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1. Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence

Author

Biella MM, Borges MK, Strauss J, Mauer S, Martinelli JE, and Aprahamian I

Subjects
subthreshold depression, prevalence, treatment, depressive symptoms, older adults, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429
Abstract

Marina Maria Biella,1 Marcus Kiiti Borges,1 Jason Strauss,2 Sivan Mauer,3 José Eduardo Martinelli,4 Ivan Aprahamian1,4 1Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 2Geriatric Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA; 3Department of Psychiatry, Tufts Medical Center, Tufts University Scholl of Medicine, Boston, MA, USA; 4Geriatrics & Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, BrazilCorrespondence: Ivan AprahamianGroup of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, BrazilEmail ivan.aprahamian@gmail.comAbstract: This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms “subthreshold depression,” “prevalence,” “treatment” and “older adults” in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.Keywords: subthreshold depression, prevalence, treatment, depressive symptoms, older adults

Published
2019

3. Duration of Treatment for Pseudomonas aeruginosa Bacteremia: a Retrospective Study

Author

Babich, T., Naucler, P., Valik, J.K., Giske, C.G., Benito, Natividad, Cardona, R., Rivera, Alba, Pulcini, C., Fattah, M.A., Haquin, J., Macgowan, A., Grier, S., Chazan, B., Yanovskay, A., Ami, R.B., Landes, M., Nesher, L., Zaidman-Shimshovitz, A., McCarthy, K., Paterson, D.L., Tacconelli, E., Buhl, M., Mauer, S., Rodríguez-Baño, J., de Cueto, M., Oliver, A., de Gopegui, E.R., Cano, A., Machuca, I., Gozalo-Marguello, M., Martinez-Martinez, L., Gonzalez-Barbera, E.M., Alfaro, I.G., Salavert, M., Beovic, B., Saje, A., Mueller-Premru, M., Pagani, L., Vitrat, V., Kofteridis, D., Zacharioudaki, M., Maraki, S., Weissman, Y., Paul, M., Dickstein, Y., Leibovici, L., Yahav, D., Universitat Autònoma de Barcelona, and Yahav, Dafna

Subjects
Microbiology (medical), Infectious Diseases, Duration, Antibiotics, Pseudomonas aeruginosa, Bacteremia, Antimicrobial stewardship
Abstract

[Introduction] There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosa bacteremia. We aimed to evaluate the impact of short antibiotic course., [Methods] We present a retrospective multicenter study including patients with P. aeruginosa bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used., [Results] We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p = 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p = 0.002]. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome., [Conclusions] In this retrospective study, 6–10 days of antibiotic course for P. aeruginosa bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.

Published
2022

22. Effect of glycemic control on early diabetic renal lesions: a 5-year randomized controlled clinical trial of insulin-dependent diabetic kidney transplant recipients

Author

Barbosa, Jose, Steffes, Michael W., Sutherland, David E.R., Connett, John E., Rao, K. Venkateswara, and Mauer, S. Michael

Subjects
Diabetic nephropathies -- Development and progression, Organ transplant recipients -- Health aspects, Hyperglycemia -- Complications, Type 1 diabetes -- Complications
Abstract

Strict glycemic control in insulin-dependent (type I) diabetic patients may prevent or delay the development of diabetic nephropathy lesions. Diabetic nephropathy is kidney disease related to diabetes. Glycemic control refers to the maintenance of healthy blood sugar levels with insulin administration. Among 48 patients with type I diabetes who had received a kidney transplant, 25 received a maximized treatment regime and 23 received standard treatment. Standard treatment consisted of one or two daily injections of insulin, and maximized treatment involved frequent blood sugar monitoring and several insulin injections daily or continuous insulin infusion. Five years after transplant surgery, biopsy samples of the transplanted kidneys showed that the development of diabetic nephropathy lesions in the standard treatment group was twice that in the maximized treatment group. A drawback to maximized treatment may be the increased risk of hypoglycemic episodes., Objective.--To determine whether optimized glycemic control in type I diabetic recipients of renal allografts will prevent or delay diabetic renal lesions in the allograft. Design.--Prospective, controlled, and randomized trial of glycemic control in an inception cohort of type I diabetic renal allograft recipients. The experimental group underwent maximized glycemic control, and the standard group was treated in the same way as other patients in the transplant clinic. Patients underwent baseline (before transplant) and 5-year posttransplant allograft biopsies. Setting.--University of Minnesota Hospital and Clinic and the Clinical Research Center and Hennepin County Medical Center, Minneapolis. Patients.--Type I diabetics with terminal diabetic renal failure undergoing renal transplantation. Forty-eight patients randomized to maximized or standard control completed the trial. intervention.--Subcutaneous insulin given several times a day or continuously (maximized group) and once or twice each day (standard group) was used throughout the trial. A significant difference for hemoglobin Al level was maintained mean[+ or -]SD: standard, 0.117[+ o r-]0.013; maximized, 0.096[+ or -]0.016; P

Published
1994

25. Abnormal renal hemodynamic response to reduced renal perfusion pressure in diabetic rats: role of NO

Author

Tolins, Jonathan P., Shultz, Pamela J., Raij, Leopoldo, Brown, David M., and Mauer, S. Michael

Subjects
Endothelium -- Research, Nitric oxide -- Research, Prostaglandins -- Research, Biological sciences
Abstract

Enhanced activity of endgenous NO in a diabetic rat model is likely to cause basal hyperfiltration and continuous renal vasodilation expressed at decreased renal perfusion pressures. Renal hemodynamic abnormalities detected in experimental diabetes are due to the abnormal activity of NO. The abnormal response curve of renal blood flow is not influenced by prostaglandin synthesis restriction with indomethacin.

Published
1993

31. Relationship between retinal and glomerular lesions in IDDM patients

Author

Chavers, Blanche M., Mauer, S. Michael, Ramsay, Robert C., and Steffes, Michael W.

Subjects
Diabetic retinopathy -- Physiological aspects -- Complications and side effects -- Risk factors -- Health aspects, Type 1 diabetes -- Complications and side effects -- Risk factors -- Health aspects -- Physiological aspects, Diabetic nephropathies -- Risk factors -- Complications and side effects -- Physiological aspects -- Health aspects, Hypertension -- Health aspects -- Risk factors -- Complications and side effects -- Physiological aspects, Health, Physiological aspects, Complications and side effects, Risk factors, Health aspects
Abstract

Current knowledge regarding the concordance and discordance of the eye and kidney complications of diabetes is based on observations by ophthalmoscopy of retinal structural changes, which may be present at [...]

Published
1994

32. Cell and matrix components of the glomerular mesangium in type I diabetes

Author

Steffes, Michael W., Bilous, Rudolf W., Sutherland, David E.R., and Mauer, S. Michael

Subjects
Diabetes -- Physiological aspects -- Development and progression, Kidney glomerulus -- Physiological aspects, Kidney diseases -- Development and progression, Health, Physiological aspects, Development and progression
Abstract

In a cross-sectional study, glomerular basement membrane (GBM) width, the volume fractions of the mesangium ([V.sub.v]Mes), its cell ([V.sub.v]Cell) and matrix ([V.sub.v]Matx) components, and surface density of the peripheral capillary [...]

Published
1992

33. Glomerular structure in IDDM women with low glomerular filtration rate and normal urinary albumin excretion

Author

Lane, Pascale H., Steffes, Michael W., and Mauer, S. Michael

Subjects
Women -- Diseases -- Analysis -- Measurement -- Physiological aspects, Urine -- Analysis, Kidney glomerulus -- Physiological aspects -- Analysis -- Measurement, Type 1 diabetes -- Complications and side effects, Albumin -- Measurement -- Physiological aspects -- Analysis, Health, Diseases, Analysis, Physiological aspects, Complications and side effects, Measurement
Abstract

Eight women with insulin-dependent diabetes mellitus (IDDM) with low creatinine clearance rate (CCR) and normal urinary albumin excretion (UAE) were compared with three other groups of diabetic women: 19 with normal creatinine clearance rate (CCR) and UAE, 7 with normal CCR and microalbuminuria, and 7 with low CCR and microalbuminuria. The four groups were similar in age, duration of diabetes, [HbA.sub.1], incidence of urinary tract infection, prevalence of bladder neuropathy, and urinary urea nitrogen excretion rate. The prevalence of hypertension was similar among the groups, although mean arterial pressure was higher in the low CCR and microalbuminuria group. Renal area index was lower in the low CCR and normal UAE groups than in the other groups of diabetic patients, but was not different from normal. Morphometric measures of mesangial expansion and estimates of arteriolar hyalinosis and global glomerulosclerosis were increased to a similar degree in the low CCR and normal UAE, normal CCR and microalbuminuria, and low CCR and microalbuminuria groups compared with the group without abnormalities of renal function. Therefore, it is likely that diabetic glomerulopathy is, at least in part, responsible for the loss of glomerular filtration rate seen in the low CCR and normal UAE patients. Thus, the definition of incipient nephropathy may have to be expanded beyond the concept of microalbuminuria if longitudinal study of such patients reveals an increased risk of the subsequent development of overt nephropathy. Finally, screening for diabetic kidney disease among IDDM patients should include determination of glomerular filtration rate and measurement of UAE and blood pressure, especially among women. Diabetes 41-581-86, 1992, Overt diabetic nephropathy classically begins with dipstick-positive proteinuria (urinary albumin excretion [UAE] 200 mg/24h) followed or accompanied by the development of hypertension and/or falling glomerular filtration rate (GFR; 1,2). At [...]

Published
1992

34. Renal transplantation in infants

Author

Najarian, John S., Frey, Daniel J., Matas, Arthur J., Gillingham, Kristen J., So, Samuel S.K., Cook, Marie, Chavers, Blanche, Mauer, S. Michael, and Nevins, Thomas E.

Subjects
Transplantation of organs, tissues, etc. -- Demographic aspects, Acute renal failure in children, Kidneys -- Transplantation, Health
Abstract

Although kidney transplants have been performed for many years, there is controversy over the advisability of this procedure for young children with kidney failure or end-stage renal disease. Kidney failure in infants is associated not only with growth failure, but also with severe central nervous system disorders including progressive encephalopathy (abnormal structure or function of brain tissue), delayed development, microcephaly (small brain size) and seizures. If these infants are to survive and develop, they need early and aggressive intervention. Results are reported from the authors' experience in treating 75 infants less than two years old with kidney transplantation; 79 transplants were performed in these children. In 63 transplant operations, the donor was a living relative of the baby; 1 was not related; and 15 organs were obtained from cadavers (dead bodies). All the infants who received transplants were on or about to begin hemodialysis (a procedure in which wastes are removed from the blood using a machine). The transplants took place between 1965 and 1989, and 64 percent of the patients are alive with functioning kidneys. Since 1983, the one-year patient survival has been 95 percent, and the five-year survival has been 91 percent. Survival of the graft (donated organ) has been 86 percent at one year and 73 percent at five years. Patients who received immunosuppressive therapy with cyclosporine had 100 percent patient survival at one and five years, with graft survival of 96 percent at one year and 82 percent at five years. There was no difference in outcome between infants and older children. The most common cause of graft loss was rejection of the donated organ (15 patients). No graft rejection episode has been experienced by 52 percent of the transplant patients. Following transplantation, infant growth and development improved. It is recommended that living donors be used whenever possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1990

42. Lösen Biokunststoffe unser Plastikproblem?

Author

Bellusová, D., Mauer, S., Endres, H.-J., and Publica

Abstract

Biokunststoffe können heute einige konventionelle Kunststoffe ersetzen. Ihre Recyclingwege und die Verwertung des Biokunststoff-Rezyklats sind Gegenstand der Forschung.

Published
2016

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