Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 2 (3) 2015 - 6 Articles


1 - Risk factors for overuse injuries in runners’ ankles: a literature review

Julia Maria D'Andréa Greve; Nathalie Ferrari Bechara Andere; Natalia Mariana Silva Luna; Alexandra Carolina Canonica; Ticiane Marcondes F. da Cruz; Mark Peterson; Angelica Castilho Alonso

MEDICALEXPRESS 2015;2(3):M150301

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INTRODUCTION: In spite of the numerous benefits to human health and given the increase of running as an exercise that has become popular worldwide, this type of sport may be the cause of a number of different injuries. The foot, ankle and lower leg comprise almost 40% of the injuries. However, the etiology of these types of injury is still not completely understood.
OBJECTIVE: To investigate the causes of the onset of overuse injury in runners.
METHODS: A systematic search of the electronic database was made: Bireme, Pubmed and PEDro, which were selected that addressed clinical trials, control cases, prospective and cross-sectional studies.
RESULTS: The search through the descriptors yielded 324 references. Using our predefined inclusion criteria (case studies, clinical trials, prospective studies and cross studies that addressed adult runners, amateur or professional) 68 articles remained; 24 citations were excluded after reading the title, and 35 were excluded after reading the abstract and the full text. Therefore nine studies that met the criteria for analysis were included.
CONCLUSION: The etiology of overuse injuries in runners is multifactorial. This review showed that distance, soil type and footwear, as well as a history of previous injuries, biomechanical changes such as increased dorsiflexion and eversion ankle, and greater knee flexion are risk factors that influence the occurrence of these injuries.

Keywords: Ankle; Overuse; Running.

2 - Efficacy, efficiency and effectiveness of gonadotropin therapy for infertility treatment

Sandro C. Esteves

MEDICALEXPRESS 2015;2(3):M150302

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Gonadotropin therapy is an essential element in infertility treatments involving assisted reproductive technology. In recent years there have been outstanding advances in the development of new gonadotropins, particularly with the production of gonadotropins using biotechnological resources. Recombinant gonadotropins have higher specific activity compared with urinary counterparts, thus allowing subcutaneous administration of minimal amounts of glycoprotein. As a result, recombinant formulations have a better safety profile despite an overall similarity in terms of efficacy for pregnancy, as reported in many randomized controlled trials and meta-analyses. Gonadotropins stimulate the ovaries to develop follicles and oocytes, which are the raw material for fertilization and embryo production. The resulting embryos are transferred (fresh or frozen-thawed) to achieve pregnancy. The efficiency of a gonadotropin should therefore measured by the amount of drug used, the number of oocytes/embryos produced, and the number of pregnancies achieved by transferring fresh and/or frozen-thawed embryos to the uterus (cumulative pregnancy). Comparisons between different gonadotropin preparations should also take into account other important quality indicators in reproductive medicine, such as safety and patient-centeredeness. Altogether, the aforementioned quality indicators favor biotech gonadotropins over biologic products in infertility therapy.

Keywords: Gonadotropins; Controlled ovarian stimulation; Assisted reproductive technology biotechnology; Infertility.


3 - Treatment effect on temperament and character in panic disorder: a prospective randomized double-blind study

Marina Dyskant Mochcovitch; Tathiana P. Baczynski; Adriana Cardoso de Oliveira e Silva; Antonio E. Nardi

MEDICALEXPRESS 2015;2(3):M150303

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OBJECTIVE: The present study aims to analyze the effect of pharmacological treatment for panic disorder on temperament and character dimensions and to compare the effect of imipramine and fluoxetine on this outcome.
METHOD: Temperament and character dimensions were evaluated in panic disorder patients before and after six months of pharmacological treatment with imipramine and fluoxetine, using the Temperament and Character Inventory-Revised. Patients were randomized between groups and both (patient and investigators) were blinded to the intervention drug. Furthermore, 34 non-panic controls answered the revised Temperament and Character Inventory through an Internet survey.
RESULTS: Panic disorder patients showed higher scores for Harm Avoidance and lower scores for Persistence, Self-Directedness, and Cooperativeness than controls at baseline, but only the low Persistence value remained different from controls after treatment. Responder patients presented significant reduction in Harm Avoidance scores and a significant increase in Self-Directedness scores, whereas non-responders showed a significant increase of Harm Avoidance levels. Fluoxetine and Imipramine showed similar effects on the revised Temperament and Character Inventory dimensions.
CONCLUSION: High Harm Avoidance and low Self-Directedness, Persistence, and Cooperativeness are associated with panic disorder. Treatment of acute panic disorder symptoms lead to the reduction of Harm Avoidance and to an increase in Self-Directedness scores. However, there was no difference between treatment with fluoxetine and imipramine for the effect on the revised Temperament and Character Inventory dimensions.

Keywords: Panic disorder; Temperament; Character; Imipramine, Fluoxetine.

4 - Determinants of prolonged length of hospital stay after cardiac surgery: impact of rheumatic heart disease

Mariângela F Pato; Cláudio L Gelape; Tammy JM Cassiano; Adriano Carvalho; Priscila R Cintra; Luiz G Passaglia; Henrique S Costa; Timothy C Tan; Paulo Cerqueira dos Santos Junior; Renato Bráulio; Maria CP Nunes

MEDICALEXPRESS 2015;2(3):M150304

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OBJETIVO: A doença cardíaca reumática continua a ser um problema grave de saúde nos países em desenvolvimento. Vários fatores contribuem para a morbidade relacionada com a cirurgia valvar cardíaca, mas o papel da etiologia reumática das valvopatias não está bem definido. Este estudo foi desenhado para determinar participação adicional de valvopatias reumáticas na previsão de morbidade após cirurgia cardíaca na era atual de tratamento da doença.
MÉTODOS: Este estudo incluiu prospectivamente 164 pacientes submetidos a cirurgia cardíaca, entre junho de 2010 a junho de 2011. O resultado medido foi a duração da estadia prolongada, definido como tempo de permanência maior ou igual ao percentil 75 para a duração da estada para cada operação, incluindo a dia da alta.
RESULTADOS: A cardiopatia reumática esteve presente em 32 pacientes (20%) e em todos os pacientes submetidos à substituição da válvula. Pacientes com doenças cardíacas reumáticas eram mais jovens e com menos comorbidades comparados com pacientes não-reumáticos; a maioria deles (63%) tinha tido cirurgia prévia. Quarenta e um pacientes foram classificados como tendo um tempo de permanência hospitalar prolongado; 11 (34%) pacientes com doenças reumáticas e 30 (23%) com doenças não-reumáticas. A doença reumática não se apresentou associada com período de internação prolongado, na análise univariada; No entanto, após o ajuste para outros fatores, incluindo endocardite infecciosa, duração da cirurgia, tempo de ventilação mecânica, EuroSCORE, e pneumonia no pós-operatório, a doença reumática revelou-se um preditor de hospitalização prolongada.
CONCLUSÕES: Este estudo demonstra que a doença cardíaca reumática é um importante fator associado com internação prolongada, após o ajuste para fatores de risco bem conhecidos de morbidade após cirurgia cardíaca. A febre reumática ainda é prevalente entre os pacientes que se submeteram à cirurgia cardíaca na época atual, contribuindo para aumentar a morbidade pós-operatória.

Keywords: doença reumática da válvula, cirurgia cardíaca, tempo de permanência hospitalar, morbidade pós-operatória, a substituição da válvula.

5 - Suicidal ideation and chronotype assessment in nurses and police officers

Verônica de Medeiros Alves; Mayra Bruna de Farias Santos; Layse Mayane Silva Nascimento; Gicilene Cavalcante Ferro; Lucas Kayzan Barbosa da Silva; Fabian Eloi Tenório; Antônio E. Nardi

MEDICALEXPRESS 2015;2(3):M150305

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BACKGROUND: Nurses and police officers are professionals that work in shifts and have jobs that require attention and responsibility. They work under conditions that can cause stress, anxiety and changes in sleep patterns.
OBJECTIVE: This study aims to identify symptoms of anxiety and depression, chronotype and the presence of suicidal ideations in nurses and police officers in the city of Arapiraca/Alagoas, Brazil.
METHODS: This is a descriptive and quantitative study. The interviews were conducted using (i) identification records and general data, (ii) the Beck Anxiety Inventory, (iii) the Center for Epidemiologic Studies Depression Scale and (iv) the Horne-Östberg Questionnaire.
RESULTS: Fifty-three nurses and 111 police officers participated in the research. Nurses and police officers exhibited indifferent to moderate matutinal chronotypes. Most of the nurses and police officers reported minimal to light levels of anxiety. Nurses and police officers presented elevated risk for depression. Five nurses and six police officers had considered attempting suicide at the time of the research. There were no significant differences between the study groups with respect to anxiety and depression symptoms, chronotype and suicidal ideations.
CONCLUSION: The nurses and police officers examined presented high risk for symptoms of anxiety and depression; a considerable number of nurses and officers had lifetime suicidal ideations. Implementation of preventive measures is necessary for the early diagnosis of anxiety and depressive disorders in order to prevent complications, including possible suicide.

Keywords: Nursing, Police, Anxiety, Depression, Suicidal ideation, Chronobiology phenomena.

6 - Arnica montana does not affect mast cell populations in experimentally induced oral ulcers in rats

Leandro Boutin Perussolo; Ana Maria Trindade Grégio; Luciana Reis Azevedo-Alanis; Maria Ângela Naval Machado; Aline Cristina Batista Rodrigues Johann; Antonio Adilson Soares de Lima

MEDICALEXPRESS 2015;2(3):M150306

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OBJETIVO: Sabe-se que a Arnica montana mostra atividade anti-inflamatória e anti-oxidante e tem sido usada em medicina tradicional para o tratamento de vários distúrbios. O objetivo deste estudo foi investigar o efeito da Arnica montana em mastócitos durante a cicatrização de feridas de úlceras orais.
MÉTODO: Uma úlcera foi quimicamente induzida na língua de 75 ratos albinos machos e, em seguida, tratada topicamente durante sete dias, utilizando solução salina (controle), gel ou tintura de Arnica montana. Os animais foram sacrificados após 2, 7, 14, 21 e 42º dia de tratamento. As línguas foram removidas e submetidas a rotina de laboratório (coloração com 0,2% de azul de toluidina). A densidade de mastócitos foi determinada em duas regiões: superficial e submucosa.
RESULTADOS: O número de mastócitos aumentou nitidamente para todos os grupos na região mais profunda do tecido peri-ulceroso, quando comparada à região superficial. Nenhuma diferença estatística foi observada no número de mastócitos entre os grupos.
CONCLUSÃO: Este estudo revelou que a tintura ou o gel de Arnica montana foram incapazes de interferir na população de mastócitos durante a cicatrização da úlcera oral de ratos. De acordo com estes resultados, os efeitos anti-inflamatórios de Arnica montana não foram relacionados à inibição da degranulação dos mastócitos.

Keywords: Arnica montana, mastócitos, mucosa oral, úlcera oral, da inflamação.