The effect of paroxetine on heart rate variability in patients with major depressive disorder: A systematic review and meta-analysis

INTRODUCTION

The impacts of antidepressant pharmacotherapies on cardiovascular risk are unclear. We completed a systematic review with meta-analysis to assess the effect of paroxetine on heart rate variability (HRV) in patients with major depressive disorder (MDD).

METHODS

The searches were accomplished via EMBASE, MEDLINE/PubMed (using the National Library of Medicine), Cochrane Library, CINAHL, Scopus, and Web of Science databases. We included non-blind, single, or double-blind randomized control trials in patients older than 18 diagnosed with MDD. Paroxetine needs to be enforced as a chronic therapeutic medication. We included individual studies that investigated resting HRV.

RESULTS

We documented 402 studies, only following screening and eligibility phases; only six were included (five studies in the meta-analysis). No significant change was noticed for the SDNN index: subtotal = 8.23 [CI: -2.17, 18.63], p = 0.12, I2 = 54 % (very low quality of evidence). A significant change was distinguished for the LF index: subtotal = 0.74 [CI: 0.33, 1.15], p = 0.0004, I2 = 0 % (low quality of evidence). A significant alteration was perceived for the HF index: subtotal = 0.33 [CI: 0.06, 0.6], p = 0.02, I2 = 0 % (low quality of evidence).

CONCLUSION

Meta-analysis demonstrated that paroxetine could advance HRV in MDD patients. Nevertheless, our supposition is founded only on statistical analysis and the very low quality of evidence breakdown reinforces the necessity for further studies to confirm or reject this theory.

Postmenopausal women's cognitive function and performance of virtual reality tasks

OBJECTIVE

This study aimed to assess whether prior knowledge of computer use determines performance of virtual reality tasks by postmenopausal women and whether menopausal symptoms, sociodemographic factors, lifestyle and cognition modify or interfere with their performance.

METHOD

This cross-sectional study included 152 postmenopausal women divided into two groups: computer users and non-users. Age, ethnicity, time of menopause, menopausal symptoms, female health status, level of physical activity and cognitive function were considered. The participants played a virtual reality game and were assessed for hits, errors, omissions and game time. The Mann-Whitney, chi-square and Fisher exact tests and multivariate linear regression analysis were used.

RESULTS

Postmenopausal computer users play virtual reality games (p = 0.005) better than postmenopausal non-users of computers. Vasomotor symptoms were high in women who used computers compared to those who did not (p = 0.006). Multivariate linear regression analysis found that the best-fitting predictors for the number of hits - that is, age (p = 0.039), Mini-Mental State Examination score (p = 0.006) and the headache symptom (p = 0.021) - influence the performance of virtual reality tasks.

CONCLUSION

Computer users performed virtual reality tasks better than non-users. Headache and age but not vasomotor symptoms negatively affected the postmenopausal women's performance.

Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents: Family and School Contexts

Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study's objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants' health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students' daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one's body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one's body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.

Pediatric oncohematological exercise program in hospital: clinical trial study protocol

Leukemias are the most common types of hematological cancers in children, and negatively impact functional capacity. There is evidence in the literature that therapeutic exercises can have a positive impact on functions. The aim of this study is to evaluate functional capacity, muscle strength, fatigue and quality of life through the application of a protocol of therapeutic exercises during pediatric leukemia hospitalization. Children will be allocated into two groups: one will carry out a protocol of therapeutic exercises, while the other will undergo conventional respiratory physiotherapy. The protocol is approved by the ethics and research committee of the host institution (No. 5.439.594). Results will be disseminated through peer-reviewed journal articles and conferences. Clinical trial registration: RBR-8sxnfyd (https://ensaiosclinicos.gov.br).

Autonomic heart rate modulation in patients with coronavirus disease 2019 in mechanical ventilation

BACKGROUND

Patients with coronavirus disease 2019 on automatic mechanical ventilation have greater heart rate modulation with greater parasympathetic modulation.

OBJECTIVE

To analyze the autonomic modulation of heart rate in critically ill patients with coronavirus disease 2019 on invasive mechanical ventilation.

METHODS

A cross-section study was carried out with 36 individuals divided into two groups. The control group included patients of both genders, in orotracheal intubation with invasive mechanical ventilation under controlled assisted mode, hospitalized in the intensive care unit for another 24 h. In the non-COVID group, patients diagnosed with coronavirus disease 2019 in the same condition mentioned in the control group.

RESULTS

There was a significant increase in heart rate variability (standard deviation of all normal RR intervals recorded at an interval of time; p=0.001; triangular interpolation histogram of RR intervals; p=0.048; and SD2; p=0.014) in the coronavirus disease group compared to the non-COVID group. Successively, the parameters that demonstrate parasympathetic modulation are shown to be higher in the group of patients with coronavirus disease 2019 (root mean square of the square of differences between adjacent normal RR intervals in an interval of time; p<0.001; pNN50; p<0.001; SD1; p=0.002; and high frequency; p=0.022).

CONCLUSIONS

There was a greater autonomic modulation of heart rate with a greater parasympathetic modulation in patients with coronavirus disease 2019 on mechanical ventilation.

Cardiac Behavior and Heart Rate Variability in Elderly Hypertensive Individuals during Aerobic Exercise: A Non-Randomized Controlled Study

BACKGROUND

High blood pressure is an important public health problem due to its high prevalence, the difficulty to control it, and its high contribution to morbidity. A series of changes may be linked to the aging process, compromising cardiac conduction, and reducing cardiovascular baroreceptor function. Advancing age promotes a decline in heart rate variability and this decrease can increase the probability of cardiovascular disease. The aim of this study was to analyze the autonomic modulation of heart rate in hypertensive elderly individuals during and after a session of aerobic exercise, and to compare it with elderly individuals without cardiovascular or metabolic disease. Our study was a non-randomized controlled study with hypertensive elderly (HBP group) and elderly without cardiovascular and/or metabolic diseases (control group). Data on blood pressure and heart rate variability (HRV) were collected before, during, and after 30 min of aerobic physical exercise on a treadmill. There was a reduction in HF (ms2) and SD1 (ms) in the 5 min of recovery for the elderly in the control group. The elderly in the control group also had greater RMSSD and SD1 30 min post-exercise when compared to the initial mins of recovery. We concluded that there was no difference in autonomic modulation and global heart rate variability between elderly individuals without cardiovascular and metabolic diseases and hypertensive individuals after a bout of aerobic exercise. Elderly individuals without metabolic diseases showed a decrease in parasympathetic modulation and global variability between the time of rest and 5 min of recovery. However, up to 30 min of post-exercise recovery, they restored parasympathetic activity.

Progressive Platelet Rich Fibrin tissue regeneration matrix: Description of a novel, low cost and effective method for the treatment of chronic diabetic ulcers-Pilot study

INTRODUCTION

Chronic lower limb ulcers (CLLU) are those injuries that persist for more than six weeks despite adequate care. They are relatively common; it is estimated that 10/1,000 people will develop CLLU in their lifetime. Diabetic ulcer, because of its unique pathophysiology (association between neuropathy, microangiopathy, and immune deficiency), is considered one of the most complex and difficult etiologies of CLLU for treatment. This treatment is complex, costly, and sometimes frustrating, as it is often ineffective, which worsens the quality of life of patients and makes its treatment a challenge.

OBJECTIVE

To describe a new method for treating diabetic CLLU and the initial results of using a new autologous tissue regeneration matrix.

METHOD

This is a pilot, prospective, an interventional study that used a novel protocol of autologous tissue regeneration matrix for the treatment of diabetic CLLU.

RESULTS

Three male cases with a mean age of 54 years were included. A total of six Giant Pro PRF Membrane (GMPro) were used varying their application between one to three sessions during treatment. A total of 11 liquid phase infiltrations were performed varying their application between three and four sessions. The patients were evaluated weekly and a reduction in the wound area and scar retraction was observed during the period studied.

CONCLUSION

The new tissue regeneration matrix described is an effective and low-cost method for the treatment of chronic diabetic ulcers.

Evaluation of autonomic cardiac modulation and body composition in elderly submitted to the protocol of exercise and the gametherapy: A clinical trial protocol (SPIRIT compliant)

INTRODUCTION

Aging affects the cardiovascular system by impairing the amount and strength of cardiac pumping. Heart rate variability (HRV) is a safe parameter to assess variations in the cardiovascular system, providing data on sympathetic and parasympathetic activations.

OBJECTIVES

Our primary aim is to investigate the cardiac autonomic modulation and body composition of active older adults participating in a physical exercise protocol and gametherapy. Our secondary aim is to assess their functional capacity, cognitive function, balance, respiratory pressures, and functional autonomy.

METHOD

This randomized clinical trial will include 100 active older adults aged 60 to 80 years. The exercise group (EG) will perform 24 supervised training sessions (strength and aerobic) for 12 weeks (2 60-minutes sessions per week). The gametherapy group (GG) will exercise using gametherapy. Assessments will occur on the first week, after the 12th week, after wash out and in the end of cross over. The primary outcome will be HRV and body composition (bioimpedance). Secondary outcomes will be functional capacity (6-minute walk test), cognitive function (mini-mental state examination), risk of falls and balance (berg balance scale and timed up and go test), inspiratory and expiratory pressures (manovacuometry) and functional autonomy (functional reach test and group of Latin American development to maturity [GDLAM] protocol).

DISCUSSION

This study will provide relevant information about the effects of physical training (physical exercises and gametherapy) on HRV and other variables in active older adults.

Relationship between musculoskeletal pain, sleep quality and migraine with level of physical activity in college students during the COVID-19 pandemic

Background

The COVID-19 pandemic has negative impacts on general health of the population, social isolation can contribute to the emergence of various dysfunctions.

Objective

To investigate the association musculoskeletal pain, sleep quality and migraine with the level of physical activity during the COVID-19 pandemic in college students.

Method

Data were collected through a sociodemographic questionnaire containing questions regarding sample characterization, the Nordic Musculoskeletal Questionnaire (NMQ), Pittsburgh Sleep Quality Index (PSQI), Migraine Disability Assessment (MIDAS) and the International Physical Activity Questionnaire (IPAQ).

Results

In the correlation made between the data at the beginning of the pandemic, there was a direct relationship between PSQI and the number of days with pain (p < 0.001), the Initial MIDAS score (p < 0.001) and the initial pain intensity (p < 0.001). There was a direct relationship between PSQI scores and age (p = 0.044), MIDAS (p < 0.001) and pain intensity (p < 0.001). We identified a direct relationship between MIDAS and the number of days with pain (p < 0.001) and pain intensity (p < 0.001).

Conclusion

Social isolation, during the COVID-19 pandemic, probably potentiated painful symptoms in various parts of the body, worsening sleep quality and migraine. In addition, there is a strong evidence that the decrease in physical activity during the pandemic is associated with sleep quality, with the number of days with musculoskeletal pain and migraine.

Use of interventions involving virtual reality tasks during the climacteric: a systematic review

Technological advances have been impacting health care worldwide. Our study aimed to research the literature systematically to determine the impact of technological treatments versus conventional treatments on the quality of life of climacteric women. The study was registered on PROSPERO (CRD42021241638). We searched seven databases, including PRISMA, using mesh terms. After screening for eligibility, we selected five clinical trials, and applying the snowball technique we were able to include four more articles, totaling nine articles that used technology-based interventions (virtual reality games) during the climacteric. The total study population consisted of 298 climacteric women. Two studies evaluated a technology-based treatment for pelvic floor, one for urinary incontinence symptoms, three for postural balance, one for cardiorespiratory capacity, one for osteoporosis and one study for lower back pain. The studies showed that the technological treatments improved pelvic floor strength, balance, cardiorespiratory fitness and bone mineral density when compared to conventional treatments. Improvement was linked to adherence to training and a high level of satisfaction during the training sessions. Technology-based treatments appear to be a viable alternative to conventional treatments in improving the quality of health, with benefits for the cardiovascular, genitourinary and skeletal systems, and ultimately for the overall quality of life.

Temporal Trend of the Prevalence of Modifiable Risk Factors of Stroke: An Ecological Study of Brazilians between 2006 and 2012

Stroke is one of the leading causes of death worldwide, including in Brazil. This study aimed to analyze the temporal trend of the prevalence of modifiable risk factors of stroke from 2006 to 2012. This ecological study was conducted by secondary analysis in May 2018, using data from the surveillance of risk factors and protection for chronic diseases by telephone inquiry (VIGITEL) available in the Department of Informatics of the Unified Health System (DATASUS). The modifiable risk factors of stroke in Brazilians were systemic arterial hypertension, diabetes mellitus, abusive alcohol consumption, overweight, and obesity. Overall, there was a significant increase in the risk factors of diabetes (β = 0.30, P = 0.001, r2 = 0.99), overweight (β = 0.50, P = 0.002, r2 = 0.98), and obesity (β = 0.88, P < 0.001, r2 = 0.96). However, there was a stability in the prevalence of hypertension (β = 0.25, P = 0.320, r2 = 0.88) and alcohol abuse (β = 0.32, P = 0.116, r2 = 0.49). There was an increase in the prevalence of diabetes mellitus, overweight, and obesity, but stability in systemic arterial hypertension and abusive alcohol consumption in the Brazilian population.

Cardiac autonomic modulation in children with severe liver disease, before and after liver transplantation

BACKGROUND

The cardiovascular system is directly influenced by the autonomic nervous system (ANS); its changes affect heart rate variability (HRV) and are sensitive indicators of physiological changes. Autonomic dysfunction (AD) is manifested in up to 60% of patients with cirrhosis. Therefore, we aim to analyze the indexes of HRV pre- and post-surgery of children submitted for liver transplantation (LT).

METHODS

HRV, in children of both genders from 6 months of age to 10 years, that attended at the pediatric surgery clinic in the queue for LT at the Children's Institute were analyzed. To access HRV we analyzed indexes such as standard deviation of the RR intervals (SDNN), root-mean-square of the successive normal sinus RR interval difference (RMSSD), low frequency (LF), high frequency (HF), and LF/HF.

RESULTS

The analysis of the behavior of cardiac autonomic modulation, in the period prior to LT and after surgery, showed an increase in HRV linear parameters SDNN, TINN (triangular interpolation of NN interval histogram), HFms². In the time domain, there was also an increase in the HFms² index.

CONCLUSIONS

The analysis of the period preceding LT and two months after surgery showed an increase in the HRV linear parameters representing a global HRV improvement. In the time domain, there was also an increase in the HFms² index, parasympathetic tone of the HRV.

Effect of resisted exercise on autonomic cardiac modulation in elderly women: STROBE-compliant study

Heart rate variability (HRV) is an important cardiac health marker, with lower values indicating a reduction in vagal control of cardiac rhythm and decreasing significantly with advancing age. In this study, we evaluated the effects of strength exercises for the upper and lower limbs on cardiac autonomic modulation in elderly women.We registered 29 participants using a portable RS800CX heart rate monitor to record the RR intervals. For the collection of HRV data, the volunteers remained seated at rest for 10 minutes. After the rest period, the participants performed the exercises. Immediately after the exercise protocol, the subjects remained seated at rest for 30 minutes. HRV indices were analyzed in the following periods: rest, 0 to 10 minutes, 5 to 10 minutes, 10 to 20 minutes, and 20 to 30 minutes. Systolic arterial pressure and diastolic arterial pressure were measured in the following periods: rest, immediately after exercise, and 30 minutes after exercise.Regarding the mean of the RR intervals, heart rate, and indexes of the time and frequency domains surveyed, there were no statistically significant differences between the 4 moments in the protocols for upper and lower limbs. No significant differences were found in systolic and diastolic pressures between the 3 time points surveyed in the protocols for the upper and lower limbs.Resistance exercises performed with low-intensity loads and a greater number of repetitions did not promote significant variations in cardiac autonomic modulation and blood pressure levels, showing good safety in elderly women.

Use of health services by the population living in contaminated areas in the region of the Santos and São Vicente estuarine system, Brazil

Objective: To relate the socio-demographic profile with access to health services of the population living in environmentally degraded areas in an estuary region.Study design: A sectional field study of 8819 people, evaluating three contaminated areas of São Vicente.Methods: Households were divided by studied area. A structured and pre-tested questionnaire was applied to obtain the data. A probabilistic sample was used. The prevalence of each of the outcomes of interest by area was calculated. To verify the existence of an association between the outcomes of interest and other variables (qualitative), by area, a descriptive analysis and to compare percentages and a comparison test was used between two proportions, a Chi-square test and/or a Fisher's exact test and a Kruska-wallis and Dunn multiple comparison were used as well. The significance level was 5%.Results: Most residents (94%) reported the use of public health services at least once a year (p < 0.001), mainly through the Basic Health Units (BHU) (p < 0.001). Most of the studied population (65%) did not have private health insurance and their schooling was basically restricted to primary education (p < 0.001). The predominant family income (70%) in the three areas was between one and five minimum wages (p < 0.001), with a higher incidence of people receiving one to three minimum wages at the time. The demand for health services was not associated with education or income.Conclusion: The population of the regions analysed heavily rely on the Unified Health System - SUS, but there was no association between income and frequency of health services and there was also no association between education and use of health services.

The Use of Cardiac Autonomic Responses to Aerobic Exercise in Elderly Stroke Patients: Functional Rehabilitation as a Public Health Policy

Background and purpose: The development of public policies must be guided by full knowledge of the health–disease process of the population. Aerobic exercises are recommended for rehabilitation in stroke patients, and have been shown to improve heart rate variability (HRV). Our aim was to compare the cardiac autonomic modulation of elderly stroke patients with that of healthy elderly people during and after an acute bout of aerobic exercise. Methods: A total of 60 elderly people participated in the study (30 in the control group, mean age of 67 ± 4 years; 30 in the stroke group, mean age of 69 ± 3 years). HRV was analyzed in rest—10 min of rest in supine position; exercise—the 30 min of peak exercise; and recovery—30 min in supine position post-exercise. Results: Taking rest and exercises together, for SDNN, RMSSD, pNN50, RRTri, and TINN, there was no difference between the stroke and control groups (p = 0.062; p = 0.601; p = 0.166; p = 0.224, and p = 0.059, respectively). The HF (ms²) was higher and the LF/HF ratio was lower for the stroke group than the control group (p < 0.001 and p = 0.007, respectively). The SD2 was lower for the stroke group than for the control group (p = 0.041). Conclusion: Stroke patients present reduced variability at rest, sympathetic predominance during exercise, and do not return to baseline after the 30 min of recovery, with similar responses found in the healthy elderly group.

Association between sleep quality and depression among institutionalized and community older people - Brazilian Western Amazonia

BACKGROUND

The transition in the population pyramid is a reality in several locations around the world and projections of an increase in the older population in Brazil demonstrate the relevance of studies on factors that may interfere in the functionality and quality of life in this age group. Thus, the present study aims to assess depression levels and their relationship with sleep quality in institutionalized and community older adults.

METHODS

This cross-sectional study included 220 older people of both sexes, divided into two groups, institutionalized older adults, and community older adults. The older adults were monitored by Community Health Agents (CHA), through identification of everyone in their micro area using a method of random name generation, based on geographic location. Due to the small number of institutionalized older adults, all residents in the institutions were recruited, according to the inclusion and exclusion criteria. The Geriatric Depression Scale (GDS-15) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression and sleep quality.

RESULTS

Among the 220 older adults, 175 were community members and 45 were institutionalized. The survey revealed that institutionalized older adults had a higher percentage of severe depression compared to community dwelling older adults (p <  0.039).

CONCLUSION

Older adults in the community present greater symptoms of depression and better sleep than institutionalized older adults. There was a direct association between sleep quality and depression. In our sample, being institutionalized and female positively influenced and feeling alone negatively influenced depressive symptoms.

Relationship of the mobility of the sacroiliac joint with foot plant pressure

[Purpose] To evaluate mobility of the sacroiliac joint and plantar pressure changes. [Participants and Methods] This was an analytical study comprised of 300 participants, using a functional kinetic evaluation involving the test of standing flexion (SFT), the test of Downing, the test of Gillet, and the analysis of baropodometry. [Results] There was an association between mobility of the sacroiliac joint and the standing center of gravity. However, the mobility of this joint was not associated with plantar pressure and the plantar contact area. [Conclusion] These data suggest that sacroiliac mobility is linked to the center of gravity. This connection may precede sacroiliac dysfunction and may help to improve the accuracy of the tests.

Open and Closed Endotracheal Suction Systems Divergently Affect Pulmonary Function in Mechanically Ventilated Subjects

BACKGROUND

In mechanically ventilated subjects, intra-tracheal secretions can be aspirated with either open suction systems (OSS) or closed suction systems (CSS). In contrast to CSS, conventional OSS require temporarily disconnecting the patient from the ventilator, which briefly diminishes PEEP and oxygen supply. On the other hand, CSS are more expensive and less effective at aspirating secretions. Thus, it was hypothesized that the 2 procedures differentially affect pulmonary and cardiovascular parameters after suction.

METHODS

Subjects in the ICU (N = 66) were quasi-randomized for initial treatment with OSS or CSS in a crossover design. To compare the potential for these suction systems to compromise cardiorespiratory stability, changes in cardiopulmonary physiology were assessed from before to just after use of each suction system (three 10-s aspirations).

RESULTS

For most pulmonary and cardiovascular parameters (ie, peak inspiratory pressure, airway resistance, pressure plateau, heart rate, and arterial pressures), the effects of aspiration inversely correlated with baseline values for that parameter, with a similar regression slope between suction systems. However, when controlling for baseline values, OSS caused significantly greater increases in airway resistance and peak inspiratory pressure (P < .001 and < .01 vs CSS, respectively).

CONCLUSIONS

Elevated airway resistance prior to endotracheal suction may justify use of a CSS and contraindicate a conventional OSS in mechanically ventilated subjects. Adoption of this approach into clinical guidelines may prevent suction-induced pulmonary injury in subjects, especially for those with underlying diseases involving increased airway resistance or increased alveolar pressure. (ClinicalTrials.gov registration: NCT03256214.).

Relevance of the vectorcardiogram in the Brugada syndrome with "northwest QRS axis"

The outcome in the Brugada syndrome (BrS) is more benign in female than in male individuals. However, outcome could be adversely affected by sinus node dysfunction (SND). Long sinus pauses indicate an overlap between the phenotypes of BrS and SND. We present a 29-year-old woman with syncopal episodes at rest since adolescence.

Heart rate variability helps to distinguish the intensity of menopausal symptoms: A prospective, observational and transversal study

Heart Rate Variability (HRV) represents cardiac autonomic behavior and have been related to menopausal symptoms, mainly vasomotor symptoms and their imbalance to cardiovascular risk. It is not clear in the literature which index represents this imbalance and what is their involvement with the menopausal state. The aim of this study was to evaluate HRV in menopausal transition and post-menopausal symptoms with different intensities. This cross-sectional study was conducted in Rio Branco, State of Acre, Brazil from October 2016 to July 2017. We used Kupperman-Blatt Menopausal Index (KMI) to measure menopausal symptoms intensity. HRV analysis was performed based on the guidelines of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. HRV is lower in the group with moderate/intense menopausal symptoms compared to mild symptoms. (RMSSD: p = 0.005, Cohen’s d = 0.53, pNN50: p = 0.0004, Cohen’s d = 0.68; HF: p = 0.024, Cohen’s d = 0.44). There was association between HRV and KMI (RMSSD: r = -1.248, p = 0.004; and pNN50: r = -0.615, p: 0.029) in inverse relation to the intensity of vasomotor symptoms in women in TM. In conclusion, HRV was able to distinguish menopausal symptoms, indicating reduced vagal control in women with more intense symptoms.

Evaluation of sleep quality and daytime somnolence in patients with chronic obstructive pulmonary disease in pulmonary rehabilitation

Background

Dyspnea, fatigue, and decline in sleep quality are symptoms of chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation programs have been shown to ameliorate dyspnea and fatigue. However, only a few studies have investigated the effects of pulmonary rehabilitation on the sleep quality of COPD patients. In this study, we analyzed the benefits of a pulmonary rehabilitation program to sleep quality and daytime somnolence in COPD patients.

Methods

This study was a study of 30 moderate-severe COPD patients. All patients were evaluated by a pulmonologist and underwent polysomnography before participating in the study. For this study, we selected only ex-smokers and patients with sleep apnea were referred to the sleep clinic. These participants were prospectively recruited and not selected based on program completion. Before the start of the program, sleep quality and daytime somnolence of the participants were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), respectively. Rehabilitation program consisted of muscular training sessions conducted at the gym 3 times per week for 12 weeks. After rehabilitation program, the patients were reassessed and their sleep quality and daytime somnolence were reevaluated using the PSQI and the ESS, respectively.

Results

Before rehabilitation, PSQI evaluation revealed that 73% of the participants had poor sleep quality, and ESS evaluation showed that 86.7% of the participants experienced daytime somnolence. After pulmonary rehabilitation, the PSQI specifically improved in terms of subjective sleep quality and sleep duration (< 0.001), habitual sleep efficiency (0.001), and sleep latency and sleep alterations (0.002) and there was also improvement in the ESS (< 0.001).

Conclusion

Pulmonary rehabilitation program of gradually increasing intensity has the potential to provide sleep-related benefits to patients with COPD who have poor sleep quality and daytime somnolence.

Trial registration

Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR62b4z2.

Preprints na Área da Saúde

Não se aplica

Increasing prevalence, time trend and seasonality of gastroschisis in São Paulo state, Brazil, 2005-2016

To estimate the gastroschisis seasonality and trend of prevalence in recent years, stratified by maternal age and geographical clusters of São Paulo state, a population-based study was designed. We used data from the Live Births Information System (SINASC) in São Paulo state, Brazil, from 2005 to 2016. Trends of prevalence were evaluated for the specific subgroups using the Prais-Winsten regression model, and the Durbin-Watson test was used, to estimate the regression coefficient, the annual percent change (APC), and 95% confidence interval (CI). We observed 1576 cases of gastroschisis among 7,317,657 live births (LB), a prevalence of 2.154 (95% CI: 2.047-2.260) per 10,000 LB which included, 50.6% males, 67.4% Caucasians, 53.4% preterm births, and 80.9% caesarean births. The prevalence of gastroschisis significantly increased by 2.6% (95% CI: 0.0-5.2) per year, and this trend was higher in mothers aged 30-34 years (APC: 10.2, 95% CI: 1.4-19.4) than in mothers of other age groups. Between 2011 and 2016, we identified the existence of seasonality based on the date of conception in the middle months of the year (p = 0.002). This is the first and largest population-based study summarizing current epidemiology and identifying trend of prevalence of gastroschisis in São Paulo state.

Is aerobic exercise training during hemodialysis a reliable intervention for autonomic dysfunction in individuals with chronic kidney disease? A prospective longitudinal clinical trial

Introduction

Physical exercises help in the rehabilitation and recovery of various diseases. Cardiovascular and hypertension problems are the main causes of people being affected by kidney problems, which as a consequence, affects the heart rate variability (HRV) of the individual. Physical activity developed in a well-planned and thorough way can be a component in the treatment of this problem.

Objective

We aimed to evaluate the effects of aerobic exercise intervention during hemodialysis on autonomic heart rate regulation in individuals with chronic kidney disease (CKD).

Methods

This was a longitudinal trial conducted in 19 CKD patients. The patients underwent three weekly sessions of aerobic exercise during hemodialysis for 30 mins for 12 weeks (three months).

Results

HRV was analyzed before and after the protocol training. Linear indices of HRV were not different between before and after the protocol training. Nonlinear HRV analysis indicated reduced values of determinism (p=0008, Cohen's d=0.82) and entropy (p=003, Cohen's d=0.84) after the training protocol.

Conclusion

In conclusion, aerobic exercise training during hemodialysis did not improve autonomic control of heart rate in CKD patients.

Contrasting performance between physically active and sedentary older people playing exergames

The increase in life expectancy associated with the increase in chronological age and less active people helps in the appearance of chronic and degenerative diseases. The encouragement of physical exercises contributes to older people abandoning sedentarism and preventing such diseases. Exergame is a promising alternative, for making exercise a pleasurable activity.In this study, we compared the performance of physically active older people with sedentary older people in exergames.Participants were 83 older adults over 65 years of age, of both sexes, divided into 2 physically active older people (AG) and sedentary older people (CG) groups. The participants performed a task through an exergame called "MoviLetrando" that uses the score, number of hits, number of omissions, and an average time of hits as an evaluation. A characterization questionnaire was applied, with information about sex, age, marital status, economic class, self-rated health, time of use of electronic games, a questionnaire on the practice of physical activity, and the Brunel Mood Scale.There was a higher exergame score in AG than in CG (P = .003), in the number of correct answers (P = .012). The number of omissions was lower in AG than in CG (P = .023). The mean time of correct answers was lower in AG than in CG (P = .013). The regression analysis revealed a significant finding F (3, 82) = 11.06, P < .001 and showed a prediction ability of 26.9% (r = .269). Three variables remained significantly associated with the score: physical activity was marginally significant (β = .19, P = .06), age (β = -.403, P < .001), depression (β = -.212, P = .028).Physically active older people perform better when compared with the sedentary older people. Age, depression, and physical activity influence the performance in exergame.

Pelvic floor disorders in postpartum adolescents in the Western Amazon: a cross-sectional study

PURPOSE

To analyze the postpartum pelvic floor disorders (PFD) and mode of delivery among adolescents, late adolescents, and young women from Western Amazon.

PATIENTS AND METHODS

Cross-sectional study was carried out in the urban area of Western Amazon in the city of Rio Branco, Acre, Brazil, from October 2016 to February 2017. This is a convenience sample of women up to 30 years who completed six months postpartum, separated in three groups according to maternal age: adolescents (age ≤19 years), late adolescents (20-24 years), and young women (25-30 years). Participants were home interviewed and answered Pelvic Floor Distress Inventory-20 (PFDI-20). Delivery clinical data were collected from patient's medical records.

RESULTS

In total, 285 participants were interviewed: 41 adolescents, 103 late adolescents, and 141 young women. After controlling for confounding factors, prevalences of PFD were higher in the adolescents' group compared with the young women's group (urinary incontinence [UI], prevalence ratio [PR] = 1.75, 95% CI 1.14-2.69; urge urinary incontinence [UUI], PR = 1.88, 95% CI 1.02-3.47; stress urinary incontinence, PR = 2.00, 95% CI 1.11-3.62; fecal incontinence [FI], PR = 4.40, 95% CI 1.36-14.27). PFDI-20 scores also presented higher values in the adolescent group (Pelvic Organ Prolapse Distress Inventory [POPDI], PR = 2.02, 95% CI 1.49-2.75; urinary distress inventory [UDI], PR = 2.09, 95% CI 1.47-2.98; PFDI, PR = 2.12, 95% CI 1.47-2.98). Analyzing the influence of cesarean section, adolescents have higher prevalence of UI (PR = 1.84, 95% CI 1.04-3.26, P=0.037), UUI (PR = 2.36, 95% CI 1.03-5.40, P=0.042), and FI (PR = 4.09, 95% CI 1.21-13.81, P=0.023). In addition, POPDI (PR = 2.15, 95% CI 1.60-2.89, P<0.001), UDI (PR = 2.25, 95% CI 1.61-3.16, P<0.001), and PFDI (PR = 2.27, 95% CI 1.68-3.08, P<0.001) scores are also higher among adolescents where the baby is born by cesarean section.

CONCLUSION

Adolescents present higher prevalence and symptoms of PFD; furthermore, cesarean delivery has a greater negative influence on the pelvic floor of adolescents when compared with young women. This reinforces the importance of PFD investigation among the adolescent population, mainly in developing countries which have high rates of adolescent pregnancy and cesarean section.

Regional differences in the temporal evolution of stroke: a population-based study of Brazil according to sex in individuals aged 15-49 years between 1997 and 2012

Objective

The present study analyzed the temporal trend of stroke mortality according to sex in individuals aged 15–49 years in the different regions of Brazil between 1997 and 2012.

Results

There was progressive reduction in mortality rate due to stroke in Brazil. The reduction trend was the same for both sexes, although mortality remained slightly higher among men. There was a difference in mortality rates according to the administrative region of the country.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3439-x) contains supplementary material, which is available to authorized users.

Cardiorespiratory parameters and glycated hemoglobin of patients with type 2 diabetes after a rehabilitation program

INTRODUCTION

Cardiovascular autonomic dysfunction reflex of the pathophysiology of diabetes mellitus (DM) favors an increase in morbidity and mortality related to cardiovascular events, and for this reason has been one of the most studied clinical entities.

METHOD

An experimental study of a randomized clinical trial type was therefore proposed to analyze the hemodynamic and glycemic response after the practice of a rehabilitation program in patients with type 2 diabetes mellitus (T2DM). In this clinical trial the patients will initially be submitted to an evaluation protocol that consists of assessing blood pressure, heart rate, Borg scale, respiratory rate, oxygen saturation, distance traveled through the 6-minute walk test, quality of life questionnaire, Pittsburgh sleep quality questionnaire, and still glycated hemoglobin and heart rate variability through the cardiofrequency meter. After careful evaluation of the patients, they will be submitted to a metabolic rehabilitation program composed of aerobic and resisted exercises, performed for 12 weeks, in 3 weekly meetings of 60 minutes each. With such evaluations, it will be possible to construct with evidence that it is possible to work safer metabolic rehabilitation programs in patients with T2DM or other diseases that generate cardiovascular risks, guaranteeing them an improvement in cardiorespiratory fitness, hemodynamic and glycemic variables, allowing improvement of the quality of life.

ETHICS AND DISSEMINATION

The protocol is approved by the host institution's ethics committee under the number 1.616.721. Results will be disseminated via peer-reviewed journal articles and conferences. This clinical trial is registered at ClinicalTrials.gov identifier: NCT3094767.

The congenital long QT syndrome Type 3: An update

Congenital long QT syndrome type 3 (LQT3) is the third in frequency compared to the 15 forms known currently of congenital long QT syndrome (LQTS). Cardiac events are less frequent in LQT3 when compared with LQT1 and LQT2, but more likely to be lethal; the likelihood of dying during a cardiac event is 20% in families with an LQT3 mutation and 4% with either an LQT1 or an LQT2 mutation. LQT3 is consequence of mutation of gene SCN5A which codes for the Nav1.5 Na+ channel α-subunit and electrocardiographically characterized by a tendency to bradycardia related to age, prolonged QT/QTc interval (mean QTc value 478 ± 52 ms), accentuated QT dispersion consequence of prolonged ST segment, late onset of T wave and frequent prominent U wave because of longer repolarization of the M cell across left ventricular wall.

Low cost assistive technology to support educational activities for adolescents with cerebral palsy

INTRODUCTION

The concept of assistive technology covers several areas of action; one of them is communication with the elaboration of accessible solutions to overcome daily difficulties. It contributes to the resumption of functional abilities, expanding and facilitating inclusion and independent living.

OBJECTIVE

To analyze the usability of a low cost prototype device to support educational activities of adolescents with cerebral palsy.

METHODS

A descriptive observational study. The evaluation of a prototype device was made through a validated questionnaire, Quest Version 2.0, on the level of the user's satisfaction with an assistive technology, composed of 12 evaluation items. The questionnaire was filled out by the educator based on the observation of four wheelchair-bound participants diagnosed with cerebral palsy according to the international classification of diseases and health-related problems, ICD-10, who attend a coexistence and teaching institution in the state of São Paulo, Brazil.

RESULTS

The device developed was considered an assistive technology, which provided an experience with a positive level of satisfaction for the participants.

CONCLUSION

The tested prototype contributes to communication and interaction allowing adolescents with cerebral palsy to participate in educational activities. Implications for Rehabilitation The device assists the individual in the educational activities and can positively influence their development, observe the individual number 5, who has an important limitation in coordination and fine movements, placing the role of the task in the vertical position offers a new perspective to perform the task, this stimulates him to try to perform the work, so the challenge was adjusted to the demands of each individual which can contribute to its neuromotor development, the amplitude of the distal movements and the manual ability, since it must look for alternatives to complete the task requested.

Reduction of heart rate variability in hypertensive elderly

INTRODUCTION

The elderly population grows globally every day, and along with it the incidence of high blood pressure also grows, following these data scientists seek tools to improve the health of this population, a widely used tool for assessing cardiovascular function is the heart rate variability(HRV), that is a mecanism that allows the investigation of oscillations in the intervals between consecutive heart beats (RR intervals). There are already studies on the autonomic nervous system in the elderly population, however, these studies investigated normotensive patients and there is little research in hypertensive patients.

AIM

To compare the cardiac autonomic modulation between healthy elderly and hypertensive elderly.

METHOD

The total sample was 80 elderly people- 40 healthy elderly and 40 elderly (HBP). Anthropometric data, HRV analysis and IPAQ questionnaire were collected. For the analysis of cardiac modulation data in the time domain (pNN50, SDNN and RMSSD) and frequency domain (LF and HF). The geometric analysis (RRtri, TINN, SD1, SD2 and SD1/SD2 ratios).

RESULTS

In the time domain the MeanRR index presented a HAS increase 832.35 ± 104.46 ms vs control 782.73 ± 112.78 ms (p = 0.040). In the SDNN, there was a 58.35ms decrease vs the SAH 43.15 ms (p = 0.030). In the frequency domain, HF decreased control 247.00 ms2 vs HAS 157.00 ms2 (p = 0.002). In the geometric, the TINN and SD2 in the HAS group decreased in relation to the control from 203.38 ± 80.26 ms to 161.83 ± 53.25 ms (p = 0.018) and from 71.95 ms to 59.40 ms (p = 0.051). The mean SD1/SD2 ratio showed an increase between the Control and SAH groups from 0.22 ± 0.10 to 4.09 ± 1.18 and there was a statistical difference (p = 0.001).

CONCLUSION

Hypertensive elderly patients present decreased heart rate variability and decreased parasympathetic modulation when compared to normotensive elderly.

A unique case of inflammatory fibroid polyp in the duodenum of a female adolescent: Case report and literature review

BACKGROUND

Inflammatory fibroid polyp (IFP) is a very rare benign condition in children that can occur throughout the gastrointestinal tract. It is characterized as a polypoid lesion originating in the submucosa, composed of connective tissue and eosinophilic infiltrate. It is most common in the stomach and in adults between the fifth and seventh decades of life. Its occurrence is unusual in the duodenum.

CASE SUMMARY

One case of duodenal IFP was described and the literature is reviewed with emphasis on the clinical and pathological features of IFP in children. A case of an IFP in the duodenum of a 13-year-old girl, who presented with abdominal pain, weight loss, vomiting, and constipation. The patient underwent exploratory laparotomy; a stenosing tumor of the third duodenal portion was found. The affected segment was resected and an end-to-end anastomosis between the duodenum and jejunum segment was performed. Immunohistochemically, actin and CD34 were positive, Ki67 was positive in <1% of cells, and the proteins CD117 and S100 were negative.

CONCLUSION

To our best of our knowledge, this is the fourth report of IFP in adolescents, the first in a female's duodenum.

Autonomic Modulation in Duchenne Muscular Dystrophy during a Computer Task: A Prospective Control Trial

INTRODUCTION

Duchenne Muscular Dystrophy (DMD) is characterized by progressive muscle weakness that can lead to disability. Owing to functional difficulties faced by individuals with DMD, the use of assistive technology is essential to provide or facilitate functional abilities. In DMD, cardiac autonomic dysfunction has been reported in addition to musculoskeletal impairment. Consequently, the objective was to investigate acute cardiac autonomic responses, by Heart Rate Variability (HRV), during computer tasks in subjects with DMD.

METHOD

HRV was assessed by linear and nonlinear methods, using the heart rate monitor Polar RS800CX chest strap Electrocardiographic measuring device. Then, 45 subjects were included in the group with DMD and 45 in the healthy Typical Development (TD) control group. They were assessed for twenty minutes at rest sitting, and five minutes after undergoing a task on the computer.

RESULTS

Individuals with DMD had a statistically significant lower parasympathetic cardiac modulation at rest when compared to the control group, which further declined when undergoing the tasks on the computer.

CONCLUSION

DMD patients presented decreased HRV and exhibited greater intensity of cardiac autonomic responses during computer tasks characterized by vagal withdrawal when compared to the healthy TD control subjects.

Socio-Environmental and Hematological Profile of Landfill Residents (São Jorge Landfill-Sao Paulo, Brazil)

We are experiencing an unprecedented urbanization process that, alongside physical, social and economic developments, has been having a significant impact on a population's health. Due to the increase in pollution, violence and poverty, our modern cities no longer ensure a good quality of life so they become unhealthy environments. This study aims to assess the effect of social, environmental and economic factors on the hematologic profile of residents of Santo André's landfill. In particular, we will assess the effect of social, economic, and environmental factors on current and potential disease markers obtained from hematological tests. The research method is the observational type, from a retrospective cohort, and by convenience sampling in Santo André in the Greater ABC (municipalities of Santo André, São Bernardo do Campo and São Caetano do Sul, southeast part of the Greater São Paulo Metropolitan Area, Brazil). The study determined a socio-environmental profile and the hematologic diseases screening related to a close location to the landfill. The disease manifests itself within a broad spectrum of symptoms that causes changes in blood count parameters. The objective of this work is to show that there is an association between social, environmental and economic factors and a variety of serious disease outcomes that may be detected from blood screening. A causal study of the effect of living near the landfill on these disease outcomes would be a very expensive and time-consuming study. This work we believe is sufficient for public health officials to consider policy and attempt remediation of the effects of living near a landfill.

Cardiac autonomic regulation during exposure to auditory stimulation with classical baroque or heavy metal music of different intensities

OBJECTIVES

The effects of chronic music auditory stimulation on the cardiovascular system have been investigated in the literature. However, data regarding the acute effects of different styles of music on cardiac autonomic regulation are lacking. The literature has indicated that auditory stimulation with white noise above 50 dB induces cardiac responses. We aimed to evaluate the acute effects of classical baroque and heavy metal music of different intensities on cardiac autonomic regulation.

STUDY DESIGN

The study was performed in 16 healthy men aged 18-25 years. All procedures were performed in the same soundproof room. We analyzed heart rate variability (HRV) in time (standard deviation of normal-to-normal R-R intervals [SDNN], root-mean square of differences [RMSSD] and percentage of adjacent NN intervals with a difference of duration greater than 50 ms [pNN50]) and frequency (low frequency [LF], high frequency [HF] and LF/HF ratio) domains. HRV was recorded at rest for 10 minutes. Subsequently, the volunteers were exposed to one of the two musical styles (classical baroque or heavy metal music) for five minutes through an earphone, followed by a five-minute period of rest, and then they were exposed to the other style for another five minutes. The subjects were exposed to three equivalent sound levels (60-70dB, 70-80dB and 80-90dB). The sequence of songs was randomized for each individual.

RESULTS

Auditory stimulation with heavy metal music did not influence HRV indices in the time and frequency domains in the three equivalent sound level ranges. The same was observed with classical baroque musical auditory stimulation with the three equivalent sound level ranges.

CONCLUSION

Musical auditory stimulation of different intensities did not influence cardiac autonomic regulation in men.

Exercícios físicos em pacientes internados em Unidade de Terapia Intensiva: novas perspectivas

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Cardiac autonomic modulation of children with Down syndrome

The aim of this study is to analyze the autonomic modulation in children with Down syndrome (DS). The study was conducted with a convenience sample of children with DS and without heart disease, from the Genetics Clinic of the Hospital Infantil Darcy Vargas and APAE São Paulo, São Paulo, SP, Brazil. The control group was matched for sex and age. The analysis of autonomic modulation was performed using the indices of heart rate variability (HRV). The children remained in the supine position with spontaneous breathing for 20 min. Heart rate was recorded beat-to-beat. HRV analysis was performed in time and frequency domain. For data analysis, we used Student's t test: unpaired and Mann-Whitney. It was considered statistically significant at p < 0.05. From 75 children with DS, 50 were excluded, a total of 25 children [16 boys, 8.6 (1.4) years] participated in this study, and the control group also consisted of 25 children [16 boys, 9.0 (1.2) years] without the syndrome. The BMI of the volunteers with DS was higher than the controls [19.1 (2.9) vs. 15.8 (1.2), p < 0.0001]. There were differences between groups in the indices in frequency domain: LFms(2) [1242.1 (788.25) vs. 786.44 (481.90), p = 0.040], LFun [69.104 (11.247) vs. 57.348 (11.683), p = 0.0004], HFun [30.896 (11.247) vs. 42.520 (11.634), p = 0.0004] and LF/HF [2.594 (1.104) vs. 1.579 (0.9982), p = 0.0004]. No differences were observed in time domain indices. The results indicate increased indices representing the sympathetic branch of the autonomic nervous system and those that indicate the overall modulation in children with DS.

Efeitos pleiotrópicos das estatinas na sepse

O objetivo do presente estudo foi revisar os efeitos da terapia com estatinas em pacientes com quadro de sepse. Foi realizada uma busca bibliográfica de artigos na base de dados MEDLINE/PubMed, SciELO e LILACS, no período de publicação delimitado entre 2009 e 2013. Foram incluídos artigos referentes a ensaios clínicos randomizados controlados e estudos de coorte observacionais clínicos. Foram encontrados diversos estudos clínicos e observacionais que investigaram o efeito do uso de estatinas em infecções e em sepse, tanto de uso contínuo pré-hospitalar (com ou sem interrupção durante internação) ou com início imediato pós-internação. Alguns estudos descrevem prováveis efeitos positivos e benéficos da terapia com estatinas no quadro de sepse, dentre eles a melhora dos parâmetros inflamatórios e da taxa de mortalidade, porém, esses resultados não se sustentam quando são aplicados métodos estatísticos que levam em conta diferentes variáveis, tais como idade, sexo, comorbidades e gravidade da doença. Até o momento nenhum estudo demonstrou evidências sólidas e significativas quanto à redução de mortalidade e morbidade no quadro séptico associado ao uso de estatinas, indicando que seu efeito benéfico e protetor ainda não foi plenamente delimitado, sendo necessários mais estudos que confirmem os resultados até agora encontrados. 

Comparison between the six-minute walk test and the six-minute step test in post stroke patients

Background

The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests.

Method

The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST.

Results

12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests.

Conclusion

The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.