Differential effects of acute diazepam on emotional and neutral memory tasks in acutely hospitalized depressed patients

With the hypothesis that depression affects memory through a mechanism other than that of the benzodiazepines, the present study evaluated the acute effect of diazepam 10 mg upon explicit memory in patients with major depression. A double-blind, placebo (starch 50 mg) controlled experiment was carried out with 19 patients randomly divided into diazepam (n = 10) and placebo (n = 9) groups. They were evaluated by the Mini-Mental State Examination, and tests were conducted for immediate and delayed (short-term) memory with emotionally toned stimuli (negative, positive, neutral), recognition, and semantic memory in visual or auditory modality. The Visual Analog Mood scale (VAMS) was applied to measure anxiety and mood changes after the administration of drugs (30 minutes and 6 hours). Higher scores in the positively toned list among patients who received diazepam were observed, at the 30-minute compared with the 6-hour evaluation. The recall index of positive words in the diazepam group was positive and significantly different from the index of the placebo group. No anterograde amnesia following diazepam was observed. The neural model of a dysfunction of limbic prefrontal cortical structures that impairs the modulation of the amygdala in major depression may explain the present results. Consequently, the action of diazepam on the amygdala, which has been proposed to be the basis of its anxiolytic action, might be altered, modifying the modulation of memory in our patients

Nutritional status and food habits of users in a psychosocial care center in Porto Alegre, Brazil

Introdução: O Centro de Atenção Psicossocial (CAPS) trabalha com o desenvolvimento de autonomia e responsabilização do usuário no seu tratamento. Levantamentos epidemiológicos mostraram que há relação entre Índice de Massa Corporal (IMC) e transtornos psiquiátricos, sendo a obesidade um desafio para usuários e trabalhadores da saúde mental. Sendo assim, o objetivo deste estudo é avaliar o estado nutricional e os hábitos alimentares de usuários de um CAPS em Porto Alegre, Brasil. Métodos: Estudo transversal desenvolvido com 40 usuários. O estado nutricional foi avaliado pela classificação do IMC e circunferência da cintura, e os hábitos alimentares foram avaliados com um questionário publicado no Guia Alimentar da População Brasileira e um questionário com perguntas referentes ao tipo de transtorno mental, comorbidades e estilo de vida. A análise foi descritiva em frequência e percentuais. Resultados: A patologia mais frequente foi a esquizofrenia (65,9%). A obesidade apresentou maior prevalência (45%) e a circunferência da cintura apresentou valores acima do recomendado. Foi verificada grande alteração nos hábitos alimentares dos usuários. De acordo com o questionário proposto, 85,4% dos usuários precisam melhorar a alimentação, pois foi observado baixo consumo de frutas, verduras e legumes e grande consumo de açúcares, gorduras e produtos industrializados. Conclusão: Grande parte dos pacientes psiquiátricos apresentou excesso de peso e valor de circunferência da cintura elevado, além de hábitos alimentares pouco saudáveis, importantes fatores de risco para doenças crônicas.Introduction: The Psychosocial Care Center (PSCC) works towards developing the user’s autonomy and accountability in the treatment. Epidemiological surveys have shown that there is a correlation between Body Mass Index (BMI) and psychiatric disorders, and obesity in particular poses a challenge for users and mental health workers. Thus, the objective of the study is to assess the nutritional status and dietary habits of the users of a PSCC from Porto Alegre, Brazil. Methods: Cross-sectional study carried out with 40 users. Nutritional assessment was performed according to the classification of BMI and waist circumference. For the evaluation of eating habits, we used a questionnaire published on the Food Guide of the Brazilian Population as well as questions regarding the type of mental disorder, comorbidity, and lifestyle. The analysis was descriptive of frequency and percentages. Results: The most frequent pathology was schizophrenia (65.9%). Obesity was more prevalent (45%) and waist circumference showed values above the recommended. A major change was seen in the dietary habits of users. According to the proposed questionnaire, 85.4% of users need to improve their eating habits since we observed low consumption of fruits and vegetables, and high intake of sugars, fats, and processed products. Conclusion: The majority of psychiatric patients presented with excess weight and high values of waist circumference, as well as poor dietary habits, which are all major risk factors for chronic diseases

Associação da educação com a ocorrência de delirium em pacientes de um serviço de emergência

Background: Delirium is a neuropsychiatric syndrome with multiple etiological factors. Evaluation of delirium in different settings, especially the Emergency Department (ED) pertaining to different regions of the world with patients from different cultural and educational backgrounds is needed. Objective: To determine the prevalence of delirium and its association with education in an ED in Brazil during a 6-month period. Methods: Patients aged >18 years were randomly selected from ED admissions. The instruments Confusion Assessment Method (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM) and Charlson comorbidity score were applied to evaluate delirium, cognitive status, and comorbidities. Results: The prevalence of delirium was10.7%. Delirium patients had significantly lower education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting episodic memory impairment. Patients with delirium had more history of neurological disorders. Three logistic regression models evaluating the association of variables with delirium were developed. Age and MMSE were retained in the first model, WLM scores in the second, and education in the third. Conclusion: To the best of our knowledge, this is the first study estimating the prevalence of delirium in a Brazilian ED. Lower education was associated with the occurrence of delirium.Introdução: Delirium é uma síndrome neuropsiquiátrica, com fatores etiológicos múltiplos. A avaliação de delirium em diferentes ambientes, especialmente no Serviço de Emergência (SE) de diferentes regiões do mundo e com diferentes características culturais e educacionais é necessária. Objetivo: Determinar a prevalência de delirium e associação com educação em um SE no Brasil, durante seis meses. Métodos: Foram randomizados aleatoriamente no SE os pacientes com idade acima de 18 anos. Escala Confusion Assessment Method (CAM), Mini Exame do Estado Mental (MEEM), o teste de Memória Lógica de Wechsler (MLW), e o escore de comorbidade de Charlson foram aplicados para avaliar delirium, status cognitivo, e comorbidades. Resultados: A prevalência de delirium foi 10,7%. Os pacientes com delirium apresentaram significativamente menor escolaridade, escores mais baixos no MEEM e MLW (imediato e tardio), sendo que 97,4% apresentava comprometimento de memória episódica. Pacientes com delirium apresentaram mais história de transtorno neurológico prévio. Três modelos de regressão logística para delirium foram realizados. No primeiro, idade e MEEM foram mantidos no modelo final. No segundo, MLW imediato e tardio; e no terceiro, apenas educação. Conclusão: Este é o primeiro estudo brasileiro, de acordo com nosso melhor conhecimento, a estimar a prevalência de delirium em serviço de emergência. Nível educacional mais baixo foi associado com ocorrência de delirium

La Educación Bimodal y su efectividad en el Proceso de Enseñanza y Aprendizaje en Enfermería Básica II: Una mirada desde la experiencia de los estudiantes

The nursing process is a substantial and useful tool for students to provide nursing care in a logical, continuous, and systematic manner. This research tries to describe the experiences of students during the teaching and learning of Basic Nursing II, in another context it refers to the transcendence between the traditional and the future where compatible and inclusive strategies are used, which are supported by information technologies. and Communication in Bimodal Education. It is a qualitative, descriptive and exploratory study, with second semester nursing students from the State University of the South of Manabí, who are part of the Innovative Bimodal Teaching Research Project for the development of competencies in university students, with a population of 83 students. For the collection of information, a structured satisfaction survey was applied using a Google form, keeping rigorous ethical and methodological characteristics. Concluding that there are three large categories that frame the experience of students during teaching and learning: Weaknesses in the teaching-learning of the Nursing Process, Student experiences in the application of the Nursing Process in clinical practice, and Importance of the Nursing Process and its usefulness to students.El proceso de enfermería es una herramienta sustancial y útil para que lo estudiantes brinden cuidados de enfermería de una manera lógica, continua y sistemática. Esta investigacion, intenta describir las experiencias de los estudiantes durante la enseñanza y aprendizaje de Enfermeria Básica II, en otro contexto refiere a la trascendencia entre lo tradicional y futuro donde se emplean estrategias compatibles e incluyentes, que se apoyan en las tecnologías de la información y comunicación en la Educación Bimodal. Es un estudio cualitativo, descriptivo y exploratorio, con estudiantes de enfermería de segundo semestre de la Universidad Estatal del Sur de Manabí, que forman parte del Proyecto de Investigacion Enseñanza bimodal innovadora para el desarrollo de competencias en estudiantes universitarios, con una población de 83 estudiantes, para la recolección de la información se aplicó una encuesta estructurada de satisfacción mediante formulario google, guardando características éticas y metodológicas de rigor. Concluyendo que, existen tres grandes categorías enmarcan la experiencia de los estudiantes durante la enseñanza y aprendizaje: Debilidades en la enseñanza-aprendizaje del Proceso Enfermero, Vivencias de los estudiantes en la aplicación del Proceso Enfermero en la práctica clínica, e Importancia del Proceso Enfermero y su utilidad para los estudiantes

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PNEN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 +/- 6.72 Kcal/kg/day) and protein (1.01 +/- 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 +/- 0.43 vs 1.17 +/- 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18-0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91-0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81-0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943

Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?

Background & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for >= 72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for <= 14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were reported. Results: We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following char-acteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 +/- 3.3 vs 8.4 +/- 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 +/- 2.1 vs 5.2 +/- 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism

Incretins in patients with rheumatoid arthritis

Background: The precise mechanism linking systemic inflammation with insulin resistance (IR) in rheumatoid arthritis (RA) remains elusive. In the present study, we determined whether the incretin-insulin axis and incretin effect are disrupted in patients with RA and if they are related to the IR found in these patients. Methods: We conducted a cross-sectional study that encompassed 361 subjects without diabetes, 151 patients with RA, and 210 sex-matched control subjects. Insulin, C-peptide, glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP), dipeptidyl peptidase 4 (DPP-4) soluble form, and IR indexes by homeostatic model assessment (HOMA2) were assessed. A multivariable analysis adjusted for IR-related factors was performed. Additionally, ten patients and ten control subjects underwent a 566-kcal meal test so that we could further study the postprandial differences of these molecules between patients and control subjects. Results: Insulin, C-peptide, and HOMA2-IR indexes were higher in patients than in control subjects. This was also the case for GLP-1 (0.49 ± 1.28 vs. 0.71 ± 0.22 ng/ml, p = 0.000) and GIP (0.37 ± 0.40 vs. 1.78 ± 0.51 ng/ml, p = 0.000). These differences remained significant after multivariable adjustment including glucocorticoid intake. Disease Activity Score in 28 joints with erythrocyte sedimentation rate (? coefficient 46, 95% CI 6?87, p = 0.026) and Clinical Disease Activity Index (? coefficient 7.74, 95% CI 1.29?14.20, p = 0.019) were associated with DPP-4 serum levels. GLP-1 positively correlated with ?-cell function (HOMA2 of ?-cell production calculated with C-peptide) in patients but not in control subjects (interaction p = 0.003). The meal test in patients with RA revealed a higher total and late response AUC for glucose response, a later maximal response of C-peptide, and a flatter curve in GIP response. Conclusions: The incretin-insulin axis, both during fasting and postprandial, is impaired in patients with RA.This work was supported by grants from the Spanish Ministry of Health, Subdirección General de Evaluación y Fomento de la Investigación, Plan Estatal de Investigación Científica y Técnica y de Innovación 2013–2016 Instituto de Salud Carlos III [ISCIII] PI14/00394) and by the Fondo Europeo de Desarrollo Regional (FEDER) (to IFA). The research of MAGG was supported by European Union FEDER funds and by the “Fondo de Investigación Sanitaria” (grants PI06/0024, PS09/00748, PI12/00060, and PI15/00525) of the Instituto de Salud Carlos III (ISCIII; Spanish Health Ministry). The research of MAGG was also partially supported by RETICS Programs RD12/0009 (RIER) and RD12/0009/0013 from the ISCIII (Spanish Health Ministry)

Factors associated with the need of parenteral nutrition in critically ill patients after the initiation of enteral nutrition therapy

Background and aimsDespite enteral nutrition (EN) is the preferred route of nutrition in patients with critical illness, EN is not always able to provide optimal nutrient provision and parenteral nutrition (PN) is needed. This is strongly associated with gastrointestinal (GI) complications, a feature of gastrointestinal dysfunction and disease severity. The aim of the present study was to investigate factors associated with the need of PN after start of EN, together with the use and complications associated with EN.MethodsAdult patients admitted to 38 Spanish intensive care units (ICUs) between April and July 2018, who needed EN therapy were included in a prospective observational study. The characteristics of EN-treated patients and those who required PN after start EN were analyzed (i.e., clinical, laboratory and scores).ResultsOf a total of 443 patients, 43 (9.7%) received PN. One-third (29.3%) of patients presented GI complications, which were more frequent among those needing PN (26% vs. 60%, p = 0.001). No differences regarding mean energy and protein delivery were found between patients treated only with EN (n = 400) and those needing supplementary or total PN (n = 43). Abnormalities in lipid profile, blood proteins, and inflammatory markers, such as C-Reactive Protein, were shown in those patients needing PN. Sequential Organ Failure Assessment (SOFA) on ICU admission (Hazard ratio [HR]:1.161, 95% confidence interval [CI]:1.053–1.281, p = 0.003) and modified Nutrition Risk in Critically Ill (mNUTRIC) score (HR:1.311, 95% CI:1.098–1.565, p = 0.003) were higher among those who needed PN. In the multivariate analysis, higher SOFA score (HR:1.221, 95% CI:1.057–1.410, p = 0.007) and higher triglyceride levels on ICU admission (HR:1.004, 95% CI:1.001–1.007, p = 0.003) were associated with an increased risk for the need of PN, whereas higher albumin levels on ICU admission (HR:0.424, 95% CI:0.210–0.687, p = 0.016) was associated with lower need of PN.ConclusionA higher SOFA and nutrition-related laboratory parameters on ICU admission may be associated with the need of PN after starting EN therapy. This may be related with a higher occurrence of GI complications, a feature of GI dysfunction.Clinical trial registrationClinicalTrials.gov: NCT03634943