Post stroke depression: clinics, etiopathogenesis and therapeutics

Background Stroke is a major cause of morbidity and mortality worldwide. Neuropsychiatric disorders are often associated with stroke and, among them, depression is the most prevalent. Post-stroke Depression (PSD) is related to disability, failure in returning to work, impairment in interpersonal functioning and mortality. Its etiopathogenesis is still uncertain, as well as its treatment. In Brazil, there are few data on the impact of PSD. Objective This work is dedicated to conduct a comprehensive review of the concept of PSD, its pathophysiology, morbidity and treatment. Methods PubMed, Medline and Lilacs searches of relevant terms yielded 3,265 papers in the last 10 years. We selected original studies and reviews that addressed the aspects mentioned above. Results We present the history of the notion of PSD and describe its epidemiology, looking to highlight Brazilian studies. Diagnostic criteria and clinical presentation were detailed, with emphasis on cognitive aspects. The four main pathophysiological theories proposed to PSD are presented and we discuss the various treatment strategies, involving psychopharmacologic options, brain stimulation techniques and psychotherapy. Discussion This work provides comprehensive information on PSD, of great utility for clinical practice and research in this topic

Plasma levels of procalcitonin and eight additional inflammatory molecules in febrile neutropenic patients

OBJECTIVE: This study aimed to examine the association between different inflammatory markers and specific clinical endpoints in patients with febrile neutropenia. METHOD: We prospectively evaluated the expression of procalcitonin (PCT), interleukin 8 (IL-8), induced protein-10, tumor necrosis factor alpha (TNF-a), two soluble TNF-a receptors (sTNF-R I and sTNF-R II), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1 alpha, and eotaxin in 37 episodes of febrile neutropenia occurring in 31 hospitalized adult onco-hematologic patients. Peripheral blood samples were collected in the morning at inclusion (day of fever onset) and on days 1, 3, and 7 after the onset of fever. Approximately 2-3 ml of plasma was obtained from each blood sample and stored at -80°C. RESULTS: The sTNF-R II level at inclusion (day 1), the PCT level on the day of fever onset, and the change (day 3 - day 1) in the IL-8 and eotaxin levels were significantly higher in patients who died during the 28-day follow-up. A requirement for early adjustment of antimicrobial treatment was associated with higher day 3 levels of IL-8, sTNF-R II, PCT, and MCP-1. CONCLUSION: Procalcitonin, sTNF-R II, IL-8, MCP-1, and eotaxin could potentially be used to assess the risk of death and the requirement for early adjustment of antimicrobial treatment in febrile, neutropenic onco-hematologic patients. The levels of the other markers showed no association with any of the evaluated endpoints

Feijoeiro em solo de cerrado submetido a doses de manganês e zinco via foliar

Em solos de cerrado tem sido cada vez mais freqüente o surgimento de casos de deficiência de micronutrientes em diversas culturas, incluindo o feijoeiro, com destaque para manganês (Mn) e zinco (Zn), o que é ocasionado pelas elevadas dosagens de corretivo utilizadas em aplicações de superfície e sem incorporação adequada. Este trabalho avaliou o efeito de doses de Mn e Zn via foliar em feijoeiros cultivados em solo de cerrado. Foram conduzidos três experimentos, sendo dois em casa de vegetação e um em campo. Os experimentos de casa de vegetação foram instalados seguindo o delineamento de blocos ao acaso, num esquema fatorial 5 x 5, com três repetições, envolvendo cinco doses de Mn (0, 75, 150, 300 e 600 g ha-1) e cinco doses de Zn (0, 50, 100, 200 e 400 g ha-1) aplicadas via foliar, aos 25 ou, alternativamente, ambas parceladas aos 25 e 35 dias após emergência (DAE), respectivamente, no primeiro e segundo experimento. No experimento de campo empregou-se o delineamento em blocos casualizados, com quatro repetições com os mesmos tratamentos usados em casa de vegetação. Duas aplicações foliares, efetuadas aos 25 e 35 DAE foram eficientes na correção dos sintomas de deficiência de Mn e Zn. A aplicação conjunta de Mn e Zn aumentou a altura de planta, os componentes primários de rendimento, o número de grãos por vagem, o número de vagens por planta e a produtividade "per se". A máxima eficiência técnica foi obtida com 315 g ha-1 de Mn e 280 g ha-1 de Zn, para uma produtividade de 2.275 kg ha-1 de grãos, correspondente a 60% acima da testemunha.The occurrence of micronutrient deficiencies, mainly of manganese (Mn) and zinc (Zn) in "cerrado" soils, has been increasing in several crops, including bean. Such a problem is caused by high rates of liming material applied entirely on the soil surface. In this study, the effects of the leaf application of Mn and Zn rates were evaluated. Three experiments were carried out: two in greenhouse and one under field conditions. The greenhouse experiments were set up using a randomized block design and a 5 x 5 factorial, with three replicates, consisting of five rates of Mn (0, 75, 150, 300, and 600 g ha-1) and five rates of Zn (0, 50, 100, 200, and 400 g ha-1) applied via leaves at the 25th day, or both alternatively parceled at 25 and 35 days after emergency (DAE), respectively, for the first and second experiments. In the field experiment, a randomized block design was used with four replicates, and the same treatments as those used in the greenhouse. Leaf applications performed at 25 and 35 DAE were efficient in correcting the symptoms of the Mn and Zn deficiencies. The combined application of Mn and Zn caused an increase in plant height, primary yield components as number of grains per pod, number of pods per plant, and productivity itself. The maximum technical efficiency was obtained with 315 g ha-1 Mn and 280 g ha-1 Zn for a bean productivity of 2.275 kg ha-1, corresponding to 60% above control

Phenytoin-Induced Gingival Overgrowth: A Review of the Molecular, Immune, and Inflammatory Features

Gingival overgrowth (GO) is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressant, and calcium channel blockers. GO is characterized by the accumulation of extracellular matrix in gingival connective tissues, particularly collagenous components, with varying degrees of inflammation. One of the main drugs associated with GO is the antiepileptic phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. Nevertheless, the pathogenesis of such drug-induced GO remains fulfilled by some contradictory findings. This paper aims to present the most relevant studies regarding the molecular, immune, and inflammatory aspects of phenytoin-induced gingival overgrowth

Neurobiologia da síndrome de Tourette: a hipótese auto-imune pós-estreptocócica

BACKGROUND: Tourette's syndrome (TS) is characterized by the presence of motor tics and at least one phonic tic. Some clinical similarities with Sydenham's chorea (SC) lead to the hypothesis of a new group of disorders associated with an autoimmune process due to a streptococcal infection (PANDAS). Objective: To review the literature in search of evidence on the existence of post-streptococcal autoimmune mechanisms involved with the etiopathogenesis of TS. METHODS: A systematic review with the terms "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" and "rheumatic" was carried on using the MedLine. RESULTS: The search found 238 articles. Fifty and three articles were selected which also had their references reviewed. The results of studies that investigated autoimmune aspects of TS, including anti-streptococcal and anti-basal ganglia anti-bodies, and immune-based therapy, were presented and discussed. DISCUSSION: The evidences to date are not satisfactory regarding a post-streptococcal auto-immune process in ST. The improvement on investigative methods and sample selection might contribute to this question.CONTEXTO: A síndrome de Tourette (ST) caracteriza-se pela presença de tiques motores e pelo menos um tique fônico. Algumas semelhanças clínicas com a coréia reumática ou de Sydenham (CS) incentivaram a formulação da hipótese da existência de um grupo de transtornos neuropsiquiátricos associados a processo auto-imune decorrente de infecção estreptocócica (PANDAS). OBJETIVO: Revisar a literatura quanto às evidências em relação à hipótese de que mecanismos auto-imunes pós-estreptocócicos estão envolvidos na etiopatogênese da ST. MÉTODOS: Revisão sistemática na base de dados MedLine com os termos "Tourette", "tic", "PANDAS", "antibodies", "streptococcal" e "rheumatic". RESULTADOS: Retornaram 238 artigos da busca. Selecionaram-se 53 trabalhos, os quais tiveram suas referências bibliográficas também revisadas. São apresentados os resultados de estudos que avaliaram aspectos imunes na ST, incluindo anticorpos antiestreptocócicos e antinúcleos da base, e sua terapêutica imunebaseada, discutindo a validade do conceito de PANDAS. CONCLUSÕES: As evidências ainda não são satisfatórias no que tange a uma base auto-imune pós-estreptocócica para a ST. Um aprimoramento dos métodos investigativos e na seleção das amostras pode trazer maiores contribuições à questão

Schizoaffective disorder and Parkinsons disease: a possible comorbidity?

The development of Parkinsons disease (PD) is rarely reported in psychotic patients. The diagnostic complexity, especially the possibility that motor symptoms could be secondary to antipsychotics, makes difficult the recognition of the comorbidity. We report on a case of 62-year-old woman with schizoaffective disorder who developed PD. This case report emphasizes the possibility of the diagnosis of both conditions on the same patient.O desenvolvimento de doença de Parkinson (DP) em pacientes psicóticos é raramente relatado na literatura. A complexidade diagnóstica, especialmente a possibilidade de os sintomas motores serem decorrentes do uso de antipsicóticos, dificulta a identificação da comorbidade. Descrevemos o caso de uma mulher de 62 anos, portadora de transtorno esquizoafetivo desde os 30 anos, que desenvolve DP. Esse relato ressalta a possibilidade de diagnóstico das duas condições

Evaluation of skin temperature, reactive C protein, and hemosedimentation speed variation in uncomplicated primary knee total arthroplasty

OBJECTIVE: To study the variation of skin temperature values (deltaT) on operative site, of reactive C protein (RCP) and of hemosedimentation speed (HSS) in patients submitted to primary knee total arthroplasty (KTA), in an attempt to establish a correlation among its curves over time. MATERIALS AND METHODS: This prospective clinical study evaluated 29 patients followed up during 12 weeks, with measurements of skin temperature in both knees and RCP and HSS serum dosages. RESULTS: After comparing the variables tested (deltaT, RCP and HSS), no statistical correlation was observed for both the Pearson s test (parametric test) and the Spearman s test (non-parametric test) among variables. Skin temperature variation follows a different pattern from that observed both for RCP and for HSS, with no correlation among curves. A standard curve was established for the three variables, and a statistically significant reduction was seen in RCP and HSS values from pre- to post-operative period. CONCLUSION: No correlation was observed between skin temperature and HSS and RCP levels in patients submitted to uncomplicated primary KTA.OBJETIVO: Estudar a variação dos valores da temperatura cutânea (deltaT) do sítio operatório, da proteína C reativa (PCR) e da velocidade de hemossedimentação (VHS) em pacientes submetidos a artroplastia total do joelho (ATJ) primária, tentando estabelecer correlação entre suas curvas ao longo do tempo. MATERIAL E MÉTODOS: Esse estudo clínico prospectivo, avaliou 29 pacientes acompanhados por 12 semanas, sendo aferida a temperatura cutânea em ambos os joelhos e realizada dosagem sérica da PCR e VHS. RESULTADOS: Após a comparação entre as variáveis testadas (deltaT, PCR e VHS), observou-se tanto para o teste de Pearson (avaliação paramétrica), quanto para o de Spearman (avaliação não-paramétrica) que não houve correlação estatística entre elas. A variação da temperatura cutânea segue um padrão diferente do observado tanto para a PCR quanto para a VHS, não existindo correlação entre as curvas. Foi estabelecida a curva padrão das três variáveis, verificando-se redução estatisticamente significativa nos valores da PCR e da VHS entre o pré e o pós-operatório. CONCLUSÃO: Não foi observada correlação entre a temperatura cutânea e os níveis de VHS e PCR em pacientes submetidos a ATJ primária, isenta de complicações.UNIFESPUFMG Faculdade de Medicina Departamento do Aparelho locomotorUFMG Serviço de Ortopedia do HCUNIFESPSciEL

The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

OBJECTIVES: During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection. METHODS: The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs. RESULTS: Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1b were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients. CONCLUSION: Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes

Frequência dos tipos de cefaleia no centro de atendimento terciário do Hospital das Clínicas da Universidade Federal de Minas Gerais

ResumoObjetivoAvaliar a frequência dos diferentes diagnósticos de cefaleias do Ambulatório de Cefaleias do Hospital das Clínicas da Universidade Federal de Minas Gerais (AmbCef-UFMG).MétodosEstudo transversal e descritivo com 289 pacientes atendidos consecutivamente no AmbCef-UFMG. O diagnóstico da cefaleia baseou-se nos critérios da Classificação Internacional das Cefaleias (ICDH-2004).ResultadosA idade média dos pacientes foi 42,6 anos, sendo a maioria do sexo feminino (86,9%) e com menos de nove anos de escolaridade. As cefaleias primárias foram as mais comuns, sendo a migrânea encontrada em 79,8% dos casos e a cefaleia do tipo tensional (CTT), em 20,4%. Entre as secundárias, o tipo mais comum foi a cefaleia por uso excessivo de analgésicos (16,6%), seguido de casos menos comuns como a hipertensão intracraniana idiopática. A cefaleia crônica diária (CCD) esteve presente em 31,8% dos casos.ConclusãoEste estudo confirma dados da literatura que mostram a migrânea como a cefaleia mais comum em centros terciários. O número expressivo de casos de CCD e de uso excessivo de analgésicos indica que, desde o nível primário de atenção, os pacientes deveriam ser orientados a evitar o uso abusivo de medicação sintomática.SummaryObjectiveTo assess the frequency of different diagnoses of headaches in the Headache Outpatient Clinic of the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AmbCef-UFMG).MethodsCross sectional study with 289 patients consecutively attended to at AmbCef-UFMG. Headaches were diagnosed based on the criteria established by the International Classification of Headache Disorders (ICDH-2004).ResultsThe average age of patients was 42.6 years, mostly women (86.9%) with less than nine years of education. Primary headaches were the most common type, with migraine found in 79.8% of cases, and tension-type headache (TTH) in 20.4%. Among the secondary types, the most common was headache caused by overuse of analgesics (16.6%), followed by less common types, such as idiopathic intracranial hypertension. Chronic daily headache (CDH) was found in 31.8% of cases.ConclusionThis study confirms literature data showing migraine as the most common headache in tertiary care centers. The expressive number of cases of CDH and headaches caused by overuse of analgesics indicates that, starting at the primary care level, patients should be advised to avoid the abuse of symptomatic drugs