Rafael Henriques Candiago

Cognitive impairment in a Brazilian sample of patients with bipolar disorder

OBJECTIVE Persistent neurocognitive deficits have been described in bipolar mood disorder. As far as we are aware, no study have examined whether the cognitive impairment is presented in the same way in a Brazilian sample. METHOD Cognitive function of 66 patients with bipolar disorder (32 with depressive symptoms and 34 euthymic) and 28 healthy subjects was examined using a complete cognitive battery. RESULTS Patients with bipolar disorder presented a significantly poorer performance in eight of the 12 subtests when compared to healthy subjects. There was no significant difference between the subgroups of patients. These patients showed impairment in both verbal and non-verbal cognitive function. CONCLUSION Cognitive impairment was found in both groups of patients with bipolar disorder. The findings described here suggest an overall impairment of cognitive function, independent of mood symptoms. This is in line with data showing that cognitive deficits may be a persistent characteristic of bipolar disorder.

Does serum ferritin correlate with coronary angiography findings

BACKGROUND A number of epidemiological studies have described a positive relationship between serum ferritin levels and coronary heart disease. In this prospective study, we evaluated the association between serum ferritin levels and the angiographic extent of coronary atherosclerosis. METHOD We studied 307 consecutive patients (60.9% male, age 60.1+/-11.0 years) referred for diagnostic coronary angiography. Risk factors for coronary artery disease, lipids and ferritin levels, as well clinical characteristics were recorded from all patients. Two experienced cardiologists blinded for clinical and laboratory data reviewed the cinefilms. Angiographic significant coronary artery disease (CAD) was defined as any more than a 50% diameter stenosis. RESULTS From the 307 patients, 196 (63.8%) were found to have angiographic significant CAD. The presence of significant CAD was associated with ferritin levels (P=0.015) as well as patient age (P<0.001), male sex (P<0.001), smoking (P<0.002), and cholesterol levels (P=0.028). By multivariate analysis, however, ferritin level was not an independent risk factor for CAD (P=0.27), while the association with all the other factors remained significant. CONCLUSION In patients referred for coronary angiography no independent relationship was found between angiographic significant coronary artery disease and serum ferritin levels.

Uso do Datasus para avaliação dos padrões das internações psiquiátricas, Rio Grande do Sul

OBJECTIVE To describe the construction and testing of a routine to assess psychiatric hospitalizations in the Brazilian Health System based on its database (DATASUS), and to assess characteristics and trends of these hospitalizations. METHODS Data were extracted from hospital admission authorizations in the state of Rio Grande do Sul, Southern Brazil, from 2000 to 2004. Data from 91,233 admissions were processed through a routine (syntaxes) using SPSS program and their reliability was tested. Hospitalization rates in general and psychiatric hospitals and main diagnoses were described, and trends were analyzed using polynomial regression models. RESULTS Intra and inter-rater reliabilities were 100%. There was seen a trend of increasing hospitalization rates due to mood disorders and decreasing rates due to schizophrenia and organic disorders. Hospitalization rates due to substance use disorders remained stable. There was an increasing trend in the number of psychiatric hospitalizations in general hospitals with a 97.7% growth in the period studied. CONCLUSIONS Routines proved to be reliable and feasible, suggesting the use of data from Hospital Information System database as a source of information for continuous evaluation of psychiatric hospitalizations in Brazilian Health System. Psychiatric hospitalization rates may have changed due to changes in the type of patients; diagnostic patterns, known as treatment-oriented diagnostic bias; and legislation.

Avanços no diagnóstico do transtorno do humor bipolar

1. INTRODUCAONa ultima decada assistimos a modifica-coes na abordagem diagnostica do Transtornode Humor Bipolar. Inspirados em ideias da Gre-cia antiga e de Emile Kraepelin, muitos autoresvem propondo a expansao do conceito de bipo-laridade para alem dos criterios atualmente va-lidos.Visando a abordar as formas atuais de pen-sar o Transtorno do Humor Bipolar (THB), reali-zamos uma revisao bibliografica, buscando osseguintes aspectos: a) aspectos historicos doTHB, b) a nocao de Espectro Bipolar, c) osconceitos de Depressao Atipica (DeA) e Disfo-ria Histeroide, d) os Estados Mistos, e) a rela-cao entre THB e os Transtornos de Ansiedade,f)a relacao com o diagnostico de Transtorno dePersonalidade Borderline (TPB), g) contrapon-to ao conceito de espectro bipolar.2. ASPECTOS HISTORICOS DOTRANSTORNO DO HUMOR BIPOLARLoucura, melancolia, mania, furia divina,possessao, bruxaria, tristeza, demencia, psico-se, depressao. Ate chegarmos no Transtornodo Humor Bipolar, um grande caminho foi per-corrido, que iniciou na Grecia e Roma junta-mente com a historia da nossa civilizacao. Des-crever o seu trajeto e descrever a historia dahumanidade.Os primeiros escritos sobre a existencia damelancolia datam da civilizacao greco-romanae sao descritas em personagens biblicos comoo rei Saul, no antigo testamento, e mitologicos,como na Iliada, de Homero.Saul, rei de Israel, um homem bravo, alto,forte e um valente guerreiro, luta contra os filis-teus de maneira corajosa, mas em um dadomomento, uma tristeza e um tormento tomamconta de sua vida. Nao tem mais certeza de suaforca e bravura, pensamentos de morte e trage-dia passam a tomar conta dos seus dias, seusservos, preocupados, chamam a Davi, que ti-nha fama de tocar harpa e acalmar os estadosde espirito; entao, o atormentado rei se acalma.

A falácia da adequação da cobertura dos Centros de Atenção Psicossocial no estado do Rio Grande do Sul

Introduction: Analysis of the results of the ongoing expansion of the Brazilian public mental health care network has used the indicator of coverage offered by Psychosocial Care Centers (Centros de Atencao Psicossocial, CAPS), which considers the rate of one CAPS per 100,000 inhabitants to be adequate, as its outcome measure. The state of Rio Grande do Sul ranks third in nationwide CAPS coverage standings, with 0.7 centers per 100,000 inhabitants. The present study sought to assess the variability of coverage in different regions in order to verify the representativeness of the overall coverage rate. Method: We used data collected from the National Database of Health Facilities (Cadastro Nacional de Estabelecimentos de Saude, CNES) and 2009 population data made available at the website of the Ministry of Health Department of Information Technology. We calculated 19 coverage indicators, one for each health region, and computed a coverage rate based on the ratio between the actual indicator and the expected indicator according to the population of each region. Results: Analysis of the variability of coverage for each region showed that seven regions had inadequate coverage, with 49% of the state population receiving inadequate coverage. Conclusion: This study showed that the use of an overall rate for mental health care coverage can be considered a fallacy, as it fails to represent regional realities; roughly half of the regions with excessive coverage masked the regions with poor coverage. This finding suggests that analysis of care coverage must be broken down into geographic areas, in order to identify regional needs and provide support for equal expansion of the community mental health care network for users living in different geographic areas.

Lack of a relationship between serum ferritin levels and coronary atherosclerosis evaluated by coronary arteriography

Many clinical and epidemiological studies have demonstrated the relationship between serum ferritin and ischemic heart disease. In the present study we evaluated the relationship between coronary heart disease (CHD) and serum ferritin levels in patients submitted to coronary arteriography. We evaluated 307 patients (210 (68.7%) males; median age: 60 years) who were submitted to coronary angiography, measurement of serum ferritin and identification of clinical events of ischemic heart disease. Serum ferritin is reported as quartiles. Ninety-six patients (31.27%) had normal coronary angiography (group 1) and 211 (68.73%) had coronary heart disease (group 2). Of the patients with CHD, 61 (28.9%) had serum ferritin levels higher than 194 ng/ml (4th quartile), as opposed to only 14 (14.58%) of those without CHD (P = 0.0067). In the 2nd quartile, 39 patients (18.48%) had CHD, while 35 patients (36.46%) had normal coronary arteries (P = 0.00064). Multivariate analysis of the data showed that the difference between groups was not statistically significant (P = 0.33). We conclude that there is no independent relationship between coronary heart disease and increased levels of serum ferritin.

Comparação da aterosclerose coronária em pacientes com infarto do miocárdio e angina do peito

Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.

Are apolipoproteins A and B better than lipoproteins for assessing risk of obstructive coronary heart disease

OBJECTIVE To evaluate whether apolipoproteins A-I (Apo A-I) and B (Apo B) have, higher ensitivity (SN), specificity (SP) and positive predictive value (PPV) than lipoproteins (LP), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), and triglycerides (TGL) in assessing the risk of coronary heart disease (CHD). METHODS This is a transversal case-control study of 241 patients, who were divided into two groups: 1) 145 patients with CHD, and 2) 96 patients without coronary disease. A model of logistic regression to evaluate the relation between the LPs and CHD was developed in which variables with a p-alpha < 0.1 were included. RESULTS Apo A-I levels were higher in the patients without CHD, (OR 2.08, CI 1.20-3.57). There were no statistical differences between the values of Apo A-I and the remaining lipid fractions (Apo A-I: 67%; Apo B: 100%; PPV: TC = 71%; TGC = 71%; HDL = 71%; LDL = 71%). The costs of the tests in Reais were as follows: Apo A-I: R

Comparative study for the identification of myocardial ischemia by contrast ventriculography under the effect of isosorbide mononitrate and by perfusional myocardial scintigraphy in patients with ischemic heart disease

56.60; Apo B-100: R

2-Hydroxybutyrate and 4-hydroxybutyrate inhibit CO2 formation from labeled substrates by rat cerebral cortex.

56.60; TC: R