Montserrat Martín-Baranera

Does nefazodone improve both depression and Parkinson disease? A pilot randomized trial.

Some of the selective serotonin reuptake inhibitors (SSRI)-induced motor side effects are mediated by stimulating 5-HT2 receptors in the basal ganglia, probably because serotonin inhibits the subsequent neuronal dopamine release. We hypothesized that nefazodone, a serotonin 2 antagonist/reuptake inhibitor (SARI) that selectively blocks 5-HT2 receptors, could disrupt the aforementioned inhibitory pathway. Therefore, increased dopamine levels in the postsynaptic milieu and an improvement in the motor symptoms in depressed patients with Parkinson disease (PD) should be observed. This study was designed to determine whether nefazodone has a dual activity as an antidepressant and as an agent capable of reducing the extrapyramidal symptoms in depressed parkinsonian patients. Depressed patients with PD were randomly assigned to 2 therapeutic groups: nefazodone or fluoxetine. Patients were evaluated by a psychiatrist and were blindly assessed by a neurologist with an array of scales. Patients on nefazodone (n = 9) showed a significant improvement over time in the total Unified Parkinson Disease Rating Scale score (UPDRS) (part II + part III) (P = 0.004) and in the UPDRS subscore part III (P = 0.003). None of these scores changed over time in the fluoxetine group (n = 7). Both, nefazodone and fluoxetine were equally effective as antidepressants: Beck Depression Inventory scores significantly improved (P < 0.001), with no significant differences between treatment groups (P = 0.97). If our results can be confirmed in a larger clinical trial, nefazodone ought to be considered over fluoxetine given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms in depressed PD patients.

Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry.

Objectives To assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h. Patients and methods Patients undergoing 48-h ABPM within the National ABPM Registry of the Spanish Society of Hypertension, based on 800 Spacelabs 90207 monitors distributed throughout Spain in hypertension units and primary healthcare centres, were included. Between June 2004 and September 2005, 611 valid 48-h ABPM recordings were obtained, 235 corresponded to patients without antihypertensive treatment. Results The percentages of patients classified as non-dipper for the first 24 h, the second 24 h and the 48-h average were 47, 50 and 48%, respectively. When the first and second 24-h periods were compared, 147 (24%) subjects switched from dipper (D) to non-dipper (ND) or vice-versa. When the first 24-h period was compared to the 48-h average, 66 (11%) subjects switched patterns. The proportions were similar separately for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and between treated and untreated patients. In subjects with poor ABPM reproducibility, night-to-day ratios were of an intermediate value between those of subjects always classified as D or ND. Conclusion Categorization of D or ND based on a single 24-h ABPM is moderately reproducible, since one out of every five patients change profile over the following 24 h. Nevertheless, the use of 48-h ABPM in clinical practice should be assessed according to cost-effectiveness criteria. Night-to-day ratios may be helpful in identifying patients with a stable profile.

Determinants of left ventricular mass in untreated mildly hypertensive subjects: hospitalet study in mild hypertension.

The objectives of this cross-sectional study were to identify the determinants of left ventricular mass in untreated mildly hypertensive subjects at the Hypertension Unit, Department of Internal Medicine, Red Cross Hospital, Hospitalet de Llobregat, Barcelona, Spain. One hundred seventy-one untreated mildly hypertensive subjects, with a mean age of 41.1+/-11.8 years (from 18 to 65 years) were sequentially visited in our Unit; 54% were men. Echocardiographic measurements of good quality were obtained in 142 subjects (83%). Two-dimensional guided M-mode echocardiograms were used and left ventricular mass was estimated according to the Penn convention. Left ventricular mass (LVM) was analyzed as a continuous variable. In the bivariate analysis, the variables that significantly correlated with LVM were patients height (r = 0.42, P<.0005), weight (r = 0.47, P< or =.0005), heart rate (r = -0.22, P = .01), HDLc (r = -0.30, P = .002), hematocrit (r = -0.28, P = .001), urinary sodium excretion (r = 0.23, P = 0.012), and different measurements from the ambulatory blood pressure profile for 24 h. By means of multiple regression analysis, a maximum of 41.2% of LVM variability could be explained from the factors registered in our study. The final model included age, gender, patients weight, and diastolic night load from ambulatory blood pressure monitoring. When added to different models, weight and diastolic night load showed a similar strength in predicting left ventricular mass. In untreated patients with mild hypertension, traditional factors such as blood pressure levels explain a maximum of 41.2% of LVM variability. More knowledge is needed about factors that may alter cardiac morphology in the evolution of hypertensive patients.

Estrés, enfermedad cardiovascular e hipertensión arterial

Estres y enfermedad cardiovascular Existe actualmente una amplia evidencia de que la aparicion de enfermedad cardiovascular en la poblacion general esta muy influida por factores psicosociales, los cuales pueden desempenar un papel tanto etiopatogenico como pronostico 1-3 . Aunque esta relacion podria explicarse por la interaccion de distintos factores dieteticos y diferencias en el estilo de vida, existe tambien alguna evidencia de que la exposicion al estres cronico podria tener alguna funcion. En estudios experimentales llevados a cabo en animales se ha observado que el estres psicosocial cronico podria conducir, a traves de una estimulacion del sistema nervioso autonomo, a una exacerbacion de la enfermedad coronaria, con disfuncion endotelial transitoria o incluso necrosis. Se definen como agentes estresantes aquellos estimulos externos o internos que provocan un incremento de la actividad fisiologica en algunos o en todos los individuos. En la bibliografia medica se han referido distintos factores estresantes como cambios en la vida, estres ocupacional, situaciones laborales de alta demanda y bajo control en la toma de decisiones, carencia de apoyo social y situaciones fisicas como temperaturas extremas o niveles elevados de ruido 4,5

Validating spongia, an expert system for sponge identification

Abstract In this article we present the validation of spongia , an expert system to help in the identification of marine sponges. Validation was performed by using data from 82 randomly selected literature descriptions of sponge species. The data gathered by spongia to identify each specimen were obtained from the bibliographical description. The set of cases, in which each case was described by the data gathered by spongia , was presented to five internationally recognised experts in sponge systematics. The identifications generated by spongia were compared with the identifications of these human experts by means of a cluster analysis. The similarity between spongia and human identifications was assessed using four measures: Euclidean distance, City-block distance, Mahalanobis distance and Kappa index. In this article we show that spongia obtains similar quality results to the experts in Porifera systematics.

Estratificación y grado de control del riesgo cardiovascular en la población hipertensa española. Resultados del estudio DICOPRESS

Fundamento y objetivo La hipertension arterial, junto con otros factores de riesgo, representa el principal determinante de enfermedades cardiovasculares. El proposito del presente estudio ha sido evaluar el riesgo cardiovascular en poblacion hipertensa espanola segun los criterios de la guia elaborada en 2003 por la Sociedad Europea de Hipertension y la Sociedad Europea de Cardiologia (ESH/ESC-2003), asi como describir el grado de control de los principales factores de riesgo cardiovasculares (FRCV). Pacientes y metodo Se ha realizado un estudio observacional y transversal en el que se incluyo a 22.639 pacientes con diagnostico de hipertension arterial esencial, procedentes de consultas de atencion primaria y unidades de hipertension de todo el territorio nacional. Resultados El FRCV asociado con mayor prevalencia fue la dislipemia (52,1%), seguido de diabetes (36,6%) y tabaquismo (22,3%). La estratificacion del riesgo cardiovascular segun la guia ESH/ESC-2003 mostro que mas del 70% de los pacientes presentaba un riesgo alto (36,9%) o muy alto (35,8%), mientras que en solo un 7,6% el riesgo era bajo. El factor de riesgo peor controlado entre la poblacion hipertensa analizada fue la presion arterial (un 80,6% de los pacientes). Otro factor de riesgo mal controlado en una parte importante de la poblacion analizada fue el colesterol total (66,4%). El predictor mas importante del mal control de la presion arterial fue la diabetes, con una odds ratio de 5,25 (intervalo de confianza del 99%, 4,57-6,06). Conclusiones La coexistencia de distintos FRCV, asi como la presencia de lesiones en organo diana y trastornos clinicos asociados en la poblacion hipertensa espanola, incrementa el riesgo vascular de la poblacion hipertensa, dificulta el control e indica la conveniencia de utilizar la guia ESH/ESC-2003 en la estimacion del riesgo cardiovascular.

Cardiac Damage in Hypertensive Patients with Inverse White Coat Hypertension. Hospitalet Study

Background: Few studies have assessed the relationship between ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH). Objectives: To determine the frequency of IWCH in untreated grade 1–2 hypertension and to assess possible differences in cardiac damage among patients with IWCH, white coat hypertension (WCH) and the rest of patients with grade 1–2 hypertension. Patients and Methods: Two hundred and eleven patients with grade 1–2 hypertension were sequentially included. A good quality 24-h ambulatory BP monitoring was obtained in 204 patients (age: 41 ± 12 years, 56% males). IWCH was defined as a daytime systolic and/or diastolic BP higher than diagnostic office systolic and/or diastolic BP, respectively. WCH was defined as a daytime BP < 135/85 mmHg. A good quality echocardiogram was obtained in 174 patients. We considered left ventricular hypertrophy a left ventricular mass index (LVMI) ≥ 125 g/m2. Results: We found IWCH in 29 subjects (14%), and WCH in 68 (33%). Office BP in patients with IWCH was in an intermediate position between WCH and the rest of grade 1–2 hypertension patients. The IWCH patients showed 24-h, daytime and night-time BP higher than the other groups. Left ventricular mass was significantly greater in patients with IWCH than in the other grade 1–2 hypertension patients after adjusting for age, gender, body mass index, smoking and office BP (regression coefficient 28.14, 95%CI: 7.36–48.91). Conclusion: IWCH is independently associated with higher values of left ventricular mass in patients with grade 1–2 hypertension.

Prevalencia de hipertensión arterial en ancianos ingresados en centros sociosanitarios y residencias españoles. Estudio Geriatric HTA

Fundamento y objetivo Los objetivos del estudio han sido estimar la prevalencia de hipertension arterial (HTA) en los ancianos institucionalizados en Espana y por comunidad autonoma, y describir el perfil del anciano hipertenso atendido en estos centros. Pacientes y metodo Se ha realizado un estudio transversal de prevalencia de HTA, de ambito estatal. Se incluyo a personas mayores de 65 anos institucionalizadas. Se excluyo a las ingresadas en unidades de cuidados paliativos. Se consideraron criterios de HTA para el estudio los siguientes: diagnostico de HTA en la historia clinica, tratamiento farmacologico antihipertensivo y valor mas alto de presion arterial en el ultimo ano de 140/90 mmHg o superior. Resultados Se incluyo a 13.272 pacientes de 223 centros, pertenecientes a las 17 comunidades autonomas y a la ciudad autonoma de Melilla, con una media (desviacion estandar) de edad de 82,9 (7,5) anos; el 70,6% eran mujeres. Cumplian al menos un criterio de HTA 8.242 pacientes (62,1%; intervalo de confianza del 95%, 61,3-62,9%). La HTA se asociaba a obesidad en el 26,3% de los casos, a diabetes en el 25,7% y a dislipemias en el 23,8%. La comorbilidad mas frecuente fue la demencia (37,1%), seguida de la insuficiencia vascular periferica (28,3%), el ictus (26,0%) y la insuficiencia cardiaca (25,1%). El 69,7% de los hipertensos (intervalo de confianza del 95%, 68,7-70,6%) recibia tratamiento farmacologico antihipertensivo. Los antihipertensivos mas utilizados eran los diureticos (46,3%) y los inhibidores de la enzima de conversion de la angiotensina (34,6%). La ultima determinacion de la presion arterial efectuada en el centro fue inferior a 140/90 mmHg en el 60,4% de los hipertensos. Conclusiones Los ancianos institucionalizados en nuestro entorno presentan una elevada prevalencia de HTA, con una comorbilidad notable y una proporcion de tratamiento farmacologico antihipertensivo similar a las publicadas en otros paises.

Agomelatine for Depression in Parkinson Disease: Additional Effect on Sleep and Motor Dysfunction.

AbstractDepression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.

Blood pressure in the initial phase of acute ischaemic stroke: Evolution and its role as an independent prognosis factor at discharge and after 3 months of follow‐up

Background. A prospective observational study was aimed at assessing the role of blood pressure (BP) during the first 24 h from stroke onset on the outcome of acute ischaemic stroke. Methods. Subjects admitted within the first 3 h from stroke onset were included. Stroke severity was evaluated with the Canadian Stroke Scale (CSS). Functional recovery was defined as a modified Rankin Scale score ⩽2. Results. One hundred subjects were included. In a logistic regression model, the independent predictors of poor functional recovery at discharge were: age (OR = 1.12; 95% CI 1.04–1.21; p = 0.0033), non‐lacunar stroke subtype (OR = 4.31; 95% CI 1.07–17.31; p = 0.0395), diabetes mellitus (OR = 8.38; 95% CI 1.67–41.95; p = 0.0097), a CSS score at admission ⩽8 (OR = 28.64; 95% CI 5.59–146.68; p<0.0001), an average systolic BP during the first 6 h ⩾180 mmHg (OR = 13.34; 95% CI 1.34–133.10; p = 0.0272) and a lower diastolic BP average from 6 to 24 h (OR for 5 mmHg increase: 0.57; CI 95% 0.36–0.88; p = 0.0115). Similar results were observed after 3 months of follow‐up. Conclusion. In ischaemic stroke patients, systolic BP over 180 mmHg in the first 6 h and a decrease of diastolic BP during the 6–24 h from stroke onset were independent predictors of a poor functional recovery.