Corradi MA, Lisboa AB, Fraguas Junior R. Inflammatory markers as predictive factors for selective serotonin reuptake inhibitors (SSRI) antidepressant effect / Marcadores inflamatórios como fatores preditivos para o efeito antidepressivo dos inibidores seletivos da recaptura de serotonina (ISRS). Rev Med (São Paulo) ABSTRACT:Introduction: Data have supported the influence of inflammation in the pathophysiology of depression and also the influence of depression in the development of a proinflammatory state. Major depressive disorder (MDD), the core depressive condition, has selective serotonin reuptake inhibitors (SSRI) as its first line pharmacological treatment. Efforts have been made to identify predictive factors for the responsiveness to SSRI. Therefore, we conducted this review to evaluate the hypothesis that baseline levels of inflammatory markers predict the responsiveness of MDD to SSRI treatment. Methods: A search in the PubMed database was made including the keywords ("SSRI" or "sertraline" or "citalopram" or "fluvoxamine" or "escitalopram" or "fluoxetine" or "paroxetine") and ("cytokines" or "CRP" or "TNF" or "inflammatory") and ("major depressive disorder" or "major depression"). Results: The search retrieved 245 manuscripts, from which 12 fulfilled our inclusion criteria. The analysis of these manuscripts suggested that high levels of interleukin-6 (IL-6), interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α) and c-reactive protein (CRP) at baseline might predict low responsiveness of MDD to SSRI treatment. Confounders such as cognitive impairment, chronicity and severity of depression, melancholic subtype, age and gender were not systematically included in the studies. Conclusion: Findings of this review suggest that high levels of pro-inflammatory markers at baseline might predict low responsiveness of MDD to SSRI treatment. Studies with adequate control for confounders are needed.Keywords: Cytokines; Depression; Inflammation; Serotonin uptake inhibitors; Biomarkers; Predictive value of tests. RESUMO:A influência da inflamação na fisiopatologia da depressão e o papel da depressão no desenvolvimento de um estado pró-inflamatório têm sido apoiados por diversos estudos. O transtorno depressivo maior (TDM), principal diagnóstico de depressão, tem os inibidores seletivos da recaptação de serotonina (ISRS) como tratamento farmacológico de primeira linha. Esforços têm sido feitos para identificar fatores preditivos da responsividade ao tratamento antidepressivo os ISRS. Portanto, esta revisão tem como objetivo avaliar a hipótese de que níveis basais de marcadores inflamatórios predizem a responsividade do TDM ao tratamento com ISRS. Métodos: Pesquisamos o banco de dados PubMed, incluindo as palavras-chave ("ISRS" ou "sertralina" ou "citalopram" ou "fluvoxamina" ou "escitalopram" ou "fluoxetina" ou "paroxetina") e ("citocinas" ou "CRP" ou "TNF" ou "inflamatório") e ("transtorno depressivo maior" ou "depressão maior"). Resultados: A pesquisa identificou 245 manuscritos, dos quais 12 satisfizeram os...

Introduction: The humanization of assistance is associated to empathy, embracing, and effective communication, being part of the medical training. According to its nature, humanization requires methods that involve affections and stimulates critical thinking. Objective: Extensive literature shows the benefits of the arts in medical education; however, there are still few studies on dancing, the subject of this study, which was carried out by medical students and whose aim was to investigate hospital dancing in the teaching of humanization, from the perspective of medical students. Method: A qualitative action research study was designed, in which medical students performed choreographies for patients, companions and employees in three different wards of the teaching hospital. The action consisted of continuous cycles in the planning of interventions, performance, observing, reflection, and re-planning of subsequent actions, in a systematic manner and controlled by the researchers. Data production took place by direct observation, narratives and focal group. The data were analyzed using the content and thematic analysis methods. Results: For three months, 17 female and 7 male students between 18 and 24 years of age performed the action, producing data that was subsequently classified into 3 thematic categories: 1. Dimension of affection: contents of the student’s emotional character; 2. Care dimension: contents about caring for the patient; 3. Dance dimension: contents on dance in the humanistic training in Medicine. In the triangulation of the techniques, it was observed that joy, anxiety, and the perception of dance as an instrument of bonding were significant. The experience of changing socially-marked places for the student and the patient made the student face and overcome different feelings. The dance allowed the refinement of the look and the capacity to understand the other, taking into account perspectives that converge to or diverge from their own convictions. On the other hand, the students experienced the anxiety and joy of an encounter with themselves, perceiving dance as a pleasurable and humanizing activity. Conclusion: The dance in the hospital lead to experiences and reflections that stimulated the students’ self-knowledge, favored the student-patient relationship, and brought elements to understand the use of dancing in medicine, mainly for the teaching of empathy and humanized care.