida. METODO: Foram incluidos 47 homens em tratamento hemodialitico estavel ha mais de seis meses. Foram aplicadas a Escala de Hamilton de depressao e o Kidney Disease Quality of Life Questionnaire, questionario de qualidade de vida relacionado a saude, em sua forma traduzida e adaptada para a lingua portuguesa. RESULTADOS: A media da idade dos pacientes era 39,4 ± 8,9 anos. Na avaliacao pela Escala de Hamilton, observou-se em 32 (68,1%) pacientes a presenca de depressao. Encontramos correlacao negativa significativa entre os resultados obtidos na escala de Hamilton e os seguintes parâmetros das dimensoes especificas do Kidney Disease Quality of Life Questionnaire: lista de sintomas e problemas (rs = -0,399; p = 0,005), qualidade da interacao social (rs = -0,433; p = 0,002) e sono (rs = -0,585; p < 0,001). Entre os dominios genericos, o estado de humor apresenta correlacao negativa significativa com a saude geral (rs = -0,475; p < 0,001), o bem-estar emocional (rs = -0,354; p = 0,015), a funcao social e a energia/fadiga (rs = -0,518; p < 0,001). Para os demais parâmetros do Kidney Disease Quality of Life Questionnaire nao foram observadas relacoes significativas com a escala de Hamilton. CONCLUSAO: O estado de humor apresentou correlacao negativa com diversos escores de qualidade de vida avaliados pelo Kidney Disease Quality of Life Questionnaire, sugerindo possivel influencia do estado de humor na qualidade de vida dos pacientes renais em hemodialise.

DEPRESIÓN POSTPARTO: PREVALENCIA DE TEST DE RASTREO POSITIVO EN PUÉRPERAS DEL HOSPITAL UNIVERSITARIO DE BRASILIA, BRASIL

RESUMENCon la intencion de estimar la prevalencia de depresion postparto en mujeres atendidas en el HospitalUniversitario de Brasilia - Brasil, fue utilizada una version en portugues de la Escala de Depresion PostNatal de Edimburgo (EPDS). La escala fue aplicada a mujeres que se encontraban entre la octava ydecima segunda semana postparto, abordadas en los consultorios de Crecimiento y Desarrollo Pediatrico,donde llevaban a sus hijos para consulta pediatrica de rutina. Fue analizada la prevalencia de testpositivo, asi como la influencia de los antecedentes reproductivos y si el embarazo fue programado oaccidental. Un total de 123 mujeres respondieron la escala; 6 fueron excluidas por dejar uno o mas itemssin respuesta. Hubo una prevalencia de test positivo de 22,2%. La edad, paridad, antecedentes de abortoo embarazo accidental no fueron factores de riesgo estadisticamente significativos para el hallazgo detest positivo.PALABRAS CLAVE: Depresion postparto, EPDS, BrasilSUMMARYWith the aim of estimating the prevalence rate of postpartum depression in women assisted at theUniversity Hospital of Brasilia - Brazil, a portuguese version of the Edinburgh Postnatal Depression Scale(EPDS) was used. The scale was applied to women who were between the 8th and 12th postpartumweek, approached in the outpatient clinic of Pediatric Growth and Development, where they took theirchildren for routine pediatric consultation. The prevalence rate of positive test was analyzed, as well asthe influence of the reproductive antecedents and of the fact that the pregnancy has been planned oraccidental. A total of 123 women responded the scale, but 6 were excluded because one or more itemswere not answered. A prevalence rate of positive test of 22.2% was found. The age, parity, abortionantecedents or unplanned pregnancy were not statistically significant risk factors for positive test.KEY WORDS: Postpartum depression, EPDS, Brazil

Fibrous mastopathy: clinical, imaging, and histopathologic findings of 31 cases.

Aim:  The aim of this study was to analyze the cases of patients with a histological diagnosis of fibrous mastopathy, diabetic mastopathy, or lymphocytic mastopathy in association with other autoimmune diseases, and to conduct histological and imaging studies as well as follow up of the lesions.

Relationship between insulin and hypogonadism in men with metabolic syndrome.

OBJECTIVE To evaluate the incidence of hypogonadism in men with metabolic syndrome and its correlation with serum insulin levels. METHODS Observational, transversal study with 80 men with metabolic syndrome. The individuals were divided into two groups: Group 1: 56 patients (70%) with total testosterone > 300 ng/dL (normal gonadal function); Group 2: 24 patients (30%) with total testosterone < 300 ng/dL (hypogonadic). RESULTS The subjects from Group 2 compared to Group 1 presented higher body mass index (BMI), waist and hip circumferences, insulin, homeostasis model assessment insulin resistance index (Homa-IR) and beta cell (Homa-beta), and triglycerides, but lower SHBG and free testosterone values. Inverse correlations between insulin levels and total testosterone and SHBG, as well as between Homa-IR and total testosterone were observed. CONCLUSION In this series of men with metabolic syndrome, hypogonadism was associated with insulin resistance and may be a marker of metabolic abnormalities.

Cerebrospinal Fluid CRH Levels in Late Pregnancy Are Not Associated With New-Onset Postpartum Depressive Symptoms.

CONTEXT CRH participates in the hypothalamic-pituitary-adrenal axis and in neural circuits involved in the pathophysiology of depression. During pregnancy, the placenta produces large amounts of CRH, and production ceases abruptly after delivery. The relationship between CRH in the cerebrospinal fluid (CSF) during pregnancy and peripartum mood disorders has not been investigated. OBJECTIVES The objectives were to determine whether there are differences in CSF CRH concentrations of pregnant and nonpregnant women and whether CSF CRH concentrations in late pregnancy are associated with the presence of depressive symptoms during pregnancy and in the early postpartum period. DESIGN This was a prospective cohort study conducted from January to April, 2011. SETTING The study was conducted in one public and two private hospitals in Brasilia, Brazil. PATIENTS Patients included 107 healthy pregnant women who underwent elective cesarean delivery and 22 nonpregnant healthy women who underwent spinal anesthesia for elective surgical sterilization. INTERVENTION CRH in CSF was measured in pregnant and nonpregnant women by ELISA. MAIN OUTCOME MEASURE The association between CSF CRH concentration at delivery and maternal depression assessed before cesarean section and postpartum (4 to 8 wk) with the Edinburgh Postnatal Depression Scale (EPDS), with a cutoff of ≥ 13. RESULTS CRH concentration in the CSF was significantly higher in pregnant (4.1 ± 0.51 log CRH) than in nonpregnant women (3.6 ± 0.26 log CRH) (P < .001). Depressive symptoms starting after delivery occurred in 5.6% of women. CRH concentration in CSF was not different between women without depressive symptoms and women showing such symptoms during pregnancy or in the postpartum period. CONCLUSION CRH concentration in the CSF was higher in pregnant women than in nonpregnant women. However, in this sample, CSF CRH in late pregnancy was not associated with new-onset depressive symptoms in the early postpartum period.

Depression with postpartum onset: a prospective cohort study in women undergoing elective cesarean section in Brasilia, Brazil

PURPOSE It was to determine the prevalence of depressive symptoms in a sample of puerperal women from Brasília, Brazil, distinguishing cases with onset after delivery from those already present during pregnancy. METHODS A prospective cohort study with convenience sampling of patients submitted to elective cesarean section at two private hospitals. As an instrument for assessing depressive symptoms, the Edinburgh Postnatal Depression Scale with cutoff >13 was applied shortly before delivery and four to eight weeks after childbirth. RESULTS Among the 107 women who completed the study, 11 (10.3%) had significant depressive symptoms during pregnancy and 12 (11.2%) during the postpartum period. Among the 12 patients with postpartum symptoms, 6 had symptoms during pregnancy, so that 5.6% of the sample had postpartum onset of depression. The higher overall frequency of depression was significantly among single women than among married women (p=0.04), a fact mainly due to a higher frequency of single women experiencing persistent depressive symptoms both before and after delivery (p=0.002). The risk of depression was not influenced by age, parity or educational level. CONCLUSION Women with depression identified during the postpartum period comprise a heterogeneous group, in which symptoms may have started before pregnancy, during pregnancy or after childbirth. In this sample, half of the postpartum depression cases already presented symptoms during late pregnancy. Since depression can arise before and after childbirth, it may have different etiologies and, therefore, a different response to treatment, a possibility that should be considered by clinicians and researchers.

Relationship between placental corticotropin-releasing hormone and postpartum depression: can defining what "postpartum depression" means make a difference?

Glynn and Sandman (1) described that increased levels of placental corticotropin-releasing hormone (pCRH) at midpregnancy are associated with increased risk of developing depressive symptoms at 3 months postpartum. Previous studies have also addressed the association between pCRH during pregnancy and the risk of postpartum depression (PPD), but with conflicting results (2–5). Glynn and Sandman, as well as the authors from previous studies, have defined PPD based on the presence of depressive symptoms on the postpartum period, whether or not the onset of symptoms was during pregnancy. We are concerned that this may not be the most appropriate strategy to define PPD and believe that this might have influenced their results. Not distinguishing women with depressive symptoms during and after pregnancy from those with depressive symptoms exclusively after pregnancy might have influenced the results because there is evidence that antenatal depression and PPD have different underlying physiopathological mechanisms, including differences in hypothalamus-pituitary-adrenal (HPA) axis function (6). According to Kammerer et al. (6), pCRH-induced HPA axis hyperactivity could contribute to antenatal depression, whereas HPA hypoactivity typically seen in the postpartum period resulting from the abrupt fall in pCRH levels could underlie PPD. We therefore believe that the role of pCRH in the development of PPD would be best addressed by assessing women with depressive symptoms with onset exclusively in the postpartum period. Distinguishing the latter from women whose symptoms were already present during pregnancy would possibly bring new insights into HPA axis involvement in PPD.

Aneurisma gigante parasselar simulando tumor de hipófise

Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicating artery, are reported. The main findings were: headache (7/7), complex ophthalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicating artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar region remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.Seven cases of compromised pituitary fossa at the conventional skull X-ray, who had the final diagnosis of giant aneurysm of the intracavernous portion of the carotid artery (6 cases) and one of the anterior communicant artery, are reported. The main findings were: headache (7/7), complex ophtalmoplegia involving the III, IV and VI cranial nerves (5/7), compromised V cranial nerve (4/7) and eyeball pain (4/7). Other manifestations were: meningeal signs (2/7), unilateral blindness (1/7), hemiparesis (1/7), cacosmia (1/7) and inferior bitemporal quadrantanopsia (1/7). Five patients with intracavernous carotid artery aneurysm showed benefits with progressive occlusion of the internal carotid artery at the cervical level. One died before surgery. The case with anterior communicant artery aneurysm improved after its surgical clipping. Our data, in accord with the literature, support the conclusion that the differential diagnosis of aneurysms in the parasellar egion remains a very difficult task. The accurate final diagnosis requires cerebral angiography and the surgical treatment with progressive occlusion at the cervical portion of the internal carotid artery has a relatively low risk with promising results.

Reflexões sobre os conflitos de interesses entre médicos e a indústria farmacêutica: a propósito da sibutramina

Desde o ano passado, tem-se presenciado a polemica sobre a proibicao de medicamentos usados no tratamento da obesidade. Neste artigo, os autores pretendem mostrar os evidentes conflitos de interesses envolvidos na discussao e a manipulacao de opiniao pelos defensores da manutencao dos medicamentos. Acham que esse poderio daindustria farmaceutica em coaptar liderancas medicas nao tem limites eticos. Muitos desses medicos se prestam ao papel de utilizar seu prestigio e sua capacidade de lideranca para defender o ponto de vista da industria, em evidente e condenavel promiscuidade. Declaram os autores nao serem contra a associacao da industria da area de saude commedicos, mas a decencia etica nessa cooperacao deve prevalecer. Since last year, one has witnessed the controversy regarding the ban of medications used for obesity treatment. In this article we intend to expose the obvious conflicts of interests enrolled on its discussion and the manipulation of opinion exerted by the defenders of the drugs continuity. We believe the power from the pharmaceutical industries tocraft and persuade the medical representatives beholds no ethical limits. And for many of such doctors, playing that role by lending their prestige and leadership to defend the industries? interests and points of view, it is a clear and reprehensible act of promiscuity. We are not against an association of the health industry with doctors. But wheneversuch cooperation happens to be, ethics and decency should prevail.