Assessment of cardiac autonomic functions by heart rate recovery,heart rate variability and QT dynamicity parameters in patients with acromegaly

Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. Herein, we aimed to investigate several parameters of cardiac autonomic functions in patients with acromegaly compared to healthy subjects. We enrolled 20 newly diagnosed acromegalic patients (55 % female, age:45.7 ± 12.6 years) and 32 age- and gender-matched healthy subjects. All participants underwent 24 h Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting 1st, 2nd and 3rd minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV) and QT dynamicity analysis. Baseline characteristics were similar except diabetes mellitus and hypertension among groups. Mean HRR1 (29.2 ± 12.3 vs 42.6 ± 6.5, p = 0.001), HRR2 (43.5 ± 15.6 vs 61.1 ± 10.8, p = 0.001) and HRR3 (46.4 ± 16.2 vs 65.8 ± 9.8, p = 0.001) values were significantly higher in control group. HRV parameters as, SDNN [standard deviation of all NN intervals] (p = 0.001), SDANN [SD of the 5 min mean RR intervals] (p = 0.001), RMSSD [root square of successive differences in RR interval] (p = 0.001), PNN50 [proportion of differences in successive NN intervals >50 ms] (p = 0.001) and high-frequency [HF] (p = 0.001) were significantly decreased in patients with acromegaly; but low frequency [LF] (p = 0.046) and LF/HF (p = 0.001) were significantly higher in acromegaly patients. QTec (p = 0.009), QTac/RR slope (p = 0.017) and QTec/RR slope (p = 0.01) were significantly higher in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HRR2, HRR3, SDNN, PNN50, RMSSD, variability index. Our study results suggest that cardiac autonomic functions are impaired in patients with acromegaly. Further large scale studies are needed to exhibit the prognostic significance of impaired autonomic functions in patients with acromegaly.     

Respiratory syncytial virus infections in northeastern Brazil: seasonal trends and general aspects

Respiratory syncytial virus (RSV) is one of the most prevalent agents of acute respiratory infections in children. Consistent data about seasonality of infections caused by this virus in Brazil proceed only from southern and southeastern regions. The purpose of this study was to determine the prevalence and the seasonal pattern of RSV infections in children living in Fortaleza city in northeastern Brazil. Nasopharyngeal aspirates of 1,950 patients attending in ambulatories, emergency room, and wards of Hospital Infantil Albert Sabin were collected and screened for RSV infections during 43 consecutive months. RSV was detected in 21% of the cases. RSV seasons in Fortaleza lasted 6 to 8 consecutive months, starting in January or February and finishing in July or August, and were associated with the rainy season.     

Validation of the Whooley questions and the Beck Depression Inventory in older adults

Objective

To analyse the psychometric properties of the Whooley questions and the 21-item Beck Depression Inventory (BDI-21) in older adults with depression and chronic health problems.

Design

A population-based study.

Setting

Community.

Subjects

474 adults, aged 72–73 years, living in the city of Oulu, Finland.

Main outcome measures

The screening parameters of the Whooley questions and the BDI-21 for detecting major depression.

Results

The prevalence of major depression according to the DSM-IV was 5.3% (single or recurrent episode) obtained by the Mini Neuropsychiatric Interview (MINI). The BDI-21 was best able to identify a current episode of major depression with a cut-off point of 11. The sensitivity and specificity of this cut-off point were 88.0% (95% confidence interval (95% CI) 68.8–97.5) and 81.7% (95% CI 77.8–85.2), respectively. The area under the receiver operating characteristics (ROC) curve was 0.89 (95% CI 0.83–0.96). The two Whooley screening questions had a sensitivity of 62.5% (95% CI 40.6–81.2) and either screening question plus the help question had a sensitivity of 66.7% (44.7–84.4).

Conclusions

The Beck Depression Inventory is a valid instrument for the diagnosis of depression in older adults. As a screening measure, the optimal cut-off score should be 11 or higher. Our results indicate that the sensitivity of the Whooley questions is not high enough to be used as a screening scale among the elderly.Key Words: Depression, elderly, Finland, general practice, screening instruments, validation studiesCurrent guidelines recommend use of screening tests in patient populations where the prevalence of depression is high, such as older adults or patients with chronic physical illnesses.

• Based on our results, the Beck Depression Inventory is a valid instrument for the diagnosis of depression among older adults. As a screening measure, the optimal cut-off score would be 11 or higher. The sensitivity of the Whooley questions seems not to be high enough to use it as a screening scale among elderly.