Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain.

BACKGROUND: Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. OBJECTIVE: The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. METHODS: A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. RESULTS: A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. CONCLUSION: Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

ANTECEDENTES: A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. OBJETIVO: O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. MéTODOS: Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. RESULTADOS: Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. CONCLUSãO: O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain / Tratamento da dor miofascial com agulhamento a seco: uma revisão sistemática para as melhores práticas baseadas em evidências em lombalgia

Abstract Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling. Objective The objective of this overview is to highlight and discuss the evidence-based treatment of myofascial pain by dry needling in patients with low back pain. Methods A systematic review was made based on meta-analysis (MA) and randomized controlled trials (RCTs) related to dry needling treatment for myofascial pain in patients with lumbar pain, published from 2000 to 2023. Results A total of 509 records were identified at first. Seventy were published before 2000, so they were excluded. From the remaining 439 studies, ninety-two were RCTs or MA, of which 86 additional studies were excluded for the following reasons: not related to dry needling treatment (n = 79), not published in English (n = 4), duplicated (n = 1), project protocol (n = 1), and not related to myofascial pain (n = 1). So, this review was based on 4 RCTs and two MA. These studies compared dry needling efficacy to other treatments, such as acupuncture, sham dry needling, laser therapy, physical therapy, local anesthetic injection, ischemic compression, and neuroscience education. Despite outcomes and follow-up period varied between them, they showed that dry needling can decrease post-intervention pain intensity and pain disability. Conclusion Dry needling is an effective procedure for the treatment of myofascial pain in patients with acute and chronic low back pain. Further high-quality studies are needed to clarify the long-term outcomes.

Resumo Antecedentes A síndrome dolorosa miofascial (SDM) é uma fonte comum de dor em centros primários de atenção à saúde ou nas clínicas de dor. Existem muitas formas diferentes de manejar e tratar a SDM, como o exercício físico, a massagem dos pontos de gatilho e o agulhamento a seco. Objetivo O objetivo desta revisão é destacar e discutir o tratamento baseado em evidências da dor miofascial por agulhamento a seco em doentes com dor lombar. Métodos Foi realizada uma revisão sistemática baseada em metanálises (MA) e ensaios clínicos randomizados (RCTs) relacionados ao tratamento da dor miofascial com agulhamento a seco em pacientes com dor lombar, publicados de 2000 a 2023. Resultados Foram identificados, inicialmente, um total de 509 registos. Setenta deles, publicados antes de 2000, foram excluídos. Dos 439 estudos restantes, 92 eram RCTs ou MA, dos quais 86 foram excluídos pelas seguintes razões: não relacionados a tratamento com agulhamento a seco (n = 79), não publicados em inglês (n = 4), duplicados (n = 1), protocolo de projeto (n = 1) e não relacionados com dor miofascial (n = 1). Assim, esta revisão baseou-se em quatro RCTs e duas MA. Esses estudos compararam a eficácia do agulhamento seco com outros tratamentos, tais como acupuntura, agulhamento a seco "sham", terapia com laser, fisioterapia, injeção de anestésico local, compressão isquêmica e educação em neurociências. Apesar de os resultados e o período de seguimento variarem entre os estudos, os estudos demonstram que o agulhamento a seco pode diminuir a intensidade da dor pós-intervenção e a incapacidade relacionada à dor. Conclusão O agulhamento a seco é um procedimento eficaz para o tratamento da dor miofascial em pacientes com dor lombar aguda e crônica. Mais estudos são necessários para esclarecer sua eficácia a longo prazo.

Equitable access to quality trauma systems in low-income and middle-income countries: assessing gaps and developing priorities in Ghana, Rwanda and South Africa.

Injuries in low-income and middle-income countries are prevalent and their number is expected to increase. Death and disability after injury can be reduced if people reach healthcare facilities in a timely manner. Knowledge of barriers to access to quality injury care is necessary to intervene to improve outcomes. We combined a four-delay framework with WHO Building Blocks and Institution of Medicine Quality Outcomes Frameworks to describe barriers to trauma care in three countries in sub-Saharan Africa: Ghana, South Africa and Rwanda. We used a parallel convergent mixed-methods research design, integrating the results to enable a holistic analysis of the barriers to access to quality injury care. Data were collected using surveys of patient experiences of injury care, interviews and focus group discussions with patients and community leaders, and a survey of policy-makers and healthcare leaders on the governance context for injury care. We identified 121 barriers across all three countries. Of these, 31 (25.6%) were shared across countries. More than half (18/31, 58%) were predominantly related to delay 3 ('Delays to receiving quality care'). The majority of the barriers were captured using just one of the multiple methods, emphasising the need to use multiple methods to identify all barriers. Given there are many barriers to access to quality care for people who have been injured in Rwanda, Ghana and South Africa, but few of these are shared across countries, solutions to overcome these barriers may also be contextually dependent. This suggests the need for rigorous assessments of contexts using multiple data collection methods before developing interventions to improve access to quality care.

La partería tradicional / Traditional midwifery

RESUMEN Introducción: Las parteras tradicionales apoyan en la atención del parto humanizado, lo cual les permite a las mujeres en trabajo de parto controlar la situación y tomar sus propias decisiones. Objetivo: Describir las prácticas de la partería tradicional en tres regiones del Departamento del Magdalena, Colombia. Métodos: Estudio descriptivo transversal, enfoque cuantitativo, desarrollado con 15 parteras de los municipios de Santa Marta, Ariguaní y Fundación, departamento del Magdalena, los datos fueron recolectados utilizando un cuestionario estructurado y validado, aplicado en el primer semestre de 2016. La muestra fue tomada a conveniencia, dado al nivel de accesibilidad de las investigadoras con las parteras se pudo obtener 5 parteras de cada población, para un total de 15. Los datos cuantitativos fueron analizados utilizando estadística descriptiva (distribución porcentual y media). Resultados: El 54 por ciento se encontraba entre los 50 y 80 años de edad, vivían en zona rural 80 por ciento, tenían entre 30 y 60 años de experiencia como parteras 53 por ciento, todas son mujeres (100 por ciento) y sabían leer y escribir, 93 por ciento hablaba español, solo el 7 por ciento hablaba la lengua nativa, 47 por ciento aprendió a atender partos por tradición familiar, el 25 por ciento aprendió sola, el 20 por ciento aprendió a atender partos por medio de otra persona y el 8 por ciento aprendió por medio de un curso de capacitación. Conclusión: La partería en esta región continúa transfiriéndose de generación en generación, teniendo prácticas tradicionales como el uso de tomas después de la atención del parto(AU)

ABSTRACT Introduction: Traditional midwives support humanized delivery, which allows women in labor to control the situation and make their own decisions. Objective: To describe the practices of traditional midwifery in three regions of Magdalena Department, Colombia. Methods: Cross-sectional descriptive study, with a quantitative approach, developed with 15 midwives from the municipalities of Santa Marta, Ariguaní, and Fundación, Magdalena Department. The data were collected using a structured and validated questionnaire, applied in the first semester of 2016. The sample was taken at convenience, given the researchers' level of accessibility with the midwives. Five midwives from each population could be obtained, for a total of 15. The quantitative data were analyzed using descriptive statistics (percentage and average distribution). Results: 54 percent were at age 50-80 years, 80 percent lived in rural areas, 53 percent had 30-60 years of experience as midwives, all are women (100 percent) and knew how to read and write, 93 percent spoke Spanish, only 7 percent spoke the native language, 47 percent learned how to assist births by family tradition, 25 percent learned by themselves, 20 percent learned how to assist births through another person, and 8 percent learned by means of a training course. Conclusion: Midwifery in this region continues to be transferred from generation to generation, having traditional practices, such as the use of intakes after delivery care(AU)

Therapeutic treatment with scFv-PLGA nanoparticles decreases pulmonary fungal load in a murine model of paracoccidioidomycosis.

Paracoccidioidomycosis (PCM) is a systemic mycosis with lymphatic dissemination that is caused by Paracoccidioides species. Treatment of PCM consists of chemotherapeutics such as itraconazole, trimethoprim, sulfamethoxazole or amphotericin B. However, several studies are aiming to develop therapeutic alternatives for the treatment of fungal infection using new molecules as adjuvants. The single-chain variable fragments (scFv) from an antibody that mimics the main fungal component incorporated within poly(lactide-co-glycolic) acid (PLGA) nanoparticles helped treat the fungal disease. After expressing the scFv in Picchia pastoris (P. pastoris), the recombinant molecules were coupled with PLGA, and the BALB/c mice were immunized before or after infection with yeast Paracoccidioides brasiliensis (P. brasiliensis). Our results showed decreased disease progression and decreased fungal burden. Taken together, our results showed an increased of IFN-γ and IL-12 cytokine production and an increased number of macrophages and dendritic cells in the pulmonary tissue of BALB/c mice treated with a high concentration of our molecule. Our data further confirm that the scFv plays an important role in the treatment of experimental PCM.

Dor crônica e suas características na Unidade de Dor do Hospital Central de Maputo/Moçambique / Chronic pain and its characteristics in the Pain Unit, Central Hospital of Maputo / Mozambique

Moçambique é um pais que vem passando por profundas mudanças políticas e sociais nos últimos 50 anos. Dentro deste contexto, em 1996, uma Unidade de Dor foi criada no Hospital Central de Maputo. O objetivo do presente estudo foi descrever e analisar os aspectos epidemiológicos, clínicos e emocionais de pacientes com dor crónica atendidos na Unidade de Dor. Um total de 118 pacientes foram entrevistados por um período de 2 meses. Destes, 79 (66,9%) eram mulheres e 39 (33,1%) eram homens. A média de idade foi de 52,4 anos, com um desvio padrão de 13,7. Cento e sete (90,7%) eram negros. Quarenta pacientes (33,9%) tiveram o diagnóstico da dor neuropática, 40 (33,9%) apresentaram dor osteomuscular, 8 (6,8%) tiveram dor relacionada com a SIDA, 17 (14,4%) tiveram dor oncológica. A média da escala numérica de dor foi 8,37 e a media de duração da dor crónica foi 41,75 meses. Entre os medicamentos abortivos para a dor, o paracetamol foi o mais utilizado e amitriptilina profilático foi o mais amplamente utilizado. Independentemente do seu tratamento na unidade de dor, cinquenta e oito pacientes (49,2%) também receberam algum tratamento de curandeiros locais. Quanto aos aspectos emocionais, foram encontrados 39 (33,1%) pacientes que preenchiam os critérios do DSM-IV de transtorno depressivo maior. Estes resultados são discutidos com base nos aspectos culturais envolvidos.

Mozambique is a country that has been experiencing profound political and social changes over the last 50 years. Within this context, in 1996 a Pain Unit was set up in the Central Hospital of Maputo. The objective of the present study was to describe and analyze the epidemiological, clinical and emotional aspects of patients with chronic pain attended at the Pain Unit. A total of 118 patients were interviewed over a period of 2 months. Of these, 79 (66.9%) were women and 39 (33.1%) were men. Mean patient age was 52.4 years, with a standard deviation of 13.7. Hundred seven (90.7%) were black. Forty patients (33.9%) had a diagnosis of neuropathic pain, 40 (33,9%) had ostheomuscular pain, 8 (6.8%) had pain related to AIDS, 17 (14.4%) had oncologic pain. Mean of visual analogic scale for pain was 8,37 and chronic pain duration was 41.75 months . Between the abortive medications for pain, paracetamol was the most used and prophylactic amitriptyline was the most widely used. Regardless of their treatment at the Pain Unit, fifty eight patients (49.2%) also received some treatment from local healers. When emotional aspects were considered, 39 (33.1%) patients were found to have depressive symptoms that fulfilled DSM IV criteria of depressive disorder. These results are discussed based on the cultural aspects involved

Dendritic cells transfected with scFv from Mab 7.B12 mimicking original antigen gp43 induces protection against experimental Paracoccidioidomycosis.

Paracoccidioidomycosis (PCM), endemic in Latin America, is a progressive systemic mycosis caused by Paracoccidioides brasiliensis (P. brasiliensis), which primarily attacks lung tissue. Dendritic cells (DCs) are able to initiate a response in naïve T cells, and they also participate in Th-cell education. Furthermore, these cells have been used for therapy in several disease models. Here we transfected DCs with a plasmid (pMAC/PS-scFv) encoding a single chain variable fragment (scFv) of an anti-Id antibody that is capable of mimicking gp43, the main antigenic component of P. brasiliensis. First, Balb/c mice were immunized subcutaneously with pMAC/PS-scFv and, after seven days, scFv protein was presented to the regional lymph nodes cells. Moreover, we showed that the DCs transfected with scFv were capable of efficiently activating proliferation of total lymph node cells and inducing a decrease in lung infection. Therefore, our results suggested that the use of scFv-transfected DCs may be a promising therapy in the paracoccidioidomycosis (PCM) model.