Stress-induced Perioperative Depressive Symptoms

Sustained stress has been correlated with increases in cortisol levels and decreased levels of brain transmitters including serotonin or dopamine. As a result of better understanding of human pathophysiology and pain physiology, the fields of surgery and anesthesia have seen major advances in the last years.However, a high percentage of patients develop depressive symptoms following major surgery and pathogenic perspective is very complex and require an holistic approach

Egalitate de șanse în domeniul medical academic și de cercetare: de la perspectiva carierei la realitățile politico-economice (Equality of opportunity in the academic and research medical field from the perrspective of the career to the political and economical realities)

The issues involved in medical research and the objectives to be drawn and to promote medium and long term achievements of women researchers are presented with applications in the working methods, centers and institutions promoting and financing resources. Women researchers in medical and related fields managed to organize institutions, foundations and websites specialized in fundraising and building networks of research or presenting the results of medical research. According to the National Science Foundation in 2013, although women obtain the PhD qualification in proportions higher increasingly in various areas (ranging up to 50% of the proportion of PhDs in biosciences and medicine) leadership position is less well represented (in US in the biosciences, 22% of professor positions are held by women teacher and approximately 30% got leadership positions in faculties or departments). Access to financial resources is a key issue for the development of academic medical research. Many statistics published in medical or economy journals indicated that fewer women have published personal research and annual funding level was lower than that achieved by men working in the same research environments. This paper present an analysis of the current representation of women in academic and scientific research, and some models currently available at European and global level, in order to be more promoted in scientific research, according to political and economic realities. The issues are presented emerging from the particularities of the medical field that blends clinical care with education and advanced research

Salivary Cortisol Fluctuations and Hyperglicemic Stress in Patients with Abdominal Obesity

Objectives We investigated a possible relationship between the onset of hyperglycaemia in prediabetes and the perturbations of hypothalamo-pituitary-adrenocortical axis. Material and methods The study included 20 patients, younger than 65 years (52.15 ± 4.55), having risk factors for diabetes mellitus like abdominal obesity or positive family history. All patients underwent oral glucose tolerance test (OGTT) and 4 concomitant determinations of salivary cortisol levels, in basal condition, at wakening, and at 1, 2, and respectively 3 hours after oral administration of 75 grams of glucose. Results The evolution of salivary cortisol levels in the morning showed that, concomitant with the peak of hyperglycaemia at the third moment of determination (221.75 ± 39.3 mg/dl) it was registered a mild tendency of increasing of salivary cortisol, at the same time (5.26 ± 2.76 mg/ml). Conclusion The simple method of salivary cortisol measurement could become a useful tool for the HPA axis functionality screening

Observations about the Principal Components Analysis and Data Clustering Techniques in the Study of Medical Data

Abstract—The medical data statistical analysis often requires the using of some special techniques, because of the particularities of these data. The principal components analysis and the data clustering are two statistical methods for data mining very useful in the medical field, the first one as a method to decrease the number of studied parameters, and the second one as a method to analyze the connections between diagnosis and the data about the patient’s condition. In this paper we investigate the implications obtained from a specific data analysis technique: the data clustering preceded by a selection of the most relevant parameters, made using the principal components analysis. Our assumption was that, using the principal components analysis before data clustering- in order to select and to classify only the most relevant parameters – the accuracy of clustering is improved, but the practical results showed the opposite fact: the clustering accuracy decreases, with a percentage approximately equal with the percentage of information loss reported by the principal components analysis. Keywords—Data clustering, medical data, principal components analysis. I

Comorbidity and Health Condition – the Necessity for Integrated Care

Comorbidity has become a global health problem, a phenomenon which equally affects developing and developed countries. Comorbidity is associated with an increase of morbidity, mortality, has a strong impact on economy and is multidimensional in the frame of mental health and beyond. Management of comorbidity requires an integrated approach; community related and also focused on person, who takes into account medical, psychiatric and contextual factors

Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study

ABSTRACT INTRODUCTION: The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients. OBJECTIVE: The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C). METHODS: Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities. RESULTS AND CONCLUSION: The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients

Obstructing Sleep Apnea in Children with Genetic Disorders—A Special Need for Early Multidisciplinary Diagnosis and Treatment

Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO2 nadir, end-tidal CO2, and transcutaneous CO2. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life