Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 2 (1) 2015 - 7 Articles


1 - February 2015: MedicalExpress stands to become a LILACS indexed journal

Mauricio Rocha e Silva

MEDICALEXPRESS 2015;2(1):M150101



2 - Cardiac autonomic modulation adjustments in isometric exercise

Ana Márcia dos Santos António; Marco Aurélio Cardoso; Joice A. T. do Amaral; Luiz Carlos de Abreu; Vitor E. Valenti

MEDICALEXPRESS 2015;2(1):M150102

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OBJECTIVE: Isometric exercise is characterized by promoting an overload on the cardiovascular system due to pulsatile contraction followed by a significant increase in muscle blood flow. The hemodynamic responses during exercise and during recovery from endurance exercise are well documented. However, there are few studies with hard data regarding the influence of isometric exercise on autonomic control, which can be obtained by analysis of heart rate variability. Thus, the object of this study was to analyze reports on cardiac autonomic regulation in isometric exercise.
METHODS: The articles used in this study were selected fromPubmed, PEDro,Medline, Lilacs and SciELO. The search wasmade by crossing the following keywords: isometric exercise, autonomic nervous system, cardiovascular system, and heart rate variability, which were defined based on descriptors of Health Headings (MeSH).
RESULTS: The search provided 17 articles in isometric exercise autonomic modulation characterized by decreased vagalmodulation followedby increased sympatheticmodulation and its reversal shortly after the endof the activity.
CONCLUSION: During isometric exercise, increased sympathetic modulation and reduced vagal modulation of the sinus node have been reported.

Keywords: Autonomic Nervous System; Exercise; Cardiovascular System.

3 - Clinical pharmacology of methadone in neonates and in their mothers. A review

Gian Maria Pacifici

MEDICALEXPRESS 2015;2(1):M150103

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The outstanding properties of methadone are its analgesic activity, its efficacy by oral route, its extended duration of action in suppressing of withdrawal symptoms in physically dependent individuals, and its tendency to show persistent effects with repeated administration. The analgesic activity of methadone, a racemate, is almost entirely the result of its R-methadone content. Respiratory depression is the chief hazard associated with methadone, and its peak respiratory depressant effects typically occur later, and persist for longer than its peak analgesic effect, particularly in the early dosing period. Methadone undergoes extensive metabolism in the liver and the major metabolic pathway is N-demethylation by CYP3A4 and CYP2B6. There is a remarkable interindividual variability in the rate of methadone metabolism. Mothers with opioid addiction are often placed on methadone before delivery in an attempt to reduce illicit opioid usage. Methadone is useful because it can be taken orally, only requires one or two daily doses and has a long-lasting effect. Weaning should not be attempted during pregnancy and, because of increased clearance, the dose of methadone may need to be increased in the last 3 months of pregnancy. Significant positive correlations were found for umbilical cord methadone concentrations, methadone mean daily dose, mean dose during the third trimester, and methadone cumulative daily dose. In conclusion, umbilical cord methadone concentrations were correlated to methadone dose. A total of 55-94% of infants born to opioid-dependent mothers in US show signs of opioid withdrawal. Methadone is useful to avoid use of opioid illicit drugs.

Keywords: methadone; neonates; metabolism; pharmacokinetic side-effects.

4 - Conscious sedation vs general anesthesia in pediatric dentistry - a review

Cátia Carvalho Silva; Carla Lavado; Cristina Areias; Joana Mourão; David de Andrade

MEDICALEXPRESS 2015;2(1):M150104

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INTRODUCTION: Performing dental treatments on pediatric patients who present behavioral problems is usually a great clinical challenge. Depending on the patients' emotional maturity and their physical, psychological and mental skills, the usual behavior control techniques may not offer adequate efficacy and safety when dental procedures are being carried out. In these circumstances, alternative and more invasive methods such as conscious sedation and general anesthesia may become necessary.
OBJECTIVE: To compare the indications and contraindications of conscious sedation and general anesthesia in pediatric dentistry.
METHOD: Literature research undertaken through the MEDLINE/Pubmed, Science Direct and B-on search engines between April and June 2013 using a 5 year time frame and the following keywords: conscious sedation, general anesthesia, pediatric dentistry and guidelines.
RESULTS: Conscious sedation is recommended to anxious patients who have dental and needle phobia, to patients that present an increased vomiting reflex and also to patients with special needs but capable of communicating. General anesthesia is indicated for non-cooperating patients under the age of four, in mouth breathers, in children ASA III or higher and in pediatric patients who do not communicate.
CONCLUSIONS: Each technique must be selected according to the characteristics showed by patient. Although conscious sedation and general anesthesia introduce benefits to pediatric dentistry, they should not be regarded as priority intervention techniques for behavior control. The pediatric dentist's previous knowledge of these techniques provides a better level of dental care quality as well as more safety and less discomfort for their patients.

Keywords: Dentistry; anesthesia; sedation; pediatrics.


5 - Effects of shortening and lengthening resistance exercise with low-intensity on physical fitness and muscular function in senior adults

Eisuke Hiruma; Shizuo Katamoto; Hisashi Naito

MEDICALEXPRESS 2015;2(1):M150105

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OBJECTIVE: To identify effects of shortening and lengthening low-intensity resistance exercise together with aerobic exercise on physical fitness and muscular strength in senior adults.
METHOD: Seventeen males (58-72yrs) and sixteen females (58-68yrs) participated in this study: seven male and six female as control subjects, ten male and ten female as exercise subjects: these subjects completed an 8-week training program (two times/week) consisting of 15 minutes of aerobike exercise at 50% of VO2max and six shortening-lengthening resistance exercises (3 exercises for upper body and 3 exercises for lower body). The subjects exercised resistance training (5 sec for shortening, 5 sec for lengthening) at 50% of one repetition maximum. Primary outcome measures included physical fitness tests (grip strength, sit-ups, sit-and-reach, 6 minutes of walking, single-leg balance test with open eyes), timed up-and-go test (UP&GO), and one repetition maximum of the same six exercises. This study examined joint angle of knee flexion and elbow flexion, visual analog scale, and muscular strength test to identify delayed onset muscle soreness.
RESULTS: The resting blood pressures in both exercising groups were significantly decreased after 16 sessions of exercise intervention (p < 0.05). The training group significantly increased muscular strength and improved physical fitness, UP&GO, and one repetition maximum of 6 resistance exercises (p < 0.05). The combined exercise did not induce delayed onset muscle soreness.
CONCLUSION: The present study showed that the combined shortening and lengthening resistance training with aerobic exercise in senior male and female adults was effective in decreasing blood pressure and increasing muscular strength and physical fitness.

Keywords: muscle strength; blood pressure; delayed onset muscle soreness.

6 - Dizziness profile and clinical features: a population based survey in São Paulo City, Brazil

Roseli Saraiva Moreira Bittar; Raquel Mezzalira; Signe Schuster Grasel; Jeanne Oiticica

MEDICALEXPRESS 2015;2(1):M150106

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OBJECTIVE: This is a cross-sectional epidemiological survey designed to estimate the prevalence of dizziness among the adult population of the city of São Paulo, Brazil, and to describe the clinical features and level of discomfort.
METHOD: This population based study was conductedin the city of São Paulo, Brazil, between April and October 2012. A total of 1,960 household interviews were completed. The following variables were assessed: gender, age, clinical characteristics of dizziness, and dizziness disability index. Chi-square test, Student's t-test,Tukey test and logistic regression were used for statistical analysis.
RESULTS: The dizziness prevalence in São Paulo was 42%. Peaks of dizziness were observed in two age groups: 49% among the 46 to 55 year-old, and 44% among the elderly subjects(. 65 years-old). Vestibular vertigo was detected in 8.3% of patients, with a strong female preponderance (p , 0.001). Symptoms caused disability in 27% of the affected respondents and were more frequent among women (p , 0.001). These sought medical care more frequently (p , 0.001). The dizziness disability index was significantly higher (p ¼ 0.0165) among subjects with a lower educational level. There was no correlation between dizziness discomfort and the type of job.
CONCLUSION: The prevalence of dizziness in São Paulo, Brazil, was established at 42%. Among the symptomatic subjects, 67% reported interruption of daily activities, but only 46% of them sought medical attention.

Keywords: dizziness; prevalence; epidemiology.

7 - Body weight dissatisfaction and its correlates among Brazilian adolescents

Diego G.D. Christofaro; Raphael M. Ritti Dias; Selma M. de Andrade; Augusto C.F. de Moraes; Marcos A.S. Cabrera; Romulo A. Fernandes

MEDICALEXPRESS 2015;2(1):M150107

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OBJECTIVE: This study examined the prevalence of body weight dissatisfaction and its relationship to physical activity and nutritional status in adolescents.
METHOD: The study enrolled 2,288 adolescents. The dependent variable was body weight dissatisfaction. The independent variables were physical activity and nutritional status. The confounders were gender, and economic condition. Associations between dependent and independent variables were analyzed through the chi-square test and the magnitude of the associations was estimated by Poisson regression.
RESULTS: A total of 56.6% of adolescents were not satisfied with their weight, with 17.9% wanting to increase it, while 37.7% wanted to decrease their weight. In boys and girls, body weight dissatisfaction was associated with nutritional status, abdominal obesity and physical activity in crude analyses. After adjustments, nutritional status and abdominal obesity remained significantly associated to body weight dissatisfaction in both sexes.
CONCLUSION: A high prevalence of body weight dissatisfaction was identified, which was associated with the nutritional status and abdominal obesity in adolescents.

Keywords: dissatisfaction; body weight; adolescents; obesity; physical activity.