Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 4(1)2017 - 6 Articles


1 - Genetic Polymorphisms and Generalized Anxiety Disorder: a systematic review

Verônica de Medeiros Alves; Edilson Leite de Moura; Larissa Tenório Andrade Correia; Antonio E. Nardi

MEDICALEXPRESS 2017;4(1):M170101

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OBJECTIVE: Generalized Anxiety Disorder is a disease characterized by feelings of anxiety, fear, excessive worrying and tension in the face of life experiences. This study aims to identify genetic polymorphisms associated with Generalized Anxiety Disorder described in scientific literature.
METHOD: This review was set up by searching PubMed/Medline, Web of Science and Scopus database using the following key words: "gene and generalized anxiety disorder", "SNP and generalized anxiety disorder" and "polymorphism and generalized anxiety disorder".
RESULTS: We found ten polymorphic varieties of nine genes that showed association and seven polymorphic varieties of three genes that showed no association with Generalized Anxiety disorder: genes NPY, BDNF, BLC2, DED2, RGS2, HTR1A, MAOA, ERS2 and 5-HTT showed association, whereas BDNF, ERS1 and TPH showed no association with the Disorder. Conflicting results regarding BDNF come from different studies.
CONCLUSION: This review identified a variety of genetic polymorphisms, that have been studied in relation to Generalized Anxiety Disorder. Taken jointly, their results are inconclusive, showing that more genetic studies focused on this mental disorder are necessary.

Keywords: Polymorphisms, Generalized anxiety disorder, Gene.


2 - Blood lactate and oxygen consumption in soccer players: comparison between different positions on the field

Paulo Roberto Santos-Silva; André Pedrinelli; Júlia Maria D'Andrea Greve

MEDICALEXPRESS 2017;4(1):M170102

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OBJECTIVE: We hypothesize that in players with better aerobic fitness, lactate production was not inhibited after high-intensity exercise, regardless of the footballer's position on the field.
METHOD: Sixty professional male soccer players performed cardiopulmonary exercise tests on an ergometric treadmill; respiratory gas exchanges were monitored throughout and blood lactate levels at peak effort was measured, using a portable device. The heart rate response was determined by computerized EKG. Training sessions took place over an average of ten hours per week, and the players had 6.8 years of experience in competitive soccer; they were tested a third of way into the season. The positions tested were (centerback, fullback, midfielder and striker).
RESULTS: The following results (mean ± std. dev.) were obtained: (1) peak oxygen consumption of 58.8 ± 4.5; (2), blood peak lactate of 12.3 ± 1.6 mmol.L-1; (3) maximum heart rate of 193 ± 3.3 beats. min-1; (4); oxygen consumption at the second ventilatory threshold of 49.6 ± 5.0 mL. kg-1.min-1; (5); running speed at the second ventilatory threshold of 13.3 ± 0.8 km.h-1; (6) percentage of oxygen consumption in the second ventilatory threshold of 84 ± 6%. There was no correlation between maximum aerobic level vs. peak lactate concentration (r = -0,031; p = 0.812), nor between submaximal aerobic level vs. peak lactate concentration (r = -0.146; p = 0.335) in the positions tested.
CONCLUSION: Better or worse aerobic profiles according to game positions in soccer players do not influence peak lactate levels following high-intensity exercise, and confirms the study hypothesis.

Keywords: training, aerobic and anaerobic exercise, ventilatory threshold, heart rate, cardiopulmonary exercise test.

3 - Patellar denervation for Anterior Knee Pain Management in Knee Arthroplasty

David Sadigursky; Felipe Magalhães Sampaio; Eron Silva Andrade; Perseu Ribeiro Almeida; Magda Leão Pinheiro; Matheus Vasconcelos Goes Mendes; Gustavo Castro de Queiroz

MEDICALEXPRESS 2017;4(1):M170103

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OBJECTIVE: To compare the effectiveness of patellar denervation versus non-patellar denervation in reducing anterior knee pain on a follow-up period of at least one year after total knee arthroplasty.
METHOD: Data from 84 patients, who underwent total knee arthroplasty were analyzed. Participants were divided into 2 groups; group A: 42 patients who previously underwent total knee arthroplasty with patellar denervation; and group B: 42 patients who previously underwent total knee arthroplasty without patellar denervation. Results were evaluated using WOMAC and KSS questionnaires, and the VAS pain measurement. Knee ranges of motion were measured. Preoperative clinical conditions of both groups were similar.
RESULTS: Postoperatively, the following results were observed. (a), the WOMAC scores for group A were significant better when compared to group B (27.95 ± 5.89 vs. 33,55 ± 6.23; (b) better results were also found in KSS scores for group A vs. group B (86.19 ± 7.10 vs. 83,07 ± 4.88); (c) the range of knee flexion was smaller than in group A vs. group B (119.0 ± 10.7 vs 125.5 ± 11.0 degrees); (d) there was no significant difference between the mean of range of knee extension between the two groups groups; (e) in terms pain referred by the patient, no difference was observed according to VAS pain.
CONCLUSION: Patellar denervation does not show better effect in pain reduction compared with TKA with non-patellar denervation. However, it had a better beneficial effect on knee function score, as measured through the KSS and WOMAC questionnaires.

Keywords: Patella, Knee Arthroplasty, Joint Pain.

4 - Grip strength predicts physical function in nursing home residents

Vagner Raso; Magdalena Ioana Tolea; Rafael Benito Mancini; Sandra Marcela Mahecha Matsudo

MEDICALEXPRESS 2017;4(1):M170104

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PURPOSE: To analyze the relationship of grip strength and physical function in institutionalized older people.
METHODS: One hundred and fifty-seven nursing home residents of seven different long-stay institutions underwent evaluation of body composition, cognitive function, grip strength, mobility, balance (balance scale test BERG and single-leg stance test) and gait speed.
RESULTS: Volunteers had no impairment of cognitive function, functional mobility, balance or gait speed. Men had higher grip strength and achieved higher scores in BERG. Fittest volunteers (i.e., P75 to P100) had better functional mobility, BERG and gait speed; less fit volunteers (i.e., P0 to P25) were taller and had better gait speed. The grip strength was independently associated with functional mobility and balance in the single-leg stance test only in females. The cognitive function (female, P25 to P75, male, total sample) and age (male, total sample) showed a tendency to be mediators of functional mobility. Age and body weight seem to confound the gait speed, especially for females (P25 to P75), while cognitive function confound it in males (P75 to P100). However, age and body weight are significantly associated with gait speed (female, total sample).
CONCLUSION: We can conclude that grip strength was independently associated with functional mobility and balance of institutionalized older women.

Keywords: Balance, elderly, institutionalization, muscle strength, physical function.

5 - Effects of the supplementation with alpha-lipoic acid on muscular antioxidant biomarkers of trained mice

Guilherme Vannucchi Portari; Ruan Carlos Macêdo de Moraes; Rafael Deminice; Fábio Lera Orsatti; Susana Merino

MEDICALEXPRESS 2017;4(1):M170105

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BACKGROUND: Performing high intensity or exhaustive exercise can lead to muscle damage such as injuries, chronic fatigue and overtraining, partly due to the high synthesis of reactive oxygen species. The α-lipoic acid (ALA) and its reduced form, dihydrolipoic acid, act as potent antioxidant and eliminate free radicals. Although this response depends on the type of exercise and supplementation, animal and human studies have shown the benefits of antioxidant supplementation on the recovery of damages caused by exhaustive exercise, either by restoring antioxidant levels or by decreasing the damage.
OBJECTIVE: We evaluated the effect of ALA supplementation on muscular biomarkers of oxidative stress following exhaustive exercise of trained mice.
METHODS: Sixty mice were trained to swim for 6 weeks. On the last week, half of the animals were supplemented daily with 100 mg/kg of oral gavage of ALA in soy oil as a vehicle. The other half received just the vehicle. On the last day 20 animals from each group were submitted to an exhaustion protocol with 10% overweight attached to tail. Animals were euthanized on 3 moments: basal, just after the exhaustive protocol (0 h) and, 4 h after the exhaustive protocol. The gastrocnemius muscle was promptly excised and homogenized. The homogenates were used to estimate oxidative stress biomarkers.
RESULTS: There was a simultaneous decrease of non-protein thiols and vitamin E after 4 h of exhaustive exercise in the ALA group (p<0.05) compared to the control group, suggesting the consumption of these compounds in the process of lipid peroxidation. Interestingly, there was an increase of nitrate and nitrite in ALA group (p<0.05) and a decrease in the control (p<0.05) compared to basal moment, possibly by activation of endothelial nitric oxide synthase. The total antioxidant capacity remained unchanged in the ALA group.
CONCLUSION: The supplementation with ALA resulted in a protection against oxidative stress caused by exhaustive exercise.

Keywords: Alpha-Lipoic acid; Antioxidants; Oxidative stress; Exercise.

6 - One wire tubeless ureteral reimplant: preliminary experience and step-by-step technique

Marcos Tobias-Machado; Alexandre Kyoshi Hidaka; Leticia Lumy Kanawa Sato; Roberto Javier Almeida-Carrera; Eliney Ferreira Faria; Hamilton Zampolli

MEDICALEXPRESS 2017;4(1):M170106

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BACKGROUND AND OBJECTIVES: Ureteral Reimplant is commonly used in pediatric and gyne-cologic surgery. Most techniques demand an experienced surgeon and lasts 2-3 hours. There is no consensus about the preferred technique until today. We report a simple modification of the Taguchi to reduce duration and make it more suitable for laparoscopic approach.
METHOD: Three patients underwent distal ureteral reimplant, based on our modified Taguchi minimally invasive approach technique. Cystography and ultrasonography were performed on the 30th, 90th and 180th postoperative days to monitor kidneys; a one-year follow-up for recurrence or clinical symptoms was also performed.
RESULTS: Operative time for ureteral reimplant using our technique was 15-25 minutes. The results of the performed exams on postoperative days showed normal kidneys without hydro-nephrosis. At the one-year follow-up no signs of recurrence or clinical symptoms were present.
CONCLUSION: Our modifications allowed a faster and easier management of distal ureteral reimplant, with excellent perioperative and post-operative outcomes. To our knowledge this is the first detailed description of this technique through minimally invasive approach. However, further studies and a longer follow up will be necessaries to confirm the long-term outcomes and clinical benefits of our technical proposal.

Keywords: ureteral reimplantation, laparoscopy, Taguchi procedure.