Prospective Follow-Up of Adolescents With and at Risk for Depression: Protocol and Methods of the Identifying Depression Early in Adolescence Risk Stratified Cohort Longitudinal Assessments.

Objective: To present the protocol and methods for the prospective longitudinal assessments-including clinical and digital phenotyping approaches-of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study, which comprises Brazilian adolescents stratified at baseline by risk of developing depression or presence of depression. Method: Of 7,720 screened adolescents aged 14 to 16 years, we recruited 150 participants (75 boys, 75 girls) based on a composite risk score: 50 with low risk for developing depression (LR), 50 with high risk for developing depression (HR), and 50 with an active untreated major depressive episode (MDD). Three annual follow-up assessments were conducted, involving clinical measures (parent- and adolescent-reported questionnaires and psychiatrist assessments), active and passive data sensing via smartphones, and neurobiological measures (neuroimaging and biological material samples). Retention rates were 96% (Wave 1), 94% (Wave 2), and 88% (Wave 3), with no significant differences by sex or group (p > .05). Participants highlighted their familiarity with the research team and assessment process as a motivator for sustained engagement. Discussion: This protocol relied on novel aspects, such as the use of a WhatsApp bot, which is particularly pertinent for low- to-middle-income countries, and the collection of information from diverse sources in a longitudinal design, encompassing clinical data, self-reports, parental reports, Global Positioning System (GPS) data, and ecological momentary assessments. The study engaged adolescents over an extensive period and demonstrated the feasibility of conducting a prospective follow-up study with a risk-enriched cohort of adolescents in a middle-income country, integrating mobile technology with traditional methodologies to enhance longitudinal data collection.

This article details the study protocol and methods used in the longitudinal assessment of 150 Brazilian teenagers with depression and at risk for depression as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo). Over 3 years, the authors collected clinical and digital data using innovative mobile technology, including a WhatsApp bot. Most adolescents participated in all the study phases, showing feasibility of prospective follow-up in a middle-income country. This approach allowed for a deeper understanding of depression in young populations, particularly in areas where mental health research is scarce.

Analysis of the prescription of benzodiazepines by family physicians in a sample in Rio de Janeiro / Análisis sobre la prescripción de benzodiazepinas por médicos de familia en una muestra en Río de Janeiro.

This qualitative study researched the determinants influencing family physician's decision on benzodiazepine prescription in a primary care setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, on how the prescription is negotiated between physician and user. Twelve general practitioners settled in primary care were recruited, gave acceptance signing free and informed consent form, responding to a semi-structured questionnaire that was recorded and transcribed verbatim for analysis, from August to December 2017. The questionnaire addressed physicians' perception of complaints in benzodiazepines users, and alternatives offered instead of medicines. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension, and dependence. Most physicians proposed the therapeutic alliance as a mechanism for offering alternatives to reduce the chronic use of benzodiazepines, despite this intervention achieving a low success rate. Longitudinal care was evidenced as a guiding principle. The analysis of the meanings attributed to BZD, as unveiled in this work, promotes a discussion about the place of medication in culture and its consequences in the approach to psychological and mental suffering.

Este estudio cualitativo investigó los determinantes que pesan sobre la decisión de la prescripción de benzodiacepinas por médicos de familia, en el contexto de la atención primaria del municipio de Río de Janeiro. Con el fin de elaborar un análisis sobre cómo la prescripción es negociada entre médico y usuario, se reclutaron 12 médicos de familia de inserción en la estrategia salud de la familia. Los candidatos convocados aceptaron firmando el formulario de consentimiento informado y respondieron un cuestionario semiestructurado, que fue grabado y transcripto para su análisis, en el período de agosto a diciembre de 2017. El cuestionario abordó la percepción del médico sobre el uso de benzodiacepinas y las alternativas al mismo. Los entrevistados relataron predominio de prescripción de repetición, preocupación por la optimización y reducción de la dosis, cuando era posible. Se evidenció como motivo de uso: ansiedad, insomnio y síntomas depresivos. Quejas somáticas, dolor crónico, hipertensión arterial y dependencia se encontraron como motivos relacionados. La mayoría de los médicos propuso la alianza terapéutica como mecanismo para ofrecer alternativas que permitieran reducir el uso crónico de benzodiacepinas, a pesar de esta intervención alcanzar una baja tasa de éxito. Por tanto, los médicos entrevistados mostraron un compromiso con el uso racional y preocupación con el uso indiscriminado. La longitudinalidad en el cuidado se evidenció como principio directriz. El análisis de los efectos atribuidos a las BZD, como se devela en este dispositivo, promueve una discusión sobre el lugar de los medicamentos en la cultura y sus consecuencias en el abordaje del sufrimiento psíquico y mental.

Assessment of risk factors in patients with rheumatoid arthritis-associated interstitial lung disease. / Avaliação de fatores de risco em pacientes com doença pulmonar intersticial associada à artrite reumatoide.

OBJECTIVE: To assess the risk factors for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and to evaluate the association of ILD with the use of methotrexate as well as with joint disease activity. METHODS: A retrospective, cross-sectional study conducted between March and December 2019 at a tertiary healthcare center, in a follow-up of RA patients who had undergone pulmonary function tests (PFT) and chest computed tomography. We evaluated the tomographic characteristics, such as the presence of ILD and its extension, as well as joint disease activity. Functional measurements, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), were also assessed. After this, a multivariate logistic regression analysis was applied in order to identify risk factors associated with ILD. RESULTS: We evaluated 1.233 patients, of which 134 were eligible for this study. The majority were female (89.6%), with a mean age of 61 years old and with a positive rheumatoid factor (86.2%). RA-associated ILD (RA-ILD) was detected in 49 patients (36.6%). We found an association of RA-ILD with age ≥= 62 year, male sex, smoking history and fine crackles in lung auscultation and a decreased DLCO. The indicators of being aged ≥ 62 years old and having moderate or high RA disease activity were both independent factors associated with RA-ILD, with an odds ratio of 4.36 and 3.03, respectively. The use of methotrexate was not associated with a higher prevalence of ILD. CONCLUSION: Age and RA disease activity are important risk factors associated with RA-ILD. Methotrexate was not associated with the development of RA-ILD in the present study.

OBJETIVO: Avaliar os fatores de risco para doença pulmonar intersticial (DPI) em pacientes com artrite reumatoide (AR), bem como a associação com uso de metotrexate e com a atividade da doença articular. MÉTODOS: Estudo retrospectivo, transversal, realizado entre março e dezembro de 2019 em um centro de saúde terciário, no seguimento de pacientes com AR submetidos a provas de função pulmonar (PFP) e tomografia computadorizada de tórax. Avaliamos as características tomográficas, como a presença de DPI e sua extensão, bem como a atividade da doença articular. Medidas funcionais, como capacidade vital forçada (CVF) e a medida de difusão de monóxido de carbono (DCO) também foram avaliadas. Em seguida, aplicou-se uma análise de regressão logística multivariada para identificar os fatores de risco associados à DPI. RESULTADOS: Foram avaliados 1.233 pacientes, dos quais 134 foram elegíveis para este estudo. A maioria era do sexo feminino (89,6%), com idade média de 61 anos e fator reumatoide positivo (86,2%). A DPI associada à AR (DPI-AR) foi detectada em 49 pacientes (36,6%). Encontramos associação de DPI-AR com idade ≥ 62 anos, sexo masculino, história de tabagismo,crepitações finas na ausculta pulmonar e diminuição da DCO. Idade ≥ 62 anos e atividade articular moderada ou alta da AR foram fatores independentes associados à DPI-AR, com odds ratio de 4,36 e 3,03, respectivamente. O uso de metotrexato não foi associado à maior prevalência de DPI. CONCLUSÃO: A idade e a atividade da doença da AR são importantes fatores de risco associados à DPI-AR. O metotrexato não foi associado ao desenvolvimento de DPI-AR no presente estudo.

Energy drinks and alcohol in a binge drinking protocol in Wistar rats: Male and female behavioral and reproductive effects.

The consumption of energy drinks is common among adolescents and young adults. The possible effects (mainly behavioral and reproductive) of ingestion in this population remain unknown. For this reason, this study aimed to evaluate the behavioral and reproductive effects of energy drinks and their main constituents (caffeine and taurine), as well as their combinations with alcohol, via a binge drinking protocol in male and female Wistar rats during puberty. In this study, 100 male and 100 female rats were treated with a binge drinking protocol 3 days a week over 4 weeks from postnatal day (PND) 28 to PND 60, which included 10 mL/kg by oral gavage of distilled water, energy drink, caffeine (3.2 mg/kg), taurine (40 mg/kg), and their combinations with alcohol (2 g/kg). The animals were evaluated by behavioral tests from PND 56 to PND 60 (open field, plus maze and object recognition) and reproductive parameters (estrous cycle regularity, weight of sexual organs, oocyte quality, spermatid and sperm count, sperm morphology and testosterone level). Locomotor activity was increased in females in the groups combined with alcohol (except alcohol + caffeine) and in the caffeine group. Long-term memory was increased in males in the caffeine and taurine groups even when combined with alcohol. The combination of energy drinks and alcohol did not have significant effects on the reproductive parameters of either sex of rats during puberty. We concluded that energy drinks (and their main constituents) and alcohol combinations did not cause alterations in reproductive profiles, and locomotor activity and long-term memory were increased in females and males, respectively.

Oral administration of oleuropein and olive leaf extract has cardioprotective effects in rodents: A systematic review.

Oleuropein is a polyphenol found in olive trees that has shown beneficial effects in animal studies and potentially in human health, although few studies have been performed to confirm this hypothesis in the latter population. Previous studies related its antioxidant activity to cardioprotective effects and showed a positive correlation between dose and response. We thus aimed to assess the cardioprotective effect of oleuropein and olive leaf extract in animal experiments. A literature search was conducted in June 2020 in the PubMed, Scopus and Web of Science databases. The descriptors "oleuropein" and "oleuropein aglycone" identified 12 articles for qualitative synthesis. Risk of bias was assessed by SYRCLE's RoB tool for animal studies. The results demonstrate evidence of a positive association between the administration of oleuropein and olive leaf extract and improvement in outcomes in hypertension, heart failure, myocardial infarction. renal hypertension and diabetes. This review presents a positive effect of oleuropein and olive leaf extract administration on cardiovascular parameters in animal studies.

Imidacloprid-based commercial pesticide causes behavioral, biochemical, and hematological impairments in Wistar rats.

Imidacloprid (IMI) is a neonicotinoid insecticide employed worldwide for crop protection. IMI's mode of action occurs through the agonism of postsynaptic nicotinic acetylcholine receptors (nAChRs), with high specificity for insect nAChRs although there are reports of mammals' toxicity. Studies on IMI's neurotoxicity are not conclusive; therefore, the aim of this study was to evaluate the subchronic toxic effects of an IMI based commercial pesticide on rats. Adult male Wistar rats received an IMI suspension via the oral route at doses of 1.5, 5, and 15 mg/kg for 45 consecutive days. IMI caused an increase in rearing and time spent at the periphery in the locomotor activity test and a decrease in time spent to finish the OX maze task (p < 0.05; ANOVA/Bonferroni). In blood, there was a decrease in mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration (p < 0.05; ANOVA/Bonferroni) and an increase in serum butyrylcholinesterase activity (p < 0.001; ANOVA/Bonferroni). Therefore, subchronic administration of an IMI-based-pesticide caused behavioral and systemic impairments in rats.

Effects of subchronic inhalation exposure to an organophosphorus insecticide compound containing dichlorvos on wistar rats' otoacoustic emissions / Efeitos da exposição inalatória subcrônica a um inseticida organofosforado contendo diclorvos nas emissões otoacústicas de ratos Wistar

Abstract Introduction Considering that previous studies suggest that pesticides may cause hearing disorders in humans, as well as the lack of studies proving the specific mechanisms of injury and the difficulty of separating concomitant etiological factors of the hearing damage, such as noise and vibration, it is important to develop studies using animal models to elucidate the effects of exposure to those substances isolated from other hearing damage etiologies. Objective To evaluate if the exposure to a dichlorvos based organophosphorus insecticide may induce ototoxicity. Methods 36 male Wistar rats were assigned to 3 groups (12 rats/group): control (exposed to water), positive control (treated with cisplatin to induce hearing damage) and experimental (exposed to dichlorvos based organophosphorus insecticide). The amplitude of distortion product otoacoustic emissions in the frequencies of 4, 6, 8, 10 and 12 kHz was evaluated before and after exposure, as well as systemic toxicity signs, body mass gain and plasma cholinesterase. Open field and plus maze tests were performed in 24 rats: experimental (n = 8), control (n = 8) and positive control group (n = 8 introduced new rats to induce anxiolytic activity) to evaluate the locomotor activity and anxiety, respectively. Results There was no significant change in body mass gain and plasma cholinesterase in the dichlorvos based organophosphorus insecticide group, however, the animals showed transient piloerection, depression and dyspnea during exposure. The behavior was not affected in any group. The frequencies of 8 and 10 kHz were significantly affected bilaterally in the insecticide group, which also showed a significant difference of the control in 10 kHz on the right and 8 and 10 kHz on the left ear. Conclusion Subchronic inhalation exposure to dichlorvos based organophosphorus insecticide induced ototoxicity in the cochlear function of rats without relevant systemic toxicity.

Resumo Introdução Considerando que estudos anteriores sugerem que pesticidas podem causar distúrbios auditivos em humanos, além da falta de estudos que comprovem os mecanismos específicos de lesão e a dificuldade em separar fatores etiológicos concomitantes dos danos auditivos, como ruído e vibração, é importante desenvolver estudos que usem modelos animais para elucidar os efeitos da exposição a substâncias isoladas de outras etiologias de danos auditivos. Objetivo Avaliar se a exposição a um inseticida organofosforado baseado em diclorvos pode induzir ototoxicidade. Método Foram divididos em 3 grupos 36 ratos Wistar machos (12 ratos/grupo): controle (exposto à água), controle positivo (tratado com cisplatina para induzir dano auditivo) e experimental (exposto ao inseticida). A amplitude das emissões otoacústicas por produto de distorção nas frequências de 4, 6, 8, 10 e 12 kHz foi avaliada antes e após a exposição, bem como sinais de toxicidade sistêmica, ganho de massa corporal e colinesterase plasmática. Os testes Open Field e Plus Maze foram feitos em 24 ratos: experimental (n = 8), controle (n = 8) e grupo controle positivo (n = 8, introduziu novos ratos para induzir atividade ansiolítica) para avaliar a atividade locomotora e a ansiedade, respectivamente. Resultados Não houve alteração significativa no ganho de massa corporal e colinesterase plasmática no grupo experimental; entretanto, os animais apresentaram piloereção transitória, depressão e dispneia durante a exposição. O comportamento não foi afetado em qualquer grupo. As frequências de 8 e 10 kHz foram significativamente afetadas bilateralmente no grupo exposto ao inseticida, o qual também mostrou uma diferença significativa do controle em 10 kHz na orelha direita e 8 e 10 kHz na orelha esquerda. Conclusão A exposição subcrônica inalatória de inseticida organofosforado baseado em diclorvos induziu ototoxicidade na função coclear de ratos sem toxicidade sistêmica relevante.

Effects of subchronic inhalation exposure to an organophosphorus insecticide compound containing dichlorvos on wistar rats' otoacoustic emissions.

INTRODUCTION: Considering that previous studies suggest that pesticides may cause hearing disorders in humans, as well as the lack of studies proving the specific mechanisms of injury and the difficulty of separating concomitant etiological factors of the hearing damage, such as noise and vibration, it is important to develop studies using animal models to elucidate the effects of exposure to those substances isolated from other hearing damage etiologies. OBJECTIVE: To evaluate if the exposure to a dichlorvos based organophosphorus insecticide may induce ototoxicity. METHODS: 36 male Wistar rats were assigned to 3 groups (12 rats/group): control (exposed to water), positive control (treated with cisplatin to induce hearing damage) and experimental (exposed to dichlorvos based organophosphorus insecticide). The amplitude of distortion product otoacoustic emissions in the frequencies of 4, 6, 8, 10 and 12kHz was evaluated before and after exposure, as well as systemic toxicity signs, body mass gain and plasma cholinesterase. Open field and plus maze tests were performed in 24 rats: experimental (n=8), control (n=8) and positive control group (n=8 introduced new rats to induce anxiolytic activity) to evaluate the locomotor activity and anxiety, respectively. RESULTS: There was no significant change in body mass gain and plasma cholinesterase in the dichlorvos based organophosphorus insecticide group, however, the animals showed transient piloerection, depression and dyspnea during exposure. The behavior was not affected in any group. The frequencies of 8 and 10kHz were significantly affected bilaterally in the insecticide group, which also showed a significant difference of the control in 10kHz on the right and 8 and 10kHz on the left ear. CONCLUSION: Subchronic inhalation exposure to dichlorvos based organophosphorus insecticide induced ototoxicity in the cochlear function of rats without relevant systemic toxicity.

Avaliação de fatores de risco em pacientes com doença pulmonar intersticial associada à artrite reumatoide / Assessment of risk factors in patients with rheumatoid arthritis-associated interstitial lung disease

RESUMO Objetivo Avaliar os fatores de risco para doença pulmonar intersticial (DPI) em pacientes com artrite reumatoide (AR), bem como a associação com uso de metotrexate e com a atividade da doença articular. Métodos Estudo retrospectivo, transversal, realizado entre março e dezembro de 2019 em um centro de saúde terciário, no seguimento de pacientes com AR submetidos a provas de função pulmonar (PFP) e tomografia computadorizada de tórax. Avaliamos as características tomográficas, como a presença de DPI e sua extensão, bem como a atividade da doença articular. Medidas funcionais, como capacidade vital forçada (CVF) e a medida de difusão de monóxido de carbono (DCO) também foram avaliadas. Em seguida, aplicou-se uma análise de regressão logística multivariada para identificar os fatores de risco associados à DPI. Resultados Foram avaliados 1.233 pacientes, dos quais 134 foram elegíveis para este estudo. A maioria era do sexo feminino (89,6%), com idade média de 61 anos e fator reumatoide positivo (86,2%). A DPI associada à AR (DPI-AR) foi detectada em 49 pacientes (36,6%). Encontramos associação de DPI-AR com idade ≥ 62 anos, sexo masculino, história de tabagismo,crepitações finas na ausculta pulmonar e diminuição da DCO. Idade ≥ 62 anos e atividade articular moderada ou alta da AR foram fatores independentes associados à DPI-AR, com odds ratio de 4,36 e 3,03, respectivamente. O uso de metotrexato não foi associado à maior prevalência de DPI. Conclusão A idade e a atividade da doença da AR são importantes fatores de risco associados à DPI-AR. O metotrexato não foi associado ao desenvolvimento de DPI-AR no presente estudo.

ABSTRACT Objective To assess the risk factors for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and to evaluate the association of ILD with the use of methotrexate as well as with joint disease activity. Methods A retrospective, cross-sectional study conducted between March and December 2019 at a tertiary healthcare center, in a follow-up of RA patients who had undergone pulmonary function tests (PFT) and chest computed tomography. We evaluated the tomographic characteristics, such as the presence of ILD and its extension, as well as joint disease activity. Functional measurements, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), were also assessed. After this, a multivariate logistic regression analysis was applied in order to identify risk factors associated with ILD. Results We evaluated 1.233 patients, of which 134 were eligible for this study. The majority were female (89.6%), with a mean age of 61 years old and with a positive rheumatoid factor (86.2%). RA-associated ILD (RA-ILD) was detected in 49 patients (36.6%). We found an association of RA-ILD with age ≥= 62 year, male sex, smoking history and fine crackles in lung auscultation and a decreased DLCO. The indicators of being aged ≥ 62 years old and having moderate or high RA disease activity were both independent factors associated with RA-ILD, with an odds ratio of 4.36 and 3.03, respectively. The use of methotrexate was not associated with a higher prevalence of ILD. Conclusion Age and RA disease activity are important risk factors associated with RA-ILD. Methotrexate was not associated with the development of RA-ILD in the present study.

Levamisole, a cocaine cutting agent, induces acute and subchronic systemic alterations in Wistar rats.

The use of the anthelmintic levamisole as a cocaine adulterant has been increasing worldwide. Complications caused by this association include systemic vasculitis, agranulocytosis, neutropenia, tissue necrosis, pulmonary hemorrhage, and renal injury. Data about toxicity of levamisole are scarce, therefore the aim of this study was to evaluate the acute and subchronic toxic effects of levamisole in rats. Male Wistar rats received saline or levamisole by intraperitoneal route at the doses of 12, 24 and 36 mg/kg in the acute toxicity test; and at 3, 6 and 12 mg/kg in the subchronic toxicity test. Toxicity was evaluated using behavioral, cognitive, renal, hematological, biochemical and histopathological parameters. Acute administration of levamisole caused behavioral and histopathological alterations. Subchronic administration caused behavioral, cognitive and hematological alterations (p < 0.0001 and p < 0.05, respectively), impairment of liver and kidney functions (p < 0.05), and changes of antioxidant defenses (p ≤ 0.0001). Both administrations produced toxic effects of clinical relevance, which make levamisole a dangerous cutting agent. Furthermore, the knowledge of these effects can contribute to the correct diagnosis and treatment of cocaine dependents with unusual systemic alterations.

Energy drink and alcohol combination leads to kidney and liver alterations in rats.

The aim of this study was to evaluate the acute toxicity of the association of energy drink and alcohol in male Wistar rats. Animals were treated by oral gavage with 10 ml/kg distilled water (control); 10 ml/kg energy drink (ED10); 3.2 mg/kg caffeine + 40 mg/kg taurine; 2 g/kg alcohol 20%; 2 g/kg alcohol 20% + ED10; and 2 g/kg alcohol 20% + 3.2 mg/kg caffeine + 40 mg/kg taurine. Behavioral alterations were observed for 6 h after treatment. Animals presented significant differences in the frequency of rearing, ambulation, grooming, wakefulness and tachypnea along time. Caffeine + taurine increased the levels of TBARS and total thiols in kidneys. ED10 increased lipoperoxidation in liver. The association of ED10 + alcohol induced nephrotoxicity observed by the increase of urinary N-acetyl-ß-d-glucosaminidase (NAG) activity. Histopathological analysis showed the presence of congestion and hydropic and hyaline degenerations in the livers of ED10 + alcohol treated rats, and hemorrhage in the liver of alcohol + caffeine + taurine group. In kidneys, hyaline degeneration was observed in ED10; ED10 + alcohol; caffeine + taurine; and alcohol + caffeine + taurine. Hemorrhage was present in the kidneys of all groups. The combination of energy drinks and alcohol is not safe for the consumers. Therefore, precautionary measures should be disseminated among risk populations, especially the teenagers.

A 28-day Sub-acute Genotoxic and Behavioural Assessment of Garcinielliptone FC.

Garcinielliptone FC (GFC) is a polyisoprenylated benzophenone isolated from Platonia insignis Mart (Clusiaceae) with promising anticonvulsant properties. However, its safe use and other effects on the central nervous system require assessment. This study assessed the toxicological effects of GFC using the comet assay and the micronucleus test in mice treated for 28 days. A behavioural model was employed to detect possible injuries on the central nervous system. Mice treated with GFC (2, 10 and 20 mg/kg; i.p.) daily for 28 days were submitted to rotarod test, open-field test and tail suspension test (TST). After the behaviour tasks, biological samples were assessed to evaluate genotoxic and mutagenic effects using the comet assay and the micronucleus test. Garcinielliptone FC did not impair the performance of the animals in the rotarod and open-field tests, with no antidepressant-like effect in TST. No genotoxic effects in blood and cerebral cortex were observable in the comet assay; however, there was a significant increase in index and frequency of damage in liver after treatment with GFC 20 mg/kg. Garcinielliptone FC did not increase micronucleus frequency in bone marrow. At the tested doses, GFC was not toxic to the CNS and did not induce genotoxic damage to blood or bone narrow cells. DNA damage to liver tissue was caused only by the highest dose, although no mutagenic potential was observed.

Análise da prescrição de benzodiazepínicos pelo médico de família em uma amostra no município do Rio de Janeiro / Analysis of the benzodiazepine prescription by the family phisician in a sample in Rio de Janeiro

A pesquisa conduzida, de cunho qualitativo, procurou refletir sobre os determinantes que pesam na decisão do médico de família pela prescrição do benzodiazepínico, no contexto da Estratégia Saúde da Família, no município do Rio de Janeiro. Procurou-se elaborar uma análise sobre como o uso de benzodiazepínicos é negociado entre o médico e o usuário, indagando sobre os significados do fármaco no imaginário dos prescriptores e os recursos alternativos à medicação levados em consideração pela equipe, na amostra estudada. Os médicos de família com inserção na Estratégia Saúde da Família foram recrutados, encaminhando o convite para participar pessoalmente, por mensagem de texto ou por e-mail. Os candidatos interessados deram aceite assinando o Termo de Consentimento Livre e Esclarecido, respondendo um questionário semiestruturado que foi gravado e transcrito na íntegra para análise. O roteiro abordou a percepção do médico sobre as queixas em relação ao uso de benzodiazepínicos; a aplicação de estratégias de descontinuação e as alternativas oferecidas no lugar do fármaco nas consultas. Entrevistaram-se 12 profissionais, no período de agosto a dezembro de 2017. Os entrevistados relataram predomínio de consultas para repetição da prescrição de benzodiazepínicos. Ansiedade, insônia e sintomas depressivos foram citados como os motivos mais frequentes de uso. Também houve menção a queixas somáticas inespecíficas, dor crônica, hipertensão arterial e à dependência. Todos os entrevistados relataram preocupação com a otimização e redução das doses dos bezodiazepínicos. Onze dos entrevistados manifestaram realizar propostas de descontinuação, uma vez estabelecida a aliança terapêutica. Ainda, a taxa de sucesso desse tipo de intervenção foi avaliada como baixa na percepção dos entrevistados. Houve menção à oferta de atividades de lazer, exercício físico, inclusão em grupos de apoio e encaminhamento para apoio matricial, como alternativas ao fármaco. O compromisso com o uso racional de benzodiazepínicos em contraste com a preocupação com o uso indiscriminado se manifestaram na pressão, nos dilemas e constrangimentos relatados pelos médicos de família nas entrevistas. A hierarquização das queixas junto ao usuário marca a possibilidade de um cuidado compartilhado, em equipe, onde o uso de fármacos pretende ser apenas um dos recursos disponíveis. Esta aposta na integralidade pode ter resultados significativos na saúde da população, no longo prazo, em termos de uso de medicamentos

Standardized Passiflora incarnata L. Extract Reverts the Analgesia Induced by Alcohol Withdrawal in Rats.

Passiflora incarnata L. (Passifloraceae) has been traditionally used for treatment of anxiety, insomnia, drug addiction, mild infections, and pain. The aim of this study was to investigate the effect of a commercial extract of P. incarnata in the analgesia induced by alcohol withdrawal syndrome in rats. In addition, brain-derived neurotrophic factor and interleukin-10 levels were evaluated in prefrontal cortex, brainstem, and hippocampus. Male adult rats received by oral gavage: (1: water group) water for 19 days, 1 day interval and water (8 days); (2: P. incarnata group) water for 19 days, 1 day interval and P. incarnata 200 mg/kg (8 days); (3: alcohol withdrawal group) alcohol for 19 days, 1 day interval and water (8 days); and (4: P. incarnata in alcohol withdrawal) alcohol for 19 days, 1 day interval and P. incarnata 200 mg/kg (8 days). The tail-flick and hot plate tests were used as nociceptive response measures. Confirming previous study of our group, it was showed that alcohol-treated groups presented an increase in the nociceptive thresholds after alcohol withdrawal, which was reverted by P. incarnata, measured by the hot plate test. Besides, alcohol treatment increased brain-derived neurotrophic factor and interleukin-10 levels in prefrontal cortex, which was not reverted by P. incarnata. Considering these results, the P. incarnata treatment might be a potential therapy in the alcohol withdrawal syndrome. Copyright © 2017 John Wiley & Sons, Ltd.

Protracted alcohol abstinence induces analgesia in rats: Possible relationships with BDNF and interleukin-10.

Exposure to ethanol alters the expression of brain-derived neurotrophic factor (BDNF) in central regions such as, the hippocampus, cortex and striatum. Moreover, chronic alcohol intake is known to induce selective neuronal damage associated with an increase in the inflammatory cascade, resulting in neuronal apoptosis and neurodegeneration. In the present study, we investigated the nociceptive response after 24h of protracted alcohol abstinence. Rats were submitted to a model of alcohol withdrawal syndrome and the nociceptive response was assessed by the tail-flick and the hot plate tests. In addition, we evaluated BDNF and interleukin-10 (IL-10) in the cerebral prefrontal cortex, brainstem and hippocampus of rats after protracted alcohol abstinence. Male adult Wistar rats were divided into three groups: non-treated group (control group), treated with water (water group), and alcohol (alcohol group). The water and alcohol administrations were done by oral gavage and were performed over three periods of five days of treatment with two intervals of two days between them. Alcohol (20%w/v) was given at 4g/kg of body weight. There was a significant effect of treatment in the tail-flick and hot plate latencies with greater latencies in alcohol-treated rats after 10days of abstinence. There was a significant increase in the prefrontal cortex BDNF levels in the alcohol group in relation to the water group, after 11days of alcohol abstinence. In addition, alcohol withdrawal induced a significant increase in the hippocampus, prefrontal cortex and brainstem IL-10 levels compared with control group. Thus, the present study demonstrates that protracted alcohol withdrawal produced an analgesic effect indexed via increased nociceptive threshold. We suggest that these effects could be related to the increased levels of BDNF and IL-10 observed in the central nervous system.