27 research outputs found
Association of depressive disorders, depression characteristics and antidepressant medication with inflammation
Growing evidence suggests that immune dysregulation may be involved in depressive disorders, but the exact nature of this association is still unknown and may be restricted to specific subgroups. This study examines the association between depressive disorders, depression characteristics and antidepressant medication with inflammation in a large cohort of controls and depressed persons, taking possible sex differences and important confounding factors into account. Persons (18â65 years) with a current (N=1132) or remitted (N=789) depressive disorder according to DSM-IV criteria and healthy controls (N=494) were selected from the Netherlands Study of Depression and Anxiety. Assessments included clinical characteristics (severity, duration and age of onset), use of antidepressant medication and inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α)). After adjustment for sociodemographics, currently depressed men, but not women, had higher levels of CRP (1.33 versus 0.92âmgâlâ1, P<0.001, Cohen's d=0.32) and IL-6 (0.88 versus 0.72âpgâmlâ1, P=0.01, Cohen's d=0.23) than non-depressed peers. Associations reduced after considering lifestyle and disease indicators â especially body mass index â but remained significant for CRP. After full adjustment, highest inflammation levels were found in depressed men with an older age of depression onset (CRP, TNF-α). Furthermore, inflammation was increased in men using serotoninânorepinephrine reuptake inhibitors (CRP, IL-6) and in men and women using tri- or tetracyclic antidepressants (CRP), but decreased among men using selective serotonin reuptake inhibitors (IL-6). In conclusion, elevated inflammation was confirmed in depressed men, especially those with a late-onset depression. Specific antidepressants may differ in their effects on inflammation
ESCAP Expert Paper: New developments in the diagnosis and treatment of adolescent anorexia nervosaâa European perspective
Tratamento cirĂșrgico de pneumonia necrosante: anĂĄlise de quatro casos Surgical treatment of necrotizing pneumonia: analysis of four cases
A pneumonia necrosante Ă© uma patologia grave que surge como complicação rara de pneumonia lobar. Quatro crianças na faixa etĂĄria entre dez e 28 meses foram hospitalizadas com pneumonia bacteriana aguda, evoluindo com toxemia, derrame pleural e insuficiĂȘncia respiratĂłria, respondendo insatisfatoriamente a antibioticoterapia e drenagem pleural. Todos os pacientes foram submetidos a tratamento cirĂșrgico para descorticação pulmonar e ressecção de tecido pulmonar necrosado. ComplicaçÔes como fĂstulas broncopleurais ocorreram em dois pacientes, havendo Ăłbito em um dos casos. Os autores concluem que a ressecção pulmonar de emergĂȘncia Ă© indicada quando a necrose pulmonar Ă© diagnosticada em pacientes septicĂȘmicos ou com fĂstula broncopleural de alto dĂ©bito, visando a melhora do prognĂłstico dessas crianças, mesmo cientes de que o Ăndice de morbimortalidade nesses casos Ă© alto.<br>Necrotizing pneumonia is a serious complication of lobar pneumonia. Four children aged between ten months and three years were admitted with acute bacteremic pneumonia and developed sepsis, pleural effusion, and respiratory distress despite adequate antibiotic treatment and chest tube drainage. Decortication and pulmonary resection were performed in all of them. The observed complications were bronchopleural fistula and one death. The emergency pulmonary resection is indicated when pulmonary necrosis is associated to sepsis and massive bronchopleural fistula. In such circumstances, morbidity and mortality are higher than in other conditions