Antifungal activity of terpenes isolated from the Brazilian Caatinga: a review.

Terpenoids, also named terpenes or isoprenoids, are a family of natural products found in all living organisms. Many plants produce terpenoids as secondary metabolites, and these make up a large part of essential oils. One of most important characteristic is that the compounds are volatile, have odor and can be used in a variety of applications in different industrial segments and traditional medicine. Brazil has a rich and diverse flora that can be used as a source of research for obtaining new molecules. Within the Brazilian flora, it is worth mentioning the Caatinga as an exclusively Brazilian biome where plants adapt to a specific series of weather conditions and therefore become a great storehouse of the terpenoid compounds to be described herein. Fungal infections have become increasingly common, and a great demand for new agents with low toxicity and side effects has thus emerged. Scientists must search for new molecules exhibiting antifungal activity to develop new drugs. This review aims to analyze scientific data from the principal published studies describing the use of terpenes and their biological applications as antifungals.

Juvenile didymozoids of the types, Torticaecum and Neotorticaecum (Didymozoidae: Digenea), from new marine fish hosts (Pisces: Teleostei) in the neotropical region of Brazil.

From December 2006 to March 2008, 60 specimens of Paralichthys isosceles and 25 specimens of P. patagonicus were investigated for helminths. One hundred and sixty-nine digeneans were recovered and parasites were identified as juvenile didymozoids of two types. Torticaecum and Neotorticaecum were found in 48 of the 60 P. isosceles (80%) and 10 of the 25 P. patagonicus (40%). Torticaecum and Neotorticaecum are reported for the first time in fish in South America (Brazil), found in the Atlantic Ocean. Morphometrics and illustrations are presented.

ARNIs: balancing "the good and the bad" of neuroendocrine response to HF.

BACKGROUND: A new class of drugs-angiotensin receptor, neprylisin inhibitors, ARNI-has shown to be prognostic superior in HFrEF to the sole inhibition of the renin-angiotensin axes with enalapril. The ultimate mechanism of action of ARNIs is unknown. AIM: We have considered that ARNI exerts a positive modulation of the neuroendocrine balance, with enhancement of the physiological diuresis and dilatation due to neprylisin inhibition by sacubitril. This represents a shift in HF medical therapy always directed to counteract (with inhibitors of the renin-angiotensin system, beta blockers or inhibitors of aldosterone) the so-called "bad" neuroendocrine response. Development of ARNI, on the contrary, has led to consider the neuroendocrine response to HFrEF from a different angle, which is to say that the activation is not always deleterious, but it could also be beneficial. This concept is highlighted by the enhancement of the activity of atrial natriuretic peptide, induced by sacubitril/valsartan in the PARADIGM trial, and found as proof from early studies on untreated patients with constrictive pericarditis. The possibility that sacubitril inhibition of neprylisin acts by enhancing substance P and gene-related calcitonin peptide is also considered, as well as the negative effect of neprylisin inhibition. CONCLUSIONS: The beneficial effects of ARNI are related, in part at least, to a positive modulation of the neuroendocrine response to the disease, resulting in an increase of physiological diuresis and dilatation.

Retinoic acid-loaded polymeric nanoparticles enhance vascular regulation of neural stem cell survival and differentiation after ischaemia.

Stroke is one of the leading causes of death and disability worldwide. However, current therapies only reach a small percentage of patients and may cause serious side effects. We propose the therapeutic use of retinoic acid-loaded nanoparticles (RA-NP) to safely and efficiently repair the ischaemic brain by creating a favourable pro-angiogenic environment that enhances neurogenesis and neuronal restitution. Our data showed that RA-NP enhanced endothelial cell proliferation and tubule network formation and protected against ischaemia-induced death. To evaluate the effect of RA-NP on vascular regulation of neural stem cell (NSC) survival and differentiation, endothelial cell-conditioned media (EC-CM) were collected. EC-CM from healthy RA-NP-treated cells reduced NSC death and promoted proliferation while EC-CM from ischaemic RA-NP-treated cells decreased cell death, increased proliferation and neuronal differentiation. In parallel, human endothelial progenitor cells (hEPC), which are part of the endogenous repair response to vascular injury, were collected from ischaemic stroke patients. hEPC treated with RA-NP had significantly higher proliferation, which further highlights the therapeutic potential of this formulation. To conclude, RA-NP protected endothelial cells from ischaemic death and stimulated the release of pro-survival, proliferation-stimulating factors and differentiation cues for NSC. RA-NP were shown to be up to 83-fold more efficient than free RA and to enhance hEPC proliferation. These data serve as a stepping stone to use RA-NP as vasculotrophic and neurogenic agents for vascular disorders and neurodegenerative diseases with compromised vasculature.

Vascular endothelial growth factor and hypertrophic osteoarthropathy.

OBJECTIVE: Hypertrophic osteoarthropathy (HOA) is characterized by the coexistence of digital clubbing and periosteal proliferation of the tubular bones. Localized vascular proliferation associated with platelet/endothelial cell activation are recognized features of this syndrome. Current knowledge suggests that HOA develops from the presence in the systemic circulation of one or more growth factors that are normally inactivated in the lungs. The nature of these purported growth factors has not yet been identified. Vascular endothelial growth factor (VEGF) has several features that may fit in with the pathogenesis of HOA. The objective of our study was to measure serum and plasma levels of VEGF in different groups of patients with HOA. METHODS: We studied 24 patients with HOA; of these, in 12 the HOA was secondary to cyanotic congenital heart disease and in 7 to lung cancer, while 5 represented primary cases. As controls we studied 28 individuals without HOA; of these, 12 were apparently healthy individuals, 7 had cyanosis secondary to chronic obstructive pulmonary disease, and 9 had lung cancer. ELISA was used to measure serum and plasma levels of VEGF. RESULTS: Plasma levels of VEGF were significantly higher in the patients with primary HOA (median 46.2; range 19.4-398.8 pg/ml) and in those with lung cancer-HOA (median 75.5; range 24.6-166.7), compared to healthy controls (median 7.4; range: 0-26.1), p < 0.05. Serum VEGF levels were higher in patients with lung cancer and HOA (median 411.4; range 164.2-959.5 pg/ml) compared with lung cancer patients without HOA (median 74.5; range 13.2-205.4), p < 0.001. CONCLUSIONS: Patients with primary HOA and those with HOA and lung cancer have increased circulating levels of VEGF. This cytokine may play a role in the pathogenesis of HOA.

Rheumatoid arthritis associated with ankylosing spondylitis defined by scintigraphic and CT abnormalities.

Rheumatoid arthritis and ankylosing spondylitis were detected in the same patient after a long period of observation of the disease. X-ray studies demonstrated the characteristic rheumatoid arthritis changes in peripheral joints. By contrast, few X-ray changes of ankylosing spondylitis were detected, during follow-up. Diagnostic approach through scintigraphic studies disclosed a symmetric uptake of the radionuclide in sacroiliac joints, and computed tomography revealed bilateral ankylosis. The combination of these tests was useful to define the presence of axial disease. This patient was both HLA B27 and DR4 positive. Rheumatoid arthritis occurred before ankylosing spondylitis, that interestingly was defined as a late onset disease.

Effect of hydrocooling, packaging, and cold storage on the post-harvest quality of peppermint (Mentha piperita L. ) / Efeito do hidroresfriamento e embalagem sobre hortelã-pimenta fresca armazenada em temperatura ambiente e ambiente refrigerado

ABSTRACT The purpose of this study was to assess the effects of hydrocooling and polyethylene terephthalate (PET) perforated and non-perforated packaging on post-harvest quality of peppermint (Mentha piperita L.) leaves stored at 5 and 25ºC. The experiments were conducted using a subdivided parcel layout in a completely randomized design with four replicates. Each parcel used a 2x3 layout (two hydrocooling treatments and three packaging treatments) with subparcels for storage time. The shelf life, chlorophyll content, mass loss (ML), relative water content (RWC), total soluble sugars (TSS), reducing sugars (Red), non-reducing sugars (NRed) and starch of the leaves were determined. Cold storage increased the shelf life of the peppermint by up to 64 times (>15 days). Hydrocooling increased the RWC of the leaves. Plastic packaging was effective in maintaining the RWC. Unperforated packages more effectively prevented ML in the peppermint leaves and prevented the leaves from wilting for a longer period of time. The chlorophyll content of the leaves varied according to the treatment. The soluble sugars and starch levels varied according to RWC. Hydrocooling with the use of non-perforated plastic packages was the most effective method for maintaining the postharvest quality of the peppermint.

RESUMO O trabalho objetivou avaliar os efeitos do hidroresfriamento e da embalagem de politereftalato de etileno (PET) perfurada e não perfurada na qualidade pós-colheita de folhas de hortelã pimenta (Mentha piperita L.) armazenadas em temperatura ambiente e sob refrigeração. Os experimentos foram instalados seguindo o esquema de parcela subdividida, tendo na parcela o esquema fatorial 2x2 (dois tratamentos envolvendo hidroresfriamento e dois tratamentos envolvendo embalagens) e nas subparcelas os tempos de armazenamento no delineamento inteiramente casualizado com quatro repetições. Foi determinada a vida de prateleira, os teores de clorofila, a perda de massa fresca (PM), o teor relativo de água (TRA), os teores de açúcares solúveis totais (AST), redutores (RED), não redutores (NRED) e amido das folhas. O armazenamento refrigerado aumentou em até 64 vezes (>15 dias) a vida de prateleira de hortelã-pimenta. O hidroresfriamento aumentou o TRA das folhas. A embalagem plástica foi efetiva no aumento da vida de prateleira de hortelã-pimenta sendo eficiente na manutenção dos TRA das folhas. A embalagem não perfurada foi mais eficiente na prevenção da PM. O teor de clorofila das folhas variou de acordo com o tratamento. AST, RED, NRED e amido variaram de acordo com TRA nas folhas. O hidroresfriamento juntamente com utilização de embalagem não perfurada foi o método mais eficiente na manutenção da qualidade pós-colheita de hortelã-pimenta.

Potencial de óleos essenciais de plantas medicinais no controle de fitopatógenos / Potential of essential oils from medicinal plants to control plant pathogens

Além do valor como recurso terapêutico, plantas medicinais também possuem potencial para serem utilizadas como fonte de princípios ativos contra fitopatógenos. O objetivo deste trabalho foi avaliar o efeito de óleos essenciais das espécies medicinais Baccharis dracunculifolia (alecrim-do-campo), Schinus terebinthifolius (aroeirinha) e Porophyllum ruderale (arnica-brasileira) sobre o crescimento dos fungos fitopatogênicos Fusarium oxysporum f. sp. phaseoli (Fop), F. solani f. sp. phaseoli (Fsp), Sclerotinia sclerotiorum (Ss), S. minor (Sm), Rhizoctonia solani (Rs), Sclerotium rolfsii (Sr) e Macrophomina phaseolina (Mp). Avaliou-se em placas de Petri o crescimento radial desses fungos em meio batata-dextrose-ágar (BDA) com cinco concentrações (0, 250, 500, 1000 e 3000 mg L-1) dos óleos essenciais. Discos de micélio (5 mm de diâmetro) de cada fungo em crescimento foram transferidos para placas de Petri que foram mantidas a 23°C no escuro por 48 horas. O óleo essencial de alecrim-do-campo foi o mais eficiente na redução do crescimento micelial de todos os fungos, com inibição completa quando se utilizou a concentração de 3000 mg L-1. A redução de crescimento variou de 29% (Fs) a 80% (Rs) a 250 mg L-1 do óleo essencial de alecrim-do-campo; a 500 mg L-1, variou de 29% (Fs) a 98% (Sr); e a 1000 mg L-1, de 41% (Fs) a 100% (Sr). A redução do crescimento dos fungos pelo óleo de aroeirinha na concentração de 3000 mg L-1 variou de 27% (Fsp) a 74% (Rs). Nessa concentração, o óleo de arnica-brasileira reduziu o crecimento micelial de Ss em 72%, o de Rs em 80% e o de Mp em 82%, sem efeitos significativos sobre o crescimento micelial de Fsp e Fop. Conclui-se que os óleos essenciais de alecrim-do-campo, aroeirinha e arnica-brasileira possuem potencial para o controle dos fungos fitopatogênicos estudados, com destaque para o óleo de alecrim-do-campo.

In addition to their value as therapeutic resources, medicinal plants also have the potential to be used as a source of alternative compounds against plant pathogens. The objective of this study was to evaluate the effect of essential oils extracted from the medicinal species Baccharis dracunculifolia, Schinus terebinthifolius and Porophyllum ruderale on the growth of the fungal plant pathogens Fusarium oxysporum f. sp. phaseoli (Fop), F. solani f. sp. phaseoli (Fsp), Sclerotinia sclerotiorum (Ss), S. minor (Sm), Rhizoctonia solani (Rs), Sclerotium rolfsii (Sr) and Macrophomina phaseolina (Mp). The radial mycelial growth of the fungi was evaluated on potato dextrose agar (PDA) in Petri dishes with five concentrations (0, 250, 500, 1000 and 3000 μL L-1) of the essential oils. Mycelial discs (5 mm diameter) of the growing colonies of each fungus were transferred to Petri dishes, which were maintained at 23 °C in the dark for 48 hours. The essential oil of B. dracunculifolia was the most effective oil in the reduction of the mycelial growth of all fungi. It completely inhibited their growth at 3000 mg L-1. At 250 mg L-1, the growth reduction caused by the oil of B. dracunculifolia varied from 29% (Fs) to 80% (Rs); at 500 mg L-1, it varied from 29% (Fs) to 98% (Sr); and at 1000 mg L-1, it varied from 41% (Fs) to 100% (Sr). The reduction of the mycelial growth caused by the oil of S. terebinthifolius at 3000 mg L-1 varied from 27% (Fsp) to 74% (Rs). At this concentration, the oil of P. ruderale reduced the mycelial growth of Ss by 72%, of Rs by 80% and of Mp by 82%, without significant effects on the mycelial growth of Fsp and Fop. We conclude that the essential oils of B. dracunculifolia, S. terebinthifolius and P. ruderale have the potential to be used to control the plant pathogens tested, especially the oil of B. dracunculifolia.

High-voltage electrical burn injuries: functional upper extremity assessment.

High-voltage electric injuries have many manifestations, and an important complication is the damage of the central/peripheral nervous system. The purpose of this work was to assess the upper limb dysfunction in patients injured by high-voltage current. The evaluation consisted of analysis of patients' records, cutaneous-sensibility threshold, handgrip and pinch strength and a specific questionnaire about upper limb dysfunctions (DASH) in 18 subjects. All subjects were men; the average age at the time of the injury was 38 years. Of these, 72% changed job/retired after the injury. The current entrance was the hand in 94% and grounding in the lower limb in 78%. The average burned surface area (BSA) was 8.6%. The handgrip strength of the injured limb was reduced (p<0.05) and so also that of the three pinch types. The relationship between the handgrip strength and the DASH was statistically significant (p<0.001) as well as the relationship between the three pinch types (p

Aproveitamento de soro lácteo na formulação de bebidas com frutas e hortaliças / The use of whey in the formulation of beverages with fruits and vegetables

O uso do soro lácteo como complemento na formulação de alimentos visando ao seu aproveitamento é uma alternativa para a obtenção de novos produtos. Neste trabalho, desenvolveram-se bebidas à base de soro oriundo de queijo coalho tipo A com frutas e hortaliças. Na formulação das bebidas, utilizaram-se diferentes proporções entre soro lácteo, frutas e hortaliças, com adição de 10% de açúcar. Seis bebidas foram formuladas e submetidas a um teste de preferência, e as três primeiras colocadas foram submetidas a um teste de aceitação sensorial. As três preferidas foram as bebidas sabor graviola, morango e goiaba. A bebida sabor graviola obteve aceitação com as melhores notas nos atributos sensoriais cor, sabor, aparência e qualidade global, seguida pela formulação de sabor morango, mas sem diferença significativa (P>0,05). A bebida sabor goiaba teve o diferencial no atributo odor e superou as bebidas sabor graviola e morango (P<0,05). Conclui-se que é viável a elaboração de bebidas à base de soro de queijo coalho com frutas.

The use of whey as complement in food formulation aiming it's an alternative for the attainment of new products. The aim of this work was developed a type A curd cheese whey derived drink with fruits and vegetables. On drink's formulation was used different ratios of whey, fruits and vegetables, with 10% of sugar. Six drinks were formulated and submited to a preference test. The three best drinks were submitted to a acceptance test. The three best drinks were graviola, strawberry and guava flavours. The graviola one had the greater acceptability with best grades in color's sensory attributes, flavor, appearance and overall quality, following the strawberry flavor, but without significant difference (P<0,05). The guava dink had it's differential on scent character, overcoming the graviola and strawberry drinks (P<0,05). In conclusion we can say that whey-based drink with fruits is viable.

Comercialização de plantas medicinais no contexto da cadeia produtiva em Minas Gerais / Commercialization of medicinal plants in the context of the productive chain in Minas Gerais

A Política Nacional de Práticas Integrativas e Complementares no Sistema Único de Saúde (SUS) contribuiu para o incremento do uso e conhecimento das plantas medicinais brasileiras, incentivando e respaldando o cultivo por agricultores familiares e a inserção no mercado. O Programa de Desenvolvimento de Plantas Medicinais prioriza ações em toda a cadeia produtiva do cultivo à distribuição. O conhecimento da demanda e dos padrões de qualidade adequados permite que distribuidores e consumidores possam tomar decisões sobre a aquisição e oferta dos produtos medicinais. Entretanto, há carência de informações e tecnologias na cadeia produtiva, o que desfavorece o seu pleno desenvolvimento, condizente com o potencial de geração de renda e promoção da saúde. O objetivo deste trabalho foi identificar e analisar o padrão atual de obtenção e comercialização de plantas medicinais no Mercado Central de Belo Horizonte. Foram realizadas entrevistas semi-estruturadas com amostra representativa de 9 comerciantes das 23 lojas de plantas medicinais do Mercado Central, de acordo com o critério de acessibilidade descrito por Berquó. Os resultados demonstraram a precariedade desse setor quanto à obtenção das plantas medicinais, principalmente pela falta de conhecimento e informações na aquisição e venda dos produtos pelos consumidores e vendedores, respectivamente.

The National Politic Integrative and complementary Practices in Health System (SUS) contributed to the increased use and knowledge of Brazilian medicinal plants, which encourages and supports the growing of family farmers and their integration in efficient markets. The Program for the Development of Medicinal Plants prioritizes actions in the entire production chain from cultivation to distribution. Knowledge of demand and adequate quality standards allows distributors and consumers to make decisions on the acquisition and supply of medicinal products. However, there is a lack of information and technologies in this supply chain, which discourages its full development, consistent with the potential for income generation and health promotion presents. The objective of this study was to identify and analyze current patterns of production and marketing of medicinal plants in the Central Market of Belo Horizonte. We conducted semi-structured interviews with nine of the 23 stores trades of medicinal plants from the Central Market. Results showed the precarious nature of this sector in obtaining medicinal plants, mainly by lack of knowledge and information in the purchase and sale of products by consumers and sellers, respectively.

Cestodes Diphyllobothriidea parasitizing blackfin goosefish, Lophius gastrophysus Miranda-Ribeiro, 1915 / Cestoides Diphyllobothriidea parasitos de peixe sapo-pescador, Lophius gastrophysus Miranda-Ribeiro, 1915

Entre os meses de março de 2000 e dezembro de 2005, 87 espécimes de L. gastrophysus foram obtidos de supermercados e empresas de exportação localizadas nos municipios de Cabo Frio, Niteroi, Duque de Caxias e Rio de Janeiro. Os peixes foram necropsiados, filetados e seus órgãos investigados para presença de helmintos. Dois espécimes (2,3 por cento) estavam parasitados por plerocecoides de Diphyllobothrium Cobbold, 1858 na cavidade abdominal e serosa do intestino, com intensidade média de um parasito por peixe e abundância média de 0,02, mostrando baixo potencial infectivo. Este é o primeiro registro de plerocercoides de Diphyllobothrium sp. no peixe sapo-pescador.

Potencial alelopático de extratos aquosos de Melissa officinalis L. e Mentha x villosa L. na germinação e vigor de sementes de Plantago major L. / Allelopathic effect of extracts of Melissa officinallis L. and Mentha x villosa L. on seed germination and vigor of Plantago major L.

O objetivo do trabalho foi avaliar o efeito dos extratos aquosos de hortelã e melissa na germinação e vigor de sementes de tanchagem. O experimento foi conduzido no Departamento de Fitotecnia da Universidade Federal de Viçosa, no mês de abril de 2011. O delineamento utilizado foi o inteiramente casualizado com cinco tratamentos (testemunha, 25 por cento, 50 por cento, 75 por cento e 100 por cento do extrato aquoso de hortelã e melissa) e quatro repetições. Os extratos foram preparados utilizando a parte aérea das plantas, na proporção de 100g de planta para 1 L de água destilada. Foram utilizadas 50 sementes de tanchagem em cada caixa gerbox, previamente umedecido com os extratos aquosos (correspondentes aos tratamentos), estas foram levadas para germinar em câmara de germinação, em temperatura de 20°C, fotoperíodo de 16 horas luz e 8 horas escuro, por 14 dias. Durante esse tempo foram feitas às contagens diárias das sementes germinadas para calcular o índice de velocidade de germinação e ao final dos 14 dias foi calculada a porcentagem de germinação. Sementes de tanchagem não submetidas aos extratos aquosos de melissa e hortelã apresentaram-se mais vigorosas quando comparado com as concentrações, evidenciando o potencial alelopático de melissa e hortelã sobre a sua qualidade fisiológica.

The aim of this work was to evaluate the effect of aqueous extracts of Melissa officinallis and Mentha x villosa for the germination and vigor of Plantago major seeds. The experiment was conducted at the Plant Science Department, Federal University of Viçosa, in April 2011. The design was a completely randomized design with five treatments (control, 25 percent, 50 percent, 75 percent and 100 percent of the aqueous extract of Mentha x villosa and Melissa Officinallis) and four replications. The extracts were prepared utulizando the shoots of plants at the rate of 100g of plant to 1 L of distilled water. We used 50 Plantago major seeds in each box incubator and these were subsequently placed in a germination chamber. 14 days during the counting of germinated seeds per day to calculate the index of germination speed and the end of 14 days was the germination percentage. Plantago major seeds not subjected to aqueous extracts of lemon balm and mint showed higher values in the variables studied when compared to other concentrations, showing the allelopathic potencial of Melissa officinallis and Mentha x villosa on the development of plantain, determined by germinating.

Risks of anticoagulant therapy in pregnant women with artificial heart valves.

In an attempt to identify the best treatment for pregnant women with cardiac-valve prostheses who are receiving oral anticoagulants, we studied 72 pregnancies prospectively. In 23 pregnancies (Group I), the coumarin derivative acenocoumarol was discontinued and the patients received 5,000 U of subcutaneous heparin every 12 hours from the 6th to the 12th week of gestation, in 12 pregnancies (Group II), heparin was not substituted for the coumarin derivative until after the 7th week, and in 37 pregnancies, detected after the first trimester (Group III), the coumarin derivative was given throughout gestation. In most patients heparin was again substituted for the oral anticoagulant after the 38th week. Three mothers had thrombosis of a tilting-disk mitral prosthesis (two cases were fatal) during heparin treatment. No differences were found in the rates of spontaneous abortion in the three groups. Coumarin embryopathy occurred in 25 percent and 29.6 percent of the pregnancies in Groups II and III, respectively. We conclude that in the second and third trimesters of pregnancy, coumarin derivatives provide effective protection against thromboembolism while causing few fetopathic effects, but that these agents are contraindicated from the 6th to the 12th weeks of gestation. Low-dose heparin does not protect against prosthetic-valve thrombosis, and the possibility that a larger dose might be more effective requires further exploration.

Comparison of two different severity scores (Paediatric Risk of Mortality [PRISM] and the Glasgow Meningococcal Sepsis Prognostic Score [GMSPS]) in meningococcal disease: preliminary analysis.

Two different illness severity scores, Pediatric Risk of Mortality (PRISM) and the Glasgow Meningococcal Sepsis Prognostic Score (GMSPS), were evaluated and compared in meningococcal disease in two paediatric intensive care units. Forty-nine children with a median age of 36 months who had meningococcal sepsis confirmed by laboratory data were evaluated. Overall mortality was 18%. The median GMSPS was 3 in survivors and 8 in non-survivors. A GMSPS > or = 8 was significantly associated with death (p = 0.0001) with a mortality predictivity and specificity of 70% and 92.5%, respectively. The median PRISM score in survivors was 5.5 and 23 in non-survivors. A PRISM score of > or = 11 was significantly related to death (p < 0.0001). The Kendal correlation co-efficient between GMSPS and PRISM showed tau = 0.6859 (p = 0.0000). It is concluded that GMSPS and PRISM are useful methods for identifying and classifying children into low and high risk categories. GMSPS > or = 8 or a PRISM score > or = 11 are significantly predictive of mortality.

A influência da mobilização articular nas tendinopatias dos músculos bíceps braquial e supra-espinal / The influence of joint mobilization on tendinopathy of the biceps brachii and supraspinatus muscles

As causas mais comuns de dor no ombro estão relacionadas às degenerações dos tendões da musculatura do manguito rotador. OBJETIVO: Verificar a influência da mobilização articular por meio dos movimentos acessórios do ombro na recuperação inicial de 14 pacientes com tendinopatia crônica dos mm. supra-espinal e/ou bíceps braquial. MÉTODOS: Foram comparados dois protocolos de tratamento, compostos da aplicação de ultra-som terapêutico na área do tendão afetado e de treinamento excêntrico na musculatura envolvida, acompanhados ou não de manobras de mobilização articular. Como métodos de avaliação foram utilizados os questionários de Constant e Disabilities of the Arm, Shoulder and Hand (DASH), no início e ao final do tratamento. RESULTADOS: Os resultados encontrados demonstraram que ambos os protocolos de tratamento foram eficazes na reabilitação dos pacientes, pois se obtiveram melhores resultados funcionais na aplicação dos questionários quando comparados o final com o início do tratamento para os pacientes (p<0,001). Os pacientes que foram submetidos à mobilização articular associada ao ultra-som terapêutico e o treinamento excêntrico obtiveram em média melhores escores para os questionários, ocorrendo diferença estatística significante entre os escores finais nos dois grupos para os dois questionários (p<0,05). CONCLUSÕES: Assim ambos os protocolos de tratamento foram eficazes no tratamento da tendinopatia crônica do ombro, sendo que, o uso associado da mobilização articular parece oferecer melhores resultados funcionais.

The most common causes of shoulder pain are related to degeneration of the tendons of the rotator cuff muscles. OBJECTIVE: To investigate the influence of joint mobilization by means of accessory movements of the shoulder during the early rehabilitation of 14 patients with chronic tendinopathy of the supraspinatus and/or biceps brachii muscles. METHODS: Two treatment protocols were compared: application of therapeutic ultrasound over the affected tendon area and eccentric training of the musculature involved, with or without joint mobilization maneuvers. The Constant and DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires were used as the assessment method, before and after the treatment. RESULTS: The results showed that both treatment protocols were effective for patient rehabilitation, since better functional results were obtained at the end of the treatment, in comparison with the beginning (p<0.001). The patients who underwent joint mobilization in association with therapeutic ultrasound and eccentric training achieved better mean scores in the questionnaires. There was a statistically significant difference in the final scores between the two groups, for both questionnaires (p<0.05). CONCLUSIONS: Thus, both treatment protocols were effective for treating chronic tendinopathy of the shoulder, although their use in association with joint mobilization seems to provide better functional results.