Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology.

There is growing interest in using cannabinoids across various clinical scenarios, including pain medicine, leading to the disregard of regulatory protocols in some countries. Legislation has been implemented in Brazil, specifically in the state of São Paulo, permitting the distribution of cannabinoid products by health authorities for clinical purposes, free of charge for patients, upon professional prescription. Thus, it is imperative to assess the existing evidence regarding the efficacy and safety of these products in pain management. In light of this, the São Paulo State Society of Anesthesiology (SAESP) established a task force to conduct a narrative review on the topic using the Delphi method, requiring a minimum agreement of 60% among panelists. The study concluded that cannabinoid products could potentially serve as adjuncts in pain management but stressed the importance of judicious prescription. Nevertheless, this review advises against their use for acute pain and cancer-related pain. In other clinical scenarios, established treatments should take precedence, particularly when clinical protocols are available, such as in neuropathic pain. Only patients exhibiting poor therapeutic responses to established protocols or demonstrating intolerance to recommended management may be considered as potential candidates for cannabinoids, which should be prescribed by physicians experienced in handling these substances. Special attention should be given to individual patient characteristics and the likelihood of drug interactions.

Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering

ABSTRACT Introduction: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and maybe related to a worse quality of life (QoL). Objectives: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. Methods: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. Results: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ± €42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. Conclusion: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Effect of Combined Training on Body Image, Body Composition and Functional Capacity in Patients with Breast Cancer: Controlled Clinical Trial.

OBJECTIVE: Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity. METHODS: This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%). RESULTS: The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033). CONCLUSION: Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

OBJETIVO: Avaliar o efeito do treinamento combinado na imagem corporal (IB), composição corporal e capacidade funcional em pacientes com câncer de mama. Assim como a relação do IB com a composição corporal e capacidade funcional. MéTODOS:: Este foi um estudo de Ensaio Clínico Controlado, este estudo incluiu 26 pacientes com câncer de mama (30 a 59 anos). O grupo de treinamento (n = 13) foi submetido a 12 semanas de treinamento, incluindo três sessões de 60 min de exercício aeróbio e treinamento de resistência, e duas sessões de treinamento de flexibilidade por semana; cada exercício de flexibilidade durou 20s. O Grupo Controle (n = 13) recebeu apenas o tratamento hospitalar padrão. Os participantes foram avaliados no início e após 12 semanas. O IB (desfechos primários) foi avaliado por meio do Body Image After Breast Cancer Questionnaire; A composição corporal foi estimada com os indicadores: índice de massa corporal; Peso, relação cintura-quadril; Relação da altura da cintura; Índice de conicidade; Índice ponderal recíproco; Porcentagem de gordura; Circunferência do abdômen e cintura; Capacidade funcional por aptidão cardiorrespiratória (cicloergômetro) e força (dinamômetro manual). A estatística foi realizada na Bioestatística e no Stata 14.0 (α = 5%). RESULTADOS: Os pacientes do grupo de treinamento apresentaram redução da dimensão da limitação (p = 0,036) no IB, porém, foi observado aumento da circunferência da cintura em ambos os grupos. Além disso, um aumento do VO2máx (p <0,001) e da força nos braços direito (p = 0,005) e esquerdo (p = 0,033). CONCLUSãO:: O treinamento combinado demonstra ser uma estratégia eficaz e não farmacológica para pacientes com câncer de mama, com melhora do IB e da capacidade funcional, alterando variáveis relacionadas negativamente quando não há treinamento físico.

Effect of Combined Training on Body Image, Body Composition and Functional Capacity in Patients with Breast Cancer: Controlled Clinical Trial / Efeito do treinamento combinado na imagem corporal, composição corporal e capacidade funcional em pacientes com câncer de mama: ensaio clínico controlado

Abstract Objective Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity. Methods This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%). Results The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033). Conclusion Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

Resumo Objetivo Avaliar o efeito do treinamento combinado na imagem corporal (IB), composição corporal e capacidade funcional em pacientes com câncer de mama. Assim como a relação do IB com a composição corporal e capacidade funcional. Métodos Este foi um estudo de Ensaio Clínico Controlado, este estudo incluiu 26 pacientes com câncer de mama (30 a 59 anos). O grupo de treinamento (n = 13) foi submetido a 12 semanas de treinamento, incluindo três sessões de 60 min de exercício aeróbio e treinamento de resistência, e duas sessões de treinamento de flexibilidade por semana; cada exercício de flexibilidade durou 20s. O Grupo Controle (n = 13) recebeu apenas o tratamento hospitalar padrão. Os participantes foram avaliados no início e após 12 semanas. O IB (desfechos primários) foi avaliado por meio do Body Image After Breast Cancer Questionnaire; A composição corporal foi estimada com os indicadores: índice de massa corporal; Peso, relação cintura-quadril; Relação da altura da cintura; Índice de conicidade; Índice ponderal recíproco; Porcentagem de gordura; Circunferência do abdômen e cintura; Capacidade funcional por aptidão cardiorrespiratória (cicloergômetro) e força (dinamômetro manual). A estatística foi realizada na Bioestatística e no Stata 14.0 (α = 5%). Resultados Os pacientes do grupo de treinamento apresentaram redução da dimensão da limitação (p = 0,036) no IB, porém, foi observado aumento da circunferência da cintura em ambos os grupos. Além disso, um aumento do VO2máx (p <0,001) e da força nos braços direito (p = 0,005) e esquerdo (p = 0,033). Conclusão O treinamento combinado demonstra ser uma estratégia eficaz e não farmacológica para pacientes com câncer de mama, com melhora do IB e da capacidade funcional, alterando variáveis relacionadas negativamente quando não há treinamento físico.

Adverse effects of cannabinoid use: what is the safety paradigm? / Efeitos adversos do uso dos canabinoides: qual o paradigma de segurança?

ABSTRACT BACKGROUND AND OBJECTIVES: Interest in the use of marijuana (Cannabis sativa) for medicinal purposes has increased exponentially in recent decades, and the plant and its derivatives are becoming more frequently found in prescriptions for patients with chronic pain. All prescription drugs and illicit substances have adverse effects, even those from plants, fruits, and flowers, as has been well established with the use of tobacco, alcohol, and opium. Marijuana is no exception. The purpose of this study was to review and synthesize the evidence related to the adverse effects promoted by plant-derived cannabinoids, and the implications for the safety of using these substances in pain patients. CONTENTS: A narrative review was conducted based on articles published in scientific journals indexed in Pubmed and Scielo between the years 2000 and 2022. CONCLUSION: The evidence is still contradictory and weak on many aspects of adverse effects and clearly there is a need for further research and advances towards a more detailed elucidation of these effects for both non-medical and medical cannabis use. Screening and monitoring of such use, identifying situations of vulnerability to mental illness and dependence, with careful surveillance for adverse effects, is critical.

RESUMO JUSTIFICATIVA E OBJETIVOS: O interesse na utilização da maconha (Cannabis sativa) com fins medicinais aumentou de forma exponencial nas últimas décadas e a planta e seus derivados vêm se tornando mais frequentemente encontrados nas prescrições médicas de pacientes com dor crônica. Todos os fármacos prescritos e substâncias ilícitas têm efeitos adversos, mesmo aquelas provenientes de plantas, frutas e flores, como já ficou bem estabelecido com o uso do tabaco, álcool e ópio. A maconha não é exceção. O objetivo deste estudo foi revisar e sintetizar as evidências relacionadas aos efeitos adversos promovidos pelos canabinoides derivados da planta, e às implicações sobre a segurança do uso destas substâncias em pacientes com dor. CONTEÚDO: Foi realizada uma revisão narrativa baseada em artigos publicados em revistas científicas indexadas no Pubmed e Scielo, entre os anos de 2000 e 2022. CONCLUSÃO: As evidências ainda são contraditórias e frágeis em relação a muitos aspectos dos efeitos adversos e claramente há a necessidade de mais pesquisas e avanços para uma elucidação mais detalhada destes efeitos tanto para o uso não medicinal quanto médico de cannabis. É fundamental uma triagem e monitoramento desse uso, identificando situações de vulnerabilidade a doenças mentais e dependência, com cuidadosa vigilância de efeitos adversos.

Glia function in the endocanabinoid system: narrative review / Função da glia no sistema endocanabinoide: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Evidence has highlighted a role of glial cell activation, and their interaction with different neural systems, especially the endocannabinoid system, in the mechanisms involved in the chronicity and maintenance of pain. The aim of this review is to bring an update on published data that demonstrate the interaction between glial cells and the endocannabinoid system in the pathophysiology of chronic pain and its treatment. CONTENTS: A narrative review was performed based on a research in the Medline database, using the Keywords "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSION: Deepening the knowledge about the function of glial cells in the endocannabinoid system will open the possibility of acting on the pathophysiological origin of the pain chronification process, attenuating the mechanisms involved in central sensitization.

RESUMO JUSTIFICATIVA E OBJETIVOS: A evidência científica tem ressaltado um papel da ativação das células da glia e de sua interação com diversos sistemas neurais, com destaque para o sistema endocanabinoide e mecanismos envolvidos na cronificação e manutenção da dor. O objetivo deste estudo foi atualizar os dados publicados que mostrem a interação entre as células da glia com o sistema endocanabinoide na fisiopatologia da dor crônica e seu tratamento. CONTEÚDO: Foi realizada uma revisão narrativa baseada em pesquisa na base de dados Medline, com uso dos unitermos "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSÃO: O aprofundamento do conhecimento acerca da função das células da glia no sistema endocanabinoide abrirá a possibilidade de atuação sobre a origem fisiopatológica do processo de cronificação de dor, atenuando os mecanismos envolvidos na sensibilização central.

Effect of concurrent training (aerobic+resistance) more static stretching on flexibility in women with breast cancer / Efeito do treinamento concorrente (aeróbio + resistência) mais alongamento estático na flexibilidade em mulheres com câncer de mama

Objective. was to assess flexibility in women with breast cancer who underwent concurrent training (aerobic+resistance) (CT) more static stretching. Methods. This was a controlled pilot study, with 31 women (age 30 to 59) under breast cancer treatment, 14 women were allocated to a training group (TG) who underwent CT more static stretching, concomitant to hospital treatment and 17 women for the control group (CG) who only underwent hospital treatment. The CT more static stretching was performed in 12 weeks with 5 sessions per week, three sessions (aerobic+resistance) and two sessions (stretching exercises) on alternate days. The flexibility of the shoulder was measured by means of the 360º Sanny pendulum goniometer and the flexibility of the lower limbs was assessed through the sit-and-reach test. Data were analyzed using repeated measures ANOVA Test and Bonferroni Post-hoc using SPSS 21 software, with α of 5%. Results. The TG presented increased flexibility in the horizontal abduction of the right shoulder (p=0.001) and in the lower limbs (p<0.001), but the CG showed a reduction in the horizontal abduction of the right shoulder (p=0.003). The effect size for horizontal abduction of the right shoulder was medium (p=0.508) and for the lower limbs was large (p=0.839). Conclusion. CT more static stretching may be a therapeutic intervention to increase flexibility of upper and lower limbs in women with breast cancer. (AU)

Objetivo. Avaliar a flexibilidade em mulheres com câncer de mama que realizaram treinamento concorrente (aeróbio + resistência) (TC) mais alongamento estático. Métodos. Este foi um estudo piloto controlado, com 31 mulheres (de 30 a 59 anos) em tratamento para câncer de mama, 14 mulheres foram alocadas em um grupo de treinamento (GT) que realizaram TC mais alongamento estático, concomitante a tratamento hospitalar e 17 mulheres para o grupo de controle (GC) que somente realizaram tratamento hospitalar. O TC mais alongamento estático foram realizados em 12 semanas com 5 sessões semanais, três sessões (aeróbia + resistência) e duas sessões (exercícios de alongamento) em dias alternados. A flexibilidade do ombro foi medida por meio do goniômetro de pêndulo 360º Sanny e a flexibilidade de membros inferiores foi avaliada por meio do teste de sentar e alcançar. Os dados foram analisados usando o Teste ANOVA de medidas repetidas e Post-hoc de Bonferroni no software SPSS 21, com α de 5%. Resultados. O GT apresentou aumento da flexibilidade na abdução horizontal do ombro direito (p=0,001) e nos membros inferiores (p<0,001), mas o GC apresentou redução da abdução horizontal do ombro direito (p=0,003). O tamanho do efeito para abdução horizontal do ombro direito foi médio (p=0,508) e para membros inferiores foi grande (p=0,839). Conclusão. O TC mais alongamento estático podem ser uma intervenção terapêutica para aumentar a flexibilidade de membros superiores e inferiores em mulheres com câncer de mama. (AU)

Ansiedade, Depressão, Dor e Fadiga em Pacientes com Câncer de Mama que Realizaram Treinamento Combinado / Anxiety, Depression, Pain and Fatigue in Patients with Breast Cancer who Submitted to Combined Training / Ansiedad, Depresión, Dolor y Fatiga en Pacientes con Cáncer de Mama con Entrenamiento Combinado

Introdução: Apesar do aumento na sobrevida de pacientes com neoplasias de mama, muitas persistem com ansiedade, depressão, fadiga e dor mesmo após o tratamento anticancerígeno, fatores associados a uma pior qualidade de vida. Objetivo: Avaliar a influência do treinamento combinado na ansiedade, depressão, dor e fadiga em pacientes com câncer de mama. Método: Ensaio controlado randomizado com 26 pacientes em quimioterapia, radioterapia ou acompanhamento clínico em um centro de referência em tratamento de câncer, com idade 30 a 59 anos, não praticantes de treinamento físico nos últimos três meses. O grupo experimental (GE) (n=13) foi submetido a três sessões por semana de treinamento aeróbico e resistido em 12 semanas, com duração de 60 minutos, e duas sessões de treinamento de flexibilidade por semana com duração de 20 segundos em três séries. O grupo controle (GC) (n=13) realizou somente o tratamento hospitalar convencional. Todas as avaliações foram realizadas no tempo basal e após 12 semanas. Resultados: As pacientes do GE apresentaram redução significativa da ansiedade (p=0,0242), intensidade da dor (p=0,0290) e dimensão comportamental da fadiga (0,0033). Não foram observadas diferenças na depressão (p=0,0803), interferência da dor nas atividades habituais (p=0,0933) e dimensões afetiva (p=0,0583) e sensorial/cognitiva/emocional (p=0,5525) da fadiga. O GC permaneceu inalterado em todas as variáveis. Conclusão: O treinamento combinado, envolvendo exercícios aeróbios, de resistência e de flexibilidade durante 12 semanas, apresenta efeitos benéficos na ansiedade, fadiga e dor em pacientes com câncer de mama

Introduction: Despite the increase of the survival of patients with breast cancer, many persist with anxiety, depression, fatigue, and pain even after anticancer treatment, factors associated with a worse quality-oflife. Objective: Evaluate the influence of combined training on anxiety, depression, pain and fatigue in breast cancer patients. Method: Randomized controlled trial with 26 patients undergoing chemotherapy, radiotherapy, or clinical follow-up at a referral centre for cancer treatment, aged 30 to 59 years, not practicing physical training in the last three months. The experimental group (EG) (n=13) was submitted to 3 sessions per week of aerobic and resistance training, for 12 weeks, lasting 60 minutes, and 2 sessions per week of flexibility training lasting 20 seconds in 3 sets. The control group (CG) (n=13) submitted only to conventional hospital treatment. All assessments were performed at baseline and after 12 weeks. Results: EG patients showed a significant reduction in anxiety (p=0.0242), pain intensity (p=0.0290) and the behavioral dimension of fatigue (0.0033). No differences were observed in depression (p=0.0803), interference of pain in usual activities (p=0.0933) and affective (p=0.0583) and sensory/ cognitive/emotional (p=0.5525) dimensions of fatigue. The GC remained unchanged in all variables. Conclusion: Combined training involving aerobic, resistance and flexibility exercises for 12 weeks has beneficial effects on anxiety, fatigue and pain in breast cancer patients

Introducción: A pesar del aumento de la supervivencia de las pacientes con cáncer de mama, muchas persisten con ansiedad, depresión, fatiga y dolor incluso después del tratamiento anticanceroso, factores asociados a una peor calidad de vida. Objetivo: evaluar la influencia del entrenamiento combinado sobre la ansiedad, la depresión, el dolor y la fatiga en pacientes con cáncer de mama. Método: Ensayo controlado aleatorio con 26 pacientes bajo quimioterapia, radioterapia o seguimiento clínico en un centro de referencia para el tratamiento del cáncer, con edades comprendidas entre los 30 y los 59 años, que no han practicado entrenamiento físico en los últimos tres meses. El grupo experimental (GE) (n=13) fue sometido a tres sesiones semanales de entrenamiento aeróbico y de resistencia en 12 semanas, de 60 minutos de duración, y a dos sesiones semanales de entrenamiento de flexibilidad de 20 segundos en tres series. El grupo de control (GC) (n=13) sólo realizó el tratamiento hospitalario convencional. Todas las evaluaciones se realizaron al inicio y después de 12 semanas. Resultados: Los pacientes del GE mostraron una reducción significativa de la ansiedad (p=0,0242), la intensidad del dolor (p=0,0290) y la dimensión conductual de la fatiga (0,0033). No se observaron diferencias en la depresión (p=0,0803), la interferencia del dolor en las actividades habituales (p=0,0933) y las dimensiones afectivas (p=0,0583) y sensoriales/cognitivas/emocionales (p=0,5525) de la fatiga. El GC se mantuvo sin cambios en todas las variables. Conclusión: El entrenamiento combinado de ejercicios aeróbicos, de resistencia y de flexibilidad durante 12 semanas presenta efectos beneficiosos sobre la ansiedad, la fatiga y el dolor en pacientes con cáncer de mama

End-of-life experience and its toll on quality of life and spirituality: a cross-sectional study.

BACKGROUND: Breast and cervical/uterine cancer affect body parts that have symbolic meaning for women. Women with this diagnosis at the end-of-life often experience anxiety and depression that severely impacts their quality of life (QoL). AIMS: This study aims to determine how the end-of-life experience impacts on the QoL and spirituality of women with advanced cancer. METHODS: End-of-life patients and their caregivers were evaluated regarding religious and spiritual coping, depression and self-efficacy. Caregivers were interviewed regarding patients' QoL at the end-of-life. A spearman correlation test was used to evaluate correlation between variables. FINDINGS: Several dimensions of positive religious and spiritual coping stood out for patients at the end of life. However, patients often experienced a negative revaluation of God. Patients reported experiencing low self-efficacy, depression and high levels of stress. The length of hospital stay, time spent in intensive care units and depression also correlated to the amount of worry and stress a patient experienced. CONCLUSIONS: The end-of-life patients had a poor quality of life, and experienced depression, but also used spiritual beliefs and religion as a means of coping with their end-of-life experience.

The use of guarana (Paullinia cupana) as a dietary supplement for fatigue in cancer patients: a systematic review with a meta-analysis.

OBJECTIVE: The objective of the present study was to carry out a systematic review with a meta-analysis to assess evidence about the use of guarana fruit to manage fatigue in cancer patients. METHODOLOGY: The data were extracted from the EMBASE, Scopus, MEDLINE, CENTRAL, and CINAHL databases, in any language, using the descriptors "neoplasms" and "Paullinia" or "guarana powder" and "placebos" and "fatigue". Searches were also conducted to identify any grey literature. Clinical studies with patients who presented cancer-related fatigue as a primary outcome and who used guarana as a dietary supplement were included. The risk of bias in randomized clinical trials was analyzed according to the Cochrane recommendations. The quality of the evidence was assessed using the GRADE system. For studies with the same types of tumors and treatments, meta-analysis was also conducted. RESULTS: A total of 383 studies were found and, of these, seven were included in the review, for a total of 427 cancer patients. The instruments used to analyze fatigue were the Brief Fatigue Inventory (BFI), the Chalder Fatigue Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-FATIGUE), and the Piper Scale. Some studies presented a low risk of bias for all the categories. Meta-analysis was conducted for three studies about breast cancer, which presented sufficient data. The use of guarana did not reduce cancer-related fatigue compared with placebo groups (mean of - 0.02 [95% CI - 1.54, 1.50]; p = 0.98) and the quality of evidence according to GRADE was very low. CONCLUSION: Dietary supplements are used to improve cancer-related fatigue. The results of this review showed that the use of guarana was not superior to the placebo groups, pointing to the need for further studies with better methodological quality.

Impact of home-based aerobic training combined with food orientation on food consumption, daily physical activity and cardiorespiratory fitness among breast cancer survivors: six-month clinical trial.

BACKGROUND: Anticancer treatment gives rise to adverse effects such as increased pain and changes to body weight and menstrual cycles, with negative effects on activities of daily living. OBJECTIVE: To analyze the effect of food orientation combined with supervised (face-to-face, FF) versus home-based (HB) aerobic training on lifestyle (food consumption and daily physical activity (PA) levels), body composition, metabolic profile and cardiorespiratory fitness, among breast cancer survivors. DESIGN AND SETTING: Clinical trial study (six months) conducted at a public university in Presidente Prudente, Brazil. METHODS: Twenty-three female breast cancer survivors (40-75 years old) were allocated to aerobic training groups, either FF or HB. Both groups were trained and received food orientation. They were evaluated through a dietary record, ergometric treadmill test and blood test and the Baecke questionnaire. RESULTS: After six months, both groups had reduced their lipid levels, total energy consumption and polyunsaturated fat intake, and had increased their PA levels and treadmill test durations. However, only the HB showed reduced carbohydrate percentage and increased folic acid; and only the FF showed reduced lipid, saturated fat and sodium levels, along with increased carbohydrate and protein levels. No differences in body composition or metabolic profile were found. CONCLUSIONS: These results demonstrated the feasibility of HB aerobic training. In isolation, HB showed greater regulation of carbohydrate percentage and increased folic acid levels. Moreover, these breast cancer survivors presented improvements in food consumption, PA levels and cardiorespiratory fitness, while also maintaining their body composition and metabolic profile after the intervention, independent of the group.

Effect of intra-articular dexmedetomidine on experimental osteoarthritis in rats.

Pharmacological treatment of osteoarthritis is still inadequate due to the low efficacy of the drugs used. Dexmedetomidine via the intra-articular (i.a.) route might be an option for the treatment of osteoarthritis-associated pain. The present study assessed the analgesic and anti-inflammatory effects of dexmedetomidine administered via the i.a. route in different doses in an experimental model of rat knee osteoarthritis induced with monosodium iodoacetate. Rats were allocated to four groups with 24 animals in each group. The OA (osteoarthritis), DEX-1 (dexmedetomidine in dose of 1µg/kg) and DEX-3 (dexmedetomidine in dose of 3µg/kg) groups were subjected to induction of osteoarthritis through injection of monosodium iodoacetate (MIA) via the i.a. route on the right knee; the control group was not subjected to osteoarthritis induction. Clinical assessment was performed on day 0 (before osteoarthritis induction) and then on days 5, 10, 14, 21 and 28 after induction. Treatment was performed on day 7 via the i.a. route, consisting of dexmedetomidine in doses of 1 and 3 µg/kg, while group OA received 0.9% normal saline. The animals were euthanized on days 7, 14, 21 and 28. Samples of the synovial membrane were collected for histopathological analysis, and the popliteal lymph nodes were collected for measurement of cytokines (interleukin [IL] IL-6, tumor necrosis factor alpha [TNF-α]). Dexmedetomidine (1 and 3 µg/kg) significantly reduced the animals' weight distribution deficit during the chronic-degenerative stage of osteoarthritis and improved the pain threshold throughout the entire experiment. Histological analysis showed that dexmedetomidine did not cause any additional damage to the synovial membrane. The TNF-α levels decreased significantly in the DEX-3 group on day 28 compared with the OA group. Dexmedetomidine reduced pain, as evidenced by clinical parameters of osteoarthritis in rats, but did not have an anti-inflammatory effect on histological evaluation.

Self-efficacy and fear of pain to movement in chronic low back pain: an intervention developed by nurses / Autoeficacia y temor de dolor al movimiento en la lombalgía crónica: una intervención desarrollada por enfermeiras / Autoeficácia e medo da dor ao movimento na lombalgia crônica: uma intervenção desenvolvida por enfermeiras

ABSTRACT Objective: To test the effect of interventions to chronic low back pain developed by nurses in the Program to Increase Self-efficacy and Reduce the Fear of Pain and Avoidance of Movement. Method: Clinical trial, with 81 patients, carried out in 2016, at the Pain Outpatient Clinic in São Luís, Maranhão, Brazil. The groups received: A (education and exposure), B (education) and C (control). Chi-square, Fisher's Exact, ANOVA and Kruskal Wallis tests were performed. Results: Patients in groups A and B improved self-efficacy, anxiety, depression, and disability, compared to group C. The reduction in fear of pain and avoidance of movement was greater in Group A, which also showed a decrease in current pain and overall scores compared to Group B and C. Conclusion: Education was effective in increasing the Self-Efficacy Belief. For the Belief of Fear of Pain and Avoidance of Movement and pain intensity, the association with exposure showed better results.

RESUMEN Objetivo: Evaluar el efecto de las intervenciones para el dolor lumbar crónico desarrolladas por las enfermeras en el programa para aumentar la autoeficacia y reducir el miedo al dolor y evitar el movimiento. Método: Ensayo clínico, con 81 pacientes, realizado en 2016, en la Clínica del Dolor en São Luís, Maranhão, Brasil. Los grupos recibieron: A (educación y exposición), B (educación) y C (control). Se realizaron pruebas de Chi-cuadrado, Exacta de Fisher, ANOVA y Kruskal Wallis. Resultados: Los pacientes en los grupos A y B mejoraron la autoeficacia, la ansiedad, la depresión y la discapacidad, en comparación con el grupo C. La reducción en el miedo al dolor y la evitación del movimiento fue mayor en el Grupo A, que también mostró una disminución en el dolor actual y las puntuaciones generales de en comparación con los grupos B y C. Conclusión: Educación fue efectiva para aumentar la creencia en la autoeficacia. Para la creencia del miedo al dolor y la evitación del movimiento y la intensidad del dolor, la asociación con la exposición mostró mejores resultados.

RESUMO Objetivo: Testar o efeito de intervenções para lombalgia crônica desenvolvidas por enfermeiros no Programa para Aumentar a Autoeficácia e Diminuir o Medo da Dor e Evitação do Movimento. Método: Ensaio clínico, com 81 pacientes, realizado em 2016, no Ambulatório de Dor em São Luís, Maranhão, Brasil. Os grupos receberam: A (educação e exposição), B (educação) e C (controle). Realizaram-se testes Qui-quadrado, Exato de Fisher, ANOVA e Kruskal Wallis. Resultados: Pacientes dos grupos A e B melhoraram a autoeficácia, ansiedade, depressão e incapacidade, comparados ao grupo C. A redução no medo da dor e evitação do movimento foi maior no Grupo A, que também apresentou diminuição na dor atual e escores gerais de dor, comparado ao Grupo B e C. Conclusão: A Educação foi efetiva no aumento da Crença de Autoeficácia. Para a Crença de Medo da Dor e Evitação ao Movimento e intensidade da dor, a associação com exposição mostrou melhores resultados.

Pain management in patients with knee osteoarthritis by ultrasound-guided genicular nerve block. Case reports / Manejo de dor em pacientes com osteoartrite de joelho por bloqueio dos nervos geniculares guiado por ultrassonografia. Relato de casos

ABSTRACT BACKGROUND AND OBJECTIVES: Knee osteoarthritis is a chronic disease that tends to affect elderly people and is characterized by severe pain, joint stiffness and limited function. In more advanced cases, the initial approach of knee osteoarthritis performed with traditional conservative pharmacological or non-pharmacological treatment may not present satisfactory results. There are alternatives for pain intervention with favorable results, with longer analgesia and that can help rehabilitation, such as analgesic peripheral nerve blocks, including the genicular nerve block, and radiofrequency ablation. The objective of this study is to report cases of genicular nerve block guided by ultrasonography, with favorable results in relation to analgesia and return of functional capacity. CASE REPORTS: Four elderly patients diagnosed with advanced knee osteoarthritis, with limited range of motion, and with severe chronic pain (mean visual numeric scale - VNS=7.75) were submitted to ultrasound-guided genicular nerve block, presenting significant pain improvement (mean VNS after 1 month of block=2.25) and regain of functional capacity. There were no cases of complications. CONCLUSION: Genicular nerve block guided by ultrasonography is a technique that can be performed as an intervention measure in pain. It presents satisfactory results of analgesia and regain of functional capacity, facilitating the rehabilitation process, and can be adopted in an outpatient clinic context.

RESUMO JUSTIFICATIVA E OBJETIVOS: A osteoartrite do joelho é uma doença crônica que tende a afetar pessoas idosas e é caracterizada por dor intensa, rigidez articular e limitação da mobilidade. Em casos mais avançados, a abordagem da osteoartrite do joelho com o tratamento conservador convencional farmacológico e não farmacológico pode não apresentar resultados satisfatórios. Nesse sentido, existem alternativas de intervenção em dor com resultados favoráveis, com maior tempo de analgesia e que auxiliam a reabilitação, como a realização de bloqueios analgésicos em nervos periféricos, como bloqueio dos nervos geniculares e a ablação por radiofrequência. Este estudo teve como objetivo relatar casos de bloqueios dos nervos geniculares guiados por ultrassonografia, com resultados favoráveis em relação à analgesia e retorno da capacidade funcional. RELATO DOS CASOS: Quatro pacientes idosos diagnosticados com osteoartrite de joelho em grau avançado, com limitação da amplitude de movimento e com dor crônica, com intensidade média de 7,75 pela escala visual numérica, foram submetidos ao bloqueio de nervos geniculares guiado por ultrassonografia, apresentando melhora importante da dor após um mês do bloqueio, com intensidade média de 2,25 e reganho da capacidade funcional, não havendo casos de complicações relacionadas aos bloqueios. CONCLUSÃO: O bloqueio dos nervos geniculares guiado por ultrassonografia é uma técnica que promoveu analgesia satisfatória e ganho da capacidade funcional, além de facilitar o processo de reabilitação, podendo ser realizada em caráter ambulatorial.

Síndrome de burnout entre profissionais de saúde nas unidades de terapia intensiva: um estudo transversal com base populacional / Burnout syndrome among healthcare professionals in intensive care units: a cross-sectional population-based study

RESUMO Objetivo: Avaliar a prevalência e os fatores associados com a síndrome de burnout em profissionais que atuam em unidade de terapia intensiva. Métodos: Estudo transversal com base populacional. Aplicou-se um questionário sociodemográfico, comportamental e ocupacional a 241 enfermeiros e médicos atuantes em 17 unidades de terapia intensiva públicas na cidade de São Luís (MA). Utilizou-se o Maslach Burnout Inventory-Human Services Survey (MBI-HSS) para identificar a síndrome, com base nos critérios de Maslach e Grunfeld. A taxa de prevalência foi estimada juntamente do intervalo de confiança de 95% para cada dimensão da síndrome. As associações foram estimadas pela razão de chance (odds ratio), por meio de análises de regressão logística múltipla (α = 5%). Resultados: A prevalência da síndrome de burnout foi de 0,41% (0,01 - 2,29) segundo Maslach e 36,9% (30,82 - 43,36) segundo Grunfeld. Os profissionais das unidades de atendimento pediátrico tiveram maior probabilidade de desenvolver exaustão emocional (OR = 3,16). Aqueles com idade superior a 35 anos tiveram menos propensão a desenvolver exaustão emocional (OR = 0,32) e despersonalização (OR = 0,06). Maior número de horas de trabalho em unidades de terapia intensiva associou-se com diminuição da realização pessoal (OR = 1,13). Dentre os enfermeiros, os homens foram mais propensos à diminuição da realização profissional, e a ausência da prática de atividades físicas regulares associou-se com mais exaustão emocional e menos despersonalização. Dentre os médicos, o trabalho nas unidades de terapia intensiva pediátrica e cardiológica os tornou menos propensos a perceberem menor realização pessoal, e os médicos sem pós-graduação em terapia intensiva tiveram maior chance de apresentar sentimento de falta de realização pessoal. Conclusão: Este estudo demonstrou baixa prevalência da síndrome de burnout. Para cada dimensão de burnout, a maioria dos profissionais demonstrou baixos níveis de exaustão emocional, despersonalização e sentimento de falta de realização pessoal. Enfermeiros e médicos apresentaram diferentes características associadas com a síndrome de burnout.

ABSTRACT Objective: To assess the prevalence of and factors associated with Burnout syndrome among intensive care unit professionals. Methods: In this cross-sectional population-based study, a questionnaire assessing sociodemographic, behavioral, and occupational data was administered to 241 nurses and physicians working in 17 public intensive care units in São Luis (MA), Brazil. The Maslach Burnout Inventory - Human Services Survey was used to identify Burnout syndrome based on Maslach's and Grunfeld's criteria. The prevalence of each dimension of the syndrome was estimated with a 95% confidence interval. Associations were estimated by the odds ratios via multiple logistic regression analyses (α = 5%). Results: The prevalence of Burnout syndrome was 0.41% (0.01 - 2.29) according to Maslach's criteria and 36.9% (30.82 - 43.36) according to Grunfeld's criteria. Infant intensive care unit professionals were more likely to develop emotional exhaustion than other intensive care professionals (OR = 3.16). Respondents over the age of 35 were less likely to develop emotional exhaustion (OR = 0.32) and depersonalization (OR = 0.06). Longer working hours in intensive care units were associated with a reduced sense of personal accomplishment (OR = 1.13). Among nurses, males had a lower sense of professional accomplishment, and not exercising regularly was associated with more emotional exhaustion and less depersonalization. Among physicians, working in infant and cardiology intensive care units made them less likely to have a reduced sense of personal accomplishment, and physicians without a postgraduate degree who worked in intensive care units had a higher chance of having a lower sense of personal accomplishment. Conclusion: This study demonstrated the low prevalence of Burnout syndrome. Most of the professionals reported low levels for each dimension of Burnout, including low levels of emotional exhaustion, low levels of depersonalization, and a lower likelihood of having a reduced sense of personal accomplishment. Nurses and physicians have different characteristics associated with Burnout syndrome.

Anti-Inflammatory and Antioxidant Activity of Pollen Extract Collected by Scaptotrigona affinis postica: in silico, in vitro, and in vivo Studies.

Bees are of great importance for plant diversity for being an important pollinating agents. Stingless bees such as Scaptotrigona affinis postica, is cultivated largely due to the products offered by it. Pollen is one of these products, which has been highlighted for exhibit various therapeutic properties. Considering the bioactivity of this natural product, this study investigated the antioxidant, anti-inflammatory, antinociceptive activities, and elucidated the chemical composition of pollen collected extract by Scaptotrigona affinis postica. Using in vitro assays, the antioxidant potential and inhibitory activity against the COX enzyme from pollen extract was evaluated. Additionally, tests were performed to measure the anti-inflammatory and antinociceptive activities in animal models. In our results, we found that pollen extract showed antioxidant effects and inhibitory activity against the COX enzyme. The in vivo assays showed that the extract acts on the nervous system in local and systemic levels and that the anti-inflammatory activity is due the prostanoids reducing. Chemical analyses recognize 10 molecules in the extract belonging to the polyphenol and flavonoids classes and the computational study suggests that is responsible for the observed results. Thus, it is reported for the first time the biological potential of S. aff. postica pollen extract and we conclude that this bee product can be considered as one source of potential new drugs.

Scalp dysesthesia. Case report / Disestesia do escalpo. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Scalp dysesthesia is characterized by the presence of several localized or diffuse symptoms, such as burning, pain, pruritus or stinging sensations, without objective findings in the physical examination of the patient that can explain and link the existing symptomatology to some other etiology. The aim of this study was to describe a case of scalp dysesthesia, from its clinical and laboratory investigation and the conduct adopted. CASE REPORT: A 38-year-old male patient, first assigned to the Dermatology Service, with complaints of pruritus in the scalp for 5 years. In the consultation at the Pain Service, the patient complained of daily, intermittent and burning dysesthetic sensations, such as tingling and pruritus in the bipariethoccipital region, worsening with heat and associated with severe pain in the cervical region. Upon physical examination, evidence of excoriations associated with this pruritus was found. The patient received conservative pharmacological treatment, with significant improvement of the symptomatology after 3 months. CONCLUSION: Larger prospective studies are needed to further characterize the pathogenesis of scalp dysesthesia, to generate optimization of the available therapeutic options and consequently improve the care that is given to patients. This report corroborates with some findings already described in the literature, such as the association with cervical alterations and the improvement through the use of low-dose antidepressants and anticonvulsants such as gabapentin.

RESUMO JUSTIFICATIVA E OBJETIVOS: A disestesia do escalpo caracteriza-se pela presença de diversos sintomas localizados ou difusos, como queimação, dor, prurido ou sensações de picada, sem achados objetivos no exame fisico do paciente que possam explicar e ligar os sintomas existentes à alguma outra etiologia. O objetivo deste estudo foi descrever um caso de disestesia de escalpo, desde a sua investigação clínica e laboratorial, até a conduta adotada. RELATO DO CASO: Paciente do sexo masculino, 38 anos. Primeiramente foi ao serviço de Dermatologia com queixa de prurido em couro cabeludo há cinco anos. Na consulta do Serviço de Dor, o paciente queixava-se de sensações disestésicas como: formigamento e prurido em região biparieto-occipital que piora com o calor, associada à dor de forte intensidade, diária, intermitente e em queimação na região cervical No exame fisico, foram encontradas evidências de escoriações ligadas a esse prurido. O paciente recebeu tratamento farmacológico conservador, com melhora importante do sintoma após 3 meses. CONCLUSÃO: São necessários maiores estudos prospectivos para caracterizar ainda mais a patogênese da disestesia do escalpo, gerar otimização das opções terapêuticas disponíveis e, consequentemente, melhora na atenção prestada aos pacientes acometidos. Este relato corroborou alguns achados já descritos na literatura, como a associação com alterações cervicais e a melhora por meio do uso de antidepressivos em baixas doses e de anticonvulsivantes como a gabapentina.

Clinical evaluation and prevalence of fibromyalgia in hepatitis C patients / Avaliação clínica e prevalência de fibromialgia em pacientes portadores de hepatite C

ABSTRACT BACKGROUND AND OBJECTIVES: The worldwide distribution and etiology of fibromyalgia are poorly understood. It is believed that different factors are involved, such as hepatitis C virus infection. The aim of this study was to estimate the prevalence of fibromyalgia in hepatitis C virus infected patients, trying to identify the occurrence of liver injury, extrahepatic clinical manifestations, anxiety, depression, and the impact on the quality of life. METHODS: This is a cross-sectional study of patients (n=118) with hepatitis C virus infection who were compared with a group of clinically stable patients not infected with the hepatitis C virus (n=118). The Anxiety and Depression Questionnaire was applied, and for those diagnosed with fibromyalgia, the Fibromyalgia Impact Questionnaire. Liver biopsies were analyzed according to the METAVIR classification. The Schirmer test was performed to investigate abnormal tear production in the studied patients. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, v.10.0. RESULTS: The prevalence of fibromyalgia in infected patients was 7.6%. In patients infected with fibromyalgia, a significant prevalence of anxiety and depression was observed. Fibromyalgia Impact Questionnaire scores were higher in infected patients with fibromyalgia. When comparing the complementary tests in infected patients with and without fibromyalgia, no significant differences were found for the Schirmer test, viral genotype, and degree of fibrosis and liver inflammation. CONCLUSION: In females, there was a positive relationship between hepatitis C virus infection, fibromyalgia, and extrahepatic symptoms, which translates into a higher prevalence of anxiety and depression and impaired quality of life.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia tem distribuição mundial e etiologia pouco comprendida. Acredita-se no envolvimento de diferentes fatores, como a infecção pelo vírus da hepatite C. O objetivo deste estudo foi estimar a prevalência de fibromialgia em pacientes infectados pelo vírus da hepatite C, procurando identificar a ocorrência de lesão hepática, manifestações clínicas extra-hepáticas, ansiedade, depressão e o impacto na qualidade de vida. MÉTODOS: Trata-se de um estudo de corte transversal com pacientes (n=118) portadores de infecção pelo vírus da hepatite C que foram comparados a um grupo composto de pacientes clinicamente estáveis e não infectados pelo vírus da hepatite C (n=118). Foi aplicado o Questionário de Ansiedade e Depressão, e para os que obtivessem o diagnóstico de fibromialgia, o Questionário de Impacto da Fibromialgia. As biopsias hepáticas foram analisadas de acordo com a classificação METAVIR. Foi realizado o teste de Schirmer para a pesquisa de lacrimejamento anormal nos pacientes estudados. A análise dos dados foi realizada através do programa Statistical Package for Social Sciences (SPSS) v.10.0. RESULTADOS: A prevalência de fibromialgia em pacientes infectados foi de 7,6%. Nos pacientes infectados com fibromialgia observou-se prevalência significativa de ansiedade e depressão. A pontuação do Questionário de Impacto da Fibromialgia foi maior nos pacientes infectados e com fibromialgia. Quando se relacionou os exames complementares em infectados com e sem fibromialgia, não foram constatadas diferenças significativas para o teste de Schirmer, genótipo viral e grau de fibrose e inflamação hepática. CONCLUSÃO: Nos indivíduos do sexo feminino, observou-se uma relação positiva entre a infecção pelo vírus da hepatite C, fibromialgia e sintomas extra-hepáticos, que se traduz em maior prevalência de ansiedade e depressão e em comprometimento na qualidade de vida.

Avaliação da percepção de dor em recém-nascidos por profissionais de saúde de unidade neonatal / Evaluation of pain perception in newborns by neonatal health professionals

Resumo Introdução A crescente utilização de recursos de terapia intensiva neonatal para manter a vida dos recém-nascidos enfermos pode gerar estímulos dolorosos, causando sofrimento a eles. Porém, nem sempre essa dor é percebida pelos profissionais envolvidos no cuidado, embora já exista um interesse crescente por parte deles nesse sentido. Objetivo Avaliar a percepção de dor do recém-nascido por profissionais de saúde que atuam em unidade neonatal. Método Pesquisa qualitativa do tipo exploratória, realizada em um hospital de referência em cuidado neonatal de uma capital do Nordeste. Foram realizadas entrevistas semiestruturadas com todos os profissionais que atuavam na Unidade de Terapia Intensiva Neonatal e/ou na Unidade de Cuidados Intermediários em cuidado direto com o recém-nascido. Utilizou-se da análise de conteúdo na modalidade temática, e os resultados foram agrupados em categorias. Resultados Foram realizadas 36 entrevistas. Os profissionais entrevistados reconheceram que a dor neonatal foi historicamente negligenciada e que hoje as evidências científicas comprovam sua existência. Foram identificadas carência na formação no tema e fragilidade na aplicação do conhecimento na prática. Conclusão Os profissionais têm conhecimento sobre a dor neonatal, entretanto quase não utilizam os parâmetros fisiológicos e possuem pouco conhecimento sobre a literatura científica atual. O principal desafio diz respeito à necessidade de uso sistemático de escalas que garantam a avaliação da dor.

Abstract Background The increasing use of neonatal intensive care resources to maintain the lives of sick infants can generate painful stimuli and cause distress for them. However, this pain is not always perceived by the professionals involved in the care, although there is already an increasing interest on the part of the professionals involved in care. Objective To evaluate the perception of health professionals, who works in a neonatal unit related to newborn pain. Method Qualitative research of the exploratory type was carried out in a reference hospital in neonatal care of a capital of the Northeast. Semi-structured interviews were conducted with all professionals working in the Neonatal Intensive Care Unit and / or Intermediate Care Unit in direct care of the newborn. Content Analysis was used in the thematic modality and the results were grouped into categories. Results 36 interviews were conducted. The professionals interviewed acknowledged that neonatal pain was historically neglected and that scientific evidence today confirms its existence. It was identified lack in the training in the theme and fragility in the application of the knowledge in the practice. Conclusion The professionals have knowledge about neonatal pain; however they still use little physiological parameters and have little knowledge of current scientific literature. The main challenge is the need for systematic use of scales that guarantee the evaluation of pain.

Anti-Inflammatory and Antinociceptive Activity of Pollen Extract Collected by Stingless Bee Melipona fasciculata.

The stingless bee, Melipona fasciculata Smith (Apidae, Meliponini), is a native species from Brazil. Their products have high biotechnological potential, however there are no studies about the biological activities of pollen collected by M. fasciculata. In this context, the present study investigated the chemical composition, anti-oxidant, anti-inflammatory, and analgesic activities of hydroethanolic pollen extracts collected by M. fasciculata in three cities in Maranhão State, Brazil. We verified the antioxidant activity of the extracts and inhibitory activity against the cyclooxygenase enzyme using in vitro assays and in allowed to select the extract with higher efficiency to be used on in vivo assays. In these trials, the selected extract showed high anti-inflammatory activity as well as nociceptive effects at central and peripheral level, suggesting that this extract acts on inhibition of histamine release and decreased synthesis of prostaglandins and the in-silico study suggested that polyphenols and acids fatty acids in the extract may be associated with these activities. The results of the present study report the high biological potential of pollen extract and we conclude that the pollen collected by M. fasciculata can be considered as the object of research for new pharmacological alternatives.