BACKGROUND: There is limited evidence regarding the use of exercise training in the treatment of panic disorder. OBJECTIVE: To describe the role of psychological and cardiorespiratory variables in the therapeutic effect of a 12-week exercise training in panic disorder patients. METHODS: Eleven symptomatic panic disorder patients completed 24 sessions, 2 sessions/week, 70%VO2max) aerobic exercise training in addition to regular pharmacological treatment. Assessment was performed at baseline, six and 12-week periods. Exercise training intensity was individualized according to maximal cardiopulmonary exercise testing data. RESULTS: Patients who exercised in conjunction with pharmacotherapy obtained significant improvements in several variables. Exercise training produced a selective, rather than a general anxiolytic impact. An early (6-week) effect was observed in fear of physiological arousal, interoceptive conditioning and in the frequency and intensity of panic attacks. Smaller additional 12-week effects were found in health concerns and agoraphobic cognitions, with no significant impact in agoraphobia. CONCLUSION: A 12-week aerobic exercise training protocol was well-tolerated and able to improve several psychological and cardiovascular indicators in most patients with panic disorders. Further studies are needed to identify the best training protocols and long-term effects of exercise, as well as interactions between cardiorespiratory and psychological variables in this context.
BACKGROUND: English is the lingua franca of science; it is the language of the two last world superpowers and the language of four out of the world’s ten greatest producers of science; it is a fairly simple language and the most hybridized language in history, with Latin and French contributing 60% of the entire English lexicon. The object of this study is to determine whether the frequency of use of imported words is a function of literary genre. METHOD: texts were randomly selected from (a) medical scientific original articles, (b) newspaper financial reports, (c) sport reportages, (d) literary texts and (e) colloquial English; for comparison a collection of similarly distributed texts were selected from Portuguese; the frequency of occurrence of Latin or Neo-Latin words was determined in the English texts as well as the occurrence of non-Latin or non-Neo-Latin words in the Portuguese texts; a oneway analysis of variance was used to determine whether significant differences occurred between genres in the two languages. RESULTS: The frequency of occurrence of Latin/French words in English text was significantly dependent on the literary genre, being maximal in medical scientific texts and minimal in colloquial English; in contrast, the frequency of occurrence of non-Latin words in Portuguese was constant throughout the same literary genres. CONCLUSION: The use of Latin/French words in English is directly proportional to the complexity of the literary genre, a phenomenon not observed in Portuguese, a typical Neo-Latin language.
Strategies for metabolic adjustments are often considered by athletes throughout a running event.Planning for such events during training does not always include variations from level training, even though up/downhill exertion should definitely be a part of such planning.The differentiation of training stimuli, under adverse conditions of intensity and inclination, can generate differentiated benefits.However, uphill running raises expectations of deleterious effects.The imposition of different slope gradients throughout running could generate increased metabolic demands for sports performance.Thus, the present study aimed to answer questions mainly about the acute effects of uphill running, its relationship with aerobic performance, allowing us to introduce new hypotheses for future studies in the area on the subject.Gaps still need to be filled concerning the relevance of uphill running, and its determinants.Many of the points presently under scrutiny only lead to speculative explanations; for logical reasons, more studies should focus on the prescription of training at different slopes.This is the point at which specific conditioning is required, because the regulation of the effort and the energy cost resulting from the imposition of uphill running during competitive races depends heavily on previous experiences.This review will cover recently published research on the subject.
OBJECTIVE:To compare adiposity indexes in physical activity individuals to evaluate behavior, diagnostic ability and to determine which parameter best reflects and diagnoses body fatness.METHODS: A cross-sectional study was performed on 100 physically active individuals (59% female).The participants were submitted to anthropometric and body composition evaluation; we measured weight, height, circumferences, blood pressure and bioelectrical impedance analysis.A physical activity questionnaire (IPAQ, short version) was applied, as well as a questionnaire about the possible use of nutritional supplementation.The data were statistically analyzed, with significance level set at p <0.05.RESULTS: Mean age, height, weight and BMI were 24.2 ± 6.65 years, 169.5 ± 8.94 cm, 69.1 ± 14.83 kg and 23.9 ± 4.19 kg/m 2 , respectively, with a significant difference between the genders, except for age.Most of the subjects were in the normal weight range, with a BMI of 18.5 to 24.9 kg/m 2 , and were very active.BMIfat correlated better with body fat for males (r = 0.896) and females (r = 0.935), followed by BMI (0.689 and 0.767, respectively) and BAI (0.590 and 0.718).CONCLUSIONS: Adiposity indexes are viable alternatives for the diagnosis of obesity and should be more explored as fast, practical and low cost measures in clinical practice.
I Universidade Federal do Rio de Janeiro (UFRJ), Programa de pós-Graduação em Psiquiatria e Saúde Mental, Rio de Janeiro, RJ, Brasil; II Faculdade Unida de Campinas (FacUNICAMPS), Departamento de Educação Física, Goiânia, Goiás, GO, Brasil. III Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Instituto de Psiquiatria, Laboratório de Pânico e Respiração, Rio de Janeiro, RJ, Brasil; IV Universidade Salgado de Oliveira (UNIVERSO), Programa de Pós-Graduação em Neurociências e atividade Física, Niterói, RJ, Brasil; V Intercontinental Neuroscience Research Group
OBJECTIVES:To describe a case series of spontaneous pneumomediastinum in dermatomyositis and to review the literature.METHODS: This was a retrospective single-center case series, reporting 9 patients with pneumomediastinum and defined dermatomyositis, followed from 2005 to 2017.RESULTS: Median age of patients: 33 years; cutaneous and pulmonary involvement in all cases; constitutional symptoms in 88.8% of patients; involvement of the joints in 11.1%, gastrointestinal tract in 44.4%, and muscles in 77.7%; subcutaneous emphysema was observed in 55.5% and pneumothorax in 11.1%, respectively.Muscle weakness was observed in 77.7% of cases and with a median level of serum creatine phosphokinase of 124U/L.Drawing on results for our literature review, the overall analysis showed that the risk factors associated with spontaneous pneumomediastinum were: (a) a history of interstitial pneumopathy; (b) normal or low levels of muscle enzymes; (c) previous use of systemic glucocorticoid; (d) over 50% of patients had subcutaneous emphysema; (e) high mortality as a consequence of severity of the interstitial lung disease.CONCLUSIONS: Our case series revealed that pneumomediastinum is a rare complication in dermatomyositis that occurs in patients with a history of interstitial pneumopathy and may be accompanied by subcutaneous emphysema and pneumothorax.
OBJECTIVE: To evaluate the factors associated with traffic motorcycles accidents. METHODS: The sample consisted of 285 motorcycle accident victims in São Paulo. Data were collected from 24-hour emergency service shifts regarding: conditions of the victims, security equipment, road and vehicle conditions. RESULTS: Victims were mostly young men (92%); 23% used the motorcycle for work (average: 8 hours per day); 45% had owned a motorcycle for less than two years; 77% were licensed motorcycle drivers; 33% had less than four years of qualification; 31% had attended a course of defensive driving. Severe lesions were identified in 67% of the unlicensed drivers. Polytrauma occurred in 9% head trauma in 5% of the entire population. Lower limb fractures occurred more frequently than upper limb (17% vs. 12%). Most wore helmets (90%) but only 18% wore helmet, boots and jacket. Positive readings for alcohol (7%) and drugs (14%) occurred in 21% of victims. Most accidents occurred as a consequence of imprudence (88%), during the day (67%), in dry weather conditions (94%). A side impact was registered in 48% of cases; 80% of motorcycles had an engine capacity up to 250 cc. In 51% of the accidents the person responsible for the accident was the driver of the other vehicle in the accident. CONCLUSION: Most accidents involve motorcyclists who are young male adults, use the motorcycle as a means of transport and do not consider safety, defensive driving and the use of alcohol and drugs as important factors.
OBJECTIVE: Verify the influence of different exercise orders on the performance of the number of maximal repetitions in older women. METHODS: Twelve older women (65.7 ± 5.6 years, 66.9 ± 9.5 kg, 1.56 ± 0.67 m, 27.4 ± 3.6 kg/m2) underwent four nonconsecutive visits and two different orders of Resistance Training. At the first visit, the volunteers were submitted to anamnesis, anthropometric evaluation and a 10RM test. On the second visit, a re-test of 10RM was performed. On the third and fourth visits, the volunteers performed two exercise sequences: sequence A: bench press, latissimus pulldown close grip, biceps curl, triceps extension; for sequence B the order was inverted. Performance was measured by the number of repetitions in each exercise. To determine differences in performance for sequence A vs. sequence B, repeated measures were performed by two-way ANOVA followed by the Tuckey post-hoc test. RESULTS: The number of repetitions of each exercise varied significantly for the bench press, biceps curl and triceps extension between the exercise sequences. CONCLUSIONS: The order of the exercises performed in a resistance training session can affect the performance in the number of repetitions in older women.
BACKGROUND: Cardiac vagal index (CVI) is supposedly higher in athletes and may differ between sports and/or between field positions. OBJECTIVE: To compare CVI: a) between elite football players vs. non-athletes and b) according to five football positions. METHOD: 242 football players of the first Brazilian/Angolan division were divided in five positions (N): goalkeepers (17), defenders (44), wingers (34), midfielders (87) and forwarders (60) and compared with 303 age-matched healthy non-athletes. CVI was estimated from a 4-second exercise test by quantifying the ratio of two cardiac cycle durations, before and at the end of a fast unloaded cycling exercise. RESULTS: Football players had resting and maximal heart rates of, respectively, 59 and 190 bpm and measured VO2max of 62.2 mL/(kg.min). Players and non-athletes showed similar CVI results (median-[P25-P75]) - 1.63-[1.46-1.84] vs 1.61-[1.41-1.81] (p = 0.22). Wingers tended to have a higher CVI (1.84-[1.60-1.99]), especially when compared to defenders (1.53-[1.41-1.72] (p = 0.01). There was a modest non-physiologically relevant association between VO2max and CVI (r = 0.15). CONCLUSIONS: Football players did not differ from non-athletes in CVI; however, among players, wingers were more often vagotonic, which may represent a hemodynamic advantage for match situations, where rapid heart rate transitions and faster oxygen delivery to muscles are required.
OBJECTIVE: To evaluate insulinemia in glucocorticoid naïve patients with dermatomyositis and to evaluate insulin resistance using the homeostatic model assessment of insulin resistance (HOMA2-IR). METHODS: This cross-sectional study included 25 dermatomyositis, non-diabetic glucocorticoid naïve patients. The control group consisted of 50 volunteers matched for age, gender, ethnicity, weight and height. The HOMA2IR index was calculated from baseline insulin and glucose data. The International Myositis Assessment & Clinical Studies Group (IMACS) parameters were used to evaluate disease status. RESULTS: Mean age of the patients was 43.5 years and these were predominantly females. Patients had low disease activity according to IMACS parameters. Higher body mass index and waist circumference were observed in the dermatomyositis group compared to the control group. Insulin level and HOMA2-IR were also higher in patients with dermatomyositis. Moreover, analyzing dermatomyositis alone, the HOMA2-IR index correlated positively with weight, body mass index and waist circumference and was independent on disease status parameters. CONCLUSIONS: Patients with dermatomyositis had higher values for basal insulinemia, insulin resistance, body mass index and waist circumference. Moreover, HOMA2-IR moderately correlated with these anthropometric parameters. These metabolic abnormalities are related to the development of metabolic syndrome, one of the main comorbidities observed in dermatomyositis.
Dear Editor Toxoplasmosis is one of the most common human infections. About one-third of the entire world population is infected with latent toxoplasmosis.1-6 Central nervous system (CNS) toxoplasmosis occurs due to reactivation of previous latent infection. Patients usually present with fever, headache, impaired consciousness, seizures, and/ or focal neurological deficits.1-5 CNS toxoplasmosis may complicate the clinical course of patients with acquired human immunodeficiency (e.g. AIDS), immune system disease, or prolonged pharmacologic immunosuppressive treatment.1-5 Because the clinical picture and diagnosis are challenging, neurotoxoplasmosis may mimic several other CNS disorders, being especially difficult to manage and frequently requiring empiric treatment.1-5 We present an unusual case of neurotoxoplasmosis developing in a patient with concomitant rheumatoid arthritis and systemic lupus erythematous (SLE).
OBJECTIVE: McArdle’s disease is a metabolic myopathy that manifests with varied clinical conditions and is often confounded with other diagnoses. Herein, the authors report a case series and carry out a literature review. METHODS: A cross-sectional single-center study evaluating 12 patients with McArdle’s disease was conducted. RESULTS: Mean age at onset of symptoms was 28.0±17.4 years, while age at disease diagnosis was 39.0±14.8 years. History of intolerance to physical exercises was observed in 10 cases; muscle weakness in 9, second wind phenomenon in only 1 case. The presence of cramps, fatigue and myalgia was observed in 12, 11 and 9 of the cases respectively. Median creatine phosphokinase level was 5951U/L. Most of the patients (83.3%) were initially diagnosed with another condition (polymyositis, inclusion body myositis, fibromyalgia and/or muscular dystrophy), and approximately half had received glucocorticoids and/or immunosuppressants prior to definitive diagnosis. All patients underwent muscular biopsy, which revealed the presence of subsarcolemmal vacuoles characterized by glycogen deposits, and negative histochemical reaction for the myophosphorylase enzyme. CONCLUSION: The present study reinforces the presence of clinical variability among patients and shows that McArdle’s disease should be considered one of the differential diagnoses of inflammatory myopathies and other rheumatic diseases.
OBJECTIVE:The anti-PM/Scl autoantibody has been described in patients with scleromyositis.However, there are scant studies evaluating its prevalence and reactivity in dermatomyositis and polymyositis.METHOD: A cross-sectional, single center study evaluating the anti-PM/Scl autoantibody in 85 dermatomyositis and 32 polymyositis patients, without overlapping syndrome, was conducted between 2000 and 2016.Clinical data and complementary examinations were reviewed from electronic medical records with pre-parameterized information. RESULTS:The mean age of dermatomyositis and polymyositis patients was 41.1 and 42.8 years, respectively.The presence of anti-PM/Scl was observed in 5 (5.9%) dermatomyositis and 2 (6.3%) polymyositis patients.Two of these patients also had the anti-Ku antibody.The relevant clinical manifestations of these 7 patients were constitutional symptoms (100% of cases), muscular (100%), pulmonary (85.7%) and joint (71.4%) involvement, "mechanic hands" (85.7%),Raynaud phenomenon (85.7%) and plantar hyperkeratosis (85.7%).The 7 patients had relapses of disease activity, but at conclusion of the present study, 5 had complete clinical response and 2 complete remission of the disease.CONCLUSION: There is a low frequency of the anti-PM/Scl autoantibody in dermatomyositis and polymyositis patients.In addition, patients with this autoantibody exhibit a similar pattern of manifestations to that of antisynthetase syndrome.
ABSTRACT Pregnancy is a transient physiological state which brings about different hormonal changes in a woman's body. These effects are generalized and there are various oral changes as well. There are a number of especially important alterations in the periodontal conditions within the oral cavity. These changes have important implications as they have been known to cause adverse pregnancy outcomes. Better knowledge about these scenarios among health care professionals and women would go a long way toward avoiding or minimizing these adverse outcomes. Health education is an important tool in creating awareness among pregnant women regarding improvement of their oral health. Awareness among the health professionals and good inter-departmental collaboration would help toward a more efficient treatment of these pregnancy related conditions.
OBJECTIVE: To determine running economy in a large sample of elite soccer and futsal players to obtain benchmarks in different positions. METHODS: Running Economy is the energy demand at a submaximal running velocity. Players were divided into 6 subgroups. Soccer: defenders, midfielders, and strikers; futsal: defenders, wingers, and pivots. Elite soccer players (n=129) and elite futsal players n=72 performed an incremental running test starting at 8.4 km.h-1 with increments of 1.2 km.h-1 every two minutes on a treadmill until exhaustion. Running Economy was determined by interpolation between ventilatory thresholds 1 and 2 (VT1 and VT2). RESULTS: Running Economy (measured as mL.kg-1.km-1) was compared between the playing positions in the two team sports. In soccer, running economy was 222.7 (defenders), 227.0 (midfielders), and 219.8 (strikers) mL.kg-1.km-1, respectively. In futsal, the corresponding values were 198.5 (defenders), 196.9 (wingers), and 190.5 (pivots) mL.kg-1.km-1, respectively. We no found significantly differences between the three positions in both sports. The Running Economy of futsal players was 12.5% better than that of soccer players. Running Economy correlated positively with oxygen uptake at VT2 in both sports and in all positions. CONCLUSION: Futsal players exhibited better Running Economy than soccer players; this should be considered as a factor in the athlete's training plan.
OBJECTIVE:To endoscopically assess the upper digestive tract of adult patients with newly diagnosed dermatomyositis; to correlate possible changes in the gastrointestinal tract with demographic, clinical and laboratory features in this population.METHOD: A cross-sectional study evaluating 65 newly diagnosed dermatomyositis cases from 2004 to 2015 was carried out.We excluded patients with clinically amyopathic dermatomyositis, overlap dermatomyositis, polymyositis, liver diseases, prior gastric surgery, upper gastrointestinal tract symptoms (except for upper dysphagia), systemic infections, alcohol consumption and smoking.RESULTS: Mean age of patients was 44.9 years, with disease duration of four months.Endoscopic findings were observed in 70.8% of patients.(1) Esophageal disease/gastric distress was documented in 18.5% of patients: erosive distal esophagitis (16.9%) and non-erosive distal esophagitis distal (1.5%); (2) gastric distress in 63.1% of cases: antral gastritis (42.3%) and pangastritis (27.8%); (3) duodenal involvement in 15.4% of patients: bulbar duodenitis (10.9%) and duodenal ulcers (7.7%).There were no neoplasic lesions.On multivariate analysis, erosive distal esophagitis was less associated with older patients.Males had a higher prevalence of erosive gastritis.Enanthematous pangastritis was less associated with lesions with "V-neck" sign lesions. CONCLUSIONS:This study provides the first estimates of the prevalence of high endoscopic findings in adult patients with newly diagnosed dermatomyositis.The results may be relevant to guide conduct in digestive disorders with upper digestive endoscopy, and point to the need for pharmacological prevention of digestive tract lesions in these patients.Further studies are needed to validate this data and evaluate patients with dyspeptic symptoms.
Talking about obesity can be a challenge for doctors. It is known that obesity is a great cause of mortality, worldwide. It leads to diabetes, a most deadly illness, and other conditions that can cause death. However, it also affects self-esteem and how people see themselves in the mirror. It can cause eating disorders and eventually become a very dangerous problem that could end in tragedy. Few patients, indeed few laypeople realize how deadly diabetes can be. Doctors should keep this in mind. Because obesity damages perception, how people view and feel about themselves, it is often hard for doctors to hit the right tact. And tact is a doctor’s best friend, most especially when talking to obese patients. It is important to make sure the person feels in friendly hands. Some doctors can be brash and tell the patient that they’re obese in the worst possible way, even using, perish the thought, the dreaded “fat” word. It is important to use the correct language, and to talk to the patient gently and in the right way to make sure he doesn’t feel offended. Talking about the risks of overweight can be a very good way of making them understand the dangers of their dietary habits. The reasons behind obesity can vary, but it is important that the person understand the meaning of it all. To talk about obesity is a great a challenge, same as talking about other life-threatening diseases, because people react in different ways when life is at stake. The doctor has to evaluate the patient’s demeanor prior to getting into the subject: it is essential to know how and when to tell them. It is important not to shatter the selfesteem of the person and at the same time, to give them hope for a change and thereby save their lives. Some patients may object that they’re not obese; a good idea might be to show them a graph or some
The ANKRD1 gene codes for the ankyrin repeat domain containing protein 1 and has an important role in myogenesis and possibly also in angiogenesis.Microvasculopathy is a cornerstone and an early pathological marker of change in dermatomyositis, leading to hypoxia and muscle perifascicular atrophy.These alterations could upregulate genes involved in myogenesis and angiogenesis such as ANKRD1.Therefore, we analyzed ANKRD1 expression in muscle biopsies of dermatomyositis and correlated with other hypoxia parameters and with histological changes.METHODS.Total RNA was extracted from frozen muscle biopsies samples of 29 dermatomyositis patients.A control group consisted of 20 muscle biopsies from adult patients with non-inflammatory myopathy diseases.The gene coding for hypoxia-inducible factor 1, alpha subunit (HIF1A), was analyzed to estimate the degree of hypoxia.ANKRD1 and HIF1A transcript expression levels were determined by quantitative real time PCR.RESULTS.Significantly higher ANKRD1 and HIF1A expression levels were observed in dermatomyositis relative to the control group (P<0.001,both genes).In addition, ANKRD1 and HIF1A were coexpressed (r=0.703,P=0.001) and their expression levels correlated positively to perifascicular atrophy (r=0.420,P=0.023 and r=0.404,P=0.030, respectively).CONCLUSIONS.Our results demonstrate ANKRD1 overexpression in dermatomyositis correlated to HIF1A expression and perifascicular atrophy.ANKRD1 involvement in myogenesis and angiogenesis mechanisms indicates that further investigation is worthwhile.
BACKGROUND: Endothelial dysfunction and low-grade inflammation are both positively associated to states of excessive adiposity but reports on the acute effects of resistance exercise on these variables are still lacking.We evaluated these acute effects of resistance exercise on vascular reactivity and on the inflammatory profile in young women.METHODS: Participants were divided into two groups: lean Controls (n=16) and Overweight (n=16).The resistance exercise session consisted of unilateral elbow flexions for five sets of 10 repetitions at 70% of one repetition maximum.Blood pressure, heart rate, forearm blood flow, vascular conductance, cytokines, adipopeptides and endothelin-1 were evaluated at rest and during the acute post-exercise period.RESULTS: The overweight group had higher forearm blood flow at rest (p=0.03) and during post-exercise (p<0.001) while forearm vascular conductance was higher only during post-exercise, at 20 (p=0.02) and 40 min (p<0.001).Endothelial-dependent vasodilation was higher during the post-exercise period in the Overweight group compared to controls (p=0.01).In the Overweight group, the resistance exercise session reduced interleukin-6 (p=0.02) and leptin (p<0.001) but increased endothelin-1 levels (p=0.02). CONCLUSIONS:We conclude that the single resistance exercise session elicited an acute increment of baseline vascular reactivity and an increased endothelial-dependent vasodilation with concomitant changes in inflammatory profile and endothelin-1 in our tested women with excessive adiposity.
