Effects of long-term metformin administration associated with high-intensity interval training on physical performance, glycogen concentration, GLUT-4 content, and NMR-based metabolomics in healthy rats.

The aim was to investigate the long-term effects of metformin ingestion on high-intensity interval training on performance, glycogen concentration (GC), GLUT-4 content, and metabolomics outcomes in rats. Fifty male Wistar rats were randomly divided into baseline, metformin (500 mg daily), and control groups. Training consisted of 4 sets of 10 jumps with 30 s of passive recovery per day, 5 days/week for 8 weeks. The intensity equivalent was 50% of body mass (BM) in the first four weeks and 70% of BM in the last four weeks. The animals were submitted to a weekly jump test until exhaustion at 50% of BM. Serum and tissues were collected at baseline and after 4 and 8 weeks for biochemical and metabolomics analysis. The number of jumps increased in the Control group without a significant difference between groups at 4 and 8 weeks. GLUT4 was lower in the gastrocnemius muscle in the Metformin at the fourth week compared to Control (P=0.03) and compared to Metformin (P=0.02) and Control (P=0.01) at eight weeks. Hepatic and soleus GC were not altered by metformin. Gastrocnemius GC was lower after 8 weeks in the Metformin group compared to Control (P=0.01). Significantly lower levels of pyruvate and phenylalanine and higher levels of ethanol, formate, betaine, very low-density lipoprotein, low-density lipoprotein, and creatine were found in the Metformin compared to the Control. Although chronic administration of metformin decreased food intake and negatively influenced the synthesis of muscle glycogen, it did not significantly change physical performance compared to the Control.

Effects of long-term metformin administration associated with high-intensity interval training on physical performance, glycogen concentration, GLUT-4 content, and NMR-based metabolomics in healthy rats

The aim was to investigate the long-term effects of metformin ingestion on high-intensity interval training on performance, glycogen concentration (GC), GLUT-4 content, and metabolomics outcomes in rats. Fifty male Wistar rats were randomly divided into baseline, metformin (500 mg daily), and control groups. Training consisted of 4 sets of 10 jumps with 30 s of passive recovery per day, 5 days/week for 8 weeks. The intensity equivalent was 50% of body mass (BM) in the first four weeks and 70% of BM in the last four weeks. The animals were submitted to a weekly jump test until exhaustion at 50% of BM. Serum and tissues were collected at baseline and after 4 and 8 weeks for biochemical and metabolomics analysis. The number of jumps increased in the Control group without a significant difference between groups at 4 and 8 weeks. GLUT4 was lower in the gastrocnemius muscle in the Metformin at the fourth week compared to Control (P=0.03) and compared to Metformin (P=0.02) and Control (P=0.01) at eight weeks. Hepatic and soleus GC were not altered by metformin. Gastrocnemius GC was lower after 8 weeks in the Metformin group compared to Control (P=0.01). Significantly lower levels of pyruvate and phenylalanine and higher levels of ethanol, formate, betaine, very low-density lipoprotein, low-density lipoprotein, and creatine were found in the Metformin compared to the Control. Although chronic administration of metformin decreased food intake and negatively influenced the synthesis of muscle glycogen, it did not significantly change physical performance compared to the Control.

Caffeine Mouth Rinse Plus Ingestion Improves the 10-Km Time Trial Compared to Caffeine Mouth Rinse Alone.

Background: The benefits of caffeine to physical performance have been extensively demonstrated, however, it has recently been speculated that there is an effect of the administration route on its effectiveness. Purpose: The current study investigated the effect of caffeine mouth rinse in isolation or combined with ingestion on performance in a 30-minute constant-load exercise followed by a 10-km cycling time trial. Methods: Ten physically active men performed a 30-minute constant-load exercise at 50% of the graded test Wmax, followed by a 10-km cycling time trial. Before and at the middle points of the constant-load exercise and 10-km cycling time trial, the following conditions were administered: PLA (cellulose ingestion plus mouth rinsing with magnesium sulfate), ING (5 mg.kg-1 of caffeine ingestion plus mouth rinsing with magnesium sulfate), MR (cellulose ingestion plus mouth rinsing with 1.2% caffeine), and COMB (5 mg.kg-1 of caffeine ingestion plus mouth rinsing with 1.2% caffeine). Results: During the 30-minute constant-load exercise, COMB presented a lower rating of perceived exertion (RPE) than MR (p = .04). For the 10-km time trial, the COMB was faster than MR (MR = 1363 ± 345 vs. COMB = 1291 ± 308s, Δ% = 5.57, p = .05). Mean power output was higher in COMB than PLA, ING, and MR (234 ± 15 vs. 169 ± 29, 148 ± 11, and 145 ± 12 W, respectively). There were no differences between conditions for heart rate and RPE during the 10-km time trial. Conclusion: In summary, caffeine mouth rinsing potentiated the effects of caffeine ingestion during the 10-km time trial compared to caffeine mouth rinsing alone.

Acute metformin administration increases mean power and the early Power phase during a Wingate test in healthy male subjects.

The present study tested the hypothesis that acute metformin would increase peak power measured during a Wingate test. Fourteen men (24 ± 6 years; 75.8 ± 10.2 kg; 177 ± 7 cm) participated in four test sessions, conducted in a crossover, counterbalanced, double-blind model. The first and second sessions consisted of anthropometric measurements and one Wingate test per day to assess test-retest reliability. In the last two sessions, the Wingate tests were performed on metformin (500 mg capsule, 1 hour before) or placebo (cellulose capsule, 1 hour before) condition. No differences were found between the placebo and metformin for peak power (1056.8 ± 215.8 W vs. 1095.2 ± 199.3 W, respectively; p = 0.24). Mean power (630.9 ± 87.8 W vs. 613.1 ± 94.8 W, respectively; p=0.01) and total work (18928 ± 2633 kJ vs. 18393 ± 2845 kJ, respectively; p = 0.01) in the metformin condition were higher than the placebo. The power were greater in metformin when compared to the placebo in moments 3 (p = 0.01), 4 (p = 0.01), 5 (p = 0.04), 6 (p = 0.04), 7 (p = 0.02), 8 (p = 0.03) and 9 (p = 0.01) seconds. There were no differences between conditions for the peak lactate (p = 0.08) and the rating of perceived exertion (p = 0.84). Acute metformin administration increased the early power phase and the mean power of a Wingate test.

Caffeine intake improves muscular endurance and induces depletion of anaerobic work capacity in the bench press

Abstract Aim: To investigate the effects of caffeine (CAF) ingestion on anaerobic work capacity (AWC) and muscular endurance in the bench press exercise at predictive intensities equivalent to 20, 25, and 30% of 1RM. Methods: Thirteen males (age: 23 ± 3 years; body mass 83.5 ± 4.9 kg; height 172.8 ± 5.0 cm and 1RM 82 ± 24 kg) had their 1RM test evaluated in the bench press exercise and the time until failure was performed at intensities equivalent to 20%, 25%, and 30% of 1RM to CAF (350mg) or placebo (PLA, cellulose). AWC was measured from the linear equation: "Force = Critical Force + (AWC x 1/timeout)". Results: CAF enhanced the time until failure at 20% of 1RM (PLA = 202.6 ± 29.1s; CAF = 243.2 ± 20.6s), but there was no ergogenic effect at 25% (PLA = 188.8 ± 23.5 s; CAF = 195.6 ± 27.1 s), and 30% (PLA = 147.4 ± 15.8 s; CAF = 145.4 ± 14.8 s). AWC in CAF was lower than PLA (PLA = 6378.0 ± 1214.9 J; CAF = 3246.4 ± 1389.7 J; p = 0.03; Effect size = 0.88). Critical Force (N) was not different between treatments PLA 29.97 ± 11.54% of 1RM and CAF 3.74 ± 3.69% of 1 RM (p=0.47; Effect size= 0.28). Conclusion: Acute CAF intake (350mg) reduces the AWC and increases the time until failure at 20% of 1 RM, but not Critical Force and muscular endurance at 25% and 30% of 1 RM in the bench press.

Caffeine mouth rinse enhances performance, fatigue tolerance and reduces muscle activity during moderate-intensity cycling.

We investigated the effects of caffeine mouth rinse on endurance performance, muscle recruitment (i.e., electromyographic activity of the vastus lateralis and rectus femoris), rating of perceived effort and heart rate. Twelve physically-active healthy men cycled at 80% of their respiratory compensation point until task failure. The participants rinsed their mouths for 10 seconds with placebo (PLA, 25 mL of a solution composed of non-caloric mint essence) or caffeine (CAF, 25 mL of 1.2% of anhydrous caffeine concentration with non-caloric mint essence) every 15 minutes of exercise. Time until exhaustion increased 17% (effect size = 0.70) in CAF compared to PLA (p = 0.04). The wavebands of low-frequency electromyographic activity (EMG) of the vastus lateralis and rectus femoris was lower in CAF group than PLA at 50% of the time until exhaustion (p = 0.04). The global EMG signal was lower in CAF group than PLA at 100% of the time until exhaustion (p = 0.001). The rating of perceived effort pooled was higher in CAF mouth rinse (p = 0.001) than PLA group. No effect was found on the heart rate between the groups (p > 0.05). Caffeine mouth rinse increases endurance performance, rating of perceived effort and decreases muscle activity during a moderate-intensity exercise.

Self-care agency and associated factors in postmenopausal women.

OBJECTIVE: The aging process in women is marked by several changes, including the transition to menopause. The evaluation of self-care management is essential and has great relevance for public health. The aim of the present study was to evaluate self-care management and associated factors in postmenopausal women. METHOD: This study was a cross-sectional study performed with 260 postmenopausal women who attended routine consultations at the Menopause Outpatient Clinic of the Hospital of the State University of Campinas-SP. Women aged 50 years or older with amenorrhea for at least 12 months were included. The women were interviewed by a researcher during the routine consultation, and the self-care agency assessment was performed using the Appraisal of Self-Care Agency Scale-Revised questionnaire. RESULTS: The average total self-care score for the women in this study was 62.27 (± 9.64). Higher Appraisal of Self-Care Agency Scale-Revised scores were associated with performing outdoor activities, better self-perceived health, and a higher score on knowledge about vitamin D. Active smoking was associated with a lower self-care score. CONCLUSION: We observed that the self-care management of postmenopausal women was satisfactory and was associated with lifestyle, self-perceived health, and knowledge about vitamin D.

Caffeine mouth rinse has no effects on anaerobic energy yield during a Wingate Test.

BACKGROUND: The purpose was to investigate the effect of caffeine (CAF) mouth rinse on peak power (PP), mean power (MP), peak power relative to body mass (rel PP), mean power relative to body mass (rel MP), fatigue index (FI) and anaerobic contribution in the Wingate Test. METHODS: Ten healthy men (age: 24.8±3.7 years; body mass: 71.0±7.8 kg; height: 170±3 cm; body fat: 17.02±4.9%; VO2max: 44.15±5.5 ml·kg-1·min=) were recruited. A randomized, double-blind, cross-over design was employed. Participants were instructed to complete Wingate Test in the fastest time possible under 2 conditions: CAF (25 ml of mint syrup with 1.2% of CAF, equivalent to 300 mg of CAF) and placebo (PLA) (25 ml of mint syrup without CAF). RESULTS: There was no difference at PP (P=0.66), MP (P=0.16), rel PP (P=0.82), rel MP (P=0.18), FI (P=0.19), anaerobic alactic (P=0.71), anaerobic lactic (P=0.25), total energy expenditure (P=0.41) and peak plasma lactate concentration (P=0.57). CONCLUSIONS: CAF mouth rinse did not increase peak power (PP), mean power (MP), peak power relative to body mass (rel PP), mean power relative to body mass (rel MP), Fatigue Index (FI) nor anaerobic contribution in the Wingate Test.

Chronic metformin intake improves anaerobic but not aerobic capacity in healthy rats.

The effect of chronic metformin intake on aerobic and anaerobic capacity was examined in healthy rats. Twenty rats completed 10 days of metformin (MET) ingestion (250 mg). After this period, the animals performed four high-intensity bouts until exhaustion at 9%, 11%, 13%, and 15% of body mass (BM) in swimming, separated by 24 h, with prior metformin (250 mg) or placebo (PL). The critical load (CL) and anaerobic work capacity (AWC - W') were calculated and considered aerobic and anaerobic capacity, respectively. There was no difference in CL between the MET and PL groups (p > 0.05). The AWC - W' was higher in the MET group than in the PL group (p = 0.004). Time until exhaustion (seconds) at all bouts were higher (p < 0.004) in the MET group (9% of BM = 434.5 ± 267.3, 11% of BM = 269.6 ± 214.2, 13% of BM = 174.0 ± 40.9, 15% of BM = 146.6 ± 15.9) compared to the PL group (9% of BM = 96.4 ± 22.3, 11% of BM = 65.5 ± 13.4, 13% of BM = 51.1 ± 5.5, 15% of BM = 40.8 ± 7.5). Glucose concentration was higher at 90 and 120 min than at 0 and 30 min for the MET group (intragroup) during the oral glucose test tolerance; there was no difference between the MET and PL groups for area under curve. MET ingestion enhances AWC - W' and times to exhaustion but not aerobic capacity.

Optimization of the Production Parameters of Composites from Sugarcane Bagasse and Iron Salts for Use in Dye Adsorption.

In this study, mechanical mixtures of sugarcane bagasse and iron salts (nitrate, acetate, or a mixture of both) were subjected to thermal decomposition for producing iron oxide and carbonaceous composite materials, which were evaluated as adsorbents for removing dyes from water using methylene blue (MB) as a model system. Aiming to optimize the conditions for obtaining composite adsorbents, the Box-Behnken design (BBD) was used to study the effects of mass sugarcane bagasse/mass iron salt, type of mixture of sugarcane bagasse/iron salt, and temperature on the response to be obtained (adsorption capacity, q e ) before the execution of the adsorption tests. The synthesized composites were characterized by X-ray diffraction (XRD) analysis, scanning electron microscopy (SEM), and Brunauer-Emmett-Teller (BET) surface area analysis. The relationship between the characteristics of different materials, based on the processing of statistical data and the results of the adsorption tests, helped determine the routes that led to formation of composites with the most suitable properties for the removal of MB dye. Different phases, such as magnetite (Fe3O4) and/or maghemite (γ-Fe2O3) and iron carbide (Fe3C), were formed. The composites that presented the highest q e values were SB/IN 1:1 (600°C) and SB/IN-IA 1:2 (400°C). The first, which contained iron carbide (Fe3C), according to the XRD results, also showed larger BET surface area than the other composites. These properties may have contributed to the higher MB adsorption efficiency of this material in aqueous medium. The sample SB/IN-IA 1:2 (400°C) had lower specific area and was composed of magnetite and/or maghemite phases. In this case, the high q e was probably associated with the surface properties promoted by combination with the carbonaceous material, favoring interactions with MB.

Effect of Carbohydrate Mouth Rinse on Training Load Volume in Resistance Exercises.

Bastos-Silva, VJ, Prestes, J, and Geraldes, AAR. Effect of carbohydrate mouth rinse on training load volume in resistance exercises. J Strength Cond Res 33(6): 1654-1658, 2019-The aim of this study was to investigate the effect of carbohydrate (CHO) mouth rinse on training load volume (TLV-number of repetitions × load lifted [kg]) on 2 resistance exercises: leg press (LP) and bench press (BP). Twelve recreational resistance trained males were recruited. Subjects were assessed for 1 repetition maximum (1RM) and muscular endurance (ME) in LP and BP. Muscular endurance was determined by the maximum number of repetitions performed to volitional fatigue, with a load equal to 80% of 1RM. Exercises were performed on separate days (72 hours apart) under 3 experimental conditions: control (CONT), CHO (25 ml with 6.4% of maltodextrin), and placebo (juice without CHO [PLA]). Carbohydrate and PLA were used immediately before each exercise. There was no significant difference between conditions for the number of repetitions (CHO = 13.5 ± 4.8; PLA = 11.5 ± 4.4; CONT = 12.4 ± 4.4, p = 0.68) nor TLV (CHO = 2006.7 ± 825.2 kg; PLA = 1712.5 ± 772.9 kg; CONT = 1817.1 ± 672.6 kg, p = 0.99) in LP. However, CHO increased both repetitions (CHO = 8.2 ± 1.6; PLA = 7.1 ± 2.4; CONT = 6.8 ± 1.8, p = 0.002) and TLV (CHO = 557.1 ± 155.4 kg; PLA = 495.9 ± 206.1 kg; CONT = 476.1 ± 175.3 kg, p = 0.035) compared with CON in BP. Thus, a CHO mouth rinse increases BP performance in trained men, suggesting an interesting strategy to be used by experienced resistance training practitioners.

Ingestion of a drink containing carbohydrate increases the number of bench press repetitions / A ingestão de uma bebida com carboidrato aumenta o número de repetições no exercício supino reto

ABSTRACT Objective The aim of this study was to analyze the effects of carbohydrate ingestion prior to exercise on the number of bench press repetitions. Methods Eight male physically active (21.3±2.7 years, 176±5cm, 73.12±6.12kg), with a minimum experience of at least one year exercising regularly, visited the laboratory at three moments. During the first visit, candidates went through their anthropometric evaluation and the application of their maximum number of bench press repetitions. The experimental tests were performed during their second and third visits in a crossover and blind study. The participants performed the maximum number of repetitions with an intensity of 70% of their maximum repetition strength. One hour before the experimental trials, participants randomly ingested a solution containing either carbohydrate or a placebo. Results The ingestion of carbohydrate increases muscle resistance in relation to placebo (p=0.014; effect size=0.71). This is evidenced by the increase in the number of repetitions (12.9±2.4 and 11.3±1.9, respectively). The individual's perception of effort is higher in the carbohydrate group than in the placebo group after exhaustion (4±0.93 and 3.1±0.64, respectively, p=0.006, effect size=0.89). Conclusion It is concluded that a previous intake of carbohydrate is useful in improving performance in resistance exercises, providing an increase in the individual's perception of effort.

RESUMO Objetivo O presente estudo teve como objetivo verificar os efeitos da ingestão prévia de carboidrato no número de repetições durante o exercício supino reto em indivíduos praticantes de musculação. Métodos Oito participantes fisicamente ativos do sexo masculino (21,3±2,7 anos, 176±5cm, 73,12±6,12kg) com experiência mínima de um ano em treinamento de força visitaram o laboratório em três momentos. Durante a primeira visita foi realizada uma avaliação antropométrica e aplicação do teste de uma repetição máxima no exercício supino reto. Os testes experimentais foram realizados nas visitas dois e três em um modelo cross over e cego onde os participantes executaram o número máximo de repetições com uma intensidade de 70% de uma repetição máxima. Uma hora antes dos testes experimentais, de forma randômica, os participantes ingeriram uma solução contendo carboidrato ou placebo. Resultados A ingestão de carboidrato foi capaz de aumentar a resistência muscular em relação ao placebo (p=0.014; effect size=0.71), fato evidenciado pelo aumento no número de repetições (12,9±2,4 e 11,3±1,9, respectivamente). A percepção subjetiva de esforço foi maior no grupo carboidrato em relação ao grupo placebo após a exaustão (4±0,93 e 3,1±0,64, respectivamente p=0.006, effect size=0.89). Conclusão Concluímos que a ingestão prévia de carboidrato é útil em melhorar o desempenho em exercícios de resistência com aumento associado da percepção subjetiva de esforço.

Carbohydrate mouth rinse reduces rating of perceived exertion but does not affect performance and energy systems contribution during a high-intensity exercise

Aim: The study aimed to verify the effect of carbohydrate (CHO) mouth rinse on time to exhaustion, energy systems contribution and rating of perceived exertion (RPE) during a high-intensity exercise. Methods Fourteen men performed an incremental exercise test to determine their maximal oxygen uptake and peak power output (PPO) and two time-to-exhaustion tests at 110% of PPO. Participants rinsed their mouth with 25ml of 6.4% of CHO or placebo (PLA) solution immediately before the time-to-exhaustion test, using a crossover design. The contribution of the energy systems was calculated using the free software GEDAE-LaB®. Results: Time to exhaustion was similar between the conditions (CHO:174.3±42.8s; PLA:166.7±26.3s; p=0.33). In addition, there was no difference between the CHO and PLA condition for aerobic (CHO:135.1±41.2kJ and PLA:129.8±35.3kJ, p=0.34), anaerobic lactic (CHO:57.6±17.1kJ and PLA:53.4±15.1kJ, p=0.10), and anaerobic alactic (CHO:10.4±8.4kJ and PLA:13.2±9.2kJ, p=0.37) contribution. Consequently, total energy expenditure was similar between conditions (CHO:203.2±46.4kJ and PLA:196.5±45.2kJ, p=0.15). However, CHO mouth rinse reduced the RPE at the moment of exhaustion (CHO:18.2±1.0units and PLA:19.1±1.1units; p=0.02). Conclusion: CHO mouth rinse neither increased time to exhaustion nor altered energy systems contribution during a high-intensity exercise, but reduced the perceived effort at the exhaustion.(AU)

Effects of carbohydrate intake on time to exhaustion and anaerobic contribution during supramaximal exercise / Efeito da ingestão de carboidrato sobre o tempo de exaustão e contribuição anaeróbia durante exercício supramáximo

ABSTRACT Objective: This study evaluated the effect of carbohydrate intake on time to exhaustion and anaerobic contribution during supramaximal exercise on a cycle ergometer. Methods: The sample comprised ten participants with a mean age of 23.9±2.5 years, mean body mass of 75.1±12.3 kg, mean height of 170.0±1.0 cm, and mean body fat of 11.3±5.2%. The participants underwent an incremental test to determine maximal oxygen uptake and maximum power output, and two supramaximal tests with a constant load of 110% of the maximum power output to exhaustion. Thirty minutes before the supramaximal tests the participants consumed carbohydrates (2 g.kg-1) or placebo. Results: The times to exhaustion of carbohydrate and placebo did not differ (carbohydrate: 170.7±44.6s; placebo: 156.1±26.7s, p=0.17; effect size=0.39). Similarly, the anaerobic contributions of the two treatments did not differ (carbohydrate: 3.0±0.9 L; placebo: 2.7±1.1 L, p=0.23; effect size=0.29). Conclusion: Carbohydrate intake was not capable of increasing time to exhaustion and anaerobic contribution in physically active men cycling at 110% of maximum power output.

RESUMO Objetivo: Este estudo foi conduzido com o intuito de verificar o efeito da ingestão de carboidrato sobre o tempo de exaustão e a contribuição anaeróbia durante o exercício supramáximo em uma bicicleta ergométrica. Métodos: Dez participantes fizeram parte da amostra (idade: 23,9±2,5 anos; massa corporal: 75,1±12,3 kg; estatura: 170,0±1,0 cm; gordura corporal: 11,3±5,2%). Todos realizaram um teste incremental para determinar o consumo máximo de oxigênio e a potência máxima e dois testes supramáximos com carga constante de 110% da potência máxima até a exaustão. Os participantes ingeriram carboidrato (2 g.kg-1) ou placebo 30 minutos antes dos testes supramáximos. Resultados: Não houve diferença significativa no tempo de exaustão entre carboidrato e placebo (carboidrato: 170,7±44,6s; placebo: 156,1±26,7s, p=0,17; effect size=0,39). De forma similar, não houve diferença significativa na contribuição anaeróbia entre as condições (carboidrato: 3,0±0,9 L; placebo: 2,7±1,1 L, p=0,23; effect size=0,29). Conclusão: A ingestão de carboidrato não foi capaz de aumentar o tempo até a exaustão e a contribuição anaeróbia em exercícios à 110% da potência máxima em homens fisicamente ativos.

Non-aneurysmal spontaneous subarachnoid hemorrhage: perimesencephalic versus non-perimesencephalic. / Hemorragia subaracnóidea espontânea não aneurismática: perimesencefálica versus não perimesencefálica.

OBJECTIVE: To compare the clinical evolution of perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage. METHODS: The study was conducted retrospectively in a tertiary hospital center in the north region of Portugal. Included patients had no identifiable cause for subarachnoid hemorrhage. Several epidemiologic, clinical and imaging aspects were statistically analyzed, taking into account the differences in perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage. RESULTS: Sixty-two patients met the inclusion criteria (46.8% - perimesencephalic subarachnoid hemorrhage; 53.2% - non-perimesencephalic subarachnoid hemorrhage). Demographic and clinical background characteristics were similar in both groups. Complications were more frequent in patients with non-perimesencephalic subarachnoid hemorrhage - 84.8% of the patients had at least one complication versus 48.3% in perimesencephalic subarachnoid hemorrhage. Vasospasm, infection and hydrocephaly were the most common complications (each was detected more frequently in the non-perimesencephalic subarachnoid hemorrhage group than in perimesencephalic subarachnoid hemorrhage group). Two patients died, both had a non-perimesencephalic subarachnoid hemorrhage. The median inpatient time was longer in the non-perimesencephalic subarachnoid hemorrhage group (21 versus 14 days). No incidents of rebleeding were reported during the follow-up period (mean time of 15 ± 10.3 months). CONCLUSION: Perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage are two different entities that have different clinical outcomes, namely in terms of complication rate and median inpatient time. The management of these patients should respect this difference to improve treatment and optimize health care resources.

Hemorragia subaracnóidea espontânea não aneurismática: perimesencefálica versus não perimesencefálica / Non-aneurysmal spontaneous subarachnoid hemorrhage: perimesencephalic versus non-perimesencephalic

RESUMO Objetivo: Comparar a evolução clínica da hemorragia subaracnóidea perimesencefálica com a da hemorragia subaracnóidea não perimesencefálica. Métodos: Estudo retrospectivo, que incluiu pacientes portadores de hemorragia subaracnóidea sem causa conhecida em um hospital terciário localizado na região norte de Portugal. Os dados epidemiológicos, clínicos e de imagem foram analisados estatisticamente, levando em conta a divisão dos pacientes em duas categorias: hemorragia subaracnóidea perimesencefálica e hemorragia subaracnóidea não perimesencefálica. Resultados: Cumpriram os critérios de inclusão 62 pacientes, 46,8% deles com hemorragia subaracnóidea perimesencefálica e 53,2% com hemorragia subaracnóidea não perimesencefálica. As caraterísticas demográficas, assim como os antecedentes clínicos, foram similares entre os grupos. As complicações foram observadas mais comumente no grupo com hemorragia subaracnóidea não perimesencefálica, sendo que 84,8% desses pacientes tiveram, no mínimo, uma complicação, comparados a 48,3% dos pacientes com hemorragia subaracnóidea perimesencefálica. Vasoespasmo, infecções e hidrocefalia foram as complicações mais comuns - todas observadas mais frequentemente nos pacientes com hemorragia subaracnóidea não perimesencefálica. Dois pacientes vieram a falecer, ambos com hemorragia subaracnóidea não perimesencefálica. A mediana do tempo de permanência no hospital foi maior nos pacientes com hemorragia subaracnóidea não perimesencefálica (21 dias, em comparação aos 14 dias observados nos pacientes com hemorragia subaracnóidea perimesencefálica). Não se observaram recidivas de sangramento durante o acompanhamento (tempo médio de 15 ± 10,3 meses). Conclusão: As hemorragias subaracnóideas perimesencefálica e não perimesencefálica tiveram formas diferentes de evolução clínica, principalmente no que se referiu à taxa de complicações e ao tempo mediano de permanência no hospital. Assim, a abordagem dessas duas formas de hemorragia subaracnóidea deve ser distinta, tanto em busca de melhorar o tratamento dos pacientes quanto para obter um melhor aproveitamento dos recursos de saúde.

ABSTRACT Objective: To compare the clinical evolution of perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage. Methods: The study was conducted retrospectively in a tertiary hospital center in the north region of Portugal. Included patients had no identifiable cause for subarachnoid hemorrhage. Several epidemiologic, clinical and imaging aspects were statistically analyzed, taking into account the differences in perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage. Results: Sixty-two patients met the inclusion criteria (46.8% - perimesencephalic subarachnoid hemorrhage; 53.2% - non-perimesencephalic subarachnoid hemorrhage). Demographic and clinical background characteristics were similar in both groups. Complications were more frequent in patients with non-perimesencephalic subarachnoid hemorrhage - 84.8% of the patients had at least one complication versus 48.3% in perimesencephalic subarachnoid hemorrhage. Vasospasm, infection and hydrocephaly were the most common complications (each was detected more frequently in the non-perimesencephalic subarachnoid hemorrhage group than in perimesencephalic subarachnoid hemorrhage group). Two patients died, both had a non-perimesencephalic subarachnoid hemorrhage. The median inpatient time was longer in the non-perimesencephalic subarachnoid hemorrhage group (21 versus 14 days). No incidents of rebleeding were reported during the follow-up period (mean time of 15 ± 10.3 months). Conclusion: Perimesencephalic subarachnoid hemorrhage and non-perimesencephalic subarachnoid hemorrhage are two different entities that have different clinical outcomes, namely in terms of complication rate and median inpatient time. The management of these patients should respect this difference to improve treatment and optimize health care resources.

Correlation between osteoporotic fracture risk in Brazilian postmenopausal women calculated using the FRAX with and without the inclusion of bone densitometry data.

UNLABELLED: The risks of fracture were calculated in 402 postmenopausal Brazilian women by FRAX with or without the inclusion of bone densitometry values. The correlation between the risk of major osteoporosis fracture or hip fracture calculated by FRAX with or without BMD was similar in this population, 0.76 and 0.64, respectively. OBJECTIVE: The objective of this study is to evaluate the degree of agreement between the 10-year fracture risk in postmenopausal Brazilian women, calculated using the WHO Fracture Risk Assessment Tool (FRAX)-Brazil, with and without the inclusion of bone mineral density (BMD) values. METHODS: A cross-sectional study was conducted with 402 postmenopausal women (≥40 years) who had undergone bone densitometry prior to initiating any pharmacological treatment for osteopenia or osteoporosis. The risks of a major osteoporosis fracture or hip fracture were calculated according to FRAX-Brazil either using clinical risk factors alone or with the inclusion of BMD value. The tests used were intraclass correlation coefficient, Mann-Whitney test, and univariate linear regression analysis. RESULTS: When the patients were classified according to the cutoff point defined as determining a high risk of a major osteoporosis fracture (≥20 %), 0.75 % were defined as high risk when BMD values were included and 1 % when they were not. With respect to the hip, 5.22 % were defined as having a high risk of fracture (≥3 %) when BMD values were included and 11.44 % when they were not. Intraclass correlation coefficient between the FRAX-Brazil assessed risk with and without the inclusion of BMD values was 0.76 (95 % CI 0.716-0.799) for a major osteoporosis fracture and 0.64 (95 %CI 0.583-0.698) for a hip fracture. CONCLUSION: The correlation found for the FRAX-Brazil score obtained with and without the inclusion of BMD values was good for the risk of a major osteoporosis fracture and moderate for the risk of a hip fracture. The fracture risk calculated was similar in this population irrespective of whether or not BMD values were included in the algorithm.

Carbohydrate Mouth Rinse Maintains Muscle Electromyographic Activity and Increases Time to Exhaustion during Moderate but not High-Intensity Cycling Exercise.

The aim was to investigate the influence of a carbohydrate (CHO) mouth rinse on the vastus lateralis (VL) and rectus femoris (RF) electromyographic activity (EMG) and time to exhaustion (TE) during moderate (MIE) and high-intensity cycling exercise (HIE). Thirteen participants cycled at 80% of their respiratory compensation point and at 110% of their peak power output to the point of exhaustion. Before the trials and every 15 min during MIE, participants rinsed with the CHO or Placebo (PLA) solutions. The root mean square was calculated. CHO had no effect on the TE during HIE (CHO: 177.3 ± 42.2 s; PLA: 163.0 ± 26.7 s, p = 0.10), but the TE was increased during MIE (CHO: 76.6 ± 19.7 min; PLA: 65.4 ± 15.2 min; p = 0.01). The EMG activity in the VL was higher than PLA at 30 min (CHO: 10.5% ± 2.6%; PLA: 7.7% ± 3.3%; p = 0.01) and before exhaustion (CHO: 10.3% ± 2.5%; PLA: 8.0% ± 2.9%; p = 0.01) with CHO rinsing. There was no CHO effect on the EMG activity of RF during MIE or for VL and RF during HIE. CHO mouth rinse maintains EMG activity and enhances performance for MIE but not for HIE.

Metformin improves performance in high-intensity exercise, but not anaerobic capacity in healthy male subjects.

The aim of this study was to determine the ergogenic effects of metformin in high-intensity exercise, as well as its effects on anaerobic capacity, in healthy and physically active men. Ten subjects (mean (± standard deviation) maximal oxygen uptake (V˙O2max ) 38.6 ± 4.5 mL/kg per min) performed the following tests in a cycle ergometer: (i) an incremental test; (ii) six submaximal constant workload tests at 40%-90% (V˙O2max ); and (iii) two supramaximal tests (110% (V˙O2max ). Metformin (500 mg) or placebo was ingested 60 min before the supramaximal test. There were no significant differences between the placebo and metformin groups in terms of maximum accumulated oxygen deficit (2.8 ± 0.6 vs 3.0 ± 0.8 L, respectively; P = 0.08), lactate concentrations (7.8 ± 2.6 vs 7.5 ± 3.0 mmol/L, respectively; P = 0.75) or O2 consumed in either the last 30 s of exercise (40.4 ± 4.4 vs 39.9 ± 4.0 mL/kg per min, respectively; P = 0.35) or the first 110 s of exercise (29.0 ± 2.5 vs 29.5 ± 3.0 mL/kg per min, respectively; P = 0.42). Time to exhaustion was significantly higher after metformin than placebo ingestion (191 ± 33 vs 167 ± 32 s, respectively; P = 0.001). The fast component of V˙O2 recovery was higher in the metformin than placebo group (12.71 vs 12.18 mL/kg per min, respectively; P = 0.025). Metformin improved performance and anaerobic alactic contribution during high-intensity exercise, but had no effect on overall anaerobic capacity in healthy subjects.

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil.

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.