Phase II clinical study of an association for the treatment of interstitial cystitis (Cystex (R))

Painful bladder syndrome associated with interstitial cystitis (PBS/IC) is a clinical condition characterized pelvic pain, urinary urgency, and urinary frequency. In this study, 22 patients were assigned to make two visits over a three weeks period. The patients were randomly, double-blinded assigned in two groups. The first group received Cystex (R) capsules. The second group received placebo capsules. Two capsules were taken three times a day away from meals. The change from baseline in the O'Leary-Sant IC symptom and problem index was the primary outcome parameter. Changes in functional bladder capacity and intensity of pain and urgency have been chosen as secondary outcome parameters. Mood as well as physical and sexual activity were rated by 10 questions on a scale 0 to 6. The ratings were analyzed and the average for each patient in both groups Cystex (R) and placebo was determined as the quality of life index. For the primary outcome there was a statistically significant difference between the groups. Mean symptom score-sum decreased from 28.4 to 20.5 in the Cystex (R) group compared with 29.5 to 26.8 in the placebo group (p<0.05). For the secondary end points, pain and urgency intensity improved statistically significantly in the Cystex (R) group compared with the placebo group (p<0.05). The frequency and functional bladder capacity improved to greater degree in the Cystex (R) group. The differences were statistically significant for comparison of frequency (p<0.05) and not for functional bladder capacity (p>0.05). In our study, Cystex (R) enhanced quality of life over the placebo showing a statistically significant. This trial have shown that the efficacy and safety of therapy with Cystex (R) in the treatment of interstitial cystitis and is an alternative for patients suffering from this pathology. Therefore, it can be concluded that the composition of Cystex (R), increased the quality of life in treated patients.

Characterization of the motor performance in infants with a diagnosis of Cerebral Palsy in process of rehabilitation: the importance of the proactivity of caregivers

Introduction: The progress in technology, associated to the high survival rate in premature newborn infants in neonatal intensive care units, causes an increase in morbidity. Individuals with CP present complex motor alterations, with primary deficits of abnormal muscle tone affecting posture and voluntary movement, alteration of balance and coordination, decrease of force, and loss of selective motor control with secondary problems of contractures and bone deformities. Objective: The aim of this work is to describe the spontaneous movement and strategies that lead infants with cerebral palsy to move. Methods: Seven infants used to receive assistance at the Essential Stimulation Center of CIAM (Israeli Center for Multidisciplinary Support - Philanthropic Institution), with ages ranging between six and 18 months with diagnosis of Cerebral Palsy (CP) were assessed. Results: The results show the difficulty presented by the infants with respect to the spontaneous motor functions and the necessity of help from the caregiver in order to perform the functional activity (mobility). Prematurity prevails as the major risk factor among the complications. Conclusion: The child development can be understood as a product of the dynamic interactions involving the infant, the family, and the context. Thus, the social interactions and family environment in which the infant live may encourage or limit both the acquisition of skills and the functional independence.

Discourse and bipolar disorder: Narrative therapy on northeast Brazil

Background: The expression 'bipolar disorder' refers to any of several psychological disorders of mood that alternate episodes of depression and mania. Also called manic depression or manic-depressive illness, it is a relatively common but unknown pathology that brings some stigmas for patients and provokes deleterious effects for their lives. This research aimed to comprehend actions, behaviors and emotions involved with bipolar disorder, through narratives of patient's personal and familiar histories. Methods: We surveyed 30 patients from a psychiatric service located in Aparecida, Paraiba, Brazil. Selected patients had bipolar disorder according to DSM-IV. For data collection, we used non-structured interview, approaching specific aspects related to bipolar disorder. Quantitative and qualitative analysis were done and Hamilton Rating Scale for Depression (HAMD) was used. Results: Most of patients presented depressive actions associated with moderate euphoria. 11 of them related familiar history of psychopathology. Mania and hippomania were prevalent on male gender, while psychotic symptoms overlay ate female. Conclusion: Patients lack a translation of behavioral and temperamental processes to minimize harm caused to their lives.

Syntax of social life in postpartum depression: Mother-child interaction

Purpose: Understand the difficulties and experienced of individuals suffering from postpartum depression, related to mood disturbances, the mother-child bond and its repercussions in the meanings established for the experience of being a mother. Methods: Forty-one patients were interviewed, with ages ranging from 20 to 49 years, from a total of 106 attended at the Primary Care Unit, in the interior of the state of Parahiba, Brazil. A sample of 21 women was selected, presenting an inclusion profile, propitious to mapping postpartum depression. The eligible patients were referred by two PSF (Health Family) teams (one each from the urban and rural zones), aimed at diagnosing the psychic disturbance of the perperium. They were accompanied by a psychologist and all signed an informed consent form. A field diary supported the information recorded. Beck's Depression Inventory complemented the inclusion and follow-up of the patients. The data were analyzed statistically. Results: We confirmed the findings of the most recent studies that infant abandonment in the postpartum period occurs in situations where multiple and serious factors add up, such as misery (86.7%), little schooling (67%), lack of a support network (36.5%), estrangement of the mother's family relations (12%) and lack of paternal involvement (91.5%). Conclusion: The feeling of psyching pain and suffering, resulting from postpartum depression, is the most emphasized by women (87%) because it triggers the greatest discomfort, due to the difficulty in overcoming it.

Role of glycated hemoglobin in the care of diabetes mellitus

Introduction: Persistently high glycemic levels are extremely harmful to the organism and can lead patients to several complications of diabetes mellitus. Glycated hemoglobin represents the glycemic levels for what patient is chronically exposed. Methods: Two virtual databases were surveyed in two languages: Portuguese and English. 12 articles were selected and reviewed. Results and discussion: The HbA1c is used since 1958 in the assessment of glycemic control in diabetic patients. It is formed by a chemical reaction between hemoglobin A and acarbohydrate. Each percentage point of glycated hemoglobin represents approximately 35mg/dL in patient's averageglycemia. Conclusion: The glycated hemoglobin should be measured at least twice per year in patients with diabetes in general. In case of change of hypoglycemic therapy, this frequency should be doubled.

Quantitative comparison of mobility and gross motor function in Brazilian children with cerebral palsy

Background: Cerebral palsy (CP) presents changes in posture and movement as a core characteristic, which requires therapeutic monitoring during the habilitation or rehabilitation of children. Besides clinical treatment, it is fundamental that professionals use systems of evaluation to quantify the difficulties presented to the individual and assist in the organization of a therapeutic program. The aim of this study was to quantitatively verify the performance of children with spastic di-paresia type CP. Methods: The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Classification System (GMFM) tests were used and classification made through the GMFCS in the assessment of 7 patients with CP, 4 females and 3 males, average age of 9 years old. Results: According to GMFCS scales, 17% (n=1) were level II and 83% (n=6) were level III. The PEDI test and 88 GMFM items were used in the area of mobility. We observed that there was high correlation between mobility and gross motor function with Pearson's correlation coefficient =0.929) showing the likely impact of these areas in the functional skills and the quality of life of these patients. Conclusion: We suggest the impact of the limitation of the areas in functional skills and quality of life of these patients.

Metabolic profile of patients with diabetes in Barbalha, Brazil

Introduction: Modern life has imposed to people sedentary habits and excessive food consumption, what results into an increase of the incidence of metabolic diseases, which promote the development of atherosclerosis. Objectives: We aimed to evaluate the metabolic profile of diabetic patients assisted by the endocrinology service from Ceara Federal University, located in Barbalha, Brazil. Methods: This is a transversal and retrospective study, based on the analysis of patient records. 119 records were reviewed and 35 of them were selected, according to their registers about anthropometric and laboratorial measuring. Results and discussion: Among the selected records, 65.71% were female patients. It was observed a positive relationship between age and the level of triglycerides, between LDL-cholesterol and the use of tobacco and between blood glucose and glycated hemoglobin. Conclusion: The superposition of risk factor in this group shows the necessity of an integrated assistance and a follow-up about their metabolic profile, aiming to mitigate or retard serious circulatory pathologies.

Vitamin E and Carnitine suplementation effects on blood glucose levels in young rats submitted to exhaustive exercise stress

Background: In this study we evaluated the effects of carnitine and vitamin E supplementation on blood glucose levels in young rats submitted to exhaustive exercise stress. Methods: Wistar rats were divided into four groups: 1) control group; 2) exercise stress group; 3) exercise stress + Vitamin E and; 4) exercise stress + carnitine group. Rats from the group 3 and 4 were treated with gavage administration of 1 mL of Vitamin E (5mg/kg) and carnitine (5mg/kg) for seven consecutive days. Animals from groups 2, 3 and 4 were submitted to a bout of swimming exhaustive exercise stress. We analyzed blood glucose levels after exercise stress. Results: Blood glucose levels after exercise stress were significantly increased in the groups treated with Vitamine E and carnitine (control group: 98.7 +/- 9mg/dL vs. stress group: 84.2 +/- 11 mg/dL vs. carnitine + stress group: 147.4 +/- 15 mg/dL vs. vintamin E + stress: 158.3 +/- 7 mg/dL; p<0.0001). Conclusion: Vitamin E and carnitine supplementation attenuate the hypoglycemia induced by exercise in young rats submitted to exhaustive exercise stress.

Basic assistance for mental health in Northeast Brazil

Introduction: Brazilian northeast region is historically affected by socioeconomic problems that made this region more needful for strategies regarding to psychiatric disorders assistance. Methods: This study includes original analysis based on data of secondary level health assistance, extracted from Brazil's Hospitalar Information System, Basic Assistance Information System and Brazilian Institute of Geographic and Statistics. Results: Between 2008 and 2010, more than two hundred million dollars were spent by Brazilian federal government to achieve better quality in the assistance for mental health in Northeast. The service network responsible for the treatment of mental disorders in primary care involves a wide range of professionals and establishments. Conclusion: In northeastern Brazil, socioeconomic and geographic conditions contribute to a particular state of vulnerability for the development of psychopathologies. The association of primary care and an integrated network of public health, however, have improved the attention to mental disordersin this region.

Weight and neuro-psycho-motor development in children discharged from neonatal intensive care unit

Background: Low birth weight affects child growth and development, requiring the intensive use of health services. There are conversely proportional associations between prematurity and academic performance around the world. In this study we evaluated factors involved in weight and neuropsychomotor profile in one and two years old discharged from Intensive Care Units (ICU). Methods/Design: We investigated 203 children from the ICU who were followed for 24 +/- 4 months. The research was conducted by collecting data from medical records of patients in a Follow-up program. We investigated the following variables: inadequate weight at one year old; inadequate weight at two years old and a severe neurological disorder at two years old. Results: We observed increase of almost 20% in the proportion of children which weighted between the 10th and 90th percentiles and decrease of around 40% of children below the 15th percentile, from one to two years old. In almost 60% of the cases neuropsychomotor development was normal at 2 years old, less than 15% of children presented abnormal development. Variables that remained influential for clinical outcome at 1 and 2 years old were related to birth weight and gestational age, except for hypoglycemia. Neurological examination was the most influential variable for severe neurological disturbance. Conclusion: Hypoglycemia was considered a new fact to explain inadequate weight. The results, new in Brazil and difficult in terms of comparison, could be used to identify risk factors and for a better approach of newborn discharged from ICUs.

Fertility in Curitiba, Brazil: levels, trends and differentials

Objectives: To identify levels, tendency and recent differentials in fertility in Curitiba, Brazil. Methods: It is a quantitative and temporal series study, in which the birth rates, general and total fertility indicators, for the period of 1995-2007, were calculated and analyzed in Curitiba, Brazil, as well as the proportion of women with high fertility in 2005-2007, compared to the state of Parana. In order to evaluate inner regional differences in the city of Curitiba the same rates were calculated for each one of the administrative districts in the capital. Results: It was noticed a tendency of decline in fertility rates in Curitiba. The total fertility rate in 2007 was 1.49 children per woman and 1.66 in Parana state. The proportion of women with high fertility in the interior of Parana was 1.8 times higher than in the capital. The analysis of fertility rates by districts in Curitiba pointed out important differences: only 10 out of 75 districts had total fertility rates higher than 2.1 children per woman, and 9 districts concentrated 59.6% of women with high fertility. Conclusions: Curitiba showed a quick and sharp reduction in fertility rates. However, the inner regional differences in the city suggests the need to devise actions of reproductive health and social measures, directed to specific groups of population.

Muscle lesion treatment in Brazilian soccer players: theory vs. practice

Background: In this study we evaluated the rehabilitation profile of Brazilian soccer players which underwent lower limb muscle lesions. Methods: This is a descriptive investigation. We evaluated 139 professional soccer players (1724 years old). We evaluated the following variables: muscle lesion diagnosis, symptoms, non steroidal anti-inflammatory used, physiotherapy treatment, which physiotherapy recourses was used if treated and train adaptation. Results: In great part of the athletes muscle lesion remained between 2 weeks and 1 month. Around 54% were diagnosed by a physician; the other part was diagnosed by a physical therapist. Non steroidal anti-inflammatory were prescribed by physicians in 42% of the cases; in 7% the physical therapist prescribed the medication while in 49% of the cases the masseur prescribed the drug. More than 1/4 of the athletes received physiotherapy treatement between 48 hours and 5 days. Isometric exercise therapy was applied in 15% of the cases. 63% were not accompanied by the physiotherapist on their return to the field. 48% received massages immediately after injury. Conclusion: We presented discrepancy between the recommended theory described by several researches and the practice. We indicate the necessity of recycling in a general context the rehabilitation of muscle injuries.

Bioethical Aspects Across Medicine: The Care of Cardiovascular Diseases in Brazil

Bioethics applied to medicine extrapolates the traditional medical concepts of non-maleficence (primum non nocere) and beneficence (bonum facere) and regards to justice, autonomy, equity, protection, compassion and humanization, not considering people just like patients, but understanding the complex existence of each single person. Worldwide, the morbidity and mortality indices regarding to diseases of heart and blood vessels became progressively grater. For countries in development, like Brazil, these numbers are even more expressive and this increase trend seems to be caused by wider exposition of population to some risk factors. This article broaches an intersection between bioethics and medicine, focusing the reality of cardiovascular diseases in Brazil and the necessity of doctors to base their behavior in bioethical paradigms.

Nutritional transition of school children from low income families of a northeastern urban area, Brazil

Background: Evaluating child growth is, in practice, performed by measuring the development of a child's weight, height, and body composition in comparison to averages observed among a reference population. Objective: To describe the nutritional status of children of low income families who live in urban region in northeastern Brazil. Methods: This study is a population case series with a transversal and observational design. The study population consisted of 257 children, aged 5 to 10 years, who were enrolled in a public school to children of low income families. We used the cutoff point for short stature of -2 Z scores for age, and underweight, overweight, and obese were classified as the 5th, 85th, and 95th percentiles, respectively, of the body mass index (BMI) for age, with both classifications in accordance with the Center for Disease Control and Prevention (CDC 2000). Comparisons by gender were performed for the measures of the central tendency and the frequency of diagnoses, in addition to the tendency of the evolution of BMI by age. Results: The prevalence of short stature was 3.5% (95% CI: 1.9-6.5). In the evaluation of BMI for age, the prevalences found for underweight, overweight, and obese were 5.8% (95% CI: 3.6-9.4), 4.7% (95% CI: 2.7-8.0), and 2.3% (95% CI: 1.1-5.0), respectively. We found a significant trend in the reduction of BMI with the increase in age. Conclusions: According to CDC references, the prevalences of underweight and short stature were higher than expected and for the overweight and obesity were lower than expected, indicating that the nutritional transition had still not reached, as commonly is described, these low income children from the urban outskirts of the Northeast region.