RESUMO
OBJECTIVE: The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'. METHODS: A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. RESULTS: 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). CONCLUSIONS: These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.
Assuntos
Atividades Cotidianas , Fadiga/terapia , Fibromialgia/terapia , Guias de Prática Clínica como Assunto , Sono , Terapia por Acupuntura , Amitriptilina/análogos & derivados , Amitriptilina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Biorretroalimentação Psicológica , Capsaicina/uso terapêutico , Terapia Cognitivo-Comportamental , Europa (Continente) , Medicina Baseada em Evidências , Terapia por Exercício , Fadiga/fisiopatologia , Fibromialgia/fisiopatologia , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Hidroterapia , Hipnose , Manipulação Quiroprática , Massagem , Terapias Mente-Corpo , Atenção Plena , Inibidores da Monoaminoxidase/uso terapêutico , Dor/fisiopatologia , S-Adenosilmetionina/uso terapêutico , Fármacos do Sistema Sensorial/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Sociedades Médicas , Oxibato de Sódio/uso terapêutico , Resultado do TratamentoRESUMO
Grape pomace is a by-product of winemaking process and rich in bioactive compounds such as plant polyphenols having antioxidant and antimicrobial activities. As known, oxidative stress may cause a number of pathological conditions in farm animals and thus affecting animal welfare and production. Moreover, pathogenic bacteria affect animals' health status. Thus, the objective of this study was to investigate whether lambs' feed supplemented with grape pomace enhances the antioxidant mechanisms and reduces the growth of pathogenic bacteria. For this purpose, redox status was assessed in blood and tissues using oxidative stress markers in lambs fed with diet supplemented with grape pomace. Moreover, the effect on bacterial growth was assessed by examining microbial populations in lambs' faecal microflora. The following oxidative stress markers were assessed: reduced glutathione (GSH), catalase activity (CAT), total antioxidant capacity (TAC), thiobarbituric acid-reactive substances (TBARS) and protein carbonyls (CARB). Twenty-four lambs were assigned to two experimental groups receiving standard or experimental diet for 55 days. Blood and tissues (liver, quadriceps muscle, spleen, heart and brain) were collected at two different time-points, 42 and 70 days post-birth, after ration administration. The results showed that lambs fed with experimental diet had significantly increased antioxidants mechanisms in blood and tissues as shown by increases in CAT and GSH compared to control. Moreover, lambs fed with the experimental diet exhibited decreased oxidative stress-induced damage to lipids and proteins as shown by decreases in TBARS and CARB respectively. In addition, the experimental diet enhanced the growth of facultative probiotic bacteria and inhibited the growth of pathogen populations such as Enterobacteriacae and E. coli. This is the first study investigating the effect of diet supplemented with grape pomace on the redox status and microbiota of lambs.
Assuntos
Ração Animal/análise , Antioxidantes/metabolismo , Fezes/microbiologia , Ovinos/fisiologia , Vitis/química , Fenômenos Fisiológicos da Nutrição Animal , Animais , Biomarcadores , Dieta/veterinária , Masculino , Estresse Oxidativo , Ovinos/microbiologiaAssuntos
Encefalite/etiologia , Encefalite/psicologia , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/parasitologia , Criança , Encefalite/tratamento farmacológico , Evolução Fatal , Feminino , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Imageamento por Ressonância MagnéticaRESUMO
In the present study, grape pomace (GP) was used as feed additive in the diet of weaned piglets in order to develop innovative feedstuffs and to investigate their potential beneficial effects on welfare, productivity and meat quality. For examining the antioxidant capacity of the experimental feeds, 24 piglets of 20 days old were assigned to two experimental groups receiving standard or experimental diet for 30 days. Blood and tissues collections were performed at four different time-points, 2, 20, 35 and 50 days post birth. The collected tissues were brain, heart, kidney, liver, lung, quadriceps muscle, pancreas, spleen and stomach. The following oxidative stress markers were assessed: reduced glutathione (GSH), catalase activity, total antioxidant capacity (TAC), thiobarbituric acid reactive substances (TBARS), protein carbonyls (CARB) and H2O2 decomposition activity. The effect on bacterial growth was assessed by examining microbial populations in piglets' fecal microbiota. Furthermore, the average daily gain (ADG) was calculated and the fatty acid profile of quadriceps muscle was assessed. The results showed that piglets fed with the diet supplemented with GP, had significantly increased antioxidants mechanisms in almost all the tissues as shown by increases in GSH, H2O2 decomposition activity and TAC compared with control group. Piglets fed with the experimental diet exhibited decreased oxidative stress-induced damage to lipids and proteins as shown by decreases in TBARS and CARB in GP group compared with control. In addition, the experimental diet increased significantly ADG (by 23.65%) (P<0.05) and enhanced the growth of facultative probiotic bacteria (by up to 1.2 log colony forming units (CFU)/g) (P<0.05) and lactic acid bacteria (by up to 2.0 log CFU/g) (P<0.05) in GP group compared with the control group. GP supplementation inhibited the growth of pathogen populations such as Enterobacteriacae (by up to 1.8 log CFU/g) (P<0.05) and Campylobacter jejuni (by up to 1.0 log CFU/g) (P<0.05). Regarding fatty acid composition of meat, GP inclusion in piglets' diet increased significantly n-3 fatty acids (EPA; C20 : 5n-3, DHA; C22 : 6n-3, α-linolenic acid; C18 : 3n-3) and decreased significantly n-6/n-3 ratio compared with control (P<0.05). The results suggested that dietary GP supplementation may have a beneficial impact on piglets' welfare and may improve productivity as well as meat quality.
Assuntos
Antioxidantes/metabolismo , Microbiota/efeitos dos fármacos , Carne Vermelha/normas , Silagem/análise , Suínos/fisiologia , Vitis , Animais , Dieta/veterinária , Suplementos Nutricionais , Ácidos Graxos/análise , Fezes/microbiologia , Feminino , Glutationa/metabolismo , Peróxido de Hidrogênio/metabolismo , Oxirredução , Estresse Oxidativo , Probióticos , Suínos/crescimento & desenvolvimento , Substâncias Reativas com Ácido Tiobarbitúrico/análiseRESUMO
Pertussis is a disease of substantial public health importance that still lacks an efficient surveillance system. It has been a notifiable disease in Cyprus since 1930, and has had an incidence rate of 1 per 100,000 persons during the last 10 years. In 2001, the Greece-Cyprus Paediatric Surveillance Unit (GCPSU) was established with the aim of active surveillance for rare paediatric diseases, including weekly data reporting, zero reporting, and obligatory laboratory tests. From November 2002, pertussis has been included in the active surveillance scheme of GCPSU, resulting in a very early detection of an outbreak in June 2003 that led to immediate and successful action.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Vigilância da População/métodos , Medição de Risco/métodos , Coqueluche/diagnóstico , Coqueluche/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Chipre/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores de Risco , Coqueluche/prevenção & controleRESUMO
BACKGROUND: The investigators hypothesized that degenerative changes accumulate in epithelial cells in the aging rat tongue and that carnitine administration is effective at reversing these alterations. MATERIAL AND METHODS: To gain insights into the effects of carnitine on epithelial cells of the tongue, the investigators used 15 Wistar rats [3 experimental groups: 5- (A), 12- (B) and 18- (C) month old rats] with 4 rats per group and 1 control group with 1 rat per age group). L-carnitine was administered intraperitoneally to animals of the experimental group for 35 days. Samples of the tongue were processed for electron microscopy. RESULTS: Degeneration of epithelial cells of the rat tongue was shown to begin early in life (5 months) and alterations were shown to accumulate while aging. L-carnitine administration eliminated degenerative changes when administered in the first age group A, while in the older rats the regeneration was only partial for the epithelium (groups B and C). CONCLUSIONS: The results of this study suggest that profound ultrastructural alterations commence in the degenerating rat tongue and that L-carnitine administration results into partial regeneration of epithelial cells.
RESUMO
Ullrich's congenital muscular dystrophy (UCMD) is an autosomal recessive myopathy characterised by neonatal muscle weakness, proximal joint contractures and distal hyperlaxity. Mutations in the COL6A1, COL6A2 (21 q22.3) and COL6A3 (2 q37) genes, encoding the alpha 1, alpha 2 and alpha 3 chains of collagen VI, respectively, have been recently identified as responsible for UCMD in a total of 9 families. We investigated in detail the clinical and morphological phenotype of 15 UCMD patients from 11 consanguineous families showing potential linkage either to 21 q22.3 (6 families) or to 2 q37 (5 families). Collagen VI deficiency was confirmed on muscle biopsies or skin fibroblasts in 8 families. Although all patients shared a common phenotype, a great variability in severity was observed. Collagen VI deficiency in muscle or cultured fibroblasts was complete in the severe cases and partial in the milder ones, which suggests a correlation between the degree of collagen VI deficiency and the clinical severity in UCMD. No significant phenotypical differences were found between the families linked to each of the 2 loci, which confirms UCMD as a unique entity with underlying genetic heterogeneity.