RESUMEN
Catechol-O-methyltransferase (COMT) inactivates catecholamines, Val/Val genotype was associated to an increased amygdala (Amy) response to negative stimuli and can influence the symptoms severity and the outcome of bipolar disorder, probably mediated by the COMT polymorphism (rs4680) interaction between cortical and subcortical dopaminergic neurotransmission. The aim of this study is to explore how rs4680 and implicit emotional processing of negative emotional stimuli could interact in affecting the Amy connectivity in bipolar depression. Forty-five BD patients (34 Met carriers vs. 11 Val/Val) underwent fMRI scanning during implicit processing of fearful and angry faces. We explore the effect of rs4680 on the strength of functional connectivity from the amygdalae to whole brain. Val/Val and Met carriers significantly differed for the connectivity between Amy and dorsolateral prefrontal cortex (DLPFC) and supramarginal gyrus. Val/Val patients showed a significant positive connectivity for all of these areas, where Met carriers presented a significant negative one for the connection between DLPFC and Amy. Our findings reveal a COMT genotype-dependent difference in corticolimbic connectivity during affective regulation, possibly identifying a neurobiological underpinning of clinical and prognostic outcome of BD. Specifically, a worse antidepressant recovery and clinical outcome previously detected in Val/Val patients could be associated to a specific increased sensitivity to negative emotional stimuli.
Asunto(s)
Amígdala del Cerebelo , Trastorno Bipolar , Catecol O-Metiltransferasa/genética , Emociones/fisiología , Corteza Prefrontal , Adulto , Amígdala del Cerebelo/diagnóstico por imagen , Amígdala del Cerebelo/metabolismo , Trastorno Bipolar/genética , Trastorno Bipolar/psicología , Mapeo Encefálico/métodos , Conectoma/métodos , Femenino , Neuroimagen Funcional/métodos , Humanos , Masculino , Persona de Mediana Edad , Polimorfismo Genético , Corteza Prefrontal/diagnóstico por imagen , Corteza Prefrontal/metabolismo , Escalas de Valoración PsiquiátricaRESUMEN
BACKGROUND: Low back pain is a leading cause of disability in Brazil. The multiple aspects of disability in these patients require comprehensive tools for their assessment. The International Classification of Functioning, Disability, and Health (ICF) core set for low back pain is designed to comprehensively describe the experience of such patients with their functioning. AIM: This study aimed to describe functioning and contextual factors and to empirically validate the ICF core set for low back pain. DESIGN: Cross sectional study. SETTING: Three outpatient clinics in Manaus, Maceio and São Paulo, Brazil. Population. 135 low back pain outpatients under rehabilitation. METHODS: Data concerning diagnosis, personal features, and the 78 ICF core set categories for low back pain were collected from clinical charts, physical examinations, tests, and interviews with patients from rehabilitation services in three parts of Brazil. RESULTS: 7.7% of the categories (6 body functions and 10 activity and participation) were affected in less than 20% of the sample, and were thus considered not validated. Pain and other sensations related to the musculoskeletal system were the body most frequently impaired functions. Mobility and domestic life were the chapters of activity and limitation most often described as limited. All environmental factors were qualified as either facilitators or barriers and acted as modulators of disability. CONCLUSION: The comprehensive ICF core sets for low back pain can be used to describe the living experience of such individuals, although efforts to make it operational and enhance the reproducibility of the results are needed to warrant its reliable routine use. CLINICAL REHABILITATION IMPACT: This study highlights the importance of a complete assessment of chronic low back pain and demonstrate the need for multidisciplinary approach.
Asunto(s)
Evaluación de la Discapacidad , Personas con Discapacidad/rehabilitación , Exposición a Riesgos Ambientales , Indicadores de Salud , Dolor de la Región Lumbar/rehabilitación , Encuestas y Cuestionarios , Actividades Cotidianas , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Dolor de la Región Lumbar/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los ResultadosRESUMEN
The authors investigated the use of slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the unaffected hemisphere to decrease interhemispheric inhibition of the lesioned hemisphere and improve motor function in patients within 12 months of a stroke. Patients showed a significant decrease in simple and choice reaction time and improved performance of the Purdue Pegboard test with their affected hand after rTMS of the motor cortex in the intact hemisphere as compared with sham rTMS.
Asunto(s)
Corteza Motora/fisiología , Paresia/terapia , Accidente Cerebrovascular/terapia , Estimulación Magnética Transcraneal/métodos , Adulto , Anciano , Femenino , Lateralidad Funcional/fisiología , Mano/inervación , Mano/fisiología , Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Destreza Motora/fisiología , Inhibición Neural/fisiología , Vías Nerviosas/fisiología , Vías Nerviosas/fisiopatología , Paresia/etiología , Paresia/fisiopatología , Tractos Piramidales/fisiología , Tractos Piramidales/fisiopatología , Tiempo de Reacción/fisiología , Recuperación de la Función/fisiología , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Estimulación Magnética Transcraneal/normas , Resultado del TratamientoRESUMEN
Avaliar a concordância de informaçöes pesquisadas sobre causa básica de óbito por acidente de trânsito e compará-las com as condiçöes feitas a partir das Declaraçöes de Obitos. Foram estudados 50 óbitos por acidentes de trânsito ocorridos em 5 hospitais de Belo Horizonte, MG. Com base nas informaçöes obtidas através de questionário procedeu-se `a codificaçäo da causa básica dos óbitos. A seguir foi feita análise de concordância entre esta classificaçäo e a registrada na Declaraçäo do Obito. Foi calculado o Kappa (0,124) com intervalo de confiança 95 por cento (-0,1533-0,4022), sendo considerada uma baixa concordância. Os dados mostraram também uma subclassificaçäo de óbitos por acidentes de trânsito, uma vez que 32 por cento dos 50 óbtos estudados foram codificados como acidentes näo especificados (E928.9). Concluiu-se pela necessidade de haver maior esforço na melhoria do preenchimento da Declaraçäo de Obito pelos médicos legistas que realizam as necrópsias em mortes por acidentes de trânsito.