Distribution and morphometry of skeletal muscle fibers in patients with chronic obstructive pulmonary disease and chronic hypoxemia

This study was designed to assess the size and distribution of muscle fiber types in patients with severe chronic obstructive pulmonary disease and stable chronic hypoxemia. Brachial biceps biopsies were performed in 8 patients and 12 controls. Histochemistry was used to count and determine the cross-sectional area of the various fiber-types (1, 2a, and 2b). A significant reduction (P < 0.05) in the proportion of type 2a fibers and an increase in the proportion and cross-sectional area of type 2b fibers were seen in hypoxemic patients. These findings suggest an adaptation of the muscle fibers to a low partial pressure of oxygen in arterial blood.     

Relevance of anger and irritability in outpatients with major depressive disorder

INTRODUCTION: Current psychiatric classification systems underestimate the part played by anger and aggressiveness in unipolar depression. This study was designed to assess the relevance of anger, irritability, aggressiveness, hostility, and psychomotor activation in major depressive disorder. METHODS: A total of 222 newly admitted consecutive outpatients with major depressive disorder (mean age 48.9 years, 64.4% females) were enrolled in the study. They had no comorbid axis I or II DSM-IV disorder, and they received no treatment with antidepressants in the preceding 2 months. They were assessed with the SVARAD, a validated scale for the rapid assessment of the main psychopathological dimensions. Principal component analysis was performed on SVARAD items. RESULTS: We obtained a three-factor solution accounting for 47.4% of total variance. The factors were interpreted as 'anger/irritability', 'depression', and 'anxiety', respectively. The anger/irritability dimension was clinically relevant in 23% of patients. Anger/aggressiveness was especially frequent (21.6%), whereas psychomotor activation was infrequent (0.9%). DISCUSSION: In depressive disorders, there are psychopathological dimensions other than depressed mood and anxiety that deserve greater clinical recognition and research. Our study suggests that one of these symptom clusters includes anger, irritability, aggressiveness, and hostility. The relevance of this dimension was not related to concurrent pharmacological treatment. Misdiagnosis of bipolar II disorder is also unlikely to explain our findings. Possibly, personality factors might at least partly explain the occurrence of anger and aggressiveness in several depressed patients. Attachment theory suggests that anger might also be conceived as part of the protest-despair-detachment reaction to a loss, either actual or symbolic.     

Simultaneous repair of myelomeningocele and shunt insertion

Methods Simultaneous shunt placement and neural tube repair are described and compared with a concomitant series of patients with delayed shunting. Twenty-eight patients with a myelomeningocele underwent closure of neural tube defects at our Institution from 1998 to 2001. Eleven patients (Group 1) had concomitant surgery performed after birth. Group 2 (7 out of 28) included patients without hydrocephalus at birth, in Group 3 (4 out of 28) the children did not develop hydrocephalus, and Group 4 (6 out of 28) patients were born outside our hospital and referred for surgical care after birth.Discussion Simultaneous insertion of shunt and correction of a myelomeningocele do not pose an additional risk to the child and do have some advantages, facilitating healing of the back without CSF leakage and protecting the brain from the effects of progressive ventricular dilatation. Patients with a myelomeningocele born outside the hospital are prone to infectious complications.     

Endemic social exclusion and early development: "made in Chacarita"

My aim is to introduce in this article a project that two foundations are developing in Chacarita, a neighborhood in Buenos Aires City, heading to provide help and support to adolescent parents under social deprivation conditions and/or undergoing emotional problems. It is an action project embracing different strategies to work on the prevention of infant psychopathological disorders as well as the parenting process. The aspects on early development on children are specially emphasized describing the interventions to promote the development and the care of the protective factors, the resilience, as well as to approach the risk factors. This is illustrated threw a clinical case.     

Cognitive therapy in patients with obsessive ruminations

The article stands out the elevate amount of patients with obsessive-compulsive disorder who only or mainly present obsessive ruminations. Firstly, the basic concepts of behavioral model of obsessive-compulsive disorder are enunciated. In the second place, the limitations of behavioural treatment for patient with obsessive ruminations are discussed. Then, the general characteristics of cognitive model of compulsive-obsessive dysfunction are formulated. Finally, steps of cognitive treatment for patient with obsessive ruminations are outlined.     

Apathy and depression in cross-cultural survivors of traumatic brain injury

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.     

Pharmacological treatment of psychosis in epilepsy

Epilepsy is one of the main causes of functional disability, and it is usually associated to psychiatric comorbidity, such as psychosis of epilepsy (POE). POE requires more careful pharmacological treatment, considering the propensity of the antipsychotics (AP) to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptic drugs (AEDs). We discussed the classification and the main types of POE, as well as some characteristics of AP typical and atypical, its potential to decrease the epileptogenic threshold (ET) and possible interactions between AP and AED. Atypical AP, except clozapine, disclosed smaller influence on ET than typical AP. Regarding pharmacokinetic interactions, AEDs are related with a significant increase of the AP metabolism. Therefore, in spite of the risk for AP induced convulsions be dose-dependent, higher doses of AP can be necessary in the treatment of POE.