Detection of hidden antibiotic resistance through real-time genomics.

Real-time genomics through nanopore sequencing holds the promise of fast antibiotic resistance prediction directly in the clinical setting. However, concerns about the accuracy of genomics-based resistance predictions persist, particularly when compared to traditional, clinically established diagnostic methods. Here, we leverage the case of a multi-drug resistant Klebsiella pneumoniae infection to demonstrate how real-time genomics can enhance the accuracy of antibiotic resistance profiling in complex infection scenarios. Our results show that unlike established diagnostics, nanopore sequencing data analysis can accurately detect low-abundance plasmid-mediated resistance, which often remains undetected by conventional methods. This capability has direct implications for clinical practice, where such "hidden" resistance profiles can critically influence treatment decisions. Consequently, the rapid, in situ application of real-time genomics holds significant promise for improving clinical decision-making and patient outcomes.

Effects of pelvic floor muscle training versus hypopressive abdominal gymnastics (HAG) on stress urinary incontinence in climacteric women: randomized clinical trial / Efectos del entrenamiento muscular del suelo pélvico versus la gimnasia abdominal hipopresiva (GAH) sobre la incontinencia urinaria de esfuerzo en mujeres climatéricas: ensayo clínico aleatorizado / Efeitos do treinamento muscular do assoalho pélvico versus Ginástica Abdominal Hipopressiva (GAH) na incontinência urinária de esforço de mulheres climatéricas: ensaio clínico randomizado

ABSTRACT Pelvic floor muscle training (PFMT) is recommended as first-line treatment for stress urinary incontinence (SUI) in women (scientific evidence level 1). Currently, hypopressive abdominal gymnastics (HAG) has been used in clinical practice without evidence for this purpose. To verify the superiority of an experimental treatment in relation to a positive control (gold standard) for the treatment of SUI and PFM function in climacteric women. A non-inferiority clinical trial was conducted with 31 climacteric women with SUI who were sexually active. They were allocated into two groups: 16 in the PFMT group and 15 in the HAG group. Both groups received 26 sessions twice per week and individual care. All participants were assessed twice, at the beginning and at the end of interventions. The primary outcome was assessed using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the secondary were given by PFM function assessed via bidigital palpation. The methods used to analyze the results were the two-way repeated measures analysis of variance (ANOVA), followed by the Tukey post-hoc test, when necessary. PFMT was better in improving SUI in the primary outcome (p=0.01). The groups showed no significant difference in force of contraction, time of sustained PFM, and fast and slow repetitions at the time of analysis. Regarding the symptoms of SUI, PFMT performed better than HAG.

RESUMEN El entrenamiento muscular del suelo pélvico (EMSP) se recomienda como tratamiento de primera línea para las pruebas de nivel 1 de incontinencia urinaria de esfuerzo (IUE). Actualmente, se utiliza la gimnasia abdominal hipopresiva (GAH) en la práctica clínica con este fin. Este estudio tuvo por objetivo comprobar la superioridad de un tratamiento experimental en comparación con el tratamiento de referencia para la IUE y la función del suelo pélvico en mujeres menopáusicas. Se realizó un ensayo clínico aleatorizado de no inferioridad con 31 mujeres climatéricas sexualmente activas y con IUE. Las participantes se distribuyeron en dos grupos: 16 se sometieron a EMSP y 15 a GAH. Ambos recibieron 26 sesiones, dos veces por semana, en sesiones individuales. Todas las voluntarias fueron evaluadas en dos momentos, al principio y al final de las intervenciones. El resultado primario se evaluó mediante el cuestionario ICIQ-SF, y el resultado secundario mediante la evaluación bidigital del suelo pélvico. Para el análisis estadístico se utilizó la prueba ANOVA de dos vías, seguida de la prueba posterior de Tukey cuando necesario. El EMSP tuvo un mejor resultado en la mejora de la IUE (p=0,01). No hubo diferencias entre los grupos en cuanto a la fuerza de contracción, el tiempo de mantenimiento y las repeticiones rápidas y lentas. En cuanto a la mejora de los síntomas de IUE, se concluyó que el EMSP es superior a la GAH.

RESUMO O treinamento dos músculos do assoalho pélvico (TMAP) é recomendado como primeira linha no tratamento do nível 1 de evidência da incontinência urinária de esforço (IUE). Atualmente, a Ginástica Abdominal Hipopressiva (GAH) tem sido utilizada na prática clínica com este propósito. Este estudo tem como objetivo verificar a superioridade de um tratamento experimental em relação ao tratamento padrão-ouro para IUE e função do assoalho pélvico em mulheres na menopausa. Foi conduzido um ensaio clínico randomizado de não inferioridade com 31 mulheres climatéricas, sexualmente ativas e com IUE. Elas foram alocadas em dois grupos, em que: 16 foram submetidas ao TMAP e 15 à GAH. Ambos receberam 26 sessões, duas vezes por semana, em atendimentos individuais. Todas as voluntárias foram avaliadas em dois momentos, no início e ao término das intervenções. O desfecho primário foi avaliado pelo Questionário (ICIQ-SF) e o secundário pela avaliação bidigital do assoalho pélvico. Para a análise estatística, foram utilizados o teste ANOVA de duas vias, seguido do pós-teste de Tukey, quando necessário. O TMAP foi superior na melhora da IUE (p=0.01). Não houve diferença entre os grupos em relação a força de contração, tempo de sustentação, repetições rápidas e lentas. Em relação à melhora dos sintomas de IUE, concluiu-se que o TMAP é superior a GAH.

Pilates vs aerobic training effects in hypertensives: randomized trial / Efectos del pilates vs entrenamiento aeróbico en hipertensos: ensayo aleatorizado / Efeitos do pilates vs treinamento aeróbio em hipertensos: ensaio randomizado

ABSTRACT Introduction: The Pilates method (PM) combines slow-deep breathing with strengthening and stretching exercises. However, it has been proposed as a method of physical conditioning for several decades and only recently aroused academic/scientific interest, with few reports of the effects of this intervention in hypertensive patients. Objective: to compare PM to aerobic training (AT) effects on hypertensive subjects' blood pressure (BP), functional capacity and autonomic balance. Methods: Twenty-four hypertensive subjects were randomly allocated into two groups: ATG performed three 40 min sessions/week, moderate intensity (40-70% of reserve HR), and PMG performed two 60 min sessions/week; both during the same eight weeks period. Blood pressure (casual and for 24 hours), 6-minute walking test (6-MWT) and autonomic balance were evaluated before and after intervention. Results: There was a reduction on systolic BP (SBP, p=0.007), diastolic (p=0.032) and mean blood pressure (MBP, p=0.016), measured on 24h, on PMG. There was also a 24h SBP reduction on ATG (p=0.021). The PMG had a greater reduction on 24h SBP (-3.4 mmHg, 95% CI -6.6 to -0.2) and MBP (-3.3 mmHg, 95% CI -6.3 to -0.3) than the ATG. ATG held a longer distance in 6-MWT. Casual BP and autonomic balance had no difference. Conclusion: This PM protocol was superior to AT on BP monitored for 24 hours in hypertensive subjects, but AT was better for functional capacity. The eight weeks of training were not enough to change the autonomic balance. Level of Evidence: I; High-quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals.

RESUMEN Introducción: el método Pilates (MP) combina la respiración lenta-profunda con ejercicios de fortalecimiento y estiramiento. Aunque se ha propuesto como un método de acondicionamiento físico durante varias décadas, solo recientemente despertó interés académico/científico, con pocos reportes de los efectos de esta intervención en pacientes hipertensos. Objetivo: comparar los efectos del MP con el entrenamiento aeróbico (EA) sobre la presión arterial (PA), la capacidad funcional y el equilibrio autónomo en sujetos hipertensos. Métodos: Veinticuatro sujetos hipertensos fueron asignados aleatoriamente en dos grupos: GEA realizó tres sesiones de 40 min/semana, intensidad moderada (40-70% de la FC de reserva), y GMP realizó dos sesiones de 60 min/semana; ambos durante el mismo período de 8 semanas. La presión arterial (casual y durante 24 horas), la prueba de marcha de 6 minutos y el equilibrio autonómico se evaluaron antes y después de la intervención. Resultados: Hubo una reducción de la PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) y presión arterial media (PAM, p = 0,016), medida a las 24 h, en GMP. También hubo una reducción de PAS en 24 h en GEA (p = 0,021). El GMP tuvo una mayor reducción en la PAS de 24 h (-3,4 mmHg, CI del 95%: -6,6 a -0,2) y la PAM (-3,3 mmHg, CI del 95%: -6,3 a -0,3) que la GEA. GEA mantuvo una mayor distancia en la prueba de marcha de 6 minutos. La PA casual y el equilibrio autónomo no tuvieron diferencias. Conclusión: Este protocolo de MP fue superior al EA en la PA monitoreada durante 24 horas en sujetos hipertensos, pero el EA fue mejor para la capacidad funcional. Las ocho semanas de entrenamiento no fueron suficientes para cambiar el equilibrio autonómico. Nivel de Evidencia: I; Estudio clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

RESUMO Introdução: O método Pilates (MP) combina respiração lenta e profunda com exercícios de fortalecimento e alongamento. Embora tenha sido proposto como método de condicionamento físico por várias décadas, só recentemente despertou-se o interesse acadêmico/científico, com poucos relatos dos efeitos dessa intervenção em hipertensos. Objetivos: comparar os efeitos do MP com o treinamento aeróbio (TA) sobre a pressão arterial (PA), capacidade funcional e equilíbrio autonômico em hipertensos. Métodos: Vinte e quatro hipertensos foram alocados aleatoriamente em dois grupos: O grupo GTA realizou três sessões de 40 min/semana, intensidade moderada (40-70% da FC de reserva), e o grupo GMP, que realizou duas sessões de 60 min/semana; ambos durante o mesmo período de 8 semanas. A pressão arterial (casual e após 24 horas), o teste de caminhada de 6 minutos (TC6) e o equilíbrio autonômico foram avaliados antes e depois da intervenção. Resultados: Houve redução da PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) e da pressão arterial média (PAM, p = 0,016), medida em 24h, sem GMP. Também houve redução da PAS em 24h no GTA (p = 0,021). O GMP teve uma redução maior em 24h PAS (-3,4 mmHg, IC 95% -6,6 a -0,2) e PAM (-3,3 mmHg, IC 95% -6,3 a -0,3) do que o GTA. O GTA manteve uma maior distância no TC6. A PA casual e o equilíbrio autonômico não apresentaram diferenças estatísticas. Conclusão: Este protocolo de MP foi superior ao TA na PA monitorada por 24 horas em hipertensos, porém o TA foi superior para a capacidade funcional. As oito semanas de treinamento não foram suficientes para alterar o equilíbrio autonômico. Nível de Evidência: 1; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significativa, mas com intervalos de confiança estreitos.

Effects of the combination of vitamins C and E supplementation on oxidative stress, inflammation, muscle soreness, and muscle strength following acute physical exercise: meta-analyses of randomized controlled trials.

Background:The combined supplementation of vitamins C and E potentially can mitigate oxidative stress (OS) and accelerate recovery following exercise. However, there is little evidence and a lack of consensus on the effects of these vitamins for this purpose. The objective of this systematic review was to summarize the evidence on the effects of the combined supplementation of vitamins C and E in OS, inflammatory markers, muscle damage, muscle soreness, and musculoskeletal functionality following acute exercise. Methods: The search was carried out from inception until March 2021, on MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and SPORT Discus. We included placebo-controlled randomized clinical trials (RCTs) that evaluated the effects of combined supplementation of vitamins C and E in OS, inflammatory markers, muscle damage, muscle soreness, and muscle strength following a single bout of exercise. Random-effect meta-analyses were used to compare pre to post-exercise mean changes in subjects who received supplementation with vitamins C and E or placebo versus controls. Data are presented as standard mean difference (SMD) and 95% confidence interval (95% CI). Results: Eighteen RCTs, accounting for data from 322 individuals, were included. The use of vitamins attenuated lipid peroxidation (SMD= -0.703; 95% CI= -1.035 to -0.372; p < 0.001), IL-6 (SMD= -0.576; 95%CI= -1.036 to -0.117; p = 0.014), and cortisol levels (SMD= -0.918; 95%CI= -1.475 to -0.361; p = 0.001) immediately, and creatine kinase levels 48 h following exercise (SMD= -0.991; 95%CI= -1.611 to -0.372; p = 0.002). Supplementing the combination of vitamins had no effects on protein carbonyls, reduced/oxidized glutathione ratio, catalase, interleukin-1Ra, C-reactive protein, lactate dehydrogenase, muscle soreness, and muscle strength. Conclusion: Prior supplementation of the combination of vitamins C and E attenuates OS (lipid peroxidation), the inflammatory response (interleukin-6), cortisol levels, and muscle damage (creatine kinase) following a session of exercise.

Idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma

Abstract Objective: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. Methods: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. Results: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929-6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039-0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2 = 0.206). Conclusion: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.

Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study.

OBJECTIVE: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. METHODS: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. RESULTS: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). CONCLUSIONS: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

Efeitos da corrente interferencial no sistema nervoso autônomo em voluntários saudáveis: ensaio clínico randomizado / Effects of interferential current on autonomic nervous system in healthy volunteers: randomized clinical trial

Avaliar os efeitos de diferentes frequências moduladas em amplitude (AMF-100Hz e AMF-10Hz) da corrente interferencial (CI) sobre o sistema nervoso autônomo (SNA) de voluntários saudáveis. Trinta voluntários saudáveis (23,7±2,7 anos) foram randomizados em intervenções placebo (desligado), CI com AMF-100Hz e CI com AMF-10Hz. As intervenções foram aplicadas na região ganglionar paravertebral por 30 minutos. O SNA foi avaliado pela variabilidade da frequência cardíaca antes e imediatamente após as intervenções. A intervenção em 10Hz reduziu a atividade simpática em 6% e aumentou a parassimpática em 6%. A intervenção de 100Hz aumentou 12% para a atividade simpática e diminuiu 12% para a atividade parassimpática. A CI altera o equilíbrio autonômico em voluntários saudáveis. 10Hz reduz a atividade simpática e aumenta parassimpático, embora o 100Hz tenha resultados opostos. A CI a 10Hz melhora o equilíbrio autonômico e apresenta efeitos potenciais a serem testados em pacientes hipertensos.

To evaluate the effects of different amplitude-modulated frequency (AMF-100Hz and AMF-10Hz) of the interferential current (IC) on autonomic nervous system (ANS) in healthy volunteers. Thirty healthy volunteers (23.7 ±2.7 years old) were randomized into placebo interventions (turned off), IC with AMF-100Hz and IC with AMF-10Hz. Interventions ware applied in the paravertebral ganglionar region for 30 minutes. ANS evaluated by the heart rate variability before and immediately after the interventions. 10Hz intervention reduced the sympathetic activity in 6% and an increase in the parasympathetic in 6%. 100Hz intervention increased 12% to sympathetic activity and decreased 12% to parasympathetic activity. IC changes the autonomic balance in healthy volunteers. 10Hz reduces the sympathetic activity and increases parasympathetic, although the 100Hz has opposite results. The IC at 10Hz improves the autonomic balance and presents potential effects to be tested in hypertensive patients.

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial.

OBJECTIVE: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. METHODS: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. RESULTS: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. CONCLUSIONS: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

Bilevel positive airway pressure improves the autonomic balance in the postoperative period following cardiac surgery: a randomized trial / Pressão positiva de duplo nível em via aérea melhora o balanço autonômico no pós-operatório de cirurgia cardíaca: ensaio randomizado / La presión positiva de doble nivel en las vías respiratorias mejora el equilibrio autonómico posoperatorio de cirugía cardíaca: un ensayo aleatorizado

ABSTRACT The use of bilevel positive airway pressure (BiPAP) has repercussions on cardiorespiratory outcomes. However, the literature still lacks analyses of the postoperative influence of BiPAP on the modulation of the autonomic nervous system after cardiac surgery. This study aimed to evaluate the effects of BiPAP on peripheral oxygen saturation, vital signs, and autonomic balance during hospitalization after cardiac surgery. This randomized controlled trial evaluated 36 patients before and after surgery. The BiPAP group was treated in two 20-minute daily sessions of routine physical therapy since 18 hours after surgery until discharge. The control group received routine physical therapy during the same period. Our primary outcome was peripheral oxygen saturation. Secondary outcomes were vital signs and autonomic balance evaluated by heart rate variability. We observed that peripheral oxygen saturation and blood pressure were unaffected at hospital discharge. Both groups showed a similar increase in heart and respiratory rates. The BiPAP group showed a reduction of the low sympathetic frequency component in −27.1 n.u. (95% CI: −39 to −15.2), increase of high parasympathetic frequency in 27.1 n.u. (95% CI: 15.2 to 39), and an improvement to the LF/HF ratio in −2.5 (95% CI: −3.8 to −1.2), when compared to the control group. BiPAP attenuated sympathetic activity and improved vagal modulation and autonomic balance at hospital discharge. These findings evidence that BiPAP enables more efficient autonomic mechanisms during hospitalization after cardiac surgery.

RESUMO O uso da pressão positiva de duplo nível nas vias aéreas (BiPAP) tem repercussões sobre desfechos cardiorrespiratórios. No entanto a influência da BiPAP na modulação do sistema nervoso autônomo no pós-operatório de cirurgia cardíaca ainda não foi explorada. O objetivo do estudo foi avaliar os efeitos da BiPAP na saturação periférica de oxigênio, sinais vitais e balanço autonômico no período de hospitalização após cirurgia cardíaca. Este ensaio controlado e randomizado avaliou 36 pacientes no pré-operatório e na alta hospitalar. O grupo BiPAP recebeu tratamento 18 horas após a cirurgia até a alta hospitalar, em duas sessões diárias de 20 minutos associado à fisioterapia de rotina. O grupo controle recebeu apenas a fisioterapia de rotina durante o mesmo período. O desfecho primário foi a saturação periférica de oxigênio, enquanto os desfechos secundários foram sinais vitais e equilíbrio autonômico avaliado pela variabilidade da frequência cardíaca (alta frequência - HF, baixa frequência - LF, relação LF/HF). Observou-se que a saturação periférica de oxigênio e a pressão arterial não se alteraram na alta hospitalar. Houve um aumento similar na frequência cardíaca e na frequência respiratória em ambos os grupos. O grupo BiPAP teve uma redução do componente LF (simpático) em −27,1 n.u. (IC 95% −39 a −15,2), aumento de HF (parassimpático) em 27,1 n.u. (IC 95% 15,2 a 39) e melhora na relação LF/HF em −2,5 (IC 95% −3,8 a −1,2) em comparação ao grupo controle. A BiPAP atenuou a atividade simpática, melhorou a modulação vagal e o equilíbrio autonômico na alta hospitalar. Esses achados evidenciam que a BiPAP possibilita mecanismos autonômicos mais eficientes durante a hospitalização após a cirurgia cardíaca.

RESUMEN El uso de la presión positiva de doble nivel en las vías respiratorias (BiPAP) tiene impacto en los resultados cardiorrespiratorios. Pero todavía no se sabe la influencia de la BiPAP en la modulación del sistema nervioso autónomo en el posoperatorio de cirugía cardíaca. El objetivo de este estudio fue evaluar los efectos de la BiPAP sobre la saturación periférica de oxígeno, los signos vitales y el equilibrio autonómico en el periodo de hospitalización después de la cirugía cardíaca. Este ensayo controlado aleatorizado evaluó a 36 pacientes antes de la operación y al alta hospitalaria. El grupo BiPAP recibió tratamiento 18 horas después de la cirugía hasta el alta hospitalaria, en dos sesiones diarias de 20 minutos cada, asociado a la fisioterapia habitual. El grupo de control recibió solo fisioterapia habitual durante el mismo periodo. El resultado primario fue la saturación periférica de oxígeno, mientras que los resultados secundarios fueron los signos vitales y el equilibrio autonómico evaluados por la variabilidad de la frecuencia cardíaca (frecuencia alta - HF, frecuencia baja - LF, relación LF/HF). Se observó que la saturación periférica de oxígeno y la presión arterial no presentaron cambios al alta hospitalaria. Hubo un aumento similar en la frecuencia cardíaca y la frecuencia respiratoria en ambos grupos. El grupo BiPAP tuvo una reducción del componente LF (simpático) en −27,1 n.u. (IC 95% −39 a −15,2), incremento de HF (parasimpático) en 27,1 n.u. (IC 95% 15,2 a 39) y mejora en la relación LF/HF en −2,5 (IC 95% −3,8 a −1,2) en comparación con el grupo de control. La BiPAP redujo la actividad simpática y mejoró la modulación vagal y el equilibrio autonómico al alta hospitalaria. Estos hallazgos muestran que la BiPAP permite mecanismos autonómicos más eficientes durante la hospitalización después de una cirugía cardíaca.

Idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma.

OBJECTIVE: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. METHODS: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. RESULTS: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929-6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039-0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R2 = 0.206). CONCLUSIONS: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.

Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study / Impacto da pronação em pacientes com COVID-19 e SDRA em ventilação mecânica invasiva: estudo de coorte multicêntrico

ABSTRACT Objective: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. Methods: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. Results: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). Conclusions: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

RESUMO Objetivo: Identificar fatores que levam a uma resposta positiva da oxigenação e fatores preditivos de mortalidade após a pronação. Métodos: Estudo de coorte retrospectivo multicêntrico envolvendo sete hospitais brasileiros. Os critérios de inclusão foram idade > 18 anos com diagnóstico suspeito ou confirmado de COVID-19, ventilação mecânica invasiva, relação PaO2/FIO2 < 150 mmHg e pronação. Após a primeira sessão de pronação, uma melhora de 20 mmHg na relação PaO2/FIO2 foi definida como resposta positiva. Resultados: O estudo envolveu 574 pacientes, dos quais 412 (72%) apresentaram resposta positiva à primeira sessão de pronação. A regressão logística múltipla mostrou que os respondedores apresentaram menores pontuações no Simplified Acute Physiology Score III (SAPS III) e no SOFA e menores níveis de dímero D (p = 0,01; p = 0,04; e p = 0,04, respectivamente). Sugeriu-se que a pontuação no SAPS III e a PaO2/FIO2 iniciais seriam preditores da resposta da oxigenação. A taxa de mortalidade foi de 69,3%. Maior risco de mortalidade foi associado à idade (OR = 1,04 [IC95%: 1,01-1,06]), tempo até a primeira sessão de pronação (OR = 1,18 [IC95%: 1,06-1,31]), número de sessões (OR = 1,31 [IC95%: 1,00-1,72]), porcentagem de comprometimento pulmonar (OR = 1,55 [IC95%: 1,02-2,35]) e imunossupressão (OR = 3,83 [IC95%: 1,35-10,86]). Conclusões: Nossos resultados mostram que a maioria dos pacientes de nossa amostra apresentou resposta positiva da oxigenação após a primeira sessão de pronação. No entanto, a taxa de mortalidade foi elevada, provavelmente em virtude do estado de saúde e número de comorbidades dos pacientes e da gravidade de sua doença. Nossos resultados também sugerem que a pontuação no SAPS III e a PaO2/FIO2 inicial predizem a resposta da oxigenação; além disso, idade, tempo até a primeira sessão de pronação, número de sessões, comprometimento pulmonar e imunossupressão podem predizer mortalidade.

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial / Efeitos da técnica de breath stacking após cirurgia abdominal alta: ensaio clínico randomizado

ABSTRACT Objective: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety. Methods: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions. Results: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed. Conclusions: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

RESUMO Objetivo: Avaliar o efeito da técnica de breath stacking (BS) associada à fisioterapia de rotina na função pulmonar, volumes pulmonares, pressões respiratórias máximas, sinais vitais, oxigenação periférica, mobilidade toracoabdominal e dor na incisão cirúrgica em pacientes no pós-operatório de cirurgia abdominal alta, bem como analisar a segurança do BS. Métodos: Trata-se de um ensaio clínico randomizado com 34 pacientes divididos em grupo controle (n = 16), que realizou apenas a fisioterapia convencional, e grupo BS (n = 18), que realizou a fisioterapia convencional e BS. Ambos os grupos realizaram duas sessões diárias desde o 2º dia do pós-operatório até a alta hospitalar. Os desfechos primários foram CVF e Vt. A segurança do BS foi avaliada pela incidência de repercussões gastrointestinais, hemodinâmicas e respiratórias. Resultados: Embora a CVF tenha aumentado significativamente no momento da alta hospitalar em ambos os grupos, o efeito foi maior no grupo BS. Aumentos significativos do VEF1, VEF1/CVF, PFE e FEF25-75% ocorreram apenas no grupo BS. Também houve aumentos significativos do Ve e do Vt no grupo BS, mas não em comparação com os valores do grupo controle no momento da alta. A PImáx e a PEmáx aumentaram significativamente em ambos os grupos, com efeito maior no grupo BS. Houve uma diminuição significativa da FR e um aumento significativo da SpO2 apenas no grupo BS. A SpO2 aumentou agudamente após o BS; entretanto, não foram observadas alterações no grau de dispneia, sinais vitais e sinais de desconforto respiratório, e não foram observadas repercussões gastrointestinais e hemodinâmicas. Conclusões: O BS mostrou-se seguro e eficaz na recuperação da função pulmonar; melhoria dos volumes pulmonares, pressões respiratórias máximas e oxigenação periférica; e redução do trabalho respiratório no pós-operatório de cirurgia abdominal alta.

Quality by design enabled the development of stable and effective oil-in-water emulsions at compounding pharmacy: the case of a sunscreen formulation.

It is widely accepted that the use of topical sunscreens has medical importance with potential to prevent skin damage by protecting from solar ultraviolet radiation (UVR) effects. Pharmaceutical emulsions require an optimal qualitative and quantitative combination of emollients, emulsifiers and others compounds such as softening agents and, for sunscreens, a combination of chemical and physical UV filters. Herein, we applied the quality by design (QbD) concept to achieve stable and effective compounded sunscreen emulsions. By using the statistical tool of design of experiments, it was possible to identify the influence of emulsifier type (with low and high Hydrophile-Lipophile Balance) and concentrations of emollient and softening agent on the achievement of formulations with suitable organoleptic and physicochemical features. Compounded emulsions with pleasant macroscopic aspects were obtained. Three formulations with physicochemical properties in targeted ranges were selected, namely pH ∼6.0, conductivity > 0.0 µS/cm2, spreadability factor ∼1-1.5 g/mm2, viscosity ∼12000 mPa.s and sunscreen protection factor ∼30. Freeze-thaw cycle and accelerated stability study under different storage conditions allowed selecting a stable emulsion that ensured photoprotection in biological assays. The QbD approach was essential to select the best, low-cost compounded sunscreen emulsion, with targeted physicochemical parameters.

Obesity enhances the recruitment of mesenchymal stem cells to visceral adipose tissue.

In obesity, high levels of TNF-α in the bone marrow microenvironment induce the bone marrow-mesenchymal stem cells (BM-MSCs) towards a pro-adipogenic phenotype. Here, we investigated the effect of obesity on the migratory potential of BM-MSCs and their fate towards the adipose tissues. BM-MSCs were isolated from male C57Bl/06 mice with high-fat diet-induced obesity. The migratory potential of the BM-MSCs, their presence in the subcutaneous (SAT) and the visceral adipose tissues (VAT), and the possible mechanisms involved were investigated. Obesity did not affect MSC content in the bone marrow but increased the frequency of MSCs in blood, SAT, and VAT. In these animals, the SAT adipocytes presented a larger area, without any changes in adipokine production or the Sdf-1α gene expression. In contrast, in VAT, obesity increased leptin and IL-10 levels but did not modify the size of the adipocytes. The BM-MSCs from obese animals presented increased spontaneous migratory activity. Despite the augmented expression of Cxcr4, these cells exhibited decreased migratory response towards SDF-1α, compared to that of BM-MSCs from lean mice. The PI3K-AKT pathway activation seems to mediate the migration of BM-MSCs from lean mice, but not from obese mice. Additionally, we observed an increase in the spontaneous migration of BM-MSCs from lean mice when they were co-cultured with BM-HCs from obese animals, suggesting a paracrine effect. We concluded that obesity increased the migratory potential of the BM-MSCs and induced their accumulation in VAT, which may represent an adaptive mechanism in response to chronic nutrient overload.

Contemplar: a trajetória de um coletivo no fomento da pesquisa, extensão e cidadania para o lazer / Contemplar: the trajectory of a collective in promoting research, extension and citizenship for leisure / Contemplar: la trayectoria de un colectivo en la promoción de la investigación, la extensión y la ciudadanía para el ocio

O artigo apresenta uma breve descrição da trajetória do Grupo de Pesquisa Coletivo Nordestino de Atenção ao Tempo Livre e Lazer ­ CONTEMPLAR, sediado na Universidade Federal do Delta do Parnaíba, no município de Parnaíba, Piauí/Brasil. A partir da análise documental e descritiva foi realizado um relato histórico e elencadas as perspectivas teóricas que embasam as linhas de pesquisa do grupo de pesquisa. Em 2018, a partir da institucionalização formal, o coletivo definiu quatro linhas para o desenvolvimento da pesquisa, extensão e divulgação científica, quais sejam: "Ócio, Bem estar e Desenvolvimento Humano", "Inovação, Criatividade e Tecnologias de Entretenimento e Lazer", "Políticas públicas e movimentos sociais em lazer" e "Territórios, espaços e lugares de lazer". Apesar da independência estratégica de cada linha, as premissas do ócio humanista, do desenvolvimento humano e da teoria das necessidades correspondem ao pano de fundo que estrutura a base conceitual dos estudos.

This article presents a brief description of the trajectory of Grupo de Pesquisa Coletivo Nordestino de Atenção ao Tempo Livre e Lazer - CONTEMPLAR, hosted at the Universidade Federal do Delta do Parnaíba, at the county of Parnaíba, Piauí/Brasil. From the descriptive and documental analysis, an historic report was made and the theoretical perspectives were listed, which base the research lines from the research group. In 2018, from the formal institutionalization, the collective defined four lines for the development of the scientific research, extension and promotion, which are: "Leisure, Well-being and Human Development", "Innovation, Creativity, Leisure and Entertainment Technologies", "Public policies and leisure social movements" and "Territories, Spaces and places of leisure". Although the strategic independence of each line, the premises of humanistic leisure, human development and theory of necessity all correspond to the background that structures the conceptual base of the studies.

El artículo presenta una breve descripción de la trayectoria del Grupo de Pesquisa Coletivo Nordestino de Atenção ao Tempo Livre e Lazer ­ CONTEMPLAR, con sede en la Universidade Federal do Delta do Parnaíba, en el municipio de Parnaíba, Piauí/Brasil. A partir del análisis documental y descriptivo, se realizó un relato histórico y se enumeraron las perspectivas teóricas que sustentan las líneas de investigación del grupo de investigación. En 2018, a partir de la institucionalización formal, el colectivo definió cuatro líneas para el desarrollo de la investigación, extensión y divulgación científica, a saber: "Políticas Públicas y Movimientos Sociales en el Ocio", "Ocio, Bienestar y Desarrollo Humano", "Innovación, Creatividad y Tecnologías de Entretenimiento y Ocio" y "Territorios, Espacios y Lugares de Ocio". A pesar de la independencia estratégica de cada línea, las premisas del ocio humanista, el desarrollo humano y la teoría de las necesidades corresponden al trasfondo que estructura la base conceptual de los estudios.

Salivary Microbial Dysbiosis Is Associated With Peri-Implantitis: A Case-Control Study in a Brazilian Population.

Background and Objectives: The aim of this study was to examine the salivary microbiome in healthy peri-implant sites and those with peri-implantitis. Methods: Saliva samples were collected from 21 participants with healthy peri-implant sites and 21 participants with peri-implantitis. The V4 hypervariable region of the 16S rRNA gene was sequenced using the Ion Torrent PGM System (Ion 318™ Chip v2 400). The NGS analysis and composition of the salivary microbiome were determined by taxonomy assignment. Downstream bioinformatic analyses were performed in QIIME (v 1.9.1). Results: Clinical differences according to peri-implant condition status were found. Alpha diversity metrics revealed that the bacterial communities of participants with healthy peri-implant sites tended to have a richer microbial composition than individuals with peri-implantitis. In terms of beta diversity, bleeding on probing (BoP) may influence the microbial diversity. However, no clear partitioning was noted between the salivary microbiome of volunteers with healthy peri-implant sites or volunteers with peri-implantitis. The highest relative abundance of Stenotrophomonas, Enterococcus and Leuconostoc genus, and Faecalibacterium prausnitzii, Haemophilus parainfluenzae, Prevotella copri, Bacteroides vulgatus, and Bacteroides stercoris bacterial species was found in participants with peri-implantitis when compared with those with healthy peri-implant sites. Conclusion: Differences in salivary microbiome composition were observed between patients with healthy peri-implant sites and those with peri-implantitis. BoP could affect the diversity (beta diversity) of the salivary microbiome.

Impactos do racismo na saúde mental da população negra: revisão integrativa de literatura / Impacts of racism on the mental health of the black population: an integrative literature review

Historicamente a população negra tem ocupado os estratos mais pobres da sociedade brasileira, apresentando dificuldades no acesso a bens materiais, educação e moradia. Além disso, sabe-se que indivíduos afrodescendentes apresentam escores reduzidos de qualidade de vida e bem estar psicológico se comparados aos apresentados pela população branca. Acredita-se que este cenário seja resultante dos atravessamentos do racismo, que se apresenta como um limitador para o desenvolvimento social destes sujeitos e como determinante psicossocial para o processo de adoecimento desta população. Diante disso, o presente estudo apresenta como questão norteadora: "Qual é o impacto do racismo na saúde mental da população negra?". Objetivo: Analisar a produção científica dos últimos dez anos sobre saúde mental da população negra e racismo. Metodologia: Revisão integrativa de literatura. Resultados: Os resultados obtidos demonstraram que o racismo impacta nos processos de subjetivação e formação de identidade da população negra, gerando sentimentos de inferioridade, inadequação e baixa autoestima nesses indivíduos. Além disso, identificou-se que profissionais da saúde mental mostram-se despreparados para o atendimento desta demanda, e que a produção científica relacionada a esta temática é escassa. (AU)

Quantitative and qualitative assessment of body balance in active elderly women and their relation to health in general. / Avaliação quantitativa e qualitativa do equilíbrio corporal em idosas ativas e sua relação com a saúde no geral.

PURPOSE: to analyze the postural balance of independent elderly women and their relation with aspects of health, ages and quality of life. METHODS: a total of 44 independent elderly women, classified according to the scales: Index of Independence in Daily Life Activities (DLA) and Instrumental Activities of Daily Life (IADL), aged 70.5 years (+6.64), submitted to the Foam-Laser Dynamic Posturography were used to evaluate the vestibular, proprioceptive and visual functions; the Dizziness Handicap Inventory (DHI) questionnaire on subjects with dizziness and the WHOQOL-Bref quality of life questionnaire. RESULTS: the tests showed a significant difference between the changes in the posturographic evaluation and health aspects such as dizziness complaint (p = 0.02), metabolic diseases (p = 0.04), cardiovascular diseases (p = 0.02) and with the use of continuous medication (p = 0.03), self-reported. The older women presented lower scores in the functional domain of the DHI (p=0.02), showing a lower handicap in activities of daily living and the longer the quality of life in the WHOQOL-Bref psychological domain (p=0.04). CONCLUSION: the presence of dizziness and systemic diseases had a negative impact on postural balance and on the quality of life of the elderly women.

OBJETIVO: analisar o equilíbrio postural de idosas independentes e sua relação com aspectos de saúde, faixa etária e qualidade de vida. MÉTODOS: foram selecionadas 44 idosas independentes classificadas de acordo com as escalas: Index de Independência nas Atividades de Vida Diária (AVD) e das Atividades Instrumentais de Vida Diária (AIVD), com média de idade de 70,5 anos (+6,64), submetidas à anamnese, Posturografia Dinâmica Foam Laser, por meio do teste da organização sensorial (TOS) e analise sensorial, utilizada para avaliar as funções vestibular, proprioceptiva e visual; ao questionário Dizziness Handicap Inventory (DHI) nos sujeitos com queixa de tontura e o questionário de qualidade de vida WHOQOL-Bref. RESULTADOS: os testes apontaram diferença significativa entre as alterações na avaliação posturográfica e aspectos de saúde como queixa de tontura (p = 0,02), doenças metabólicas (p = 0,04), cardiovasculares (p = 0,02), dores na coluna (p = 0,02) e com o uso de medicação contínua (p = 0,03), autorrelatadas. As idosas mais velhas apresentaram pontuação inferior no domínio funcional do DHI (p = 0,02), demonstrando menor restrição de participação nas atividades de vida diária e, quanto maior a idade, melhor a qualidade de vida no domínio psicológico do WHOQOL-Bref (p = 0,04). CONCLUSÃO: a presença da tontura e das doenças sistêmicas impactou negativamente no equilíbrio postural e na qualidade de vida das idosas avaliadas.

Obese adipose tissue extracellular vesicles raise breast cancer cell malignancy.

Obesity is a chronic low-grade inflammatory condition that strongly impacts breast cancer. Aside from inflammatory mediators, obese adipose tissue (AT) secretes high amounts of extracellular vesicles (EVs), which are capable of transferring molecules to target cells and promoting cell-to-cell communication. Here, we investigated how soluble mediators and EVs secreted by human obese AT influence MCF-7 and MDA-MB-231 mammary adenocarcinoma cell lines by modulating cell proliferation, migration, invasion, and signaling pathways. Both cell lineages were stimulated with conditioned media (CM) or EVs obtained from cultures of AT explants collected from lean or obese individuals who underwent plastic or bariatric surgeries, respectively. EVs derived from obese AT increased the proliferative potential of both cell lines and further potentiated the migratory and invasive properties of MDA-MB-231 cells. The proliferative effects of CM and EVs on MCF-7 cells were dependent on ERK/MAPK pathway activation, while the migration and invasiveness of MDA-MB-231 cells were dependent on PI3K/AKT pathway activation. Furthermore, CM derived from obese AT potentiated the pro-angiogenic effect of MDA-MB-231 on endothelial cells. We also detected that EVs derived from obese AT were enriched in leptin and bioactive matrix metallopeptidase 9 (MMP9), and stimulation of MDA-MD-231 cells with those EVs or CM derived from obese AT potentiated the release of MMP9 by those cells. Our data indicate that obese AT secretes molecules and EVs with pro-tumoral activities capable of increasing breast cancer cell malignancy and provide strong evidence of the key role of AT-derived EV signaling in the tumor microenvironment.

Electrolyte changes related to muscle pain after resistance exercises / Alterações eletrolíticas relacionadas à dor muscular após exercícios resistidos / Alteraciones electrolíticas relacionadas al dolor muscular después de ejercicios resistidos

ABSTRACT Introduction Resistance exercises (RE) performed at high intensity cause an inflammatory response and electrolyte abnormalities in blood plasma. Objectives To study the plasma electrolyte changes resulting from a high-intensity session of RE in untrained volunteers, and to correlate these with delayed onset muscle soreness (DOMS). Methods Twenty volunteers, aged 26.9 (±4.4) years, underwent an RE session. The workout (leg extension, squat and leg press) consisted of four sets of 10 maximum repetitions. Electrolytes (Na+, K+, Ca2+ e Mg2+) were evaluated before the training (baseline), immediately (0 min), and 30 minutes after the RE. The DOMS was assessed 24 hours after the sessions. Results The Na+ increased immediately after the RE and returned to normal after 30 min (p<0.001). After 30 min, K+ increased compared to baseline levels and immediately after the RE (p<0.001). Ca2+ and Mg2+ levels did not change throughout the study. Changes in Na+ and K+ levels were correlated immediately (r=-0.511; p=0.021) and 30 min (r=-0.455; p=0.049) after RE. Plasma concentrations of Na+ 0 min were correlated (r=-0.520; p=0.018) with the DOMS. Conclusion High-intensity RE in untrained volunteers leads to changes in plasma concentrations of Na+ and K+. Na+ concentrations immediately after RE were related to DOMS; individuals that presented smaller alterations in this electrolyte reported more muscular pain. Level of evidence II; Diagnostic Studies - Development of diagnostic criteria on consecutive patients (with universally applied reference "gold" standard).

RESUMO Introdução Os exercícios resistidos (ER) realizados em alta intensidade provocam uma resposta inflamatória e alterações eletrolíticas no plasma sanguíneo. Objetivo Estudar as alterações eletrolíticas plasmáticas resultantes de uma sessão de ER de alta intensidade em voluntários destreinados e correlacionar com a dor muscular de início tardio (DMIT). Métodos Vinte voluntários com 26,9 (±4,4) anos de idade foram submetidos à sessão de ER. A sessão de exercícios (cadeira extensora, agachamento e leg press) consistiu em quatro séries de 10 repetições máximas. Os eletrólitos (Na+, K+, Ca2+ e Mg2+) foram avaliados previamente (basal), imediatamente (0 min) e 30 minutos após os ER. A DMIT foi avaliada 24 horas após as sessões. Resultados O Na+ aumentou imediatamente após os ER e retornou ao normal após 30 min (p<0,001). Em 30 min, o K+ aumentou em relação aos valores basais e imediatamente após os ER (p<0,001). O Ca2+ e o Mg2+ não se modificaram ao longo do estudo. As alterações de Na+ e de K+ correlacionaram-se imediatamente (r=-0,511; p=0,021) e 30 min (r=-0,455; p=0,049) após os ER. As concentrações plasmáticas de Na+ 0 min correlacionam-se (r=-0,520; p=0,018) com a DMIT. Conclusão Os ER de alta intensidade em voluntários destreinados aumentaram as concentrações plasmáticas de Na+ e de K+. As concentrações de Na+ imediatamente após os ER correlacionaram-se com a DMIT, em que os indivíduos que apresentam menores alterações desse eletrólito sentem mais dor muscular. Nível de Evidência II; Estudos diagnósticos - Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com padrão de referência "ouro" aplicado).

RESUMEN Introducción Los ejercicios resistidos (ER) realizados en alta intensidad provocan una respuesta inflamatoria y alteraciones electrolíticas en el plasma sanguíneo. Objetivo Estudiar las alteraciones electrolíticas plasmáticas resultantes de una sesión de ER de alta intensidad en voluntarios desentrenados y correlacionar con el dolor muscular de inicio tardío (DMIT). Métodos Veinte voluntarios con 26,9 (±4,4) años de edad fueron sometidos a la sesión de ER. La sesión de ejercicios (mesa extensora, sentadillas y leg press) consistió en cuatro series de 10 repeticiones máximas. Los electrólitos (Na+, K+, Ca2+ y Mg2+) fueron evaluados previamente (basal), inmediatamente (0 min) y 30 minutos después de los ER. La DMIT fue evaluada 24 horas después de las sesiones. Resultados El Na+ aumentó inmediatamente después de los ER y retornó a lo normal después de 30 min (p<0,001). En 30 min el K+ aumentó con relación a los valores basales e inmediatamente después de los ER (p<0,001). El Ca2+ y el Mg2+ no se modificaron a lo largo del estudio. Las alteraciones de Na+ y de K+ se correlacionaron inmediatamente (r=-0,511, p=0,021) y 30 min (r=-0,455, p=0,049) después de los ER. Las concentraciones plasmáticas de Na+ 0 min se correlacionan (r=-0,520, p=0,018) con la DMIT. Conclusión Los ER de alta intensidad en voluntarios desentrenados aumentaron las concentraciones plasmáticas de Na+ y de K+. Las concentraciones de Na+ inmediatamente después de los ER se correlacionaron con la DMIT, en que los individuos que presentan menores alteraciones de ese electrolito sienten más dolor muscular. Nivel de evidencia II; Estudios diagnósticos - Desarrollo de criterios diagnósticos en pacientes consecutivos (con estándar de referencia "oro" aplicado).