Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 2018 - 15 Articles

RAPID COMMUNICATION

1 - Writing good English: is scientific English a Latin language in disguise?

Mauricio Rocha-e-Silva

MEDICALEXPRESS 2018;5:

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BACKGROUND: English is the lingua franca of science; it is the language of the two last world superpowers and the language of four out of the world's ten greatest producers of science; it is a fairly simple language and the most hybridized language in history, with Latin and French contributing 60% of the entire English lexicon. The object of this study is to determine whether the frequency of use of imported words is a function of literary genre.
METHOD: texts were randomly selected from (a) medical scientific original articles, (b) newspaper financial reports, (c) sport reportages, (d) literary texts and (e) colloquial English; for comparison a collection of similarly distributed texts were selected from Portuguese; the frequency of occurrence of Latin or Neo-Latin words was determined in the English texts as well as the occurrence of non-Latin or non-Neo-Latin words in the Portuguese texts; a oneway analysis of variance was used to determine whether significant differences occurred between genres in the two languages.
RESULTS: The frequency of occurrence of Latin/French words in English text was significantly dependent on the literary genre, being maximal in medical scientific texts and minimal in colloquial English; in contrast, the frequency of occurrence of non-Latin words in Portuguese was constant throughout the same literary genres.
CONCLUSION: The use of Latin/French words in English is directly proportional to the complexity of the literary genre, a phenomenon not observed in Portuguese, a typical Neo-Latin language.


Keywords: Medical Education; Scientific language; Ethymology.

LETTER TO THE EDITOR

ORIGINAL RESEARCH

3 - Analysis of Reliability of Peak Treadmill Running in Maximum Progressive Effort Test: Influence of Training Level

Alberto Souza de Sá Filho; Wendel Alves; Thiago Gottgtroy Miranda; Eduardo Portuga; Sérgio Machado

MEDICALEXPRESS 2018;5:

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OBJECTIVE: To determine the reliability (stability) of the peak velocity measurement (VPeak) derived from the incremental maximal effort test, as well as to establish the possible influence of the level of training on these responses.
METHOD: Thirty-eight male volunteers made two visits (3 - 5 days apart) to the training center where the study was conducted and performed maximal progressive running tests. The protocol consisted of increments of 0.5 km.h-1/min, starting at a running speed comfortable for each participant (7-9 km.h-1). All subjects were encouraged to achieve the maximum possible performance in both tests, with final voluntary exhaustion being the criterion for interruption.
RESULTS: The intra-class correlation coefficient presented excellent consistency of measurements (ICC = 0.975 - p = 0.001). The typical relative error of the measurement was 2.6% for the stability of the measurement of VPeak. Moreover, there were no significant differences between the individual coefficients of variation for measures 1 vs. 2 (p > 0.05). Graphical representation of Bland-Altman demonstrated a homogeneous distribution of the measurement error for all dependent variables.
CONCLUSION: Determination of VPeak exhibited excellent levels of reliability with small measurement errors. There was no influence of the training level on the reliability responses.


Keywords: Reliability; VO<sub>2Max</sub>; Aerobic Exercise; Aerobic Performance.

REVIEW

4 - Acute effect of uphill running: current scenario and future hypotheses

Alberto Souza Sá Filho; Sérgio Machado

MEDICALEXPRESS 2018;5:

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Strategies for metabolic adjustments are often considered by athletes throughout a running event. Planning for such events during training does not always include variations from level training, even though up/downhill exertion should definitely be a part of such planning. The differentiation of training stimuli, under adverse conditions of intensity and inclination, can generate differentiated benefits. However, uphill running raises expectations of deleterious effects. The imposition of different slope gradients throughout running could generate increased metabolic demands for sports performance. Thus, the present study aimed to answer questions mainly about the acute effects of uphill running, its relationship with aerobic performance, allowing us to introduce new hypotheses for future studies in the area on the subject. Gaps still need to be filled concerning the relevance of uphill running, and its determinants. Many of the points presently under scrutiny only lead to speculative explanations; for logical reasons, more studies should focus on the prescription of training at different slopes. This is the point at which specific conditioning is required, because the regulation of the effort and the energy cost resulting from the imposition of uphill running during competitive races depends heavily on previous experiences. This review will cover recently published research on the subject.


Keywords: Uphill Running; Kinematic Analysis; Stretching-Shortening Cycle; VO<sub>2Max</sub>.

5 - The Importance of Oral Health during Pregnancy: A review

Vinay Marla; Ritesh Srii; Deepak Kumar Roy; Hardik Ajmera

MEDICALEXPRESS 2018;5:

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Pregnancy is a transient physiological state which brings about different hormonal changes in a woman’s body. These effects are generalized and there are various oral changes as well. There are a number of especially important alterations in the periodontal conditions within the oral cavity. These changes have important implications as they have been known to cause adverse pregnancy outcomes. Better knowledge about these scenarios among health care professionals and women would go a long way toward avoiding or minimizing these adverse outcomes. Health education is an important tool in creating awareness among pregnant women regarding improvement of their oral health. Awareness among the health professionals and good inter-departmental collaboration would help toward a more efficient treatment of these pregnancy related conditions.


Keywords: oral health, oral health education, pregnancy

LETTER TO THE EDITOR

6 - Rapid progression of neurotoxoplasmosis in a patient with concomitant rheumatoid arthritis and systemic lupus erythematous

Matheus Fernandes de Oliveira; Cristiana Borges Pereira; Vitor Brito Silva; Maristela Carvalho Costa; Vitor Ribeiro Paes; Roberto El Ibrahim

MEDICALEXPRESS 2018;5:

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ORIGINAL RESEARCH

7 - Patients with pure dermatomyositis/polymyositis and anti-PM/Scl autoantibody resembling anti-synthetase syndrome

Samara Pereira Alves; Marilda Guimarães Silva; Isabela Bruna Pires Borges; Samuel Katsuyuki Shinjo

MEDICALEXPRESS 2018;5:

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OBJECTIVE: The anti-PM/Scl autoantibody has been described in patients with scleromyositis. However, there are scant studies evaluating its prevalence and reactivity in dermatomyositis and polymyositis.
METHOD: A cross-sectional, single center study evaluating the anti-PM/Scl autoantibody in 85 dermatomyositis and 32 polymyositis patients, without overlapping syndrome, was conducted between 2000 and 2016. Clinical data and complementary examinations were reviewed from electronic medical records with pre-parameterized information.
RESULTS: The mean age of dermatomyositis and polymyositis patients was 41.1 and 42.8 years, respectively. The presence of anti-PM/Scl was observed in 5 (5.9%) dermatomyositis and 2 (6.3%) polymyositis patients. Two of these patients also had the anti-Ku antibody. The relevant clinical manifestations of these 7 patients were constitutional symptoms (100% of cases), muscular (100%), pulmonary (85.7%) and joint (71.4%) involvement, “mechanic hands” (85.7%), Raynaud phenomenon (85.7%) and plantar hyperkeratosis (85.7%). The 7 patients had relapses of disease activity, but at conclusion of the present study, 5 had complete clinical response and 2 complete remission of the disease.
CONCLUSION: There is a low frequency of the anti-PM/Scl autoantibody in dermatomyositis and polymyositis patients. In addition, patients with this autoantibody exhibit a similar pattern of manifestations to that of antisynthetase syndrome.


Keywords: Autoantibodies; dermatomyositis; myositis; polymyositis.

8 - Insulin resistance is increased in adult patients with dermatomyositis

Diego Sales de Oliveira; Marilda Silva Guimarães; Samuel Katsuyuki Shinjo

MEDICALEXPRESS 2018;5:

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OBJECTIVE: To evaluate insulinemia in glucocorticoid naïve patients with dermatomyositis and to evaluate insulin resistance using the homeostatic model assessment of insulin resistance (HOMA2-IR).
METHODS: This cross-sectional study included 25 dermatomyositis, non-diabetic glucocorticoid naïve patients. The control group consisted of 50 volunteers matched for age, gender, ethnicity, weight and height. The HOMA2-IR index was calculated from baseline insulin and glucose data. The International Myositis Assessment & Clinical Studies Group (IMACS) parameters were used to evaluate disease status.
RESULTS: Mean age of the patients was 43.5 years and these were predominantly females. Patients had low disease activity according to IMACS parameters. Higher body mass index and waist circumference were observed in the dermatomyositis group compared to the control group. Insulin level and HOMA2-IR were also higher in patients with dermatomyositis. Moreover, analyzing dermatomyositis alone, the HOMA2-IR index correlated positively with weight, body mass index and waist circumference and was independent on disease status parameters.
CONCLUSIONS: Patients with dermatomyositis had higher values for basal insulinemia, insulin resistance, body mass index and waist circumference. Moreover, HOMA2-IR moderately correlated with these anthropometric parameters. These metabolic abnormalities are related to the development of metabolic syndrome, one of the main comorbidities observed in dermatomyositis.


Keywords: Glucose; insulin resistance; dermatomyositis; metabolic syndrome; myositis.

9 - Application of adiposity indices to a sample of physically active individuals living in the city of Ribeirão Preto, São Paulo, Brazil

Mirele Savegnago Mialich; Ana Maria Aiello; Bruna Ramos Silva; Alceu Afonso Jordão

MEDICALEXPRESS 2018;5:

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OBJECTIVE: To compare adiposity indexes in physical activity individuals to evaluate behavior, diagnostic ability and to determine which parameter best reflects and diagnoses body fatness.
METHODS: A cross-sectional study was performed on 100 physically active individuals (59% female). The participants were submitted to anthropometric and body composition evaluation; we measured weight, height, circumferences, blood pressure and bioelectrical impedance analysis. A physical activity questionnaire (IPAQ, short version) was applied, as well as a questionnaire about the possible use of nutritional supplementation. The data were statistically analyzed, with significance level set at p <0.05.
RESULTS: Mean age, height, weight and BMI were 24.2 ± 6.65 years, 169.5 ± 8.94 cm, 69.1 ± 14.83 kg and 23.9 ± 4.19 kg/m2 , respectively, with a significant difference between the genders, except for age. Most of the subjects were in the normal weight range, with a BMI of 18.5 to 24.9 kg/m2, and were very active. BMIfat correlated better with body fat for males (r = 0.896) and females (r = 0.935), followed by BMI (0.689 and 0.767, respectively) and BAI (0.590 and 0.718).
CONCLUSIONS: Adiposity indexes are viable alternatives for the diagnosis of obesity and should be more explored as fast, practical and low cost measures in clinical practice.


Keywords: Body composition, Fat mass, Adiposity index, Body mass index, Physically active individuals

10 - Cardiac vagal index varies according to field position in male elite football players

Claudio Gil Soares de Araújo; Altamiro Bottino; Flávio Gomes Ferreira Pinto

MEDICALEXPRESS 2018;5:

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BACKGROUND: Cardiac vagal index (CVI) is supposedly higher in athletes and may differ between sports and/or between field positions.
OBJECTIVE: To compare CVI: a) between elite football players vs. non-athletes and b) according to five football positions.
METHOD: 242 football players of the first Brazilian/Angolan division were divided in five positions (N): goalkeepers (17), defenders (44), wingers (34), midfielders (87) and forwarders (60) and compared with 303 age-matched healthy non-athletes. CVI was estimated from a 4-second exercise test by quantifying the ratio of two cardiac cycle durations, before and at the end of a fast unloaded cycling exercise.
RESULTS: Football players had resting and maximal heart rates of, respectively, 59 and 190 bpm and measured VO2max of 62.2 mL/(kg.min). Players and non-athletes showed similar CVI results (median-[P25-P75]) – 1.63- [1.46-1.84] vs 1.61-[1.41-1.81] (p = 0.22). Wingers tended to have a higher CVI (1.84-[1.60-1.99]), especially when compared to defenders (1.53-[1.41-1.72] (p = 0.01). There was a modest non-physiologically relevant association between VO2max and CVI (r = 0.15).
CONCLUSIONS: Football players did not differ from non-athletes in CVI; however, among players, wingers were more often vagotonic, which may represent a hemodynamic advantage for match situations, where rapid heart rate transitions and faster oxygen delivery to muscles are required.


Keywords: Sports; Autonomic nervous system; Heart rate; 4-second exercise test; Parasympathetic activity.

11 - Factors related to motorcycle accidents with victims: an epidemiological survey

Júlia Maria D'Andréa Greve; Marcelo Rosa Resende; Heráclito Barbosa da Silva; Gabriel Andreuccetti; Celso O. Bernini; Vilma Leyton

MEDICALEXPRESS 2018;5:

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OBJECTIVE: To evaluate the factors associated with traffic motorcycles accidents.
METHODS: The sample consisted of 285 motorcycle accident victims in São Paulo. Data were collected from 24-hour emergency service shifts regarding: conditions of the victims, security equipment, road and vehicle conditions.
RESULTS: Victims were mostly young men (92%); 23% used the motorcycle for work (average: 8 hours per day); 45% had owned a motorcycle for less than two years; 77% were licensed motorcycle drivers; 33% had less than four years of qualification; 31% had attended a course of defensive driving. Severe lesions were identified in 67% of the unlicensed drivers. Polytrauma occurred in 9% head trauma in 5% of the entire population. Lower limb fractures occurred more frequently than upper limb (17% vs. 12%). Most wore helmets (90%) but only 18% wore helmet, boots and jacket. Positive readings for alcohol (7%) and drugs (14%) occurred in 21% of victims. Most accidents occurred as a consequence of imprudence (88%), during the day (67%), in dry weather conditions (94%). A side impact was registered in 48% of cases; 80% of motorcycles had an engine capacity up to 250 cc. In 51% of the accidents the person responsible for the accident was the driver of the other vehicle in the accident.
CONCLUSION: Most accidents involve motorcyclists who are young male adults, use the motorcycle as a means of transport and do not consider safety, defensive driving and the use of alcohol and drugs as important factors.


Keywords: Motorcycle, Accidents, Epidemiology, Trauma.

12 - The influence of exercise order on strength performance in post menopause women

Jéssica Cid Jesus; Amanda Brown; Diogo Cardozo; Luiz Gustavo Dias dos Santos; Ingrid Dias; Fábio Cahuê; Verônica P. Salerno; Roberto Simão

MEDICALEXPRESS 2018;5:

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OBJECTIVE: Verify the influence of different exercise orders on the performance of the number of maximal repetitions in older women.
METHODS: Twelve older women (65.7 ± 5.6 years, 66.9 ± 9.5 kg, 1.56 ± 0.67 m, 27.4 ± 3.6 kg/m2) underwent four nonconsecutive visits and two different orders of Resistance Training. At the first visit, the volunteers were submitted to anamnesis, anthropometric evaluation and a 10RM test. On the second visit, a re-test of 10RM was performed. On the third and fourth visits, the volunteers performed two exercise sequences: sequence A: bench press, latissimus pulldown close grip, biceps curl, triceps extension; for sequence B the order was inverted. Performance was measured by the number of repetitions in each exercise. To determine differences in performance for sequence A vs. sequence B, repeated measures were performed by two-way ANOVA followed by the Tuckey post-hoc test.
RESULTS: The number of repetitions of each exercise varied significantly for the bench press, biceps curl and triceps extension between the exercise sequences.
CONCLUSIONS: The order of the exercises performed in a resistance training session can affect the performance in the number of repetitions in older women.


Keywords: Muscle Strength, Weight Lifting, Older People, Physical Fitness.

13 - McArdle’s disease: an underestimated or underdiagnosed myopathy in rheumatologic practice? Cases series and literature review

Pablo Arturo Olivo Pallo; André Macedo Serafim da Silva; Edmar Zanoteli; Samuel Shinjo

MEDICALEXPRESS 2018;5:

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OBJECTIVE: McArdle’s disease is a metabolic myopathy that manifests with varied clinical conditions and is often confounded with other diagnoses. Herein, the authors report a case series and carry out a literature review.
METHODS: A cross-sectional single-center study evaluating 12 patients with McArdle’s disease was conducted.
RESULTS: Mean age at onset of symptoms was 28.0±17.4 years, while age at disease diagnosis was 39.0±14.8 years. History of intolerance to physical exercises was observed in 10 cases; muscle weakness in 9, second wind phenomenon in only 1 case. The presence of cramps, fatigue and myalgia was observed in 12, 11 and 9 of the cases respectively. Median creatine phosphokinase level was 5951U/L. Most of the patients (83.3%) were initially diagnosed with another condition (polymyositis, inclusion body myositis, fibromyalgia and/or muscular dystrophy), and approximately half had received glucocorticoids and/or immunosuppressants prior to definitive diagnosis. All patients underwent muscular biopsy, which revealed the presence of subsarcolemmal vacuoles characterized by glycogen deposits, and negative histochemical reaction for the myophosphorylase enzyme.
CONCLUSION: The present study reinforces the presence of clinical variability among patients and shows that McArdle’s disease should be considered one of the differential diagnoses of inflammatory myopathies and other rheumatic diseases.


Keywords: Fibromyalgia; glycogen storage disease; myopathies; myophosphorylase; myositis.

14 - Spontaneous pneumomediastinum in dermatomyositis: a case series and literature review

Pablo Arturo Olivo Pallo; Samuel Katsuyuki Shinjo

MEDICALEXPRESS 2018;5:

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OBJECTIVES: To describe a case series of spontaneous pneumomediastinum in dermatomyositis and to review the literature.
METHODS: This was a retrospective single-center case series, reporting 9 patients with pneumomediastinum and defined dermatomyositis, followed from 2005 to 2017.
RESULTS: Median age of patients: 33 years; cutaneous and pulmonary involvement in all cases; constitutional symptoms in 88.8% of patients; involvement of the joints in 11.1%, gastrointestinal tract in 44.4%, and muscles in 77.7%; subcutaneous emphysema was observed in 55.5% and pneumothorax in 11.1%, respectively. Muscle weakness was observed in 77.7% of cases and with a median level of serum creatine phosphokinase of 124U/L. Drawing on results for our literature review, the overall analysis showed that the risk factors associated with spontaneous pneumomediastinum were: (a) a history of interstitial pneumopathy; (b) normal or low levels of muscle enzymes; (c) previous use of systemic glucocorticoid; (d) over 50% of patients had subcutaneous emphysema; (e) high mortality as a consequence of severity of the interstitial lung disease.
CONCLUSIONS: Our case series revealed that pneumomediastinum is a rare complication in dermatomyositis that occurs in patients with a history of interstitial pneumopathy and may be accompanied by subcutaneous emphysema and pneumothorax.


Keywords: Dermatomyositis; myositis; pneumomediastinum; pneumopathy.

15 - Unveiling the specific role of psychological and cardiorespiratory variables in the therapeutic effect of an aerobic exercise training protocol for panic disorder

Aline Sardinha; Raphael Marques Gomes; Claudio Gil Soares de Araújo; Rafael C Freire; Marina Dyskant Mochcovitch; Andrea Camaz Deslandes; Antonio E Nardi

MEDICALEXPRESS 2018;5:

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BACKGROUND: There is limited evidence regarding the use of exercise training in the treatment of panic disorder.
OBJECTIVE: To describe the role of psychological and cardiorespiratory variables in the therapeutic effect of a 12-week exercise training in panic disorder patients.
METHODS: Eleven symptomatic panic disorder patients completed 24 sessions, 2 sessions/week, 70%VO2max) aerobic exercise training in addition to regular pharmacological treatment. Assessment was performed at baseline, six and 12-week periods. Exercise training intensity was individualized according to maximal cardiopulmonary exercise testing data.
RESULTS: Patients who exercised in conjunction with pharmacotherapy obtained significant improvements in several variables. Exercise training produced a selective, rather than a general anxiolytic impact. An early (6-week) effect was observed in fear of physiological arousal, interoceptive conditioning and in the frequency and intensity of panic attacks. Smaller additional 12-week effects were found in health concerns and agoraphobic cognitions, with no significant impact in agoraphobia.
CONCLUSION: A 12-week aerobic exercise training protocol was well-tolerated and able to improve several psychological and cardiovascular indicators in most patients with panic disorders. Further studies are needed to identify the best training protocols and long-term effects of exercise, as well as interactions between cardiorespiratory and psychological variables in this context.


Keywords: Mental health, Anxiety sensitivity, Interoceptive exposure, Exercise, Cardiovascular risk.