Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 3(2)2016 - 8 Articles

REVIEW

1 - Motor learning through virtual reality in elderly - a systematic review

Denise Cardoso Ribeiro-Papa; Thais Massetti; Tânia Brusque Crocetta; Lilian Del Ciello de Menezes; Thaiany Pedrozo Campos Antunes; Ítalla Maria Pinheiro Bezerra; Carlos Bandeira de Mello Monteiro

MEDICALEXPRESS 2016;3(2):M160201

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INTRODUCTION: Decline in physical function is a common feature of older age and has important outcomes in terms of physical health as it relates to quality of life. Our capacity for motor learning allows us to flexibly adapt movements to an ever-changing environment. The term Virtual Reality refers to a wide variety of methods used to simulate an alternative or virtual world.
OBJECTIVE: To analyze the results shown in previous studies on motor learning with Virtual Reality use in elderly participants.
METHOD: To select the articles, three steps were followed. A systematic literature review was performed without time limitation. The research was carried out using PubMed, BVS and Web of science; considering the keywords, we included articles that showed the following three terms: elderly, virtual reality and motor learning.
RESULTS: The initial search yielded 49 articles. After duplicates were removed, two of the authors independently evaluated the title and abstract of each article against the study inclusion criteria. From these, 45 articles were excluded based on title and abstract. Finally, four articles met the inclusion criteria.
CONCLUSION: Although few studies were conducted on motor learning in elderly people through virtual reality and, even fewer were of good quality, it was shown that elderly people, with or without a specific disease, can benefit from interventions based on virtual reality to improve motor learning skills.


Keywords: Elderly, Aged, Virtual reality, Motor learning.

2 - Working memory dysfunction in insomniac adults: a systematic metanalytical review

Bárbara Monteiro; Maristela Candida; Suzana Monteiro; Flávia Paes; Ti-Fei Yuan; Ang Li; Xin Sun; Nuno Barbosa F. Rocha; Carlos Campos; Antonio Egidio Nardi; Sergio Machado

MEDICALEXPRESS 2016;3(2):M160202

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BACKGROUND: Insomnia is the most commonly occurring sleep disorder: recent reports estimate that 25-30% of adults in the general population occasional instances of experience insomnia, while 10% suffer from disturbances severe enough to meet diagnostic criteria for insomnia. Little is known about the mechanisms, causes, clinical course, and consequences of this condition. Over 30 studies have been published on the matter but only a small proportion has found differences in the working memory of individuals with vs. without insomnia.
OBJECTIVE: To summarize evidence regarding the differences in working memory performance between insomniac vs. normal adult sleepers.
METHODS: The survey was conducted using an advanced search in the ISI Web of Science and MEDLINE/PubMed with the terms "sleep", "insomnia" and "working memory" as major descriptors; these were crossed with the following keywords: "psychological tests", "neuropsychology" and "performance".
RESULTS: A total of 112 articles were identified in the search conducted in PubMed and Web of Science. After the screening, 102 articles unrelated to the proposed theme were excluded. Thus, 10 articles were analyzed by the eligibility and exclusion criteria, and included in this systematic review.
CONCLUSION: The information resulting from the analysis of the reviewed articles suggests that mild, but not definitive deficits in cognitive performance might be masked by insignificant disparities in studies comparing insomniac individuals with normal sleepers. This shortcoming can be circumvented by larger and better-characterized samples, together with optimized methodological control of factors which might otherwise result in confounding variations among participants.


Keywords: Insomnia, working memory, cognitive performance.

ORIGINAL RESEARCH

3 - Positive correlation of postural balance evaluation by two different devices in community dwelling women

Guilherme Carlos Brech; Natália Mariana Silva Luna; Angélica Castilho Alonso; Júlia María D'Andréa Greve

MEDICALEXPRESS 2016;3(2):M160203

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OBJECTIVE: To establish the convergent validity or relationship of the Balance Master® as balance assessment device by comparing its performance results with those obtained from the AccuSway Plus® force plate.
METHOD: Cross-sectional observational study, without intervention, of 126 postmenopausal women (60.3 ± 3.2 years; body mass index = 27.6 ± 4.7 kg/m2). Two devices were used for the independent assessments of static balance: (a) Static postural balance assessment (posturography) was performed on a force platform (AccuSway Plus); (b) static evaluation was performed on the Balance Master® System. The variables studied in the two devices, were: (i) the Mean Velocity of the Center of Pressure Displacement in all directions (Vavg or Mean Firm), (ii) the Anteroposterior (Mean-Y) and (iii) the Mediolateral (Mean-X) Centers of Pressure Displacement. The Spearman correlation coefficient was calculated to measure the correlation of the variables of balance obtained with the two different devices.
RESULTS: Significant correlations were obtained when the relationships between both variables were described by fitting multiple linear regression models. There was an association between the mean velocity of center of pressure displacement in both devices, with eyes open (r = 0.21) and eyes closed (r = 0.47). In the eyes open condition, Vavg increased, on average, 0.26 units, while Mean Firm increased 1.0 unit; in the Mean-Firm; in eyes closed condition, Vavg increased, on average, 1.27 units, while Mean-Firm increased by 1,0 unit.
CONCLUSION: The devices investigated presented a significant correlation for the mean velocity calculated from the total displacement of the center of pressure in all directions.


Keywords: Postural balance; Center of pressure; Device; Force plate; Postmenopausal.

4 - Symbolic analysis of heart rate variability and its interaction with p-value of normality tests applied on RR intervals

Andrey A. Porto; Celso Ferreira; Luiz Carlos de Abreu; David M. Garner; Luana Gonzaga; Vitor E. Valenti

MEDICALEXPRESS 2016;3(2):M160204

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OBJECTIVE: A previous study suggested that the p-value of normality test applied to RR intervals is an index able to quantify Heart Rate Variability (HRV) through correlation of traditional time and frequency domain indices. We investigate the association between the p-value of normality test applied in RR intervals and symbolic analysis of HRV.
METHOD: We evaluated 32 healthy women between 18 and 30 years old. RR intervals were used for HRV analysis and we performed symbolic analysis, where RR intervals are joined by symbols. Sets of three consecutive symbols (RR intervals) were grouped into four types of clusters, as follows: 1. Three equal symbols (zero variation); 2: two equal, one divergent symbol (one variation); 3. Three different symbols monotonically ascending or descending (two like variations); 4. Three different symbols, forming a peak or a trough (two unlike variations). Frequency of occurrence of each type of cluster was calculated. Normality tests were applied to all RR intervals and the p-value was calculated. We computed the correlations between the p-value of normality test and symbolic analysis of HRV.
RESULTS: Correlation coefficients between the p-value of normality test from Kolmorogov-Smirnov test and the four types of clusters showed no correlation for any of them. Likewise, the correlation coefficient index between the p-value of normality test calculated from the Shapiro-Wilk test and symbolic analysis produced no significant results for any of the four types of clusters.
CONCLUSION: There was no significant correlation between the p-value of normality test and HRV symbolic analysis. The physiological significance of this result is that the PNT is not related to chaotic behavior of HRV.


Keywords: Autonomic nervous system; Cardiovascular system; Cardiovascular physiology; Gaussian distribution.

5 - Relationship of comorbidities and heart failure mortality in the city of São Paulo, Brazil

Marcia Kiyomi Koike; Viviane Silva; Flavia Alves Ribeiro Monclùs Romanek; Mirian Matsura Shirassu

MEDICALEXPRESS 2016;3(2):M160205

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OBJECTIVE: The epidemiology of heart failure mortality in the city of São Paulo, Brazil has not been studied. The present study aims to characterize comorbities associated to cardiac heart failure deaths in São Paulo between 2000 and 2012.
METHOD: The mortality information system (SIM/DataSUS) was evaluated and the following parameters were retrieved: age, sex, race, level of education and comorbidities (hypertension, diabetes, obesity, chronic obstructive pulmonary disease). Socioeconomic status was estimated by years of schooling, as: lower (0-3 years) and higher (> 3 years). We analyzed 14,814 death certificates.
RESULTS: There was a prevalence of subjects in the subgroup: female, white, married or divorced, aged 78 years and lower socioeconomic status. Hypertension and diabetes were the most frequent comorbidities. There were associations of (a) diabetes with age, (b) age, gender and educational level with hypertension in individuals belonging to both the lower and higher socioeconomic levels.
CONCLUSION: Individuals who died of congestive heart failure in São Paulo are mostly elderly, women, caucasian, with little education. Hypertension and diabetes are the two most common chronic diseases associated with death bycongestive heart failure.


Keywords: Mortality, Heart Failure, Epidemiology.

6 - Acute cardiovascular responses to strength exercise for biceps and quadriceps muscles in middle-aged women

Rodrigo Cunha de Mello Pedreiro; Ramila Ferreira da Silva Santos; Sérgio Machado; Geraldo de Albuquerque Maranhão Neto

MEDICALEXPRESS 2016;3(2):M160206

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OBJECTIVE: Strength Training is increasingly popular and is studied for its efficacy in increasing muscular power and endurance. It has been claimed that cardiovascular responses are related to the muscle mass involved during execution, but some studies do not confirm these findings. We analyzed the behavior of heart rate, systolic/diastolic blood pressure, and double product in middle-aged women while performing exercises for two muscle groups with different volumes: elbow flexors (small mass) and knee extensors (large mass).
METHOD: The study sample comprised eight women physically active for at least 6 months. The experimental procedure was performed in 3 sessions. In the first session, the characterization of the sample and a 10 repetition maximum (10RM) test were conducted. In the second, participants performed a warm up and then (depending on randomization), either the elbow flexion or the knee extension exercises in 3 series of 10 repeats. In the third session, participants performed the alternate exercise, folllowing the same procedures. Systolic and diastolic pressures and heart rate were measured 5 minutes before warm up and at the end of each series.
RESULTS: No difference was observed in the acute cardiovascular responses for exercises involving the two different muscle mass volumes in normotensive women above age 45 years.
CONCLUSION: The cardiovascular response is not affected by the exercised muscular mass in this specific population. Further studies should examine these variables in different conditions such as weather, climate and other populations.


Keywords: Strength training, Blood pressure, Double product.

7 - Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Jaime Freitas Bastos; Mauricio Ferri; José Jayme Galvão de Lima; Liliane Kopel; Silvia Gelás Lage

MEDICALEXPRESS 2016;3(2):M160207

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OBJECTIVES: Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach.
METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate.
RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups.
CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.


Keywords: Cardiogenic shock, Pulmonary artery catheter, Monitoring hemodynamic, Heart failure, acute kidney injury

EDITORIAL

8 - MedicalExpress: your article online one month after acceptance

Mauricio Rocha-e-Silva

MEDICALEXPRESS 2016;3(2):M160208

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