Antioxidant and Renin Inhibitory Activities of Peptides from Food Proteins on Hypertension: A Review.

Hypertension is a condition induced by oxidative stress causing an alteration in the endothelium, which increases the risk of suffering from other degenerative diseases. This review compiles the findings on peptides from food proteins with antioxidant and antihypertensive activities. Antihypertensive peptides are mainly focused on renin inhibition. Peptides containing hydrophobic amino acids have antioxidant and renin inhibitory activities, as reported by studies on the biological activity of peptides from various food sources evaluated separately and simultaneously. Peptides from food sources can present multiple biological activities. Moreover, antioxidant peptides have the potential to be evaluated against renin, offering an alternative for hypertension therapy without causing adverse side effects.

"Fibromyalgia - are there any new approaches?"

INTRODUCTION: Approaching patients with fibromyalgia (FM) is challenging due to the limited availability of scientifically proven effective therapies. OBJECTIVE: Review the treatments in use for FM and present new knowledge that could benefit these patients. Non-pharmacological interventions are recommended as the first line of treatment: aerobic exercise, cognitive behavioral therapy and patient education, all aimed at improving pain and other symptoms. Additional approaches have been studied, such as, digital health interventions, combined treatments, noninvasive neuromodulation, and others. Concerning pharmacological therapy, the mechanism of action of the medications currently used is to promote pain modulation. Medications approved by Food and Drug Administration are duloxetine, milnacipran and pregabalin. Amitriptyline, cyclobenzaprine, gabapentin and naltrexone are considered for off-label use. Cannabinoids, vitamin D supplementation are still controversial and further research is needed. CONCLUSION: The combination of therapies, whether old, recent or reformulated, are the most effective strategy for managing symptoms in patients with fibromyalgia. KEY WORDS: fibromyalgia, treatment, nonpharmacological interventions, pharmacological treatment.

Impact of germination time on protein solubility and anti-inflammatory properties of Pisum sativum L grains.

During germination processes take place that modify the major components of the grain, such is the case of proteins that are hydrolyzed to generate peptides that can lead to the generation of bioactivity. The objective of the present work was to germinate grains of Pisum sativum to evaluate the effect on the soluble protein content and the anti-inflammatory activity. The grains were subjected to 10 days of germination at 24 °C and relative humidity of 75%. Sprouts were lyophilized, milled, and phenolic compounds were extracted to avoid interferences. Soluble protein content varied significantly during the 10 days of germination. In vitro assays indicate that sprouts protein inhibits thermal denaturation of proteins, protease activity, and stabilize cell membranes. The IC50 values indicate that after germination the bioactivity increased between 1.4 and 3.5 times, with respect to the ungerminated grains. Results indicated that Pisum sativum sprouts may constitute promising health-promoting foods.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force.

OBJECTIVE: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. METHODS: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. RESULTS: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4-agree-and 5-strongly agree-, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. CONCLUSION: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Screening for cognitive impairment among individuals aged 60 years or over: scoping review.

BACKGROUND: Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. OBJECTIVES: To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. DESIGN AND SETTING: Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. METHOD: A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. RESULTS: A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. CONCLUSION: The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

Treatment data from the Brazilian fibromyalgia registry (EpiFibro).

BACKGROUND: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). OBJECTIVE: To analyze the therapeutic measures prescribed by Brazilian physicians. MATERIALS AND METHODS: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. RESULTS: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). CONCLUSION: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.

Is the symptom of pain adequately addressed in hospitalization at Internal Medicine? Cross-sectional study / O sintoma dor é abordado adequadamente em internação hospitalar de Clínica Médica? Estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is one of the main reasons for seeking medical care. Thus, the objective of the present study was to evaluate the treatment of pain complaints in a medical clinic ward. METHODS: Cross-sectional and descriptive study at the Santa Lucinda Hospital (Hospital Santa Lucinda - HSL) and Sorocaba Hospital Complex (Conjunto Hospitalar de Sorocaba - CHS). Data was collected by: (1) interviewing the participants using a structured questionnaire drawn up by the researchers, and (2) accessing information such as pain records and drug prescriptions in the medical records. RESULTS: The sample consisted of 85 patients, 11.8% in the HSL and 88.2% in the CHS. More than 80% of patients had already experienced pain at some point in their lives, whether chronic or acute. Forty-one percent of patients had pain during hospitalization, regardless of the reason for admission. A minority of pain events had the complaint recorded in their medical records. Drugs were prescribed for 73.0% of the patients, mostly on demand. There was a mismatch between the type of drug prescribed and the intensity of the pain in 80% of prescriptions. CONCLUSION: The complaint of pain is prevalent in Internal Medicine hospitalizations. In this study, 41.2% of the pain was musculoskeletal, followed by abdominal pain, regardless of the reason for hospitalization. The complaint of pain was medicated in most of the patients' pain reports, but around 23% of the patients complaining of pain did not receive drugs. Most patients (80%) with pain received drugs that were inconsistent with the intensity of the pain; however, the recording of the complaint of pain in the medical records remains insufficient.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor é um dos principais motivos por assistência ao serviço médico-hospitalar. Desta forma, o objetivo deste estudo foi avaliar o atendimento de queixas dolorosas em enfermaria de clínica médica. MÉTODOS: Estudo transversal e descritivo nos hospitais Santa Lucinda (HSL) e Conjunto Hospitalar de Sorocaba (CHS). A coleta de dados foi realizada por: (1) entrevista com os participantes direcionada por um questionário estruturado elaborado pelos pesquisadores, e (2) acesso a informações como registro de dor e prescrição de fármacos no prontuário. RESULTADOS: A amostra foi composta por 85 pacientes, sendo 11.8% no HSL e 88,2% no CHS. Mais de 80% dos participantes relataram experiência prévia de dor aguda ou crônica em algum momento da vida. Quarenta e um por cento dos participantes relatou dor durante a internação independente da causa da internação. A minoria dos eventos de dor constava nos registros da queixa em seu prontuário. Houve fármaco prescrito para 73% dos pacientes, sendo em sua maioria, por demanda. Houve uma inadequação entre o tipo de fármaco prescrito e a intensidade da dor em 80% das prescrições. CONCLUSÃO: A queixa de dor é um sintoma prevalente entre pacientes internados de Clínica Médica. Neste estudo, 41,2%; das dores foram musculoesqueléticas, seguida de dores abdominais, independente do motivo da internação. A queixa de dor foi medicada na maior parte dos relatos de dor dos pacientes, porém cerca de 23% dos pacientes com queixa de dor não receberam fármacos. A maior parte dos pacientes (80%) com dor recebeu fármacos incoerentes à intensidade da dor; porém o registro da queixa de dor nas evoluções dos prontuários permanece insuficiente.

Teste de Progresso: a percepção do discente de Medicina / Progress Test: the perception of the medical student

Resumo: Introdução: O Teste de Progresso (TP) como instrumento de avaliação na educação médica constitui-se em relevante subsídio para avaliar a eficiência do programa. Contudo, a percepção do aluno quanto ao seu desempenho e o impacto do TP na aprendizagem podem variar de acordo com contextos pessoais, educacionais, sociais e culturais. Objetivo: Esta pesquisa descritiva de abordagem qualitativa objetivou analisar a percepção dos estudantes do curso de graduação em Medicina de um centro universitário do noroeste paulista sobre o seu desempenho no TP, bem como o impacto dessa percepção em curto prazo sobre suas estratégias de estudo. Método: A amostra de conveniência foi constituída por 20 participantes após aprovação da pesquisa no Comitê de Ética em Pesquisa. Utilizou-se a técnica de grupos focais em dois momentos distintos para a coleta de dados: um grupo foi constituído por dez estudantes do quinto período, e o outro, por dez estudantes do oitavo período. A análise de dados fundamentou-se na análise de conteúdo temática descrita por Bardin et al. Resultado: Identificou-se que os estudantes entrevistados consideram: 1. as condições de realização do TP inadequadas; 2. o TP uma ferramenta pedagógica relevante que permite a autoavaliação e a correção das lacunas de aprendizagem, mas sugerem que seja aprimorado; 3. a participação no TP determinou sentimentos contraditórios para os estudantes, conforme o período que estão cursando. Conclusão: O TP é considerado pelos estudantes uma "ferramenta pedagógica" relevante. Entretanto, o impacto dos resultados de desempenho obtidos e o feedback recebidos não promoveram em curto prazo mudanças no plano de estudo dos estudantes entrevistados. A prática da autoavaliação ainda não se constitui cultura na vida acadêmica. É preciso considerar novas estratégias para a entrega do feedback formativo que permita a discussão das questões e dos resultados do curso/das turmas de forma reflexiva, de modo a potencializar o processo ensino-aprendizagem.

Abstract: Introduction: The Progress Test (PT) as an assessment tool in medical education is an important tool to evaluate the efficiency of the program. However, students' perception of their performance and the impact of the PT on learning may vary according to personal, educational, social and cultural contexts. Objective: This descriptive research with a qualitative approach aimed to analyze the perception of undergraduate medical students of a University Center in northwestern São Paulo about their performance in the PT, as well as the impact of this perception in the short term on their study strategies. Method: The convenience sample was composed of twenty participants, after approval of the research by the Research Ethics Committee. The focus group technique was used in two different moments for data collection; one group consisted of ten fifth-period students and the other, of ten eighth-period students. Data analysis was based on content analysis, thematic modality, as described by Bardin (2011). Results: It was identified that the interviewed students consider: 1. the PT performance conditions as inadequate; 2. the PT a relevant pedagogical tool, which allows self-assessment and the correction of learning gaps, but they suggest that it should be improved; 3. sitting the PT determined contradictory feelings for the students, according to their period of study. Conclusion: The Progress Test is considered by students a relevant "pedagogical tool". However, the impact of the performance results obtained and the feedback received did not promote changes in the study plan of the interviewed students in the short term. The practice of self-assessment is not yet a culture in academic life. It is necessary to consider new strategies for the delivery of formative feedback, allowing for reflective discussion of the issues and the course/class results in order to enhance the teaching-learning process.

New guidelines for the diagnosis of fibromyalgia.

OBJECTIVE: To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. MATERIAL AND METHODS: Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.

EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation.

INTRODUCTION: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). OBJECTIVES: To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. METHODS: This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. RESULTS: 810 patients' data were analyzed. Patients presented a mean age of 51.8±11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1±7.5 months (1-44). Most patients became stable. CONCLUSION: InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Screening for cognitive impairment among individuals aged 60 years or over: scoping review

BACKGROUND: Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. OBJECTIVES: To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. DESIGN AND SETTING: Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. METHOD: A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. RESULTS: A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. CONCLUSION: The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

Los desafíos de la educación médica en México / The challenges of medical education in Mexico

La educación médica genera impacto en la salud de las poblaciones; formar médicos profesionalizados con capacidad para adaptarse a entornos cambiantes permite comprender con mayor detalle la epidemiología de una comunidad o país y mejorar la salud pública. Dar al estudiante de medicina las herramientas necesarias para proporcionar una atención de calidad puede mejorar la salud de cientos de pacientes. La educación médica está llena de desafíos y se encuentra en una búsqueda continua de excelencia. El modelo educa-tivo actual busca centrarse en las competencias requeridas por los sistemas de salud y educación de México, pero COVID-19 rompió paradigmas y revolucionó la manera en la que se enseña medicina, centrándose en el aprendizaje autorregulado. El mundo está en constante cambio y la educación médica debe evolucionar con el mundo. La tecnología es la herramienta que revoluciona la enseñanza y permite introducir la globalización a las escuelas, aprendiendo así sobre otras culturas y su manera de practicar la medicina. La salud mental de los estudiantes es determinante para evitar la deserción y formar médicos sanos. El integrar condiciones de bienestar a nivel nacional e institucional tendrá un impacto positivo en la vida de los estudiantes, y los ayudará a desempeñarse mejor en el futuro. El reto de la educación médica actualmente es inspirar la formación de médicos capaces de insertarse en un mercado laboral competitivo, sin descuidar la atención al paciente, con habilidades directivas y organizacionales, evitando la sobre-especialización como limitante del desarrollo profesional.

Medical education creates an impact on the health of the population. To train professional doctors capable of adapting to changing environments allows a more detailed understanding of the epidemiology in a community or country; and improves public health. When medical students have the tools needed to provide quality care, it can improve the health of hundreds of patients. Medical edu-cation is full of challenges and is in a continuous search of excellence. The current educational model focuses on the skills required by Mexico ́s health and educational systems, but COVID-19 broke paradigms and revolutionised the way we teach medicine, focusing on self-regulated learning. The world is in constant change, and medical education has to evolve with the world. Technology is a tool that revolutionises teaching and allows us to introduce globalisation to schools while learning about other cultures and how they practice medicine. Focusing on the mental health of students is a determining factor in training healthy doctors and avoiding desertion. Incor-porating well-being conditions at hospitals and schools can have a positive impact on the lives of the students, helping them have a better performance. The challenge of medical education today is to inspire the training of doctors capable of inserting themselves in a competitive labour market without neglecting patient care and with managerial and organisational skills, avoiding over-specialization as a limitation of professional development

[Analysis of conditions for the diagnosis of rheumatic diseases in primary health care in the city of Sorocaba-SP]. / Análise das condições para diagnóstico de doenças reumáticas na atenção básica de saúde na cidade de Sorocaba-SP.

OBJECTIVES: The study had as main goal to define the profile of the attending professional working at the primary healthcare sector in the city of Sorocaba, and to analyze the environment in which this professional is inserted, trying to identify if there are conditions for the care of low-complexity rheumatic diseases and possible reasons that would lead to a high degree of referral to specialists. METHODS: A quantitative study was performed in which physicians of primary health care were invited to answer a questionnaire that addressed personal aspects, besides the technical aspects of four rheumatic diseases: osteoarthritis, gout, fibromyalgia and osteoporosis, which served as the basis for evaluating the care for low-complexity diseases in UBSs. RESULTS: It was observed that the professional is part integral of an organizational system that hinders his/her performance; moreover, certain personal difficulty techniques were realized. Together, these conditions turned out to be the factors that determine a quality of care that falls short of that expected. CONCLUSION: There must be a review of how medical education is offered, in order to seek a more qualified training, focused on the basic needs of the health system, as well as a restructuring of the entire health system in terms of its organization and management, in order to attain a suitable condition for the development of a good medical practice, and thus, for providing a good service to the community.

[The association of fibromyalgia and systemic lupus erythematosus change the presentation and severity of both diseases?]. / A associação fibromialgia e lúpus eritematoso sistêmico altera a apresentação e a gravidade de ambas as doenças?

INTRODUCTION: The association of fibromyalgia (FM) and systemic lupus erythematosus (SLE) have been investigated, with conflicting results regarding the impact of a condition on the other. OBJECTIVES: To determine the frequency of FM in a sample of patients with SLE treated at the Hospital Complex of Sorocaba (CHS) and the impact of FM in SLE activity and quality of life, as well as of SLE in FM. MATERIAL AND METHODS: Descriptive and correlational study. Patients who met the American College of Rheumatology (ACR) criteria for SLE and/or FM were included. The total sample was divided into three groups: FM/SLE (patients with association of SLE and FM), SLE (SLE patients only) and FM (FM patients only). The following variables were used: Fibromyalgia Impact Questionnaire (FIQ), activity index of SLE (SLEDAI), Indices of Diagnostic Criteria for Fibromyalgia 2010 (SSI end GPI) and SF-36. RESULTS: The prevalence of patients with FM among SLE patients was 12%. FIQ showed no difference between groups, indicating that SLE did not affect the impact caused by FM alone. The presence of FM in SLE patients did not influence the clinical activity of this disease. A strong impact of FM on the quality of life in patients with SLE was observed; the opposite was not observed. CONCLUSIONS: The prevalence of FM observed in SLE patients is 12%. The presence of FM adversely affects the quality of life of patients with SLE.

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)

Abstract Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.(AU)

Disease perceptions of Brazilian fibromyalgia patients: do they resemble perceptions from other countries?

The purpose of this study was to discover how Brazilian fibromyalgia patients perceive their disease. Fifteen women who fulfilled the American College of Rheumatology Classification Criteria for Fibromyalgia were given an individual semi-structured interview about their perception of fibromyalgia. There was a marked uniformity in the description of clinical symptoms, with diffuse pain and fatigue being considered the most important symptoms. Pain descriptions were imprecise as to the main localization but insidious pain of moderate intensity was frequently described. Other referred symptoms were: sleep disturbances, anxiety and memory and concentration difficulties. The following points were considered to be trigger events for pain: intense physical efforts, physical trauma, climate variation and genetic heritage. The reported modulating factors were: stressful events, emotional disturbances, climate variation and period of the day. Most patients reported being unable to control the symptoms of fibromyalgia. Religious support, reduction of tasks, physical exercises and short resting periods during the day were the main coping strategies mentioned by the interviewed patients. Their main concern was an eventual evolution to total physical incapacity and loss of independence in self-care. The clinical characteristics and patient perceptions in these Brazilian patients are very similar to those described in international studies.

Study of self-medication for musculoskeletal pain among nursing and medicine students at Pontifícia Universidade Católica - São Paulo.

OBJECTIVE: To study the self-medication for pain among students of medicine and nursing of the PUCSP compared with students from other knowledge areas. MATERIAL AND METHODS: Data were obtained in two groups: A - students from the health knowledge area, and B - students of law and engineering. It was used a questionnaire developed by the authors. Statistical analysis used the Chi-square test and the Fischer. RESULTS: In relation to gender, there is a predominance of women in the health group and a male majority in other one. In the health group there was a greater number of medical students, and in the control group of engineering. It is observed a high degree of selftreatment in both groups. It appears that participants in the health group have used more anti-inflammatory drugs and opioid than the others subjects studied. CONCLUSION: The frequency of medication for pain is higher in the group of health students, and self-medication is equally practiced among students of health and other areas.

Correlation between demographic and clinical variables and fibromyalgia severity.

INTRODUCTION: Fibromyalgia (FM) is a rheumatic condition characterized by a picture of generalized chronic pain, hyperalgesia and allodynia. Symptoms such as fatigue, sleep disorders, morning stiffness, headache and paresthesia can also be present. It is also associated with other comorbidities, such as depression, anxiety, irritable bowel syndrome, myofascial pain syndrome and nonspecific urethral syndrome. Few studies have addressed the evolution of FM, especially regarding medium and long-term evolution, such as why some patients do better than others, despite the fact of being submitted to the same treatment. OBJECTIVE: To determine whether there is a correlation between demographic and clinical variables and FM severity. MATERIAL AND METHODS: Sixty women who met the classification criteria for FM of the American College of Rheumatology of 1990 were divided into three groups, according to the severity established by the Fibromyalgia Impact Questionnaire (FIQ): severe (70-100), moderate (50 to 70) and mild (0 to 50). RESULTS: Nine demographic and clinical variables were assessed, with a significant difference (P <0.05) being observed only in the groups showing higher FIQ scores with the presence of depression and workers' compensation interests. CONCLUSION: The impact of FM measured by the FIQ is directly correlated with the severity of depression and the presence of workers' compensation interests.