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Prevalence of depressive symptoms in a large series of smokers intending to quit. Effective implications for clinics in the field of internal medicine

Fabio Lugoboni, Margherita Residori, Lorenzo Zamboni, Rebecca Casari, Marco Faccini, Daniel L. Amram, Vincenzo ZagÓ
Prevalence of depressive symptoms in a large series of smokers intending to quit. Effective implications for clinics in the field of internal medicine
Background. The association linking nicotine addiction with depression is known, described and clinically significant. Tobacco addiction has much in common with the dependence on illegal drugs, but it results significantly a more lethal factor. When compared with the general population, patients with depression smoke two times more, and among this population there was not noticed any downward trend in the prevalence of smoking as it is widely reported in the general population. The bond between smoking and depressive disorders is complex. While some studies indicate that no significant relapse has been observed during the cessation in patients with a history of affective disorders, others underline the development of an increased risk of maniac episodes and/or recurrent depression during the 6 months following smoking cessation. The current guidelines do not suggest specific assessments with diagnostic screening for depression, nor do they consider the utility of an eventual anti-depression treatment prior to the smoking cessation intervention, although having quite a few anti-depressive drugs among those used as first and second choice treatment for smoking cessation. The aim of the study is to assess the prevalence and the degree of depression at baseline of a large cohort of smokers intending to quit.
Methods. A cross-sectional investigation was carried out on a population of 1110 smokers attending the Medical Service at Verona University Hospital. The degree of nicotine addiction was measured by the Fagerstrom Test of Nicotine Dependence (FTND) and current mood tested by the Self-rating Depression Scale (SDS), a commonly used and well validated instrument to assess depressive mood.
Results. 132 subjects (12%) were depressed at baseline (SDS test score ≥50). Bivariate analysis, using the SDS score dichotomised at the cut-off of 50 as dependent variable, shows that female gender and degree of nicotine dependence were correlated to depression.
Conclusions. The study showed a high degree of pre-treatment depression in smokers intending to quit. Although the association between depression and nicotine dependence has been consistently reported many times, and it is well known that depressed subjects may encounter more difficulty to quit, most guidelines do not seem to consider this issue. These findings suggest the need for baseline assessment of depression by screening all smokers seeking assistance in quitting.

Obesity, exercise capacity and systemic inflammation in severe obstructive sleep apnea

Carmen C. Stroescu, Ștefan Dumitrache-Rujinski, Ionela Erhan, Bianca Paraschiv, Irina Pele, Miron A. Bogdan
Obesity, exercise capacity and systemic inflammation in severe obstructive sleep apnea
Background. Obesity and obstructive sleep apnea syndrome (OSAS) are associated with systemic inflammation, secondary cardiovascular comorbidities and low exercise capacity.
Aim. To assess the relations between obesity, exercise capacity and systemic inflammation in patients with severe OSAS. Method. Newly diagnosed severe OSAS patients (Apnea-Hypopnea Index [AHI] >30/hour, cardiorespiratory polygraphy), with no clinically significant cardio-respiratory comorbidities, were evaluated by anthropometric measurements (Body Mass Index [BMI]; neck, waist and hip circumference and ratio [WHR]); complete blood count and markers of systemic inflammation: erythrocyte sedimentation rate (ESR), fibrinogen (Fb), neutrophils and platelets to lymphocytes ratios (NLR, PLR). All subjects underwent a six-minute walk test, with measure of the 6-minute walk distance, and an incremental cardio-pulmonary exercise test with measurement of the peak oxygen uptake (peakVO2), in order to asses maximal exercise capacity. The relations between these parameters were analyzed.
Results. In a group of 30 severe OSAS patients (23 men), with mean/median values for age 45±9 years, BMI 34.9±4.7 kg/m2, WHR 1 (0.9-1.2), AHI 58.8/hour (26-113.5), Oxygen Desaturation Index (ODI) 46/hour (16.5-100.3), hemoglobin (Hb) 15 g/dl (11.6-17), ESR 8 mm/1 hour (1-39), FB 336 mg/dl (232-652), NLR 2 (1-3.73), PLR 97.5 (55-166), we found a peakVO2 of 82.11±2.58% predicted value. A statistically significant negative correlation between BMI and peakVO2 (r=-0.493, p=0.006) was found. OSAS severity (AHI, ODI) also negatively correlated with VO2 peak (r=-0.477, p=0.008; r=-0.379, p=0.043). Surprisingly, BMI negatively correlated with PLR (r=-0.401, p=0.042). No correlation between peak exercise capacity and OSAS severity with PLR was identified.
Conclusion. Both obesity and severe OSAS are associated with decreased exercise capacity. In our study group, we did not find a relation between markers of systemic inflamation and OSAS severity or peak exercise capacity. Systemic inflammation may not be the main mechanism of reduced exercise capacity in severe OSAS, other mechanisms being probably involved (cardiac dysfunction).

Prooxidant - antioxidant balance in COPD patients

Fariba Rezaeetalab, Asghar Dalili, Daryoush Hamidi Alamdari
Prooxidant - antioxidant balance in COPD patients
Objective. Oxidative stress is an important risk factor for the pathogenesis of chronic obstructive pulmonary disease (COPD). Oxidative stress and chronic inflammation are the two major pathogenesis features of COPD. The aim of this study was to assess the role of oxidative stress in the pathogenesis of COPD by using a rapid novel assay of prooxidant-antioxidant balance (PAB).
Patients and methods. In the present study, we assessed the extent of oxidative stress in the serum of 60 COPD patients and 60 healthy control subjects using a rapid assay of prooxidant-antioxidant balance (PAB). It is notable that due to non-parametric distribution of quantitative variables, the Mann-Whitney and Kruskal-Wallis tests were performed using SPSS for statistical analysis.
Results. Each group consisted of 42 (70%) males and 18 (30%) females. The mean ages of the study and control groups were 58.9±6 and 58.5±6, respectively. Furthermore, the mean rate of smoking was 24.2±9.2 (packet/year) in the study group and 5.1 (packet/year) in the control group. Also, the mean smoking rate (packet/year) was 25.4±8.8 for males and 13.3±5.7 for female COPD patients. Mean serum PAB [Hamidi-Koliakos (H.K.) units] were 193.6±43 and 62.05±40.4 among the patient group and control group, respectively (P<0.001).
Conclusion. The current study highlights the key role of oxidative stress in the pathogenesis of COPD.