Marcos Almeida Matos

Prevalência de dor lombar crônica na população da cidade de Salvador

INTRODUCTION: Chronic low back pain has epidemic levels in the general population and profiling the individuals affected may help directing investments to control the problem. OBJECTIVE: To estimate the prevalence of chronic low back pain in the population and to identify associated factors. METHODS: Transversal study based on a population survey carried out in the sectors classified by the census in the city of Salvador according to socio-economic level. 2,297 individuals were interviewed in whom low back pain was evaluated through a bodily map. Exploratory analysis of associated factors was performed by logistic regression. RESULTS: Chronic low back pain prevalence in the population was 14.7%, with higher incidence among former smokers (19.7%), people with belly circumference above the range of normality (16.8%), and individuals with low level of schooling (17.4%) when compared to the other categories. Factors such as physical activity, social class, excessive alcohol intake, race, gender, and occupation at the time of the interview were not associated to low back pain. In the multiple regression analysis, being single was negatively associated to chronic low back pain, whereas positive and statistically significant associations were observed between current smoking or smoking in the past and low back pain (OR 1.47; IC95%; 1.11-1.96; p < 0.000). CONCLUSION: The population in Salvador shows high prevalence of chronic low back pain associated to smoking.

Chronic pain and gender in Salvador population, Brazil.

Abstract Chronic pain is a public health problem with high impact on various population segments. There are few population studies with the aim of delineating the profile of the chronic pain patient, and generating data for actions to prevent, control and minimize the problem. The aim of this study was to estimate the prevalence of chronic pain in the population of Salvador, Bahia, Brazil and identify independent predictors associated with this morbidity. A cross‐sectional study was conducted in a sample population of 2297 individuals of >20 years of age, in Salvador, Brazil. A standardized questionnaire was applied at home to collect data about socio‐demographic characteristics, lifestyle, chronic pain and abdominal circumference measurement. The chronic pain was defined as pain with a duration of longer than 6 months. Prevalence of pain and the OR (univariate analysis) were estimated and adjusted (logistic regression), and their ICs at 95% and p < 0.05 in the two analyses. The presence of chronic pain was found in 41.4% of the total study population, women being more affected (48.4% against 32.8% in men), with OR of 1.92 IC 95% 1.6–2,28 p < 0.001. Among the studied factors, in the gross analysis, the following were shown to be associated with chronic pain: conjugal situation, smoking, excessive alcohol consumption, presence of central obesity and age, all with p < 0.05. In the multivariate analysis, female sex, smoking, excessive alcohol consumption, and age were sustained as independent predictors. The presence of chronic pain was predominant in women, the elderly, smokers or ex‐smokers and excessive alcohol consumers.

Prevalência de dor crônica e fatores associados na população de Salvador, Bahia

OBJETIVO: Estimar a prevalencia de dor cronica, identificando os fatores associados. METODOS: Estudo transversal realizado em amostra populacional de 2.297 individuos com idade igual ou superior a 20 anos, em Salvador (BA), em 1999 e 2000. Aplicou-se em domicilio questionario padronizado para coleta de dados sobre dor e caracteristicas sociodemograficas e a medida da circunferencia abdominal. O criterio para classificacao de dor cronica foi duracao superior a seis meses. Foram estimadas as prevalencias de dor por razao de prevalencia ajustada com intervalo com 95% de confianca e valor de p<0,05 para as analises univariadas e regressao logistica. RESULTADOS: A presenca de dor cronica foi encontrada em 41,4% da populacao. Na analise bruta, os fatores associados mais frequentes foram: sexo, idade, situacao conjugal, fumo, consumo de alcool (p<0,05). Na analise multivariada, sexo feminino, idade, fumo e obesidade central foram preditores independentes enquanto consumo moderado de alcool e ser solteiro foram protetores. CONCLUSOES: A presenca de dor cronica predominou em mulheres, idosos, obesos, fumantes e ex-fumantes. Estrategias preventivas de saude publica sao sugeridas, visando a divulgacao dos riscos do tabagismo e da obesidade para o desenvolvimento de dor cronica, bem como o incentivo ao acompanhamento periodico da saude.

Prevalência da apneia obstrutiva do sono em crianças e adolescentes portadores da anemia falciforme

OBJECTIVE: To estimate the prevalence of obstructive sleep apnea syndrome (OSAS) in children and adolescents with sickle cell anemia (SCA); to investigate the possible correlation between mean annual hemoglobin level and total sleep time with SpO2 1 was considered indicative of a diagnosis of OSAS. RESULTS: The prevalence of OSAS was 10.6%. We found a negative correlation between mean annual hemoglobin level and total sleep time with SpO2 < 90% (r = µ0.343; p = 0.002), as well as between mean annual hemoglobin level and total sleep time with SpO2 < 80% (r = µ0.270; p = 0.016). There was no association between AHI and painful crisis. CONCLUSIONS: The prevalence of OSAS in this population was high (10.6%). Therefore, it is important to identify signs of OSAS as soon as possible and to determine the mean annual hemoglobin level because of the inverse correlation between that level and the total sleep time with SpO2 < 90% or < 80%.

Histomorphometric evaluation of bone healing in rabbit fibular osteotomy model without fixation

BackgroundAnimal models of fracture consolidation are fundamental for the understanding of the biological process of bone repair in humans, but histological studies are rare and provide only qualitative results. The objective of this article is to present the histomorphometric study of the bone healing process using an experimental model of osteotomy in rabbit fibula without interference of synthesis material.MethodsFifteen rabbits were submitted to fibular osteotomy without any fixation device. Groups of five animals were submitted to pharmacological euthanasia during a period of one (group A), two (group B) and four weeks (group C) after osteotomy. Histomorphometric evaluation was performed in the histological sections.ResultsDuring week one there was intense cellularity (67/field), a large amount of woven bone (75.7%) and a small amount of lamellar bone (7.65%). At two weeks there was a decrease in woven bone (41.59%) and an increase in lamellar bone (15.16%). At four weeks there was a decrease of cellularity (19.17/field) and lamellar bone (55.56%) exceeded the quantity of woven bone (31.68%).ConclusionHistomorphometric (quantitative) evaluation of the present study was shown to be compatible with bone healing achieved in qualitative experimental models that have been commended in the literature.

Quality of life after total knee arthroplasty: systematic review,

Objective To review the literature on quality of life among patients who underwent total knee arthroplasty (TKA) and assess the impact of various associated factors. Methods this was a systematic review of the literature in the Medline, Embase, Lilacs and SciELO databases, using the terms: TKA (total knee arthroplasty); TKR (total knee replacement); quality of life; and outcomes. There were no restrictions regarding study design. Results 31 articles addressing this topic using various quality-of-life evaluation protocols were selected. SF-36/SF-12, WOMAC and Oxford were the ones most frequently used. The studies made it possible to define that TKA is capable of making an overall improvement in patients’ quality of life. Pain and function are among the most important predictors of improvement in quality of life, even when function remains inferior to that of healthy patients. Conclusion The factors associated negatively were obesity, advanced age, comorbidities, persistence of pain after the procedure and a lengthy wait for surgery.

Selective suprascapular and axillary nerve block provides adequate analgesia and minimal motor block: comparison with interscalene block

BACKGROUND AND OBJECTIVE Shoulder arthroscopic surgeries evolve with intense postoperative pain. Several analgesic techniques have been advocated. The aim of this study was to compare suprascapular and axillary nerve blocks in shoulder arthroscopy using the interscalene approach to brachial plexus blockade. METHODS According to the technique used, sixty-eight patients were allocated into two groups: interscalene group (IG, n=34) and selective group (SG, n=34), with neurostimulation approach used for both techniques. After appropriate motor response, IG received 30 mL of 0.33% levobupivacaine in 50% enantiomeric excess with adrenalin 1:200,000. After motor response of suprascapular and axillary nerves, SG received 15 mL of the same substance on each nerve. General anesthesia was then administered. Variables assessed were time to perform the blocks, analgesia, opioid consumption, motor block, cardiovascular stability, patient satisfaction and acceptability. RESULTS Time for interscalene blockade was significantly shorter than for selective blockade. Analgesia was significantly higher in the immediate postoperative period in IG and in the late postoperative period in SG. Morphine consumption was significantly higher in the first hour in SG. Motor block was significantly lower in SG. There was no difference between groups regarding cardiocirculatory stability and patient satisfaction and acceptability. Failure occurred in IG (1) and SG (2). CONCLUSIONS Both techniques are safe, effective, and with the same degree of satisfaction and acceptability. The selective blockade of both nerves showed satisfactory analgesia, with the advantage of providing motor block restricted to the shoulder.

The effect of zoledronate on bone remodeling during the healing process

PURPOSE To check the effect of zoledronate in bone remodeling during bone healing. METHODS Thirty rabbits were divided into two groups of fifteen animals each (control and experimental group respectively). Shaft osteotomy was performed on the cranial portion of the fibula of each animal. In the experimental group, a single dose of 0.04mg/kg of zoledronate was administered. In the control group, the same volume of bi-distilled water was administered. After one, two and four weeks, animals of both groups were killed and histological sections of the fibular metaphyseal area were examined histomorphometrically. The parameters analyzed were tissue volume (TV), fractional trabecular bone volume (BV/TV) and fractional medullary fibrous volume (FbV/TV). RESULTS Tissue volume increased in the experimental group (237.2mm(2).10-2) compared to the control (166.62mm(2).10-2). Trabecular bone volume was significantly larger in the experimental (60.2%) than in the control group (34.8%). The amount of fibrosis volume decreased in the experimental group (22%) compared to the control (49.4%). CONCLUSION The effect of zoledronate is characterized by accentuated stimulus of bone formation in the metaphyseal area, resulting in a larger amount of trabecular bone volume and little fibrosis volume.

Intensidade da dor em pacientes com síndrome do ombro doloroso

The aim of this study was to assess the severity of pain and its correlations to clinical characteristics in Painful Shoulder Syndrome (PSS) patients. A descriptive study was conducted using retrospective data from 77 medical record files. The Visual Numerical Scale (VNS) was used as an assessment instrument. The following variables of interest were considered: VNS (77), diagnosis (57), affected shoulder (77), sex (77), age (76), pain site (77), use of medications (59) and associated cervical pain (77). 53.2% of the patients were females and the mean age was 50.4±15.7 years. The right shoulder was the most affected side (57.1%). Severe pain was reported by 41.6% of patients, more frequently in women (56.1% vs 25.0%; p=0.006), and on left shoulder (57.7% vs 31.8%, p=0.034). Of the studied patients, 59 (81.3%) used medications, most frequently anti-inflammatory drugs. The rotator cuff syndrome was present in 80.7% (57) and associated cervical pain in 15.6% (77). Pain exclusively on the shoulder accounted for 76.5%. The rotator cuff syndrome was shown to be the most frequent cause of PSS, more commonly and severely affecting women close to 51 years old. EVN was shown to be a relevant instrument for measuring pain in PSS.

Prevalence of chronic pain and associated factors in the population of Salvador, Bahia

OBJETIVO: Estimar a prevalencia de dor cronica, identificando os fatores associados. METODOS: Estudo transversal realizado em amostra populacional de 2.297 individuos com idade igual ou superior a 20 anos, em Salvador (BA), em 1999 e 2000. Aplicou-se em domicilio questionario padronizado para coleta de dados sobre dor e caracteristicas sociodemograficas e a medida da circunferencia abdominal. O criterio para classificacao de dor cronica foi duracao superior a seis meses. Foram estimadas as prevalencias de dor por razao de prevalencia ajustada com intervalo com 95% de confianca e valor de p<0,05 para as analises univariadas e regressao logistica. RESULTADOS: A presenca de dor cronica foi encontrada em 41,4% da populacao. Na analise bruta, os fatores associados mais frequentes foram: sexo, idade, situacao conjugal, fumo, consumo de alcool (p<0,05). Na analise multivariada, sexo feminino, idade, fumo e obesidade central foram preditores independentes enquanto consumo moderado de alcool e ser solteiro foram protetores. CONCLUSOES: A presenca de dor cronica predominou em mulheres, idosos, obesos, fumantes e ex-fumantes. Estrategias preventivas de saude publica sao sugeridas, visando a divulgacao dos riscos do tabagismo e da obesidade para o desenvolvimento de dor cronica, bem como o incentivo ao acompanhamento periodico da saude.