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1.
Arch. argent. pediatr ; 120(2): 89-98, abril 2022. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1363662

ABSTRACT

Introducción: los beneficios de la ventilación asistida ajustada neuronalmente (NAVA) en los recién nacidos prematuros son inciertos. El objetivo de este estudio fue explorar si la NAVA no invasiva (NIV) era más beneficiosa para los recién nacidos prematuros que la presión positiva continua nasal (NCPAP). Diseño del estudio: metanálisis de tres ensayos clínicos: dos ensayos controlados aleatorizados y un estudio de grupos cruzados. Se comparó la NAVA-NIV con la NCPAP y se informó sobre el fracaso del tratamiento, la mortalidad y los eventos adversos como resultados principales. Resultados: tres estudios con 173 pacientes (89 recibieron NAVA-NIV) cumplieron los criterios de inclusión en este metanálisis. No se observaron diferencias en el fracaso del tratamiento entre la NAVA-NIV y la NCPAP (razón de riesgos [RR] = 1,09; intervalo de confianza [IC] del 95 % = 0,65-1,84; diferencia de riesgos = 0,02; IC95% = -0,10-0,14; I2 = 33 %; P = 0,23). De manera similar, no hubo diferencias en la mortalidad (RR = 1,52; IC95% = 0,51-4,52; no aplica heterogeneidad). En comparación con la NCPAP, la NAVA-NIV redujo significativamente el uso de cafeína (RR = 0,85; IC 95% = 0,74-0,98; I2 = 71 %; P = 0,03). Conclusiones: en comparación con la NCPAP, no hay evidencia suficiente para sacar una conclusión sobre los beneficios o daños de la NAVA-NIV en los recién nacidos prematuros. Los hallazgos de esta revisión deben confirmarse en ensayos clínicos con una metodología rigurosa y potencia adecuada


Introduction: The benefits of neurally adjusted ventilatory assist (NAVA) in preterm infants are unclear. This study aimed to explore if noninvasive NAVA is more beneficial for preterm infants than nasal continuous positive airway pressure (NCPAP). Study design: Meta-analysis was performed in three clinical trials comprising two randomized controlled trials and one crossover study. We compared NIV-NAVA and NCPAP and reported treatment failure, mortality, and adverse events as the primary outcomes. Results: Three studies including 173 patients (89 of whom underwent NIV-NAVA) were eligible for this meta-analysis. This review found no difference in treatment failure between NIV-NAVA and NCPAP (RR 1.09, 95% CI 0.65 to 1.84; RD 0.02, 95% CI -0.10-0.14; I2=33%, P=0.23). Similarly, there was no difference in mortality (RR 1.52, 95% CI 0.51-4.52, heterogeneity not applicable). Compared with NCPAP, NIV-NAVA significantly reduced the use of caffeine (RR 0.85, 95% CI 0.74-0.98, I2=71%, P=0.03). Conclusions: Compared with NCPAP, there is insufficient evidence to conclude on the benefits or harm of NIV-NAVA therapy for preterm infants. The findings of this review should be confirmed using methodologically rigorous and adequately powered clinical trials.


Subject(s)
Humans , Infant, Newborn , Interactive Ventilatory Support/adverse effects , Infant, Premature , Treatment Failure , Cross-Over Studies , Continuous Positive Airway Pressure/adverse effects
2.
Braz. j. med. biol. res ; 54(5): e10693, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153555

ABSTRACT

The present study compared the effects of a footwear designed to enhance energy return (thermoplastic polyurethane, TPU) vs minimalist shoes on running economy (RE) and endurance performance. In this counterbalanced and crossover design study, 11 recreational male runners performed two submaximal constant-speed running tests and two 3-km time-trials with the two shoe models. Oxygen uptake was measured during submaximal constant-speed running tests in order to determine the RE at 12 km/h and oxygen cost of running (CTO2) at individual average speed sustained during the 3-km running time-trials wearing either of the two shoes. Our results revealed that RE was improved (2.4%) with TPU shoes compared with minimalist shoes (P=0.01). However, there was no significant difference for CTO2 (P=0.61) and running performance (P=0.52) comparing the TPU (710±60 s) and the minimalist (718±63 s) shoe models. These novel findings demonstrate that shoes with enhanced mechanical energy return (i.e. TPU) produced a lower energy cost of running at low (i.e., 12 km/h) but not at high speeds (i.e., average speed sustained during the 3-km running time-trial, ∼15 km/h), ultimately resulting in similar running performance compared to the minimalist shoe.


Subject(s)
Male , Running , Oxygen Consumption , Shoes , Biomechanical Phenomena , Cross-Over Studies
3.
Article in Chinese | WPRIM | ID: wpr-921530

ABSTRACT

Objective To compare the effects of carbohydrate-electrolyte beverage on post-exercise rehydration of healthy young men in different seasons,and to explore the influence of seasonal adaptability on fluid and electrolyte balance.Methods Fifteen healthy men,aged(24.4±0.5)years,completed 2 trails in a random crossover design both in summer and winter.During recovery,they consumed a drink volume equivalent to 100% of their sweat loss with plain boiled water(the water group)or carbohydrate-electrolyte beverage(the beverage group).Recovery was monitored for further 180 minutes by the collection of blood and urine samples.Results The dehydration time in summer was significantly shorter by about 20 minutes than that in winter(


Subject(s)
Adult , Beverages , Cross-Over Studies , Dietary Carbohydrates , Electrolytes , Fluid Therapy , Humans , Male , Seasons
4.
Article in English | WPRIM | ID: wpr-888608

ABSTRACT

BACKGROUND@#Ambient fine particle (PM@*METHODS@#A time-stratified case-crossover design was used to analyze YLL from respiratory diseases in the elderly related to ambient PM@*RESULTS@#Each 10 μg/m@*CONCLUSIONS@#Birth season which reflects the early-life PM


Subject(s)
Aged , Aged, 80 and over , Air Pollutants/analysis , Cause of Death , China/epidemiology , Cross-Over Studies , Environmental Exposure/analysis , Humans , Life Expectancy , Particulate Matter/analysis , Respiration Disorders/mortality , Seasons
5.
Chinese Medical Journal ; (24): 281-291, 2021.
Article in English | WPRIM | ID: wpr-878037

ABSTRACT

BACKGROUND@#Conventional pressure support ventilation (PSP) is triggered and cycled off by pneumatic signals such as flow. Patient-ventilator asynchrony is common during pressure support ventilation, thereby contributing to an increased inspiratory effort. Using diaphragm electrical activity, neurally controlled pressure support (PSN) could hypothetically eliminate the asynchrony and reduce inspiratory effort. The purpose of this study was to compare the differences between PSN and PSP in terms of patient-ventilator synchrony, inspiratory effort, and breathing pattern.@*METHODS@#Eight post-operative patients without respiratory system comorbidity, eight patients with acute respiratory distress syndrome (ARDS) and obvious restrictive acute respiratory failure (ARF), and eight patients with chronic obstructive pulmonary disease (COPD) and mixed restrictive and obstructive ARF were enrolled. Patient-ventilator interactions were analyzed with macro asynchronies (ineffective, double, and auto triggering), micro asynchronies (inspiratory trigger delay, premature, and late cycling), and the total asynchrony index (AI). Inspiratory efforts for triggering and total inspiration were analyzed.@*RESULTS@#Total AI of PSN was consistently lower than that of PSP in COPD (3% vs. 93%, P = 0.012 for 100% support level; 8% vs. 104%, P = 0.012 for 150% support level), ARDS (8% vs. 29%, P = 0.012 for 100% support level; 16% vs. 41%, P = 0.017 for 150% support level), and post-operative patients (21% vs. 35%, P = 0.012 for 100% support level; 15% vs. 50%, P = 0.017 for 150% support level). Improved support levels from 100% to 150% statistically increased total AI during PSP but not during PSN in patients with COPD or ARDS. Patients' inspiratory efforts for triggering and total inspiration were significantly lower during PSN than during PSP in patients with COPD or ARDS under both support levels (P < 0.05). There was no difference in breathing patterns between PSN and PSP.@*CONCLUSIONS@#PSN improves patient-ventilator synchrony and generates a respiratory pattern similar to PSP independently of any level of support in patients with different respiratory system mechanical properties. PSN, which reduces the trigger and total patient's inspiratory effort in patients with COPD or ARDS, might be an alternative mode for PSP.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01979627; https://clinicaltrials.gov/ct2/show/record/NCT01979627.


Subject(s)
Cross-Over Studies , Humans , Prospective Studies , Respiration , Respiration, Artificial , Respiratory System , Ventilators, Mechanical
6.
J. bras. pneumol ; 46(4): e20190295, 2020. tab, graf
Article in English | LILACS | ID: biblio-1134884

ABSTRACT

ABSTRACT Objective: To compare the effects of voluntary breath stacking (VBS) and involuntary breath stacking (IBS) techniques on respiratory mechanics, lung function patterns, and inspiratory capacity in tracheostomized patients. Methods: This was a randomized crossover clinical trial involving 20 tracheostomized patients admitted to the ICU and submitted to the VBS and IBS techniques, in random order, with an interval of 5 h between each. Ten cycles of each technique were performed with an interval of 30 s between each cycle. In VBS, patients performed successive inspirations for up to 30 s through a one-way valve, whereas in IBS, successive slow insufflations were performed with a resuscitator bag until the pressure reached 40 cmH2O. Respiratory mechanics, inspiratory capacity, and the lung function pattern were evaluated before and after the interventions. Results: After IBS, there was an increase in static compliance (p = 0.007), which was also higher after IBS than after VBS (p = 0.03). There was no significant difference between the pre-VBS and post-VBS evaluations in terms of static compliance (p = 0.42). Inspiratory capacity was also greater after IBS than after VBS (2,420.7 ± 480.9 mL vs. 1,211.3 ± 562.8 mL; p < 0.001), as was airway pressure (38.3 ± 2.6 cmH2O vs. 25.8 ± 5.5 cmH2O; p < 0.001). There were no changes in resistance or lung function pattern after the application of either technique. Conclusions: In comparison with VBS, IBS promoted greater inspiratory capacity and higher airway pressure, resulting in an increase in static compliance.


RESUMO Objetivo: Comparar os efeitos das técnicas breath stacking (BS) e air stacking (AS) sobre a mecânica respiratória, o padrão ventilatório e a capacidade inspiratória em pacientes traqueostomizados. Métodos: Ensaio clínico cruzado randomizado envolvendo 20 pacientes traqueostomizados internados em UTI e submetidos a ambas as técnicas, com intervalo de 5 h entre si, de acordo com a randomização. Foram realizados dez ciclos de cada técnica com intervalos de 30 segundos entre si. No BS, os pacientes realizaram inspirações sucessivas por até 30 s por meio de uma válvula unidirecional, enquanto no AS foram realizadas insuflações lentas sucessivas através de um ressuscitador manual até que a pressão atingisse 40 cmH2O. Os pacientes foram avaliados quanto a mecânica respiratória, capacidade inspiratória e padrão ventilatório antes e depois da realização das intervenções. Resultados: Com relação à mecânica respiratória no AS, houve aumento da complacência estática na comparação pré- e pós-intervenção (p = 0,007), assim como entre os momentos pós-AS e pós-BS (p = 0,03). Não houve diferença significativa da complacência estática na realização do BS (p = 0,42). A capacidade inspiratória foi maior após o AS que após o BS (2.420,7 ± 480,9 mL vs. 1.211,3 ± 562,8 mL; p < 0,001), bem como em relação à pressão nas vias aéreas (38,3 ± 2,6 cmH2O vs. 25,8 ± 5,5 cmH2O; p < 0,001). Não foram observadas alterações na resistência ou no padrão ventilatório em ambas as técnicas. Conclusões: Na presente amostra, o AS promoveu maior capacidade inspiratória e maior pressão nas vias aéreas que as observadas após o BS, com consequente aumento da complacência estática.


Subject(s)
Humans , Male , Middle Aged , Aged , Respiratory Physiological Phenomena , Tracheostomy , Respiratory Mechanics , Lung/physiology , Inspiratory Capacity , Cross-Over Studies
7.
Braz. oral res. (Online) ; 34: e057, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1132713

ABSTRACT

Abstract Poor oral hygiene seems to be the norm in children and teenagers with Down Syndrome (DS). Advances in design and types of toothbrushes may improve biofilm control. This randomized, single-blind, crossover clinical trial evaluated the effectiveness of electric toothbrushes regarding mechanical control of biofilm in children and teenagers with DS and their cooperation. Twenty-nine participants with DS, aged 6 to 14 years, used both types of toothbrushes: electric (ET) and manual (MT). The order of use of the different types of toothbrushes was randomly defined, including a 7-day period with each type with 7-day washout period in between. The Turesky-Quigley-Hein biofilm index was used before and after brushing to assess the effectiveness of the technique. Frankl's behavioral scale was used during toothbrushing to assess the participants' cooperation. Paired T-test, Mann Whitney, Chi-square, and Fisher's Exact tests were applied, with a significance level of 5%. The quantity of dental biofilm was significantly reduced after both brushing techniques (p < 0.001). However, no significant difference was found in total biofilm (ET: 0.73 ± 0.36; MT: 0.73 ± 0.34; p = 0.985) or % biofilm reduction (ET: 72.22%; MT: 70.96%; p = 0.762) after brushing between techniques or in % biofilm reduction between toothbrushes of age groups (6 -9 years, p = 0.919; 10-14 years, p = 0.671). Participants showed similar cooperation level with the two types of toothbrush (p = 1.000). The use of electric or manual toothbrush had no effect on the quantity of dental biofilm removed in children and teenagers with DS, nor did it influence their cooperation during the procedure.


Subject(s)
Humans , Male , Female , Child , Adolescent , Toothbrushing/instrumentation , Down Syndrome/physiopathology , Biofilms , Dental Devices, Home Care , Dental Plaque/prevention & control , Time Factors , Child Behavior , Adolescent Behavior , Treatment Outcome , Caregivers , Statistics, Nonparametric , Cross-Over Studies , Dental Caries/prevention & control , Equipment Design
8.
Clinics ; 75: e1512, 2020. tab, graf
Article in English | LILACS | ID: biblio-1055871

ABSTRACT

OBJECTIVES: This study aimed to analyze the efficiency of physiotherapy techniques in sputum induction and in the evaluation of pulmonary inflammation in asthmatic children and adolescents. Although hypertonic saline (HS) is widely used for sputum induction (SI), specific techniques and maneuvers of physiotherapy (P) may facilitate the collection of mucus in some asthmatic children and adolescents. METHODS: A randomized crossover study was performed in patients with well-controlled asthma, and 90 sputum samples were collected. Children and adolescents were assessed using spirometry and randomized at entry into one of three sputum induction techniques: (i) 3% hypertonic saline - HS technique; (ii) physiotherapy (oscillatory positive expiratory pressure, forced expiration, and acceleration of expiratory flow) - P technique; and (iii) hypertonic saline + physiotherapy - HSP technique. ClinicalTrials.gov: NCT03136042. RESULTS: The total cells (mL) and the percentage (%) of differential inflammatory cells were similar in all techniques. The sputum weight (g) in the HSP technique was significantly higher than that in the HS technique. In all techniques, the percentage of viable cells was >50%, and there was no difference between the HS and P techniques. Moreover, sputum induction did not cause any alterations in the pulmonary function of patients. CONCLUSION: The physiotherapy sputum collection technique was effective in obtaining viable cells from mucus samples and yielded the same amount of sputum as the gold standard technique (hypertonic saline). In addition, the physiotherapy maneuvers were both safe and useful for sputum induction in asthmatic children and adolescents with well-controlled asthma.


Subject(s)
Humans , Child , Adolescent , Asthma/complications , Saline Solution, Hypertonic , Sputum , Physical Therapy Modalities , Forced Expiratory Volume , Cross-Over Studies
9.
Rev. latinoam. enferm. (Online) ; 28: e3264, 2020. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1101735

ABSTRACT

Objective: to compare the time for performance of dry and traditional bed bathing and its effects on transcutaneous arterial oxygen saturation and respiratory rates in critical adult patients. Method: pilot study of a randomized, open, crossover clinical trial, performed with 15 adult critically ill patients. Each patient received a dry and a traditional bed bath. Analysis of variance with repeated measures was used, adopting p-value ≤ 0.05. Results: most patients were male (73.3%), white (66.7%), with a mean age of 69.7 years. The dry bath was faster (20.0 minutes) than the traditional bath (30.0 minutes) (p<0.001). There was no significant difference between the patients' saturation means between baths (p=0.381), with 94.7% for the dry bath and 95.2% for the traditional bath. During the traditional bath, the patients' respiratory rate mean was higher (24.2 incursions per minute) and statistically different (p<0.001) from the value obtained for the dry bath (20.5 incursions per minute). Conclusion: the dry bath had a shorter duration than did the traditional bath, resulting in less patient exposure. The traditional bed bath had a negative effect on patients' respiratory rate, increasing it. Brazilian Registry of Clinical Trials (ReBEC): RBR-5qwkqd


Objetivo: comparar o tempo de execução do banho no leito a seco e do tradicional, e os seus efeitos sobre a saturação transcutânea de oxigênio arterial e a frequência respiratória em pacientes críticos adultos. Método: estudo piloto de um ensaio clínico randomizado crossover, aberto, realizado com 15 pacientes críticos adultos. Cada paciente recebeu o banho no leito a seco e o tradicional. Utilizou-se a análise de variância com medidas repetidas, adotando-se o valor p≤0,05. Resultados: a maioria dos pacientes era do sexo masculino (73,3%), brancos (66,7%), com média de idade de 69,7 anos. O banho a seco foi mais rápido (20,0 minutos) que o tradicional (30,0 minutos) (p<0,001). Não houve diferença significativa entre as médias de saturação dos pacientes entre os banhos (p=0,381), sendo 94,7% no banho a seco e 95,2% no tradicional. Durante o banho tradicional, a média da frequência respiratória dos pacientes foi maior (24,2 incursões por minuto) e estatisticamente diferente (p<0,001) do valor obtido no banho a seco (20,5 incursões por minuto). Conclusão: o banho a seco teve uma duração menor que o tradicional, resultando em uma menor exposição dos pacientes. O tradicional banho no leito gerou efeito negativo sobre a frequência respiratória dos pacientes, elevando-a. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-5qwkqd


Objetivo: comparar el tiempo de ejecución del baño en la cama a seco y con el tradicional, y observar los efectos sobre la saturación del oxígeno transcutáneo arterial y la frecuencia respiratoria, en pacientes críticos adultos. Método: estudio piloto de un ensayo clínico aleatorizado crossover, abierto, realizado con 15 pacientes críticos adultos. Cada paciente recibió el baño en la cama, a seco y de forma tradicional. Se utilizó el análisis de variancia con medidas repetidas adoptando el valor p≤0,05. Resultados: la mayoría de los pacientes era del sexo masculino (73,3%), blancos (66,7%), con media de edad de 69,7 años. El baño a seco fue más rápido (20,0 minutos) que el tradicional (30,0 minutos) (p<0,001). No hubo diferencia significativa entre los promedios de saturación de los pacientes entre los baños (p=0,381), siendo 94,7% en el baño a seco y 95,2% en el tradicional. Durante el baño tradicional la media, de la frecuencia respiratoria, de los pacientes fue mayor (24,2 incursiones por minuto) y estadísticamente diferente (p<0,001) del valor obtenido en el baño a seco (20,5 incursiones por minuto). Conclusión: El baño a seco tuvo una duración menor que el tradicional, resultando en una menor exposición de los pacientes. El tradicional baño en la cama generó efecto negativo sobre la frecuencia respiratoria de los pacientes, elevándola. Registro Brasileño de Ensayos Clínicos (ReBEC): RBR-5qwkqd


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Baths/nursing , Baths/methods , Pilot Projects , Critical Illness/nursing , Cross-Over Studies , Respiratory Rate/physiology
11.
J. bras. nefrol ; 41(4): 492-500, Out.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1056600

ABSTRACT

Abstract Introduction: Intradialytic hypotension (IDH) is a major complication of hemodialysis, with a prevalence of about 25% during hemodialysis sessions, causing increased morbidity and mortality. Objective: To study the effects of sertraline to prevent IDH in hemodialysis patients. Methods: This was a double-blind, crossover clinical trial comparing the use of sertraline versus placebo to reduce intradialytic hypotension. Results: Sixteen patients completed the two phases of the study during a 12-week period. The IDH prevalence was 32%. A comparison between intradialytic interventions, intradialytic symptoms, and IDH episodes revealed no statistical difference in the reduction of IDH episodes (p = 0.207) between the two intervention groups. However, the risk of IDH interventions was 60% higher in the placebo group compared to the sertraline group, and the risk of IDH symptoms was 40% higher in the placebo group compared to the sertraline group. Survival analysis using Kaplan-Meier estimator supported the results of this study. Sertraline presented a number needed to treat (NNT) of 16.3 patients to prevent an episode from IDH intervention and 14.2 patients to prevent an episode from intradialytic symptoms. Conclusion: This study suggests that the use of sertraline may be beneficial to reduce the number of symptoms and ID interventions, although there was no statistically significant difference in the blood pressure levels.


Resumo Introdução: A hipotensão intradialítica (HID) é uma das principais complicações da hemodiálise, com uma prevalência de cerca de 25% durante as sessões de hemodiálise, causando aumento da morbimortalidade. Objetivo: Estudar os efeitos da sertralina na prevenção da HID em pacientes em hemodiálise. Métodos: Este foi um ensaio clínico duplo-cego, cruzado, comparando o uso de sertralina versus placebo para reduzir a hipotensão intradialítica. Resultados: Dezesseis pacientes completaram as duas fases do estudo durante um período de 12 semanas. A prevalência de HID foi de 32%. Uma comparação entre intervenções intradialíticas, sintomas intradialíticos (ID) e episódios de HID não revelou diferença estatística na redução dos episódios de HID (p = 0,207) entre os dois grupos de intervenção. No entanto, o risco de intervenções para HID foi 60% maior no grupo placebo em comparação com o grupo Sertralina, e o risco de sintomas ID foi 40% maior no grupo placebo em comparação com o grupo Sertralina. A análise de sobrevida utilizando o estimador de Kaplan-Meier corroborou os resultados deste estudo. A sertralina apresentou um número necessário para tratar (NNT) de 16,3 pacientes para prevenir um episódio de intervenção de HID e 14,2 pacientes para prevenir um episódio de sintomas intradialíticos. Conclusão: Este estudo sugere que o uso de sertralina pode ser benéfico para reduzir o número de sintomas e intervenções de HID, embora não tenha havido diferença estatisticamente significante nos níveis pressóricos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Renal Dialysis/adverse effects , Serotonin Uptake Inhibitors/therapeutic use , Sertraline/therapeutic use , Renal Insufficiency/therapy , Hypotension/physiopathology , Placebos/administration & dosage , Blood Pressure/drug effects , Blood Pressure/physiology , Double-Blind Method , Prevalence , Renal Dialysis/mortality , Cross-Over Studies , Renal Insufficiency/complications , Hypotension/prevention & control , Hypotension/epidemiology
12.
Arq. bras. cardiol ; 113(4): 725-733, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038569

ABSTRACT

Abstract Background: The Gini coefficient is a statistical tool generally used by economists to quantify income inequality. However, it can be applied to any kind of data with unequal distribution, including heart rate variability (HRV). Objectives: To assess the application of the Gini coefficient to measure inequality in power spectral density of RR intervals, and to use this application as a psychophysiological indicator of mental stress. Methods: Thirteen healthy subjects (19 ± 1.5 years) participated in this study, and their RR intervals were obtained by electrocardiogram during rest (five minutes) and during mental stress (arithmetic challenge; five minutes). These RR intervals were used to obtain the estimates of power spectral densities (PSD). The limits for the PSD bands were defined from 0.15 to 0.40 Hz for high frequency band (HF), from 0.04 to 0.15 Hz for low frequency band (LF), from 0.04 to 0.085 Hz for first low frequency sub-band (LF1) and from 0.085 to 0.15 Hz for second low frequency sub-band (LF2). The spectral Gini coefficient (SpG) was proposed to measure the inequality in the power distribution of the RR intervals in each of above-mentioned HRV bands. SpG from each band was compared with its respective traditional index of HRV during the conditions of rest and mental stress. All the differences were considered statistically significant for p < 0.05. Results: There was a significant decrease in HF power (p = 0.046), as well as significant increases in heart rate (p = 0.004), LF power (p = 0.033), LF2 power (p = 0.019) and LF/HF (p = 0.002) during mental stress. There was also a significant increase in SpG(LF) (p = 0.009) and SpG(LF2) (p = 0.033) during mental stress. Coefficient of variation showed SpG has more homogeneity compared to the traditional index of HRV during mental stress. Conclusions: This pilot study suggested that spectral inequality of Heart Rate Variability analyzed using the Gini coefficient seems to be an independent and homogeneous psychophysiological indicator of mental stress. Also, HR, LF/HF, SpG(LF) of HRV are possibly important, reliable and valid indicators of mental stress.


Resumo Fundamento: O coeficiente de Gini é um instrumento estatístico geralmente usado por economistas para quantificar a desigualdade de renda. No entanto, ele pode ser aplicado a qualquer tipo de dados com distribuição desigual, incluindo a variabilidade da frequência cardíaca (VFC). Objetivos: Avaliar a aplicação do coeficiente de Gini para medir a desigualdade na densidade espectral de potência de intervalos RR, e usar esta aplicação como um indicador psicofisiológico do estresse mental. Métodos: Treze indivíduos saudáveis (19 ± 1,5 anos) participaram deste estudo, e seus intervalos RR foram obtidos por eletrocardiograma durante repouso (cinco minutos) e durante estresse mental (desafio aritmético; cinco minutos). Esses intervalos RR foram utilizados para obter as estimativas de densidades espectrais de potência (PSD). Os limites para as bandas PSD foram definidos de 0,15 a 0,40 Hz para banda de alta frequência (HF), de 0,04 a 0,15 Hz para banda de baixa frequência (LF), de 0,04 a 0,085 Hz para a primeira sub-banda de baixa frequência (LF1) e de 0,085 a 0,15 Hz para a segunda sub-banda de baixa frequência (LF2). O coeficiente de Gini espectral (SpG) foi proposto para medir a desigualdade na distribuição de potência dos intervalos RR em cada uma das bandas de VFC mencionadas acima. O SpG de cada banda foi comparado com seu respectivo índice tradicional de VFC durante as condições de repouso e de estresse mental. Todas as diferenças foram consideradas estatisticamente significativas para p < 0,05. Resultados: Houve uma diminuição significativa no poder de FC (p=0,046), bem como aumentos significativos na frequência cardíaca (p = 0,004), potência da LF (p = 0,033), potência da LF2 (p = 0,019) e LF/HF (p = 0,002) durante estresse mental. Houve também um aumento significativo de SpG(LF) (p = 0,009) e SpG(LF2) (p = 0,033) durante estresse mental. O coeficiente de variação mostrou que o SpG tem mais homogeneidade em comparação com o índice tradicional de VFC durante o estresse mental. Conclusões: Este estudo piloto sugeriu que a desigualdade espectral da VFC analisada pelo coeficiente de Gini parece ser um indicador psicofisiológico independente e homogêneo de estresse mental. Além disso, FC, LF/HF, SpG(LF) da VFC são possivelmente indicadores importantes, confiáveis e válidos de estresse mental.


Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Stress, Psychological/physiopathology , Heart Rate/physiology , Reference Values , Case-Control Studies , Pilot Projects , Reproducibility of Results , ROC Curve , Statistics, Nonparametric , Cross-Over Studies , Electroencephalography
13.
Rev. bras. ter. intensiva ; 31(3): 289-295, jul.-set. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1042581

ABSTRACT

RESUMO Objetivo: Avaliar os efeitos da hiperinsuflação com o ventilador sobre a mecânica respiratória. Métodos: Foi realizado ensaio clínico cruzado randomizado com 38 pacientes ventilados mecanicamente com infecção pulmonar. A ordem da hiperinsuflação ou controle (sem alterações nos parâmetros) foi randomizada. A hiperinsuflação foi realizada por 5 minutos no modo ventilação com pressão controlada, com aumentos progressivos de 5cmH2O até atingir pressão máxima de 35cmH2O, mantendo-se a pressão positiva expiratória final. Após atingir 35cmH2O, o tempo inspiratório e a frequência respiratória foram ajustados para que os fluxos inspiratório e expiratório atingissem a linha de base, respectivamente. As medidas de complacência estática, resistências total e de vias aéreas e pico de fluxo expiratório foram avaliadas antes, imediatamente após a manobra e após aspiração. Foi utilizada a análise de variância two-way para medidas repetidas com pós-teste de Tukey, considerando significativo p < 0,05. Resultados: A hiperinsuflação com o ventilador aumentou a complacência estática, mantendo-se após aspiração (46,2 ± 14,8 versus 52,0 ± 14,9 versus 52,3 ± 16,0mL/cmH2O; p < 0,001). Houve aumento transitório da resistência de vias aéreas (6,6 ± 3,6 versus 8,0 ± 5,5 versus 6,6 ± 3,5cmH2O/L.s-1; p < 0,001) e redução transitória do pico de fluxo expiratório (32,0 ± 16,0 versus 29,8 ± 14,8 versus 32,1 ± 15,3Lpm; p < 0,05) imediatamente após a manobra, com redução após aspiração traqueal. Não foram observadas modificações no controle e nem alterações hemodinâmicas. Conclusão: A hiperinsuflação com o ventilador promoveu aumento da complacência associado ao aumento transitório da resistência de vias aéreas e do pico de fluxo expiratório, com redução após aspiração.


ABSTRACT Objective: To evaluate the effects of ventilator hyperinflation on respiratory mechanics. Methods: A randomized crossover clinical trial was conducted with 38 mechanically ventilated patients with pulmonary infection. The order of the hyperinflation and control (without changes in the parameters) conditions was randomized. Hyperinflation was performed for 5 minutes in pressure-controlled ventilation mode, with progressive increases of 5cmH2O until a maximum pressure of 35cmH2O was reached, maintaining positive end expiratory pressure. After 35cmH2O was reached, the inspiratory time and respiratory rate were adjusted so that the inspiratory and expiratory flows reached baseline levels. Measurements of static compliance, total resistance and airway resistance, and peak expiratory flow were evaluated before the technique, immediately after the technique and after aspiration. Two-way analysis of variance for repeated measures was used with Tukey's post hoc test, and p < 0.05 was considered significant. Results: Ventilator hyperinflation increased static compliance, which remained at the same level after aspiration (46.2 ± 14.8 versus 52.0 ± 14.9 versus 52.3 ± 16.0mL/cmH2O; p < 0.001). There was a transient increase in airway resistance (6.6 ± 3.6 versus 8.0 ± 5.5 versus 6.6 ± 3.5cmH2O/Ls-1; p < 0.001) and a transient reduction in peak expiratory flow (32.0 ± 16.0 versus 29.8 ± 14.8 versus 32.1 ± 15.3Lpm; p <0.05) immediately after the technique; these values returned to pretechnique levels after tracheal aspiration. There were no changes in the control condition, nor were hemodynamic alterations observed. Conclusion: Ventilator hyperinflation promoted increased compliance associated with a transient increase in airway resistance and peak expiratory flow, with reduction after aspiration.


Subject(s)
Humans , Male , Female , Adult , Aged , Respiration, Artificial/methods , Ventilators, Mechanical , Respiratory Mechanics , Inhalation , Time Factors , Airway Resistance , Cross-Over Studies , Middle Aged
14.
J. bras. nefrol ; 41(3): 384-392, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040258

ABSTRACT

Abstract Introduction: Chronic kidney disease (CKD) has a high prevalence and is a worldwide public health problem. Reuse of dialyzers is a cost reduction strategy used in many countries. There is controversy over its effects on clinical parameters and microbiological safety. Methods: In this clinical crossover study, 10 patients performed consecutive hemodialysis (HD) sessions divided in two phases: "single use" sessions (N = 10 HD sessions) followed by "dialyzer reuse" sessions (N = 30 HD sessions). Clinical, laboratory, and microbiological parameters were collected in the following time points: "single use", 1st, 6th, and 12th sessions with reuse of dialyzers, including bacterial cultures, endotoxins quantification in serum and dialyzer blood chamber, and detection of hemoglobin and protein residues in dialyzers. Results: Mean age of the sample was 37 ± 16 years, 6 (60%) were men, and 5 (50%) were white. CKD and HD vintage were 169 ± 108 and 47 (23-111) months, respectively. Serum C-reactive protein (CRP) [4.9 (2.1) mg/mL], ferritin (454 ± 223 ng/mL), and endotoxin levels [0.76 (0.61-0.91) EU/mL] were high at baseline. Comparison of pre- and post-HD variations of serum levels of CRP and endotoxins in the "single use" versus "reuse" phases did not result in differences (p = 0.8 and 0.4, respectively). Samples of liquid in the dialyzer inner chamber were negative for the growth of bacteria or endotoxins. There was no significant clinical manifestation within and between the phases. Conclusion: Dialyzers reuse was safe from a clinical, microbiological, and inflammatory point of view. The dialyzer performance remained adequate until the 12th reuse.


Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial de alta prevalência. O reúso de dialisadores é uma estratégia de redução de custos empregada em muitos países. Seus efeitos sobre parâmetros clínicos e de segurança microbiológica são alvo de controvérsia. Métodos: No presente estudo clínico cruzado, 10 pacientes realizaram sessões consecutivas de hemodiálise (HD) divididas em duas fases: a primeira com sessões de "uso único" (N = 10 sessões de HD) e a segunda com sessões com "reúso de dialisadores" (N = 30 sessões de HD). Parâmetros clínicos, laboratoriais e microbiológicos foram registrados nos seguintes momentos: "uso único", 1a, 6a e 12a sessões com reúso de dialisadores, incluindo culturas bacterianas, quantificação de endotoxinas no soro e na câmara interna do dialisador e detecção de hemoglobina e resíduos de proteína nos dialisadores. Resultados: A idade média da amostra foi de 37 ± 16 anos seis (60%) eram homens e cinco (50%) eram brancos. Os tempos com DRC e em HD foram de 169 ± 108 e 47 (23-111) meses, respectivamente. Os níveis séricos de proteína C-reativa (PCR) [4,9 (2,1) mg/mL], ferritina (454 ± 223 ng/mL) e endotoxinas [0,76 (0,61-0,91) UE/mL] estavam elevados no início do estudo. A diferença dos níveis séricos de PCR e endotoxinas pré e pós-HD nas fases de "uso único" e "reúso" não foi significativa (p = 0,8 e 0,4, respectivamente). As amostras de líquido retiradas da câmara interna do dialisador foram negativas para crescimento de bactérias e endotoxinas. Não houve registro de manifestações clínicas significativas nas fases do estudo. Conclusão: O reúso de dialisadores foi seguro dos pontos de vista clínico, microbiológico e inflamatório. O desempenho do dialisador permaneceu adequado até o 12º reuso.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Renal Dialysis/instrumentation , Equipment Reuse , Kidneys, Artificial/adverse effects , Kidneys, Artificial/microbiology , C-Reactive Protein/analysis , Pilot Projects , Follow-Up Studies , Cross-Over Studies , Endotoxins/blood , Renal Insufficiency, Chronic/therapy , Ferritins/blood , Inflammation/blood
15.
Arch. endocrinol. metab. (Online) ; 63(4): 376-384, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1019349

ABSTRACT

ABSTRACT Objective To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. Subjects and methods The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. Results Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. Conclusions Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Sweetening Agents/metabolism , Postprandial Period/drug effects , Diabetes Mellitus, Type 1/metabolism , Fructose/metabolism , Glucose/metabolism , Triglycerides/blood , Blood Glucose/analysis , Blood Glucose/drug effects , Cross-Over Studies , Dose-Response Relationship, Drug , Drug Tolerance
16.
Braz. dent. j ; 30(4): 404-409, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011571

ABSTRACT

Abstract Crossover studies continue to be published in spite of warnings about their inherent risks in relation to behavioral outcomes. This study took the opportunity of access to secondary data analysis in order to demonstrate the impact of a crossover design on the outcomes of randomized clinical trials aimed at the behavior of children during dental treatment. We evaluated the effect of the sequence of sedative administration, the sedative and the participant's age on the behavior of children undergoing two sequential dental visits. Eighteen uncooperative healthy young children were equally randomly assigned to: (G1) 1.0 mg/kg oral midazolam (first session) and oral placebo (second session); (G2) oral placebo (first) and 1.0 mg/kg oral midazolam (second). One trained observer assessed children's behavior. Data were analyzed by three-way mixed ANOVA. Both midazolam [mean(SD); 71.7%(16.5)] and placebo [48.6%(33.1)] produced more struggling behavior when they were administered in the first session compared to the second one (p=0.001). For the placebo, children aged 2-3 years exhibited more struggling behavior [G1 54.9%(36.2); G2 80.5%(8.3)] than those aged 4-5 years (p=0.04). Also, the reduction of percentage of struggling behavior was higher in G1 for older children (76.2%) and in G2 for younger children (32.9%). There were significant interactions between drug and sequence of administration, and between drug and age. The results of our study confirm the conventional wisdom that crossover study design is inappropriate to evaluate children's behavior/anxiety related-dental treatment under sedation and the results of crossover studies of dental sedation should be treated with extreme caution.


Resumo Pouco se sabe sobre o impacto de um delineamento cruzado nos desfechos de ensaios clínicos randomizados voltados ao comportamento de crianças durante tratamento odontológico. Este estudo objetivou avaliar o efeito da sequência de administração do sedativo, da droga em si e da idade dos participantes no comportamento de crianças que receberam duas consultas odontológicas consecutivas. Dezoito crianças saudáveis não colaboradoras, 2-5 anos de idade, foram randomizadas em dois grupos: G1 - 1,0 mg/kg midazolam oral (primeira sessão) e placebo oral (segunda sessão); G2 - placebo (primeira) e 1,0 mg/kg midazolam oral (segunda). Um observador treinado avaliou o comportamento infantil. Os dados foram analisados por ANOVA de três fatores (alfa=0,05). Midazolam [média(DP); 71,7%(16,5)] e placebo [48,6%(33,1)] resultaram em mais comportamento não cooperativo quando administrados na primeira sessão comparado com a segunda (p=0,001). Com o uso do placebo, crianças de 2-3 anos de idade exibiram mais comportamento não cooperativo [G1 54,9%(36,2); G2 80,5%(8,3)] que as de 4-5 anos de idade (p=0,04). Além disso, a porcentagem de redução do comportamento não cooperativo foi maior em crianças mais velhas em G1 (76,2%) e em crianças mais novas em G2 (32,9%). Considerando a avaliação do comportamento infantil sob sedação, a primeira sessão odontológica influenciou a segunda visita. Os resultados deste estudo confirmam a especulação de que o delineamento cruzado é inadequado para avaliar o comportamento odontológico relacionado à ansiedade/comportamento infantil; os resultados dos ensaios cruzados de sedação odontológica devem ser tratados com extrema cautela.


Subject(s)
Humans , Child, Preschool , Child , Conscious Sedation , Anesthesia, Dental , Midazolam , Child Behavior , Cross-Over Studies , Hypnotics and Sedatives
17.
Rev. chil. pediatr ; 90(2): 166-174, abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1003734

ABSTRACT

INTRODUCCIÓN: Santiago de Chile con 7 millones de habitantes alcanza elevados niveles de contaminación atmosférica en invierno, el material particulado habitualmente excede los estándares de la OMS. OBJETIVO: Evaluar la influencia de la contaminación atmosférica por material particulado en las hospitalizaciones por enfermedades respiratorias en niños, entre 2001 y 2005 en la Región Metropolitana de Chile, independientemente de la presencia ambiental de virus sincicial respiratorio (VRS). MATERIAL Y MÉTODO: 72.479 hospitalizaciones públicas y privadas por enfermedades respiratorias de niños menores de 15 años residentes en la región del estudio se analizaron con un diseño de caso control alternante, con estratificación temporal. Se evaluó principalmente: hospitalizaciones por enfermedades respiratorias (J00-J99), neumonía (J12-J18); asma (J21.0 - J21.9) y bronquiolitis (J45 - J46). Recopilándose diariamente temperatura, MP10, MP2,5, ozono, virus respiratorios (VRS) y humedad ambientales. RESULTADOS: Los promedios de MP10 y MP2,5 fueron 81,5 y 41,2 pg/m3 respectivamente. El promedio de temperatura fue 12,8 °C y de la humedad del aire 72,6 %. Un aumento de 10 pg/m3 de MP25 con 1 y 2 días de rezago se asoció con un incremento de las hospitalizaciones por enfermedades respiratorias cercano a 2%, este porcentaje aumentó a 5% cuando la exposición fue con 8 días de rezago, reflejando sinergismo entre material particulado y virus respiratorio (VRS). CONCLUSIÓN: La exposición breve a contaminación atmosférica puede provocar hospitalizaciones por enfermedades respiratorias en niños.


INTRODUCTION: With seven million inhabitants, Santiago de Chile reaches high levels of air pollution in winter, the particulate matter usually exceeds WHO standards. OBJECTIVE: To assess the influence of air pollution caused by particulate matter on children's hospitalizations due to respiratory diseases between 2001 and 2005 in the Metropolitan Region of Chile, independently from the environmental presence of respiratory syncytial virus (RSV). MATERIAL AND METHOD: 72,479 public and private hospitalizations due to respiratory diseases of children under 15 years of age residing in the study region were analyzed using a time-stratified alternating case-control design. The main evaluations were: hospitalizations due to respiratory diseases (J00-J99), pneumonia (J12-J18); asthma (J21.0 - J21.9), and bronchiolitis (J45 - J46). Daily compilation of temperature data, PM10, PM2,5, ozone, respiratory virus (RSV), and environmental humidity. RESULTS: Mean values of PM10 and PM2.5 were 81.5 and 41.2 pg/m3 respec tively. The average temperature was 12.8 °C and air humidity 72.6%. An increase of 10 pg/m3 of PM25 with one and two days of lag was associated with an hospitalizations increase due to respiratory diseases close to 2%, this percentage increased to 5% when the exposure was with eight days of lag, reflecting synergism between particulate matter and respiratory viruses (RSV). CONCLUSION: Short air pollution exposure can lead to children's hospitalizations due to respiratory diseases.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Respiratory Tract Diseases/etiology , Air Pollutants/toxicity , Air Pollution/adverse effects , Environmental Exposure/adverse effects , Particulate Matter/toxicity , Hospitalization/statistics & numerical data , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/epidemiology , Logistic Models , Chile/epidemiology , Risk Factors , Cross-Over Studies , Air Pollutants/analysis , Air Pollution/analysis , Air Pollution/statistics & numerical data , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Particulate Matter/analysis
18.
J. oral res. (Impresa) ; 8(2): 159-165, abr. 30, 2019. tab
Article in English | LILACS | ID: biblio-1145330

ABSTRACT

Objective: To evaluate the effect of the application of a flipped learning model for teaching biostatistics to dental students in a Peruvian public university. Methodology: A quasi-experimental, crossover, longitudinal and prospective design was used. A non-probability sampling technique was employed. The sample consisted of 63 students that enrolled in the Biostatistics course at the School of Dentistry at Universidad Nacional Mayor de San Marcos. Students were divided into two groups according to their designated training schedule. The contents of two units were assessed. For the first unit (descriptive statistics), the first group was taught using the flipped learning model and the second group with the master class model. For the second unit (inferential statistics), groups were crossed over. At both periods of the study, cognitive, procedural and attitudinal skills were assessed through previously validated questionnaires. Mann-Whitney U test, Cohen is d and multiple linear regression analysis were performed. Results: the mean total score for the second unit was higher (p<0.001) in the flipped learning group (32.58) compared to the master class guided training group (27.94), presenting a Cohen's d=0.97. Procedural (9.23 versus 7.80) and attitudinal (15.63 versus 12.90) skills were on average higher in the flipped learning group. Regression analysis resulted in R2=0.245, p=0.003. Conclusion: the flipped learning method achieved a higher content learning in the second unit, compared to the master class model.


Objetivo: Evaluar el efecto de la experiencia de aplicación del modelo flipped learning para el aprendizaje de bioestadística en estudiantes de odontología de una universidad pública peruana. Metodología: Se realizó un diseño cuasi experimental de secuencia cruzada, longitudinal, prospectivo. La muestra se obtuvo de manera no probabilística y estuvo conformada por 63 estudiantes que cursaron la asignatura de Bioestadística en la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos. Se conformaron dos grupos de acuerdo al horario de práctica designado y se evaluaron los contenidos de dos unidades de la asignatura. En la primera unidad (estadística descriptiva) el primer grupo fue sometido al modelo flipped learning y el segundo sometido al modelo presencial clase magistral. En la segunda unidad del curso (estadística inferencial) los grupos se cruzaron. En ambos momentos se evaluaron las capacidades cognitivas, procedimentales y actitudinales a través de cuestionarios previamente validados para el estudio. Se aplicó la prueba U de Mann-Whitney, la d de Cohen y la regresión lineal múltiple. Resultados: En la segunda unidad la puntuación media total fue mayor (p<0,001) en el grupo flipped learning (32,58) en comparación al de clase magistral-práctica dirigida (27,94) con un efecto alto d Cohen= 0,97. Las capacidades procedimentales (9,23 versus7,80) y actitudinales (15,63 versus 12,90) fueron en promedios mayores en el grupo flipped learning. Al aplicarse la regresión se halló un R2= 0,245 p=0,003. Conclusión: La aplicación del modelo flipped learning logró un mayor aprendizaje en contenidos de la segunda unidad, en comparación con el modelo presencial clase magistral en los estudiantes.


Subject(s)
Humans , Male , Female , Biostatistics/methods , Problem-Based Learning/methods , Education, Dental/methods , Peru , Students, Dental , Teaching/standards , Cross-Over Studies , Education, Distance/methods , Learning
19.
Arq. bras. cardiol ; 112(3): 304-308, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038536

ABSTRACT

Abstract The effect of third and second-generation type of beta-blocker on substrate oxidation especially during high-intensity exercises are scarce. The objective of the study is to explore differences of beta-blocker regimens (vasodilating vs. non-vasodilating beta-blockers) for substrate oxidation during in high-intensity intermittent exercise (HIIE) in chronic heart failure and reduced ejection fraction (HFrEF). Eighteen CHF males (58.8 ± 9 years), 8 under use of β1 specific beta-blockers+alfa 1-blocker and 10 using β1 non-specific beta-blockers, were randomly assigned to 4 different HIIE, in a cross-over design. The 4 protocols were: 30 seconds (A and B) or 90 seconds (C and D) at 100% peak power output, with passive (A and C) or active recovery (50% of PPO; B and D). Energy expenditure (EE; kcal/min), quantitative carbohydrate (CHO) and lipid oxidation (g/min) and qualitative (%) contribution were calculated. Two-way ANOVA and Bonferroni post-hoc test were used (p-value ≤ 0.05) to compare CHO and lipid oxidation at rest and at 10min. Total exercise time or EE did not show differences for beta-blocker use. The type of beta-blocker use showed impact in CHO (%) and lipid (g/min and %) for rest and 10 min, but absolute contribution of CHO (g/min) was different just at 10min (Interaction p = 0.029). Higher CHO oxidation was found in vasodilating beta-blockers when comparing to non-vasodilating. According to our pilot data, there is an effect of beta-blocker type on substrate oxidation during HIIE, but no influence on EE or exercise total time in HFrEF patients.


Resumo Os dados sobre efeito do tipo de betabloqueador de terceira e segunda geração na oxidação do substrato, especialmente durante exercícios de alta intensidade, são escassos. O objetivo do estudo é explorar as diferenças de tratamentos com betabloqueadores (betabloqueadores vasodilatadores vs. não-vasodilatadores) na oxidação de substratos durante exercícios intermitentes de alta intensidade (HIIE) na insuficiência cardíaca crônica e fração de ejeção do ventrículo esquerdo reduzida (ICFEr). Dezoito pacientes do sexo masculino com ICC (58,8 ± 9 anos), 8 em uso de betabloqueadores β1 específicos + bloqueador α-1 e 10 utilizando betabloqueadores β1 não-específicos, foram aleatoriamente designados para 4 diferentes HIIE, em um desenho cruzado. Os 4 protocolos foram: 30 segundos (A e B) ou 90 segundos (C e D) a 100% da potência de pico de saída (PPO), com recuperação passiva (A e C) ou ativa (50% de PPO; B e D). O gasto energético (GE; kcal/min), a ingestão de carboidratos quantitativos (CHO) e oxidação lipídica (g/min) e qualitativa (%) foram calculados. Anova de dois fatores e teste post-hoc de Bonferroni foram usados (p-valor ≤ 0,05) para comparar a oxidação de CHO e lipídios em repouso e aos 10 minutos. O tempo total de exercício ou GE não mostraram diferenças de acordo com o uso de betabloqueadores. O tipo de betabloqueador mostrou impacto em CHO (%) e lípides (g/min e %) para repouso e aos 10 min, mas a contribuição absoluta de CHO (g/min) foi diferente apenas aos 10 minutos (Interação p = 0,029). Foram encontradas maiores oxidações de CHO com betabloqueadores vasodilatadores quando comparados com os não-vasodilatadores. De acordo com nossos dados piloto, há um efeito do tipo do betabloqueador na oxidação do substrato durante o HIIE, mas nenhuma influência no GE ou no tempo total de exercício nos pacientes com ICFEr.


Subject(s)
Humans , Male , Middle Aged , Aged , Exercise/physiology , Adrenergic beta-Agonists/pharmacology , Energy Metabolism/drug effects , Carbohydrate Metabolism/physiology , High-Intensity Interval Training/methods , Heart Failure/physiopathology , Ventricular Function, Left/physiology , Adrenergic beta-Agonists/metabolism , Cross-Over Studies , Lipid Metabolism/physiology , Heart Failure/metabolism
20.
Arq. bras. oftalmol ; 82(2): 129-135, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-989398

ABSTRACT

ABSTRACT Purpose: To determine the reliability of swept- source optical coherence tomography in cases in which soft contact lenses cannot be removed when acquiring biometric measurements. Methods: Eight subjects were included and only one eye per participant was analyzed. Each eye was measured six times by swept-source optical coherence tomography with the IOLMaster 700 instrument (Carl Zeiss Meditec, Jena, Germany). Axial length, central corneal thickness, anterior chamber depth, lens thickness, and keratometric measurements were evaluated for the naked eye and while wearing soft contact lenses of three different powers (-1.5, -3.0, and +2.0 D). Results: There were statistically significant changes in axial length, central corneal thickness, anterior chamber depth, and keratometric measurements with soft contact lenses as compared to the naked eye (p<0.001). However, there were no significant differences in lens thickness outcomes between the naked eye and while wearing the three soft contact lenses (p>0.5). The changes in axial length, central corneal thickness, and anterior chamber depth were lens-specific and dependent on the thickness of the lens used. Conclusions: Sept-source optical coherence tomography based lens thickness measurements while wearing soft contact lenses are comparable to those of the naked eye. However, the thickness and the optical design of the soft contact lens may lead to significant differences in the axial lengh, central corneal thickness, anterior chamber deph, and keratometric measurements.


RESUMO Objetivo: Determinar a confiabilidade da tomografia de coerência óptica de varredura em casos especiais em que lentes de contato gelatinosas não podem ser removidas ao realizar medições biométricas. Métodos: Oito indivíduos foram incluídos e apenas um olho por participante foi analisado. Cada olho foi medido seis vezes por tomografia de coerência óptica de varredura com o instrumento IOLMaster 700 (Carl Zeiss Meditec, Jena, Alemanha). O comprimento axial, a espessura central da córnea, a profundidade da câmara anterior, a espessura da lente e as medidas ceratométricas foram avaliados a olho nu e enquanto usavam lentes de contato gelatinosas de três diferentes potências (-1,5, -3,0 e +2,0 D). Resultados: Houve alterações significativas no comprimento axial, espessura central da córnea, profundidade da câmara anterior e medidas ceratométricas com as lentes de contato gelatinosas em comparação com as a olho nu (p<0,001). No entanto, não houve diferenças significativas nos resultados de espessura do cristalino entre o olho nu e enquanto usava as três lentes de contato gelatinosas (p>0,5). As alterações de comprimento axial, espessura central da córnea e profundidade da câmara anterior foram específicas da lente e dependentes da espessura da lente usada. Conclusões: As medições da espessura da lente baseadas na tomografia de coerência óptica da Sept-source, enquanto usam lentes de lentes de contato gelatinosas, são comparáveis às do olho nu. Entretanto, a es pessura e o desenho óptico da lente de contato gelatinosa podem levar a diferenças significativas no comprimento axial, na espessura central da córnea, na profundidade da câmara anterior e nas medidas ceratométricas.


Subject(s)
Humans , Adult , Biometry/methods , Contact Lenses , Tomography, Optical Coherence/methods , Axial Length, Eye/anatomy & histology , Axial Length, Eye/diagnostic imaging , Anterior Eye Segment/anatomy & histology , Anterior Eye Segment/diagnostic imaging , Reference Values , Reproducibility of Results , Analysis of Variance , Statistics, Nonparametric , Cross-Over Studies
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