Discal Cyst: a Rare Cause of Neurologic Compression in the Young Adult

Introduction: discal cysts are rare pathology. Its clinical presentation can be mistaken for disc herniation, with back pain, radiculopathy and neurological defi cit. It is more common in male patients in their fourth life decade. Because they are rare, there is no consensus about the treatment. A great variety of procedures, from medication for the pain to endoscopic or microdiscectomy excision, have been described. Objetive: Describe a case of discal cyst on the l4-l5 level with compression of l5 right nerve root treated successfully with a minimal invasive procedure. Study design: Case report. Methods: Review medical records, pertinent images, interview with the patient and surgical team, intraoperative and histopathological fi ndings. The surgical technique used was minimally invasive. Results: Magnetic resonance imaging (MRI) demonstrated a cystic lesion imaging at the level of the L4-L5 disc. The cystic mass displaced the thecal sac dorsally compressed the L5 transversing root. The patient was submitted to a minimally invasive microendoscopic technique using a tubular retractor. He recovered completely after the procedure, presenting absence of leg pain and went back to his regular activities 3 weeks after the surgery. Histopathological examination of the cyst revealed thick fi brous connective tissue interspersed with areas of chronic infl ammation. Conclusion: Discal cysts are rare intraspinal lesions. They can trigger severe neurological symptoms, and should be differentiated from other forms of epidural cysts and tumors. There are many treatment options that can be chosen from but no consensus. We used a treatment that was less invasive than the ones described in the literature

MEDICINES WASTE POLICIES AND THE POPULATION KNOWLEDGE IN BRAZIL

Objective: To investigate the degree of knowledge of the patients enrolled in the Unified Health System of the Medicine School of ABC (Faculdade de Medicina do ABC) regarding the proper use and disposal of medicaments. Methods: Participants were recruited for convenience, during their medical appointments at the clinic of the Medical School of ABC (Santo André, Sao Paulo, Brazil) in the period from 04 August to 30 September 2014. Data collection was conducted through a self-administered poll designed specifically for the purpose of this study, which consisted of 25 questions multiple choice about socioeconomic issues and the subject disposal of drugs, consumption and environmental pollution. Results: We selected the 140 patients’ polls. Most of them is of white ethnicity (58%) and female (58%). Level of education: 31% have completed secondary education (31%) or incomplete graduation (19%). Most of the participants (76%) buy drugs without a prescription, and most families (76%) seek understanding by reading the labels. 71.43% reported knowing that incorrect disposal of drugs could contaminate the environment, but 78% reported never having seen or received information about these. After using, 22.15% maintains the medication at home for future use, 55% of subjects reported improper disposal sites and 13% are delivered in health care institutions. Conclusion: Our study has showed that most participants inappropriately use and dispose of drugs, even though they know they can contaminate the environment

Auditory stimulation with Mozart sonata k-448 and heavy metal music improves short-term memory in rats

Objectives. We aimed to assess the effect of both classical and heavy metal music on short-term and long-term memory. Methods. Male rats were separated into three groups: Mozart (n=14), rats were exposed to Mozart´s K-448 piano sonata; Heavy Metal (n=15), rats were exposed to Psychosocial (band: Slipknot), and Control (n=12), rats were exposed to ambient sounds in an acoustically isolated room. The animals were exposed to the music for 8 hours per day, between 10:00 pm to 06:00 am, with an intensity of 50-75 dB, for 61 consecutive days. Twenty-four hours after the final day of adjustment to the enclosure the animals were individually exposed for 5 minutes in the enclosure to explore two identical objects. Ninety minutes after the object recognition training session, the animals were submitted to the short-term memory test and twenty-eight days after the object recognition training session, the animals were submitted to a long-term memory test. Results. There was no modification amongst the three groups during the object recognition training. Regarding the short-term memory test both Mozart (U=33.00, p=0.016, FDR-corrected) and Heavy Metal (U=44.00, p=0.033, FDR-corrected) groups revealed a higher percentage value of significance compared to the control group. In contrast, there was no significant change in relation to the long-term memory test. Conclusion. Mozart Sonata K-448 and heavy metal music achieved beneficial effects on the short-term memory in rats

Association between autonomic modulation of heart rate and the disease severity in children with severe liver disease

Introdução: A AVB é a principal indicação de transplante hepático pediátrico, responsável por 60% das indicações nos maiores centros. O fígado possui importante papel na metabolização de substâncias e homeostase do organismo, seu comprometimento pela cirrose gera uma série de desordens e desequilíbrios em vários órgãos e sistemas. Já existem estudos sobre o sistema nervoso autônomo em criança em diversas condições, contudo, não há na literatura um estudo que analise o sistema nervoso autônomo de crianças com hepatopatia. Objetivo: Analisar a modulação autonômica cardíaca e relacioná-la com o grau de gravidade da doença em crianças com doença hepática grave. Método: Foram analisadas crianças com diagnóstico de atresia de vias biliares na fila para o transplante de fígado, ambos os sexos, de 6 meses a 3 anos de vida, aguardando o transplante no Instituto da Criança, avaliadas pelo PELD quanto a gravidade da doença e crianças saudáveis no grupo controle. Para análise de dados da modulação cardíaca no domínio do tempo foram utilizados (pNN50, SDNN e RMSSD) e domínio da frequência foram utilizados os componentes espectrais de baixa frequência LF e alta frequência HF. A análise geométrica foi realizada por meio dos índices RRtri, TINN, SD1, SD2 e relação SD1/SD2. Nos índices não lineares DFA ?1 e ?2, DET, REC, D2 e análise simbólica. Resultados: Ao comparar os dois grupos de crianças, os resultados foram significantes nos índices do domínio do tempo: SDNN (p=0,001), RMSSD (<0,01), NN50 (p=0,03), pNN50 (p=0,04). No domínio da frequência os índices LF(ms²) e HF(ms²) apresentaram valores de p <0,001. Já nos índices geométricos, RRTri e TINN ambos com p <0,001, e SD1 (p=0,003) e SD2 (p=0,001). Conclusão: Há uma alteração da variabilidade da frequência cardíaca tanto na modulação simpática quanto na modulação parassimpática, demonstrando uma diminuição dos índices da VFC e possível maior morbidade nas crianças com atresia de vias biliares.Introduction: The AVB is the main indication for pediatric liver transplantation, responsible for 60% of indications in the major centers. Because the liver is the great \"laboratory\" of the human body, with an important role in the metabolism of substances and homeostasis of the organism, its involvement by cirrhosis generates a series of requirements and imbalances in various organs and systems. There are already studies on the autonomic nervous system in children in different conditions, however, there is no literature that studies the autonomic nervous system of children with liver disease. Aim: To analyze a cardiac autonomic modulation with the degree of severity of the disease in children with severe hepatic disease. Methods: Children with a diagnosis of biliary atresia waiting for liver transplantation, both sexes, from 6 months to 3 years of age, who were waiting list transplantation at the Children\'s Institute, were analyzed by the PELD regarding the severity of the disease. Healthy children were evaluated for the control group. Data analysis of cardiac modulation without time domain and used (pNN50, SDNN and RMSSD) and domain of the frequency and use of low frequency LF components and high frequency HF. A geometric analysis will be performed using the RRtri, TINN, SD1, SD2 and SD1 / SD2 ratios. In the non-linear indexes DFA ?1 and ?2, DET, REC, D2 and symbolic analysis. RESULTS: When comparing the two groups of children, the results were significant in the time domain indices: SDNN (p = 0.001), RMSSD (<0.01), NN50 (p = 0.03), pNN50 (p = 0.04). In the frequency domain of the indexes LF (ms²) and HF (ms²) presented values of p <0.001. In the geometric indices, RRTri and TINN both with p <0.001, and SD1 (p = 0.003) and SD2 (p = 0.001). The correlation of the PELD with the indexes RMSSD and SD1 the values respectively were r = -0.46 (p = 0.008) and r = -0.45 (p = 0.009). Conclusion: There is a change in heart rate variability in both sympathetic modulation and parasympathetic modulation, demonstrating a decrease in HRV and a higher prognosis of morbidity in children with biliary atresia

Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life

Abstract Background: The aim of this study was to evaluate the QoL of patients undergoing heart valve replacement using the SF-36 questionnaire, compare it between patients with mechanical prosthesis and patients with bioprosthesis, and correlate the results with sociodemographic variables. Objective: To assess the QoL of patients undergoing heart valve replacement and compare it between patients with bioprosthetic valves and patients with mechanical prosthetic valves. Methods: We included 36 consecutive patients (16 men) with a mean age of 51 years and six months, who underwent mitral or aortic valve replacement from September 2007 to December 2011. The study was conducted between March and May 2012 and involved the application of the SF-36 survey and a sociodemographic questionnaire. Statistical tests were performed, and data are expressed as absolute frequency and percentile, and median and interquartile range (P25 and P75) (Mann-Whitney test), considering a significance of 95%. Results: The average time of surgery was 32.5 months (8-61 months). Participants were asked about the practice of physical activity, and 41.7% were physically active. For the SF-36 domains, the highest scores were observed for the social domain whereas the lowest scores were found for mental health, with a mean of 89.25 and 54.44, respectively. In the statistical analysis, we found statistically higher values in emotional functional for patients with mechanical valve prosthesis (p = 0.0084). Conclusion: The QoL of the patients undergoing heart valve replacement improves considerably after the surgery, except for the mental health domain, probably due to the low practice of physical activity. The type of prosthesis seems not to influence the QoL or the patients in the late postoperative period

Energy drink before exercise did not affect autonomic recovery following moderate aerobic exercise: A crossover, randomized and controlled trial

Introduction. Energy drink (ED) intake could initiate physiological changes owing to its stimulant characteristics and, it improves endurance and athletic performance. We evaluated the acute effects of ED on autonomic heart rate (HR) control during recovery after a session of submaximal aerobic exercise. Method. The study was completed by submitting 29 healthy males between 18 and 30 years old to three conventions: (A) Maximum exercise test by the adapted Bruce protocol; (B) Placebo protocol (PP) - water intake 15 minutes prior to exercise, rest in dorsal decubitus for 15 minutes followed by 5 minutes of treadmill running at 1% inclination, initial speed of 5 km/h for 5 minutes 25 minutes with 60% of the velocity consistent to the maximum oxygen consumption (VO2max), and finally 60 minutes of recovery at rest in the supine position; (C) Experimental protocol (PE) - similar to PP previously, but with ED intake 15 minutes before physical exercise. The time, frequency and geometric indexes of HR variability (HRV) were inspected before and after exercise. Results. There was a significant (p < 0.05, <5%) effect on the HRV index (HR-nu and ms2, LF-nu and ms2, LF/HF, SD1, SDNN and RMSSD), indicating a reduction in HRV in the first 5 minutes after exercise in both protocols (PP and PE). Yet, no protocol interaction was detected, suggesting no effect of ED on HRV throughout recovery after submaximal aerobic exercise. Conclusion. There was no significant effect of ED on the autonomic control of HR in the recovery phase after submaximal aerobic exercise

Reduction of heart rate variability in hypertensive elderly

Introduction: The elderly population grows globally every day, and along with it the incidence of high blood pressure also grows, following these data scientists seek tools to improve the health of this population, a widely used tool for assessing cardiovascular function is the heart rate variability(HRV), that is a mecanism that allows the investigation of oscillations in the intervals between consecutive heart beats (RR intervals). There are already studies on the autonomic nervous system in the elderly population, however, these studies investigated normotensive patients and there is little research in hypertensive patients. Aim: To compare the cardiac autonomic modulation between healthy elderly and hypertensive elderly. Method: The total sample was 80 elderly people- 40 healthy elderly and 40 elderly (HBP). Anthropometric data, HRV analysis and IPAQ questionnaire were collected. For the analysis of cardiac modulation data in the time domain (pNN50, SDNN and RMSSD) and frequency domain (LF and HF). The geometric analysis (RRtri, TINN, SD1, SD2 and SD1/SD2 ratios). Results: In the time domain the MeanRR index presented a HAS increase 832.35 ± 104.46 ms vs control 782.73 ± 112.78 ms (p = 0.040). In the SDNN, there was a 58.35ms decrease vs the SAH 43.15 ms (p = 0.030). In the frequency domain, HF decreased control 247.00 ms2 vs HAS 157.00 ms2 (p = 0.002). In the geometric, the TINN and SD2 in the HAS group decreased in relation to the control from 203.38 ± 80.26 ms to 161.83 ± 53.25 ms (p = 0.018) and from 71.95 ms to 59.40 ms (p = 0.051). The mean SD1/SD2 ratio showed an increase between the Control and SAH groups from 0.22 ± 0.10 to 4.09 ± 1.18 and there was a statistical difference (p = 0.001). Conclusion: Hypertensive elderly patients present decreased heart rate variability and decreased parasympathetic modulation when compared to normotensive elderly

Cardiac autonomic regulation during exposure to auditory stimulation with classical baroque or heavy metal music of different intensities

Objectives: The effects of chronic music auditory stimulation on the cardiovascular system have been investigated in the literature. However, data regarding the acute effects of different styles of music on cardiac autonomic regulation are lacking. The literature has indicated that auditory stimulation with white noise above 50 dB induces cardiac responses. We aimed to evaluate the acute effects of classical baroque and heavy metal music of different intensities on cardiac autonomic regulation. Study design: The study was performed in 16 healthy men aged 18-25 years. All procedures were performed in the same soundproof room. We analyzed heart rate variability (HRV) in time (standard deviation of normal-to-normal R-R intervals [SDNN], root-mean square of differences [RMSSD] and percentage of adjacent NN intervals with a difference of duration greater than 50 ms [pNN50]) and frequency (low frequency [LF], high frequency [HF] and LF/HF ratio) domains. HRV was recorded at rest for 10 minutes. Subsequently, the volunteers were exposed to one of the two musical styles (classical baroque or heavy metal music) for five minutes through an earphone, followed by a five-minute period of rest, and then they were exposed to the other style for another five minutes. The subjects were exposed to three equivalent sound levels (60- 70dB, 70-80dB and 80-90dB). The sequence of songs was randomized for each individual. Results: Auditory stimulation with heavy metal music did not influence HRV indices in the time and frequency domains in the three equivalent sound level ranges. The same was observed with classical baroque musical auditory stimulation with the three equivalent sound level ranges. Conclusion: Musical auditory stimulation of different intensities did not influence cardiac autonomic regulation in men

Fractal dynamics of heart rate variability for short term

The fractal analysis of heart rate variability (HRV) has been associated to the chaos theory. We evaluated the association of the fractal exponents of HRV with the time and frequency domain and geometric indices of HRV for short period. HRV was analyzed with a minimal number of 256 RR intervals in the time (SDNN-standard deviation of normal-to-normal R-R intervals, pNN50-percentage of adjacent RR intervals with a difference of duration greater than 50ms and RMSSD-root-mean square of differences between adjacent normal RR intervals in a time interval) and frequency (LF-low frequency, HF-high frequency and LF/HF ratio) domains. The geometric indexes were also analyzed (RRtri-triangular index, TINN-triangular interpolation of RR intervals and Poincaré plot) as well as short and long-term fractal exponents (alpha-1 and alpha-2) of the detrended fluctuation analysis (DFA). We observed strong correlation of the alpha-1 exponent with RMSSD, pNN50, SDNN/RMSSD, LF (nu), HF (nu), LF/HF ratio, SD1 and SD1/Sd2 ratio. In conclusion, we suggest that the alpha-1 exponent could be applied for HRV analysis with a minimal number of 256 RR intervals