Electromyographic activity of pelvic floor muscles in different positions during the use an innovative vaginal educator: Cross-sectional study.

The pelvic floor requires an integrated anatomical structure owing to its multiple functions. Therefore, it is necessary to study methods for improving muscle recruitment during training. This study aimed to analyze the effect of using an innovative vaginal trainer on the bioelectrical activity of the pelvic floor muscles. Pelvic positioning and interference factors, such as age, childbirth, sexual activity, urinary incontinence, and menopause, were also analyzed. A cross-sectional study assessed 30 women using an evaluation form, International Consultation on Incontinence Questionnaire-Short Form, and surface electromyography. The root mean square of a 5-second contraction period, peak root mean square values, area values, % maximal voluntary contraction (root mean square normalized by peak signal), and median frequency were collected. These findings with and without the use of a vaginal educator were compared in the anteversion, neutral, and retroversion pelvic positions. The use of a vaginal educator was found to increase the electromyographic activity of the pelvic floor muscles in the neutral position. In this position, older women showed an increased peak contraction when using the educator. Multiparas also benefited from increased bioelectric activity (root mean square and area). Sexually active women increased their bioelectric activity in a neutral position when using the trainer, exerting less effort in retroversion (%-maximal voluntary contraction). Incontinent and menopausal women exhibited slower body-building activation (decreased frequency) with the device, which requires further investigation. Our innovative biofeedback device induced greater recruitment of muscle fibers, is more effective in the neutral pelvic position, and may be effective in training the pelvic floor muscles, even in women with a greater tendency toward pelvic floor dysfunction.

Imbalance of Peripheral Temperature, Sympathovagal, and Cytokine Profile in Long COVID.

A persistent state of inflammation has been reported during the COVID-19 pandemic. This study aimed to assess short-term heart rate variability (HRV), peripheral body temperature, and serum cytokine levels in patients with long COVID. We evaluated 202 patients with long COVID symptoms categorized them according to the duration of their COVID symptoms (≤120 days, n = 81; >120 days, n = 121), in addition to 95 healthy individuals selected as controls. All HRV variables differed significantly between the control group and patients with long COVID in the ≤120 days group (p < 0.05), and participants in the long COVID ≤120 days group had higher temperatures than those in the long COVID >120 days group in all regions analysed (p < 0.05). Cytokine analysis showed higher levels of interleukin 17 (IL-17) and interleukin 2 (IL-2), and lower levels of interleukin 4 (IL-4) (p < 0.05). Our results suggest a reduction in parasympathetic activation during long COVID and an increase in body temperature due to possible endothelial damage caused by the maintenance of elevated levels of inflammatory mediators. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 appear to constitute a long-term profile of COVID-19 cytokines, and these markers are potential targets for long COVID-treatment and prevention strategies.

Cytokine Profiles Associated With Acute COVID-19 and Long COVID-19 Syndrome.

The duration and severity of COVID-19 are related to age, comorbidities, and cytokine synthesis. This study evaluated the impact of these factors on patients with clinical presentations of COVID-19 in a Brazilian cohort. A total of 317 patients diagnosed with COVID-19 were included; cases were distributed according to clinical status as severe (n=91), moderate (n=56) and mild (n=170). Of these patients, 92 had acute COVID-19 at sample collection, 90 had already recovered from COVID-19 without sequelae, and 135 had sequelae (long COVID syndrome). In the acute COVID-19 group, patients with the severe form had higher IL-6 levels (p=0.0260). In the post-COVID-19 group, there was no significant difference in cytokine levels between groups with different clinical conditions. In the acute COVID-19 group, younger patients had higher levels of TNF-α, and patients without comorbidities had higher levels of TNF-α, IL-4 and IL-2 (p<0.05). In contrast, patients over age 60 with comorbidities had higher levels of IL-6. In the post-COVID-19 group, subjects with long COVID-19 had higher levels of IL-17 and IL-2 (p<0.05), and subjects without sequelae had higher levels of IL-10, IL-6 and IL- 4 (p<0.05). Our results suggest that advanced age, comorbidities and elevated serum IL-6 levels are associated with severe COVID-19 and are good markers to differentiate severe from mild cases. Furthermore, high serum levels of IL-17 and IL-2 and low levels of IL-4 and IL-10 appear to constitute a cytokine profile of long COVID-19, and these markers are potential targets for COVID-19 treatment and prevention strategies.

Analysis of epidemiological profile and ventilator parameters of postpartum women submitted to mechanical ventilation guided by electrical impedance tomography / Análise de perfil epidemiológico e parâmetros ventilatórios de puérperas submetidas à ventilação mecânica por meio da tomografia por impedância elétrica

INTRODUCTION: Pregnancy-related diseases have aggravated the situation of postpartum women, who end up using Mechanical Ventilation (MV) when admitted to Intensive Care Units (ICU). Although MV has benefits, it is associated with deleterious effects that can be minimized with the use of Electrical Impedance Tomography (EIT). OBJECTIVE: The aim was to analyze the epidemiological profile and ventilatory parameters of mothers, which developed HELLP Syndrome, sepsis and/or Acute Respiratory Distress Syndrome (ARDS), under MV and monitored with EIT. METHODS: The study was observational, cross-sectional, retrospective and prospective conducted between March and September 2018, using data collection forms filled from the database and sociodemographic, obstetric and ventilatory records of postpartum women admitted to adult ICU. RESULTS: The sample consisted of 13 postpartum women, 8 with sepsis (61.5%), 7 with HELLP syndrome (53.8%) and 4 with ARDS (30.8%). Five patients (38.5%) evolved with more than one of these conditions. Regarding the ventilatory parameters evaluated, VT 378.9 (±103.9) mL were observed and mean values found for PEEP 9.8 (±1.9) cmH2O and driving pressure 11.1 (±1.4) cmH2O are below recommendations in the literature, predicting lower mortality and morbidity index. CONCLUSION: The relevance of the driving pressure assessment in the MV setting was demonstrated, a parameter assessed by the EIT and directly related to static lung compliance (Cstat), PEEP, VT and optimization of regional pulmonary ventilation. It is highlighted the need for future research with greater clinical significance regarding the profile of postpartum women about the increasingly frequent diseases in this population.

INTRODUÇÃO: As doenças relacionadas à gravidez tem agravado o quadro de puérperas, que acabam fazendo uso de Ventilação Mecânica (VM) quando internadas em Unidades de Terapia Intensiva (UTI). A VM, apesar de trazer benefícios, está associada a efeitos deletérios que podem ser minimizados com o uso da Tomografia por Impedância Elétrica (TIE). OBJETIVO: Analisar o perfil epidemiológico e parâmetros ventilatórios de puérperas que evoluíram com Síndrome HELLP, Sepse e/ou Síndrome do Desconforto Respiratório Agudo (SDRA), sob VM e monitoradas com a TIE. MÉTODOS: Estudo observacional, transversal retrospectivo e prospectivo, realizado entre março e setembro de 2018, por meio de fichas de coletas preenchidas a partir de banco de dados/prontuários sociodemográficos, obstétricos e ventilatórios de puérperas internadas em UTI. RESULTADOS: Amostra composta por 13 puérperas, oito com Sepse (61,5%), sete com Síndrome HELLP (53,8%) e quatro com SDRA (30,8%), demonstrando que cinco (38,5%) pacientes evoluíram com mais de uma dessas patologias. Acerca dos parâmetros ventilatórios avaliados, observou-se VT 378.9 (± 103.9) e que valores médios encontrados para PEEP 9.8 (±1.9) e driving pressure 11.1 (±1.4) estão abaixo dos preconizados pela literatura, predizendo menores índices de mortalidade e morbidade. CONCLUSÃO: Demonstrou-se relevância da avaliação de driving pressure no cenário da VM, parâmetro avaliado por meio da TIE e diretamente relacionado à Cst, PEEP, VT e otimização da ventilação pulmonar regional. Destaca-se a necessidade de pesquisas futuras que apresentem maiores significâncias clínicas voltadas ao perfil de puérperas em relação às doenças cada vez mais frequentes nesta população.

Aspectos clínicos de recém-nascidos admitidos em unidade de terapia intensiva de hospital de referência da região norte do Brasil / Clinical aspects of newborns admitted in neonatal intensive care unit of the reference hospital in the northern region from Brazil

INTRODUÇÃO: O conhecimento das características de nascimento e óbitos de recém-nascidos, condições biológicas da gestação e parto, bem como dos neonatos admitidos em Unidades de Terapia Intensiva Neonatal (UTIN), disponibilizadas através de estudos epidemiológicos podem subsidiar ações de assistência em saúde materno-infantil, minimizando a ocorrência de agravos e planejando um atendimento mais adequado. OBJETIVO: Descrever os aspectos clínicos de recém-nascidos admitidos na UTIN de hospital de referência da região norte do país. MÉTODOS: Estudo transversal, descritivo e documental com amostragem aleatória simples composta por 318 prontuários de recém-nascidos admitidos na UTIN no ano de 2013,coletados por meio de ficha estruturada durante os meses de abrila julho de 2014. Foi realizada análise descritiva simples dos dados. RESULTADOS: A amostra constituiu-se de neonatos masculinos (53,14%),prematuros (92,14%) e de baixo peso ao nascimento (80,5%), com Apgar adequados no 1º e 5º minutos e sem utilizar surfactante pulmonar exógeno (54,72%). Suas genitoras constituíram-se de adultas jovens,com pré-natal inadequado (72,6%), partos cesarianos (56,0%), sem corticoterapia antenatal (91,19%) e provenientes do interior do estado (44,0%). Prematuridade foi a principal causa de admissão na Unidade (77,04%). Os neonatos necessitaram de suporte ventilatório, oxigenoterapia e assistência fisioterapêutica (92,14%). No total, 55% dos óbitos ocorreram precocemente, sendo o choque séptico a principal causa (40,83%). CONCLUSÃO: Estes resultados revelam as características dos recém-nascidos desta Unidade podendo contribuir no direcionamento de ações públicas voltadas à prevenção de agravos e a promoção da saúde materna e neonatal a nível regional e nacional.

INTRODUCTION: The knowledge of the characteristics of birth and newborn deaths, the biological conditions of pregnancy and delivery, as well as the neonates admitted to the Neonatal Intensive Care Unit (NICU), available through epidemiological studies can support care actions in maternal health and child, minimizing the occurrence of injuries and planning a more appropriate care. OBJECTIVE: To describe the clinical aspects of newborns admitted in the reference hospital's NICU in the northern region of the country. METHODS: Cross-sectional, descriptive and documentary study with a simple random sample composed of 318 medical records of newborns admitted in the NICU in 2013, collected through structured form during the months from April to July of 2014. It was performed the simple descriptive analysis of data. RESULTS: The sample consisted of male newborns (53.14%), premature (92.14%) and low birth weight (80.5%), with appropriate Apgarat 1st and 5th minutes and without using exogenous surfactant (54.72%). Their mothers consisted of young adults, with inadequate prenatal care (72.6%), cesarean deliveries (56.0%) without antenatal corticosteroids (91.19%) and from the interior of the state (44.0%). Prematurity was the main cause of admission to the unit (77.04%). Neonates required ventilatory support, oxygen therapy and physical therapy (92.14%). In total 55% ofthe deaths occurred early, being the main cause septic shock (40.83%). CONCLUSION: These results reveal the characteristics of newborns this unit which can contribute in directing public actions aimed at disease prevention and the promotion of maternal and newborn health at regional and national level.