Angélica da Silva Tenório

Early vibrissae removal facilitates cortical spreading depression propagation in the brain of well-nourished and malnourished developing rats

Reduced sensory input activity during brain development can induce morphological and physiological changes in the cerebral cortex, altering their response properties. Malnutrition delays the formation of somatosensory pathways. Here we used cortical spreading depression as a neurophysiological parameter to investigate electrophysiological changes after vibrissae removal in well‐nourished and malnourished rats. Male Wistar rat pups had the right mystacial vibrissae‐removed at postnatal days 2–3, and were submitted to spreading depression recording at 30–40 days of life. In both nutritional conditions, spreading depression velocities were increased in the hemisphere contralateral to the vibrissae removal, as compared to age‐ and nutrition‐matched non‐lesioned controls, in which no inter‐hemispheric differences were found. In contrast to the well‐nourished rats, in the vibrissae‐removed malnourished animals the spreading depression propagation in the ipsilateral hemisphere decreased as compared to the corresponding hemisphere of the non‐lesioned malnourished rats. It is concluded that deprivation of sensory input from whiskers during brain development facilitates spreading depression propagation, and early malnutrition seems to influence this effect. Since the effect persisted until 40 days, it is tempting to suggest that it is permanent, or at least long‐lasting. Data might contribute to the understanding of sensory input deprivation‐induced plasticity mechanisms underlying cerebral electrophysiological changes in the developing brain.

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment

Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 2 – Tratamento

Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommen-s, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face S440 r e v b r a s r e u m a t o l . 2 0 1 7;5 7(S 2):S438–S451 meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia–SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever: part 1 - diagnosis and special situations

Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

Lasting facilitatory effects of neonatal vibrissae removal on the propagation of cortical spreading depression: an electrophysiological study in well-nourished and early-malnourished adult rats

Abstract Early malnutrition interferes with the formation of somatosensory pathways and reduced sensory input activity during brain development can induce morphological and physiological changes in the cerebral cortex, altering their response properties in the long-term. Here, we investigated cortical spreading depression (CSD) propagation in male adult rats submitted to unilateral vibrissae removal, at postnatal days 2–3, and malnourished during lactation followed by nutritional recovery until adulthood (90–120 days), when CSD was recorded. Compared to nutrition-matched non-lesioned controls, CSD-propagation was increased in the hemisphere contralateral to the vibrissae removal. The findings indicate that vibrissae removal during brain development enhances CSD-propagation, and early malnutrition did not modify this effect. Considering that CSD-facilitation persisted until adulthood, we suggest that this effect is permanent. The data might contribute to the understanding of the mechanisms by which sensory input deprivation-induced plasticity modifies cerebral electrophysiological responses in the developing brain.

Efficacy of the whole-body vibration for pain, fatigue and quality of life in women with fibromyalgia: a systematic review

Abstract Purpose: To determine the quality of evidence on the use of whole-body vibration (WBV) in controlling pain, fatigue and quality of life in women with fibromyalgia. Methods: The search involved MEDLINE/PubMed, LILACS, CINAHL, CENTRAL and PEDro, without temporal or language restriction. The terms “fibromyalgia” and “whole-body vibration” were used. Trials (randomized or quasi-randomized) that compared a group of women with fibromyalgia who received WBV to a control group with no intervention were included. The quality of evidence was assessed using the GRADE system. The quantitative evaluation by meta-analysis was also used, whenever possible. Results: Three studies were included. Regarding the outcome pain, it has not been possible to assess the magnitude of effect of treatment. The result of the outcome fatigue showed no difference between the groups after the proposed intervention (Mean Difference: 0.01; 95% CI: −0.11 to 0.09). The meta-analysis for the outcome quality of life showed a small difference between groups, favoring the WBV group (Standard Mean Difference: 0.4943; p = 0.05; 95% CI: 0.0045 to 0.9841). Conclusions: The results, based on very low quality of evidence, were inconclusive regarding pain, and showed no clinically important effects on the control of fatigue and improvement of quality of life. Implications for rehabilitation There is no evidence to support the use of whole-body vibration for pain treatment of women with fibromyalgia. The use of whole-body vibration in women with fibromyalgia showed no clinically important effects in the control of fatigue and improvement of quality of life.

Efeitos da pompage associada ao exercício aeróbico sobre dor, fadiga e qualidade do sono em mulheres com fibromialgia: um estudo piloto

Para evaluar los efectos de la pompage como terapia complementaria a los ejercicios aerobicos y de estiramiento en el dolor, fatiga y en la calidad de sueno de mujeres con fibromialgia (MF), se dividieron veintitres mujeres con este diagnostico en grupos al alzar: Grupo Experimental (GE, n=13) y Grupo Control (GC, n=10). Despues les aplicaron el Cuestionario de dolor McGill, el Cuestionario de fatiga de Chalder y el Inventario del sueno. Durante 12 semanas, dos veces a la semana, el GE hizo pompage, ejercicios aerobicos y estiramientos, mientras que el GC solo hizo ejercicios aerobicos y estiramientos. Se repitio la evaluacion despues de 6 y 12 semanas. La cantidad de participantes redujo para 15 (GE, n=7, GC, n=8). En el analisis estadistico se empelo la ANOVA para medidas iguales, la prueba t para las muestras independientes, en las cuales presentaron diferencias significantes (p ≤ 0,05). En la puntuacion de dimension mixta del Cuestionario de dolor McGill tras 12 semanas presento reduccion significativa en el GE comparado al GC. En los demas items evaluados, dolor, fatiga y calidad de sueno, no se observaron diferencias significantes. Asi que la pompage como terapia complementaria a ejercicios aerobicos y de estiramiento no presento efectos relevantes en mujeres con FM, debido a que solamente uno de los items de dolor evaluados ha presentado mejora. Son necesarios estudios con muestras mas grandes para un analisis mas detenido de los items evaluados.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.

Effects of pompage associated with aerobic exercises on pain, fatigue, and sleep quality in female patients with fibromyalgia: a pilot study

Para evaluar los efectos de la pompage como terapia complementaria a los ejercicios aerobicos y de estiramiento en el dolor, fatiga y en la calidad de sueno de mujeres con fibromialgia (MF), se dividieron veintitres mujeres con este diagnostico en grupos al alzar: Grupo Experimental (GE, n=13) y Grupo Control (GC, n=10). Despues les aplicaron el Cuestionario de dolor McGill, el Cuestionario de fatiga de Chalder y el Inventario del sueno. Durante 12 semanas, dos veces a la semana, el GE hizo pompage, ejercicios aerobicos y estiramientos, mientras que el GC solo hizo ejercicios aerobicos y estiramientos. Se repitio la evaluacion despues de 6 y 12 semanas. La cantidad de participantes redujo para 15 (GE, n=7, GC, n=8). En el analisis estadistico se empelo la ANOVA para medidas iguales, la prueba t para las muestras independientes, en las cuales presentaron diferencias significantes (p ≤ 0,05). En la puntuacion de dimension mixta del Cuestionario de dolor McGill tras 12 semanas presento reduccion significativa en el GE comparado al GC. En los demas items evaluados, dolor, fatiga y calidad de sueno, no se observaron diferencias significantes. Asi que la pompage como terapia complementaria a ejercicios aerobicos y de estiramiento no presento efectos relevantes en mujeres con FM, debido a que solamente uno de los items de dolor evaluados ha presentado mejora. Son necesarios estudios con muestras mas grandes para un analisis mas detenido de los items evaluados.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.

Los efectos de la pompage con ejercicios aeróbicos en el dolor, fatiga y en la calidad de sueño de mujeres con fibromialgia: un estudio piloto

Para evaluar los efectos de la pompage como terapia complementaria a los ejercicios aerobicos y de estiramiento en el dolor, fatiga y en la calidad de sueno de mujeres con fibromialgia (MF), se dividieron veintitres mujeres con este diagnostico en grupos al alzar: Grupo Experimental (GE, n=13) y Grupo Control (GC, n=10). Despues les aplicaron el Cuestionario de dolor McGill, el Cuestionario de fatiga de Chalder y el Inventario del sueno. Durante 12 semanas, dos veces a la semana, el GE hizo pompage, ejercicios aerobicos y estiramientos, mientras que el GC solo hizo ejercicios aerobicos y estiramientos. Se repitio la evaluacion despues de 6 y 12 semanas. La cantidad de participantes redujo para 15 (GE, n=7, GC, n=8). En el analisis estadistico se empelo la ANOVA para medidas iguales, la prueba t para las muestras independientes, en las cuales presentaron diferencias significantes (p ≤ 0,05). En la puntuacion de dimension mixta del Cuestionario de dolor McGill tras 12 semanas presento reduccion significativa en el GE comparado al GC. En los demas items evaluados, dolor, fatiga y calidad de sueno, no se observaron diferencias significantes. Asi que la pompage como terapia complementaria a ejercicios aerobicos y de estiramiento no presento efectos relevantes en mujeres con FM, debido a que solamente uno de los items de dolor evaluados ha presentado mejora. Son necesarios estudios con muestras mas grandes para un analisis mas detenido de los items evaluados.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.