Activation of mineralocorticoid receptors facilitate the acquisition of fear memory extinction and impair the generalization of fear memory in diabetic animals.

RATIONALE: Studies point out a higher prevalence of posttraumatic stress disorder (PTSD) in individuals with diabetes mellitus. It is known that glucocorticoid (GR) and mineralocorticoid (MR) receptors are implicated in fear memory processes and PTSD. However, there is no preclinical studies addressing the involvement of these receptors on abnormal fear memories related to diabetic condition. OBJECTIVES: By inducing a contextual conditioned fear memory, we generate a suitable condition to investigate the extinction and the generalization of the fear memory in streptozotocin-induced diabetic (DBT) rats alongside the expression of the cytosolic and nuclear GR and MR in the hippocampus (HIP) and prefrontal cortex (PFC). Moreover, we investigated the involvement of the MR or GR on the acquisition of fear memory extinction and on the generalization of this fear memory. When appropriate, anxiety-related behavior was evaluated. METHODS: Male Wistar rats received one injection of steptozotocin (i.p.) to induce diabetes. After 4 weeks, the animals (DBTs and non-DBTs) were subjected to a conditioned contextual fear protocol. RESULTS: The expression of MR and GR in the HIP and PFC was similar among all the groups. The single injection of MR agonist was able to facilitate the acquisition of the impaired fear memory extinction in DBTs animals together with the impairment of its generalization. However, the GR antagonism impaired only the generalization of this fear memory which was blocked by the previous injection of the MR antagonist. All treatments were able to exert anxiolytic-like effects. CONCLUSIONS: The results indicate that MR activation in DBT animals disrupts the overconsolidation of aversive memory, without discarding the involvement of emotional behavior in these processes.

Onde dói? O sentido da dor para médicos e residentes / Where does it hurt? Pain meaning for physicians and residents / ¿Dónde duele? El sentido del dolor para médicos y residentes

A avaliação da dor pode variar entre médicos e pacientes. Para compreender os sentidos que médicos atribuem à dor de seus pacientes, seis médicas foram entrevistadas e seus relatos submetidos a análise qualitativa, pelo método fenomenológico de Giorgi. Os resultados evidenciaram que a estrutura do sentido da dor se constitui centralmente pela ambiguidade, que atravessa não apenas o seu sentido conceitual, mas também a clínica e a intervenção. As análises indicam que as dificuldades enfrentadas pelos médicos na avaliação da dor são intensificadas pela falta de evidências objetivas e por seu caráter ambíguo e subjetivo, dependente do relato. Indicam também conflito entre a clínica e os paradigmas que sustentam explicações fisiológicas da dor. Conclui-se que o paradigma organicista é questionado pelo fenômeno doloroso que exige avaliação fundamentada em uma relação empática, na qual o critério avaliativo se sustente na confiança no relato do paciente e não apenas em dados objetivos

The pain evaluation may differ between physicians and patients. To understand the meanings doctors give to their patient's pain, we interviewed six physicians, and their reports were analyzed through Giorgi´s phenomenological qualitative method. The results revealed ambiguity as central to the pain meaning structure and it is present not only in its conceptual definition but also in its clinics and intervention. The analyses show that the absence of material evidence of pain and its ambiguous and subjective nature, subordinated to patient's reports, intensifies the difficulties faced by physicians in pain evaluation. The analyses also indicate a conflict between the paradigms that support physiological explanations of pain and its clinical manifestations. We conclude that the painful phenomenon defies the organicist paradigm and requires an empathetic evaluation, in which evaluative criteria must be the confidence in patient's reports not just in objective data

La evaluación del dolor puede variar entre médicos y pacientes. Para comprender los sentidos que los médicos atribuyen al dolor de sus pacientes, seis médicas fueron entrevistadas y sus relatos sometidos al análisis cualitativo del método fenomenológico de Giorgi. Los resultados evidenciaron que la estructura del sentido del dolor se constituye centralmente por la ambigüedad, que atraviesa no sólo su concepto, sino también la clínica y la intervención. Los análisis indican que las dificultades enfrentadas en la evaluación del dolor son intensificadas por la falta de evidencias objetivas y por su carácter ambiguo y subjetivo, dependiente del relato. También indican conflicto entre la clínica y los paradigmas que sustentan explicaciones fisiológicas del dolor. Se concluye que el paradigma organicista es cuestionado por el fenómeno doloroso que exige evaluación fundamentada en una relación empática, donde el criterio de evaluación se sustenta en la confianza en el relato y no solo en datos objetivos