Non-invasive ventilation in obesity hypoventilation syndrome without severe obstructive sleep apnoea.

BACKGROUND: Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. METHODS: Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2 months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. RESULTS: A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of -6 (95% CI -7.7 to -4.2) mm Hg versus -2.8 (95% CI -4.3 to -1.3) mm Hg, (p<0.001) and serum bicarbonate of -3.4 (95% CI -4.5 to -2.3) versus -1 (95% CI -1.7 to -0.2 95% CI)  mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. CONCLUSIONS: NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. TRIAL REGISTRATION NUMBER: NCT01405976; results.

Action of nicotinic acid on the reversion of hypoxic-inflammatory link on 3T3-L1 adipocytes.

BACKGROUND: Hypoxia resulting from adipocyte expansion is considered the basis of the inflammatory milieu observed in Metabolic Syndrome. Nicotinic acid can act on adipocytes interfering on the inflammatory response. In this study, we investigated the role of HIF-1 α (hypoxia-inducible factor -1 alpha) in the inflammatory process induced by hypoxia. The effect of nicotinic acid on the PPARs (peroxisome proliferator-activated receptors) expression during the inflammatory response was assessed over its action under HIF-1 α in 3T3-L1 adipocytes submitted to hypoxia. METHODS: 3T3-L1 adipocytes were pre-treated with nicotinic acid and incubated under hypoxic conditions. The level of adipokines and HIF-1 α were quantified using immunoassays. Adipokine expression was measured using real-time PCR, whereas PPARs and HIF-1 α expression were analyzed by western blot. The statistical significance of the differences between variables studied was determined by analysis of variance (ANOVA) complemented by Bonferroni's test. RESULTS: The results demonstrated an increase in leptin and PAI-1 (plasminogen activator inhibitor-1) expression, while adiponectin production decreased under hypoxia. In parallel, induction with hypoxia enhanced HIF-1 α expression, despite causing reduced expression of PPAR α and PPAR γ. However, nicotinic acid reversed adipokine modulation under hypoxic conditions, leading to decreased HIF-1 α expression and increased PPARs expression. CONCLUSIONS: Our findings suggest that nicotinic acid blunt the inflammatory response resulting from hypoxia by the reduction of HIF-1 α expression and concomitant increase of PPARs α and γ expression in 3T3-L1 adipocytes.

Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial.

BACKGROUND: Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. MATERIAL AND METHODS: A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient's own home. RESULTS: Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. CONCLUSIONS: The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy.

Upper extremities functional disability and pain intensity in female volleyball athletes: cross-sectional study / Incapacidade funcional de membro superior e intensidade de dor em atletas de voleibol do sexo feminino: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: In volleyball, the high demand for shoulder sports makes it susceptible to injuries due to the repetition of sporting gestures. The presence of pain in the shoulder can lead to the disability to perform movements correctly, resulting in reduced sports performance. The study aimed to evaluate and correlate the presence of pain and functional disability of the upper extremity in volleyball athletes. METHODS: Cross-sectional descriptive study, developed with 30 female volleyball athletes. Functional disability was assessed using the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and pain intensity using the Visual Numeric Scale (VNS). The study was conducted in an online format. The IBM SPSS 21.0 statistical package for Windows was used, where descriptive measures, Wilcoxon, and Spearman correlation tests were performed, adopting p≤0.05. RESULTS: Nineteen athletes reported mild to moderate pain to perform daily activities, and 21 athletes reported pain to perform sporting gestures, with pain being significantly more intense in the dominant shoulder in the spike movement (p<0.001), serve (p<0.001), and blocking (p=0.03). Athletes did not present functional limitations in the DASH, but the opposite, outside hitter, and middle blocker, presented mild limitations in the DASH sport. There was a strong correlation between DASH and day-to-day pain (rs=0.79; p<0.001) and a moderate correlation between sports DASH and pain in the dominant shoulder in the spike (rs=0.67; p<0.001) and in the serve (rs=0.60; p<0.001) movements. CONCLUSION: Evaluated athletes presented shoulder pain, higher functional disability to performer the sports activity, and pain and functional disability were positively correlated HIGHLIGHTS Overhead movements such as serve and spike contribute to shoulder pain in volleyball players; The functional disability of the upper limbs is positively correlated with the intensity of pain to perform daily activities and sports; The kinetic-functional diagnosis is important to minimize the risk of injury, rehabilitate injured athletes and provide an adequate return of the athlete to sports practice.

RESUMO JUSTIFICATIVA E OBJETIVOS: No voleibol, a alta exigência da articulação do ombro torna-o suscetível a lesões devido à repetição dos gestos esportivos. A presença de dor no ombro pode gerar incapacidade para executar os movimentos corretamente, ocasionando redução do desempenho esportivo. O estudo teve como objetivo avaliar e correlacionar a presença de dor e incapacidade funcional de membro superior em atletas de voleibol. METODOS: Estudo transversal, descritivo, desenvolvido com 30 mulheres atletas de voleibol de quadra. A incapacidade funcional foi avaliada por meio do Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) e a intensidade de dor pela Escala Visual Numérica (EVN) de 10 pontos. A pesquisa foi conduzida no formato on-line. Utilizou-se o programa estatístico IBM SPSS 21.0 para Windows, pelo qual foram realizadas as medidas descritivas, o teste de Wilcoxon e a correlação de Spearman adotando p≤0,05. RESULTADOS: Dezenove atletas relataram dor leve a moderada para realizar as atividades diárias, e 21 atletas para realizar os gestos esportivos, sendo a dor significativamente mais intensa no ombro dominante em movimentos para ataque (p<0,001), saque (p<0,001) e bloqueio (p=0,03). As atletas não apresentaram limitação funcional no DASH geral, mas no DASH esporte as opostas, ponteiras e centrais foram classificadas com limitação leve. Houve correlação forte entre DASH e dor no dia a dia (rs=0,79; p<0,001) e correlação moderada entre DASH esporte e dor no ombro dominante no ataque (rs=0,67; p<0,001) e no saque (rs=0,60; p<0,001). CONCLUSAO: Atletas avaliadas apresentaram dor no ombro, maior incapacidade funcional na atividade esportiva, e dor e incapacidade funcional estavam positivamente correlacionadas. DESTAQUES Movimentos aéreos como saque e ataque contribuem para a dor no ombro em jogadores de voleibol; A incapacidade funcional dos membros superiores correlaciona-se positivamente com a intensidade da dor para a realização de atividades cotidianas e esportivas; O diagnóstico cinético-funcional é importante para minimizar o risco de lesão, reabilitar atletas lesionados e proporcionar um retorno adequado do atleta à prática esportiva.

Hábitos alimentarios en tiempos del COVID 19: un estudio con escolares de la ciudad de Puerto Colombia (Atlántico) / Eating habits in the time of COVID 19: a study with schoolchildren from the city of Puerto Colombia (Atlántico)

Antecedentes: la inseguridad alimentaria es una de las problemáticas a las que induce la actual pandemia COVID 19, ya sea por razones económicas o debido a la modificación en la rutina de los individuos, especialmente en los jóvenes, acostumbrados a la dinámica escolar y social activa. Materiales y métodos:estudio de tipo descriptivo-transversal en el cual se indagó sobre el estado nutricional de escolares de la ciudad de Puerto Colombia (Atlántico), a través de la aplicación del cuestionario Krece Plus, describiendo los aspectos sociodemográficos, el estado nutricional general y la caracterización de los hábitos alimentarios. Esto se aplicó a una muestra de 145 escolares en edad de 13 y 14 años. Resultados: los estudiantes indagados se encontraban cursando educación secundaria y, el 68% se encontró en nivel socioeconómico bajo. Se evidenció una prevalencia del estado nutricional muy bajo (73,1%), lo que indica la prevalencia de riesgo o tendencia a la inseguridad alimentaria, que se asocia con la falta de desayuno, bajo consumo de frutas, verduras, lácteos, legumbres. Asimismo, se aprecia un alto consumo de comidas rápidas y dulces. Discusión y conclusión:los resultados discrepan de las recomendaciones dadas por las organizaciones mundiales, especialmente en materia del consumo de frutas y verduras y el consumo de alimentos 3 veces al día. Por lo anterior, es preciso que se induzca a los estudiantes a llevar estilos de vida saludable en tiempos de pandemia COVID 19, que impliquen la sana alimentación y la práctica de actividad física que induzca hacia una salud integral

Background: food insecurity is one of the problems that the current pandemic COVID 19 induces, either for economic reasons or due to the modification in the routine of individuals, especially young people, accustomed to active school and social dynamics. Materials and methods:descriptive-cross-sectional study in which the nutritional status of schoolchildren in the city of Puerto Colombia (Atlántico) was investigated, through the application of the Krece Plus questionnaire, describing the sociodemographic aspects, the general nutritional status and the characterization of eating habits. This was applied to a sample of 145 schoolchildren aged 13 and 14 years. Results: the investigated students were in secondary education and 68% were in low socioeconomic level. A very low prevalence of nutritional status (73.1%) was evidenced, indicating the prevalence of risk or tendency to food insecurity, which is associated with the lack of breakfast, low consumption of fruits, vegetables, dairy products, and legumes. Also, a high consumption of fast and sweet foods is appreciated. Discussion and conclusion:the results disagree with the recommendations given by world organizations, especially regarding the consumption of fruits and vegetables and the consumption of food 3 times a day. Therefore, students must be encouraged to lead healthy lifestyles in times of the COVID 19 pandemic, involving healthy eating and physical activity that induces towards comprehensive health.

Caso Clínico: Infarto Agudo de Miocardio sin Enfermedad Coronaria Aterosclerótica Obstructiva / Case Report: Myocardial Infarction with Non-Obstructive Coronary Arteries

INTRODUCCIÓN: El Infarto Agudo de Miocardio (IAM) sin enfermedad coronaria aterosclerótica obstructiva (MINOCA por sus siglas en inglés) es un diagnóstico con una frecuencia variable de acuerdo a varias series. Se caracteriza por ser un cuadro clínico de IAM con coronariografía normal. CASO CLÍNICO: Paciente masculino de 49 años de edad con antecedentes de Linfoma de Células T del Adulto ingresado para inicio de tratamiento con quimioterapia. Durante la hospitalización presentó síncope con bradicardia extrema, supradesnivel del segmento ST y elevación de enzimas cardíacas por lo que fue diagnosticado con IAM. EVOLUCIÓN: Se realizó coronariografía que evidenció arterias normales sin lesiones obstructivas e hipocinesia de paredes cardíacas lateral e inferior. El paciente requirió ingreso en la unidad de cuidados coronarios para su tratamiento. Su evolución clínica, enzimática y electrocardiográfica fue satisfactoria; fue dado de alta con tratamiento de prevención secundaria. CONCLUSIÓN: El Infarto Agudo de Miocardio sin enfermedad coronaria ateroesclerótica obstructiva (MINOCA) debe ser considerado en todo paciente con clínica de IAM y requiere de un manejo diferenciado para establecer su etiología y tratamiento.(AU)

BACKGROUND: Acute Myocardial Infarction (AMI) with Non-Obstructive Coronary Arteries (MINOCA) has a variable frequency according to many studies. It concerns to clinical presentation of myocardial infarction and normal findings on coronary angiography. CASE REPORT: A 49-year old male patient diagnosed previously with Adult T-Cell Lymphoma who was admitted to receive chemotherapy. The patient suffered syncope, bradycardia and had positive cardiac enzymes with ST-segment elevation, so was diagnosed with AMI. EVOLUTION: A coronary angiography was performed, which revealed normal arteries and hypokinetic lateral and inferior heart walls. The patient required admission to coronary care unit to be treated. The patient had a positive evolution and was discharged with secondary prevention treatment. CONCLUSION: MINOCA is not a conventional diagnosis. It must be considered with every patient suspected with AMI and requires a specific approach to establish its etiology and treatment.(au)

Estudo piloto – desvio positivo de pacientes hipertensos na cidade de Barbacena, Minas Gerais – Brasil / Pilot profect – positive deviance on hypertensive patients in a midsize city, Minas Gerais – Brazil

A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de pressão arterial (PA). 1 O paciente é considerado hipertenso quando a pressão sistólica é ≥ 140 mmHg e a diastólica é ≥ 90 mmHg em três aferições 1-5.Embora o tratamento adequado seja importante para o controle da HAS, a prevenção se destaca, especialmente nos pacientes de risco 5-9...

Oral health status of 207 head and neck cancer patients before, during and after radiotherapy.

The aim of this retrospective study was to describe the oral health status of patients before, during, and after radiotherapy (RT) for the treatment of head and neck cancer (HNC). Before RT, the following data was collected: presence of unrecoverable teeth, residual roots, unerupted teeth, use of dentures, periodontal alterations, caries, candidiasis, and xerostomia. Mucositis, candidiasis, and xerostomia were evaluated during RT. Patients continued to be followed after RT for evaluation of mucositis, candidiasis, xerostomia, radiation caries, and osteoradionecrosis. For statistical analysis, 95% confidence intervals (CI) were determined using sample size, population, and percentages. Before RT, 120 (57.9%) patients presented with alterations in the oral cavity namely, 85 (41.0%) with periodontal disease, 44 (21.2%) with residual roots, 25 (12.0%) with caries, 15 (7.2%) with candidiasis, and 12 (5.8%) had an unerupted tooth present. Xerostomia was a complaint of 19 patients (9.1%). Restorations were indicated for 33 patients (15.9%), whereas extraction was indicated for 104 (50.2%) patients. During RT, mucositis was found in 80 (61.7%) patients, candidiasis in 60 (45.8%), and xerostomia was a complaint of 82 patients (62.6%). After RT, mucositis persisted in 21 patients (19.2%), candidiasis was identified in 23 patients (21.1%), and xerostomia was reported by 58 patients (53.2%). Radiation caries developed in 12 patients (11.0%), whereas six patients (5.5%) developed osteoradionecrosis. The demographic profile herein presented will be useful as baseline data to provide additional epidemiological information and to determine future measures for prevention and treatment of RT-induced complications and sequelae.