Phonoarticulation in spinocerebellar ataxia type 3.

Phonoarticulation is characterized by changes in resonance, diadochokinesis, prosody, sound frequency, vocal quality, and intraoral pressure. The main aim of this study was to characterize the phonoarticulation in spinocerebellar ataxia type 3 (SCA3) and correlate it with clinical and genetic factors. Thirty-one patients with SCA3 who were subjected to spontaneous speech recordings and phonoarticulatory diadochokinesis (DDK) participated in the study. Speech analyses were performed starting after 10 s of spontaneous speech, by three experienced speech therapists, using a protocol for dysarthria adapted from the Mayo Clinic. The intra-evaluator reliability was analyzed. The lower the patient's age at disease onset was, the more frequent the occurrences of monofrequency and altered speech rhythm were. Articulation, DDK, resonance, and prosody showed a moderate correlation with the number of "CAG" triplet repeats. We conclude that the phonoarticulation of patients with Machado-Joseph disease (MJD) is characterized by mixed dysarthrophonia with cerebellar and hypokinetic components, and that there is a tendency toward higher frequency of dysarthrophonia symptoms with lower age of disease onset, longer time since onset and higher number of "CAG" triplet repeats.

Yield and centesimal characterization of collagen extracted from the skin of peacock bass Cichla monoculus.

Fish processing provides waste of around 50.0% to 70.0% of the animal's initial weight, especially the skin. Thus, this residue contains the by-product that allows biopolymers to be obtained, highlighting collagen, which can be widely used in different areas. The present study aimed to evaluate the yield of collagen extracted from peacock bass Cichla monoculus skin and to characterize them physicochemically. Twenty-five peacock bass with an average weight of 646 ± 175 g were used. The skin samples were removed by manual filleting and weighed, with an average yield of 3.7%. Subsequently, such models were analyzed for chemical composition, showing 61.8% for moisture, 29.3% for crude protein, 1.5% for ash, 6.3% for total lipids, and 1.2% for non-nitrogenous extract (NNE). Acid-soluble collagen (ASC) presented an average yield of 8.2%, presenting in its analysis of centesimal composition 12.5% ​​of moisture, 82.6% of crude protein, 1.1% of ash, 2.6% of total lipids, and 1.2% NNE. The skin and collagen extracted from the tucunaré skin have technological potential for use in the preparation of products, adding value to these by-products from fish processing.

Gross efficiency and energy expenditure in kayak ergometer exercise.

We purposed to study energy expenditure, power output and gross efficiency during kayak ergometer exercise in 12 elite sprint kayakers. 6 males (age 24.2±4.8 years, height 180.4±4.8 cm, body mass 79.7±8.5 kg) and 6 females (age 24.3±4.5 years, height 164.5±3.9 cm, body mass 65.4±3.5 kg), performed an incremental intermittent protocol on kayak ergometer with VO2 and blood lactate concentration assessment, a non-linear increase between power output and energy expenditure being observed. Paddling power output, energy expenditure and gross efficiency corresponding to VO2max averaged 199.92±50.41 W, 75.27±6.30 ml.kg - 1.min - 1, and 10.10±1.08%. Male kayakers presented higher VO2max, power output and gross efficiency at the VO2max, and lower heart rate and maximal lactate concentration than females, but no differences were found between genders regarding energy expenditure at VO2max. Aerobic and anaerobic components of energy expenditure evidenced a significant contribution of anaerobic energy sources in sprint kayak performance. Results also suggested the dependence of the gross efficiency on the changes in the amount of the aerobic and anaerobic contributions, at heavy and severe intensities. The inter-individual variance of the relationship between energy expenditure and the corresponding paddling power output revealed a relevant tracking for females (FDγ=0.73±0.06), conversely to the male group (FDγ=0.27±0.08), supporting that some male kayakers are more skilled in some paddling intensities than others.

[Mechanism of action of nitrates]. / Mecanismo de acção dos nitratos.

Nitrates' mechanisms of action are reviewed focusing on are reviewed its hemodynamic effects on the systemic circulation and particularly on the coronary circulation. The beneficial effect of its use is discussed both in angina pectoris and heart failure clinical situations. These drugs mechanisms of action are described, particularly at cellular level, explaining its importance as exogenous suppliers of nitric oxide, and the location of its receptors is discussed. Particular attention is given to the tolerance phenomenon observed when they are used in clinical practice.

[Unstable angina. An evaluation of a diagnostic and therapeutic methodology]. / Angina instável. Avaliação de uma metodologia diagnóstica e terapêutica.

The authors describe the diagnostic and therapeutic management of 55 patients with the diagnosis of unstable angina admitted at a medical intensive care unit. According to Braunwald classification, 52 patients had primary angina and the remaining three had post-infarction angina. Risk stratification was based on non invasive procedures such as 2D echocardiogram and exercise test after clinical stabilization. Coronary angiography was performed in all patients. Most of the patients needed revascularization: 62% by percutaneous transluminal coronary angioplasty (PTCA) and 13% were submitted to coronary artery by-pass graft (CABG). None of the patients died during hospitalization.

[Risk stratification in non-Q-wave myocardial infarct]. / Estratificação de risco no enfarte do miocárdio sem onda Q.

There was been some controversy about non-Q wave myocardial infarction, its evolution and prognosis. The most recent studies showed that, in spite of the low immediate mortality in non-Q wave myocardial infarction, the long-term risk of ischaemia, reinfarction or sudden death is equal or even greater than in the Q-Wave myocardial infarction. In order to define an adequate ischaemic risk stratification strategy in the post non-Q wave myocardial infarction without complications, the authors studied 21 patients who were submitted to treadmill exercise test and coronary angiography within 30 days after the acute event. Of the 17 patients with positive stress testing, 14 showed significant relationship between ischaemic area detected in the stress testing and the anatomic localization and severity of the lesions in the coronary angiography (chi 2 = 14,875; p < 0.006). Revascularization therapy (PTCA or bypass surgery) was very high in this group of patients (47.6%). From the date obtained the authors conclude that it is not necessary to use invasive studies in every patient that has suffered from non-Q wave myocardial infarction without complications, since the stress testing showed high sensitivity (94.4%), specificity (75%) and high predictive value (100%) in the ischaemic risk stratification.

[Hemodynamic effects of captopril in acute infarct of the anterior myocardium]. / Efeitos hemodinâmicos do captopril no enfarte agudo do miocárdio anterior.

OBJECTIVE: Evaluation of haemodynamic effects after sublingual administration of 25 mg of captopril in patients with Acute Anterior Myocardial Infarction within the first 48 hours. DESIGN: Determination of basal parameters and 30 minutes after 25 mg of captopril. SETTING: Patients admitted in the ICU with Anterior Myocardial Infarction diagnosis. PATIENTS: 41 consecutive patients; 22 patients submitted to thrombolysis with streptokinase; 19 patients submitted to conventional therapy. RESULTS: A) In the whole group: No significant change in the HR, PAP, CI, SI, MAP, SVR, PR. RA and CWP were reduced. B) In thrombolysed patients: No significant change in HR, RA, PAP, CWP, MAP, SVR, PR. CI and SI were significantly increased. C) In non-thrombolysed patients: No significant change in HR, PAP, CI, SI, SVR, PR. RA, CWP and MAP were reduced. CONCLUSION: 1. We found no significant hypotension with sublingual captopril in Acute Myocardial Infarction. 2. Non-thrombolysed patients showed a greater reduction of arterial pressure. 3. Thrombolysed patients had significant increases in systolic function indices.

[Severe thrombocytopenia associated with Abciximab therapy--apropos a clinical case]. / Trombocitopénia grave associada à terapêutica com Abciximab--a propósito de um caso clínico.

The authors present the case of a 52-year-old male patient with severe coronary artery disease, submitted to percutaneous transluminal coronary angioplasty on a type C right coronary artery lesion. The use of a platelet glycoprotein receptor IIb-IIIa inhibitor, Abciximab, led to severe thrombocytopenia, treated only with platelet concentrate transfusions and with complete recovery. We also review the principal characteristics of the drug, its main indications and side effects. Severe thrombocytopenia has rarely been described in the literature.

[The evaluation of the hemodynamic effects of captopril one year after a myocardial infarct]. / Avaliação dos efeitos hemodinâmicos do captopril um ano após enfarte do miocárdio.

In the present study, the authors evaluate the haemodynamic effects of continuous captopril therapy during one-year after a first anterior myocardial infarction (MI). Haemodynamic measurements are made during the first 48 hours after de MI and repeated one year later. Patients are divided in two groups: The first group had therapy with acetylsalicylic acid (ASA) and isosorbide dinitrate (ISDNI) and the second group had therapy with ASA, ISDNI and captopril. From their results the authors conclude that captopril helps peripheral resistances elevations, and that this is one of the mechanisms by which it can have a favourable effect after an anterior MI.

[Arterial hypertension and the right heart. A hemodynamic and echocardiographic study]. / Hipertensão arterial e coração direito. Estudo hemodinâmico e ecocardiográfico.

OBJECTIVE: To evaluate the effects of arterial hypertension on the pulmonary circulation and the right heart. SETTING: Coronary Care Unit (UTIC Arsénio Cordeiro) Hemodynamics Laboratory and Medicine I Echocardiography Laboratory-Santa Maria Hospital. PARTICIPANTS: 38 hypertensive patients separated in two groups: 24 with thickened septum and left ventricular posterior wall (10 with hemodynamic evaluation)--Group A--and 14 without thickening--Group B; a control group of 12 healthy volunteers--Group C. RESULTS: The hypertensive patients with hemodynamic evaluation had normal pulmonary capillary wedge pressure the average pulmonary resistance (135.29 +/- 63.47 dyn.cm.5), pulmonary systolic (31.30 +/- 10.01 mmHg) and mean pressures (18.23 +/- 8.21 mmHg) were raised, but the diastolic pulmonary pressure was normal. The right ventricle systolic pressure was raised (32.10 +/- 9.12 mmHg) and there was no modification of the right atrial or ventricular telediastolic pressures. On echocardiography there was a diastolic thickening of the right ventricular free wall in both group A (7.08 +/- 1.41 mm) and B (4.07 +/- 1.00 mm) as compared to group C (3.08 +/- 0.51 mm); there were similar findings regarding systolic thickness with statistical significance in group A (p less than 0.001). The right ventricular ejection fraction was normal in both groups. There was a positive correlation between the diastolic thickness of left ventricular posterior wall and right ventricular free wall in hypertensive patients and normotensive volunteers (r = 0.7754; p less than 0.001). CONCLUSIONS: The findings suggest an anatomic an functional relationship between both ventricles regarding the cardiac repercussions of arterial hypertension.

Use of stents for small coronary arteries. Results of the Multi-Link 2.5 Portuguese Registry.

INTRODUCTION: Stents are being used with increasing frequency in percutaneous transluminal coronary angioplasty (PTCA) but their use in small vessels is still controversial, due to the possibility of excessively high rates of adverse events and restenosis. OBJECTIVE: To assess the safety and clinical efficacy of ACS RX Multi-Link (ML) 2.5 mm stents, in "de novo" coronary stenosis. DESIGN: Prospective Registry, with 6 months clinical follow-up, involving all Portuguese centers of Interventional Cardiology. POPULATION: Between April 7 and November 20 1998, 102 patients were enrolled, 82 male and with ages ranging from 30 to 86 years (average 58 +/- 11). Clinical presentation for PTCA was stable angina in 53%, unstable angina in 36% and silent ischemia in 11%. There was a history of previous myocardial infarction in 29% of patients. The main risk factors were hypertension (58%), hyperlipidemia (57%), smoking (25%) and diabetes (20%). Multivessel coronary artery disease was present in 46% of patients and left ventricular function was normal in 89%. Of the 217 existing lesions, 188 (87%) were treated: 35 with balloon angioplasty and 153 with stent implantation, 114 of which were ML 2.5 mm: 79 of 15 mm in length and 35 of 25 mm. METHODS: Angiographic success with ML stent implantation and major adverse cardiac events (MACE)--myocardial infarction (MI), coronary artery bypass graft (CABG), new target vessel revascularizations and death--were evaluated during hospital stay, and at 1 and 6 months clinical follow-up. RESULTS: Angiographic success was 97.4%. In one patient it was not possible to cross the lesion, in another there was stent migration and in a third distal coronary flow after stenting was TIMI grade 1. Clinical success was 96.1% and there were no cases of death, Q-wave MI or urgent CABG. Two patients had non-Q wave MI and two required urgent repeat angioplasty. Subacute stent thrombosis occurred in 1 patient. There were no additional MACE at 1 month follow-up. At 6-month follow-up (in 97% of patients) MACE had occurred in 14.1%: 2 deaths (one non-cardiac), 3 MI (one non-Q) and 14 new PTCA (one in a non-ML stent). There was no need for CABG in any patient. Six-month survival rate was 97.9%, 94.9% were free of infarction and 84.8% were free of infarction and new revascularization. CONCLUSIONS: Multi-Link 2.5 mm stent implantation appears to be safe and efficient with a low incidence of immediate and 6-month adverse events in the range of centers and operators of the Registry.

[Severe poisoning by organophosphate compounds. An analysis of mortality and of the value of serum cholinesterase in monitoring the clinical course]. / Intoxicação grave por compostos organofosforados. Análise da mortalidade e do valor da colinesterase sérica na monitorização do curso clínico.

Ingestion of organophosphate (OP) compounds usually results in severe poisoning. We undertook a retrospective study of 52 consecutive patients admitted with severe OP poisoning to determine the value of serum cholinesterase (SChE) in monitoring clinical course. Considering survivors and non-survivors, we evaluate clinical and laboratory baseline characteristics, severity scores (APACHE II, SAPS II), atropine rate (mg/h), SChE evolution at 24, 72 and 120 h and final SChE (SChE at the day of discharge or death). Mortality in the ICU was 28.9% (n = 15). In both groups SChE showed a trend to increase. In survivors, SChE recovery was statistically significant for SChE 24h-SChE 72 h, SChE 24 h-SChE 120 h and SChE initial-SChE 120 h (p = 0.008, p = 0.00003, p = 0.0002 respectively). In this group a simultaneous decrease in atropine requirements was registered. In non-survivors, the rate of atropine remained unchanged up to 120 h. Three groups could be defined in non-survivors according to their final SChE and day of death. Non-survivors-1 (death in the first 24h; 2 patients) and non-survivors-2 (death after the first 24 h; 5 patients) had a final SChE below 10% of normal SChE activity and statistically different from survivors' final SChE. Non-survivors-3 (8 patients) had a final SChE similar to the survivors and death was due to sepsis and multiple organ failure (MOF). We conclude that SChE is useful in OP poisoning diagnosis and also in monitoring clinical course. SChE recovery above 10% of normal seems to correlate with good prognosis. Sepsis and MOF were important determinants of mortality.

Amyotrophic Lateral Sclerosis survival analysis: Swallowing and non-oral feeding.

BACKGROUND: Dysphagia-related complications, such as aspiration pneumonia and malnutrition, are major causes of death among patients with Amyotrophic Lateral Sclerosis (ALS). OBJECTIVE: To analyze clinical features associated with worsened swallowing and non-oral feeding in ALS. METHODS: This is a long-term study of 33 ALS patients, who were observed between 2006 and 2011 in three month intervals. These subjects underwent Fiberoptic Endoscopic Evaluation of Swallowing and Functional Oral Intake Scale classification. Survival analysis was performed using Cox Regression. RESULTS: The worsening of swallowing functionality was more rapid in late-onset ALS patients (risk of 4% per year) and individuals with bulbar onset ALS (risk of 188% per year). Non-oral feeding was associated with both the later onset of ALS symptoms (risk of 7.5% per year) and shorter disease duration (risk of 13% per year). CONCLUSION: Worsened swallowing was more rapid in individuals who were older at symptoms onset and who had bulbar onset ALS. Non-oral feeding was associated with both age at symptoms onset and shorter disease duration.

Additional effects of homeopathy on chronic periodontitis: a 1-year follow-up randomized clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this study was test the hypothesis that homeopathy (H) enhances the effects of scaling and root planing (SRP) in patients with chronic periodontitis (CP). MATERIALS AND METHODS: 50 patients with CP were randomly allocated to one of two treatment groups: SRP (C-G) or SRP + H (H-G). Assessments were made at baseline and after 3 and 12 months of treatments. The local and systemic responses to the treatments were evaluated by clinical and serologic parameters, respectively. RESULTS: Both groups displayed significant improvements, however, using clinical attachment gain and reductions in HDL, LDL and Total Cholesterol, Triglycerides, Glucose and Uric acid, from baseline to 1 year, as criteria for treatment success, H-G performed significantly better than C-G. CONCLUSION: The findings of this 1-year follow-up randomized clinical trial suggest that homeopathic medicines, as an adjunctive to SRP, can provide significant local and systemic improvements for CP patients.

Additional benefits of homeopathy in the treatment of chronic periodontitis: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Homeopathic medicine (HM) in the treatment of Chronic Periodontitis (CP) aims to restore the vital energy balance of the patient allowing the body to heal itself. Thus, the aim of this study was to evaluate the additional benefits of HM as an adjunctive to conventional periodontal treatment (CPT). MATERIALS AND METHODS: After sample size calculation, sixty individuals of both genders, and ages varying between 35 and 70 years old, 40 with chronic periodontitis (CP group - CPG) and 20 without CP (Healthy Group - HG) participated in this "Single-Blind Randomized Controlled Clinical Trial". The CP patients were divided into two groups: one was submitted only to CPT (CP Control Group - CPT-C) and the other group was submitted to CPT and HM, according to the similia principle (CP Test Group - CPTT). Assessments were made at baseline and after 90 days of treatments. The local and systemic responses to the treatments were evaluated by clinical and laboratory parameters, respectively. Data were analyzed by parametric and nonparametric tests. The level of significance was 5%. RESULTS: At baseline, CP patients presented higher values of LDL cholesterol and blood glucose than HG individuals. After the treatment, all the systemic parameters evaluated decreased in CP patients, except LDL and HDL Cholesterol in CPT-C, and HDL Cholesterol in CPT-T. There was a statistical gain in clinical attachment level only in CPT-T (+0.51 mm) after 90 days; however, there was a reduction in probing depth, in the level of visible plaque and in the bleeding on probing, in both CP groups (CPT-C and CPT-T) after 90 days. CONCLUSION: The findings of this 3-month follow-up study concluded that H M, as an adjunctive to CPT, can provide additional benefits in the treatment of CP.

The value of tubular enzymes for early detection of acute kidney injury after liver transplantation: an observational study.

Tubular enzymes (TE) are early markers of acute kidney injury (AKI), but their value for liver transplant (LT) recipients is unknown. We sought to evaluate the usefulness of TE to predict AKI after LT. We enrolled Thirty-nine adult patients without AKI who had been admitted to the Intensive Care Unit (ICU). AKI was diagnosed according to the Acute Kidney Injury Network criteria. Of these patients, 23 had received orthotopic LT and 16 controls had been admitted for other conditions. Urinary lactate dehydrogenase (LDH), alkaline phosphatase (AF) and γ-glutamyl transpeptidase (γ-GT) measured on days 1 and 3 of the ICU stay were normalized to urinary creatinine concentrations. AKI was diagnosed in 14 patients: 8 in the LT group and 6 in the control group. In the LT group, on the first day of the patients' stay in the ICU, urinary LDH (P = .032), AF (P = .022), and γ-GT (P = .002) were significantly higher among those who developed AKI; these elevations preceded those of serum creatinine. In forward receiver-operating characteristic (ROC) plot analysis, the areas under the ROC curves were 0.8, 0.86, and 0.92 for LDH, AF, and γ-GT, respectively. We concluded that TE determined early after LT are a helpful predictors of AKI.

Habilidades sociais e vivência acadêmica de estudantes universitários / Social skills and academic integration of college students

O estudo objetivou caracterizar os universitários quanto ao repertório de habilidades sociais e àvivência acadêmica, examinando a correlação entre tais variáveis e comparando as diferenças porgênero e curso. Participaram 202 alunos de Informática e Psicologia, com idades entre 16 e 49 anos(M = 22,84; DP = 5,92), sendo 75,6% (n = 146) homens, que responderam ao Questionário deVivência Acadêmica – reduzido, Escala de Avaliação da Vida Acadêmica e Inventário de HabilidadesSociais. Os resultados indicaram percepção moderada da vivência acadêmica e do repertório dehabilidades sociais e correlações de baixa magnitude entre essas variáveis. Diferenças entre os cursose entre os sexos foram identificadas. Os achados são discutidos com base na literatura e novaspesquisas são sugeridas(AU)