RESUMO

OBJECTIVES: Early signs of bleeding are often masked by the physiologic compensatory responses delaying its identification. We sought to describe early physiologic signatures of bleeding during the blood donation process. SETTING: Waveform-level vital sign data including electrocardiography, photoplethysmography (PPG), continuous noninvasive arterial pressure, and respiratory waveforms were collected before, during, and after bleeding. SUBJECTS: Fifty-five healthy volunteers visited blood donation center to donate whole blood. INTERVENTION: After obtaining the informed consent, 3 minutes of resting time was given to each subject. Then 3 minutes of orthostasis was done, followed by another 3 minutes of resting before the blood donation. After the completion of donating blood, another 3 minutes of postbleeding resting time, followed by 3 minutes of orthostasis period again. MEASUREMENTS AND MAIN RESULTS: From 55 subjects, waveform signals as well as numerical vital signs (heart rate [HR], respiratory rate, blood pressure) and clinical characteristics were collected, and data from 51 subjects were analyzable. Any adverse events (AEs; dizziness, lightheadedness, nausea) were documented. Statistical and physiologic features including HR variability (HRV) metrics and other waveform morphologic parameters were modeled. Feature trends for all participants across the study protocol were analyzed. No significant changes in HR, blood pressure, or estimated cardiac output were seen during bleeding. Both orthostatic challenges and bleeding significantly decreased time domain and high-frequency domain HRV, and PPG amplitude, whereas increasing PPG amplitude variation. During bleeding, time-domain HRV feature trends were most sensitive to the first 100 mL of blood loss, and incremental changes of different HRV parameters (from 300 mL of blood loss), as well as a PPG morphologic feature (from 400 mL of blood loss), were shown with statistical significance. The AE group (n = 6) showed decreased sample entropy compared with the non-AE group during postbleed orthostatic challenge (p = 0.003). No significant other trend differences were observed during bleeding between AE and non-AE groups. CONCLUSIONS: Various HRV-related features were changed during rapid bleeding seen within the first minute. Subjects with AE during postbleeding orthostasis showed decreased sample entropy. These findings could be leveraged toward earlier identification of donors at risk for AE, and more broadly building a data-driven hemorrhage model for the early treatment of critical bleeding.

RESUMO

Introducción. La población de personas mayores (PM) en Chile presenta un incremento sostenido con importantes tasas de fragilidad y riesgo de caídas (RC). El desempeño de marcha permite valorarlo mediante parámetros mecánicos y fisiológicos. Nos preguntamos, ¿cuáles podrían ser los más relevantes para estimar RC en condiciones de marcha confortable (MC) y máxima (MM)? Objetivo. Identificar los principales parámetros de marcha que podrían explicar RC en PM autovalentes de la comunidad. Métodos. Estudio observacional y transversal en el cual participaron 53 PM autovalentes de la comuna de Talca, Chile (edad 71±7años; IMC 29,1±3,4 kg/m2). Se solicitó a los participantes la ejecución de MC (n=53) y posteriormente MM (n=36). Ambas modalidades fueron desarrolladas en un circuito elíptico de 40m durante 3min. El RC se categorizó como: "sin riesgo", "riesgo dinámico" según prueba timed up and go (TUG) positiva, "riesgo estático" según estación unipodal (EUP) positiva y "riesgo mixto" con ambas pruebas positivas. Para la visualización de la variación gráfica en el morfoespacio de los individuos según RC, se realizó un análisis de componentes principales (ACP) mediante el Programa RStudio, utilizando 6 variables cinemáticas: i) velocidad promedio de marcha (VPM), ii) cadencia, iii) máximo despeje del pie (MDP), iv) coeficiente de variación (%CV) del MDP, v) longitud de zancada (LZ) y vi) %CV de la LZ. Además de 2 variables fisiológicas: i) % frecuencia cardiaca de reserva utilizada (%FCRu) y ii) el índice de costo fisiológico según la relación entre FC y VM (latidos/metros). Resultados. Para MC las dimensiones del ACP explican el 56% de la variabilidad de los datos, siendo los indicadores de seguridad de RC la VM, cadencia, LZ y MDP. La variabilidad de marcha explica RC mixto y el ICF junto al %FCRu se asocian a RC dinámico. En condiciones de MM, el ACP explica 60% de la variabilidad de datos, donde las PM sin RC se asocian con VM, LZ y MDP. Por su parte, la variabilidad del MDP se vincula con RC dinámico y las variables fisiológicas con el RC mixto. Conclusiones. Los parámetros de marcha que mejor explican una marcha segura y eficiente son cinemáticos de la fase de balanceo, mientras que la variabilidad y el costo fisiológico se asocian como indicadores de RC dinámico y mixto.

Background. Introduction: The elderly population (EP) in Chile is experiencing a sustained increase with significant rates of frailty and risk of falls (RF). Gait performance can be assessed using mechanical and physiological parameters. We wonder, which ones could be the most relevant to estimate RF in self-selected walking speed (SSWS) and maximum walking speed (MWS) conditions? Objective. Identify the main gait parameters that could explain RF in self-sufficient elderly individuals from the community. Methods. This observational and cross-sectional study included 53 self-sufficient elderly individuals from the commune of Talca, Chile (age 71±7 years; BMI 29.1±3.4 kg/m2). Participants were asked to perform SSWS (n=53) and subsequently MWS (n=36). Both modalities were conducted on a 40m elliptical circuit for 3 minutes. RF was categorized as: "no risk," "dynamic risk" based on a positive timed up and go test, "static risk" based on a positive one-legged stance test, and "mixed risk" with both tests positive. To visualize the graphical variation in the morphospace of individuals according to RF, a principal component analysis (PCA) was conducted using RStudio, utilizing 6 kinematic variables: i) walking speed (WS), ii) cadence, iii) maximum foot clearance (MFC), iv) coefficient of variation (%CV) of MFC, v) stride length (SL), and vi) %CV of SL. In addition to 2 physiological variables: i) % of reserve heart rate used (%RHRu) and ii) the physiological cost index based on the relationship between heart rate and WS (heartbeats/meters). Results. For SSWS, the PCA dimensions explained 56% of the data variability, with gait safety indicators such as WS, cadence, SL, and MFC explaining RF. Gait variability explains mixed RF, while the physiological cost index and %RHRu are associated with dynamic RF. In MWS conditions, PCA explains 60% of the data variability, where the elderly persons without RF are associated with WS, SL, and MFC. On the other hand, MFC variability is related to dynamic RF, and physiological variables are associated with mixed RF. Conclusions. The gait parameters that best explain safe and efficient walking are kinematic parameters of the swing phase, while variability and physiological cost are indicators of dynamic and mixed RF.

RESUMO

OBJECTIVES: To evaluate whether low bone mineral density (BMD) has an association with the presence of head and neck soft tissue calcifications (STC), aging, and impaired mandibular canal cortices visibility. MATERIALS AND METHODS: Panoramic radiographs of 1000 women aged between 50 and 75 years old were evaluated by two examiners to classify BMD using mandibular cortical index (C1- normal, C2-moderately eroded and C3-severely eroded), the presence of STC, and also the mandibular canal cortices visibility at the ramus region. Chi-square test evaluated the association between the variables (α = 5%). RESULTS: There was no association between bone loss and the presence of head and neck soft tissue calcifications, except for calcified thyroid cartilage, which was less visualized at C3 group than others (p < 0.05). Women aged 61 to 70 years old presented higher bone loss than those between 50 and 60 (p < 0.05). The mandibular canal was more poorly visualized at C3 group than C1 and C2 (p < 0.05). CONCLUSIONS: In general, no association between BMD and the presence of STC was found. However, greater bone loss had a positive correlation with aging and impaired mandibular canal cortices visibility. CLINICAL RELEVANCE: No relationship between bone mineral density and the existence of soft tissue calcifications was found. Nevertheless, increased bone loss was positively associated with aging and a reduced mandibular canal cortices visibility. This finding highlights the clinical importance of considering bone density factors when planning treatment strategies for patients with related disorders.

Assuntos

RESUMO

Introdução: Em pacientes em enfermarias, eventos adversos evitáveis podem decorrer de deterioração clínica despercebida, frequentemente antecedida por alterações nos sinais vitais, fornecendo oportunidade para intervenção precoce. A adoção de Equipe de Resposta Rápida (ERR) pode melhorar esse desfecho, porém é altamente dependente do monitoramento dos parâmetros fisiológicos e da notificação da ERR. Objetivo: Avaliar a qualidade das informações em prontuários e da resposta assistencial a pacientes em enfermarias com agravamento do estado clínico, resultando em óbito ou transferência para UTI em um Hospital Universitário e fornecer dados para comparação de resultados após implantação da ERR. Material e Métodos: Estudo documental retrospectivo, entre junho de 2013 e julho de 2014, em 128 prontuários de pacientes com piora clínica que resultou em óbito ou admissão em UTI ("evento"). Foram coletados os parâmetros fisiológicos, a pontuação no Escore para Alerta Precoce e o Plano de Ação registrado em 11 momentos que antecederam o "evento", resultando em 11 escores. A relação entre a pontuação do Escore de Alerta Precoce e a execução do Plano de Ação foi classificada como "adequada", "inadequada" ou "ausente". Resultados: Quanto mais se afastava momento de ocorrência do "evento", maior foi o número de dados faltantes, ocasionando Escores de Alerta Precoce não calculáveis. O número de casos adequados foi menor quanto mais distante estava o "evento" do momento da aferição dos parâmetros fisiológicos. Conclusão: Os tempos de resposta foram inadequados ao Plano de Ação. A falha em socorrer pacientes em deterioração clínica é complexa e multifatorial, mas acredita-se que no presente relato isto se deveu, pelo menos em parte, à anotação inadequada dos parâmetros fisiológicos. Esforços devem ser envidados no sentido de reforçar a importância do registro dos parâmetros fisiológicos, de reconhecer, de intervir e de comunicar agravos, essenciais para o correto funcionamento das alças aferente e eferentes das ERR.

Introduction: Preventable adverse events may result from unnoticed clinical deterioration in inpatients, which are often preceded by changes in warning signs, providing an opportunity for early intervention. The adoption of the Rapid Response Team (ERR) can improve the outcome; however, it is highly dependent on monitoring of the physiological parameters and on notification of the ERR. Objective: To evaluate the quality of information in medical records and the care response to patients in wards with worsening of the clinical status, which resulting in death or transfer to the ICU in a University Hospital and provide data for future comparison of results after ERR deployment. Material and Methods: Documentary retrospective study, between June 2013 and July 2014, of 128 medical records of patients with clinical worsening who died in death or admission to the ICU ("event"). The physiological parameters, the score on the Early Warning Score and the Action Plan recorded in 11 moments that preceded the "event" were collected, resulting in 11 scores. The relationship between the Early Warning Score and Action Plan execution was classified as "adequate", "inadequate" or "absent". Results: The further away from the moment of occurrence of the "event", greater the number of missing data, causing non- calculable Early Warning Scores. The number of adequate cases was smaller the further away the "event" was from the moment of measurement of the physiological parameters. Conclusion: Response times were inadequate to the Action Plan. Failure to rescue patients in the clinic is a complex and multifactorial, but it is believed that in the present report this was due, at least in part, to inadequate recording of physiological parameters. Efforts should be made to reinforce the importance of recording physiological parameters, recognizing, intervening, and communicating injuries, which are essential for the correct functioning of the afferent and efferent loops of the ERR.

RESUMO

Traveling to high altitudes for entertainment or work is sometimes associated with acute high altitude pathologies. In the past, scientific literature from the lowlander point of view was primarily based on mountain climbing. Sea level scientists developed all guidelines, but they need modifications for medical care in high altitude cities. Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions that some travelers can face. We present how to diagnose and treat acute high altitude pathologies, based on 51 years of high altitude physiology research and medical practice in hypobaric hypoxic diseases in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI - IPPA). These can occasionally present after flights to high altitude cities, both in lowlanders or high-altitude residents during re-entry. Acute high altitude ascent diseases can be adequately diagnosed and treated in high altitude cities following the presented guidelines. Treating these high-altitude illnesses, we had no loss of life. Traveling to a high altitude with sound medical advice should not be feared as it has many benefits. Nowadays, altitude descent and evacuation are not mandatory in populated highland cities, with adequate medical resources.

Assuntos

RESUMO

Hypoxic exposure is safely associated with exercise for many pathological conditions, providing additional effects on health outcomes. COVID-19 is a new disease, so the physiological repercussions caused by exercise in affected patients and the safety of exposure to hypoxia in these conditions are still unknown. Due to the effects of the disease on the respiratory system and following the sequence of AEROBICOVID research work, this study aimed to evaluate the effectiveness, tolerance and acute safety of 24 bicycle training sessions performed under intermittent hypoxic conditions through analysis of peripheral oxyhemoglobin saturation (SpO2), heart rate (HR), rate of perceived exertion (RPE), blood lactate concentration ([La-]) and symptoms of acute mountain sickness in patients recovered from COVID-19. Participants were allocated to three training groups: the normoxia group (GN) remained in normoxia (inspired fraction of O2 (FiO2) of ∼20.9%, a city with 526 m altitude) for the entire session; the recovery hypoxia group (GHR) was exposed to hypoxia (FiO2 ∼13.5%, corresponding to 3,000 m altitude) all the time except during the effort; the hypoxia group (GH) trained in hypoxia (FiO2 ∼13.5%) throughout the session. The altitude simulation effectively reduced SpO2 mean with significant differences between groups GN, GHR, and GH, being 96.9(1.6), 95.1(3.1), and 87.7(6.5), respectively. Additionally, the proposed exercise and hypoxic stimulus was well-tolerated, since 93% of participants showed no or moderate acute mountain sickness symptoms; maintained nearly 80% of sets at target heart rate; and most frequently reporting session intensity as an RPE of "3" (moderate). The internal load calculation, analyzed through training impulse (TRIMP), calculated using HR [TRIMPHR = HR * training volume (min)] and RPE [TRIMPRPE = RPE * training volume (min)], showed no significant difference between groups. The current strategy effectively promoted the altitude simulation and monitoring variables, being well-tolerated and safely acute exposure, as the low Lake Louise scores and the stable HR, SpO2, and RPE values showed during the sessions.

RESUMO

BACKGROUND: Congenitally corrected transposition of the great arteries is a complex pathology characterised by atrioventricular and ventriculo-arterial discordance. Optimal surgical approaches are still a matter of debate. OBJECTIVE: To evaluate the outcomes of different surgical treatments in a single centre. METHODS: Between 1998 and 2020, 89 patients were studied. The cohort was divided into three groups: physiologic, anatomic, and univentricular repair. RESULT: Physiologic correction (56.18%) was associated with significant tricuspid valve regurgitation progress (42%) and complete AV block (30%) compared to anatomic repair. Right ventricular systolic dysfunction was developed in 14%. Instead, anatomic correction (30.34%) (double switch 59% and Rastelli type 40.7%) presented moderate to severe aortic regurgitation (4%) and left ventricular systolic dysfunction (11%). Complete AV block was developed in 14.8%. Rate of reintervention was 34% for physiologic and 26% for anatomic. Univentricular palliation (13.8%) presented no complications or late mortality during the follow-up. The overall survival at 5 and 10 years, respectively, was 80% (95% CI 69, 87) and 75% (95% CI 62, 84). There was no statistically significant difference in mortality between the groups (p log-rank = 0.5752). CONCLUSION: Management of congenitally corrected transposition of the great arteries remains a challenge. In this cohort, outcomes after physiologic repair were satisfactory in spite of the progression of tricuspid regurgitation and the high incidence of AV block. Anatomic repair improved tricuspid regurgitation but increased the risk of aortic regurgitation and left ventricular systolic dysfunction. The Fontan group showed the lowest incidence of complications.

RESUMO

OBJECTIVES: Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. DESIGN: Multicenter retrospective cohort study. SETTING: Three pediatric cardiac ICUs at tertiary academic children's hospitals. PATIENTS: Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Postoperative patients were identified who successfully weaned off initial vasoactive infusions (n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) (n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [sd 19.0] vs 6.4 [sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5-6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007). CONCLUSIONS: During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.

RESUMO

Acute high-altitude illnesses are of great concern for physicians and people traveling to high altitude. Our recent article "Acute Mountain Sickness, High-Altitude Pulmonary Edema and High-Altitude Cerebral Edema, a View from the High Andes" was questioned by some sea-level high-altitude experts. As a result of this, we answer some observations and further explain our opinion on these diseases. High-Altitude Pulmonary Edema (HAPE) can be better understood through the Oxygen Transport Triad, which involves the pneumo-dynamic pump (ventilation), the hemo-dynamic pump (heart and circulation), and hemoglobin. The two pumps are the first physiologic response upon initial exposure to hypobaric hypoxia. Hemoglobin is the balancing energy-saving time-evolving equilibrating factor. The acid-base balance must be adequately interpreted using the high-altitude Van Slyke correction factors. Pulse-oximetry measurements during breath-holding at high altitude allow for the evaluation of high altitude diseases. The Tolerance to Hypoxia Formula shows that, paradoxically, the higher the altitude, the more tolerance to hypoxia. In order to survive, all organisms adapt physiologically and optimally to the high-altitude environment, and there cannot be any "loss of adaptation". A favorable evolution in HAPE and pulmonary hypertension can result from the oxygen treatment along with other measures.

Assuntos

RESUMO

A perda óssea dentária e a formação de lesões periapicais surgem como uma consequênc ia do desequilíbrio da homeostase óssea. Os osteoblastos, juntamente com os osteoclastos e osteócitos, atuam na formação e na reabsorção óssea. Vários marcadores de formação óssea são produzidos por osteoblastos ativos e refletem diferentes aspectos da dif erenciação osteoblástica e da remodelação óssea. Com isso, muitos autores têm explorado o uso de fitoterápicos, visando obter novos compostos que apresentem propriedades terapêuticas, como os flavonoides, e que estimulem a neoformação óssea e o reparo da r egião periapical. O objetivo deste estudo foi avaliar in vitro a citotoxicidade e efeito indutor de mineralização de flavonoides sobre células osteoblásticas humanas. Para isso, células osteoblásticas da linhagem Saos expostas aos seguintes flavono2 foram ides: quercetina, miricetina e seus derivados taxifolina, isoquercitrina, rutina, ampelopsina e EGCG, além de pinocembrina, crisina e canferol, de forma isolada e combinada. Foi avaliado o efeito citotóxico, a atividade de fosfatase alcalina e indução de n mé todo de Shapiroódulos de mineralização. Os resultados foram analisados p elo Wilk, e as variáveis foram submetidas à análise de ANOVA seguida pelo teste de Tukey para comparar entre os grupos e/ou concentrações ou teste de Dunnett para comparar entre cada grupo e o controle, com nível de significância de 5%. A viabilidade da cultura de osteoblastos não teve uma redução estatisticamente significativa na presença da maioria dos compostos, exceto crisina a 100µM. Taxifolina, isoquercitrina, rutina, ampelopsina e EGCG foram os compostos que estimularam significativamente a atividade da fosfatase alcalina, juntamente com as combinações taxifolina+isoquercitrina, taxifolina+ampelopsina e taxifolina+rutina a 25/25 µM. Quanto a formação de nódulos de mine ralização, ampelopsina, isoquercitrina, rutina, pinocembrina e miricetina isolados e taxifolina+isoquercitrina, taxifolina+ampelopsina e taxifolina+rutina combinados obtiveram os melhores resultados, variando de acordo com as concentrações. Concluise que a taxifolina, isoquercitrina, rutina e ampelopsina e combinações de taxifolina com esses flavonoides são citocompatíveis e apresentam efeito indutor de mineralização em osteoblastos Saos-2(AU)

Dental bone loss and the formation of periapical lesions arise as a consequence of imbalance of bone homeostasis. Osteoblasts, together with osteoclasts and osteocytes, act in bone formation and resorption. Several markers of bone formation are produced by active osteoblasts and reflect different aspects of osteoblastic differentiation and bone remodeling. Thus, many authors have explored the use of phytotherapics in order to obtain new compounds with therapeutic properties, such as flavonoids, and also stimulate bone neoformation and periapical region repair. The objective of this study was to evaluate in vitro the cytotoxicity and inducing effect of flavonoid mineralization on human osteoblastic cells. For this, osteoblastic cells of the Saos-2 lineage were exposed to the following flavonoids: quercetin, myricetin and its derivatives taxifoline, isoquercitrin, rutin, ampelopsin and EGCG, in addition to pinocembrin, chrysin and kaempferol, in an isolated and combined manner. The cytotoxic effect, the activity of alkaline phosphatase and the induction of mineralization nodules were evaluated. The results were analyzed using the Shapiro-Wilk method, and the variables were submitted to ANOVA analysis followed by the Tukey test to compare between groups and/or concentrations or Dunnett's test to compare between each group and the control, with a level of 5% significance. The viability of the osteoblast culture did not have a statistically significant reduction in the presence of most compounds, except 100 µM chrysin. Taxifoline, isoquercitrin, rutin, ampelopsin and EGCG were the compounds that significantly stimulated the activity of alkaline phosphatase, together with the combinations taxifoline+isoquercitrin, taxifoline+ampelopsin and taxifoline+rutin at 25/25 µM. As for the formation of mineralization nodules, ampelopsin, isoquercitrin, rutin, pinocembrin and myricetin alone and taxifoline+isoquercitrin, taxifoline+ampelopsin and taxifoline+rutin combined obtained the best results, varying according to the concentrations. It is concluded that taxifoline, isoquercitrin, rutin and ampelopsin and combinations of taxifolin with these flavonoids are cytocompatible and have a mineralization-inducing effect on Saos-2 osteoblasts(AU)

Assuntos

RESUMO

Physical training stimulates the development of physiologic cardiac hypertrophy (CH), being a key event in this process the inhibition of the Na+/H+ exchanger. However, the role of the sodium bicarbonate cotransporter (NBC) has not been explored yet under this circumstance. C57/Bl6 mice were allowed to voluntary exercise (wheel running) for five weeks. Cardiac mass was evaluated by echocardiography and histomorphometry detecting that training promoted the development of physiological CH (heart weight/tibia length ratio, mg/mm: 6.54 ± 0.20 vs 8.81 ± 0.24; interstitial collagen content, %: 3.14 ± 0.63 vs. 1.57 ± 0.27; and cross-sectional area of cardiomyocytes, µm2: 200.6 ± 8.92 vs. 281.9 ± 24.05; sedentary (Sed) and exercised (Ex) mice, respectively). The activity of the electrogenic isoform of the cardiac NBC (NBCe1) was estimated by recording intracellular pH under high potassium concentration and by measuring action potential duration (APD). NBCe1 activity was significantly increased in isolated cardiomyocytes of trained mice. Additionally, the APD was shorter and the alkalization due to high extracellular potassium-induced depolarization was greater in this group, indicating that the NBCe1 was hyperactive. These results are online with the observed myocardial up-regulation of the NBCe1 (Western Blot, %: 100 ± 13.86 vs. 202 ± 29.98; Sed vs. Ex, n = 6 each group). In addition, we detected a reduction in H2O2 production in the myocardium of trained mice. These results support that voluntary training induces the development of physiologic CH with up-regulation of the cardiac NBCe1 in mice. Furthermore, the improvement in the antioxidant capacity contributes to the beneficial cardiovascular consequences of physical training.

Assuntos

RESUMO

Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene "solute carrier family 34 member 2". The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.

Assuntos

RESUMO

Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene "solute carrier family 34 member 2". The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.

RESUMO

Objective: To investigate the prevalence of calcified triticeous cartilage (CTC)-compatible images on digital panoramic radiographs of a significant Brazilian population sample. Methods: In this retrospective study, 2500 digital panoramic radiographs were analyzed by a trained examiner using contrast and brightness adjustments of the Adobe® Photoshop® CC 2015 software. Data were collected and exported for statistical analysis (p-value <0.05 was considered statistically significant). Results: The prevalence of CTC-compatible images was 4.5% (61.1% in women and 38.9% in men). The most prevalent age ranged between 51 and 60 years (32.7%), and bilateral occurrence had a higher prevalence (46.9%). Women between the ages of 61 and 70 years showed a significantly higher prevalence of CTC-compatible images (p=0.027). Conclusion: This study showed a low prevalence of CTC-compatible images, which mainly occurred in women close to 70 years of age.

Objetivo: Investigar a prevalência de imagens compatíveis com calcificação da cartilagem tritícea (CCT) em radiografias panorâmicas digitais de uma significante amostra populacional brasileira. Métodos: Neste estudo retrospectivo, 2500 radiografias panorâmicas digitais foram analisadas por um examinador treinado utilizando ajustes de contraste e brilho através do software Adobe® Photoshop® CC 2015. Os dados foram coletados e exportados para análise estatística (p<0,05 foi considerado como valor estatisticamente significante). Resultados: A prevalência de imagens compatíveis com CCT foi de 4,5% (61.1% em mulheres e 38.9% em homens). A idade mais prevalente variou entre 51 e 60 anos (32,7%), sendo a ocorrência bilateral a mais comum (46,9%). Mulheres com idade entre 61 e 70 anos apresentaram prevalência significativamente maior de imagens compatíveis com CCT (p=0,027). Conclusão: O presente estudo evidenciou uma baixa prevalência de imagens compatíveis com CCT, que ocorreram, principalmente, em mulheres com idade próxima aos 70 anos.

Assuntos

RESUMO

El análisis de la interfase entre función orgánica y física tiene una raíz histórica de larga data por parte de los especialistas en morfología humana en el campo de la salud y ciencias del deporte. En la actualidad cuando en décadas recientes se ha incrementado el descenso de la edad de los participantes en los eventos de alta competencia, se hace necesario explorar las particularidades sobre la dinámica del crecimiento y la maduración biológica que podrían condicionar el desempeño atlético. Desde esta perspectiva, la presente revisión se enfoca en la maduración biológica y su posible impacto en las diferencias inter individuales, las cuales están correlacionadas con los cambios que se experimentan en la velocidad del crecimiento. Así mismo se destaca la importancia del momento cuando se alcanza el punto máximo de velocidad lineal, la relevancia de la proporcionalidad corporal asociada a especialidades deportivas e inclusive diferencias encontradas de acuerdo a la posición de juego. Se reporta por otra parte, la importancia de los componentes cardiovasculares y fisiológicos asociados al estado de maduración que marcan su huella en el desempeño atlético. Así mismo se pone de relieve el rol potencial de la participación en deportes de alta competencia asociado a riesgos y beneficios en el crecimiento y maduración del joven atleta. Finalmente y dada la complejidad del tema, se sugiere la intervención de un equipo multidisciplinario en capacidad de analizar el impacto del crecimiento, maduración y entrenamiento en el desempeño del joven atleta(AU)

Relationship between organic morphology and athletic performance has been the concern long time ago for health and sport science. However in recent decades due to the young participation in organized sport, the swift has turned to highlight the kinetics of growth and the potential role of sport participation that influence growth and maturation. The aim of this brief article, review biological maturation (sexual, skeletal and somatic), inter-individual differences, the adolescent growth spurt, peak height velocity , as well as, cardiovascular and physiological related items, allowing for variation changes in size, body composition and proportionality that could influence performance. Keys findings for the review are consistent in showing the relevance of these factors along the process of growth and maturation. Some of the observations reported the potential role of sport participation that influence growth and maturation in terms of risk and or benefic. Attention has been given to the need of understanding the impact of growth, maturation along with training in performance. Finally it is suggested that this issue has to be focuses from an auxological approach given its complexity and to avoid the decline in youth participation. On the other hand, the need for the official support for the welfare of children involved in sport participation is requested(AU)

Assuntos

RESUMO

OBJECTIVE: To measure the time required in patients with tympanic perforation to reverse paradoxical stimulation (reverse pseudo-nystagmus) and to create a physical model of the process. METHOD: An analytical, observational, cross-sectional study with vestibular evaluation (electronystagmography) of 52 individuals with tympanic membrane perforation without otorrhea or concomitant disease. Increased duration of caloric stimulation in the presence of paradoxical stimulation (reverse pseudo-nystagmus) reverses nystagmic responses. RESULTS: Reversal of nystagmus was observed in 90.9% of patients. The average reversal time was 105.5 seconds. The physical model we prepared provided supporting evidenced for the effects seen in these individuals: warm stimulation in a moist environment initially caused a decrease in temperature (nystagmus to the unexpected side, which characterizes paradoxical stimulation in the warm caloric test); but, as time passed by, the moisture evaporated, and the temperature gradually increased (reversal of nystagmus). CONCLUSIONS: Increasing the stimulation time can be used as a strategy to differentiate reverse nystagmus from paradoxical stimulation. Confusion is thus avoided in diagnostic findings, allowing peripheral alterations to be distinguished from central ones.

Assuntos

RESUMO

INTRODUÇÃO: As mudanças físicas e psicológicas que a mulher enfrenta durante o climatério, podem prejudicar a sexualidade devido às alterações hormonais do período. OBJETIVOS: Com isso, o objetivo desta revisão é de investigar os possíveis recursos fisioterapêuticos usados sob um prisma cinesiológico funcional para minimizar os efeitos deste período. MÉTODOS: Uma busca eletrônica das seguintes bases de dados foi realizada: PubMed, Lilacs e Google Scholar. A pesquisa foi executada do ano de 2010 até o ano de 2018, utilizando as seguintes combinações de palavras: disfunção sexual feminina AND menopausa AND fisioterapia, com os termos em português e inglês. RESULTADOS: Durante o climatério ocorre uma atrofia vaginal, e essa condição pode levar a dores durante o intercurso sexual que, por sua vez, podem gerar contratura no músculo do assoalho pélvico (MAP). Uma vez instaurada esta contratura a dor tende a aumentar, assim originando um ciclo vicioso de dor. A MAP durante o climatério também sofrem uma queda da sua função muscular, podendo gerar disfunções pélvicas como a incontinência urinária, os prolapsos de órgãos pélvicos e prejudicar a função sexual da mulher. CONCLUSÕES: A fisioterapia tem um grande arsenal de recursos terapêuticos que podem incrementar a musculatura pélvica e melhorar a qualidade de vida nesse período de declínio hormonal. Apesar de se necessitar de mais estudos a esse respeito, as técnicas fisioterapêuticas que obtiveram maior eficácia no tratamento da dispareunia em mulheres no climatério, descritas nesta revisão, foram a termoterapia na MAP, liberação manual dos ponto-gatilhos miofasciais da MAP e treinamento dessa musculatura. Sendo assim, a fisioterapia pélvica deve ser uma linha terapêutica a ser prescrita no climatério.

INTRODUCTION: The physical and psychological changes that the woman faces during the climacteric can damage sexuality due to the hormonal changes of the period. OBJECTIVES: Therefore, the objective of this review is to investigate the possible physiotherapeutic resources used under a functional kinesiological prism to minimize the effects of this period. METHODS: An electronic search of the following databases was performed: PubMed, Lilacs and Google Scholar. The research was performed from the year 2010 to the year 2018, using the following combinations of words: female sexual dysfunction AND menopause AND physiotherapy, with the terms in Portuguese and English. RESULTS: During climacteric vaginal atrophy occurs, and this condition can lead to pain during sexual intercourse which, in turn, may lead to contractures in the pelvic floor muscles (PFM), once this contracture is established, the pain tends to increase, thus giving rise to a vicious cycle of pain. PFMs during the climacteric also suffer a decrease of their muscular function, being able to generate pelvic dysfunctions, such as urinary incontinence, prolapses of pelvic organs and also to impair the sexual function of the woman. CONCLUSIONS: With this, physiotherapy has a great arsenal of therapeutic resources that can boost pelvic floor muscles and improve the quality of life in this period of hormonal decline. Despite the need for further studies in this regard, the physiotherapeutic techniques that were most effective in the treatment of dyspareunia in menopausal women, described in this review, were the thermotherapy in PFM, manual release of PFM myofascial trigger points and training of this musculature. Therefore, pelvic physiotherapy should be a therapeutic line to be prescribed in climacteric.

Assuntos

RESUMO

BACKGROUND: Currently there are campaigns to raise the awareness of the need to practice physical exercise with several objectives, mainly as a preventive measure. The Pilates method is a form of therapeutic exercise for maintaining and improving health. However, despite being popular, there is still no scientific evidence on the standardization and progression of the method. Therefore, the purpose of this study was to develop a protocol to monitor the progression of daily Pilates loads between the basic, intermediate, and advanced levels, as well as to analyze the effects of the method on psychometric, cardiorespiratory, and autonomic measures. METHODS/DESIGN: In total, 54 healthy men underwent 36 sessions of Pilates mat work. Before each training session, cardiorespiratory measures, pain (visual analogue scale), and a psychometric questionnaire were collected. Heart rate (HR), subjective perception of effort (SPE), and RR intervals were measured during the sessions and used later in the analysis of the progression of training load by monitoring the internal training load and heart rate variability. At the end of the sessions, cardiorespiratory measures, the visual analogue scale, and the psychometric questionnaire were measured again. After 15 min of rest, the final HR measurement was made and the participants noted the effort on the SPE scale. The psychometric, cardiorespiratory, and autonomic measures were evaluated before and after each of the 36 training sessions. DISCUSSION: This is a parallel randomized clinical trial of standardized Pilates training, with the aim of estimating training loads and measuring the efficacy of Pilates through clinical, cardiorespiratory, and autonomic outcomes. The protocol can easily be reproduced and could be used to support professionals in prescribing the method. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03232866 . Registered on 28 July 2017.

Assuntos

RESUMO

OBJECTIVES: The Internet of Things (IoT) and its applications are growing simultaneously. These applications need new intelligent devices along heterogeneous networking. Which makes them costly to implement indeed. Platforms and open devices designed for open-source hardware are possible solutions. This research was conducted under an IoT design, implementation, and assessment model for the remote monitoring of pulse oximetry via oxygen partial saturation (SpO2) and heart rate (HR) with low-energy consumption. METHODS: This study focused on the development of SpO2 and HR measurements that will allow the monitoring and estimation in real time of the user's state and health related to the established parameters. Measurements were acquired and recorded using a remote web server that recorded the acquired variables for further processing. The statistical analysis data allows comparison of the registered data measured with theoretical models. RESULTS: The IoT model was developed use Bluetooth low-energy devices, which comply with low-cost and open-hardware solutions operated via 'HTTP requests' for data transmission and reception from a cloud server to an edge device. Network performance assessment was conducted to guarantee the availability and integrity of the acquired values and signals. The system measured SpO2 and HR variables. The most significant result was to achieve energy consumption 20% lower than that of devices in the market. CONCLUSIONS: In summary, the acquired data validation based on the IoT model had a transmission error of 0.001% which proves its applicability in healthcare.

RESUMO

In recent years there has been substantial progress in the imaging evaluation of patients with lung disease requiring mechanical ventilatory assistance. This has been demonstrated by the inclusion of pulmonary ultrasound, positron emission tomography, electrical impedance tomography (EIT), and magnetic resonance imaging (MRI). The EIT uses electric current to evaluate the distribution of alternating current conductivity within the thoracic cavity. The advantage of the latter is that it is non-invasive, bedside radiation-free functional imaging modality for continuous monitoring of lung ventilation and perfusion. EIT can detect recruitment or derecruitment, overdistension, variation of poorly ventilated lung units (silent spaces), and pendelluft phenomenon in spontaneously breathing patients. In addition, the regional expiratory time constants have been recently explored.