Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 1(4)2014 - 11 Articles

REVIEW

1 - Updating technology of shunt valves

Matheus Fernandes de Oliveira; Renan Muralho Pereira; Fernando Gomes Pinto

MEDICALEXPRESS 2014;1(4):166-169

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Cerebrospinal fluid shunts are one of the greatest advances of modern neurosurgery and represent a shift in the treatment of hydrocephalus. The underlying physical principle is quite simple and consists of diverting the flow of cerebrospinal fluid to either intracranial structures, jugular system, right heart atrium, pleura, peritoneum or to other natural cavities, such as the omental bursa and even the bladder. All systems operate by means of a differential pressure between the proximal catheter and distal catheter and are composed of ventricular and distal catheters, and a valve, which is the device that allows unidirectional cerebrospinal fluid flow. Current valve technology allows control of the shunt through regulation of drainage pressure, flow regulation or anti-siphon devices. There are valves with low, medium and high pressure designed to open and allow the flow out of CSF when the intraventricular pressure rises above the opening pressure. In contrast to fixed pressure and programmable pressure, valves with flow regulation attempt to maintain constant flow despite changes in the fluid pressure and patient position. Anti-siphon devices are used to avoid the siphon effect and prevent under- or over-drainage of fluid. We discuss briefly the current aspects of hydrodynamics and update valve technology.


Keywords: hydrocephalus; cerebrospinal fluid shunt; technology.

ORIGINAL RESEARCH

2 - Pain assessment in patients with adolescent idiopathic scoliosis at different stages of disease evolution

Alberto Ofenhejm Gotfryd; Fernando José Franzin; Patricia Rios Poletto; Luiz Carlos de Abreu; Vitor E. Valenti; Luciano Miller Reis Rodrigues

MEDICALEXPRESS 2014;1(4):170-173

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OBJECTIVE: The correlation between pain complaints and the severity of the spinal curvature in adolescent idiopathic scoliosis remains controversial. The aim of this study was to evaluate the presence and intensity of back pain in adolescent idiopathic scoliosis patients at different stages of the disease.
METHODS: Sixty-four individuals participated in this study with scoliotic curves (Cobb angles) between 20 and 90 degrees. Patients were divided into four groups according to the scoliotic curves: Group 1 (with 20 to 45 degrees) Group 2 (curves greater than 45 degrees before surgery), Group 3 (curves greater than 45 degrees one year after posterior spinal arthrodesis with pedicle screws) and Group 4 (healthy adolescents between 11 and 18 years of age; control group).
RESULTS: The scores obtained from the pain domain of the SRS-30 questionnaire (specifically developed for the assessment of adolescent scoliosis) were significantly worse for patients with scoliosis, regardless of the evolutionary phase of the disease. Patients who underwent surgical treatment presented statistically better results one year after surgery than did the group of patients with moderate Cobb angles.
CONCLUSION: Patients with adolescent idiopathic scoliosis had a higher intensity of back pain than healthy individuals. Pain was reduced one year after spinal arthrodesis.


Keywords: scoliosis; adolescent; pain.

3 - Immunophenotype of lung granulomas in HIV and non-HIV associated tuberculosis

Andréia A. Silva; Thais Mauad; Paulo H.N. Saldiva; Ruy C. Pires-Neto; Ricardo D. Coletta; Edgard Graner; Pablo A. Vargas

MEDICALEXPRESS 2014;1(4):174-179

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OBJECTIVE: To describe the immunophenotype of pulmonary TB granulomas from autopsied patients with tuberculosis (TB group) and from HIV patients with tuberculosis (TB/HIV group), and to identify the Mycobacterium species using polymerase chain reaction (PCR) technique.
METHODS: Lung samples of 15 TB group patients and 23 TB/HIV group patients were selected. Histopathologic analyses and immunohistochemistry tests were performed to describe the granulomas and to detect the infectious agent (anti-BCG). CD4, CD8, CD20 and CD68 were evaluated to characterize the immnophenotype of the granulomas. Polymerase Chain Reaction was performed to identify the mycobacterium species.
RESULTS: CD4 + T lymphocytes were the cells with highest density in the TB group, whereas CD68 cells exhibited the highest density in the TB/HIV group. Comparison between groups showed that the CD4 + T density was significantly higher in the TB patients; whereas, CD68 density was significantly higher in the TB/HIV patients. M. tuberculosis was identified in 8 cases of each group; M. avium was only found in one case of the TB/HIV group.
CONCLUSION: With the advent of AIDS, the immunological profile of TB has changed. This may be associated with the depletion of CD4 + T lymphocytes in lung granulomas. M. tuberculosis was the major etiological agent of TB in both groups.


Keywords: tuberculosis; HIV; AIDS; autopsy.

4 - Short term exposure to cigarette smoke on general activity and anxiety

Vitor E. Valenti; Rodrigo Y. Taniguchi; Carlos A. Lazarini; Luiz Carlos de Abreu; Flávia C. Goulart

MEDICALEXPRESS 2014;1(4):180-183

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OBJECTIVE: Sidestream cigarette smoke differs from mainstream smoke because it presents more intense effects. We aimed to evaluate the performance of rats exposed to short term sidestream cigarette smoke during open field and elevated plus-maze tests.
METHOD: Cigarette exposure was carried out during 5 days. The rats were exposed to the cigarette smoke during one hour. Elevated plus-maze and open field tests were applied according to previous studies. During the open field test we measured the time spent stopped, raising and the number of times that the rat intercepted each cross (locomotion). We examined the number of entries in the open and closed arms and the time spent in the closed and open arms during elevated plus-maze test.
RESULTS: Control group presented significantly higher values regarding locomotion and raising during the open field test. No difference was noted between the groups regarding the elevated plus-maze test.
CONCLUSION: Sidestream cigarette smoke exposure for short term on rats affects their performance during the open field test.


Keywords: tobacco; anxiety; rats.

5 - Ambulatory blood pressure monitoring in prepubertal idiopathic dilated cardiomyopathy children

Aline Cristina Tavares; Edimar Alcides Bocchi; Iram Soares Teixeira-Neto; Guilherme Veiga Guimarães

MEDICALEXPRESS 2014;1(4):184-189

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BACKGROUND AND OBJECTIVES: Ambulatory blood pressure monitoring is recommended for several diseases in childhood; however, there are no reports about its use in the monitoring of children with dilated cardiomyopathy so far. We evaluated the pattern of ambulatory blood pressure monitoring in children with dilated cardiomyopathy and correlated it to height, weight, and body mass index.
METHODS: Prepubertal children with dilated cardiomyopathy were assessed by ambulatory blood pressure monitoring. Data were collected for systolic and diastolic blood pressure. Means, for 24 hours, daytime, and nighttime, dipping pattern and levels above the normal expected values were computed.
RESULTS: Children with cardiomyopathy have the same blood pressure as normal kids. Weight was moderately but significantly correlated to nighttime systolic blood pressure. Children with left ventricular ejection fraction < 50% have 6% less diastolic blood pressure dipping. These same children were also receiving higher doses of carvedilol and captopril.
CONCLUSIONS: Children with idiopathic dilated cardiomyopathy have the same blood pressure values and blood pressure dipping patterns on ambulatory blood pressure monitoring as normal healthy children are expected to have. Children with low left ventricular ejection pressure have lower dipping pattern.


Keywords: ambulatory blood pressure monitoring; children; cardiomyopathy.

REVIEW

6 - Parameters involved and viability of immunosuppression on islet allotransplantation procedure in rodents

Leandro R. Iuamoto; Alberto Meyer; Eleazar Chaib; Luiz AC D'Albuquerque

MEDICALEXPRESS 2014;1(4):190-194

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INTRODUCTION: Autoimmunity and rejection after transplantation must still be overcome in the technical development of islet transplantation for the treatment of type 1 diabetes. It is therefore necessary to inhibit rejection of islet grafts while maintaining the graft's ability to secrete insulin. Although the use of immunosuppressants reduces the acute rejection rate in transplant patients, long-term side effects must be prevented.
OBJECTIVES: The aim of the present study is to organize and analyze the parameters of immunosuppression involved in experimental attempts of allotransplantation in rodents.
METHODOLOGY: This review was performed using the Pubmed database to search for published articles containing the keywords "rodent islet transplantation". The inclusion criteria involved allotransplantation with rodents' islets and the reference lists of the publications retrieved that were eligible. The exclusion criteria involved isotransplantation, autotransplantation, and xenotransplantation such as transplantation in other species.
RESULTS: Twenty studies related to allotransplantation were selected for this systematic review based on immunosuppression.
CONCLUSION: New immunosuppressive drugs increased the survival rates of allotransplantation in rodents by reducing the side effects. The advances in immunosuppression raise the possibility of overcoming autoimmunity and rejection after allotransplantation.


Keywords: islet transplantation; allograft; immunosuppressive therapy.

ORIGINAL RESEARCH

7 - Aerobic training intervention in panic disorder: a case-series study

Raphael Marques Gomes; Aline Sardinha; Claudio Gil Soares de Araújo; Antônio Egidio Nardi; Andrea Camaz Deslandes

MEDICALEXPRESS 2014;1(4):195-201

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OBJECTIVES: The anxiolytic effect of regular aerobic exercise in panic disorder patients is well known. However, a protocol for aerobic exercise intervention as an adjunct non-pharmacologic treatment for panic disorder is still lacking. Our aim was to propose and present a pilot study about an aerobic training protocol that could be replicable, safe and viable for other clinical trials with panic disorder patients.
METHODS: A total of 24 exercise sessions (twice/week) of treadmill walking at controlled intensity (75% VO2max) were completed by four panic disorder patients.
RESULTS: No major complications were observed. The benefits of the aerobic training intervention were reflected in favorable changes in the Panic and Agoraphobia Scale, the Cardiac Anxiety Questionnaire, the Anxiety Sensitivity Index and in the Body Sensations Questionnaire scores, in spite of no significant differences in physiological variables.
CONCLUSIONS: The proposed protocol of aerobic training intervention was shown to be a safe and potentially useful tool as adjunct non-pharmacologic treatment of panic disorder. Further studies are needed in order to determine whether higher intensities and/or longer exercise interventions would induce physiological benefits while still being feasible and safe.


Keywords: physical exercise; anxiety; non-pharmacological treatment.

RAPID COMMUNICATION

8 - Anthropometric indicators as predictors of serum triglycerides and hypertriglyceridemia in older adults

Raildo Silva Coqueiro; Daniele Fares; Aline Rodrigues Barbosa; Tassla Dél Rei Oliveria Passos; Wanderley Matos Reis-Júnior; Marcos Henrique Fernandes

MEDICALEXPRESS 2014;1(4):202-205

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OBJECTIVES: To compare the relation between anthropometric indicators and serum triglycerides, and to identify the indicators most strongly associated with hypertriglyceridemia in older adults.
METHODS: A population-based, cross-sectional study conducted with 316 subjects (>60 years old) in 2011. The following were checked: triglycerides, body mass index, waist-to-hip ratio, waist-to-height ratio, conicity index, body adiposity index, triceps skinfold thickness, and waist and calf circumference.
RESULTS: Linear regression analyses showed that waist-to-hip ration (R2 = 0.065) in women and body mass index (R2 = 0.123) in men were the indicators that best correlated with triglyceride. Poisson's regression showed that body mass index, calf circumference, and triceps skinfold thickness were the only indicators associated with hypertriglyceridemia (triglycerides > 150 mg/dl) among female subjects. For male subjects, with the exception of waist-to-hip ratio and the conicity index, all other indicators were associated with hypertriglyceridemia.
CONCLUSION: The anthropometric indicators that best explain the variability of triglyceride differ according to sex. Body mass index, calf circumference, and triceps skinfold thickness are the best anthropometric indicators for hypertriglyceridemia in older adults of both sexes.


Keywords: Anthropometry; Health of the Elderly; Risk Factors; Dyslipidemia.

ORIGINAL RESEARCH

9 - Cardiac autonomic responses induced by auditory stimulation with music is influenced by affinity

Bruna de O. Plassa; Réveni C. Milan; Heraldo L. Guida; Luiz Carlos de Abreu; Rodrigo D. Raimundo; Luana A. Gonzaga; Vitor E. Valenti

MEDICALEXPRESS 2014;1(4):206-210

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INTRODUCTION: We aimed to evaluate the effects of musical auditory stimulation on cardiac autonomic regulation in subjects who enjoy and who do not enjoy the music.
METHOD: The study was performed in young women (18-27 years old) divided in two groups (1) volunteers who enjoyed the music and (2) volunteers who did not enjoy the music. Linear indices of heart rate variability were analyzed in the time domain. The subjects were exposed to a musical piece (Pachelbel: Canon in D Major) during 10 minutes. Heart rate variability was analyzed at rest with no music and during musical auditory stimulation.
RESULTS: In the group that enjoyed the music the standard deviation of normal-to-normal R-R intervals (SDNN) was significantly reduced during exposure to musical auditory stimulation. We found no significant changes for the other linear indices. The group composed of women who did not enjoy the music did not present significant cardiac autonomic responses during exposure to musical auditory stimulation.
CONCLUSION: Women who enjoyed the music presented a significant cardiac autonomic response consisting of a reduction in heart rate variability induced by the musical auditory stimulation. Those who did not enjoy the musical piece presented no such response.


Keywords: Hearing; Autonomic nervous system; Cardiovascular physiology.

REVIEW

10 - Chondroprotective agents: are we being too dogmatic?

Gustavo Constantino de Campos

MEDICALEXPRESS 2014;1(4):211-213

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Recent major guidelines to osteoarthritis treatment have ceased to recommend the use of chondroprotective drugs; this new standing is based on new data, but comes mostly from a reassessment of existing information through methods of evidence-based medicine; these were more rigorous, with significant changes in the search and inclusion criteria, minimum follow-up requirement and the use of the concept of minimum clinically important improvement. However, currently available data includes a wealth of high quality studies demonstrating long term symptomatic relief and additional benefits such as global efficacy that match results described for non steroidal anti-inflammatory drugs. It is an undisputed concept that osteoarthritis should be managed as an integrated package of care rather than through single treatments, ministered alone or in succession. Thus, when osteoarthritis is in fact managed through any single treatment in order to conduct a controlled trial, it logically follows that it would be difficult to produce significant symptomatic improvements. Moreover, it is well established that positive placebo effects are a significant entity in osteoarthritis research. Therefore, it seems unreasonable to disqualify statistically significant results favoring chondroprotective agents used as monotherapy vs. a powerful placebo and consider them to be "not clinically relevant".
We performed a review of the literature and found high quality data showing that chondroprotective agents are safe, effective and decrease the use of non-steroidal anti-inflammatory agents. We therefore suggest that recent guidelines are overly dogmatic.


Keywords: Osteoarthritis; chondroprotective drugs; treatment.

ORIGINAL RESEARCH

11 - Sequential hemodynamic assessment in aortic valve insufficiency in rats

Marcia Kiyomi Koike; Beatriz Bojikian Matsubara; Luiz Shiguero Matsubara; Clovis de Carvalho Frimm

MEDICALEXPRESS 2014;1(4):214-218

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OBJECTIVE: In animal models of aortic insufficiency, the right common carotid artery is typically used to damage valve leaflets; this strategy impedes subsequent assessments of left ventricular hemodynamics. The present study aimed to establish an alternative technique that would allow subsequent left ventricular catheterization to monitor sequential hemodynamics in rats with aortic insufficiency.
METHOD: The right internal and external carotid artery branches were dissected. The internal branch was temporarily occluded. The external branch was also occluded, and the proximal, patent segment was catheterized. Via the catheter, ventricular hemodynamic evaluations were performed before and after incurring leaflet damage. The catheter was removed, and the right external branch was permanently ligated. The temporary right internal carotid occlusion was released, and blood flow was re-established. After four weeks, left ventricular hemodynamic measurements were performed from the right common carotid artery.
RESULTS: Four weeks after the establishment of aortic insufficiency, left ventricular hemodynamic parameters showed a classic chronic hemodynamic pattern, similar to that observed in patients with chronic or compensated aortic insufficiency. Systolic blood pressure was elevated and pulse pressure was increased.
CONCLUSION: This new method of carotid artery catheterization permitted two sequential, distinct hemodynamic measurements, in experimental model of aortic valve insufficiency.


Keywords: aortic insufficiency; hemodynamic; cardiac remodelling.