MedicalExpress, Volume: 1, Issue: 2, Published: 2014
  • In the April 2014 issue of MedicalExpress Editorial

    Rocha-e-Silva, Mauricio
  • Clinical pharmacology of ibuprofen in preterm infants: A meta-analysis of published data Reviews

    Pacifici, Gian Maria

    Abstract in Portuguese:

    RESUMO: OBJETIVOS: O ibuprofeno é um inibidor não-seletivo da ciclooxigenase pertencente à classe de drogas anti-inflamatórias não-esteroidais do ácido propiónico; é fármaco disponível sem receita médica nos Estados Unidos. Em recém-nascidos, o ibuprofeno é usado para fechar o canal arterial patente e mostrou-se mais eficaz que a indometacina. Esta meta-análise determina se existem diferenças na taxa de fechamento de canal arterial patente apósa administração oral versus intravenosa de ibuprofeno em prematuros; examina também o metabolismo, a farmacocinética e efeitos renais adversos do ibuprofeno. MÉTODO: A pesquisa bibliográfica foi realizada utilizando as bases de dados PubMed e EMBASE. Além disso, os livros "Neofax: a Manual of Drugs Used in the Neonatal Care" by Young and Mangum and the "Neonatal Formulary" foram consultados. RESULTADOS: A taxa de fechamento do canal arterial patente foi de 89% com o ibuprofeno oral (9 publicações) vs. 75% com ibuprofeno intravenoso (13 publicações), p = 0,011. A meia-vida (t1/2) do ibuprofeno foi de 43,1 e 26,8 horas em crianças no tereiro e no quinto dia de vida, respectivamente. Em adultos, a meia-vida de ibuprofeno é de 2 horas. A rápida diminuiçãoda meia-vida deve-se ao rápido aumento de atividade dos citocromos CYP2C9 e CYP2C8, que metabolizam o ibuprofeno; estes agentes apresentam grande elevação no fígado durante as primeiras semanas de vida. O ibuprofeno reduz a filtração glomerular renal e as taxas de transporte tubular de sódio. CONCLUSÃO: O ibuprofeno oral é mais eficaz do que o ibuprofeno intravenoso para fechar o canal arterial persistente. A via oral produz menos efeitos adversos renais do que a intravenosa e apresenta uma relação risco/benefício mais favorável.

    Abstract in English:

    OBJECTIVES: Ibuprofen is a non-selective anti-inflammatory cyclooxygenase inhibitor drug of the propionic acid class of non-steroidal agents, available without prescription in the USA. In preterm infants, ibuprofen is used to close the Patent Ductus Arteriosus and it was found to be more effective than indomethacin. This metaanalysis determined whether differences exist in the closure rate of Patent Ductus Arteriosus following the oral vs. intravenous ibuprofen administration to preterm infants; it examines metabolism, pharmacokinetics and adverse renal effects of ibuprofen. METHOD: The bibliographic search was performed using PubMed and EMBASE databases as search engines. In addition, the books "Neofax: a Manual of Drugs Used in the Neonatal Care" by Young and Mangum and the "Neonatal Formulary" were consulted. RESULTS: Patent Ductus Arteriosus closure was 89% with oral ibuprofen (9 reports) vs. 75% with intravenous ibuprofen (13 reports); p = 0.011. The half-life (t1/2) of ibuprofen is 43.1 and 26.8 hours in infants on the 3rd and 5th day of life, respectively. In adults, the half-life of ibuprofen is 2 hours. The rapid shortening of ibuprofen t1/2 is due to the rapid increase of cytochromes CYP2C9 and CYP2C8 activities, which metabolize ibuprofen and which surge in the liver during the first weeks of life. Ibuprofen reduces the renal glomerular filtration and the sodium tubular transport rates. CONCLUSION: Oral ibuprofen is more effective than intravenous ibuprofen to close patent ductus arteriosus. Ibuprofen has fewer renal adverse effects than intravenous ibuprofen and has the most favourable risk/benefit ratio.
  • Alteration of vascular permeability in burn injury Reviews

    Huang, Qiaobing; Zhao, Ming; Zhao, Keseng

    Abstract in English:

    Massive burn trauma is characterized by hypovolemic shock induced by the loss of plasma from vessels. The elevation of vascular permeability and the ultimate formation of tissue edema are important events during the development of severe burn injury. The underlying mechanisms involved in the increased permeability include the activation of multiple endothelial signaling pathways and the changes of endothelial structure and functions. This review summarizes some of our recent discoveries in endothelial mechanisms during burninduced vascular hyper-permeability. The emphasis is put on tight junction, adherens junction, and the contraction of endothelial cells. The effects of several protein kinases, including Rho kinase, protein kinase C, and MAPKs are also stressed.
  • Analysis of velocity and direction of trunk movement in wheelchair basketball athletes Original Research

    Santos, Sileno da Silva; Monteiro, Carlos Bandeira de Mello; Cantelli, Bruno; Alonso, Angelica Castilho; Mochizuki, Luis; Ré, Alessandro H. Nicolai; Greve, Julia Maria D'Andréia

    Abstract in Portuguese:

    RESUMO: OBJETIVO: O controle postural do tronco é importante para estabilizar o corpo e gerar força muscular durante atividades esportivas. Quando o tronco está estabilizado, é mais fácil e mais seguro transferir forças aplicadas ao longo do corpo para executar qualquer tarefa motora, porque incrementa-se a ação muscular e reduzem-se as cargas articulares. O controle postural do tronco é importante para estabilizar o corpo inteiro e gerar força muscular durante atividades esportivas. O objetivo deste estudo é verificar a velocidade e direção do movimento do tronco em atletas de basquetebol em cadeira de rodas. MÉTODO: Participaram 26 atletas de basquetebol em cadeira de rodas testados no sistema "NeuroCom Balance Master", através do protocolo "Mudança Rítmica de Carga". Foram convidados a lançar todo o corpo para a direita, esquerda, para frente e para trás. Testes avaliaram esses movimentos em baixa, média e alta velocidade. RESULTADO: A velocidade de movimento foi significativamente afetada pela velocidade e direção da tarefa. A maior velocidade de movimento foi observada para a tarefa rápida na direção esquerda/direita. Não houve interação entre a tarefa e sua direção. CONCLUSÃO: Atletas de basquetebol em cadeira de rodas moveram-se mais rapidamente na direção esquerda/direita. Este resultado sugere que o controle postural para o indivíduo em cadeira de rodas é dependente da direção do movimento.

    Abstract in English:

    OBJECTIVE: Postural control of the trunk is important to stabilize the entire body and to generate muscle force during sports activities. When the trunk is stable, it is easier and safer to transfer applied forces along the body to perform any motor task because it enhances muscle action and reduces joint loads. Postural control of the trunk is important to stabilize the entire body and to generate muscle force during sports activities. The aim of this study is to verify the velocity and direction of trunk movement in wheelchair basketball athletes. METHOD: Participants were 26 wheelchair basketball athletes, they were tested on the NeuroCom Balance Master System, protocol: Rhythmic Weight Shift. They were asked to sway the entire body to the right, left, forward and backward. Trials evaluated these movements in low, medium and high velocities. RESULT: Movement velocity was very significantly affected by task speed and task direction. The highest movement velocity was observed for the fast task and for the left/right direction. There was no interaction between the task and its direction. CONCLUSION: Wheelchair basketball athletes moved their body faster in the left/right direction. This result suggests that postural control is direction-dependent for the wheelchair-bound individual.
  • Emotional memory in patients with agoraphobic panic disorder compared to a control group Original Research

    King, Anna Lucia Spear; Valença, Alexandre; Cardoso, Adriana; Nardi, Antonio Egidio

    Abstract in Portuguese:

    RESUMO: OBJETIVOS: Mentes racionais fazem conexões lógicas entre causa e efeito, ao passo que as mentes emocionais não fazem tais distinções, seguindo uma lógica instintiva. Este artigo investiga a memória emocional episódica em pacientes com transtorno de pânico com agorafobia, em comparação com um grupo controle. MÉTODO: Sessenta voluntários, 30 pacientes com transtorno do pânico com agorafobia e 30 controles saudáveis foram expostos ao mesmo slide-show de 11 slides, mas narrados aleatoriamente em duas versões diferentes: uma narrativa emocional e uma neutra. Cada grupo de 30 participantes foi subdividido aleatoriamente em dois subgrupos de 15; cada subgrupo de pacientes e controles foi exposta à narrativa emocional ou à neutra. Uma semana depois, os pacientes e os controles voltaram para responder questionários sobre os slides e respectivas histórias narradas. RESULTADOS: Pacientes com transtorno de pânico expostos ao conteúdo emocional da história exibiram memória emocional significativamente aumentada, fato evidenciado por uma melhor lembrança da narração emocional quando comparados aos pacientes expostos à versão neutra. Comparados aos controles, pacientes com transtorno de pânico apresentaram maior discrepância entre as narrativas emocional e neutra. CONCLUSÃO: Os resultados mostraram que os pacientes com transtorno de pânico foram afetados significativamente pelo conteúdo da versão emocional da história, no que diz respeito à sua memória emocional. O mesmo não foi observado para o grupo de controle exposto à mesma versão emocional da história. Conclui-se que as características da condição transtorno do pânico tiveram influência na memória emocional.

    Abstract in English:

    OBJECTIVES: Rational minds make logical connections between cause and effect, whereas emotional minds make no such distinctions, following instinctive logic. This paper investigates episodic emotional memory in patients with panic disorder with agoraphobia in comparison to a control group. METHOD: Sixty volunteers, 30 patients with panic disorder with agoraphobia and 30 healthy controls were exposed to the same slideshow of 11 slides, but randomly exposed to two different narrated versions, namely one emotional and one neutral. Each group of 30 participants was randomly subdivided into two subgroups of 15; each subgroup of patients and controls was exposed either to the emotional or to the neutral narrative. One week later patients and controls returned to answer questionnaires about the slides and respective narrated stories. RESULTS: Panic disorder patients exposed to the emotional content of the story showed a significantly enhanced emotional memory, evidenced by a better recollection of the emotional narration when compared to patients exposed to the neutral version. Compared to controls, panic disorder patients exhibited greater discrepancy between the emotional versus the neutral narrative. CONCLUSION: Results showed that the panic disorder patients were significantly impacted by the content of the emotional version of the story, with respect to their emotional memory; the same was not observed for the control group exposed to the same emotional version of the story. We conclude that the characteristics of the panic disorder condition had an influence on emotional memory.
  • Major depression in high-risk obstetric inpatients and outpatients Original Research

    Juhas, Thiago Robles; Benute, Gláucia Rosana Guerra; Lucia, Mara Cristina Souza de; Francisco, Rossana Pulcineli Vieira

    Abstract in Portuguese:

    RESUMO: OBJETIVO: Avaliar e comparar a presença de depressão intensa em gestantes de alto risco entre pacientes ambulatoriais e internadas. MÉTODO: Estudo exploratório, descritivo transversal realizado com 542 mulheres grávidas de alto risco, divididas em dois grupos: 278 pacientes ambulatoriais e 264 pacientes hospitalizadas atendidas em hospital público universitário do Estado de São Paulo, Brasil. O diagnóstico de depressão maior foi avaliado mediante aplicação da versão brasileira do Primary Care Evaluation of Mental Disorders. Para análise estatística foi utilizado o teste do Χ2, adotando nível de significância de 5% (p<0.05). RESULTADOS: Sessenta mulheres (11.0%) foram diagnosticadas com depressão maior, sendo vinte e cinco (9.0%) pacientes ambulatoriais e trinta e cinco (13.0%) pacientes internadas. Não houve diferença estatisticamente significante em relação à depressão (p = 0.11). Foi identificada diferença estatística entre os grupos quando avaliados os sintomas: insônia ou hipersonia (p<0.01); fadiga ou perda de energia (p = 0.02); diminuição da concentração (p<0,01); e agitação ou retardo psicomotor (p<0,01). CONCLUSÕES: A hospitalização pode intensificar alguns sintomas depressivos. A elevada proporção de mulheres com depressão em tratamento ambulatorial ou internadas, demonstra a necessidade do acesso ao suporte psicossocial durante a gestação, especialmente em gestante de alto risco.

    Abstract in English:

    OBJECTIVE: To evaluate and compare the presence of major depression in high-risk obstetric patients among ward and ambulatory patients. METHOD: An exploratory, descriptive, and cross-sectional study was carried out among 542 high-risk pregnant women divided into two groups: 278 were outpatients receiving ambulatory care, and 264 were ward patients. Both attended a public university hospital in the State of São Paulo, Brazil. Major depressive disorder was evaluated using the Brazilian version of the Primary Care Evaluation of Mental Disorders. The Χ2 test was used in the statistical analysis with a level of significance of 5% (p<0.05). RESULTS: Sixty women (11.0%) were diagnosed with major depression, twenty-five (9%) were outpatients and thirty-five (13%) were ward patients. There was no statistically significant difference between groups with respect to the major depression (p = 0.11). Statistically significant differences were found between outpatients and ward patients as follows: insomnia or hypersomnia (p<0.01); fatigue or loss of energy (p = 0.02); diminished concentration (p<0.01); and restlessness or psychomotor retardation (p<0.01). CONCLUSIONS: Hospitalization may intensify some depressive symptoms. The high proportion of women with major depression demonstrates the need for access to psychosocial support during the pregnancy period, especially in pregnant women at high-risk.
  • Antinociceptive effects of saccharose and aqueous extract of Cordyline dracaenoides kunth (uvarana) in experimental models after induction of hyperalgesia using capsaicin Original Research

    Ribeiro, Larissa Gulogurski; Kerppers, Ivo Ilvan; Paz, Isabel de Almeida; Rolão, Marcos Paulo Polowei; Oliveira, Thais Barbosa de; Eltchechem, Camila da Luz; Pereira, Mário César da Silva

    Abstract in Portuguese:

    RESUMO: OBJETIVO: Há evidância de que substâncias doces, tais como a sacarose podem acentuar as propriedades analgésicas dos opióides endógenos, com alívio da dor; sabe-se também Cordyline dracaenoides Kunth, vulgarmente conhecida como uvarana, é utilizada na medicina popular como anti-inflamatório e agente analgésico. O objetivo do presente estudo foi comparar os efeitos antinociceptivos de extratos aquosos da uvarana com a sacarose em ratos. MÉTODO: Foram utilizados vinte e quatro ratos Wistar, divididos em dois grupos de doze, um tratado com uvarana e outro com sacarose. A capsaicina foi usada para a induçãoo da hiperalgesia e o limiar nociceptivo foi avaliado a cada cinco minutos durante um total de 50 minutos. Valores basais foram obtidos e em seguida foram administradas oralmente extrato de uvarana ou sacarose em três diferentes concentrações (100, 250 e 300 g/L). O limiar nociceptivo foi avaliada através do teste de retirada da cauda (tail flick test). RESULTADO: Em comparação com os valores basais, auvarana e a sacarose provocaram efeitos antinociceptivos significativos e comparáveis em concentrações de 250 e 300 g/L, respectivamente. CONCLUSÃO: Ambas as substâncias causaram efeitos antinociceptivos semelhantes em relação aos valores basais.

    Abstract in English:

    OBJECTIVE: There is evidence that sweet substances such as saccharose can enhance the analgesic properties of endogenous opioids, leading to pain relief; it is also known that Cordyline dracaenoides Kunt, commonly known as uvarana, is used in folk medicine as an anti-inflammatory and analgesic agent. The aim of the present study was to compare the antinociceptive effects of uvarana aqueous extracts vs. saccharose in rats. METHOD: Twenty-four Wistar rats were used, divided into two groups of twelve, namely a uvarana and a saccharose group. Capsaicin was used to induce hyperalgesia and the nociceptive threshold was assessed every five minutes for a total of 50 minutes Baseline values were obtained and this was followed by administration of uvarana or saccharose at threedifferent concentrations (100, 250 and 300 g/L) The nociceptive threshold was assessed using the tail flick test. RESULT: In comparison to baseline values, uvarana and saccharose provoked significant and comparable antinociceptive effects at concentrations of 250 g/L and 300 g/L, respectively. CONCLUSION: Both substances caused similar antinociceptive effects in comparison to baseline values.
  • Reliability Index of inter- and intra-rater of manual goniometry and computerized biophotogrammetry to assess the range of motion of internal and external shoulder rotation Original Research

    Antonietti, Leandro; Luna, Natalia; Nogueira, Gabriel; Ito, Ana; Santos, Marcelo; Alonso, Angelica; Cohen, Moises

    Abstract in English:

    OBJECTIVES: Measurements of the joint angles of the shoulder complex are important for diagnosis, assessment and monitoring of the treatment progression of movement disorders, provided that they can be seen as valid and reliable. The object of this study was to determine inter- and intra-rater reliability of manual goniometry and computerized biophotogrammetry for the assessment of range of motion of the medial and lateral rotations of the shoulder. METHODS: Four evaluators (two for goniometry and two for biophotogrammetry) assessed 11 males, 16 - 26 years old, right-handed and with no shoulder anomalies. A universal plastic goniometer was used for the goniometry assessment. The biophotogrammetry assessment involved the use of a digital camera Sony DSC-W1 (5.1Mp), with non-reflective markers placed on the subjects. Photographic frames were analyzed the though the SAPO software (version 0.67). Each evaluator was blinded to data from all other valuators; inter-rater datas were compared. Seven days after the first assessment, all measurements were repeated in order to complete the intra-rater comparison. The Wilcoxon test was used to check statistical significance, the Spearman correlation was calculated and inter-class correlations coefficients were determined. RESULTS: Inter-class correlations for inter- and intra-rater goniometry results were 0.897 and 0.830 respectively; the corresponding biophotogrammetric values were 0.982 and 0.954, all representing excellent reliability levels. CONCLUSION: Goniometry and biophotogrammetry are reliable methods for assessment of shoulder rotation; however, biophotogrammetry has been shown to be more reliable.
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