RESUMO

OBJECTIVE: The aim of this study was to evaluate the role of obstructive sleep apnea (OSA) treatment on heart remodeling and diastolic dysfunction in patients with metabolic syndrome (MS). METHODS: This study is a prespecified analysis of a randomized placebo-controlled trial that enrolled patients with a recent diagnosis of MS and moderate-to-severe OSA to undergo continuous positive airway pressure (CPAP) or nasal dilators (placebo) for 6 months. Patients were invited to perform a transthoracic echocardiogram by a single investigator blinded to treatment assignment. RESULTS: A total of 99 (79% men; mean [SD], age: 48 [9] years; BMI: 33 [4] kg/m2 ) completed the study. At follow-up, in the placebo group, patients had a significant increase in atrial diameter: from 39.5 (37.0-43.0) mm to 40.5 (39.0-44.8) mm (p = 0.003). CPAP prevented atrial enlargement: from 40.0 (38.0-44.0) to 40.0 (39.0-45.0) mm (p = 0.194). In patients with diastolic dysfunction at baseline, almost half had diastolic dysfunction reversibility with CPAP (in comparison with only two patients in the placebo group, p = 0.039). In the regression analysis, the chance of diastolic dysfunction reversibility by CPAP was 6.8-fold (95% CI: 1.48-50.26, p = 0.025) compared with placebo. CONCLUSIONS: In patients with MS and OSA, 6 months of CPAP therapy prevented atrial remodeling and increased the chance of diastolic dysfunction reversibility.

Assuntos

Fibrilação Atrial , Remodelamento Atrial , Síndrome Metabólica , Apneia Obstrutiva do Sono , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Pressão Positiva Contínua nas Vias Aéreas , Síndrome Metabólica/complicações , Síndrome Metabólica/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia

RESUMO

Non-invasive measures are preferred when assessing animal welfare. Differences in behavioral and physiological responses toward a stressor could be the result of the selection of horses for specific uses. Behavioral and physiological responses of working and Chilean rodeo horses subjected to a handling test were assessed. Five behaviors, number of attempts, and the time to cross a bridge were video recorded and analyzed with the Observer XT software. Heart rate (HR) and heart rate variability (HRV), to assess the physiological response to the novel stimulus, were registered with a Polar Equine V800 heart rate monitor system during rest and the bridge test. Heart rate variability data were obtained with the Kubios software. Differences between working and Chilean rodeo horses were assessed, and within-group differences between rest and the test were also analyzed. Chilean rodeo horses presented more proactive behaviors and required significantly more attempts to cross the bridge than working horses. Physiologically, Chilean rodeo horses presented lower variability of the heart rate than working horses.

RESUMO

Objective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

Assuntos

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtorno Bipolar/psicologia , Escalas de Graduação Psiquiátrica , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Brasil/epidemiologia , Comorbidade , Métodos Epidemiológicos , Idade de Início , Hospitalização , Antidepressivos/uso terapêutico

RESUMO

OBJECTIVE:: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. METHODS:: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. RESULTS:: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. CONCLUSION:: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

Assuntos

Transtorno Bipolar/psicologia , Adulto , Idade de Início , Antidepressivos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/fisiopatologia , Brasil/epidemiologia , Comorbidade , Métodos Epidemiológicos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos

RESUMO

UNLABELLED: de Macedo-Soares MB, Brietzke E, da Silva Dias R, Mendonca T, Moreira C, Lafer B. A comparison of the symptomatic profile between two consecutive depressive episodes in patients with bipolar disorder type I. OBJECTIVE: To compare the variability of patterns of depressive symptoms between two consecutive depressive episodes in patients with bipolar disorder type I. METHODS: Review of prospectively collected data from 136 subjects of an out-patient bipolar unit from 1997 to 2007. Binomial statistics was used for the analysis of Hamilton Depression Rating Scale (HDRS)-31 items of the first and second episodes, and the correlation of the HDRS-31 item scores of both episodes was determined using the Spearman coefficient. RESULTS: Ten depressive symptoms showed a significant correlation between index and subsequent episodes: psychological anxiety, somatic anxiety, somatic symptoms, diurnal variation, paranoid symptoms, obsessive and compulsive symptoms, hypersomnia, loss of appetite and helplessness. Only four symptoms were stable in both statistical tests: paranoid symptoms, obsessive-compulsive symptoms, loss of appetite and hypersomnia. CONCLUSIONS: Paranoid and obsessive-compulsive symptoms, loss of appetite and hypersomnia tended to be found in successive episodes. However, the moderate correlations of the symptoms across two depressive recurrences suggested that clinical presentations in bipolar depression may not be predicted by symptom profiles presented in previous episodes.