Study on peripheral antinociception induced by hydrogen peroxide (H2O2): characterization and mechanisms.

The present study aimed to evaluate the possible peripheral H2O2-induced antinociception and determine the involvement of opioidergic, cannabinoidergic and nitrergic systems, besides potassium channels in its antinociceptive effect. Prostaglandin E2 was used to induce hyperalgesia in male Swiss mice using the mechanical paw pressure test. H2O2 (0.1, 0.2, 0.3 µg/paw) promoted a dose-dependent antinociceptive effect that was not observed in contralateral paw. Female mice also showed antinociception in the model. The partial H2O2-induced antinociception was potentiated by the inhibitor of catalase enzyme, aminotriazole (40, 60, 80 µg/paw). The antinociception was not reversed by opioid and cannabinoid receptor antagonists naloxone, AM 251 and AM 630. The involvement of nitric oxide (NO) was observed by the reversal of H2O2-induced antinociception using the non-selective inhibitor of nitric oxide synthases L-NOarg and by inhibition of iNOS (L-NIL), eNOS (L-NIO) and nNOS (L-NPA). ODQ, a cGMP-forming enzyme selective inhibitor, also reversed the antinociception. The blockers of potassium channels voltage-gated (TEA), ATP-sensitive (glibenclamide), large (paxillin) and small (dequalinium) conductance calcium-activated were able to revert H2O2 antinociception. Our data suggest that H2O2 induced a peripheral antinociception in mice and the NO pathway and potassium channels (voltage-gated, ATP-sensitive, calcium-activated) are involved in this mechanism. However, the role of the opioid and cannabinoid systems was not evidenced.

Aplicação de farinhas de coprodutos de frutas em bolos sem glúten / Application of fruit co-product flours in gluten-free cakes

O presente estudo teve como objetivo empregar farinhas de coprodutos de frutas em bolos sem glúten e analisar a qualidade sensorial e tecnológica das receitas. Foi desenvolvido um bolo padrão e seis com adição de 14% de cada farinha de coproduto. Foi realizada avaliação de volume, dureza instrumental e análise sensorial de aceitação. O bolo com farinha da casca de banana apresentou os melhores resultados de volume e dureza, enquanto o bolo com farinha da casca de abacaxi os piores resultados, menor volume e maior dureza. As diferenças de cor dos bolos foram refletidas pela característica de cada farinha adicionada. Todos os bolos atingiram mais de 70% de aceitabilidade sensorial, demonstrando a viabilidade das aplicações. Conclui-se que a utilização de farinhas produzidas com coprodutos de frutas em bolos é uma opção para uma alimentação saudável e sustentável, em especial, para indivíduos celíacos. (AU)

The present study aimed to use fruit co-product flours in gluten-free cakes and analyze the sensorial and technological quality of the recipes. One standard and six cakes were developed by the addition of 14% of each co-product flour. Volume, instrumental hardness and sensory acceptance analysis were performed. The cake with banana peel flour showed the best results for volume and hardness, while the cake with pineapple peel flour had the worst results, lower volume and higher hardness. The differences in cake colors were reflected by the characteristics of each flour added. All cakes reached more than 70% of sensorial acceptability, demonstrating the viability of the applications. The use of flours produced with fruit co-products in cakes is therefore an option for a healthy and sustainable diet, especially for individuals with celiac disease. (AU)

Effects of SARS-CoV-2 infection on health and functional capacity in institutionalized older adults.

OBJECTIVE: To assess the effect of SARS-CoV-2 infection on the health conditions and functional capacity of older adults living in long-term care units in Maceió City - Alagoas State. METHODS: A prospective cohort was conducted with institutionalized older adults of both sexes. Older adults were assessed for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity, and nutritional status. All assessments were repeated on two occasions, maintaining a 6-month interval between them. RESULTS: The sample was composed of 289 older adults. Of the total, 98 (33.9%) were positive for COVID-19 and eight died (2.8%). Men were more likely to have COVID-19 (OR = 3.50; p < 0.01). It was observed that the disease contributed to increasing the frequency of dependent older adults after six months (OR = 1.38; p-interaction < 0.01). It was also observed that after six months of positive diagnosis for COVID-19, there was greater weight loss (p < 0.01), reduced BMI (p < 0.01), increased mean SBP (p = 0.04), and DBP (p = 0.03). CONCLUSION: Effects of COVID-19 in institutionalized older adults go beyond acute complications and compromise blood pressure control, functional capacity, and favor weight loss.

The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort.

METHODS: This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire. RESULTS: A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (ß = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (ß = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item. CONCLUSIONS: In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

Effects of SARS-CoV-2 infection on health and functional capacity in institutionalized older adults / Efectos de la infección por SARS-CoV-2 en la salud y capacidad funcional de personas mayores institucionalizadas / Efeitos da infecção por SARS-CoV-2 na saúde e na capacidade funcional de pessoas idosas institucionalizadas

ABSTRACT Objective: To assess the effect of SARS-CoV-2 infection on the health conditions and functional capacity of older adults living in long-term care units in Maceió City - Alagoas State. Methods: A prospective cohort was conducted with institutionalized older adults of both sexes. Older adults were assessed for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity, and nutritional status. All assessments were repeated on two occasions, maintaining a 6-month interval between them. Results: The sample was composed of 289 older adults. Of the total, 98 (33.9%) were positive for COVID-19 and eight died (2.8%). Men were more likely to have COVID-19 (OR = 3.50; p < 0.01). It was observed that the disease contributed to increasing the frequency of dependent older adults after six months (OR = 1.38; p-interaction < 0.01). It was also observed that after six months of positive diagnosis for COVID-19, there was greater weight loss (p < 0.01), reduced BMI (p < 0.01), increased mean SBP (p = 0.04), and DBP (p = 0.03). Conclusion: Effects of COVID-19 in institutionalized older adults go beyond acute complications and compromise blood pressure control, functional capacity, and favor weight loss.

RESUMEN Objetivo: Evaluar el efecto de la infección por SARS-CoV-2 sobre las condiciones de salud y la capacidad funcional de personas mayores que viven en unidades de cuidados a largo plazo en la ciudad de Maceió - Alagoas. Métodos: Se realizó una cohorte prospectiva con ancianos institucionalizados de ambos sexos. Los ancianos fueron evaluados en cuanto a condiciones clínicas (diagnóstico de enfermedades crónicas y pruebas bioquímicas), capacidad funcional y estado nutricional. Todas las evaluaciones se repitieron en dos ocasiones, manteniendo un intervalo de 6 meses entre ellas. Resultados: La muestra estuvo compuesta por 289 personas mayores. Del total, 98 (33,9%) dieron positivo a la COVID-19 y ocho fallecieron (2,8%). Los hombres tenían más probabilidades de tener COVID-19 (OR = 3,50; p <0,01). Se observó que la enfermedad contribuyó al aumento de la frecuencia de ancianos dependientes después de seis meses (OR = 1,38; interacción p < 0,01). Se observó que la enfermedad contribuyó al aumento de la frecuencia de ancianos dependientes después de seis meses (OR = 1,38; interacción p < 0,01). También se observó que después de seis meses de diagnóstico positivo para COVID-19, hubo mayor pérdida de peso (p < 0,01), reducción del IMC (p < 0,01), aumento de la PAS media (p = 0,04) y la PAD (p = 0,03). Conclusión: Los efectos del COVID-19 en ancianos institucionalizados van más allá de las complicaciones agudas y comprometen el control de la presión arterial, la capacidad funcional, favoreciendo la pérdida de peso.

RESUMO Objetivo: Avaliar o efeito da infecção pelo SARS-CoV-2 nas condições de saúde e capacidade funcional de idosos residentes em unidades de longa permanência na cidade de Maceió - Alagoas. Métodos: Foi realizada uma coorte prospectiva com idosos institucionalizados de ambos os sexos. Os idosos foram avaliados quanto às condições clínicas (diagnóstico de doenças crônicas e exames bioquímicos), capacidade funcional e estado nutricional. Todas as avaliações foram repetidas em duas ocasiões, mantendo um intervalo de 6 meses entre elas. Resultados: A amostra foi composta por 289 idosos. Do total, 98 (33,9%) deram positivo para COVID-19 e oito faleceram (2,8%). Os homens tiveram maior probabilidade de ter COVID-19 (OR = 3,50; p < 0,01). Observou-se que a doença contribuiu para o aumento da frequência de idosos dependentes após seis meses (OR = 1,38; interação de p <0,01). Observou-se também que após seis meses de diagnóstico positivo para COVID-19, houve maior perda de peso (p < 0,01), redução do IMC (p < 0,01), aumento da média da PAS (p = 0,04) e da PAD (p = 0,03). Conclusão: Os efeitos da COVID-19 em idosos institucionalizados vão além das complicações agudas e comprometem o controle da pressão arterial, a capacidade funcional, favorecendo a perda de peso.

Associação entre risco de sarcopenia e complicações clínicas da covid-19 em pessoas idosas hospitalizadas: estudo de coorte multicêntrico / Association between the risk of sarcopenia and clinical complications of covid-19 in hospitalized older adults: a multicenter cohort study

Resumo Objetivo Verificar se o risco de sarcopenia em pessoas idosas diagnosticadas com covid-19 associa-se com demanda por cuidados intensivos, ventilação mecânica e óbito. Método Estudo multicêntrico do tipo coorte, que incluiu pessoas idosas (≥65 anos) com diagnóstico laboratorial confirmado de covid-19. Foram coletados dados relacionados às características sociodemográficas, clínicas e nutricionais. O risco de sarcopenia foi avaliado pelo questionário Sarcopenia Risk Screening. As variáveis de desfecho foram: necessidade de terapia intensiva, ventilação mecânica e óbito. Foram realizadas regressões logísticas para verificar a associação dos desfechos clínicos e o risco de sarcopenia, com as seguintes variáveis de ajuste: idade, sexo, renda familiar, atividade física, hipertensão, diabetes, doença cardiovascular doença pulmonar obstrutiva crônica e índice de massa corporal. Resultados Foram incluídas no estudo 264 pessoas idosas com covid-19, com média de idade de 71,7 (±8,2) anos. Cento e quarenta e oito pessoas idosas (56,1%) tinham risco de sarcopenia. Hipertensão, diabetes e doença cardiovascular foram as principais comorbidades identificadas nas pessoas idosas, respectivamente, 75,4%, 45,5% e 28,4%. O risco de sarcopenia nas pessoas idosas hospitalizadas com covid-19 aumentou em mais de 2 vezes as chances de internamento na UTI (OR: 2,71 [1,57;4,68], p<0,001), em cerca de 5 vezes as chances de ventilação mecânica (OR: 5,19 [2,75;9,78], p<0,001) e em mais de 3 vezes as chances de óbito (OR: 4,05 [2,05;7,98], p<0,001). Conclusão Em pessoas idosas hospitalizadas com covid-19, a pré-existência do risco de sarcopenia foi preditor de desfechos clínicos desfavoráveis.

Abstract Objective To investigate whether the risk of sarcopenia in older adults diagnosed with covid-19 is associated with the need for intensive care, mechanical ventilation, and mortality. Method A multicenter cohort study was conducted, including older adults (≥65 years) with laboratory-confirmed covid-19 diagnosis. Data related to sociodemographic, clinical, and nutritional characteristics were collected. The risk of sarcopenia was assessed using the Sarcopenia Risk Screening questionnaire. Outcome variables included the need for intensive care, mechanical ventilation, and mortality. Logistic regressions were performed to assess the association between clinical outcomes and the risk of sarcopenia, adjusting for the following variables: age, gender, family income, physical activity, hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and body mass index. Results The study included 264 older adults with covid-19, with an average age of 71.7 (±8.2) years. One hundred and forty-eight older adults (56.1%) were at risk of sarcopenia. Hypertension, diabetes, and cardiovascular disease were the most common comorbidities identified in older adults, at 75.4%, 45.5%, and 28.4%, respectively. The presence of sarcopenia risk in hospitalized older adults with covid-19 increased the odds of ICU admission by more than 2-fold (OR: 2.71 [1.57; 4.68], p<0.001), nearly 5-fold for mechanical ventilation (OR: 5.19 [2.75; 9.78], p<0.001), and over 3-fold for mortality (OR: 4.05 [2.05; 7.98], p<0.001). Conclusion In hospitalized older adults with covid-19, pre-existing risk of sarcopenia was a predictor of unfavorable clinical outcomes.

Relacionamentos amorosos na contemporaneidade: um estudo exploratório sobre expectativas e experiências das mulheres / Loving relationships: an exploratory research on the expectations and life experiences of women / Relaciones amorosas contemporáneas: un estudio exploratorio sobre las expectativas y experiencias de las mujeres

O presente artigo apresenta os resultados parciais de pesquisa realizada com 2778 mulheres, intitulada "Relacionamentos amorosos na contempo-raneidade: quais as expectativas das mulheres?" (Millan et al., 2019), que visou à compreensão das relações afetivo-sexuais na contemporaneidade a partir da visão das mulheres e o conhecimento da dinâmica das relações com seus pares, com vistas ao manejo de conflitos nos relacionamentos afetivos e familiares, em intervenções clínicas e sociais. Teve-se como objetivo destacar aspectos relativos às diferenças entre expectativas e experiências vividas nos relacionamentos, no que diz respeito aos papéis de gênero (desempenho das tarefas domésticas e cuidados com filhos), à vida profissional, à independência financeira, aos sonhos e projetos de vida. A metodologia utilizada foi de carac-terística quantitativa e qualitativa, com as respostas ao questionário tratadas como variáveis qualitativas ordinais e analisadas pelos testes estatísticos não paramétricos de Kruskal-Wallis ou de Mann-Whitney (1952), de acordo com o agrupamento das participantes, quanto à faixa etária, escolaridade e estado civil. As variáveis categóricas foram analisadas pelo Teste de Qui-quadrado ou pelo Teste Exato de Fisher, conforme a indicação. Na análise qualitativa, adotaram-se os referenciais psicanalítico e sistêmico. Os resultados obtidos mostram que as expectativas das mulheres nos relacionamentos amorosos são moduladas pela experiência vivida e passíveis de ajustes e reajustes durante o ciclo vital pessoal e familiar. As variáveis independentes (escolaridade, estado civil, faixa etária) influenciaram significativamente e de maneiras distintas as respostas analisadas neste artigo. Conclui-se que os relacionamentos amorosos expressam elementos próprios da contemporaneidade, na qual convivem tendências variadas de valores, condutas e pontos de vista dissonantes, em constante transformação.

This article reports partial results of the research "Loving relationships in contemporary times: what are women's expectations?" (Millan et al., 2019) carried out with 2,778 women, that aimed to comprehend affective-sexual rela-tionships in the contemporary era, from women's point of view and knowledge of the dynamics in their relationships with their peers, in order to develop clinical tools to manage conflicts in affective and familiar relationships, via clinical and social interventions. Its objective is to highlight aspects concerning differences between expectations and experiences in relationships, regarding gender roles (in the performance of household tasks and childcare), profes-sional life, financial independence, life dreams and projects. Quantitative and qualitative data were obtained, while answers to the questionnaire were labeled as qualitative ordinal variables and analyzed through Kruskal-Wallis or Mann-Whitney (1952) nonparametric statistical tests, according to the grouping of participants, by age, education and marital status. Categorical variables were analyzed through a Chi-squared Test or Fisher's exact test, as appropriate. In the qualitative analysis, psychoanalytic and systemic refe-rences were adopted. The obtained results show that women's expectations towards loving relationships are influenced by life experiences and prone to change throughout personal and familiar life cycles. The independent varia-bles (education, age, marital status) have significantly influenced the results in different ways. It is concluded that loving relationships express elements characteristic of contemporaneity, which presents several tendencies, diverse in values, conducts and dissonant points of view, in constant transformation.

Este artículo presenta los resultados parciales de una investigación realizada con una muestra de 2.778 mujeres, denominada "Relaciones amorosas en la actualidad: ¿cuáles son las expectativas de las mujeres?" (Millan et al., 2019), que tuvo como objetivo comprender las relaciones afectivo-sexuales en la contemporaneidad desde la perspectiva de las mujeres y el conocimiento de la dinámica de las relaciones con sus pares, con miras a gestionar los conflictos en las relaciones afectivas y familiares en intervenciones clínicas y sociales. El objetivo fue resaltar aspectos relacionados con las diferencias entre expec-tativas y experiencias vividas en las relaciones, en cuanto a roles de género (desempeño de las tareas del hogar y cuidado de los niños), vida profesional, independencia económica, sueños y proyectos de vida. La metodología utilizada fue cuantitativa y cualitativa, con las respuestas a las entrevistas tratadas como variables cualitativas ordinales y analizadas mediante las pruebas estadísticas no paramétricas de Kruskal-Wallis o Mann-Whitney (1952), agrupando las participantes en función del grupo etario, nivel de educación y estado civil. Las variables categóricas se analizaron mediante la prueba de Chi-cuadrado o la prueba exacta de Fisher, según se indica en cada caso. En el análisis cualitativo se adoptaron referencias psicoanalíticas y sistémicas. Los resultados obtenidos muestran que las expectativas de las mujeres en las relaciones amorosas están moduladas por la experiencia vivida y están sujetas a ajustes y reajustes durante el ciclo de vida personal y familiar. Las variables independientes (nivel de educación, estado civil, grupo etario) influyeron significativamente de diferentes formas en las respuestas analizadas en este artículo. Se concluye que las relaciones amorosas expresan elementos de contemporaneidad en los que conviven diferentes tendencias de valores, comportamientos y puntos de vista disonantes en constante transformación.

The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE).

This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Knee extension strength and handgrip strength are important predictors of Timed Up and Go test performance among community-dwelling elderly women: a cross-sectional study.

BACKGROUND: Handgrip and knee extension strengths have each been used to characterize disability. However, it has been reported that the association between handgrip and knee extension strengths is weak. OBJECTIVE: To evaluate the influence of knee extensor and handgrip muscle strength on Timed Up and Go (TUG) test results among elderly women with worse (≥ 10 seconds) and better (< 10 seconds) performance, after controlling for confounders. DATA AND SETTING: Cross-sectional study on a sample selected according to convenience, carried out in a federal public institution of higher education. METHODS: Assessment of handgrip was carried out using the Jamar dynamometer (Lafayette Instrument Company, Inc., Lafayette, United States). Knee extensor muscle performance was measured using an isokinetic dynamometer (Biodex System 3 Pro; Biodex Medical Systems, Inc., United States), The confounding factors were education, age, comorbidities, body mass index and Geriatric Depression Scale and Human Activity Profile scores. Functional performance was assessed through the TUG test. A backward linear regression model was used. RESULTS: 127 elderly women performed the TUG test in more than 10 seconds and 93 in less than 10 seconds. However, regardless of test performance, handgrip strength and knee extension strength comprised the reduced final model. CONCLUSIONS: Knee extension strength and handgrip strength might be particularly useful indicators for measuring disability.

Knee extension strength and handgrip strength are important predictors of Timed Up and Go test performance among community-dwelling elderly women: a cross-sectional study

ABSTRACT BACKGROUND: Handgrip and knee extension strengths have each been used to characterize disability. However, it has been reported that the association between handgrip and knee extension strengths is weak. OBJECTIVE: To evaluate the influence of knee extensor and handgrip muscle strength on Timed Up and Go (TUG) test results among elderly women with worse (≥ 10 seconds) and better (< 10 seconds) performance, after controlling for confounders. DATA AND SETTING: Cross-sectional study on a sample selected according to convenience, carried out in a federal public institution of higher education. METHODS: Assessment of handgrip was carried out using the Jamar dynamometer (Lafayette Instrument Company, Inc., Lafayette, United States). Knee extensor muscle performance was measured using an isokinetic dynamometer (Biodex System 3 Pro; Biodex Medical Systems, Inc., United States), The confounding factors were education, age, comorbidities, body mass index and Geriatric Depression Scale and Human Activity Profile scores. Functional performance was assessed through the TUG test. A backward linear regression model was used. RESULTS: 127 elderly women performed the TUG test in more than 10 seconds and 93 in less than 10 seconds. However, regardless of test performance, handgrip strength and knee extension strength comprised the reduced final model. CONCLUSIONS: Knee extension strength and handgrip strength might be particularly useful indicators for measuring disability.

The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE) / O efeito da cinesiofobia em idosos com dor lombar aguda: dados longitudinais do estudo Back Complaints in the Elders (BACE) / El efecto de la quinesofobia en personas mayores con dolor lumbar agudo: datos longitudinales de Back Complaints in the Elders (BACE)

Abstract: This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Resumo: O estudo teve como objetivo investigar a evolução da intensidade da dor lombar (DL) ao longo de 12 meses em idosos com e sem cinesiofobia. Este foi um estudo multicêntrico internacional. A intensidade da DL foi avaliada com a Numerical Pain Scale na linha de base e ao longo de 5 períodos de seguimento. As crenças e os medos dos pacientes foram medidos com o Fear-Avoidance Beliefs Questionnaire. O estudo incluiu 532 idosos (sem cinesiofobia = 227; com cinesiofobia = 305). Os idosos apresentavam dor moderada na linha de base, com uma diferença significativa entre os grupos. Os participantes mostraram melhora rápida nas primeiras seis semanas, seguida por melhoras menores nos meses seguintes. Entretanto, persistiu uma diferença significativa entre os grupos durante o período de seguimento. A cinesiofobia é um fator prognóstico importante e independente. Os achados sugerem a importância da triagem de fatores psicossociais no manejo de pacientes idosos com DL. Implicações práticas: os pacientes devem ser advertidos que a dor pode ser perpetuada por comportamentos inadequados de evitação, podendo à incapacidade no longo prazo.

Resumen: El objetivo fue investigar el curso de la intensidad del dolor lumbar (LBP), durante un período de 12 meses, en personas ancianas con y sin quinesofobia. Se trata de un estudio multicéntrico internacional. La intensidad del LBP se evaluó usando la Escala Numérica de Dolor en una base de referencia y sobre 5 períodos de seguimiento. Con el fin de medir las creencias y temores de los pacientes, usamos el Fear-Avoidance Beliefs Questionnaire. El estudio incluyó a 532 ancianos (no quinesofóbicos = 227; quinesofóbicos = 305). Los ancianos sufrieron un dolor moderado en la base de referencia, con una significativa diferencia observada entre grupos. Los participantes mostraron una rápida mejora durante las 6 primeras semanas, seguidas por mejoras menores en los meses siguientes. No obstante, se mantuvo una diferencia significativa entre grupos durante el período de seguimiento. Independientemente, la quinesofobia es un factor pronóstico importante. Estos resultados sugieren la importancia de monitorear factores psicosociales en la gestión de pacientes ancianos con LBP. Implicaciones clínicas: los pacientes necesitan ser avisados de que el dolor puede perpetuarse por comportamientos inapropiados de prevención que quizás más tarde conduzcan a la discapacidad.

Therapeutic Applications of Solid Dispersions for Drugs and New Molecules: In Vitro and In Vivo Activities.

This review aims to provide an overview of studies that address the use, in therapeutic applications, of solid dispersions (SDs) with biological activities in vitro and/or in vivo mainly made up of polymeric matrices, as well as to evaluate the bioactive activity of their constituents. This bibliographic survey shows that the development of solid dispersions provides benefits in the physicochemical properties of bioactive compounds, which lead to an increase in their biological potential. However, despite the reports found on solid dispersions, there is still a need for biological assay-based studies, mainly in vivo, to assist in the investigation and to devise new applications. Therefore, studies based on such an approach are of great importance to enhance and extend the use of solid dispersions in the most diverse therapeutic applications.

Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke.

BACKGROUND: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. OBJECTIVE: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. METHODS: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. RESULTS: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). CONCLUSION: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke / Craniectomia descompressiva versus tratamento conservador: limites e possibilidades no AVC maligno

ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

RESUMO Introdução: O infarto maligno da artéria cerebral média (ACM) ocorre em um subgrupo de pacientes com acidente vascular cerebral (AVC) isquêmico e a craniectomia descompressiva (CD) precoce é um de seus tratamentos. Objetivo: Investigar o desfecho funcional de pacientes com acidente vascular cerebral isquêmico maligno submetidos à craniectomia descompressiva em um centro de emergência neurológica do nordeste do Brasil. Métodos: Nesta coorte prospectiva, os pacientes foram divididos em dois grupos: aqueles submetidos a tratamento cirúrgico com craniectomia descompressiva (CD) e aqueles que mantiveram tratamento conservador (TC) padrão. A funcionalidade foi avaliada por meio da Escala de Rankin modificada (ERm) ao final de seis meses de seguimento. Resultados: Evidenciou-se desfecho favorável (ERm≤3) em 37,5% dos pacientes craniectomizados e em 29,4% dos pacientes não craniectomizados (p=0,42). A mortalidade foi menor no grupo de pacientes que se submeteram a tratamento cirúrgico (25%) do que entre aqueles tratados conservadoramente (52,8%), porém sem significância estatística. Por outro lado, a proporção de pacientes com incapacidade moderada a grave (ERm 4‒5) foi maior no grupo cirúrgico (37,5%) do que no grupo não cirúrgico (17,7%). Conclusão: Em valores absolutos, percebeu-se superioridade na eficácia do tratamento cirúrgico sobre o conservador, mostrando que a redução de mortalidade se dá à custa de aumento da incapacidade funcional.

Evaluation of the serum biochemistry and histopathology of kidney and bladder of dogs with Leishmania sp. in their urine / Avaliação da bioquímica sérica e histopatologia de rim e bexiga de cães com Leishmania sp. na urina

The visceral establishment of Leishmania infantum in dogs may result in kidney and bladder tissue injury, with L. infantum ending up in urine. This study therefore aimed at investigating the presence of Leishmania sp. in urinary sediments, and correlating the results with those from renal and bladder serum biochemistry and histopathology. Thirty dogs with negative Nested-Polymerase Chain Reaction (PCR) for E. canis were used in the experiment, and were divided into three groups: control group (10 dogs), neither leishmaniasis nor clinical changes; group I (15 dogs), leishmaniasis but no Leishmania sp. in urine; and group II (5 dogs), leishmaniasis, as well as Leishmania sp. in urine. All animals were submitted to clinical, serological, and parasitological diagnosis for leishmaniasis, biochemical exams, and kidney and bladder histopathology. The parasite was also detected in the bladder imprint of one group II dog. Group II dogs presented with very low albumin concentrations, low albumin/globulin ratios, and kidney and bladder lesions. In the kidneys, hydropic degeneration, thickened Bowman's capsule, and thickening of the tubular capsule were detected in all dogs with positive urinary sediment. However, no significant difference in these renal changes was observed between groups. The intensity and distribution of bladder inflammatory infiltrates were significantly (p-value < 0.05, Kruskal-Wallis' and Dunn's tests) higher in group II dogs, compared with those of the other groups. The presence of Leishmania sp.in the urine of infected dogs appeared to be related to low serum albumin concentrations and more severe bladder lesions

O estabelecimento visceral de Leishmania infantum em cães pode resultar em lesões nos tecidos dos rins e da bexiga, favorecendo a chegando do parasito até a urina. Portanto, este estudo teve como objetivo investigar a presença de Leishmania sp. em sedimentos urinários e correlacionar os resultados com os achados de quantificações bioquímicas séricas e histopatologia de rim e bexiga. Trinta cães com Nested-Reação em Cadeia da Polimerase (PCR) negativa para E. canis foram utilizados no experimento e foram divididos em três grupos: grupo controle (10 cães), negativos para leishmaniose e sem alterações clínicas; grupo I (15 cães), com leishmaniose, mas sem Leishmania sp. na urina; e grupo II (5 cães), com leishmaniose e com Leishmaniasp. na urina. Todos os animais foram submetidos a diagnóstico clínico, sorológico e parasitológico para leishmaniose, exames bioquímicos e histopatologia de rim e bexiga. O parasito foi detectado no imprimt de bexiga de um cão do grupo II. Os cães do grupo II apresentaram concentrações muito baixas de albumina, baixa relação albumina/globulina e lesões nos rins e na bexiga. Nos rins, foram detectadas degeneração hidrópica, espessamento da cápsula de Bowman e espessamento da cápsula tubular, em todos os cães com sedimento urinário positivo. No entanto, nenhuma diferença significativa nessas alterações renais foi observada entre os grupos. A intensidade e a distribuição dos infiltrados inflamatórios da bexiga foram significativamente (p-valor < 0,05, testes de Kruskal-Wallis e Dunn) maiores nos cães do grupo II, em comparação com a dos outros grupos. A presença de Leishmania sp. na urina de cães infectados parece estar relacionada a baixa concentração sérica de albumina e a lesões mais graves na bexiga.

Inflammatory mediators and the risk of falls among older women with acute low back pain: data from Back Complaints in the Elders (BACE)-Brazil.

PURPOSE: To investigate the association between plasma levels of inflammatory cytokines (interleukin [IL]-1-ß, IL-6, tumor necrosis factor [TNF]-α, and the soluble TNF receptor 1 [sTNF-R1]), disability, and risk of falls in older women with acute low back pain (LBP). METHODS: This cross-sectional study comprised a subsample of older women from the Back Complaints in the Elders international cohort study. Plasma levels of IL-1-ß, IL-6, TNF-α, and sTNF-R1 were measured using enzyme-linked immunosorbent assays. Pain was assessed using the Numerical Pain Scale and McGill Pain Questionnaire, while disability was measured using the Roland Morris Questionnaire and gait speed. Risk of falls was estimated using the Physiological Profile Assessment. Linear regression model was used to verify the association between independent variables and fall risk. RESULTS: One hundred and ten women (aged 69.97 ± 5.5 years) with acute LBP were included. The regression model showed an association between the risk of falls and IL-6 levels, pain, gait speed, and years of education. It also explained 21.2% of risk of falls variance. The model equation was: fall risk = 1.28 + (0.19 IL-6) + (0.02 quality of pain) + (- 0.71 gait speed) + (-0 .17 educational level). CONCLUSIONS: This study showed an association between risk of falls and IL-6, pain, gait speed, and educational level in older women with LBP. These slides can be retrieved under Electronic Supplementary Material.

Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study. / Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil.

This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil / Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study

Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Calcitonin-gene related peptide is a potent inducer of oedema in rat orofacial tissue.

BACKGROUND AND AIMS: This study aimed to assess the potential of calcitonin-gene related peptide (CGRP), a neuropeptide released from sensory nerves, to induce oedema in orofacial tissue. EXPERIMENTAL APPROACH: Wistar rats (150-200 g) anesthetized with isoflurane were injected intraorally with CGRP (100 µl; 8-33 pmol) in the right side of the mouth. The contralateral side was injected with the same volume of physiological saline. Increased cheek thickness (in mm), as a measure of oedema formation, was assayed bilaterally with a digital caliper before (T = 0) and up to 24 h following injection of CGRP. Pretreatment with antagonists (CGRP8-37, 10 nmol; pizotifen, 2 mg/kg) was given by intra-oral or subcutaneous injection, 10 or 30 min, respectively, before the inflammatory stimulus. CGRP and CGRP8-37 were also injected into the rat hind paw to induce oedema. Data are presented as the mean (±SEM) difference in thickness between the right and the left sides at each time. RESULTS: Following intra-oral injection, CGRP induced a rapidly developing (5-15 min) and long-lasting (6 h), dose-dependent oedema in the rat cheek, blocked by pre-treatment with CGRP8-37 or pizotifen. CGRP induced a smaller oedematogenic effect in the rat hind paw also blocked by the CGRP antagonist. CGRP (16 pmol) potentiated the oedema induced by co-injected substance P (3.7 nmol) and contributed to the oedema following intraoral injection of carrageenan (100 µg). Injection of CGRP8-37 alone induced an early but short-lasting oedema. CONCLUSION: Local injection of CGRP potently induced oedema in the orofacial tissue of rats which was blocked by a CGRP receptor antagonist. The overall inhibition of carrageenan-induced oedema by CGRP8-37 suggests that endogenous CGRP contributes to an oedematogenic response in orofacial tissues.

Handgrip strength is associated with, but poorly predicts, disability in older women with acute low back pain: A 12-month follow-up study.

BACKGROUND: Older women with low back pain (LBP) constitute a special subpopulation at risk of severe and permanent disability. It is important to identify factors limiting functionality in this population in order to reduce costs and improve both prevention and intervention. Handgrip strength (HGS) is a biomarker of aging associated with several adverse health outcomes, but long-term associations with disability in older patients with LBP are not known. OBJECTIVE: To examine whether HGS predicts disability in older women with acute low back pain (LBP). METHODS: Longitudinal analyses were conducted with a sample of 135 older women from the international multicenter study Back Complaints in the Elders (BACE-Brazil). Women aged 60 years and over with a new episode of acute LBP were included. HGS was assessed with Jamar® dynamometer, and disability was assessed using the Roland Morris questionnaire and gait speed test. Variables were assessed at baseline and at 12-month follow-up. Linear regression models explored associations between HGS and disability measures. RESULTS: Significant association was found between HGS at baseline and gait speed at 12-month follow-up (r=-0.24; p=0.004). A multivariable-adjusted model showed that this association was independent of age, body mass index, and pain intensity (adjusted R2=0.13; p<0.001). A final prediction model showed an incremental difference of only 2.1% in gait speed after inclusion of HGS as an independent variable. No association was found between HGS and score on the Roland Morris questionnaire. CONCLUSION: Caution is needed regarding the use of HGS as a predictive measure of disability in older women with acute LBP. Changes in gait speed were very small and unlikely to be of clinical relevance.