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Introduction: The Syndrome Z (SyndZ) has been drawing scientific community’s attention on the past years. It is characterized by the interaction between obstructive sleep apnea (OSA) and Metabolic Syndrome (MetS). On its turn, MetS is knew for the association with various metabolic disturbances occurring simultaneously in the same patient, those of which include central obesity, systemic hypertension (SH), glucose intolerance or insulin resitance, low serum high-density lipoprotein cholesterol (HDL), and elevated serum triglycerides. OSA is a prevalent condition all over the world, and presents potential adverse health outcomes, with a particular impact in cardiovascular diseases. Therefore, OSA and MetS present important cardiovascular risk factors, that when superimposed can mean a higher cardiovascular morbi-mortality. This associated pathogenesis has not been completely elucidated. Objectives: A pilot study to determine the prevalence and severity of SyndZ in severely obese female patients on the waiting list for bariatric surgery. Methods/Design: This cross-sectional study will be conducted with severely obese female patients, on waiting list for bariatric surgery, from the Santa Casa de Misericordia de São Paulo Hospital, in the city of Sao Paulo (Brazil). Demographic, anthropometric and clinical data will be collected, as well as blood’s biochemical analysis. The patients will also undergo standard overnight polysomnography at the Sleep Laboratory of Nove de Julho University.

Background: Although the progressive nature of pulmonary hypertension (PH), including the impairment of respiratory muscle function, studies have demonstrated beneficial effects of physical exercise on the functional limitations caused by the disease in this population, being an important ally to the conventional drug therapy. There is no training protocol focused exclusively on respiratory musculature that is performed without supervision, since these patients have low adherence to the rehabilitation programs performed in an outpatient setting. Respiratory muscle training (RMT) improves functional capacity and quality of life (QoL) in patients with chronic diseases such as heart failure and COPD. However, the effects of an unsupervised RMT protocol on PH are not yet known. Objective: To developed an unsupervised, home-based RMT protocol for patients with PH. Methods: A double-blind, controlled, randomized clinical trial to evaluate the effectiveness of this protocol on respiratory muscle strength and endurance, functional capacity, by the six-minute walk test and QoL with the questionnaire The Medical Outcomes Study 36- item Short Form Health Survey (Sf-36) before and after an unsupervised training protocol and performed in a home environment with POWERbreathe. Two groups (IMT and SHAM) will be followed for 12 weeks with training performed 30 minutes daily. Results: We hope the intervention idealized by the protocol may will increase the respiratory muscle strength and endurance, the walk distance in six-minute walk test and QoL. Conclusions: Patients with PH who perform the intervention with inspiratory muscle training protocol may will be increase the respiratory muscle strength, functional capacity and QoL.

Introduction: Vaginismus is characterized by involuntary recurrent or persistent contraction of the perineum muscles adjacent to the lower third of the vagina when vaginal penetration with penis, finger, tampon or speculum is attempted. However, there may be low adherence to the therapy due to the need of the touch of the perineal region by the therapist. The interferential current can be an alternative, once it can be used externally and superficially. Objective: To evaluate a clinical protocol with the use of interferential current to treat vaginismus and to observe the decrease of pain and the behavior of the electrical activity on the perineal musculature. Methods: The protocol was registered in the Clinical Trials (NCT03176069) and it was approved by the Research Ethics Committee (CAAE: 51995515.4.0000.5479). This will be a controlled clinical trial with a group of patients with Vaginismus (n = 30) and another without (n = 30). All women will be submitted to evaluation and reassessment with algometry, electromyographic biofeedback and visual analogue pain scale. The vaginismus group will perform 10 sessions, twice a week, with the interferential current (frequency = 2000 Hz, modulated amplitude = 80 Hz, pulse width = 200 μs and intensity according to sensory level) for 30 minutes. The evolution of vaginismus group before and after the intervention and the correlations between groups will be statistically analysed with the t Student’s or the Mann-Whitney test with a significance level of 5% (p ≤ 0.05). Hypothesis: This protocol will present a possible alternative for the treatment of vaginismus and it will investigate the electrical activity of the pelvic floor musculature in vaginismus compared to women who do not suffer from this disorder. It is expected to decrease the pain, to measure the muscular electrical activity before and after the intervention in the vaginismus group and to investigate the muscular electrical activity in the group without sexual dysfunction.

Antecedentes: A hipertensao arterial sistemica (HAS) e uma doenca cardiovascular comum que reflete uma importante incidencia e prevalencia para a saude publica, sendo a apneia obstrutiva do sono (AOS) considerada a segunda causa de HAS. O exercicio aerobico e uma das acoes para controlar as alteracoes da pressao arterial. Objetivos: Verificar o perfil antropometrico, a aptidao fisica, a funcao pulmonar, a presenca de disturbios respiratorios do sono e o comportamento da atividade autonomica em hipertensos submetidos ao treinamento aerobico. Metodos / Projeto: Este e um estudo randomizado, controlado e cego. O desenho, conducao e relatorio deste estudo seguiram as diretrizes do CONSORT (declaracao CONsolidated Standards of Reporting Trials). O estudo sera realizado entre julho de 2015 e dezembro de 2017, e incluira pacientes hipertensos controlados de ambos os sexos, com idade entre 30 e 70 anos, com diagnostico clinico de hipertensao primaria (estagio 1, pressao arterial sistolica e diastolica com variacoes de 140/79 a 90/109 mmHg), controlados por medicamentos especificos, que nao contem betabloqueadores. Os pacientes que nao apresentarem liberacao clinica para participar do programa de treinamento, com presenca de outra doenca cardiovascular ou doenca nos orgaos-alvo e que apresentarem os fatores de risco de fumaca e alcool, estarao nos criterios de exclusao. A amostra sera de conveniencia, encaminhada pela Secretaria de Saude do Bairro Aeroporto Velho e pela Unidade de Referencia Especializada - URE de Santarem (PA). Inicialmente, sera uma avaliacao clinica realizada por um cardiologista e os sujeitos serao submetidos a varios exames de rotina, como ecocardiograma, radiografia de torax e exames laboratoriais (hemograma completo, glicose, glicemia de jejum, colesterol e fracoes totais, triglicerideos, proteina C reativa , potassio, etc). Apos a avaliacao medica inicial, serao aplicados alguns questionarios e outros testes especificos, como o Questionario de Qualidade de Vida (SF-36), Questionario de prontidao para atividade fisica, Questionario de Berlim, Escala de sonolencia Epworth, Escala de sonolencia de Stanford, Escala de sonolencia de Stanford, Monitoramento cardiorrespiratorio do sono, Questionario de aptidao fisica , monitoramento da variabilidade da frequencia cardiaca, testes de funcao pulmonar e teste de caminhada de seis minutos. Todos os pacientes realizarao os testes antes e apos o protocolo de exercicios de reabilitacao de 12 semanas. O protocolo de treinamento aerobico sera de 30 a 60 minutos, com intensidade variando entre 70% e 85% da FC maxima alcancada no teste de esforco de avaliacao funcional e sera realizado por tres meses, tres vezes por semana. INSCRICAO DO TESTE: Este estudo de protocolo foi aprovado pelo Comite de Etica em Pesquisa da Universidade Nove de Julho (UNINOVE), Brasil, processo no 370474/2010, e sera registrado no ensaiosclinicos.gov.br