Josimari Melo de Santana

Radiographic measurement of the cervical spine in patients with temporomandibular dysfunction

AIM To compare the craniocervical angles and distances between temporomandibular dysfunction (TMD) and free TMD subjects. CASUISTIC AND METHODS The sample consisted of young adults, of both genders, with age ranging between 18 and 30 years. TMD diagnosis was based on the clinical criteria of the Research Diagnostic Criteria for TMD (RDC/TMD), associated with self-reported symptoms of TMD. For radiological analysis we measured three angles and two distances of craniocervical region. RESULTS Of the 56 subjects, only 23 completed all stages of research, which were divided into two groups: (1) free TMD group - composed of 11 individuals; (2) TMD group - constituted of 12 subjects. The most common clinical diagnosis of TMD was arthralgia (75.0%) followed by myofascial pain without limited mouth opening (58.4%). Among the self-reported symptoms of TMD, the most frequents were facial (83.4%) and neck (66.6%) pain. Of radiological measurement, only plane atlas angle (APA) (p=0.026) and anterior translation distance (Tz C(2)-C(7)) (p=0.045) showed statistical difference between groups TMD (APA=16.7+/-1.63; Tz C(2)-C(7)=28.7+/-2.58) and free TMD (APA=21.64+/-1.24; Tz C(2)-C(7)=19.82+/-3.29). CONCLUSION It could be verified that the symptomatic TMD patients presented a flexion of the first cervical vertebra associated with an anteriorization of the cervical spine (hyperlordosis).

Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients.

ObjectiveThe objective of this study was to determine the frequency of signs and symptoms of temporomandibular disorder (TMD) in fibromyalgic patients. MethodsSixty subjects of both sexes (mean age, 49.2 ± 13.8 years) with fibromyalgia (FM) diagnosis were included in this study. All patients were examined by a calibrated investigator to identify the presence of TMD using the Research Diagnostic Criteria for TMD. ResultsThe most common signs (A) and symptoms (B) reported by FM patients were (A) pain in the masticatory muscles (masseter, 80%; posterior digastric, 76.7%), pain in the temporomandibular joint (83.3%), and 33.3% and 28.3%, respectively, presented joint sounds when opening and closing the mouth; (B) headache (97%) and facial pain (81.7%). In regard to the classic triad for the diagnosis of the TMD, it was found that 35% of the FM patients presented, at the same time, pain, joint sounds, and alteration of the mandibular movements. It was verified that myofascial pain without limitation of mouth opening was the most prevalent diagnosis (47%) for the RDC subgroup I. For the subgroup II, the disk displacement with reduction was the most prevalent diagnosis (21.6%). For the subgroup III, 36.7% of the subjects presented osteoarthritis. ConclusionsThus, there is a high prevalence of signs and symptoms of TMD in FM patients, indicating the need for an integrated diagnosis and treatment of these patients, which suggest that the FM could be a medium- or long-term risk factor for the development of TMD.

Female urinary incontinence: quality of life comparison on reproductive age and postmenopausal period

Introduction: urinary incontinence (UI) is defined as any involuntary leakage of urine and their symptoms can affect womens quality of life (QoL). Objectives: to compare incontinent womens QoLin reproductive age (G1) with those in post menopausal period(G2). Material and methods: a descriptive and retrospective study involved 86 women with UI complaints. Clinical, sociodemographic, obstetrical and gynecological antecedents were collected. Pelvic floor evaluation was conducted by digital palpation and QoL was evaluated by Kings Health Questionnaire (KHQ). Mann-Whitney and t Student test were used to compare QoL domains. Results: 36 women in reproductive age (G1) 42.9 (± 7,4) years and 50 women in postmenopausal period (G2) 61,6 (± 9,3) years were assessed. The G2 showed significantly more nocturia (p = 0,0057), urge incontinence (p = 0,0061) and enuresis (0,0021) symptoms, whereas in G1 bladder pain and voiding difficulties were more significant. KHQ domains showed statistical differences in: general health perception (G1 26,4 ± 16,8 versus G2 38,0 ± 16.2; p = 0,0019) and emotions (G1 15,1 ± 31,3 versus G2 38,9 ± 37,5; p = 0,0051). Conclusion: UI affects negatively QoLin women. Women on postmenopausal period showed higher impact on the QoLdomains related to general health perception and emotions.

Validação da versão Brasileira da Escala Comportamental de Dor (Behavioral Pain Scale) em adultos sedados e sob ventilação mecânica

BACKGROUND AND OBJECTIVES The Behavioral Pain Scale is a pain assessment tool for uncommunicative and sedated Intensive Care Unit patients. The lack of a Brazilian scale for pain assessment in adults mechanically ventilated justifies the relevance of this study that aimed to validate the Brazilian version of Behavioral Pain Scale as well as to correlate its scores with the records of physiological parameters, sedation level and severity of disease. METHODS Twenty-five Intensive Care Unit adult patients were included in this study. The Brazilian Behavioral Pain Scale version (previously translated and culturally adapted) and the recording of physiological parameters were performed by two investigators simultaneously during rest, during eye cleaning (non-painful stimulus) and during endotracheal suctioning (painful stimulus). RESULTS High values of responsiveness coefficient (coefficient=3.22) were observed. The Cronbachs alpha of total Behavioral Pain Scale score at eye cleaning and endotracheal suctioning was 0.8. The intraclass correlation coefficient of total Behavioral Pain Scale score was ≥ 0.8 at eye cleaning and endotracheal suctioning. There was a significant highest Behavioral Pain Scale score during application of painful procedure when compared with rest period (p≤0.0001). However, no correlations were observed between pain and hemodynamic parameters, sedation level, and severity of disease. CONCLUSIONS This pioneer validation study of Brazilian Behavioral Pain Scale exhibits satisfactory index of internal consistency, interrater reliability, responsiveness and validity. Therefore, the Brazilian Behavioral Pain Scale version was considered a valid instrument for being used in adult sedated and mechanically ventilated patients in Brazil.

Development of an experimental model of schistosomal myeloradiculopathy

Schistosomal myeloradiculopathy (SMR) is a severe form of presentation of schistosomiasis in which Schistosoma spp. affect the spinal cord. The aims of the present study were to develop an animal model of SMR caused by S. mansoni, to characterize both sensory and motor abnormalities in the infected animals, and to investigate the relationship of the sensory, motor and histological findings with the progression of the infection over time. Mechanical sensitivity and behavioral tests were performed followed by euthanasia in male Wistar rats divided into six groups of five animals each, on days 5, 10, 20 and 30 after infection of S. mansoni eggs. The controls were subjected to the same procedure but were administered phosphate-buffered saline (PBS). The spinal cord was removed and subjected to histological analysis. S. mansoni eggs were found in the spinal cord of 25% of the infected animals, which belonged to the groups that exhibited more significant reduction of the superficial mechanical sensitivity, thermal sensitivity and muscle strength. This model proved to be satisfactory to assess functional changes in Wistar rats and might be used in studies investigating the pathogenesis of SMR. To our knowledge, this is the first experimental model of SMR.

Comparação da qualidade de vida após a cirurgia para câncer de mama associada ou não à radioterapia adjuvante

O tratamento cirurgico e adjuvante do câncer de mama muitas vezes e indispensavel, mas pode trazer complicacoes funcionais. Da mesma forma, o emprego da radioterapia (RT) pode causar efeitos adversos e prejuizo na qualidade de vida (QV). O objetivo do estudo foi avaliar e comparar a QV de mulheres submetidas a cirurgia para o câncer de mama que realizaram ou nao RT adjuvante. Foram incluidas 28 mulheres alocadas em dois grupos: grupo radioterapia (GRT) e grupo controle (GC). O GRT foi investigado antes e apos a RT e o GC somente em um momento. Foi aplicado na forma de entrevista o questionario da European Organization for Research and Treatment of Cancer (EORTC), o Quality of Life Questionnaire C-30 (QLQ-C30) e o Breast Cancer Module (BR-23), especifico para câncer de mama. Para a comparacao entre grupos foi utilizado o teste de Mann Whitney e intragrupo o Wilcoxon Signed Rank Test, adotando significância p<0,05. Observou-se piora da QV no item funcao fisica e desempenho funcional da escala de funcoes em ambos os grupos (p=0,00 e p= 0,02) e do item fadiga na escala de sintomas na analise final do GRT quando comparado com o GC (p=0,03). Nos demais itens nao foram encontradas diferencas significativas. Na analise dos escores do BR-23 verificou-se diferenca nos sintomas no braco na comparacao inicial e final do GRT com o GC (p=0,02 e p=0,02). Dessa forma, o emprego da RT adjuvante pode comprometer a QV destas mulheres, especialmente com relacao a funcao fisica, desempenho funcional e fadiga.