Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Issue: 4 (6) 2017 - 7 Articles


1 - The role of p16 as putative biomarker for cervical neoplasia: A controversial issue?

Jessica E.S. Gonçalves; Cecilia Vianna de Andrade; Fabio B Russomano; Gerard J Nuovo; Sergio M Amaro-Filho; Maria OO Carvalho; Alcina Frederica Nicol

MEDICALEXPRESS 2017;4(6):M170601

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INTRODUCTION: Protein p16 has been extensively studied as a potential biomarker for precursor lesions to distinguish cervical Intraepithelial neoplasia (CIN) from their mimics. However, the use of p16 as prognostic biomarker for diagnosis of cervical cancer and precancer is controversial. This study focuses on the assessment of peer-reviewed scientific data related to the use of p16 to predict disease severity and its controversies.
METHODS: We reviewed publications in MEDLINE/PubMed assessing the clinical, diagnostic and prognostic significance of p16 in CIN and cervical cancer; we included publications from 2009 to June 2017.
RESULTS: The use of p16 as a prognostic marker is still unreliable, although it could be a useful tool for diagnosis of Cervical Intraepithelial Neoplasia lesions with undetermined morphology. Moreover, p16 appears to be a specific marker of high-risk oncogenic HPV infection.
CONCLUSION: This review shows the potential utility and drawbacks of p16 for clinical practice and the diagnosis of cervical cancer. Further studies are required to substantiate the role of p16 in conjunction with other more sensitive and specific biomarkers for diagnosing CIN and predicting its progression.

Keywords: p16 protein, HPV infection, cervical cancer, biomarker, cervical intraepithelial lesion.

2 - Running economy in elite soccer and futsal players: differences among positions on the field

Paulo Roberto Santos-Silva; Júlia Maria D´Andrea Greve; André Pedrinelli

MEDICALEXPRESS 2017;4(6):M170602

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OBJECTIVE: To determine running economy in a large sample of elite soccer and futsal players to obtain benchmarks in different positions.
METHODS: Running Economy is the energy demand at a submaximal running velocity. Players were divided into 6 subgroups. Soccer: defenders, midfielders, and strikers; futsal: defenders, wingers, and pivots. Elite soccer players (n=129) and elite futsal players n=72 performed an incremental running test starting at 8.4 km.h-1 with increments of 1.2 km.h-1 every two minutes on a treadmill until exhaustion. Running Economy was determined by interpolation between ventilatory thresholds 1 and 2 (VT1 and VT2).
RESULTS: Running Economy (measured as was compared between the playing positions in the two team sports. In soccer, running economy was 222.7 (defenders), 227.0 (midfielders), and 219.8 (strikers), respectively. In futsal, the corresponding values were 198.5 (defenders), 196.9 (wingers), and 190.5 (pivots), respectively. We no found significantly differences between the three positions in both sports. The Running Economy of futsal players was 12.5% better than that of soccer players. Running Economy correlated positively with oxygen uptake at VT2 in both sports and in all positions.
CONCLUSION: Futsal players exhibited better Running Economy than soccer players; this should be considered as a factor in the athlete’s training plan.

Keywords: maximal oxygen uptake, ventilatory threshold, oxygen cost, aerobic performance, intermittent exercise.

3 - Effectiveness of lidocaine patches for pain treatment after total knee arthroplasty

David Sadigursky; Mariana de Castro Oliveira; João Gilberto Gomes Macedo; Francisco Roque Paim Costa Junior; Matheus Lemos Azi; Daniel Figueiredo Alencar

MEDICALEXPRESS 2017;4(6):M170603

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BACKGROUND: Effective analgesic therapy in the postoperative period of total knee arthroplasty is essential for good surgical outcomes. The current trend is to use multimodal treatment, in which the use of patches with lidocaine as adjuvant therapy has an increasingly relevant role.
OBJECTIVE: To investigate the potential benefits of lidocaine patch association with the basic analgesia regimen for pain relief during the postoperative period of total knee arthroplasty.
METHOD: A retrospective cohort study was performed , with a total of 24 patients in each group, who underwent total knee arthroplasty. Pain levels using a visual analogue scale and opioid intake were controlled from the immediate postoperative to the end of a 28-day interval.
RESULTS: During the postoperative period, pain was less intense in patients who used lidocaine patches. In these same patients, the doses of opioids needed to control pain were lower in 15 of the 28 days analyzed. The relative frequency of nausea was higher in the group that did not use adjuvant therapy. Patients older than 70 years and females predominated.
CONCLUSION: Adjuvant treatment after total knee arthroplasty using lidocaine patches was effective in reducing pain and decreasing the use of opioids in the period analyzed, and represents a good addition to multimodal analgesic therapy.

Keywords: Knee Arthroplasty; Analgesia; Lidocaine.

4 - Involvement of rest diastolic arterial pressure in autonomic heart rate recovery from exercise in normotensive men

Rayana L. Gomes; Luiz Carlos M. Vanderlei; Franciele M. Vanderlei; David M. Garner; Rodrigo D. Raimundo; Luiz Carlos de Abreu; Vitor E. Valenti

MEDICALEXPRESS 2017;4(6):M170604

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OBJECTIVE: Rest arterial pressure has been shown to be associated with cardiovascular mortality. Autonomic heart rate control during recovery from exercise is estimated to detect changes in cardiovascular system, which may lead to cardiovascular diseases. We assessed the involvement of rest diastolic arterial pressure (DAP) on heart rate dynamics after exercise in normotensive physically active men.
METHOD: We evaluated healthy physically active men aged 18 to 22 years old divided into two unequal groups: G1- rest DAP between 80 and 90 mmHg (N=11) and G2- rest DAP < 80mmHg (N=24). Volunteers performed physical exercise on a treadmill with intensity equivalent to 60% of Vmax. Heart rate recovery in the first (HRR1) and third (HRR3) minute after exercise were measured and heart rate variability (HRV) was examined in the time and frequency domain. Additionally, we performed the quantitative analysis of the Poincaré plot. HRV was recorded in the following phases: the 10-minute period before exercise, during exercise and the 60 minute period after exercise.
RESULTS: We found no significant difference between G1 and G2 concerning HRV changes during exercise. The G2 group exhibited a delayed recovery of SDNN, RMSSD, RRTri, LF, HF, LF/HF, SD1 and SD2 indices during recovery from exercise. HRR1 and HRR3 was greater in the G2 group.
CONCLUSION: Normotensive physically active men with DAP between 80 and 90 mmHg presented faster heart rate recovery and an accelerated recovery of heart rate autonomic control after aerobic exercise.

Keywords: Arterial Pressure; Autonomic Nervous System; Cardiovascular Physiological Phenomena; Cardiovascular system.


5 - Walking economy and aerobic power in Parkinson’s disease after endurance exercise training: A pilot study

Júlia Maria D´Andrea Greve; Paulo Roberto Santos-Silva; Danielli S Speciali

MEDICALEXPRESS 2017;4(6):M170605

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OBJECTIVE: To verify the effect of an endurance exercise program in middle stages of Parkinson’s disease.
METHODS: The patients were two women and seven men with Parkinson’s disease, aged 56 to 74 years, classified at Hoehn and Yahr stages 2 to 2.5. The study was designed as an open long-term pilot trial over three months of supervised treadmill exercise training. Cardiopulmonary exercise test evaluations were performed before the start of the study (test 1) and after three months (test 2). The main outcome measure was walking economy (i.e., the rate of oxygen consumption during gait) measured between VT1 and VT2 speeds and Oxygen consumption (VO2).
RESULTS: No changes (p=0.551) were observed for maximal oxygen uptake (VO2max, 24.6 vs 23.6 between tests. The walking economy was 20% better (p<0.001) after three months of aerobic endurance training (266.7 vs 212.6, pre- vs. post-training); the Cohen’s “d” effect size (ES) was 0.99, a very large effect.
CONCLUSION: Evidence from this pilot study in individuals with Parkinson’s disease suggests that gains in walking economy occurs with a treadmill-training program without gain in aerobic power, but which may positively reduce the energy expenditure of activities of daily living in these patients.

Keywords: physical functioning, ventilatory threshold, maximal oxygen uptake.

6 - The influence of glycerol upon L. reuteri activity against enteropathogens

Marina Camargo Etchebehere; Cristiane Piveta; Carlos E. Levy

MEDICALEXPRESS 2017;4(6):M170606

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BACKGROUND: Probiotics containing L. reuteri are popular for treating and preventing bacterial gastrointestinal infections. L. reuteri, produces reuterin, an antibiotic that inhibits gram-negative bacteria. Reuterin production is the result of glycerol fermentation by L reuteri. Although L. reuteri is normally present in the gastrointestinal system, only small amounts of glycerol are usually available; therefore, the production of reuterin may not occur and this could reduce the effectiveness of the probiotic supplement. Our objective is to identify the minimum concentrations of glycerol required for L. reuteri to exert an inhibitory effect on enteropathogenic enterobacteriaceae.
METHOD: Samples containing 108 colony forming units (CFU) of L. reuteri DSM17938 (Colikids®, Ache, Brazil/BioGaia, Sweden) were grown with varying concentrations of glycerol (0.05-5%). 106 CFU of E.coli (CDC0126/INCQS/FIOCRUZ), Shigella flexneri (ATCC/120022), S. enterica (ATCC6539) and Y. enterocolitica (ATCC9610) were inoculated with L. reuteri in the different glycerol concentrations. Each enterobacteria and glycerol 5% without L. reuteri cultures were used as positive control groups.
RESULTS: All bacteria were completely inhibited at higher ranges of glycerol concentrations (0.2-5%) and grew at lower concentrations (0.05-0.1%).
CONCLUSION: L. reuteri requires at least 0.2% of glycerol to completely inhibit enterobacterial growth. These preliminary findings may influence the current method of use of probiotic supplements. The antibiotic activity of L. reuteri may have potential clinical use against important enteropathogens.

Keywords: L. reuteri; reuterin; enteropathogenic enterobacteriaceae; glycerol.


7 - How to talk to the patient about obesity

Zeev N. Kain

MEDICALEXPRESS 2017;4(6):M170607