Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 3 (3) 2016 - 9 Articles


1 - Ibuprofen and indomethacin for the closure of the patent ductus arteriosus

Gian Maria Pacifici

MEDICALEXPRESS 2016;3(3):M160301

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The ductus arteriosus connects the pulmonary artery with the aorta and allows right ventricular blood to bypass the unexpanded lungs. In mature infants, the ductus arteriosus closes after birth. Patent ductus arteriosus occurs in 70% of preterm infants with a birth weight < 1,000 grams. Failure of the ductus arteriosus to close has been associated with intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leukomalacia, renal failure, and persistent pulmonary hypertension. The drugs used to treat the patent ductus arteriosus are ibuprofen and indomethacin which are potent non-selective inhibitors of cyclo-oxygenase (COX) and therefore inhibit prostaglandin E2 synthesis. Prostaglandin E2 relaxes smooth muscle and tends to inhibit the closure of the patent ductus arteriosus. Intravenous ibuprofen and indomethacin inhibit prostaglandin E2 synthesis and thereby close the patent ductus arteriosus with similar efficacy. Indomethacin reduces the blood flow velocity in kidneys, intestine and brain. Ibuprofen has less effect on blood flow velocity in these organs. There is a significant increase in serum creatinine after indomethacin administration but not after ibuprofen and infants treated with ibuprofen have higher creatinine clearance. Oliguria (urine output < 1 ml/kg/h) occurs more frequently with indomethacin than with ibuprofen. Indomethacin requires furosemide for urine output more often than ibuprofen. Ibuprofen reduces the risk of necrotizing enterocolitis and transient renal insufficiency and it is the drug of choice for closing the patent ductus arteriosus. Ibuprofen and indomethacin may be administered orally. In conclusion, intravenous ibuprofen and indomethacin close the patent ductus arteriosus at the same rate, but indomethacin is more toxic than ibuprofen.

Keywords: Ibuprofen, Indomethacin, Neonate, Patent-ductus-arteriosus.

2 - Establishing a quality management system in a fertility center: experience with ISO 9001

Fabiola C. Bento; Sandro C. Esteves

MEDICALEXPRESS 2016;3(3):M160302

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In Fertility Centers, quality should be measured by how well the organization complies with pre-defined requirements, and by how quality policies are implemented and quality objectives achieved. Having a quality management system (QMS) is a mandatory requirement for IVF centers established in most countries with regulatory guidelines, including Brazil. Nevertheless, none of the regulatory directives specify what a QMS must have in detail or how it should be implemented and/or maintained. ISO 9001 is the most important and widespread international requirement for quality management. ISO 9001 standards are generic and applicable to all organizations in any economic sector, including IVF centers. In this review, we discuss how we implemented QMS according to ISO 9001 and what we achieved 5 years later. In brief, with ISO we defined our structure, policies, procedures, processes and resources needed to implement quality management. In addition, we determined the quality orientation of our center and the quality objectives and indicators used to guarantee that a high-quality service is provided. Once measuring progress became part of our daily routine, quantifying and evaluating the organization's success and how much improvement has been achieved was an inevitable result of our well-established QMS. Several lessons were learned throughout our quality journey, but foremost among them was the creation of an internal environment with unity of purpose and direction; this has in fact been the key to achieving the organization's goals.

Keywords: Quality Management System, ISO 9001, Fertility Center.


3 - Correlation between Hounsfield Unit Value and Stone Composition in Nephrolithiasis

Tennyson Rene Silva; Marcelo Lopes de Lima

MEDICALEXPRESS 2016;3(3):M160303

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OBJECTIVE: To examine whether the Hounsfield Unit value predicts calcium oxalate monohydrate stones in patients who are undergoing percutaneous nephrolithotomy.
METHOD: 119 patients who underwent percutaneous nephrolithotomy were prospectively evaluated between February 2012 and August 2014. Using thin cuts, the highest single-energy computed tomography attenuation value within a pixel was measured for each stone. Data regarding age and gender were assessed before surgery. The extracted stones were analyzed using infrared spectrophotometry.
RESULTS: By receiver operating characteristics analysis, a cutoff value of 1548 Hounsfield Unit and an age of 42.5 years were used to determine the likelihood of a stone being composed of calcium oxalate monohydrate. A higher Hounsfield Unit value and increased age augmented the chances of a stone being composed of calcium oxalate monohydrate. In general, females had a greater likelihood of harboring calcium oxalate monohydrate stones than males.
CONCLUSION: The maximum Hounsfield Unit value, as determined by unenhanced single-energy computed tomography in association with gender, predicts the presence of calcium oxalate monohydrate stones in patients who are undergoing percutaneous nephrolithotomy.

Keywords: Urinary Calculi, Lithotripsy, Tomography, Hounsfield Unit.

4 - Low intensity static stretching does not modulate heart rate variability in trained men

Gabriel Costa e Silva; Rodrigo Conceição; Fabrízio Di Masi; Thiago Domingos; Carlos Herdy; Anderson Silveira

MEDICALEXPRESS 2016;3(3):M160304

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OBJECTIVE: To investigate the acute effect of static stretching on heart rate variability in trained men.
METHODS: Eight subjects were randomly submitted to two situations, as follows: a static stretch protocol and 20 minutes at rest. The stretch protocol consisted of two sets of 30 seconds of static stretch of the chest muscles with a 40 second of interval between them. After 48 hours, the procedures were reversed so that all the subjects should were submitted to the two situations. The values of heart rate variability were measured before and after the experimental and control situation (stretch vs. rest). We registered the following cardiac variables: root mean square of standard deviation (rMSSD), the number of pairs of successive beats that differ by more than 50 ms (pNN50), low frequency (LF) and high frequency (HF). The Shapiro-Wilk and the paired Student's test were used for statistical analysis; a critical level of significance of p < 0.05 was adopted.
RESULTS: No significant differences (p > 0.05) were found (stretching vs. control) to the RMSSD, pNN50, LF and HF indices. However, although no statistical differences were observed, the figures show large changes on mean values, suggesting an unclear effect on the sympathetic-vagal modulation.
CONCLUSION: The present results suggest that a low intensity (motion range until discomfort point) and volume (1 minute) of static stretching does not significantly affect the acute sympathetic-vagal control in trained men. Because the protocol did not show differences regarding the studied variables, we suggest that there is not a sufficient level of physiological basis to perform this type of exercise in a traditional pre-exercise setting, if the purpose is obtain gains in physical performance.

Keywords: Heart rate variability, Static stretching, Autonomic modulation.

5 - Appropriate adherence to antiretroviral therapy in the Alto Paranaiba, Minas Gerais, Brazil

Gabriela de Oliveira Souza; Aline Andréia Caixeta Magalhães Tibúrcio; Márcia Kiyomi Koike

MEDICALEXPRESS 2016;3(3):M160305

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OBJECTIVE: This study aimed to assess the adherence to antiretroviral treatment of HIV-infected patients at the Centro de Referência Viva Vida in Patos de Minas, Minas Gerais, Brazil.
METHODS: As a descriptive and quantitative retrospective cross-sectional study, we enlisted HIV-infected patients, over 18 years old, users of highly active antiretroviral therapy (HAART) from June 2011 to July 2012. Data on withdrawal of medication and viral load were collected from the drug logistics management information system and from the medical records, respectively. Sociodemographic and data regarding HAART use were collected manually, using appropriate forms. The CEAT-HIV questionnaire was filled out by140 patients who were using HAART. For data analysis, we used ANOVA and Kruskal-Wallis Rank Sum tests, complemented with Dunn's test, when necessary. P < 0.05 was adopted as the limit for significance.
RESULTS: The age group 18-30 years presented lower adherence compared with the group aged over 60 years (p = 0.047). Regarding the HAART usage time, there was no difference between groups (p = 0.515). For the number of pills taken per day, there was greater adherence for patients taking up to 4 pills compared to those taking 5-10 pills daily (p = 0.037). Concerning adherence measured by the CEAT-HIV questionnaire, there was strict/rigorous adherence in 57.8% of patients, with 21.4% of the patients classified as having adequate adherence, according to the data on dispensation of medicines.
CONCLUSION: Patients participating in HAART and taking up to 4 pills had good adherence to treatment.

Keywords: Adherence, Compliance, HAART, HIV/AIDS.

6 - Aerobic exercise reduces anxiety symptoms and improves fitness in patients with panic disorder

Murilo Khede Lamego; Eduardo Lattari; Alberto Souza de Sá Filho; Flávia Paes; Jarbas Mascarenhas Jr.; Geraldo Maranhão Neto; Aldair José de Oliveira; Carlos Campos; Nuno Barbosa F. Rocha; Antonio E. Nardi; Sergio Machado

MEDICALEXPRESS 2016;3(3):M160306

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OBJECTIVE: To investigate the effects of a regularly repeated aerobic exercise series on anxiety and maximum oxygen consumption (VO2max) in Panic Disorder patients.
METHODS: Ten previously sedentary female subjects diagnosed with Panic Disorder performed 36 sessions of aerobic exercise (at 70 to 75% of VO2max), 3 times per week during 12 weeks. A cardiopulmonary evaluation (ergospirometry test) was used to set the intensity of training as well as to establish baseline and post-training VO2max parameters. The assessment of anxiety symptoms was performed at baseline, at the end of the 6th and 12th weeks, using the Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S), and the Subjective Units of Distress Scale (SUDS) questionnaires. One-way ANOVA for repeated measurements (at 3 moments: Baseline, 6th week (mid-training) and 12th week (post-training) was used to compare the evolution of the questionnaires; the Bonferroni post hoc test was applied to identify differences between moments. A dependent t-test was performed for measures of VO2max.
RESULTS: Compared to baseline, (a) STAI-T showed significant anxiety reductions at mid- and post-training moments; (b) STAI-S and SUDS recorded anxiety reductions only at Post-training; (c) VO2max showed a significant improvement at Post-training.
CONCLUSION: This protocol promoted beneficial effects on cardiorespiratory fitness and anxiety levels of Panic Disorder patients.

Keywords: Panic disorder, aerobic exercise, maximum oxygen consumption.

7 - Depression, stress and guilt are linked to the risk of suicide associated to ectopic pregnancy

Gláucia Rosana Guerra Benute; Debora Cristina Nozzella Bordini; Thiago Robles Juhas; Fabio Roberto Cabar; Pedro Paulo Pereira; Mara Cristina Souza de Lucia; Rossana Pulcineli Vieira Francisco

MEDICALEXPRESS 2016;3(3):M160307

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OBJECTIVE: To identify the risk for suicidal behavior in women who had a fetal loss resulting from ectopic pregnancy and verify the association of suicide risk with depression and psychosocial aspects.
METHODS: Thirty-one women diagnosed with an ectopic pregnancy were interviewed. Major depression was identified using the Primary Care Evaluation of Mental Disorders questionnaire. The Prenatal Psychosocial Profile questionnaire was used to measure stress, social support and self-esteem.
RESULTS: We found that 16% (n = 5) reported suicide risk behavior. The correlation between suicide risk and symptoms of major depression, stress and guilt was statistically significant.
CONCLUSIONS: Depression and stress have been linked to the presence of suicide risk, further increasing the vulnerability of women with ectopic prgnancy, which generates intense emotional reactions as guilt.

Keywords: Ectopic Pregnancy, Risk of suicide, Depression, Stress, Guilt.

8 - Evaluation of efficacy, efficiency and effectiveness of community projects of visual health in the population of the amazon riversides

Vagner Loduca; José Ricardo Rehder; Halmelio Sobral Neto; Guilherme Daher; Marina Gracia; Priscilla A. Jorge; Newton Kara-Junior

MEDICALEXPRESS 2016;3(3):M160308

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OBJECTIVE: To estimate the prevalence of eye diseases in the Amazon region and evaluate the efficacy, efficiency and effectiveness of community projects of visual health in underserved communities.
METHODS: Retrospective, observational and ecological study, which covers the underserved communities of the Brazilian Amazon by the Amazon Project Vision 2000. The data were retrieved from a total sample of 1,276 patients. A questionnaire was applied to patients with 22 questions divided into general and health data. All patients were submitted to a complete eye examination. All project data were stored in a database for later evaluation.
RESULTS: Of the 1,276 patients evaluated, 65% were female, 51.9% said they had never had an eye examination and 91% believed to have some visual problem. Emmetropia was detected in 3.8% and 47.2% had presbyopia. Cataract (16.2%) and pterygium (23.6%) were the prevalent diseases. During the project, cataract surgeries were performed in 27.6% and pterygium in 6.9% of patients. When asked why they had not operated before, 24.1% said they had no financial conditions and 55.2% because there was no specialized doctor nearby.
CONCLUSION: Refractive errors, pterygium and cataract were the most common ocular findings in the population evaluated. The Amazon Project Vision 2000 provided the equipment and resources for the activities proposed, reaching the pre-defined goal.

Keywords: Cataract; indigenous health services; vision; low; blindness.

9 - Predictors of muscle strength in older individuals

Vagner Raso; Ricardo Cardoso Cassilhas; Marcos Gonçalves de Santana; Rita Aurélia Boscolo; Valter Antônio Rocha Viana; Viviane Grassmann; Sergio Tufik; Marco Túlio de Mello

MEDICALEXPRESS 2016;3(3):M160309

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PURPOSE: To analyze possible relationships between load, body mass and lean body mass in an effort to provide norm-referenced standards for the one repetition maximum test and to predict whole body muscle strength (WBMS) in older individuals.
METHODS: We measured body mass, lean body mass and the one repetition maximum (1RM) test in different exercises in 189 older men and women aged 61 to 82 years. Whole body muscle strength (WBMS) was calculated as the sum of loads of the different exercises.
RESULTS: For women, the inclusion of body mass or lean body mass increased the R2 from 0.41 to 0.82, and yielded the following equation: WBMS = 75.788 + (2.288 × load in kg of latissimus pull down) + (0.799 × lean body mass in kg). For men, the inclusion of either body mass (WBMS = 290.33 - [3.140 × age in years] + [1.236 × body mass in kg] + [1.549 × load in kg of leg press]) or, in particular, lean body mass (WBMS = 343.25 - [3.298 × age in years] + [.415 × lean body mass in kg] + [1.737 × load in kg of leg press]) decreased the standard error of the estimate.
CONCLUSION: Our data support the idea that load correlates with body mass and lean body mass and that the load used for a specific exercise is significantly associated with WBMS, thereby permitting the development of a predictive model of WBMS with increased accuracy.

Keywords: Aging, Muscle strength, Resistance exercise