Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 1 (2) 2014 - 8 Articles


1 - In the April 2014 issue of MedicalExpress

Mauricio Rocha-e-Silva

MEDICALEXPRESS 2014;1(2):53-54



2 - Clinical pharmacology of ibuprofen in preterm infants: A meta-analysis of published data

Gian Maria Pacifici

MEDICALEXPRESS 2014;1(2):55-61

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OBJECTIVES: Ibuprofen is a non-selective anti-inflammatory cyclooxygenase inhibitor drug of the propionic acid class of non-steroidal agents, available without prescription in the USA. In preterm infants, ibuprofen is used to close the Patent Ductus Arteriosus and it was found to be more effective than indomethacin. This metaanalysis determined whether differences exist in the closure rate of Patent Ductus Arteriosus following the oral vs. intravenous ibuprofen administration to preterm infants; it examines metabolism, pharmacokinetics and adverse renal effects of ibuprofen.
METHOD: The bibliographic search was performed using PubMed and EMBASE databases as search engines. In addition, the books "Neofax: a Manual of Drugs Used in the Neonatal Care" by Young and Mangum and the "Neonatal Formulary" were consulted.
RESULTS: Patent Ductus Arteriosus closure was 89% with oral ibuprofen (9 reports) vs. 75% with intravenous ibuprofen (13 reports); p = 0.011. The half-life (t1/2) of ibuprofen is 43.1 and 26.8 hours in infants on the 3rd and 5th day of life, respectively. In adults, the half-life of ibuprofen is 2 hours. The rapid shortening of ibuprofen t1/2 is due to the rapid increase of cytochromes CYP2C9 and CYP2C8 activities, which metabolize ibuprofen and which surge in the liver during the first weeks of life. Ibuprofen reduces the renal glomerular filtration and the sodium tubular transport rates.
CONCLUSION: Oral ibuprofen is more effective than intravenous ibuprofen to close patent ductus arteriosus. Ibuprofen has fewer renal adverse effects than intravenous ibuprofen and has the most favourable risk/benefit ratio.

Keywords: adverse-effects; ibuprofen; metabolism; neonate; pharmacokinetics.

3 - Alteration of vascular permeability in burn injury

Qiaobing Huang; Ming Zhao; Keseng Zhao

MEDICALEXPRESS 2014;1(2):62-76

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Massive burn trauma is characterized by hypovolemic shock induced by the loss of plasma from vessels. The elevation of vascular permeability and the ultimate formation of tissue edema are important events during the development of severe burn injury. The underlying mechanisms involved in the increased permeability include the activation of multiple endothelial signaling pathways and the changes of endothelial structure and functions. This review summarizes some of our recent discoveries in endothelial mechanisms during burninduced vascular hyper-permeability. The emphasis is put on tight junction, adherens junction, and the contraction of endothelial cells. The effects of several protein kinases, including Rho kinase, protein kinase C, and MAPKs are also stressed.

Keywords: Microcirculation; Permeability; Burn.


4 - Analysis of velocity and direction of trunk movement in wheelchair basketball athletes

Sileno da Silva Santos; Carlos Bandeira de Mello Monteiro; Bruno Cantelli; Angelica Castilho Alonso; Luis Mochizuki; Alessandro H. Nicolai Ré; Julia Maria D'Andréia Greve

MEDICALEXPRESS 2014;1(2):77-80

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OBJECTIVE: Postural control of the trunk is important to stabilize the entire body and to generate muscle force during sports activities. When the trunk is stable, it is easier and safer to transfer applied forces along the body to perform any motor task because it enhances muscle action and reduces joint loads. Postural control of the trunk is important to stabilize the entire body and to generate muscle force during sports activities. The aim of this study is to verify the velocity and direction of trunk movement in wheelchair basketball athletes.
METHOD: Participants were 26 wheelchair basketball athletes, they were tested on the NeuroCom Balance Master System, protocol: Rhythmic Weight Shift. They were asked to sway the entire body to the right, left, forward and backward. Trials evaluated these movements in low, medium and high velocities.
RESULT: Movement velocity was very significantly affected by task speed and task direction. The highest movement velocity was observed for the fast task and for the left/right direction. There was no interaction between the task and its direction.
CONCLUSION: Wheelchair basketball athletes moved their body faster in the left/right direction. This result suggests that postural control is direction-dependent for the wheelchair-bound individual.

Keywords: basketball; biomechanics; athletes.

5 - Emotional memory in patients with agoraphobic panic disorder compared to a control group

Anna Lucia Spear King; Alexandre Valença; Adriana Cardoso; Antonio Egidio Nardi

MEDICALEXPRESS 2014;1(2):81-86

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OBJECTIVES: Rational minds make logical connections between cause and effect, whereas emotional minds make no such distinctions, following instinctive logic. This paper investigates episodic emotional memory in patients with panic disorder with agoraphobia in comparison to a control group.
METHOD: Sixty volunteers, 30 patients with panic disorder with agoraphobia and 30 healthy controls were exposed to the same slideshow of 11 slides, but randomly exposed to two different narrated versions, namely one emotional and one neutral. Each group of 30 participants was randomly subdivided into two subgroups of 15; each subgroup of patients and controls was exposed either to the emotional or to the neutral narrative. One week later patients and controls returned to answer questionnaires about the slides and respective narrated stories.
RESULTS: Panic disorder patients exposed to the emotional content of the story showed a significantly enhanced emotional memory, evidenced by a better recollection of the emotional narration when compared to patients exposed to the neutral version. Compared to controls, panic disorder patients exhibited greater discrepancy between the emotional versus the neutral narrative.
CONCLUSION: Results showed that the panic disorder patients were significantly impacted by the content of the emotional version of the story, with respect to their emotional memory; the same was not observed for the control group exposed to the same emotional version of the story. We conclude that the characteristics of the panic disorder condition had an influence on emotional memory.

Keywords: memory; panic; neuroscience; emotion.

6 - Major depression in high-risk obstetric inpatients and outpatients

Thiago Robles Juhas; Gláucia Rosana Guerra Benute; Mara Cristina Souza de Lucia; Rossana Pulcineli Vieira Francisco

MEDICALEXPRESS 2014;1(2):87-90

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OBJECTIVE: To evaluate and compare the presence of major depression in high-risk obstetric patients among ward and ambulatory patients.
METHOD: An exploratory, descriptive, and cross-sectional study was carried out among 542 high-risk pregnant women divided into two groups: 278 were outpatients receiving ambulatory care, and 264 were ward patients. Both attended a public university hospital in the State of São Paulo, Brazil. Major depressive disorder was evaluated using the Brazilian version of the Primary Care Evaluation of Mental Disorders. The Χ2 test was used in the statistical analysis with a level of significance of 5% (p<0.05).
RESULTS: Sixty women (11.0%) were diagnosed with major depression, twenty-five (9%) were outpatients and thirty-five (13%) were ward patients. There was no statistically significant difference between groups with respect to the major depression (p = 0.11). Statistically significant differences were found between outpatients and ward patients as follows: insomnia or hypersomnia (p<0.01); fatigue or loss of energy (p = 0.02); diminished concentration (p<0.01); and restlessness or psychomotor retardation (p<0.01).
CONCLUSIONS: Hospitalization may intensify some depressive symptoms. The high proportion of women with major depression demonstrates the need for access to psychosocial support during the pregnancy period, especially in pregnant women at high-risk.

Keywords: Major Depression; Pregnancy; High-Risk; Hospitalization.

7 - Antinociceptive effects of saccharose and aqueous extract of Cordyline dracaenoides kunth (uvarana) in experimental models after induction of hyperalgesia using capsaicin

Larissa Gulogurski Ribeiro; Ivo Ilvan Kerppers; Isabel de Almeida Paz; Marcos Paulo Polowei Rolão; Thais Barbosa de Oliveira; Camila da Luz Eltchechem; Mário César da Silva Pereira

MEDICALEXPRESS 2014;1(2):91-94

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OBJECTIVE: There is evidence that sweet substances such as saccharose can enhance the analgesic properties of endogenous opioids, leading to pain relief; it is also known that Cordyline dracaenoides Kunt, commonly known as uvarana, is used in folk medicine as an anti-inflammatory and analgesic agent. The aim of the present study was to compare the antinociceptive effects of uvarana aqueous extracts vs. saccharose in rats.
METHOD: Twenty-four Wistar rats were used, divided into two groups of twelve, namely a uvarana and a saccharose group. Capsaicin was used to induce hyperalgesia and the nociceptive threshold was assessed every five minutes for a total of 50 minutes Baseline values were obtained and this was followed by administration of uvarana or saccharose at threedifferent concentrations (100, 250 and 300 g/L) The nociceptive threshold was assessed using the tail flick test.
RESULT: In comparison to baseline values, uvarana and saccharose provoked significant and comparable antinociceptive effects at concentrations of 250 g/L and 300 g/L, respectively.
CONCLUSION: Both substances caused similar antinociceptive effects in comparison to baseline values.

Keywords: analgesia; saccharose; uvarana.

8 - Reliability Index of inter- and intra-rater of manual goniometry and computerized biophotogrammetry to assess the range of motion of internal and external shoulder rotation

Leandro Antonietti; Natalia Luna; Gabriel Nogueira; Ana Ito; Marcelo Santos; Angelica Alonso; Moises Cohen

MEDICALEXPRESS 2014;1(2):95-99

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OBJECTIVES: Measurements of the joint angles of the shoulder complex are important for diagnosis, assessment and monitoring of the treatment progression of movement disorders, provided that they can be seen as valid and reliable. The object of this study was to determine inter- and intra-rater reliability of manual goniometry and computerized biophotogrammetry for the assessment of range of motion of the medial and lateral rotations of the shoulder.
METHODS: Four evaluators (two for goniometry and two for biophotogrammetry) assessed 11 males, 16 - 26 years old, right-handed and with no shoulder anomalies. A universal plastic goniometer was used for the goniometry assessment. The biophotogrammetry assessment involved the use of a digital camera Sony DSC-W1 (5.1Mp), with non-reflective markers placed on the subjects. Photographic frames were analyzed the though the SAPO software (version 0.67). Each evaluator was blinded to data from all other valuators; inter-rater datas were compared. Seven days after the first assessment, all measurements were repeated in order to complete the intra-rater comparison. The Wilcoxon test was used to check statistical significance, the Spearman correlation was calculated and inter-class correlations coefficients were determined.
RESULTS: Inter-class correlations for inter- and intra-rater goniometry results were 0.897 and 0.830 respectively; the corresponding biophotogrammetric values were 0.982 and 0.954, all representing excellent reliability levels.
CONCLUSION: Goniometry and biophotogrammetry are reliable methods for assessment of shoulder rotation; however, biophotogrammetry has been shown to be more reliable.

Keywords: biophotogrammetry; goniometry; reliability; shoulder; joint angles.