Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 1(3)2014 - 12 Articles

EDITORIAL

1 - In the June issue of MedicalExpress

Mauricio Rocha e Silva

MEDICALEXPRESS 2014;1(3):100

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2 - Inhalation conscious sedation with nitrous oxide/oxygen in pediatric dentistry

Ana Catarina Barroso Macedo Barbosa; Joana Mourão; Virgínia Milagre; David Casimiro de Andrade; Cristina Areias

MEDICALEXPRESS 2014;1(3):102-104

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REVIEW

3 - Clinical pharmacology of analgesics in infants and the pharmacologic management of pain in neonates

Gian Maria Pacifici

MEDICALEXPRESS 2014;1(3):105-115

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OBJECTIVES: The objectives of this study are to describe (1) the clinical pharmacology of analgesics in infants and (2) the pharmacologic management of pain in neonates.
METHODS: The bibliographic search was performed using PubMed and EMBASE databases as search engines.
RESULTS: Opioid analgesics are the most commonly used analgesics for acute pain and they include intravenous morphine (50 to 200 µg/kg), oral methadone (50 to 200 µg/kg), intravenous fentanyl (0.5 to 4 µg/kg), alfentanyl (10 to 20 µg/kg), sufentanil (10 to 15 µg/kg), and remifentanil (5 µg/kg). Fentanyl, alfentanyl, sufentanil and remifentanil are short-action opioid analgesics. Non-opioid analgesics can be used for moderate pain; they include oral paracetamol (acetaminophen, 12 to 15 mg/kg), the intravenous benzodiazepine midazolam (50 to 150 µg/kg) which is not recommended in neonates, intravenous propofol (2.5 mg/kg) which is used for induction of general anaesthesia, and ketamine, (2 mg/kg intravenously or 4 mg/kg intramuscularly) which produces a short-lasting, trance-like state with profound analgesia and amnesia.
CONCLUSION: The use of non-opioid analgesics has increased in the last years for the management of non-acute pain. If prevention or elimination of pain is not possible, a more realistic goal may be to aggressively intervene to minimize pain and its effects.


Keywords: analgesia; analgesics; management of pain; neonate; pain; pharmacokinetics.

4 - Childhood restless legs syndrome

José Carlos Pereira Jr.; Márcia Pradella-Hallinan; Rosana Cardoso Alves

MEDICALEXPRESS 2014;1(3):116-122

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BACKGROUND: The last 20 years witnessed increased medical awareness regarding restless legs syndrome (Willis-Ekbom disease) among adults and children. However, it remains underdiagnosed and undertreated. Diagnosis relies exclusively on the history described by patients in their own words. Children who cannot adequately describe their symptoms represent a difficulty. To circumvent this, probable and possible restless legs syndrome have been instituted as diagnostic alternatives.
OBJECTIVE: This review aims to emphasize to general Pediatricians that among children restless legs syndrome is not only common, but also has the potential to impair the quality of life of affected patients and their caregivers.
METHODS: We performed a search in the database of Medline-PubMed for articles dated from January 1, 2008 to December 31, 2013. Many relevant articles before 2008 were also studied. Key words used were: restless legs syndrome and/or restless legs syndrome children. The Google Scholar database and pages in Portuguese were also investigated. We also searched for the theme in various relevant textbooks. We have added our personal experience to published literature.
CONCLUSION: We observed that restless legs syndrome is common in children, and its diagnosis requires knowledge and intuition on the part of the Pediatrician.


Keywords: Restless legs syndrome; Willis-Ekbom disease; Restless legs syndrome in children.

ORIGINAL RESEARCH

5 - Effectiveness of sperm washing by discontinuous density gradient centrifugation to remove antibodies bound to the sperm membrane

Danielle Schneider; Cinthia Feijo; Sidney Verza Jr.; Sandro Esteves

MEDICALEXPRESS 2014;1(3):123-126

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OBJECTIVE: We evaluated the effectiveness of sperm washing using the discontinuous two-layer density gradient centrifugation method to remove antisperm antibodies attached to the sperm surface.
METHOD: We prospectively enrolled sixty-six men with unexplained infertility who were seeking evaluation. Each patient delivered one semen specimen for the study. We determined antisperm antibody levels using the direct immunobeads test. Specimens were classified into two groups according to the pre-washing levels of antibody-bound spermatozoa: group 1 (low antisperm antibodies levels, immunobeads test <20%; n = 54), and group 2 (high antisperm antibodies levels, immunobeads test > 20% n = 12). Sperm washing was carried out using the discontinuous two-layer colloidal density gradient centrifugation method. Pre- and post-wash levels of antisperm antibodies were compared in the groups.
RESULTS: The pre- and post-wash percentage of spermatozoa with antisperm antibodies attached to their surface was 11% and 6.5% in group 1 (mean difference = 40% p < 0.01), and 30% and 19.5% in group 2 (mean difference = 36.8% p = 0.02), respectively. The effectiveness of density gradient centrifugation in removing antisperm antibodies was not different between the groups, but individual variations from - 52.3% to - 3.9% were observed.
CONCLUSIONS: Sperm washing by density gradient centrifugation is an overall effective method to remove antibodies bound to sperm membranes, regardless of the levels of antisperm antibodies in the neat semen. Due to an inter-individual variation in the effectiveness of the method, we recommend that each patient be tested before applying sperm washing by density gradient centrifugation in intrauterine insemination.


Keywords: Antibodies; sperm; sperm washing; immunobead test; male infertility

6 - Protective microcirculatory and anti-inflammatory effects of heparin on endotoxemic hamsters

Marcos L. Miranda; Luiz Felipe M. Prota; Maria Júlia B. Silva; Fernando L. Sicuro; Eliane S. Furtado; Ana Olimpia M. T. Santos; Eliete Bouskela

MEDICALEXPRESS 2014;1(3):127-134

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OBJECTIVE: Apart from its anticoagulant properties, heparin has vasodilator and anti-inflammatory effects that could assist in the reversal of septic microcirculatory changes. This paper investigates the effects of heparin on endotoxemia-related microcirculatory changes and compares them to those observed with the use of recombinant human activated protein C.
METHODS: After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.kg-1), male golden Syrian hamsters were treated with intravenous unfractionated heparin (0.2 mg.kg-1). Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables and venular leukocyte rolling and adhesion. Macrohemodynamic parameters were also analyzed. Endotoxemic hamsters treated with recombinant human activated protein C and non-treated animals served as controls.
RESULTS: Heparin decreased lipopolysaccharide-induced leukocyte rolling and arteriolar vasoconstriction; it also increased survival when compared with non-treated animals, while recombinant human activated protein C decreased leukocyte adhesion. Administration of heparin plus recombinant human activated protein C was associated with a significant attenuation of lipopolysaccharide-induced capillary perfusion deficits.
CONCLUSIONS: Heparin yields protective effects on endotoxemic animals' microcirculation. Those benefits were potentiated when heparin was administered in conjunction with recombinant human activated protein C.


Keywords: sepsis; endotoxemia; microcirculation; heparin; recombinant human activated protein C.

7 - Body disabling chronic hemiparesis does not appear to determine differences in the body mass index when compared to able-bodied controls

Paulo Henrique Ferreira de Araujo-Barbosa; Lidiane Teles de Menezes; Abraão Souza Costa; Anderson Castro Mundim; Osmair Gomes de Macedo; Emerson Fachin-Martins

MEDICALEXPRESS 2014;1(3):135-139

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OBJECTIVE: (a) To compare the Body Mass Index between hemiparetic (disabled-bodied) patients vs. matched able-bodied controls, establishing relationships between Body Mass Index and the anthropometric variables (weight and height) used to calculate it; (b) to determine whether the Body Mass Index could be used as a disability indicator.
METHODS: Twenty hemiparetic patients were matched by gender and age to twenty control subjects. All of them were included in procedures to measure the anthropometric parameters used to calculate Body Mass Index. The data were submitted to statistical procedures.
RESULTS: The hemiparetic group did not present significant difference in the Body Mass Index when compared with controls, despite the fact that controls were 5.5 cm taller. From the variables used to calculate Body Mass Index, only weight presented a significant correlation to the index for both groups.
CONCLUSION: Significant differences in the Body Mass Index were not observed between groups. Moreover, for both groups, the index was only associated with body mass. Our results show that Body Mass Index is not a good parameter to establish relationships with disability indicators for disable-bodied patients.


Keywords: stroke; anthropometry; body composition.

RAPID COMMUNICATION

8 - YouTube as a source of information for New Delhi Metallo-β-lactamase-1 superbug gene

Sourabh Aggarwal; Harkirat Singh; Navkaran Bajaj; Vishal Sharma

MEDICALEXPRESS 2014;1(3):140-142

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OBJECTIVE: Internet has become an easy source for healthcare information. In recent years, websites like YouTube have become increasingly popular as a source of information. It is necessary to keep in check the information disseminated from these open-access sites to prevent the spread of false information. This study analyzed how information related to the superbug New Delhi Metallo-β-lactamase 1 (NDM1) was portrayed in video clips available on YouTube.
METHODS: YouTube (www.youtube.com) was searched on June 22, 2011, using the search terms keywords NDM1, New Delhi beta-metallolactamase, NDM, New Delhi superbug, New Delhi metallolactamase to identify clips related to NDM-1. Videos were classified as useful, misleading and news update. Data analyses were conducted for the duration of videos, number of viewers, and positive and negative rating.
RESULTS: A total of 47 videos were included in this analysis. Twenty-nine videos were classified as news update, 9 videos as useful, and 9 videos as misleading videos. There was no statistically significant difference in the 3 groups regarding duration of videos, number of viewers, and positive and negative rating.
CONCLUSIONS: The results demonstrate that there is a wide variety of information on YouTube regarding NDM-1. The viewers are exposed to the useful videos as much as to misleading videos. As a result, public health professionals should be more vigilant in recognizing videos containing misleading information and physicians should counsel and educate patients against inappropriate use of online videos for medical purposes.


Keywords: Drug resistance; youtube; antibiotic.

ORIGINAL RESEARCH

9 - Early serum tacrolimus levels predict long-term chronic kidney disease after liver transplantation

Vanessa B. A. Brandão; Luciana C. Faria; Danielle M. Bicalho; Fernando H. Pereira; Agnaldo S. Lima; Teresa C. A. Ferrari

MEDICALEXPRESS 2014;1(3):143-149

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OBJECTIVE: To investigate risk factors for the development of chronic kidney disease and death two years postliver transplantation.
METHOD: Associations between clinical and laboratory parameters and the development of chronic kidney disease and survival two years post-liver transplant were analyzed in a cohort of 148 adult patients with hepatic cirrhosis consecutively submitted to liver transplantation in a referral Brazilian center.
RESULTS: Median age at liver transplantation was 56 (range, 20-73) years, and 105 (70.9%) patients were males. The prevalence of chronic kidney disease at two years post-liver transplantation was: stage 1 or no chronic kidney disease, 27.5%; stage 2, 33.8%; stage 3, 34.6%; stages 4-5, 4.7%. Four variables were independently associated with the stage of chronic kidney disease two years after liver transplantation: (i) age (at liver transplantation), (ii) male gender, (iii) median tacrolimus levels in the first three months post-liver transplantation, and (iv) median of serum creatinine in the first six months post-liver transplantation. Two variables showed independent association with death in two years post-liver transplantation: (i) stay in Intensive Care Unit for three or more days after the liver transplantation surgery and (ii) median of serum creatinine levels in the first six months post-liver transplantation equal or higher than 1.3 mg/dL.
CONCLUSIONS: Administration of the lowest effective dose of tacrolimus and adoption of strategies to spare renal function are important measures to reduce the risk of late chronic kidney disease and death post-liver transplantation especially in high risk patients.


Keywords: Chronic kidney disease; Kidney dysfunction; Liver transplantation; Tacrolimus.

10 - Women respond better to biological therapy in Crohn's Disease

Carlos Henrique Marques dos Santos

MEDICALEXPRESS 2014;1(3):150-152

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OBJECTIVE: Crohn's disease is in itself a major challenge for those treating inflammatory bowel diseases. Those exhibiting the fistulizing form, particularly perianal fistulas, create even more of a challenge, as there is great difficulty in obtaining disease control even using long-term therapeutic advances made in recent years. We evaluated the difference between the gender of patients under biological treatment for Crohn's Disease and perianal fistula.
METHODS: We studied 30 patients with Crohn's Disease with perianal fistula with a mean age of 35 years, from 2000 to 2013. All were naïve to biological agents and received these medications in usual doses and intervals. All were also treated surgically with curettage and placement of seton-stitches prior to the use of biological agents. The results were analyzed statistically by Student's t test, p < 0.05 being considered a significant difference.
RESULTS: Among responders, ten were men and nine were women, with no significant difference between genders in this regard. Among non-responders, eight were men and three were women: thus, significantly more men vs. women were non-responders. In general, 55% of men and 75% of women were responders.
CONCLUSION: Women exhibited a lower failure rate when exposed to biological treatment for perianal fistula in Crohn's Disease when compared to men.


Keywords: Crohn's disease; Infliximab; Adalimumab; perianal fistula; gender.

11 - Cardiovascular responses induced by acute video game boxing performance in healthy women

Luciano Moreira de Souza; Raquel Annoni; Luiz Carlos de Abreu; Vitor E. Valenti; Erica E. Valenti; Fernando R. Oliveira; Rodrigo D. Raimundo; Sidney Benedito Silva

MEDICALEXPRESS 2014;1(3):153-157

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BACKGROUND: Previous studies suggested that some interactive video games induce cardiovascular responses. However, some different styles of video games have not been investigated.
OBJECTIVE: We aimed to evaluate cardiovascular responses induced by video game boxing performance in healthy women.
METHOD: We evaluated ten female sedentary volunteers, aged 20.9 ± 1.4 years, weight 58.7 ± 8.0 kg, height 163.2 ± 5.4cm. All subjects were weighed and measured. Their heart rate, blood pressure and lactate levels were recorded before and after video game performance. The volunteers played a Sony video game (Nintendo® Wii) by using the boxing method, in which all volunteers played for 10 minutes without interruption. At the end of the game the volunteers were reassessed using the same parameters mentioned above.
RESULTS: At the end of the video game boxing performance we observed highly significant increases of lactate production (p < 0.0035) and the double product (heart rate vs. systolic blood pressure) was also higher (p < 0.0001). Both parameters indicate that the performance increased demands of the cardiovascular system.
CONCLUSION: We conclude that a ten-minute video game boxing performance induces cardiovascular responses similar to aerobic exercise. This may be a practical form of exercise, but care should be exercised concerning subjects with cardiovascular disorders.


Keywords: Video Games; Lactic Acid; Physiology, Cardiovascular; Oxygen Consumption.

12 - Psychoeducation improves the quality of life of informal caregivers of Glioblastoma patients

Tatiana Bukstein Vainboim; Maria Helena Pereira Franco; Alessandra Oliveira Ciccone; Flávio Key Miura; Paulo Henrique Pires de Aguiar; Milberto Scaff; Suely Kazue Nagahashi Marie

MEDICALEXPRESS 2014;1(3):158-165

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OBJECTIVE: To evaluate the impact of a psychoeducational program on the quality of life of informal caregivers of Glioblastoma patients.
METHOD: Twenty informal caregivers (test group) were evaluated before and after attending four sessions of psychoeducation and compared to a group of 10 caregivers (control group), who did not attend the sessions, but were also evaluated in two different equivalent time points. The quality of life was evaluated by WHOQOL-BREF questionnaire developed by the World Health Organization, which was applied by the same interviewer to all the participants. At the end of the study, a blinded interviewer who had no previous contact with the participants applied the tool again to check for any interference bias. The Cronbach's alpha coefficient for consistent evaluation, Student's t-test for parametric, and Wilcoxon test for non-parametric data were applied for statistical analysis.
RESULTS: The questionnaire was shown to be a consistent tool to evaluate quality of life. The test group showed significant improvement in the quality of life, especially in the psychological domain. The control group presented deterioration in all WHOQOL-BREF domains.
CONCLUSIONS: The psychoeducational program improved the quality of life of caregivers of Glioblastoma patients, and revealed to be a valuable support program to be implemented in the treatment of this type of cancer.


Keywords: Glioblastoma multiforme; Caregiver; Psychology; Grief; Quality of Life.