Gisela Rocha de Siqueira

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.

Violência entre torcidas nos estádios de futebol: uma questão de Saúde Pública

Este artigo tem o objetivo de trazer a debate a tematica da violencia entre torcedores nos estadios de futebol sob o foco da perspectiva da Saude Publica. Foi desenvolvido a partir de uma revisao de literatura, consubstanciada por uma consulta a Secretaria de Saude Publica e a Policia Militar do Estado de Pernambuco. A partir disso, ficaram constatadas a escassez de dados relacionados ao assunto, a subutilizacao dos dados existentes e a falta de intercâmbio entre as instituicoes para utiliza-los na criacao de mecanismos de reflexao e acao conjunta em busca de solucoes para o problema. Na coleta de material, foram consultadas obras de referencia, dentre elas: livros, periodicos, anais de congressos, priorizando-se textos da literatura das ultimas duas decadas nos idiomas portugues e ingles. Foram consultados tambem base de dados da literatura cientifica on-line como Lilacs, Medline, Scielo, Bireme, entre outros, utilizando-se os seguintes descritores: violencia, torcedores, torcidas organizadas, futebol, saude publica. Este artigo propoe uma reflexao sobre a possibilidade de propostas e procura apontar caminhos para uma mudanca de comportamento a partir de um melhor entendimento desse fenomeno tao atual quanto complexo no cenario da sociedade brasileira.

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.

Efeito do pilates sobre a flexibilidade do tronco e as medidas ultrassonográficas dos músculos abdominais

Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle strength. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, transversus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.INTRODUCAO: a Pilates consiste em um metodo de treinamento fisico e mental que trabalha a flexibilidade e a forca muscular. Esse metodo prioriza fortalecer o conjunto de musculos responsavel pelo controle de tronco, chamado de Powerhouse e, consequentemente, aumentar o trofismo dos musculos abdominais reto do abdome, obliquo interno e externo, transverso do abdome, gluteos, musculos do perineo e paravertebrais lombares.OBJETIVO: avaliar o efeito do metodo Pilates sobre o trofismo do grupamento abdominal e na flexibilidade do tronco, comparado a aplicacao de uma tecnica tradicional de fortalecimento dos musculos abdominais e alongamentos estaticos em mulheres saudaveis.METODOS: treze mulheres sedentarias e saudaveis na faixa etaria entre 18 e 25 anos foram submetidas a 10 sessoes de Pilates grupo Pilates, n = 6 e 10 sessoes de alongamento e fortalecimento tradicionais grupo controle, n = 7. Antes e apos as intervencoes, o trofismo da musculatura abdominal das voluntarias foi avaliado atraves do ultrassom e a flexibilidade do tronco atraves do fleximetro.RESULTADOS: no grupo Pilates, apos a intervencao, houve um aumento significativo das medidas ultrassonograficas do reto do abdome, da amplitude da rotacao para direita e esquerda e da inclinacao da coluna vertebral para a esquerda. No grupo controle, observou-se melhora apenas na rotacao para a esquerda.CONCLUSAO: o numero de sessoes pode ter sido insuficiente para que ocorresse aumento do trofismo de todos os musculos avaliados e da flexibilidade do tronco. E importante investir em pesquisas sobre Pilates, especialmente com a utilizacao de metodos de imagem mais acurados.ABSTRACT Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle streng-th. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, trans-versus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.Keywords: physical therapy, ultrasonics, abdomen, exercise movement techniques.

Prevalência de desconforto osteomuscular e fatores associados em estudantes universitários

Objective: To assess the prevalence and factors associated with musculoskeletal pain in college students. Methods: A descriptive cross-sectional study, with representative sample (n = 527) selected from two-stage cluster considering the ratio of students per course and period. The dependent variable - the musculoskeletal pain - was assessed by a questionnaire. The independent variables were divided into socioeconomic factors regarding the institution, health behaviors and health perception. Data was tabulated in EpiData 3.1 and further analysis was performed with SPSS 12.0 using the chi-square and Student’s t test, adopting p<0.05. For the logistic regression, the pain was considered dependent, the other variables being adjusted. Results: The thoracic region presented the highest average pain intensity (6.23), followed by lumbar (5.85) and cervical (5.80) pain. The discomfort was more prevalent in women, with negative perception of health due to remaining seated for longer. There was also a higher prevalence among students in the health area, when compared to students in the humanities. Conclusion: The result indicated thoracic, lumbar and cervical regions with greater intensity of referred pain. The associated factors were gender, study area and footwear, influencing the perception of health. doi:10.5020/18061230.2013.p242

Concordance and Reliability of Photogrammetric Protocols for Measuring the Cervical Lordosis Angle: A Systematic Review of the Literature

OBJECTIVE The aim of this study was to examine and interpret the concordance, accuracy, and reliability of photogrammetric protocols available in the literature for evaluating cervical lordosis in an adult population aged 18 to 59 years. METHODS A systematic search of 6 electronic databases (MEDLINE via PubMed, LILACS, CINAHL, Scopus, ScienceDirect, and Web of Science) located studies that assessed the reliability and/or concordance and/or accuracy of photogrammetric protocols for evaluating cervical lordosis, compared with radiography. Articles published through April 2016 were selected. Two independent reviewers used a critical appraisal tool (QUADAS and QAREL) to assess the quality of the selected studies. RESULTS Two studies were included in the review and had high levels of reliability (intraclass correlation coefficient: 0.974-0.98). Only 1 study assessed the concordance between the methods, which was calculated using Pearsons correlation coefficient. To date, the accuracy of photogrammetry has not been investigated thoroughly. CONCLUSION We encountered no study in the literature that investigated the accuracy of photogrammetry in diagnosing hyperlordosis of cervical spine. However, both current studies report high levels of intra- and interrater reliability. To increase the level of evidence of photogrammetry in the evaluation of cervical lordosis, it is necessary to conduct further studies using a larger sample to increase the external validity of the findings.

Effect of low frequency transcutaneous electrical nerve stimulation of TE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain

[Purpose] This study assesse the effect of low frequency transcutaneous electrical nerve stimulation (TENS) of theTE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain. [Subjects and Methods] Forty-eight subjects were divided by convenience into three groups: TENS with electrodes of 1 cm2 area, TENS with electrodes of area 15 cm2 and a placebo group. The study consisted of three phases: cold-induced pain without electroanalgesia, cold-induced pain with electroanalgesia or placebo, and cold-induced pain post-electroanalgesia or placebo. [Results] Acupuncture like TENS increased the pain threshold latency during treatment (45.7 ± 11.7s) compared to pre-treatment (30.9 ± 8.9s) in the TENS group with 1 cm2 electrodes. In the TENS group with 15 cm2 electrodes, the pain threshold latency increased at post-treatment (36.2 ± 12.9s) compared to pre-treatment (25.5 ± 7.4s). The placebo group showed no significant changes. The group with 1 cm2 electrodes showed a significantly higher pain threshold latency (45.7 ± 11.7s) than the other two groups. At post-treatment, the pain threshold latencies of both the 1 cm2 (39.4 ± 11.5s) and 15 cm2 (36.2 ± 12.9s) TENS group were higher than that of the placebo group (22.4 ± 7.4s). [Conclusion] Acupuncture like TENS applied to PC6 and TE5 acupoints increased the pain threshold latency. The pain intensity was reduced by TENS with an electrode area of 1 cm2.

Effect of pilates on trunk flexibility and ultrasound measures of abdominal muscles

Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle strength. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, transversus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.INTRODUCAO: a Pilates consiste em um metodo de treinamento fisico e mental que trabalha a flexibilidade e a forca muscular. Esse metodo prioriza fortalecer o conjunto de musculos responsavel pelo controle de tronco, chamado de Powerhouse e, consequentemente, aumentar o trofismo dos musculos abdominais reto do abdome, obliquo interno e externo, transverso do abdome, gluteos, musculos do perineo e paravertebrais lombares.OBJETIVO: avaliar o efeito do metodo Pilates sobre o trofismo do grupamento abdominal e na flexibilidade do tronco, comparado a aplicacao de uma tecnica tradicional de fortalecimento dos musculos abdominais e alongamentos estaticos em mulheres saudaveis.METODOS: treze mulheres sedentarias e saudaveis na faixa etaria entre 18 e 25 anos foram submetidas a 10 sessoes de Pilates grupo Pilates, n = 6 e 10 sessoes de alongamento e fortalecimento tradicionais grupo controle, n = 7. Antes e apos as intervencoes, o trofismo da musculatura abdominal das voluntarias foi avaliado atraves do ultrassom e a flexibilidade do tronco atraves do fleximetro.RESULTADOS: no grupo Pilates, apos a intervencao, houve um aumento significativo das medidas ultrassonograficas do reto do abdome, da amplitude da rotacao para direita e esquerda e da inclinacao da coluna vertebral para a esquerda. No grupo controle, observou-se melhora apenas na rotacao para a esquerda.CONCLUSAO: o numero de sessoes pode ter sido insuficiente para que ocorresse aumento do trofismo de todos os musculos avaliados e da flexibilidade do tronco. E importante investir em pesquisas sobre Pilates, especialmente com a utilizacao de metodos de imagem mais acurados.ABSTRACT Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle streng-th. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, trans-versus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.Keywords: physical therapy, ultrasonics, abdomen, exercise movement techniques.

Efecto del pilates en la flexibilidad del torso y las medidas de los músculos abdominales por ultrasonido

Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle strength. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, transversus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.INTRODUCAO: a Pilates consiste em um metodo de treinamento fisico e mental que trabalha a flexibilidade e a forca muscular. Esse metodo prioriza fortalecer o conjunto de musculos responsavel pelo controle de tronco, chamado de Powerhouse e, consequentemente, aumentar o trofismo dos musculos abdominais reto do abdome, obliquo interno e externo, transverso do abdome, gluteos, musculos do perineo e paravertebrais lombares.OBJETIVO: avaliar o efeito do metodo Pilates sobre o trofismo do grupamento abdominal e na flexibilidade do tronco, comparado a aplicacao de uma tecnica tradicional de fortalecimento dos musculos abdominais e alongamentos estaticos em mulheres saudaveis.METODOS: treze mulheres sedentarias e saudaveis na faixa etaria entre 18 e 25 anos foram submetidas a 10 sessoes de Pilates grupo Pilates, n = 6 e 10 sessoes de alongamento e fortalecimento tradicionais grupo controle, n = 7. Antes e apos as intervencoes, o trofismo da musculatura abdominal das voluntarias foi avaliado atraves do ultrassom e a flexibilidade do tronco atraves do fleximetro.RESULTADOS: no grupo Pilates, apos a intervencao, houve um aumento significativo das medidas ultrassonograficas do reto do abdome, da amplitude da rotacao para direita e esquerda e da inclinacao da coluna vertebral para a esquerda. No grupo controle, observou-se melhora apenas na rotacao para a esquerda.CONCLUSAO: o numero de sessoes pode ter sido insuficiente para que ocorresse aumento do trofismo de todos os musculos avaliados e da flexibilidade do tronco. E importante investir em pesquisas sobre Pilates, especialmente com a utilizacao de metodos de imagem mais acurados.ABSTRACT Introduction: Pilates is a method of physical and mental training that works on flexibility and muscle streng-th. This method prioritizes strengthening the set of muscles responsible for trunk control, called Powerhouse, and thereby increase the trophysm of the abdominal muscles (rectus abdominis, internal and external oblique, trans-versus abdominis), gluteus, perineal and lumbar paraspinal muscles. Objective: to evaluate the effect of the Pilates method on the trophysm of abdominal and trunk flexibility compared to the application of a traditional technique to strengthen the abdominal muscles and static stretching in healthy women. Methods: thirteen healthy sedentary women, aged between 18 and 25 years underwent 10 sessions of Pilates (Pilates group, n=6) and 10 sessions of traditional stretching and strengthening (control group, n=7). Before and after the intervention, the trophysm of the abdominal muscles of the volunteers was assessed using ultrasound, and trunk flexibility was evaluated through the fleximeter. Results: after the intervention, there was a significant increase in ultrasound measures of the rectus abdominis muscle, the range of the rotation to right and left, and tilt of the spine to the left in the Pilates group. In the control group, improvement was observed only in the rotation to the left. Conclusion: the number of sessions may have been insufficient for the increase in the trophysm of all muscles tested and the flexibility of the trunk to occur. It is important to invest in research on Pilates, especially with the use of more accurate imaging methods.Keywords: physical therapy, ultrasonics, abdomen, exercise movement techniques.