Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 1(1)2014 - 11 Articles

EDITORIAL

2 - Costs of elderly health care in Brazil: challenges and strategies1

Luiz E. Garcez-Leme; Mariana Deckers Leme

MEDICALEXPRESS 2014;1(1):3-8

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REVIEW

3 - Suicide among elderly: a systematic review

Verônica de Medeiros Alves; Ana Claudia C. de Ornelas Maia; Antonio Egidio Nardi

MEDICALEXPRESS 2014;1(1):9-13

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This article aimed to perform a systematic review of suicide among the elderly. The literature review was conducted using three databases (SCOPUS, Medline/Pubmed and ISI Web of Science) using the terms suicide and elderly, suicide and older adult and suicide attempt. The publication dates were restricted between 2008 and 2013. Review or theoretical articles were excluded; only epidemiologic studies were selected. A total of 1613 references were found, but only seven met the inclusion criteria, namely articles that assessed the prevalence of suicide in elderly through retrospective cohort studies. The average study period was 7.9 years. The following average annual suicide rates were calculated: Italy (173/cases-year), New York (118.1/cases-year and 51 cases/year - two studies), Ireland (92/cases-year), Finland (12.9/cases-year), Turkey (3.5/cases-year) and England (3/cases-year). All of the studies reported that elderly males had a higher rate of death by suicide compared to elderly females. Hanging, shooting by firearms, drowning and jumping from high places were prevalent suicide methods. Three articles reported that death by suicide was associated with the presence of psychiatric disorders, psychoactive substance use, and physical illnesses, as well as economic and emotional reasons. This review determined that the topic of suicide among the elderly is rarely discussed and that little is known about influences, causes, or prevalence of suicide among the elderly. Moreover, neither the type of health monitoring nor the medications that are used as interventions for eventual suicide victims are commonly reported in elderly populations.


Keywords: Suicide; Elderly; Primary Care.

4 - Hypertonic saline for treatment of shock: have we looked for everything?

Mauricio Rocha e Silva

MEDICALEXPRESS 2014;1(1):14-21

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This review is dedicated to the memory of Luis Poli de Figueiredo, who is responsible for much of what we know about small volume resuscitation. Small volume hypertonic resuscitation was originally based on the concept that a physiologically significant blood volume expansion follows the administration of a comparatively small volume of hypertonic fluid. Because hypertonicity is a physiological vasodilator, its use after severe blood loss induces reperfusion. Previously reported research disclosed a number of additional properties of hypertonic NaCl, amongst them (i) the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow; (ii) modulation of the immune system, with applications repercussions in the field of sepsis. This review covers developments in this field that occurred from 2005 through 2013. We discuss the discrepancy between animal experiments and human trials, and argue that the basic objective of most multicenter clinical trials may have been based upon a poor strategy.


Keywords: Shock; Hemorrhage; Sepsis Hypertonic saline; Immune circulation.

ORIGINAL RESEARCH

5 - Is there any correlation between functional and clinical tests in anterior cruciate ligament reconstructed knees after three years?

Ozge Cinar Medeni; Gul Baltaci; Hamza Ozer

MEDICALEXPRESS 2014;1(1):22-26

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OBJECTIVE: Hop and jump tests are frequently used in clinical situations in patients with anterior cruciate ligament injury and reconstruction. We are not aware of any study that analyses correlation of functional tests with clinical tests after three years of reconstruction. The purpose of this study was to analyze the relationship between functional and clinical tests.
METHOD: Twelve male patients with unilateral anterior cruciate ligament reconstruction were assessed. They performed a one-legged hop test and one-legged jump and reach test, to evaluate knee function. Clinical assessments were: (a) instrumental knee laxity measurement, (b) Q angle, (c) knee flexor and (d) extensor muscle strength. To determine the relationship between functional and clinical tests, a correlation analysis was performed by means of the Spearman correlation coefficient. A p value < 0.05 was considered significant.
RESULTS: In anterior cruciate ligament reconstructed vs. healthy knees, hop and jump performance correlated well with muscle strength. Knee laxity did not affect hop and jump performance.
CONCLUSIONS: The correlation of functional and strength tests in each group showed functional performance was restored and was independent of anterior knee laxity three years after reconstruction when compared with the contralateral healthy knee. The single-legged hop test correlated better with knee muscle strength and could give information about muscle strength three years after reconstruction. Q angle and extensor strength must be considered together when evaluating hop performance.


Keywords: Anterior Cruciate Ligament; Knee Recosntruction; Test; Outcome.

RAPID COMMUNICATION

6 - Safety and efficacy of hypertonic saline versus isotonic saline solution in off-pump coronary artery bypass grafting

Ricardo de Mola; Jorge Flório; Vanessa R. Pescioto; Douglas Humberto Lovatti; Luis Alberto Oliveira Dallan; Roberto Rocha-e-Silva

MEDICALEXPRESS 2014;1(1):27-30

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OBJECTIVES: Off-pump coronary artery bypass grafting occurrence increases constantly. However transient low cardiac output events occur during this procedure requiring aggressive volume replacement, which may lead to hypervolemia and its complications.
METHOD: This study evaluates the safety and efficacy of a hypertonic-hyperoncotic NaCl solution (6% hydroxyethylamide + 7.5% sodium chloride) versus isotonic saline during the creation of anastomosis in the lateral wall of the left ventricle. In each case, 250 ml of solution was administered from coded bags at the start of the grafting procedure. All staff directly connected with the surgical procedure and post-operative management of patients was blinded to the coding. The primary objective was the determination of post-surgery complications. Secondary objectives were the determination of mean arterial blood pressure and central venous pressure during anastomotic grafting.
RESULTS: Primary objectives showed no difference between hypertonic versus isotonic saline in post-operatory surgery complication. Significant increases of mean arterial pressure and central venous pressure in the Hypertonic Saline group versus normal saline patients during grafting were observed.
CONCLUSION: The use of hypertonic saline during off-pump coronary artery bypass grafting on the lateral posterior wall of the left ventricle led to no complications and improved arterial and central venous pressure, favoring the creation of anastomosis in this wall.


Keywords: cardiac surgery; hypertonic-hyperoncotic solution; cardiopulmonary bypass; off-pump; beating heart.

7 - Depth-scanning confocal Raman for rapid in vivo determination of testosterone concentration profiles in human skin

Marco Antonio Botelho; Stela Julia Guerreiro; Dinalva Brito Queiroz; Gisele Barros; Monaliza Cavalcante; Juliana M. O. Souza; André M. Silva; Telma L. G. Lemos; Lucindo Quintans Jr

MEDICALEXPRESS 2014;1(1):31-35

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OBJECTIVE: The present study aimed to measure in-vivo the depth and the percentage of testosterone in human skin.
METHOD: Two healthy young Brazilian volunteers were evaluated through a Confocal Raman Spectroscopy probe on the right volar forearm. Testosterone spectroscopy of was performed on the Stratum Corneum, Viable Epidermis and Dermis; the percentage concentration of testosterone was compared between the baseline and one hour after local application of a transdermal nanostructured testosterone (5%) formulation.
RESULTS: To the best of our knowledge, this is the first time that the depth and percentage of testosterone has been evaluated non-invasively in-vivo. No adverse events were attributed to this protocol. The method is effective in differentially measuring testosterone in the skin layers.
CONCLUSION: This protocol may serve as a good choice for rapid hormone quantification for forensic or medical purposes.


Keywords: Nanotechnology; Confocal Raman Spectroscopy; Transdermal Delivery; Testosterone; Nanoparticles.

ORIGINAL RESEARCH

8 - Bixa orellana (annatto) exerts a sustained hypoglycemic effect in experimental diabetes mellitus in rats

Flávio Teles; Felipe Silveira dos Anjos; Tarcilo Machado; Roberta Lima

MEDICALEXPRESS 2014;1(1):36-38

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OBJECTIVE: Bixa orellana (annatto) is a natural pigment and food colorant that has been used for a variety of therapeutic purposes. It has been suggested that annatto could have the property of reducing blood glucose levels. However, most previous studies have demonstrated a hypoglycemic effect in non-diabetic animals. We evaluated the impact of annatto on blood glucose levels in an experimental model of diabetes mellitus.
METHOD: Male Wistar rats were made diabetic by a single dose of60 mg/kg streptozotocin, injected intraperitoneally. One group of diabetic animals was treated with annatto, 540 mg/kg, administered via gavage.
RESULTS: Annatto treated diabetic animals showed significantly lower blood sugar levels than untreated diabetics. The blood glucose curve showed that the hypoglycemic effect of annatto lasted for the twelve hours of evaluation. However, the most significant reduction on blood glucose took place two hours after drug administration. Annatto did not prevent the weight loss that is characteristic of decompensated diabetes mellitus.
CONCLUSION: Annatto has a hypoglycemic property in rats with severe diabetes mellitus. Such an effect had a relatively long duration, but is more pronounced two hours after drug administration.


Keywords: Bixa orellana; Diabetes Mellitus; Rats.

9 - Development of an efficient multiplex semi-nested PCR for convenient use in urine samples for diagnosis of toxoplasmosis

Abbas Ali Eskandarian

MEDICALEXPRESS 2014;1(1):39-42

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BACKGROUND: Toxoplasmosis is a protozoan parasitic infection. The cerebrospinal, ocular and congenital forms of the disease are complicated and life threatening. Diagnosis of toxoplasmosis is difficult due to invasive sample requirement, complications in pathogenesis, immunology, and interpretation of test results. Using urine as a non invasive sample source for molecular diagnosis of toxoplasmosis is the main object of this research. Attempts were made to diagnose toxoplasmosis using polymerase chain reaction (PCR) technique on the parasite's deoxyribonucleic acid (DNA) in urine.
METHODS: Parasite: The Toxoplasma gondii (T. gondii) RH strain was obtained from peritoneal exudates of small white laboratory mice inoculated with 5x105 tachyzoites three days before aspiration. Urine samples with defined numbers of tachyzoites per ml were used as laboratory samples. The target was a 529 bp segment (AF146527 gene bank) of the T. gondii genome with 200-300 repeats as target in PCR. Selected primers were designed on its sequence.
RESULTS: A multiplex semi-nested PCR technique was developed for obtaining a method for precise diagnosis of toxoplasmosis, time and budget saving and to diminish the DNA cross contamination risk. It was sensitive to detect 2 this tachyzoites DNA per final sample.
CONCLUSION: With further development, nested PCR can be a useful and non-invasive method for diagnosis of cerebrospinal, ocular, and congenital toxoplasmosis.


Keywords: Toxoplasmosis; Toxoplasma gondii; Diagnosis; Urine sample; Multiplex; Nested PCR.

10 - Health-related quality of life in adults with attention-deficit and hyperactivity disorder

Maria Aparecida da Silva; Tiffany M. Chaim; Mikael Cavalett; Mauricio H. Serpa; Marcus V. Zanetti; Glauco F. Vieira; Geraldo F. Busatto; Mário R. Louzã

MEDICALEXPRESS 2014;1(1):43-46

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OBJECTIVE: Attention-Deficit and Hyperactivity Disorder is a neurodevelopmental condition that causes substantial deficits in several aspects of human function, resulting in a poor quality of life. However, studies using valid reports to objectively document Quality of Life impairment in never-treated adults with Hyperactivity Disorder Self-Report Scale have, to date, been scarce. The aim of this study was to assess Quality of Life in a clinical sample of treatment-naïve adults with Attention-Deficit and Hyperactivity Disorder in comparison to a healthy control group, and to investigate the relationship between Quality of Life and symptom severity ratings.
METHOD: Symptom severity ratings (assessed using the Attention-Deficit and Hyperactivity Disorder Self-Report Scale) and quality of life measurements using the World Health Organization Quality of Life scale (through WHOQOL-BREF) were obtained from a sample of 46 treatment-naïve adults with Attention-Deficit and Hyperactivity Disorder (mean age=29.3 years) and a group of 28 healthy controls (mean age=28.7 years).
RESULTS: Quality of Life was significantly worse in the Attention-deficit and Hyperactivity Disorder group compared to the healthy controls. The severity of symptoms of hyperactivity (but not of inattention) was negatively correlated with quality of life.
CONCLUSION: The use of a generic Quality of Life tool such as the WHOQOL-BREF allows the detection of lower Quality of Life, vs. healthy controls, in adult Attention-Deficit and Hyperactivity Disorder patients, and highlights the relevance of Quality of Life impairment when planning and monitoring treatment strategies for such a population.


Keywords: Attention-deficit and hyperactivity disorder; Adult; Treatment-naïve; Quality of life.

11 - Use of small volume hypertonic acetate dextran during aortic occlusion in pigs: assessment of blood flow and antioxidant status in tissues

Michael A. Dubick; Luis F. Poli de Figueiredo; George C. Kramer

MEDICALEXPRESS 2014;1(1):47-52

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BACKGROUND: Hypertonic/hyperoncotic fluids may reduce overall fluid requirements and tissue edema, improve perfusion and reduce the incidence of paraplegia associated with aortic cross-clamping and subsequent reperfusion.
OBJECTIVE: We evaluated potential benefits of a hypertonic saline acetate solution on reperfusion injury following ischemia. We examined blood flow and plasma antioxidant status, spinal cord and skeletal muscle above and below the cross-clamp, as well as in the liver and the kidney.
METHOD: The aorta of anesthetized swine (n=5-6/group) was cross-clamped at the level of T9 for 30 min; animals were infused with 4 ml/kg of hypertonic acetate dextran (HAD) or 8.4% NaHCO3 (Control). Pigs were euthanatized 1h later.
RESULTS: As blood flow fell to zero in lower spinal cord and muscle, it doubled in the upper cord and increased 6-fold in upper muscle. Upon reperfusion, blood flow in all regions returned to baseline levels, with no statistical differences between HAD and Controls. Lipid peroxidation in plasma was lower in HAD than Controls. Lower muscle had 41% lower glutathione levels and significantly lower activities of the antioxidant enzymes glutathione peroxidase and reductase, catalase, superoxide dismutase versus upper muscle. The lower spinal cord had 2.5 fold higher malondialdehyde levels and 50% higher catalase activity than upper spinal cord. Within a tissue, any significant differences in antioxidant status or evidence of lipid peroxidation favored HAD over Control.
CONCLUSION: HAD offered only minor advantages over NaHCO3 with respect to blood flow and antioxidant status of spinal cord and muscle following this period of aortic cross-clamping and reperfusion.


Keywords: ischemia/reperfusion; hypertonic saline; blood flow; oxidant stress; swine.