Fibromialgia e síndrome miofascial: vai ou não vai?

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Prevalence of irritable bowel syndrome in patients with fibromyalgia

INTRODUCTION: Fibromyalgia is a prevalent syndrome of widespread pain and multiple tender points, with no inflammatory, dystrophic or degenerative changes, probably related to abnormal central modulation of pain processing. Irritable bowel syndrome is considered a dysfunctional syndrome of visceral pain and/or alteration on gastrointestinal motility, also related to the same central nervous system (CNS) abnormalities. OBJECTIVE: The aim of this study was to evaluate the prevalence of irritable bowel syndrome in patients with fibromyalgia and to establish their clinical characteristics. PATIENTS AND METHODS:Two hundred consecutive patients with fibromyalgia syndrome were studied. RESULTS: These, 134 (67%) had irritable bowel syndrome. The most common presentation was the constipation subtype (121 =90.2%). The majority of patients had high scores of anxiety and/or depression. Conclusion: No differences were noted among patients with fibromyalgia without irritable bowel syndrome, and those with both conditions.INTRODUÇÃO: a síndrome da fibromialgia (FM) é uma síndrome dolorosa crônica comum na população em geral. Não apresenta qualquer processo inflamatório, distrófico ou degenerativo, e é considerada como conseqüente a disfunções neurofisiológicas envolvendo, principalmente, o sistema nervoso central (SNC). A síndrome do cólon irritável (SCI) é considerada como uma entidade disfuncional visceral, caracterizada por fenômenos motores do trânsito gastrointestinal, possivelmente relacionados a alterações neurofisiológicas nas mesmas vias do SNC. OBJETIVO: estudar a prevalência da SCI em portadores de FM e verificar as suas características clínicas. PACIENTES E MÉTODOS: foram estudados 200 portadores da síndrome da FM. RESULTADOS: verificou-se que, entre esses pacientes, 134 (67%) apresentaram, concomitantemente, a SCI; entre esses, a maioria (121 = 90,2%) sofria o subtipo constipativo da moléstia. Traço de personalidade e estado emocional associados à ansiedade e depressão foram evidenciados numa substancial proporção desses pacientes. CONCLUSÃO: entre os pacientes com FM, não houve diferenças clínicas entre aqueles com e sem a SCI.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Improved IBD Detection Using Incomplete Haplotype Information

The availability of high density genetic maps and genotyping platforms has transformed human genetic studies. The use of these platforms has enabled population-based genome-wide association studies. However, in inheritance-based studies, current methods do not take full advantage of the information present in such genotyping analyses. In this paper we describe an improved method for identifying genetic regions shared identical-by-descent (IBD) from recent common ancestors. This method improves existing methods by taking advantage of phase information even if it is less than fully accurate or missing. We present an analysis of how using phase information increases the accuracy of IBD detection compared to using only genotype information

Attention bias and anxiety in young children exposed to family violence

Background—Attention bias towards threat is associated with anxiety in older youth and adults and has been linked with violence exposure. Attention bias may moderate the relationship between violence exposure and anxiety in young children. Capitalizing on measurement advances, the current study examines these relationships at a younger age than previously possible. Methods—Young children (mean age 4.7, ±0.8) from a cross-sectional sample oversampled for violence exposure (N = 218) completed the dot-probe task to assess their attention biases. Observed fear/anxiety was characterized with a novel observational paradigm, the Anxiety Diagnostic Observation Schedule. Mother-reported symptoms were assessed with the Preschool-Age Psychiatric Assessment and Trauma Symptom Checklist for Young Children. Violence exposure was characterized with dimensional scores reflecting probability of membership in two classes derived via latent class analysis from the Conflict Tactics Scales: Abuse and Harsh Parenting. Results—Family violence predicted greater child anxiety and trauma symptoms. Attention bias moderated the relationship between violence and anxiety

The shoulder in a production line: clinical and ultrasound study

INTRODUCTION: The correlation among shoulder pain, abnormal physical examination and ultrasonography is controversial in the occupational scenario. OBJECTIVE: Establish the association between pain, physical examination and ultrasounds in workers of a pharmaceutical industry. PATIENTS AND METHODS: One hundred workers were invited to take part in the study and submitted to the inclusion and exclusion criteria, and 93 were included. All enrolled patients gave written informed consent, and had a physical examination performed by one of the authors. Ultrasound examination was performed, at the latest one month of the physical examination, by an experienced operator who was blind to the clinical setting. RESULTS: There was statistical correlation between pain and clinical maneuvers in 57 shoulders for supraspinatus tendon (SE) (P = 0,000) and no correlation with biceps tendon maneuvers (P > 0,05). In the comparison between clinical findings and ultrasonography, the maneuvers of Neer, Hawkins and Jobe had statistical association (P 0,05). Na comparação entre os achados clínicos e a ultrassonografia, as manobras de Neer, Hawkins e Jobe tiveram associação estatística (P < 0,05). A associação entre dor e ultrassonografia alterada foi estatisticamente significativa (16 dentre 57 ombros com dor, com P < 0,05), porém houve falsa-positividade significativa de achados ultrassonográficos em ombros assintomáticos (sete ombros). CONCLUSÃO: O diagnóstico preciso é um processo complexo que requer a associação de anamnese clínica e ocupacional, exame físico acurado e ultrassonografia realizada por um operador experiente.UNIFESP Disciplina de ReumatologiaUNIFESP, Disciplina de ReumatologiaSciEL

Assessing knowledge on fibromyalgia among internet users

OBJECTIVE: To assess knowledge on fibromyalgia in a sample of patients, their families, and professionals interested on the theme from some Brazilian states. METHODS: Analysis of the results of an electronic fibromyalgia knowledge questionnaire completed by 362 adults who had access to the the support group for fibromyalgia site (www.unifesp.br/grupos/fibromialgia). The answers were grouped according to age, sex, years of schooling, and type of interest in the condition. RESULTS: 92% of the responders were women and 62% had higher educational level. The worst results were observed in the joint protection and energy conservation domain, followed by the medication in fibromyalgia domain. The best results were recorded in the exercises in fibromyalgia domain. The answers differed significantly between sexes, and women achieved a higher percentage of correct answers. The female sex accounted for a statistically superior result in five statistical analyses (four questions and one domain). CONCLUSIONS: The study suggests the need for a strategic planning for an educational approach to fibromyalgia in BrazilOBJETIVO: Analisar o nível de conhecimento sobre fibromialgia em uma amostra incluindo pacientes, familiares e profissionais de vários estados do Brasil. MÉTODOS: Análise dos resultados de 362 adultos que acessaram o site do Grupo de Apoio à Fibromialgia (www.unifesp.br/grupos/fibromialgia) e responderam a um questionário eletrônico de conhecimento sobre a síndrome. As respostas foram avaliadas em relação a idade, sexo, nível de escolaridade e tipo de interesse no Grupo. RESULTADOS: 92% eram mulheres e 62% haviam completado o ensino superior. O pior resultado foi no domínio proteção articular e conservação de energia, seguido pelo domínio conhecimento sobre medicação. O melhor resultado ocorreu no domínio exercícios para fibromialgia. Houve diferença significativa entre os gêneros, sendo as mulheres responsáveis por um porcentual maior de acertos. O gênero feminino foi responsável por um resultado estatisticamente superior em cinco análises estatísticas (quatro perguntas e um domínio). CONCLUSÕES: O estudo sugere a necessidade de um planejamento estratégico para ações educativas sobre fibromialgia no BrasilUNIFESP Centro Cochrane do BrasilUniversidade Federal do ABCUNIFESPCentro CochraneUNIFESP, Centro Cochrane do BrasilUNIFESPSciEL

An electrophysiological investigation of power-amplification in the ballistic mantis shrimp punch

Author Posting. © Faculty for Undergraduate Neuroscience, 2019. This article is posted here by permission of Faculty for Undergraduate Neuroscience for personal use, not for redistribution. The definitive version was published in Journal of Undergraduate Neuroscience Education 17(1), (2019): T12-T19.Mantis shrimp are aggressive, burrowing crustaceans that hunt using one the fastest movements in the natural world. These stomatopods can crack the calcified shells of prey or spear down unsuspecting fish with lighting speed. Their strike makes use of power-amplification mechanisms to move their limbs much faster than is possible by muscles alone. Other arthropods such as crickets and grasshoppers also use power-amplified kicks that allow these animals to rapidly jump away from predator threats. Here we present a template laboratory exercise for studying the electrophysiology of power-amplified limb movement in arthropods, with a specific focus on mantis shrimp strikes. The exercise is designed in such a way that it can be applied to other species that perform power-amplified limb movements (e.g., house crickets, Acheta domesticus) and species that do not (e.g., cockroaches, Blaberus discoidalis). Students learn to handle the animals, make and implant electromyogram (EMG) probes, and finally perform experiments. This integrative approach introduces the concept of power-amplified neuromuscular control; allows students to develop scientific methods, and conveys high-level insights into behavior, and convergent evolution, the process by which different species evolve similar traits.Author GJG declares a commercial interest in the SpikerBox used here as a co-owner in Backyard Brains. Authors ES and SM are employed by Backyard Brains. DJP and GJG were supported by a National Institute of Mental Health (NIMH) Small Business Innovative Research (SBIR) award #R44MH093334. Author KDF is funded by European Commission Marie Sklodowska-Curie Independent Postdoctoral Research Fellowship and the Grass Foundation

Assessment of different instruments used as outcome measures in patients with fibromyalgia

OBJECTIVE: To assess the different measure instruments used for patients with fibromyalgia. PATIENTS AND METHODS: This study assessed 60 individuals participating in a clinical trial of cross-sectional cohort comparing the effects of exercises performed in water and on land. The following instruments were used: the Fibromyalgia Impact Questionnaire (FIQ) to assess the impact of the disease; the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) to assess quality of life; the Beck Depression Inventory to assess depression; and the Visual Analogue Scale (VAS) of pain. Those questionnaires were compared with the results obtained in a transitional Likert-type scale, the verbal scale for assessing change (VSAC), considered as a criterion of change in the assessment of other instruments. RESULTS: The Spearman coefficient was used to study the correlation between the VSAC measure and the other instruments at two occasions (T1 and T2). At T1, a moderate correlation was observed between VSAC and VAS (r = 0.49), and between VSAC and FIQ (r = 0.41), and a negative correlation was observed between VSAC and the SF-36 domains pain (r = -0.49) and general health perception (r = -0.55), and the SF-36 physical component (r = -0.42). At T2, only the SF-36 domain vitality showed a weak negative correlation with VSAC (r = -0.27). CONCLUSION: Considering VSAC as gold standard, none of the instruments assessed could optimally identify a change in the health status of patients with fibromyalgia.OBJETIVO: Avaliar os diferentes instrumentos de medida usados em pacientes com fibromialgia. PACIENTES E MÉTODOS: Foram avaliados 60 indivíduos que participaram de um ensaio clínico de corte transversal comparando os efeitos de exercícios realizados na água e exercícios realizados em solo, por meio dos questionários Fibromyalgia Impact Questionnaire (FIQ) para avaliar o impacto da doença, The Medical Outcomes Study 36 item Short-Form Health Survey (SF-36) para avaliação da qualidade de vida, Inventário Beck para avaliar o estado de depressão e escala visual analógica da dor (EVA). Esses questionários foram comparados aos resultados obtidos em uma escala transicional do tipo Likert, a Escala verbal de avaliação de mudança (EVAM), considerada como critério de mudança na avaliação dos outros instrumentos. RESULTADOS: O coeficiente de Spearman foi usado para estudar a correlação entre a medida EVAM e os outros instrumentos em dois momentos (T1 e T2). Em T1 houve correlação moderada entre EVAM e EVA (r = 0,49), EVAM e FIQ (r = 0,41) e correlação negativa entre EVAM e os domínios referentes a dor (r = -0,49), estado geral (r = -0,55) e componente físico (r = -0,42) do SF-36. Em T2, apenas o domínio vitalidade do SF-36 mostrou correlação negativa com EVAM, de valor fraco (r = -0,27). CONCLUSÃO: Considerando-se a EVAM como padrão ouro, nenhum dos instrumentos avaliados conseguiu captar, de maneira ótima, mudança no estado de saúde do paciente com fibromialgia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFaculdade de Medicina de MaríliaUNIFESP, EPMSciEL

Travel related histoplasmosis – a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy

INTRODUCTION In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions. METHODS We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting. RESULTS The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals. DISCUSSION Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients

Travel related histoplasmosis - a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy.

INTRODUCTION In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions. METHODS We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting. RESULTS The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals. DISCUSSION Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients