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INTRODUCTION: Transdermal laser is an option for varicous veins treatment, yet it may be painful. In this study, we will present a technique for performing tumescent anesthesia associated to transdermal laser (TTL) to reduce pain during treatment. OBJECTIVE: The study compares pain during treatment of telangiectasias in lower limb with and without tumescent anesthesia to offer a less painful procedure. METHODS: 50 CEAP C1 patients with bilateral telangiectasias on thighs underwent transdermal laser treatment, using tumescent anesthesia on one side and standard technique on the other. Pain was assessed via the Visual Analogue Scale. The outcomes were compared with Student's t-test. Significance was set at p < .05. RESULTS: Laser treatment without tumescent anesthesia resulted in a VAS pain score of 7.9, versus 0.0 with anesthesia, showing a significant statistical difference. CONCLUSION: Tumescent anesthesia and transdermal laser (TTL) is capable of reducing pain in laser treatment of telangiectasias and reticular veins.
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Telangiectasia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anestesia Local , Terapia por Láser , Láseres de Estado Sólido/uso terapéutico , Extremidad Inferior/irrigación sanguínea , Dolor/etiología , Dimensión del Dolor , Telangiectasia/cirugía , Estudios de Casos y ControlesRESUMEN
Chikungunya fever (CHIKF) is an acute viral disease caused by the chikungunya virus (CHIKV) transmitted by Aedes mosquitoes. The acute phase presents with limited symptoms and low mortality, but approximately half of cases progress to more chronic illness with persistent and disabling joint symptoms. To better characterize the burden of chronic disease, we analyzed the relationship between pain intensity, the Disease Activity Index by DAS28-ESR, rheumatoid factor (RF) positivity, sex, and age in a retrospective cohort of 133 patients with chikungunya arthritis (CHIKA). We assessed all subjects by clinical evaluations, and laboratory testing, including the Pain Visual Analog Scale (VAS), the Disease Activity Score (DAS28-ESR), and RF measurement. We observed that pain intensity increased significantly with disease activity (ρ = 0.416 and p-value < 0.05) and with age (ρ = 0.259 and p-value = 0.003). Despite a predominance of women in our cohort, sex/gender was not associated with increased pain risk. Our study demonstrated a strong correlation between pain and disease activity, but assessment of these variables in a larger, prospective cohort should be undertaken to further characterize risk variables and improve therapy for patients with CHIKA.
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Fiebre Chikungunya , Dolor , Factor Reumatoide , Humanos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/virología , Femenino , Masculino , Persona de Mediana Edad , Factor Reumatoide/sangre , Dolor/virología , Adulto , Anciano , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Dimensión del Dolor , Artritis/metabolismo , Artritis/virologíaRESUMEN
OBJECTIVE: This systematic review aimed to analyze the literature on changes in endogenous salivary biomarkers of pain, anxiety, stress, and inflammation related to tooth movement during orthodontic treatment of children and adolescents. MATERIAL AND METHODS: An electronic search was performed in nine databases to identify quasi-experimental studies, without restricting publication language and year. Two reviewers extracted the data and assessed the individual risk of bias using the JBI tools, and the certainty of evidence using the GRADE tool. RESULTS: The electronic search found 7,038 records, of which 12 met the eligibility criteria and were included in the qualitative synthesis. Most studies had a low risk of bias. Biomarkers were grouped into five categories: electrolytes, enzymes, hormones, immunoglobulins, and mediators. Electrolytes showed decreased Ca2+, Pi3+ and K+ levels, and increased Na+ and Cl- levels. All enzymes (ALP, LDH, MMP8, and MMP9) increased over time. Hormones presented a decrease in leptin and some fluctuations in daily cortisol levels. Immunoglobulins (IgA, IgG, IgM, IgD, and IgE) had no significant changes, and salivary IgA showed divergent results among studies. Mediators (sRANKL, OPG, IL-1ß, and PGE2) showed fluctuations at different treatment stages, mainly after orthodontic activation. CONCLUSIONS: Based on a very low certainty level, orthodontic tooth movement had little to no effect on endogenous salivary biomarkers.
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Biomarcadores , Inflamación , Saliva , Técnicas de Movimiento Dental , Humanos , Técnicas de Movimiento Dental/efectos adversos , Biomarcadores/análisis , Saliva/química , Saliva/metabolismo , Adolescente , Niño , Ansiedad , Estrés Psicológico/metabolismo , Dolor , Metaloproteinasa 8 de la Matriz/análisis , Metaloproteinasa 8 de la Matriz/metabolismo , Hidrocortisona/análisis , Hidrocortisona/metabolismoRESUMEN
Pain is the main symptom of inflammatory arthritis and it can impair physical functional performance and physical activity level. Some individuals can develop kinesiophobia and experience a vicious circle of worsening health. This study aimed to investigate the association between pain and physical functional performance/physical activity and determine whether kinesiophobia mediates this association. This was a cross-sectional study with individuals diagnosed with inflammatory arthritis (rheumatoid arthritis or spondyloarthritis) treated at a Rheumatology Outpatient Clinic. We assessed pain (Visual Analogue Scale), physical activity (International Physical Activity Questionnaire - long form), kinesiophobia (Tampa Scale for Kinesiophobia), and physical functional performance (Handgrip Strength Dynamometry, 30-second Sit-to-Stand test, Static Muscular Endurance test, and Timed Up and Go test). The mediating effect of kinesiophobia on the relationship between pain intensity and physical functional performance/physical activity was analyzed, and the significance of the mediating effect (kinesiophobia) was tested through a bootstrap approach. Thirty-three individuals with inflammatory arthritis (mean age: 48â ±â 12 years) participated in the study. Kinesiophobia mediates the relationship between pain intensity and physical functional performance analyzed by the 30-second Sit-to-Stand test [indirect effect (IE)overall = -0.343, bootstrap 95% confidence interval (CI): -0.698 to -0.002] and by knee flexion at 90º of the dominant limb (IEoverall = -1.55, bootstrap 95% CI: -3.43 to -0.237). In conclusion, pain intensity can affect physical functional performance through kinesiophobia in individuals with inflammatory arthritis.
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Ejercicio Físico , Dimensión del Dolor , Trastornos Fóbicos , Humanos , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Adulto , Ejercicio Físico/psicología , Trastornos Fóbicos/psicología , Trastornos Fóbicos/fisiopatología , Artritis Reumatoide/psicología , Artritis Reumatoide/fisiopatología , Rendimiento Físico Funcional , Miedo , Dolor/psicología , Dolor/fisiopatología , KinesiofobiaRESUMEN
OBJECTIVE: The study aimed to evaluate the effects of musical-animated toys and audiobooks on the fear and pain in the tracheostomy care of children in the palliative care clinic. METHODS: The study design was a single-center, single-arm, crossover-controlled study. The sample consisted of 16 children who were 3-6 years old. Musical-animated toys and audiobooks were used to divert the children's attention during tracheostomy care. The children whose control data were collected on the first day were shown musical-animated toys on the second day and listened to an audiobook a week later. The children were video-recorded during the interventions. RESULTS: The children who received musical-animated toy and audiobook interventions during and after tracheostomy care expressed less pain than those in the control group, and their fear levels were less during the care. CONCLUSION: Audiobook and musical-animated toy interventions were effective in reducing children's procedure-related fear and pain during tracheostomy care in the pediatric palliative care clinic.
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Estudios Cruzados , Miedo , Cuidados Paliativos , Juego e Implementos de Juego , Traqueostomía , Humanos , Niño , Cuidados Paliativos/psicología , Cuidados Paliativos/métodos , Masculino , Femenino , Preescolar , Juego e Implementos de Juego/psicología , Miedo/psicología , Música/psicología , Musicoterapia/métodos , Dolor/psicología , Dimensión del DolorRESUMEN
OBJECTIVE: This study aimed to evaluate kinesiophobia levels in patients with osteoporosis compared to healthy controls and investigate the associations with pain, depression, anxiety, fear of falling, and quality of life. METHODS: The study involved 60 postmenopausal osteoporosis patients and 60 healthy controls aged 50 years and above. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia, while quality of life, psychological symptoms, and fear of falling were evaluated using the Quality of Life Questionnaire of the European Foundation for Osteoporosis, Hospital Anxiety and Depression Scale, and Tinetti Falls Efficacy Scale. RESULTS: Kinesiophobia levels were significantly higher in the osteoporosis group compared to controls (p<0.05). Positive correlations were observed between kinesiophobia and Falls Efficacy Scale (r=0.278, p=0.002), as well as with Quality of Life Questionnaire of the European Foundation for Osteoporosis physical function scores (r=0.185, p=0.043). No significant relationship was found between kinesiophobia and depression or anxiety scores. CONCLUSION: Kinesiophobia is notably higher in osteoporosis patients compared to healthy individuals, correlating with an increased fear of falling and reduced physical function. Early identification and management of kinesiophobia are essential to prevent reduced physical activity and associated risks, such as decreased bone mineral density and higher fracture risk.
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Accidentes por Caídas , Ansiedad , Depresión , Miedo , Osteoporosis Posmenopáusica , Trastornos Fóbicos , Calidad de Vida , Humanos , Femenino , Osteoporosis Posmenopáusica/psicología , Persona de Mediana Edad , Calidad de Vida/psicología , Estudios de Casos y Controles , Anciano , Miedo/psicología , Trastornos Fóbicos/psicología , Depresión/psicología , Depresión/etiología , Ansiedad/psicología , Ansiedad/etiología , Encuestas y Cuestionarios , Dolor/psicología , Estudios Transversales , KinesiofobiaRESUMEN
BACKGROUND: Hypophosphatasia (HPP; OMIM 241510, 241500, and 146300) is a progressive metabolic, genetic disease with wide clinical heterogeneity, ranging from perinatal lethality to mild or moderate localized symptoms. This study aims to analyze the perception of pain, quality of life, and access barriers to healthcare among patients diagnosed with hypophosphatasia in Colombia. In this document we present pain and quality of life results. METHODS: This study is an observational cohort of 18 HPP patients registered in the Colombian Association of Patients with Lysosomal Storage Diseases and Other Orphan Diseases (ACOPEL) database. We conducted a descriptive analysis using data from three questionnaires (SF-36, Brief Pain Questionnaire (BPQ), and Hypophosphatasia Impact Patient Survey (HIPS); the latter was translated into Spanish and validated for this study. RESULTS: The most affected features, according to the SF-36 questionnaire, were overall health, vitality, and pain, with a median score above 67%. Patients' perception of their health status (HIPS questionnaire) was favorable, with 38.9% of cases reporting excellent health. On average, results from the BPQ indicated mild to moderate intensity of current pain experienced by patients. Consistency was observed in the reports of either the absence of pain or the presence of mild to moderate intensity when analyzing the results of the three questionnaires. CONCLUSIONS: Colombian patients with HPP experience mild to moderate impairment in quality of life and pain that interfere with their daily activities. However, there is wide variability in the results obtained.
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Hipofosfatasia , Calidad de Vida , Humanos , Colombia , Femenino , Masculino , Adulto , Adolescente , Encuestas y Cuestionarios , Estudios de Cohortes , Niño , Adulto Joven , Dolor , Preescolar , Persona de Mediana EdadRESUMEN
OBJECTIVE: Herein, we investigate the potential analgesic effect of a newly synthesized chalcone-derived apocynin in a neurogenic pain model. METHODS: Molecular docking was used to foretell the apocynin binding features and dynamics with the TRPV1 channel, and the activity was tested in vitro, using transfected HEK 293T cells with the rat TRPV1 receptor. The analgesic effect of apocynin was investigated using a capsaicin-induced pain model. The expression of TRPV1, TRPA1, TRPM8, and MAPKs was assessed by electrophoresis, and immunosorbent assays were performed to quantify the neurotransmitters Substance P, Glutamate, and CGRP. A survival assay using Galleria mellonella was carried out to determine the toxicity. RESULTS: We observed that apocynin exhibits greater thermodynamic stability. Upon apocynin ligand binding, it changes the electrostatic potential for a predominantly electronegative state in the interior and neutral in its external vanilloid pocket. Treatment of apocynin induces antinociceptive effects against the noxious challenge of capsaicin. Histologically, apocynin decreased the number of TRPV1+ immunopositive cells. Electrophoresis showed reduced phosphorylation of p44/42 (ERK1/2) and decreased protein levels of substance P, and CGRP. In the survival assay, apocynin showed low toxicity. CONCLUSIONS: In conclusion, we provide proof-of-principles that the newly synthesized apocynin compound effectively prevented nociception in a neurogenic model of orofacial pain.
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Acetofenonas , Simulación del Acoplamiento Molecular , Canales Catiónicos TRPV , Animales , Canales Catiónicos TRPV/metabolismo , Canales Catiónicos TRPV/antagonistas & inhibidores , Acetofenonas/farmacología , Acetofenonas/uso terapéutico , Humanos , Ratas , Células HEK293 , Masculino , Capsaicina/farmacología , Modelos Animales de Enfermedad , Analgésicos/farmacología , Ratas Sprague-Dawley , Nervio Trigémino/efectos de los fármacos , Nervio Trigémino/metabolismo , Dolor/tratamiento farmacológico , Dolor/metabolismoRESUMEN
Mexico is considered one of the countries with the greatest diversity of the Salvia genus. A significant percentage of its species are known for their use in traditional medicine, highlighting their use as an analgesic. The objective of this work was to determine the chemical composition of the methanolic extracts of S. cinnabarina, S. lavanduloides and S. longispicata through untargeted metabolomics, as well as the in vivo evaluation of the antinociceptive effect and acute oral toxicity. The chemical profiling was performed using ultra-high performance liquid chromatography coupled with a high-resolution mass spectrometry (UPLC-ESI+/--MS-QTOF) system and tentative identifications were performed using a compendium of information on compounds previously isolated from Mexican species of the genus. Pharmacological evaluation was carried out using the formalin test and OECD guidelines. The analysis of the spectrometric features of the mass/charge ratios of the three salvias shows that a low percentage of similarity is shared between them. Likewise, the putative identification allowed the annotation of 46 compounds, mainly of diterpene and phenolic nature, with only four compounds shared between the three species. Additionally, the extracts of the three salvias produced a significant antinociceptive effect at a dose of 300 mg/kg administered orally and did not present an acute oral toxicity effect at the maximum dose tested, indicating a parameter of LD50 > 2000 mg/kg. The exploration of the chemical profile of the three salvias by untargeted metabolomics shows that, despite being species with antinociceptive potential, they have different chemical profiles and therefore different active metabolites.
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Analgésicos , Metabolómica , Extractos Vegetales , Salvia , Salvia/química , Analgésicos/farmacología , Analgésicos/química , Extractos Vegetales/farmacología , Extractos Vegetales/química , Animales , Metabolómica/métodos , Ratones , Metanol/química , Masculino , Cromatografía Líquida de Alta Presión , Dolor/tratamiento farmacológico , MéxicoRESUMEN
BACKGROUND: Clowning has been used in many hospitals, particularly for children. Studies suggest the effectiveness of this methodology, but more evidence is needed. The aim of this study was to evaluate the impact of a humour therapy intervention on biological markers, pain and anxiety levels in paediatric patients. METHODS: Three different clinical contexts were chosen to assess the effect of clowning interventions: patients who were subjected to venepuncture (group 1), patients undergoing general anesthesia for any cause (group 2)and patients hospitalized in the pediatric ward without distinction of their disease (group 3). Groups 1 and 2 were divided into control (C) and intervention (I) subgroups. A saliva sample was taken from all the children to measure oxytocin and cortisol levels by ELISAs. Validated scales and crying time were used to determine pain, stress, and anxiety levels. Children in group 3 were assessed before and after the intervention, employing the same methods. RESULTS: A total of 272 patients were included. The children in group 1 (n = 125) were 7.7 ± 3.2 years old, and 53.6% were females. 48% were in the I group, which showed decreased cortisol levels and increased oxytocin levels. The I group exhibited a decrease in perceived pain and crying time. The children in group 2 (n = 69) were aged 7.1 ± 3.5 years, and 36% were females. 51% were in the I group, which showed increased oxytocin levels and decreased cortisol levels, acute stress levels, perceived pain, and crying time. The children in group 3 (n = 78) were 8.6 ± 3.3 years old, and 54% of the children were females. There was an increase in oxytocin levels and a decrease in cortisol levels, stress levels and perceived pain following the intervention. CONCLUSIONS: This study suggested that an intervention based on clowning is an effective strategy for decreasing pain, stress, and anxiety levels in paediatric patients in different clinical contexts. These findings support the implementation of humour therapy programs in paediatric units.
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Ansiedad , Biomarcadores , Hidrocortisona , Risoterapia , Oxitocina , Saliva , Estrés Psicológico , Humanos , Femenino , Masculino , Niño , Hidrocortisona/sangre , Hidrocortisona/análisis , Oxitocina/sangre , Risoterapia/métodos , Saliva/química , Saliva/metabolismo , Biomarcadores/sangre , Preescolar , Llanto , Dolor , Flebotomía , Dimensión del Dolor , AdolescenteRESUMEN
This study examines the influence of body mass index (BMI) on the relationship between quantitative sensory testing measures and clinical characteristics in fibromyalgia syndrome (FMS). Utilizing BMI as a categorical covariate (≥25 or ≥30 kg/m²) in associations between quantitative sensory testing metrics (pain-60, conditioned pain modulation, and temporal summation of pain [TSP]) and FMS clinical features, we explored BMI's role as both a confounder (change-in-estimate criterion-change equal or higher than 10%) and effect modifier (interaction term). Significant interactions revealed overweight/obese BMI as a modifier in the relationship between conditioned pain modification and both depression and symptom impact, with a homeostatic relationship between better clinical profile and pain inhibitory response observed solely in the normal-weight group. Similar results were found for pain-60 and depression. Additionally, BMI ≥30 kg/m² modified TSP's effect on pain, demonstrating lower pain with increased TSP, exclusively in the nonobese group. This study highlights the significant role of BMI in moderating the relationships of important pain inhibitory control processes and pain intensity, depression, and the overall impact of FMS symptoms. Our results suggest that high BMI states disrupt the homeostatic effects of pain inhibition, reducing its salutogenic response in FMS participants. We discuss the mechanistic and therapeutic implications of targeting BMI in FMS clinical trials and the potential impact of this important relationship. PERSPECTIVE: This investigation highlights the disruptive influence of high BMI on pain inhibitory control in fibromyalgia, unbalancing clinical symptoms such as pain and depression. It underscores the necessity of integrating BMI considerations into therapeutic approaches to enhance pain management and patient outcomes.
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Índice de Masa Corporal , Fibromialgia , Homeostasis , Dimensión del Dolor , Humanos , Fibromialgia/fisiopatología , Femenino , Persona de Mediana Edad , Homeostasis/fisiología , Adulto , Masculino , Dolor/fisiopatología , Depresión/fisiopatología , Depresión/etiología , Umbral del Dolor/fisiologíaRESUMEN
The development of new analgesics has been challenging. Candidate drugs often have limited clinical utility due to side effects that arise because many drug targets are involved in signaling pathways other than pain transduction. Here, we explored the potential of targeting protein-protein interactions (PPIs) that mediate pain signaling as an approach to developing drugs to treat chronic pain. We reviewed the approaches used to identify small molecules and peptide modulators of PPIs and their ability to decrease pain-like behaviors in rodent animal models. We analyzed data from rodent and human sensory nerve tissues to build associated signaling networks and assessed both validated and potential interactions and the structures of the interacting domains that could inform the design of synthetic peptides and small molecules. This resource identifies PPIs that could be explored for the development of new analgesics, particularly between scaffolding proteins and receptors for various growth factors and neurotransmitters, as well as ion channels and other enzymes. Targeting the adaptor function of CBL by blocking interactions between its proline-rich carboxyl-terminal domain and its SH3-domain-containing protein partners, such as GRB2, could disrupt endosomal signaling induced by pain-associated growth factors. This approach would leave intact its E3-ligase functions, which are mediated by other domains and are critical for other cellular functions. This potential of PPI modulators to be more selective may mitigate side effects and improve the clinical management of pain.
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Analgésicos , Transducción de Señal , Humanos , Animales , Analgésicos/farmacología , Analgésicos/química , Transducción de Señal/efectos de los fármacos , Mapas de Interacción de Proteínas/efectos de los fármacos , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/metabolismo , Dolor/metabolismo , Dolor/tratamiento farmacológicoRESUMEN
BACKGROUND: Pilomatricoma is a common benign adnexal neoplasm in children. There are few epidemiological studies on this subject, with most relying solely on descriptive statistics. METHODS: A cross-sectional study conducted in two tertiary hospitals in Mexico City from January 2017 to December 2023. Clinical and electronic records of patients with histopathological diagnosis of pilomatricoma, both sexes, under 18 years old, with any type of present comorbidity were selected. Records of patients with diagnosis not confirmed by histopathology or incomplete records were not included in the study. RESULTS: Fifty-two cases with pilomatrixoma were included in the study, showing a total of 74 lesions. About 23.1% of the cases had multiple pilomatrixomas. 40.4% of the cases experienced pain; this symptom was associated with lesions > 15 mm in diameter and with multiple pilomatrixomas. Risk factors for lesions > 15 mm included age under 8 years, positive tent sign, tumor evolution longer than a year, and a non-classical clinical variety. The head and neck were the most commonly affected areas. The left upper extremity presented larger pilomatrixomas (median 18.5 mm) and occurred more frequently in adolescent patients (mean age 12.1 years) compared to other body areas. CONCLUSIONS: Pilomatrixoma in children shows clinical diversity, with specific findings based on size, number, and anatomical location.
INTRODUCCIÓN: El pilomatricoma es una neoplasia anexial benigna frecuente en la infancia. Hay muy pocos estudios epidemiológicos al respecto y la mayoría solo han utilizado estadística descriptiva. MÉTODOS: Estudio transversal realizado en dos hospitales de concentración de la Ciudad de México de enero de 2017 a diciembre de 2023. Se seleccionaron expedientes clínicos y electrónicos de pacientes con diagnóstico histopatológico de pilomatricoma, ambos sexos, menores de 18 años, con cualquier tipo de comorbilidad presente. No se incluyeron los expedientes de pacientes con diagnóstico no confirmado por histopatología o expediente incompleto. RESULTADOS: Se incluyeron 52 casos con diagnóstico de pilomatricoma que mostraron un total de 74 lesiones. El 23.1% de los pacientes tuvieron pilomatricomas múltiples. El 40.4% experimentaron dolor; este signo se asoció con lesiones de diámetro superior a 15 mm y pilomatricomas múltiples. La edad menor de 8 años, el signo de la tienda de campaña positivo, un tiempo de evolución mayor de 1 año y una variedad clínica no clásica son factores de riesgo asociados con las lesiones mayores de 15 mm. La cabeza y el cuello fueron las áreas más comúnmente afectadas por estos tumores. La extremidad superior izquierda presento pilomatricomas de mayor tamaño (mediana 18.5 mm), y ocurrieron más en pacientes adolescentes (media 12.1 años), en comparación con otras áreas del cuerpo. CONCLUSIONES: El pilomatricoma en niños muestra diversidad clínica. Presenta hallazgos y asociaciones específicas según el tamaño, el número y la ubicación anatómica.
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Enfermedades del Cabello , Pilomatrixoma , Neoplasias Cutáneas , Humanos , Pilomatrixoma/patología , Pilomatrixoma/epidemiología , Pilomatrixoma/diagnóstico , México/epidemiología , Masculino , Niño , Femenino , Estudios Transversales , Adolescente , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/epidemiología , Preescolar , Enfermedades del Cabello/epidemiología , Enfermedades del Cabello/patología , Factores de Riesgo , Lactante , Dolor/epidemiología , Dolor/etiologíaRESUMEN
OBJECTIVE: This study aims to compare vastus lateralis and ventrogluteal site utilizations concerning pain and fear in intramuscular injection in children between 4 and 6 years of age. METHODS: A randomized trial design was utilized in this study. Groups were randomly assigned as ventrogluteal (n=43) and vastus lateralis (n=40). Children in both groups were compared before, during, and after the procedure using the Children's Fear Scale and the Wong-Baker Faces Pain Rating Scale. Crying time was measured using a stopwatch during the procedure. RESULTS: While the mean Children's Fear Scale total scores of the children in the ventrogluteal group were similar before the procedure, the mean Children's Fear Scale total scores during and after the procedure were significantly lower than the children in the vastus lateralis group. Wong-Baker Faces Pain Rating Scale mean scores were significantly lower in the ventrogluteal group. The mean crying time of the children in the ventrogluteal group was significantly lesser than those in the vastus lateralis group (p=0.000). CONCLUSION: The results of the study showed that the choice of the ventrogluteal site in intramuscular injection in children between 4 and 6 years of age was effective in reducing pain, fear, and crying time.
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Miedo , Dimensión del Dolor , Dolor , Humanos , Inyecciones Intramusculares , Miedo/psicología , Preescolar , Masculino , Femenino , Niño , Dolor/psicología , Músculo Cuádriceps , Llanto/psicologíaRESUMEN
Introduction: TRUS-guided prostate biopsy is a current method used to obtain the histopathological material necessary to make a definitive diagnosis of prostate cancer. Objective: To investigate patient-related variables affecting the level of pain felt during prostate biopsy to determine what can be done to minimize pain. Methods: The study included 241 patients scheduled for prostate biopsy. Four patients who did not meet the criteria were excluded. Local anesthesia was administered intrarectally 10 minutes before the biopsy to 237 patients, and a conventional 12-core biopsy was performed. The level of pain felt by all patients during the biopsy was measured using the Visual Analog Scale (VAS) score. Pain scores were compared by forming groups according to the selected parameters. Results: The mean age of the 237 included patients was 66.0±7.8 years, the mean serum PSA level was 33.7±197.5 ng/dL, and the mean prostate volume was 33.7±197.5 ml. The mean VAS score was 4.3±1.9. The pain score was higher in patients with positive digital rectal examination findings and lower in patients using 5-alpha reductase inhibitors(5-ARI). At the same time, no significant difference was found in patients with positive tumor pathology, perineural invasion, alpha-blockers, or combination therapy. Conclusion: Some patient parameters may affect the level of pain felt during TRUS-guided prostate biopsy.
Introducción: La biopsia de próstata guiada por ecografía transrectal (TRUS) es un método utilizado para obtener el material histopatológico necesario para realizar un diagnóstico definitivo de cáncer de próstata. Objetivo: Investigar las variables relacionadas con el paciente que afectan al nivel de dolor sentido durante la biopsia de próstata para para tratar de minimizar el dolor durante el procedimiento. Métodos: El estudio incluyó a 241 pacientes programados para biopsia de próstata. Se excluyeron cuatro pacientes que no cumplieron los criterios. Se administró anestesia local por vía intrarrectal 10 minutos antes de la biopsia a 237 pacientes y se realizó una biopsia convencional de 12 núcleos. El nivel de dolor sentido por todos los pacientes durante la biopsia se midió mediante la puntuación de la Escala Visual Analógica (EVA). Se compararon las puntuaciones de dolor formando grupos según los parámetros seleccionados. Resultados: La edad media de los 237 pacientes fue de 66.0±7.8 años, el nivel sérico medio de PSA fue de 33.7±197.5 ng/dL y el volumen prostático fue de 33.7±197.5 ml. La puntuación media de la EAV fue de 4.3±1.9. La puntuación del dolor fue mayor en los pacientes con resultados positivos del tacto rectal y menor en los pacientes que utilizaban inhibidores de la 5-alfa reductasa (5-ARI). Al mismo tiempo, no se encontraron diferencias significativas en los pacientes con patología tumoral positiva, invasión peri neural, alfa bloqueantes o terapia combinada. Conclusiones: Algunos parámetros del paciente pueden afectar al nivel de dolor sentido durante la biopsia de próstata guiada por TRUS.
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Dimensión del Dolor , Próstata , Neoplasias de la Próstata , Ultrasonografía Intervencional , Humanos , Masculino , Anciano , Neoplasias de la Próstata/patología , Persona de Mediana Edad , Próstata/patología , Próstata/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Biopsia Guiada por Imagen/métodos , Dolor/etiología , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/diagnóstico , Dolor Asociado a Procedimientos Médicos/prevención & control , Antígeno Prostático Específico/sangre , Anestesia Local/métodos , Tacto RectalRESUMEN
BACKGROUND: Electroencephalography (EEG) is a promising tool for identifying the physiological biomarkers of fibromyalgia (FM). Evidence suggests differences in power band and density between individuals with FM and healthy controls. EEG changes appear to be associated with pain intensity; however, their relationship with the quality of pain has not been examined. We aimed to investigate whether abnormal EEG in the frontal and central points of the 10-20 EEG system in individuals with FM is associated with pain's sensory-discriminative and affective-motivational dimensions. The association between EEG and the two dimensions of emotional disorders (depression and anxiety) was also investigated. METHODS: In this cross-sectional pilot study, pain experience (pain rating index [PRI]) and two dimensions of emotional disorders (depression and anxiety) were assessed using the McGill Pain Questionnaire (PRI-sensory and PRI-affective) and Hospital Anxiety and Depression Scale (HADS), respectively. In quantitative EEG analysis, the relative spectral power of each frequency band (delta, theta, alpha, and beta) was identified in the frontal and central points during rest. RESULTS: A negative correlation was found between the relative spectral power for the delta bands in the frontal (r= -0.656; p = 0.028) and central points (r= -0.624; p = 0.040) and the PRI-affective scores. A positive correlation was found between the alpha bands in the frontal (r = 0.642; p = 0.033) and central points (r = 0.642; p = 0.033) and the PRI-affective scores. A negative correlation between the delta bands in the central points and the anxiety subscale of the HADS (r = -0.648; p = 0.031) was detected. CONCLUSION: The affective-motivational dimension of pain and mood disorders may be related to abnormal patterns of electrical activity in patients with FM. TRIAL REGISTRATION: Retrospectively registered on ClinicalTrials.gov (NCT05962658).
Asunto(s)
Ansiedad , Electroencefalografía , Fibromialgia , Dimensión del Dolor , Humanos , Fibromialgia/fisiopatología , Fibromialgia/diagnóstico , Fibromialgia/psicología , Fibromialgia/complicaciones , Proyectos Piloto , Femenino , Electroencefalografía/métodos , Estudios Transversales , Persona de Mediana Edad , Adulto , Dimensión del Dolor/métodos , Masculino , Ansiedad/diagnóstico , Ansiedad/psicología , Depresión/diagnóstico , Depresión/psicología , Dolor/diagnóstico , Dolor/fisiopatología , Dolor/psicologíaRESUMEN
The painful hip has been a topic of study that has evolved from the beginning of the last century to the present. The clinical approach is complex, and requires a systematization process associated with good questioning, clinical maneuvers with their corresponding interpretation, and complementary imaging studies. The understanding of hip pathology, especially in young adults, is highly simplified and sometimes underdiagnosed, therefore, not treated in a timely manner. The prevalence of painful hip is more common in males (49 to 55%) than in females (25 to 28%), and the causes may vary according to demographic characteristics and the history of each patient. Bryan Kelly, made a topographic and anatomical description of the approach to the painful hip according to the theory or system of the layers: I. Osteochondral layer; II. Inert layer; III. Contractile layer; and IV. Neuro-mechanical layer. This system helps us understand the anatomical site of pain and its clinicopathological correlation. The semiological approach to hip pain is the fundamental pillar for differential diagnosis. We can divide it according to its topography into anterior, lateral and posterior, as well as according to its chronology and characteristics. The physical examination should be carried out systematically, starting from a generalized inspection of gait and posture to the evaluation of specific signs for alterations in each layer, which evoke pain with specific postures and ranges of mobility, or weakness and alterations in the arc of mobility of the joint. Image evaluation is initially recommended with radiographic projections that evaluate different planes, both coronal, sagittal and axial, complemented with panoramic views, and eventually dynamic sagittal ones if necessary. Requesting specific studies such as tomography to evaluate bone structure and reserve, or simple MRI when there is suspicion of soft tissue affection, or failing that, arthroresonance for joint pathology, will depend on the clinical symptoms and radiographic findings.
La cadera dolorosa ha sido un tema de estudio que ha evolucionado desde principios del siglo pasado hasta la actualidad. El abordaje clínico es complejo y exige un proceso de sistematización asociado a un buen interrogatorio, maniobras clínicas con su interpretación correspondiente y estudios de imagen complementarios. El entendimiento de la patología de cadera, sobre todo en adulto joven, es altamente simplificado y en ocasiones infradiagnosticado, por lo tanto, no tratado en tiempo y forma. La prevalencia de cadera dolorosa es más frecuente en el sexo masculino (49 a 55%) que en el femenino (25 a 28%), y las causas pueden variar de acuerdo a características demográficas y a los antecedentes de cada paciente. Bryan Kelly realizó una descripción topográfica y anatómica del abordaje de la cadera dolorosa de acuerdo con la teoría o sistema de las capas: I. Capa osteocondral; II. Capa inerte; III. Capa contráctil; y IV. Capa neuromecánica. Este sistema nos ayuda a entender el sitio anatómico del dolor y su correlación clínico-patológica. El abordaje semiológico del dolor de cadera es el pilar fundamental para el diagnóstico diferencial. Podemos dividirlo de acuerdo con su topografía en anterior, lateral y posterior, así como de acuerdo a su cronología y características. La exploración física debe realizarse de manera sistemática, iniciando desde inspección generalizada, de la marcha y postura hasta la evaluación de signos específicos para alteraciones en cada capa, los cuales evocan dolor con posturas y arcos de movilidad específicos, o bien debilidad y alteraciones en el arco de movilidad de la articulación. La evaluación por imagen se recomienda inicialmente con proyecciones radiográficas que evaluen diferentes planos, tanto coronal, sagital y axial, complementado con panorámicas, y eventualmente sagitales dinámicas de ser necesarios. Solicitar estudios específicos como tomografía para evaluar estructura y reserva ósea, o bien, resonancia simple cuando hay sospecha de afección a tejidos blandos, o en su defecto, artrorresonancia para patología articular, dependerá de la clínica y los hallazgos radiográficos.
Asunto(s)
Articulación de la Cadera , Humanos , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Femenino , Masculino , Examen Físico/métodos , Artralgia/etiología , Artralgia/diagnóstico , Dolor/etiologíaRESUMEN
OBJECTIVE: To analyze the effect of breastfeeding on reducing Pentavalent vaccination pain in infants and to identify the necessary breastfeeding interval for antinociceptive action. METHOD: Open parallel randomized clinical trial. Ninety mother-infant dyads participated, distributed into intervention group 1 (n = 30), which breastfed five minutes before vaccination; intervention group 2 (n = 30), which breastfed five minutes before and during vaccination; and control group (n = 30), which did not breastfeed. The outcome variable was the pain level measured by the FLACC Scale. Data analysis was conducted using descriptive and inferential statistics, applying Fisher's Exact, Kolmogorov-Smirnov, Kruskal-Wallis and Dunn's multiple comparison tests, with 0.05 significance level. RESULTS: Pain induced by the Pentavalent vaccine was reduced in intervention groups 1 and 2 (mean pain of 6.06 versus 3.83, respectively) compared to the control group (mean of pain of 7.43), which was significant for intervention group 2 (p < 0.001), indicating that, to achieve lower levels of pain, breastfeeding should be carried out before and during vaccination. CONCLUSION: Longer breastfeeding, conducted five minutes before and during vaccination, reduces the pain induced by the Pentavalent vaccine. No vaccination risks were identified to outweigh the benefits. These results endorse that health professionals should encourage breastfeeding at least five minutes before and during vaccine injection for an antinociception effect. Brazilian Clinical Trials Registry: RBR-9vh37wr.
Asunto(s)
Lactancia Materna , Dolor , Humanos , Lactante , Femenino , Masculino , Dolor/etiología , Dolor/prevención & control , Vacunación/efectos adversos , Adulto , Vacunas Combinadas/efectos adversos , Vacunas Combinadas/administración & dosificación , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/efectos adversos , Vacunas contra Haemophilus/administración & dosificación , Vacunas contra Haemophilus/efectos adversos , Factores de Tiempo , Dimensión del Dolor , Vacuna Antipolio de Virus Inactivados/efectos adversos , Vacuna Antipolio de Virus Inactivados/administración & dosificaciónRESUMEN
ABASTRACT Background: To study the association between pain and depression, its characteristics and related factors in chilean older adults. METHODS: Cross-sectional analytical study of the National Survey of Dependence in Chilean older adults 2009, with a sample of 4766 people aged 60 years and older. Pain was described using a Likert scale from "no pain" to "very much pain". Depression was measured using the GDS-15 scale. Adjusted logistic regression analyses were performed to identify the association between pain and depression. RESULTS: 70% of the sample reported pain, 21.6% of high intensity. The screening was positive for depression in 23% of the sample, and 5% suspected severe depression. Both conditions were more frequent in women, subjects with low levels of schooling and rural residence. There was an association between pain and depression OR 3.46. The greater the intensity of pain, the greater the association OR 5.2 (95% CI 4.1-6.7) for depressive symptoms and OR 13.9 for suspected severe depression (95% CI 8.1-23.9). CONCLUSION: The association between pain and depression is high and is related to pain intensity, being higher in people with less education and physical dependency. The high frequency of both conditions in Chilean elderly people and their serious consequences make it an urgent public health problem, aggravated as a consequence of the prolonged isolation due to the COVID-19 pandemic.