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INTRODUCTION: Mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) is a surgically remediable epilepsy with a relatively high prevalence and psychiatric comorbidities. Depressive disorders may occur in up to 25% of MTLE-HS patients suggesting a common molecular mechanism underlying both conditions. OBJECTIVE: To compare the gene expression comprising serotonin 5HT1A and 5HT2A, noradrenaline (NA) ADRA1A, and ADRA2A receptors in the hippocampus of MTLE-HS patients with and without major depression. METHODS: A cross-sectional study allocated 31 patients in three groups: MTLE-HS without psychiatric diagnosis (MTLE-HS group), MTLE-HS with major depression (MTLE-HS-D group) and a control group consisting of healthy volunteers without any neurological or psychiatric disorders. Demographic and clinical characteristics were compared among groups. Gene expression of receptors were analyzed using general linear mixed models (GLMM), with an unstructured matrix, normal link. RESULTS: The three groups showed a similar distribution regarding age, gender (pâ¯>â¯0.16), history of initial precipitating injury, family history of epilepsy, monthly frequency of seizures, side of hippocampal sclerosis, interictal spike distribution and anti-seizure medications did not differ between MTLE-HS and MTLE-HS-D groups (pâ¯>â¯0.05). We observed a greater expression of the 5HT1A receptor in the control group when compared to the MTLE-HS (Pâ¯=â¯.004) and MTLE-HS-D (Pâ¯=â¯.007). Nevertheless, we did not observe any difference when MTLE-HS and MTLE-HS-D groups were compared to the controls for the ADRA1A (Pâ¯=â¯.931; Pâ¯=â¯.931), ADRA2A (Pâ¯=â¯.120; Pâ¯=â¯.121) and 5HT2A (Pâ¯=â¯.638; Pâ¯=â¯.318, respectively) gene expression. CONCLUSION: Mesial temporal lobe epilepsy related to hippocampal sclerosis and MTLE-HS-D patients showed a lowered expression of the 5HT1A receptors when compared with the controls adjusted for age and schooling. Data suggest that temporal lobe epilepsy plasticity may affect serotonin receptors, which may lead to more frequent cases of major depression in this population. More studies comprising wider samples are necessary to confirm these results; they also should investigate serotonin reuptake drugs as an adjuvant therapeutic option for MTLE-HS disorder.
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Epilepsia do Lobo Temporal , Epilepsia , Estudos Transversais , Epilepsia/metabolismo , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/epidemiologia , Epilepsia do Lobo Temporal/genética , Hipocampo/patologia , Humanos , Imageamento por Ressonância Magnética , Esclerose/patologia , Serotonina/metabolismo , Lobo Temporal/metabolismoRESUMO
We demonstrate that the rate of extracellular signal-related kinase phosphorylation (P-ERK1,2/Total-ERK1,2) in the amygdala is negatively and independently associated with anxiety symptoms in 23 consecutive patients with drug-resistant mesial temporal lobe epilepsy that was surgically treated. In naive Wistar rats, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala correlates negatively with innate anxiety-related behavior on the elevated plus maze (n = 20) but positively with expression of defensive-learned behavior (i.e., freezing) on Pavlovian aversive (fear) conditioning (n = 29). The microinfusion of ERK1/2 inhibitor (FR180204, n = 8-13/group) or MEK inhibitor (U0126, n = 8-9/group) into the basolateral amygdala did not affect anxiety-related behavior but impaired the evocation (anticipation) of conditioned-defensive behavior (n = 9-11/group). In conclusion, the P-ERK1,2/Total-ERK1,2 ratio in the amygdala predicts anxiety in humans and the innate anxiety- and conditioned freezing behaviors in rats. However, the ERK1/2 in the basolateral AMY is only required for the expression of defensive-learned behavior. These results support a dissociate ERK-dependent mechanism in the amygdala between innate anxiety-like responses and the anticipation of learned-defensive behavior. These findings have implications for understanding highly prevalent psychiatric disorders related to the defensive circuit manifested by anxiety and fear. HIGHLIGHTS: The P-ERK1,2/Total-ERK1,2 ratio in the amygdala (AMY) correlates negatively with anxiety symptoms in patients with mesial temporal lobe epilepsy. The P-ERK1,2/Total-ERK1,2 in the amygdala correlates negatively with the anxiety-like behavior and positively with freezing-learned behavior in naive rats. ERK1,2 in the basolateral amygdala is required for learned-defensive but not for the anxiety-like behavior expression in rats.
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Tonsila do Cerebelo , Ansiedade , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Tonsila do Cerebelo/metabolismo , Animais , Ansiedade/metabolismo , Humanos , Proteína Quinase 1 Ativada por Mitógeno/antagonistas & inibidores , Proteína Quinase 3 Ativada por Mitógeno/antagonistas & inibidores , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , Fosforilação , Ratos , Ratos WistarRESUMO
OBJECTIVES: To identify variables independently associated with a meaningful improvement in QOL long after surgical treatment of drug-resistant MTLE-HS patients. MATERIAL & METHODS: We prospectively evaluated 72 consecutive MTLE-HS surgically treated patients and analyzed pre and post-surgical variables independently associated with a meaningful improvement in QOL evaluated by the Quality of Life in Epilepsy-31 (QOLIE-31) overall score, and its domain scores determined at follow-up after 36 to 131 months (mean 93 months) after surgery. RESULTS: The mean overall QOLIE-31 score and its subdomain scores improved significantly after surgery (p < 0.01), and 55 patients (76.4%) had a meaningful QOL improvement. Being seizure-free (Engel IA) after surgery showed a non-significant association (OR 2.63, CI 95% 0.53 to 13.05, p = 0.23) and lower depressive symptoms a significant association (OR 4.15, CI 95% 1.19 to 14.53, p = 0.03) with meaningful improvement of QOL. CONCLUSIONS: Patients with MTLE-HS who underwent epilepsy surgery show a sustained, meaningful improvement in their QOL. Pre-surgical variables do not predict long-term QOL improvement after surgery. Lower levels of depressive symptoms at postoperative evaluation are associated with meaningful QOL improvement.
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Epilepsia do Lobo Temporal/cirurgia , Qualidade de Vida , Resultado do Tratamento , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , TempoRESUMO
Interictal dysphoric disorder (IDD) is a poorly understood psychiatric disorder of epilepsy patients. Interictal dysphoric disorder is characterized by depressive, somatoform, and affective symptoms observed in up to 5.9% of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). This study aimed to evaluate the association between ictal fear (IF) and the psychiatric symptoms and diagnosis in MTLE-HS patients. We included 116 (54.3% male) consecutive adult patients (36⯱â¯11â¯years) with MTLE-HS. Anxiety and depression symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS) and the psychiatric diagnosis were according to Fourth Edition of the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV). The independent association between the occurrence of IF aura and the psychiatric diagnosis was determined by binary regression. When compared to those with other auras or without aura, patients reporting IF have higher HADS anxiety, but not HADS depression, scores. Ictal fear was independently associated with the diagnosis of interictal dysphoric disorder (OR, IC 95%â¯=â¯7.6, 1.3-43.2, pâ¯=â¯0.02), but not with the diagnosis of anxiety (OR, CI 95%â¯=â¯0.72, 0.08-6.0, pâ¯=â¯0.73), depression (OR, CI 95%â¯=â¯0.94, 0.19-4.8, pâ¯=â¯0.94) or psychotic disorders (pâ¯=â¯0.99). Only patients with drug-resistant MTLE-HS were included and the small number of cases with DD diagnosis in the sample. In MTLE-HS patients, the occurrence of IF is associated with higher levels of anxiety symptoms and IDD. The results provide insights about fear-related neural network connections with anxiety symptoms and the IDD in MTLE-HS.
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Epilepsia Resistente a Medicamentos , Epilepsia do Lobo Temporal , Preparações Farmacêuticas , Adulto , Ansiedade/etiologia , Epilepsia Resistente a Medicamentos/complicações , Epilepsia Resistente a Medicamentos/patologia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/patologia , Medo , Feminino , Hipocampo/patologia , Humanos , Masculino , Esclerose/patologiaRESUMO
OBJECTIVE: The objective of the study was to investigate the independent association between clinical, demographic, psychiatric, radiologic, electrophysiological, and pharmacologic variables and cognitive performance of Brazilian patients with pharmacoresistant mesial temporal lobe epilepsy (MTLE). METHODS: Ninety-three patients with pharmacoresistant MTLE related to hippocampal sclerosis (HS) were included in the study. Multiple linear regressions were done to identify predictor variables for 24 cognitive tests. Independent variables analyzed were sex, hand dominance, age, years of education, marital status, work activity, history for an initial precipitant injury (IPI), family history of epilepsy, lesion side, antiseizure medication (ASM) treatment type, ASM serum levels, benzodiazepine (BDZ) treatment, age at epilepsy onset, disease duration, monthly frequency of seizures, and Hospital Anxiety and Depression Scale (HADS) scores. RESULTS: Years of education was an independent and positive predictor in 22 of the 24 cognitive tests evaluated. Male sex was also a positive predictor of one cognitive test. Variables negatively associated with cognitive performance were left side lesion (10 tests), disease duration (5 tests), polytherapy (3 tests), ASM serum levels (3 tests), and BDZ treatment or not working (1 test each). The regression model explained between 6% and 44% of the cognitive test scores variation. SIGNIFICANCE: In Brazilian patients with pharmacoresistant MTLE-HS, up to 44% of cognitive test scores variation is predictable by clinical, demographic, psychiatric, radiologic, electrophysiology, and pharmacological variables. The identification of predictors of cognitive performance may be helpful for better planning of patient care.
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Epilepsia do Lobo Temporal , Brasil , Cognição , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/tratamento farmacológico , Epilepsia do Lobo Temporal/patologia , Hipocampo/patologia , Humanos , Masculino , Esclerose/patologiaRESUMO
PURPOSE: The purpose of this study was to investigate the following: i) the objective impairment in neuropsychological tests that were associated with the subjective perception of cognitive function decline in Brazilian patients who underwent mesial temporal lobe epilepsy (MTLE) surgery and ii) the predictive variables for those impaired objective neuropsychological tests. METHODS: Forty-eight adults with MTLE (27 right HS and 23 male) were divided according to their perception of changes (Decline or No-decline) of cognitive function domain of the QOLIE-31 questionnaire applied before and 1year after the ATL. The mean (SD) of changes in the raw score difference of the neuropsychological tests before and after the ATL was compared between Decline and No-decline groups. Receiver Operating Characteristic curves, sensitivity, specificity, and predictive values were used to assess the optimum cutoff points of neuropsychological test score changes to predict patient-reported subjective cognitive decline. KEY FINDINGS: Six (12.5%) patients reported a perception of cognitive function decline after ATL. Among the 25 cognitive tests analyzed, only changes in the Boston Naming Test (BNT) were associated with subjective cognitive decline reported by patients. A reduction of ≥8 points in the raw score of BNT after surgery had 91% of sensitivity and 45% specificity for predicting subjective perception of cognitive function decline by the patient. Left side surgery and age older than 40years were more associated with an important BNT reduction with overall accuracy of 91.7%, 95% predictive ability for no impairment, and 75% for impairment of cognitive function. SIGNIFICANCE: Impairment in word-finding seems to be the objective cognitive finding most relevant to Brazilian patients after mesial temporal lobe epilepsy surgery. Similar to American patients, the side of surgery and age are good predictors for no decline in the BNT, but shows a lower accuracy to predict its decline. If replicated in other populations, the results may have wider implications for the surgical management of patients with drug-resistant MTLE.
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Cognição/fisiologia , Disfunção Cognitiva/etiologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Complicações Pós-Operatórias , Adulto , Atenção/fisiologia , Brasil , Epilepsia Resistente a Medicamentos/cirurgia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Destreza Motora/fisiologia , Testes Neuropsicológicos , Qualidade de Vida , Percepção Espacial/fisiologia , Lobo Temporal/fisiopatologia , Percepção Visual/fisiologiaAssuntos
Epilepsia Resistente a Medicamentos/enzimologia , Epilepsia do Lobo Temporal/enzimologia , Sistema Límbico/enzimologia , Transtornos Mentais/enzimologia , Mitocôndrias/enzimologia , Complexos Multienzimáticos/metabolismo , Adulto , Epilepsia Resistente a Medicamentos/patologia , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/patologia , Epilepsia do Lobo Temporal/psicologia , Epilepsia do Lobo Temporal/cirurgia , Feminino , Humanos , Sistema Límbico/patologia , Sistema Límbico/cirurgia , Masculino , Transtornos Mentais/complicações , Neocórtex/enzimologia , Neocórtex/cirurgia , Dados Preliminares , Estudos Prospectivos , Esclerose/enzimologia , Esclerose/patologia , Esclerose/psicologia , Esclerose/cirurgia , Lobo Temporal/enzimologia , Lobo Temporal/cirurgiaRESUMO
OBJECTIVES: To investigate prospectively the independent predictors of a minimum clinically important change (MCIC) in quality of life (QOL) after anterior temporal lobectomy (ATL) for drug-resistant mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) in Brazilian patients. METHODS: Multiple binary logistic regression analysis was performed to identify the clinical, demographic, radiologic, and electrophysiologic variables independently associated with MCIC in the Quality of Life in Epilepsy-31 Inventory (QOLIE-31) overall score 1 year after ATL in 77 consecutive patients with unilateral MTLE-HS. RESULTS: The overall QOLIE-31 score and all its subscale scores increased significantly (p < 0.0001) 1 year after ATL. In the final logistic regression model, absence of presurgical diagnosis of depression (adjusted odds ratio [OR] 4.4, 95% confidence interval [CI] 1.1-16.1, p = 0.02) and a complete postoperative seizure control (adjusted OR 4.1, 95% CI 1.2-14.5, p = 0.03) were independently associated with improvement equal to or greater than the MCIC in QOL after ATL. The overall model accuracy for MCIC improvement in the QOL was 85.6%, with a 95.2% of sensitivity and 46.7% of specificity. SIGNIFICANCE: These results in Brazilian patients reinforce the external validation of previous findings in Canadian patients showing that presurgical depression and complete seizure control after surgery are independent predictors for meaningful improvement in QOL after ATL, and have implications for the surgical management of MTLE patients.
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Lobectomia Temporal Anterior/psicologia , Epilepsia Resistente a Medicamentos/psicologia , Epilepsia Resistente a Medicamentos/cirurgia , Epilepsia do Lobo Temporal/psicologia , Epilepsia do Lobo Temporal/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida/psicologia , Adulto , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia do Lobo Temporal/diagnóstico , Feminino , Seguimentos , Hipocampo/patologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Psicometria , Esclerose , Adulto JovemRESUMO
In this work, a comprehensive study was performed for the evaluation of ultrasound (US) frequency for demulsification of crude oil emulsions. Experiments were performed using ultrasonic baths operating at the following frequencies: 25, 35, 45, 130, 582, 862 and 1146kHz. Synthetic water-in-oil emulsions with 12%, 35% and 50% of water and medians of droplet size distribution (DSD, D(0.5)) of 5, 10 and 25µm were prepared using a heavy crude oil (API density of 19). Crude oil demulsification was achieved at frequencies in the range of 25-45kHz for all tested emulsions. When frequencies higher than 45kHz were applied, no changes in the characteristics of the crude oil emulsions were observed. Demulsification efficiencies of about 65% were achieved at a frequency of 45kHz after 15min of US application (emulsions with original water content of 50% and D(0.5)=10µm). An important aspect is that no addition of chemical demulsifiers was performed, and the demulsification efficiency was considered high, taking into account that the results were obtained using a non-conventional crude oil. Contrary to the normal application of low-frequency US that has been used for emulsification, the proposed approach seems to be a promising technology for water removal from crude oil emulsions.
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Deep brain stimulation (DBS) benefits Parkinson's disease (PD) patient's quality of life specially in domains as mobility, activities of daily living (ADL) and bodily discomfort (BD), but little is known about the variables associated with these HRQOL domains in patients presenting for DBS. The objective is to evaluate variables associated with of HRQOL in a Brazilian sample of PD patients presenting for DBS treatment, specifically in the domains related with motor symptoms. In a cross-sectional study of 59 PD patients evaluated at outpatient Unit for Movement Disorders, multiple linear regression analysis was performed to identify independent variables associated with mobility, ADL and BD domains of the 39-item Parkinson's disease questionnaire (PDQ-39). UPDRS III "on" scores, duration of the disease, age, presence of comorbidities and anxiety and depressive symptoms quantified by hospital anxiety and depression scale (HADS), were the independent variables. In our results, HADS scores were independently associated to mobility domain: ß coefficient 1.36 (95 % CI 0.55-2.15) and BD domain: ß coefficient 1.57 (95 % CI 0.67-2.48). UPDRS III "on" scores were independently associated to mobility domain: 0.42 (95 % CI 0.03-0.81). The model of each multiple linear regression analysis explains 25 % of the mobility domain variability (p < 0.01) and 24 % of the BD domain variability (p < 0.01). Psychiatric symptoms were at least as relevant to quality of life as motor symptoms in PD patients presenting for DBS treatment. The effect of treating these psychiatric symptoms on patients' HRQOL deserves further investigation.
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Atividades Cotidianas , Doença de Parkinson/fisiopatologia , Qualidade de Vida , Idoso , Brasil , Estudos Transversais , Estimulação Encefálica Profunda , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/psicologiaRESUMO
This study aimed to assess subjective and objective sleep parameters in a homogeneous group of drug-resistant mesial temporal lobe epilepsy (MTLE) patients through internationally validated clinical questionnaires, video-electroencephalographic (VEEG) and polysomnographic (PSG) studies. Fifty-six patients with definite diagnosis of MTLE who were candidates for epilepsy surgery underwent a detailed clinical history, the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS), neurological examination, 1.5 T brain magnetic resonance imaging, VEEG and PSG. Sixteen percent of patients reported significant daytime sleepiness as measured by ESS and 27% reported low levels of sleep quality as measured by PSQI. Patients with medically resistant epilepsy by MTLE showed increased wakefulness after sleep onset (WASO) with mean ± standard deviation of 17.4 ± 15.6, longer non-rapid eye movement (NREM) 1 (7.5 ± 4.6%) and NREM3 sleep (26.6 ± 11.8%), abnormal rapid eye movement (REM) latency in 30/56 patients, shorter REM sleep (16.7 ± 6.6%), and abnormal alpha delta patterns were observed in 41/56 patients. The analysis of interictal epileptic discharges (IEDs) evidenced highest spiking rate during NREM3 sleep and higher concordance with imaging data when IEDs were recorded in sleep, mainly during REM sleep. We concluded that patients with MTLE showed disrupted sleep architecture that may result in daytime dysfunction and sleep complaints. Furthermore, NREM sleep activated focal IEDs and them - when recorded during sleep - had higher localizing value.
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INTRODUCTION: Health-related quality of life (HRQOL) assessment tools have been broadly used in the medical context. These tools are used to measure the subjective impact of the disease on patients. The objective of this study was to evaluate the variables associated with HRQOL in a Brazilian sample of patients followed up in a tertiary outpatient clinic for depression and anxiety disorders. METHOD: Cross-sectional study. Independent variables were those included in a sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) scores. Dependent variables were those included in the short version of the World Health Organization Quality of Life (WHOQOL-BREF) and the scores for its subdomains (overall quality of life and general health, physical health, psychological health, social relationships, and environment). A multiple linear regression analysis was used to find the variables independently associated with each outcome. RESULTS: Seventy-five adult patients were evaluated. After multiple linear regression analysis, the HADS scores were associated with all outcomes, except social relationships (p = 0.08). Female gender was associated with poor total scores, as well as psychological health and environment. Unemployment was associated with poor physical health. CONCLUSION: Identifying the factors associated with HRQOL and recognizing that depression and anxiety are major factors are essential to improve the care of patients.
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Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Qualidade de Vida , Adulto , Instituições de Assistência Ambulatorial , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Pacientes Ambulatoriais/psicologia , Escalas de Graduação Psiquiátrica , Fatores Sexuais , Fatores Socioeconômicos , Centros de Atenção TerciáriaRESUMO
Introduction: Health-related quality of life (HRQOL) assessment tools have been broadly used in the medical context. These tools are used to measure the subjective impact of the disease on patients. The objective of this study was to evaluate the variables associated with HRQOL in a Brazilian sample of patients followed up in a tertiary outpatient clinic for depression and anxiety disorders. Method: Cross-sectional study. Independent variables were those included in a sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) scores. Dependent variables were those included in the short version of the World Health Organization Quality of Life (WHOQOL-BREF) and the scores for its subdomains (overall quality of life and general health, physical health, psychological health, social relationships, and environment). A multiple linear regression analysis was used to find the variables independently associated with each outcome. Results: Seventy-five adult patients were evaluated. After multiple linear regression analysis, the HADS scores were associated with all outcomes, except social relationships (p = 0.08). Female gender was associated with poor total scores, as well as psychological health and environment. Unemployment was associated with poor physical health. Conclusion: Identifying the factors associated with HRQOL and recognizing that depression and anxiety are major factors are essential to improve the care of patients.
Introdução: Instrumentos para avaliar qualidade de vida relacionada à saúde têm sido amplamente utilizados no contexto médico, visando mensurar o impacto da doença de uma perspectiva subjetiva e relevante ao paciente. O objetivo desse estudo foi identificar variáveis associadas à qualidade de vida em uma amostra de pacientes acompanhados em um ambulatório terciário para transtornos de ansiedade e depressão. Métodos: Estudo transversal. As variáveis independentes incluíram dados de um questionário sociodemográfico e pontuação na Escala Hospitalar de Ansiedade e Depressão (HADS). Variáveis dependentes: pontuação total na escala breve de qualidade de vida da Organização Mundial de Saúde (WHOQOL-Bref) e cada um de seus subdomínios (geral, físico, psicológico, social e ambiental). Regressão linear múltipla foi aplicada para identificar as variáveis preditoras associadas de forma independente a cada uma das variáveis dependentes. Resultados: Setenta e cinco pacientes adultos foram avaliados. Após análise de regressão linear múltipla, pontuação na HADS esteve associada com todos os desfechos analisados, exceto para o subdomínio social (p = 0,08). Sexo feminino esteve negativamente associado com a pontuação total da WHOQOL-Bref e com os subdomínios psicológico e ambiental. Desemprego esteve associado com o subdomínio físico. Conclusão: A identificação de fatores associados à qualidade de vida relacionada à saúde e o reconhecimento de que a depressão e a ansiedade são variáveis fundamentais são essenciais para uma melhor assistência aos pacientes.
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Humanos , Masculino , Feminino , Adulto , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/epidemiologia , Qualidade de Vida , Transtorno Depressivo/psicologia , Transtorno Depressivo/epidemiologia , Pacientes Ambulatoriais/psicologia , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Brasil/epidemiologia , Modelos Lineares , Fatores Sexuais , Estudos Transversais , Centros de Atenção Terciária , Instituições de Assistência AmbulatorialRESUMO
INTRODUCTION: Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties. AIMS: This study aimed to identify independent predictor factors for ED in patients with epilepsy. MAIN OUTCOME MEASURES: the five-question form of the International Index of Erectile Function (IIEF-5). METHODS: Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis. RESULTS: Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation. CONCLUSIONS: Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy.
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Anticonvulsivantes/efeitos adversos , Epilepsias Parciais/epidemiologia , Disfunção Erétil/etiologia , Ereção Peniana/fisiologia , Adulto , Anticonvulsivantes/administração & dosagem , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/epidemiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prolactina/sangue , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
The feasibility of indirect application of low frequency ultrasound for demulsification of crude oil was investigated without using chemical demulsifiers. Experiments were performed in an ultrasonic bath with frequency of 35 kHz. Synthetic emulsions with water content of 12%, 35% and 50% and median of droplet size distribution (DSD), median D(0.5), of 5, 10 and 25 µm were prepared from crude oil with API density of 19 (heavy crude oil) and submitted to the proposed ultrasound-assisted demulsification procedure. Experimental conditions as temperature, time of exposition to ultrasound and ultrasonic power were evaluated. Separation of water from crude oil emulsion was observed for all emulsions investigated. Demulsification efficiency up to 65% was obtained for emulsion with 50% of water content and DSD of 10 µm. Higher efficiency of demulsification was achieved using US temperature of 45 °C and ultrasound power of 160 W by 15 min. Results obtained in this study showed that ultrasound could be considered a promising technology for industrial crude oil treatment and respective water removal.
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Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. .
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Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Lesões Encefálicas/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Escalas de Graduação Psiquiátrica/normas , Fatores Etários , Área Sob a Curva , Intervalos de Confiança , Programas de Rastreamento/métodos , Estudos Prospectivos , Psicometria , Inquéritos e Questionários/normas , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores SexuaisRESUMO
Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition. .
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Lesões Encefálicas/complicações , Transtornos da Personalidade/etiologia , Retorno ao Trabalho/estatística & dados numéricos , Brasil , Escala de Coma de Glasgow , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicotrópicos/uso terapêutico , Retorno ao Trabalho/psicologia , Fatores de Risco , Fatores Socioeconômicos , Estatísticas não ParamétricasRESUMO
OBJECTIVE: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. METHODS: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. RESULTS: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). CONCLUSIONS: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition.
Assuntos
Lesões Encefálicas/complicações , Transtornos da Personalidade/etiologia , Retorno ao Trabalho/estatística & dados numéricos , Adolescente , Adulto , Brasil , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicotrópicos/uso terapêutico , Retorno ao Trabalho/psicologia , Fatores de Risco , Fatores Socioeconômicos , Estatísticas não Paramétricas , Adulto JovemRESUMO
OBJECTIVE: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). METHODS: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. RESULTS: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. CONCLUSION: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points.