Isometric handgrip exercise impacts only on very short-term blood pressure variability, but not on short-term blood pressure variability in hypertensive individuals : a randomized controlled trial

Background: The effect of a single isometric handgrip exercise (IHG) on blood pressure (BP) variability (BPV) has not been addressed. This randomized controlled trial evaluated the effect of IHG vs. sham on BPV and BP. Methods: Hypertensive patients using up to two BP-lowering medications were randomly assigned to IHG (4 × 2 min; 30% of maximal voluntary contraction, MVC, with 1 min rest between sets, unilateral) or sham (protocol; 0.3% of MVC). Systolic and diastolic BP were assessed beat-to-beat in the laboratory before, during, and post-intervention and also using 24-h ambulatory BP monitoring (ABPM). BPV was expressed as average real variability (ARV) and standard deviation (SD). Results: Laboratory BPV, ARV and SD variability, had marked increase during the intervention, but not in the sham group, decreasing in the post-intervention recovery period. The overall change in ARV from pre- to 15 min post-intervention were 0.27 ± 0.07 (IHG) vs. 0.05 ± 0.15 (sham group), with a statistically significant p-value for interaction. Similarly, mean systolic BP increased during the intervention (IHG 165.4 ± 4.5 vs. sham 152.4 ± 3.5 mmHg; p = 0.02) as did diastolic BP (104.0 ± 2.5 vs. 90.5 ± 1.7 mmHg, respectively; p < 0.001) and decreased afterward. However, neither the short-term BPV nor BP assessed by ABPM reached statistically significant differences between groups. Conclusion: A single session of IHG reduces very short-term variability but does not affect short-term variability. IHG promotes PEH in the laboratory, but does not sustain 24-h systolic and diastolic PEH beyond the recovery period

VALIDITY OF THE INSTRUMENT interRAI EMERGENCY SCREENER FOR PSYCHIATRY FOR THE BRAZILIAN CONTEXT

Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyses suggested an appropriate structure to the purpose of the instrument, two sections containing two factors instead of the expected one-dimensional structure. However, sections with two factors have interpretability and theoretical consistency. The factors presented internal consistency. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.Objetivo: El objetivo de este estudio era realizar la traducción y presentar la evidencia de validez del examinador de emergencia interRAI para psiquiatría (ESP). Método: se trata de una encuesta transversal realizada en un hospital municipal de la región metropolitana de Porto Alegre, Rio Grande do Sul. Un total de 161 pacientes fueron evaluados en las primeras 24 horas de llegada de emergencia utilizando ESP. Los análisis exploratorios de factores de las secciones del instrumento y los análisis de fiabilidad se llevaron a cabo utilizando Cronbach's alpha y McDonald's Omega. Resultados: los análisis sugirieron una estructura adecuada a los propósitos del instrumento, dos secciones que contienen dos factores en lugar de la estructura unidimensional esperada. Sin embargo, las secciones con dos factores tienen interpretabilidad y consistencia teórica. Los factores presentaron consistencia interna. Conclusión: la versión brasileña del Examinador de Emergencia InterRAI para Psiquiatría (ESP) demuestra propiedades psicométricas adecuadas a través de la estructura interna del instrumento. Los estudios futuros deben investigar la relación de las puntuaciones producidas por el instrumento con el diagnóstico clínico y con covariables relevantes para los resultados de salud mental.Objetivo: O objetivo do estudo foi realizar a tradução e apresentar as evidências de validade do interRAI Emergency Screener for Psychiatry (ESP). Método: trata-se de uma pesquisa transversal realizada em um hospital municipal da região metropolitana de Porto Alegre, Rio Grande do Sul. Foram avaliados 161 pacientes nas primeiras 24 hs da chegada a emergência utilizando o ESP. Foram conduzidas análises fatoriais exploratórias das seções do instrumento e análises de fidedignidade por meio do alfa de Cronbach e Ômega de McDonald. Resultados: as análises sugeriram uma estrutura adequada ao propósito do instrumento, sendo duas seções contendo dois fatores ao invés da estrutura unidimensional esperada. Contudo, as seções com dois fatores possuem interpretabilidade e consistência teórica. Os fatores apresentaram consistência interna. Conclusão: a versão brasileira do interRAI Emergency Screener for Psychiatry (ESP) demonstra adequadas propriedades psicométricas por meio da estrutura interna do instrumento. Estudos futuros deverão investigar a relação dos escores produzidos pelo instrumento com diagnóstico clínico e com covariáveis relevantes para os desfechos de saúde mental

Inspiratory Muscle Training Improves Blood Flow to Resting and Exercising Limbs in Patients With Chronic Heart Failure

ObjectivesWe tested the hypothesis that inspiratory muscle loading could result in exaggerated peripheral vasoconstriction in resting and exercising limbs and that inspiratory muscle training (IMT) could attenuate this effect in patients with chronic heart failure (CHF) and inspiratory muscle weakness.BackgroundInspiratory muscle training improves functional capacity of patients with CHF, but the mechanisms of this effect are unknown.MethodsEighteen patients with CHF and inspiratory muscle weakness (maximal inspiratory pressure <70% of predicted) and 10 healthy volunteers participated in the study. Inspiratory muscle loading was induced by the addition of inspiratory resistance of 60% of maximal inspiratory pressure, while blood flow to the resting calf (CBF) and exercising forearm (FBF) were measured by venous occlusion plethysmography. For the patients with CHF, blood flow measurements as well as ultrasound determination of diaphragm thickness were made before and after a 4-week program of IMT.ResultsWith inspiratory muscle loading, CHF patients demonstrated a more marked reduction in resting CBF and showed an attenuated rise in exercising FBF when compared with control subjects. After 4 weeks of IMT, CHF patients presented hypertrophy of the diaphragm and improved resting CBF and exercise FBF with inspiratory muscle loading.ConclusionsIn patients with CHF and inspiratory muscle weakness, inspiratory muscle loading results in marked reduction of blood flow to resting and exercising limbs. Inspiratory muscle training improves limb blood flow under inspiratory loading in these patients

New equipment for otologic surgery developed at HCPA (microcautery) : part II - study in human beings

OBJETIVO: Descrever a avaliação, em cirurgias de ouvido médio em seres humanos, do microcautério otológico Lavinsky/HCPA. MATERIAIS E MÉTODOS: Vinte e quatro pacientes com indicação para estapedectomias e timpanoplastias unilaterais ou bilaterais foram selecionados. Foram excluídos pacientes com doenças sistêmicas, como hipertensão arterial sistêmica não controlada e discrasia sangüíneas. Os pacientes foram divididos em dois grupos: 12 foram operados com o microcautério e 12, sem. As cirurgias foram gravadas em vídeo e avaliadas por dois cirurgiões otológicos, cegos para o tipo de procedimento utilizado. Os resultados foram qualificados como ótimo, bom, regular ou ruim. O parâmetro utilizado na avaliação foi hemostasia. RESULTADOS: Os avaliadores qualificaram como ótimo o resultado global de todas as cirurgias realizadas com o microcautério. No grupo controle, um avaliador qualificou 42% das cirurgias como ruim e 58% como regular. CONCLUSÕES: O uso do microcautério demonstrou benefícios concretos em comparação com métodos convencionais.OBJECTIVE: To describe the evaluation, in middle ear surgeries in human beings, of the Lavinsky/HCPA otologic microcautery . MATERIALS AND METHODS: Twenty-four patients with indication for unilateral or bilateral stapedoctomies and tympanoplasties were selected. Patients presenting systemic diseases, non controlled systemic arterial hypertension and blood dyscrasia were excluded. Patients were divideded into two groups: 12 were operated with the microcautery and 12 without it. Surgeries were videotaped and evaluated by two otologic surgeries, blind to the kind of procedure used. Surgeries were classified as excellent, good, regular and poor. Hemostasis was the parameter considered in the evaluation. RESULTS: The evaluators considered as excellent the overall outcome of all surgeries performed with the microcautery. In the control group, one evaluator qualified 42% of surgeries as poor and 58% as regular. CONCLUSIONS: The utilization of the microcautery had concrete benefits in comparison with conventional methods

Dispositivo para emulação de mouse dedicado a pacientes tetraplégicos ou portadores de doença degenerativa do sistema neuromuscular

O trabalho descreve o desenvolvimento de um dispositivo que emula um mouse serial MicrosoftÒ. Este dispositivo permite ao deficiente físico tetraplégico acessar os recursos de informática em ambiente WindowsÒ 95/98 (ler e editar textos, navegar na Internet e utilizar o correio eletrônico) e auxilia o paciente de doenças degenerativas do sistema neuromuscular, como a esclerose lateral amiotrófica (ELA), com disartria, a comunicar-se com as pessoas ao seu redor. O movimento do cursor na tela do computador é produzido a partir do movimento de flexão e extensão da cabeça do usuário, sendo utilizado para medir os ângulos de inclinação um sensor de aceleração estática e dinâmica de dois eixos. Para emular o botão do mouse, são captados os sinais EMG (eletromiográficos) produzidos a partir do movimento voluntário dos músculos mímicos da região frontal do usuário. O processamento digital é realizado por um microcontrolador de oito bits e os dados são transmitidos para um computador padrão IBM-PC através da interface RS232C.This work describes the development of a pointing data entry device that emulates a MicrosoftÒ serial mouse. The device is aimed to individuals with a spinal cord injury or amyotrophic lateral sclerosys (A.L.S.), a degenerative disease of the neuromuscular system. This equipment allows individuals without hand movements to acess some computing resources such as reading, writing, surfing on the web, etc. The user’s head tilt, measured by a dual axis accelerometer, is responsible for the cursor movements on the computer screen. The click and double-click are produced by the voluntary movement of the user’s forehead muscle, which are acquired using electromyographic techniques. An eight bit microcontroller is used for the digital processing and interface to the computer via a RS232 port