Depression severity levels and cognitive functions in institutionalized elderly patients

Depression is a highly prevalent illness among institutionalized aged and assumes peculiar characteristics such as the risk for progressing to dementia. The aims of this study was to assess the cognitive functions of institutionalized elderly with clinical diagnosis of depression and compare the severity of depressive symptoms with cognitive performance. From 120 residents at a nursing home in Rio Claro, Brazil, we study 23 individuals (mean age: 74.3 years; mean schooling: 4.0 years) with diagnosis of depression. At first, a clinical diagnosis of depression and measurement of its symptoms using the Geriatric Depression Scale were performed. The patient then underwent a neuropsychological assessment based on the following tests: Mini-Mental Examination, Verbal Fluency, Visual Perception, Immediate Memory, Recent Memory, Recognition, Clock Drawing Test. The patients were divided into two groups: those with less severe depression symptoms (Group 1: N=9) and more severe symptoms (Group 2: N=14). The significant difference between symptom severity of the two groups was p=0.0001. Patients with more severe symptoms revealed a slightly inferior cognitive performance in most of the tests when compared to those with less severe symptoms (p>0.05). In relation to Verbal Fluency, patients with more severe depression symptoms presented a significantly inferior cognitive performance when compared to those with less severe symptoms (p=0.0082). Verbal Fluency revealed to be a more sensitive test for measuring early cognitive alterations in institutionalized aged with depression, and appears to be a useful resource in monitoring the cognitive functions of patients faced with the risk of dementia. © Copyright Moreira Jr. Editora.

Palpebral dimensions in Brazilian children: Assessment based on digital images

Purpose: To determine palpebral dimensions and development in Brazilian children using digital images. Methods: An observational study was performed measuring eyelid angles, palpebral fissure area and interpupillary distance in 220 children aged from 4 to 72 months. Digital images were obtained with a Sony Lithium movie camera (Sony DCR-TRV110, Brazil) in frontal view from awake children in primary ocular position; the object of observation was located at pupil height. The images were saved to tape, transferred to a Macintosh G4 (Apple Computer Inc., USA) computer and processed using NIH 1.58 software (NTIS, 5285 Port Royal Rd., Springfield, VA 22161, USA). Data were submitted to statistical analysis. Results: All parameters studied increased with age. The outer palpebral angle was greater than the inner, and palpebral fissure and angles showed greater changes between 4 and 5 months old and at around 24 to 36 months. Conclusion: There are significant variations in palpebral dimensions in children under 72 months old, especially around 24 to 36 months. Copyright © 2006 Informa Healthcare.

Etiologia e incidência das fraturas faciais em adultos e crianças: Experiência em 513 casos

Facial trauma has presented an increasing occurrence in the last four decades, due especially to the growth of accidents with automobiles as well as to the urban violence. Both of which continue being the main cause of such traumas. Aim: To evaluate the features of the population victim of facial trauma as to gender, age, occupation, origin, type of fracture and its cause. Design study: retrospective clinical with transversal cohort. Material and Method: Retrospective study consulting hospital registers of 513 patients victms of the facial trauma. Results: There was a higher incidence of facial trauma on men (84,9%), white (82,7) and with an average age of 29. Regarding occupation, the trauma was mostly occurred to students (16,6%) and Masons (11,2%). The jaw was the most affected place (35%), followed by zygoma (24%) and by the nose (23%), though most patients presented a single facial fracture (82,5%). Among the causes, accidents with automobiles (28,3%), aggressions (21%) and accidental fall s (19,5%) were the most common. Conclusions: Accidents with automobiles continue being the main cause of facial trauma, especially of multiple factures due to the great transmission of kinetic energy.

Transmission analysis of candidate genes for nonsyndromic oral clefts in Brazilian parent-child triads with recurrence

Cleft lip and/or palate (CL/P) is a major congenital defect with complex etiology, including multiple genetic and environmental factors. Approximately two thirds of the cases are not accompanied by other anomalies and are called nonsyndromic (NS). In the present study, we performed transmission distortion analysis of the MSX1-CA, TGFB3-CA and MTHFR-C677T polymorphisms in 60 parent-child triads, in which the NS-CL/ P affected child had at least one affected parent. No association with genes MSX1 or TGFB3 was found, but the results were suggestive of an association of the MTHFR-C677T polymorphism with NS-CL/P. © 2006 Sociedade Brasileira de Genética.

Implantation sites after embryo transfer into the central area of the uterine cavity

A total of 63 pregnancies (47 singleton, 15 twin, 1 triplet) from intracytoplasmic sperm injection cycles were analysed. In all embryo transfers, the catheter was introduced into the endometrial cavity guided by abdominal ultrasound, with the catheter tip placed at the middle point of the endometrial cavity. Gestational sacs (GS) were located 21-24 days after transfer (gestational age = 5 weeks) by two-dimensional and three-dimensional transvaginal ultrasound. The uterine cavity was divided into three parts: upper, middle and lower. Furthermore, the upper region was subdivided into right, middle and left areas, and the middle region was subdivided into right and left areas. The frequency of gestational sacs in each area was evaluated. In singleton pregnancies 66.0% (31/47) of the GS were detected in the upper region, 29.8% (14/47) in the middle region and 4.2% (2/47) in the lower region. In multiple pregnancies (twins and triplet) 45.5% (15/33) of the GS were detected in the upper region, 51.5% (17/33) in the middle region and 3.0% (1/33) in the lower region. In conclusion, the results demonstrate that when embryos are transferred to the central area of the uterine cavity there is an increase in implantation rate in the middle region compared with the rate expected in naturally conceived pregnancies (9-15%).

Laser-assisted hatching of cryopreserved-thawed embryos by thinning one quarter of the zona

Laser-assisted hatching is little documented in the literature regarding its efficacy in cryopreserved-thawed (CT) embryo transfer cycles. The aim of the present study was to evaluate in a randomized manner the efficacy of thinning one quarter of the zona pellucida of CT embryos to a depth of 50-80% of the original thickness, via laser treatment (the qLZT-AH procedure), in improving implantation and pregnancy rates. Two populations were studied: population I, patients who had all their supernumerary embryos cryopreserved, regardless of their morphology, and population II, patients at risk of ovarian hyperstimulation syndrome who had all their embryos cryopreserved. Artificial and natural protocols were used for the embryo transfers. A total of 350 laser-thinned CT embryos were compared with 352 intact zona embryos. No difference in implantation or pregnancy rate was found after using qLZT-AH in either population. These findings suggest that qLZT-AH should not be routinely performed in cryopreserved embryo programmes.

Assessment of health-related quality of life in children with functional defecation disorders

Objective: To evaluate the health-related quality of life in children with functional defecation disorders. Methods: One hundred children seen consecutively were enrolled and subdivided into three subsets according to the Roma II classification criteria: functional constipation (n = 57), functional fecal retention (n = 29) and nonretentive functional soiling (n = 14). The generic instrument Child Health Questionnaire - Parent Form 50 (CHQ-PF50®), was used to measure quality of life and to assess the impact of these disorders from the point of view of parents. The instrument measures physical and psychosocial wellbeing in 15 health domains, each of which is graded on a scale from 0 to 100, with higher values indicating better health and greater wellbeing. Ten of these are then used to obtain two aggregated and summary scores: the physical and psychosocial scores. Results: No statistically significant differences were detected between subsets in terms of demographic or anthropometric characteristics. In 14 domains, children with defecation disorders scored lower than healthy children. When subsets were compared, statistically significant differences were detected between children with nonretentive functional soiling (lower scores) and those with functional constipation. Physical and psychosocial scores for the entire sample were lower than those for the group of healthy children used as controls. Conclusions: The CHQ-PF50® was considered adequate for demonstrating compromised quality of life in children with functional defecation disorders, as has been reported for other diseases, being a useful tool for making treatment decisions and for patient follow-up. Copyright © 2006 by Sociedade Brasileira de Pediatria.

Evaluating quality of life in mercury intoxicated people in urban-industrial environments through short-form 36 application

Context and objective: Records of contact with mercury (Hg) exist for more than 3500 years and several problems related to the use of this element can be noticed. Considering inexistence of current reports about it, quality of life perception evaluation was studied in people chronically intoxicated by mercury in an industrial environment. Design and setting: This is a cross-sectional descriptive observational study. Information from 47 urban-industrial workers from lamps manufacturing in São Paulo, clinically diagnosed as intoxicated by mercury and currently followed by the Occupational Health Service of Faculdade de Medicine da Universidade de São Paulo, with average age of 41.7 years old, was considered. Methods: SF36 questionnaire application was performed, with inferences tested by χ-square proof, by Spearman linear correlation and Mann-Whitney non-parametric test, adopting p < 0.05 as significant level. Results: In the eight domains, observed medians are 40% for physical functioning; 0 for physical function; 30% for body pain; 30% for general health; 22.2% for vitality; 50% for social functioning; 0 for emotional role and 36% for mental health. Correlation between age and SF36 domains does not reveal statistical significance, except for physical functioning, indicating that lower scores presented by older people in this domain are not followed by changes on other ones. Conclusions: Values obtained in people chronically intoxicated by mercury are actually lower, in the motor and mental scope components. Some instruments domains are higher for men than for women. Older ages are inversely associated to good performance in physical function domain. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

HFE gene mutations in Brazilian thalassemic patients

Hereditary hemochromatosis is a disorder of iron metabolism characterized by increased iron intake and progressive storage and is related to mutations in the HFE gene. Interactions between thalassemia and hemochromatosis may further increase iron overload. The ethnic background of the Brazilian population is heterogeneous and studies analyzing the simultaneous presence of HFE and thalassemia-related mutations have not been carried out. The aim of this study was to evaluate the prevalence of the H63D, S65C and C282Y mutations in the HFE gene among 102 individuals with alpha-thalassemia and 168 beta-thalassemia heterozygotes and to compare them with 173 control individuals without hemoglobinopathies. The allelic frequencies found in these three groups were 0.98, 2.38, and 0.29% for the C282Y mutation, 13.72, 13.70, and 9.54% for the H63D mutation, and 0, 0.60, and 0.87% for the S65C mutation, respectively. The chi-square test for multiple independent individuals indicated a significant difference among groups for the C282Y mutation, which was shown to be significant between the beta-thalassemia heterozygote and the control group by the Fisher exact test (P value = 0.009). The higher frequency of inheritance of the C282Y mutation in the HFE gene among beta-thalassemic patients may contribute to worsen the clinical picture of these individuals. In view of the characteristics of the Brazilian population, the present results emphasize the need to screen for HFE mutations in beta-thalassemia carriers.

Estudo da distribuição dos casos de Diabetes Mellitus em Presidente Prudente - SP

The main causes of illness and consequent death in patients affected by Diabetes Mellitus are the long-term complications. Depression can make it harder to control the level of glucose in the blood, as well as intensifying and worsening the clinical complications, thus reducing the quality of life. The aim of this study was to estimate the incidence of Diabetes Mellitus in Public Health Clinic in Presidente Prudente (SP) in patients enrolled in the Hiper-Dia Program. From October 2003 to July 2004, a descriptive survey was carried out. Data were obtained from doctor's records of 50 diabetes patients and also their answers to a specific questionnaire. The majority of the patients were female, had not completed elementary school, with a family income below five minimum wages, a nationally-defined amount related to the poverty line. It was observed that 24% of the patients had depression and 76% never followed a controlled diet. Pharmacological treatment was prescribed for 82% of the patients. Twenty-eight patients were receiving psyicological treatment, together with oral hypoglycemic agents. The glycated hemoglobin was measured in 68%. The association between depression and submission to treatment was not significant. No statistical association was found between the psychologically assisted patient's group and glucose control (p= 0.40), diet control (p= 0.37) and physical activities (p= 0.77). It was concluded that 24% patients had depression and the majority not under diet control, but 82% were under pharmacological treatment.

Estudo da bula de medicamentos: Uma análise da situação

This study was carried out in the city of Araraquara (SP, Brazil), where 1829 people selected randomly from 42 districts were interviewed with regard to their use of medicines, in particular whether and how they read the insert information sheet and the most frequently read items and problems encountered in the text. Surveys were performed in two stages, the first when package inserts were regulated in Brazil by Portaria SVS 110/1997 (Ministry of Health directive) and the second after the new regulation (RDC 140/2003) came into force. Out of 1829 people interviewed, 1597 reported using some medicine. The markedly similar results in both stages of the research pointed to the difficulties encounteved in reading the package inserts, due to the small letters, the obscure language and the massive amount of information. This paper shows that package inserts of medicines need to be simpler, so the patients have an idea of the importance of the medicine and are able to realize soon any problem that might appear due to the use of the medicine and what action they should take. Furthermore, it will be helpful to the evaluation of the package inserts of medicines, elaborated in conformity with RDC 140, if they work effectively as a source of information and guidance for the patient are not simply given a new layout, while maintaining items that impede their understanding and use.

Avaliação de diferentes métodos no diagnóstico laboratorial de Giardia lamblia

The protozoan parasite Giardia lamblia is responsible for a common intestinal infection in all regions of the world. In this study, four laboratory tests were evaluated for diagnostic reproducibility in the detection of this infection: Coprotest®, Direct modified method, Faust method and iron-hematoxylin staining. Positive diagnoses were tested for association with factors such as the age group and gender of the subject and the month when the sample was taken. Feces of 200 children in the Araraquara region (SP, Brazil) were examined by all four methods and the results compared. G. lamblia was found to be the most frequent parasite and 8.0% of the children showed giardiasis. There was no apparent correlation with gender, but most of the parasites were found in three- to five-year-olds. The highest frequency of infection occurred in January. The most reliable diagnostic results for G. lamblia were achieved by combining at least two methods of good reproducibility, i.e. Coprotest-Faust, Direct-Faust or Coprotest-Direct (A > 0.81).

Shorter CAG repeat in the AR gene is associated with atypical hyperplasia and breast carcinoma

Background: Previous reports into the role of [CAG]n repeat lengths in the androgen receptor (AR) gene indicate that these may play an important part in the development and progression of breast cancer, however, knowledge regarding benign breast lesions is limited. Patients and Methods: PCR-based GeneScan analysis was used to investigate the [CAG]n repeat length at exon 1 of the AR gene in 59 benign breast lesions (27 fibroadenomas, 18 atypical hyperplasias, and 14 hyperplasias without atypia) and 54 ductal breast carcinomas. Seventy-two cancer-free women were used as a control group. In addition, [CAG]n repeats were evaluated for the presence of loss of heterozygosity (LOH) and microsatellite instability (MSI) in a subset of these samples (27 fibroadenomas, 14 hyperplasias without atypia and 22 breast carcinomas). Results: Shorter [CAG]n repeat lengths were strongly correlated with atypical hyperplasias (p=0.0209) and carcinomas (p<0.0001). LOH was found in 1/12 and 4/20 informative cases of hyperplasias without atypia and breast carcinomas, respectively. Three patients with breast carcinoma who had previously presented atypical hyperplasia showed a reduction in the [CAG]n repeat length in their carcinomas. Conclusion: Short [CAG]n repeat length (≤20) polymorphisms are strongly associated with breast carcinomas and atypical hyperplasias. Although non-significant, a subgroup of patients with breast carcinoma and genotype SS showed an association with parameters of worse outcome.

Antisperm antibodies in infertile men and their correlation with seminal parameters

Aim: Antisperm antibodies (ASA) in males cause the autoimmune disease 'immune infertility'. The present study intended to detect the presence of ASA and their incidence in men with unexplained infertility, as well as to evaluate the correlation between the presence of ASA and semen parameter alterations. Methods: Blood and sperm assessment were collected to carry out a direct and indirect mixed antiglobulin reaction (MAR) test and semen analysis in infertile and fertile men from the University Hospital of the Faculty of Medicine, Sao Paulo State University, Sao Paulo. Results: In the MARtest, 18.18% of infertile men were positive for ASA. In fertile men, no positivity was found. A significant correlation between the presence of ASA with an increased white blood cell count plus a decreased hypoosmotic swelling test result was observed. Conclusions: The results indicate that ASA are involved in reduced fertility. It is not ASA detection per.se that provides conclusive information about the occurrence of damage to fertility. The correlation between infertility and altered seminal parameters reinforce the ASA participation in this pathology. © 2007 The Authors Journal compilation. © 2007 Japan Society for Reproductive Medicine.

Sertralina no tratamento de pacientes com depressão maior leve e moderada: Estudo multicêntrico brasileiro

Introduction: To evaluate the efficacy, safety, and tolerability of sertraline for the treatment of Brazilian patients with mild to moderate major depression. Patients and methods: Patients were 18 years old or older treated on an out-patient basis. Previous medications were stopped for a 2-week washout period. Afterwards, patients received sertraline, initial dose of 50 mg/day up to the 4 th week. The dose could then be increased up to 200 mg/day according to the efficacy and tolerability. Therapeutic efficacy was evaluated with the Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton scale for depression (HAM-D), and Clinical Global Impression (CGI). Results: 51 patients (42 women) were evaluated regarding efficacy and safety. Treatment with sertraline significantly decreased scores of MADRS, HAM-D e ICGfrom 15.7 ± 6.1; 12.2 ± 3.9 e 3.5 ± 0.6 to 6.2 ± 6.5; 5.4 ± 4.7 e 2.3 ± 1.0 (P < 0.0001), respectively. Sertraline was well tolerated. Gastro-intestinal upset (N=14; 24.6%), headache (N=7; 12.3%), sleep alterations (H-7; 12.3%), dizziness (N-4; 7.0%), and anorexia (N=4; 7.0%) were the most common adverse events. Six patients discontinued the treatment due to adverse events. Conclusion: Sertraline is efficient and presents a favorable safety and tolerability profile for the treatment of Brazilian patients with mild to moderate major depression. © Copyright Moreira Jr. Editora.