Efeitos do Tai Chi Chuan na força dos músculos extensores dos joelhos e no equilíbrio em idosas / Effects of Tai Chi Chuan on knee extensor muscle strength and balance in elderly women

CONTEXTUALIZAÇÃO: Alguns estudos têm indicado que o Tai Chi Chuan (TCC) é capaz de melhorar o condicionamento físico, a força muscular e o equilíbrio entre os praticantes idosos, prevenindo quedas, fraturas e dependência física. OBJETIVO: Verificar os efeitos do TCC no equilíbrio (EQ) e na força dos músculos extensores dos joelhos (F) em mulheres idosas. MATERIAIS E MÉTODOS: Participaram do estudo 77 mulheres saudáveis, não praticantes de atividade física orientada. No Grupo Experimental (G1) foram incluídas 38 voluntárias (68 ± 5 anos) e no Grupo Controle (G2), 39 voluntárias (69 ± 7 anos). O G1 praticou o TCC estilo Yang de 24 movimentos durante 12 semanas, três vezes por semana, com duração de 50 minutos. O G2 não realizou atividades físicas orientadas. A força foi mensurada pelo teste de 1-RM na cadeira extensora e o equilíbrio foi avaliado utilizando o teste de apoio unipodal com os olhos fechados. Na análise estatística, utilizou-se teste de normalidade, split-plot análise de variância (ANOVA) e correlação de Pearson. RESULTADOS: O Grupo Experimental apresentou incrementos de 17,83 por cento na F e 26,10 por cento no EQ. O Grupo Controle não apresentou alteração significativa em nenhuma variável. Não foi observada correlação significativa entre estas duas variáveis no G1 (r= 0,09; p= 0,554) e no G2 (r= 0,07; p= 0,660). CONCLUSÕES: Estes resultados sugerem que o TCC melhora F e EQ em mulheres idosas. Entretanto, a força dos músculos extensores dos joelhos não está necessariamente ligada ao equilíbrio nesta modalidade.

BACKGROUND: Some studies have indicated that Tai Chi Chuan (TCC) is capable of improving physical fitness, muscle strength and balance in elderly people. This improvement could prevent falls, fractures and physical dependence. OBJECTIVE: To investigate the effects of TCC on balance and knee extensor muscle strength among elderly women. METHODS: Seventy-seven healthy women who were not engaged in any guided physical activity participated in this study. There were 38 volunteers (68 ± 5 years) in the Experimental Group and 39 volunteers (69 ± 7 years) in the Control Group. The Experimental Group practiced 24-movement Yang-style TCC for 12 weeks, consisting of 50-minute sessions three times per week. The Control Group did not perform any guided physical activities. Strength was measured using the one maximum repetition test in an extensor chair and balance was evaluated using the unipodal support test with the eyes closed. The statistical analysis consisted of the normality test, split-plot analysis of variance (ANOVA) and Pearson's correlation coefficient. RESULTS: The Experimental Group presented increases of 17.83 percent in knee extensor muscle strength and 26.10 percent in balance. The Control Group did not show any significant changes in these variables. No significant correlation was observed between these two variables in the Experimental (r= 0.09; p= 0.554) or in the Control Groups (r= 0.07; p= 0.660). CONCLUSIONS: These results suggest that TCC improves knee extensor muscle strength and balance among elderly women. However, knee extensor muscle strength was not necessarily linked to balance in this activity.

Effect of caffeine on respiratory and quadriceps muscle contractility in man

A cafeína pontencializa a funçäo do músculo esquelético in vitro, mas há poucos dados sobre seu efeito no homem. Foram examinados os efeitos de dose máxima tolerada de cafeína (600mg) na funçäo dos músculos respiratórios e quadríceps em seis pessoas normais (cinco homens, idade 25-41 anos), como é mostrado a seguir: 1) Em estudo sobre o efeito agudo no músculo quadríceps femoris, seis pessoas realizaram quatro contraçöes máximas voluntárias isométricas (MVC). A seguir, foram produzidas contraçöes tetânicas isométricas involuntárias com estimulaçäo elétrica de 20Hz, aplicada através de elétrodos de superfície, com voltagem suficiente para alcançar 30 por cento MVC. Este estímulo constante foi repetido dez vezes, a intervalos de cinco minutos, antes de cafeína ou placebo ter sido ingerido em cada um dos quatro dias de estudo. Trinta minutos após, foram medidas outras dez estimulaçöes elétricas idênticas às descritas anteriormente e quatro MVCs. 2) Em estudo controlado cruzado dos efeitos da cafeína sobre a força de músculos respiratórios e da força e fadiga do quadríceps femoris, quatro pessoas ingeriram cafeína ou placebo em quatro dias de estudo. Uma hora após, cada sujeito realizou quatro pressöes bucais inspiratórias e expiratórias máximas (PImáx & PEmáx) e mediu-se duas vezes a força produzida por estimulaçäo elétrica com freqüências de dez, 20, 30, 50 e 100Hz. Entäo, foi produzida fadiga por estimulaçäo repetitiva durante dois minutos com freqüência de 20Hz, ciclo de 50 por cento e força inicial de 30 por cento MVC. Um e dez minutos após, repetiu-se a curva freqüência-força. Näo houve diferença significativa nas MVC, PImáx e PEmáx produzidas após cafeína e placebo. Cafeína näo teve efeito significativo no desenvolvimento da fadiga (medida por amplitude das contraçöes e máxima taxa de relaxamento) e na sua recuperaçäo. No quadríceps femoris, encontramos pequeno mas estatisticamente significativo aumento da força de contraçäo estimulada eletricamente com baixa freqüência (20Hz).

The effects of beta 2-agonists and caffeine on respiratory and limb muscle performance.

The possibility that respiratory muscle function may be improved by drug therapy is of clinical importance, but remains controversial. A series of studies concerning the effects of maximally tolerated dosages of terbutaline, tulobuterol (a new beta 2-agonist) and caffeine on respiratory muscle strength and limb muscle strength and endurance were undertaken in normal subjects. Drugs were administered orally, 2 h before study. Caffeine produced a small but statistically significant increase in the stimulated contraction force at 20 Hz, and a small beneficial effect on recovery from a fatiguing protocol; maximum voluntary contraction force of the quadriceps was increased by 3.8%. Terbutaline and tulobuterol had no beneficial effects on either respiratory or limb muscle function. We conclude that conventional dosages of these bronchodilator drugs do not greatly affect skeletal muscle performance.

Lack of effect of acute hypoxia and hypercapnia on muscle relaxation rate in man.

The effect of acute hypoxia and hypercapnia on skeletal muscle relaxation rate was investigated in man. The contractile force of limb muscles (quadriceps femoris and adductor pollicis) was studied in normal subjects using electrical stimulation. The twitch transdiaphragmatic pressure was used to investigate the diaphragm. The maximum relaxation rate was measured from contractions of the non-fatigued quadriceps femoris, adductor pollicis and diaphragm. Severe hypoxia (mean transcutaneous oxygen tension 40 mmHg) did not alter the maximum relaxation rate from 20 Hz stimulated contractions of the non-fatigued quadriceps. Acute hypercapnia (mean end-tidal CO2 tension 65.1 mmHg) did not significantly change the maximum relaxation rate from 20 and 100 Hz tetanic contractions of non-fatigued quadriceps. The maximum relaxation rate from 1 Hz twitch tension and 20 Hz tetanic tension of adductor pollicis was also not altered by acute hypercapnia (mean end-tidal carbon dioxide tension 63 and 60 mmHg, respectively). The maximum relaxation rate from twitch transdiaphragmatic pressure was not altered by acute hypercapnia (mean end-tidal carbon dioxide tension 69.7 mmHg).

[Comparative study of immunoenzyme tests ELISA-G and ELISA-M, indirect immunofluorescence, and complement fixation in the diagnosis of human cysticercosis]. / Estudo comparativo dos testes immunoenzimáticos ELISA-G e ELISA-M, imunofluorescência indireta e fixação do complemento no diagnóstico da cisticercose humana.

A comparative study of four immunological tests used for anti-Cysticercus antibodies detection--Enzyme-Linked ImmunoSorbent Assay IgG (ELISA-G) and IgM (ELISA-M), indirect immunofluorescence (RIFI) and complement fixation (RFC)--was made in serum and cerebrospinal fluid (CSF). 539 patients with symptoms suggesting cysticercosis, 450 relatives of these patients and 133 normal people (control group) were examined. 1122 serum samples and 120 CSF samples were analysed by ELISA-G and RIFI, 83 sera and 60 CSF also by RFC, and 28 CSF by ELISA-M. 5.2% serum samples were reagent in ELISA-G and RIFI, and 3.5% of them had discordant results. All control group sera were negative. The same tests in CSF were positive in 16.7% and had discordant results in 7.5%. ELISA-G and RIFI in serum and CSF had concordant results in 89.6% (17.7% were positive). ELISA-G, RIFI and RFC had concordant results in 54.2% sera (16.9% positives) and in 81.7% CSF (11.7% positives). When ELISA-G and RIFI were negative, RFC was positive in 41.0% sera and 11.7% CSF. ELISA-G and ELISA-M had concordant results in 78.6% CSF. When these results were discordant ELISA-G was positive in 10.7% and ELISA-M in another 10.7%. It is necessary to use concomitantly several immunological tests for anti-Cysticercus antibodies detection in serum and in CSF, in attempting to reach correct diagnosis.

Cisticercose musculo-cutanea e visceral: doenca rara? / Musculocutaneous and visceral cysticercosis: a rare disease?

O presente trabalho teve como objetivos estimar a frequencia das formas musculo-cutanea e visceral da cisticercose em exames anatomo-patologicos e necropsias realizados em Brasilia, Distrito Federal (estudo retrospectivo) e diagnosticar a cisticercose musculo-cutanea em pacientes residentes na mesma regiao geografica (estudo prospectivo). Em 64.911 protocolos de exames anatomo-patologicos, o diagnostico de cisticercose foi observado em 30 (0,05 por cento), sendo que em 27 (90,0 por cento) os cistos estavam nos tecidos musculo-cutaneo-mucoso, em 1 (3,3 por cento) em ganglio e em 2 (6,7 por cento) no sistema nervoso central. Entre aqueles com cistos nos tecidos musculo-cutaneo-mucoso 2 (7,4 por cento) tinham cisticercos em lingua. Em 1520 protocolos de necropsia, encontraram-se 25 (1,6 por cento) com diagnostico de cisticercose, sendo: 24 (96,0 por cento) com neurocisticercose, seja isolada ou associada a outras formas da doenca; e 2 (8,0 por cento) com cisticercos em coracao, 2 (8,0 por cento) em musculo esqueletico e 1 (4,0 por cento) em figado, seja isolados ou associados a outras localizacoes do parasito. Foram tambem examinados 1122 individuos, realizando-se em todos eles as reacoes sorologicas de imunofluorescencia indireta e ELISA para cisticercose e a investigacao radiologica de partes mole do cranio...

[Musculocutaneous and visceral cysticercosis: a rare disease?]. / Cisticercose músculo-cutânea e visceral--doença rara?

The aims of the present study were to measure the frequency of cutaneous, muscular and visceral forms of cysticercosis in anatomopathological examinations and necropsies in the Federal District and to study the clinical aspects of this disease. In 64.911 protocols of anatomopathological examinations reviewed, 30 (0.05%) had the diagnosis of cysticercosis, 90% had cysticerci in the subcutaneous tissue, skeletal muscle or mucous membrane, 3.3% in lymph node and 6.7% in the central nervous system. Two (7.4%) patients had cysticerci in the tongue. In 1520 autopsies protocols reviewed, 25 (1.6%) autopsies with cysticercosis were found. 96% had cysticerci in the central nervous system, 8% in the heart, 8% in the skeletal muscle and 4% in the liver, either isolated or associated with cysticerci in other viscera. 1122 people were also examined. Indirect immunofluorescence and ELISA were the serological tests used in all patients for the diagnosis of cysticercosis. The radiological investigation of the skull and soft tissues was also performed. 59 (5.3%) patients had both serological tests positive (10 had also biopsies with the diagnosis of cysticercosis). The muscular form was found in 42.4%, subcutaneous cysts were present in 20.3% and the visceral form was found in 3.4% of cases. In patients with visceral cysticercosis, the cysts were localized in the heart, pleura, kidney and ovary. Calcifications in the skull and/or soft tissues were demonstrated radiologically in 32 (2.8%) patients with negative serological tests for cysticercosis. The present study suggests a high frequency of subcutaneous and muscular forms of cysticercosis in the Federal District. The visceral form of the disease is also found in various organs, without clinical manifestations of importance.

[Treatment of neurocysticercosis with praziquantel]. / Tratamento da neurocisticercose com praziquantel.

Twenty seven patients with neurocysticercosis were treated with praziquantel in progressive doses reaching 50 mg/kg/day associated with dexamethasone for 21 days. The patients were followed during and after treatment and those followed up for one year repeated their immunological tests (indirect immunofluorescence and ELISA) at this time. Headache was the most frequent symptom during the treatment, occurring on 37% of patients. During the treatment 18.5% of patients had intracranial hypertension and one died. One year after treatment 72.2% of patients who finished treatment improved. The immunological tests became negative in 45.4% of patients sera and 42.8% of cerebrospinal fluids. There was no correlation between the clinical evolution and immunological tests. In this study it is not possible to affirm that both negative immunological tests and good clinical evolution were consequent to the efficacy of praziquantel treatment. Due to the great frequency and seriousness of this treatment complications, the patients with neurocysticercosis must be individually evaluated to know the risks and the benefits of the treatment with praziquantel.

Effect of acute hypercapnia on limb muscle contractility in humans.

The effect of acute hypercapnia on skeletal muscle contractility and relaxation rate was investigated. The contractile force of fresh and fatigued quadriceps femoris (QF) and adductor pollicis (AP) was studied in normal humans by use of electrical stimulation. Maximum relaxation rate from stimulated contractions was measured for both muscles. Acute hypercapnia led to a rapid substantial reduction of contraction force. The respiratory acidosis after 9% CO2 was breathed for 20 min [mean venous blood pH 7.26 and end-tidal PCO2 (PETCO2) 65.1 Torr] reduced 20- and 100-Hz stimulated contractions of QF to 72.8 +/- 4.4 and 80.0 +/- 5.1% of control values, respectively. After 8 and 9% CO2 were breathed for 12 min, AP forces at 20- and 50-Hz stimulation were also reduced. Twitch tension of AP was reduced by a mean of 25.5% when subjects breathed 9% CO2 for 12 min [mean arterialized venous blood pH (pHav) 7.25 and PETCO2 66 Torr]. Over the range of 5% (pHav 7.38 and PETCO2 47 Torr) to 9% CO2, there was a linear relationship between twitch tension loss and pHav, arterialized venous blood PCO2, and PETCO2. Acute respiratory acidosis (mean PETCO2 61 Torr) increased the severity of low-frequency fatigue after intermittent voluntary contractions of AP. At 20 min of recovery, twitch tension was 63.2 +/- 13.4 and 46.8 +/- 16.4% of control value after exercise breathing air and 8% CO2, respectively. Acute hypercapnia (mean PETCO2 65.1 and 60.5 Torr) did not alter the maximum relaxation rate from tetanic contractions of fresh QF and from twitch tensions of AP.

[Histoplasmoma with pleural effusion. Report of a case]. / Histoplasmoma com derrame pleural. Relato de um caso.

Pleural effusions are rare events accompanying histoplasmosis, and in general they are associated with acute forms of the disease. It is described here a case of histoplasmoma associated with pleuritic pain and pleural effusion.

Estudo clinico e laboratorial da neurocisticercose em Brasilia

Este trabalho teve como objetivo analisar clinica e laboratorialmente pacientes com sintomatologia neurologica residentes em Brasilia, identificando aqueles cujos sintomas eram decorrentes da neurocisticercose. Foram examinados 520 doentes, sendo: 428 com epilepsia; 29 com hipertensao intracraniana; e 63 com cefaleia persistente de causa nao identificada e/ou com calcificacao no estudo radiologico de cranio. Classificou-se a neurocisticercose nas seguintes formas: epileptica; hipertensiva, subdividida nas formas hidrocefalica, pseudotumoral e tumoral; com cefaleia; apopletica; psiquica e raquidiana. Foram identificados 67 pacientes (12,9 por cento) com neurocisticercose, sendo 35 (6,7 por cento) com o diagnostico confirmado por apresentarem um ou ambos testes imunologicos reagente no liquor ou cistos intracranianos (Grupo A) e 32 (6,1 por cento) por mostrarem calcificacoes intracranianas e ambos testes imunologicos nao-reagentes no liquor (Grupo B). Entre os enfermos com cistos, 18,2 por cento tiveram os testes imunologicos nao-reagentes no liquor. As formas clinicas mais frequentemente encontradas foram a epileptica, quer seja isolada ou associada, surgiu em 62,7 por cento dos pacientes e a hipertensiva, que foi encontrada em 34,3 por cento. Foi observada maior frequencia da forma hipertensiva no Grupo A e da forma epileptica no Grupo B. Encontraram-se ainda 13,4 por cento com a forma apopletica (associada ou isolada), 6,0 por cento com cefaleia, 4,5 por cento com a forma psiquica e 1,5 por cento com a forma raquidiana. Nos pacientes epilepticos, ambos os testes imunologicos foram reagentes no soro em 4,2 por cento e mostraram resultados discordantes em 4,0 por cento. Entre os 53 doentes que realizaram os testes imunologicos no liquor, 15,1 por cento foram reagentes e 1,9 por cento mostrou resultados discordantes entre os dois testes. Surgiu correlacao entre a presenca de anticorpos anti-Cysticercus no liquor e a faixa etaria de inicio dos sintomas. A epilepsia parcial ocorreu em maior frequencia nos pacientes com o liquor reagente. Ambos os testes imunologicos foram reagentes no liquor em 41,2 por cento dos doentes com a forma hidrocefalica, 12,5 por cento daqueles com a forma pseudotumoral e 50,0 por cento dos com a forma tumoral da cisticercose. Estes testes tiveram resultados discordantes no liquor em 27,6 por cento dos pacientes com hipertensao intracraniana, sendo que 20,7 por cento deles apresentavam a forma pseudotumoral. Uma ou ambas reacoes imunologicas foram reagentes no liquor em 52,9 por cento dos enfermos com hidrocefalia e 87,5 por cento daqueles com a forma pseudotumoral. A sorologia reagente predominou no sexo masculino nas formas hidrocefalica e tumoral e no feminino na forma pseudotumoral. Este estudo permitiu-nos concluir que a neurocisticercose tem grande prevalencia em Brasilia, apresentando-se em diferentes formas clinicas e mostrando sintomatologia polimorfa.

Maximal relaxation rates of esophageal, nose, and mouth pressures during a sniff reflect inspiratory muscle fatigue.

Maximal relaxation rate (MRR, % pressure fall/10 msec) of the inspiratory muscles is reduced with fatigue. We have investigated whether MRR of esophageal pressure (Pes) generated by voluntary sniffs is decreased by fatigue, and whether sniff nasopharyngeal (Pnp) and mouth (Pmo) MRR reflect these changes. In 10 normal subjects, control MRR of sniff Pes correlated closely to Pnp MRR (r = 0.977, p less than 0.001) and Pmo MRR (r = 0.947, p less than 0.001). To produce inspiratory muscle fatigue, four highly motivated subjects breathed to exhaustion (3 to 6 min) through a high inspiratory resistance. MRR was determined from 10 sniffs for Pes, Pnp, and Pmo before fatigue, and at intervals up to 10 min after fatigue. The subjects showed a mean decrease in sniff Pes MRR of 33% (range, 20 to 42) immediately after fatigue, which returned exponentially to control values within 3 to 4 min. The mean changes in Pes MRR were reflected by similar changes in Pnp MRR, 32% (range, 18 to 43) and Pmo MRR, 33% (range, 21 to 42). Studies were repeated in the four subjects with closely similar results. We conclude that fatigue of the inspiratory muscles reduces MRR of sniff Pes, and that this is reflected in Pnp and Pmo. Sniff Pes, Pnp, and Pmo MRR measurements may provide a useful method for detecting and monitoring fatigue; Pnp and Pmo have the advantage of being less invasive.

Cough threshold to citric acid in diabetic patients with and without autonomic neuropathy.

The cough reflex has been investigated in insulin dependent diabetic patients with and without autonomic neuropathy. The cough response to inhaled citric acid was determined in eight patients with diabetes who had severe autonomic neuropathy and compared with that in 10 who had no evidence of neuropathy. The patients with autonomic neuropathy had a higher median threshold for the cough response to citric acid (median 50%, range 20- greater than 100%) than non-neuropathic control patients (median 10%, range 2-20%). These results suggest that vagal innervation of the bronchial tree is damaged by diabetic autonomic neuropathy.

Semmelweiss e a febre puerperal. / Semmelweiss and the childbed fever

O autor relata como Semmelweiss, procurando a causa da febre puerperal, aproximouse da solucao do seu problema gradualmente, como um verdadeiro cientista

Maximal expiratory flow-volume curve in chronic chagasic patients with megaesophagus with or without megacolon

The maximal expiratory flow-volume curve was used to evaluate existing physiological abnormalities in forty patientes with chronic Chagas'Disease. All patients had megaoesophagus with or without megacolon, some had ECG evidence of cardiomyopathy but none had clinic signs of cardiac failure. The 40 patients were studied in four groups: I)The total group with or without cardiomyopathy. II) 24 patients with associated cardiomyopathy. III) 16 patients without cardiomyopathy. IV) 17 non smoking patients with or without cardiomyopathy. The results indicated that there was: a) a dmininution of the forced vital capacity (FVC) in group I, II and IV; b) a diminution of maximal expiratory flow (Vmax) in group I and II; c) a diminution of the maximal expiratory flow rates at 50% and 25% of the expired vital capacity (Vmax50 and Vmax25) in all four groups. The alterations of the first-second forced expired volume (FEV1) were not significant in any group. Diminution of FVC and Vmax seen to be dependent upon the presence of associated cardiomyopathy while diminution of the Vmax50 and Vmax25 was a constant finding, independent of the presence of cardiopathy