Fibromialgia e disfunção temporomandibular: uma revisão de escopo

A fibromialgia (FM) é uma síndrome complexa com alterações nociplásticas, caracterizadas por hiperalgesia e alodinia, frequentemente acompanhada pela presença de dor orofacial. Estudos têm demonstrado alta prevalência de disfunção temporomandibular (DTM) em pacientes fibromiálgicos, como fator etiológico ou agravante. O objetivo desta revisão foi avaliar a ocorrência concomitante da DTM e da síndrome fibromiálgica e o seu tratamento. Tratamentos não-farmacológicos, como psicoterapia e exercícios físicos, melhoram a dor, a qualidade de vida e a saúde mental dos pacientes. Duloxetina e Pregabalina são aprovadas pela ANVISA para o tratamento da FM, aos quais o FDA inclui o milnaciprano. Os principais fármacos utilizados para os sintomas de FM são pregabalina, amitriptilina, antidepressivos duais, tramadol, baixas doses de naltrexona e canabinoides. A associação de fármacos pode ser útil para aumentar a eficácia do tratamento e reduzir as doses dos mesmos. Por outro lado, novas terapias não farmacológicas, como as técnicas modulatórias não-invasivas, surgem como opções promissoras, promovendo alterações neuroplásticas importantes no tratamento. Conclusão: Há diversas opções terapêuticas farmacológicas e não-farmacológicas disponíveis no tratamento do paciente fibromiálgico para o especialista em DTM e Dor Orofacial. Portanto, a combinação de diferentes abordagens pode auxiliar na obtenção de um protocolo individualizado, adequado às necessidades do paciente

Detection of variable VHE gamma-ray emission from the extra-galactic gamma-ray binary LMC P3

Context. Recently, the high-energy (HE, 0.1-100 GeV) $\gamma$-ray emission from the object LMC P3 in the Large Magellanic Cloud (LMC) has been discovered to be modulated with a 10.3-day period, making it the first extra-galactic $\gamma$-ray binary. Aims. This work aims at the detection of very-high-energy (VHE, >100 GeV) $\gamma$-ray emission and the search for modulation of the VHE signal with the orbital period of the binary system. Methods. LMC P3 has been observed with the High Energy Stereoscopic System (H.E.S.S.); the acceptance-corrected exposure time is 100 h. The data set has been folded with the known orbital period of the system in order to test for variability of the emission. Energy spectra are obtained for the orbit-averaged data set, and for the orbital phase bin around the VHE maximum. Results. VHE $\gamma$-ray emission is detected with a statistical significance of 6.4 $\sigma$. The data clearly show variability which is phase-locked to the orbital period of the system. Periodicity cannot be deduced from the H.E.S.S. data set alone. The orbit-averaged luminosity in the $1-10$ TeV energy range is $(1.4 \pm 0.2) \times 10^{35}$ erg/s. A luminosity of $(5 \pm 1) \times 10^{35}$ erg/s is reached during 20% of the orbit. HE and VHE $\gamma$-ray emissions are anti-correlated. LMC P3 is the most luminous $\gamma$-ray binary known so far.Comment: 5 pages, 3 figures, 1 table, accepted for publication in A&

Characterizing the gamma-ray long-term variability of PKS 2155-304 with H.E.S.S. and Fermi-LAT

Studying the temporal variability of BL Lac objects at the highest energies provides unique insights into the extreme physical processes occurring in relativistic jets and in the vicinity of super-massive black holes. To this end, the long-term variability of the BL Lac object PKS 2155-304 is analyzed in the high (HE, 100 MeV 200 GeV) gamma-ray domain. Over the course of ~9 yr of H.E.S.S observations the VHE light curve in the quiescent state is consistent with a log-normal behavior. The VHE variability in this state is well described by flicker noise (power-spectral-density index {\ss}_VHE = 1.10 +0.10 -0.13) on time scales larger than one day. An analysis of 5.5 yr of HE Fermi LAT data gives consistent results ({\ss}_HE = 1.20 +0.21 -0.23, on time scales larger than 10 days) compatible with the VHE findings. The HE and VHE power spectral densities show a scale invariance across the probed time ranges. A direct linear correlation between the VHE and HE fluxes could neither be excluded nor firmly established. These long-term-variability properties are discussed and compared to the red noise behavior ({\ss} ~ 2) seen on shorter time scales during VHE-flaring states. The difference in power spectral noise behavior at VHE energies during quiescent and flaring states provides evidence that these states are influenced by different physical processes, while the compatibility of the HE and VHE long-term results is suggestive of a common physical link as it might be introduced by an underlying jet-disk connection.Comment: 11 pages, 16 figure

H.E.S.S. and MAGIC observations of a sudden cessation of a very-high-energy γ-ray flare in PKS 1510-089 in May 2016

The flat spectrum radio quasar (FSRQ) PKS 1510-089 is known for its complex multiwavelength behaviour and it is one of only a few FSRQs detected in very-high-energy (VHE, E> 100 GeV) γ rays. The VHE γ-ray observations with H.E.S.S. and MAGIC in late May and early June 2016 resulted in the detection of an unprecedented flare, which revealed, for the first time, VHE γ-ray intranight variability for this source. While a common variability timescale of 1.5 h has been found, there is a significant deviation near the end of the flare, with a timescale of ∼20 min marking the cessation of the event. The peak flux is nearly two orders of magnitude above the low-level emission. For the first time, a curvature was detected in the VHE γ-ray spectrum of PKS 1510-089, which can be fully explained by the absorption on the part of the extragalactic background light. Optical R-band observations with ATOM revealed a counterpart of the γ-ray flare, even though the detailed flux evolution differs from the VHE γ-ray light curve. Interestingly, a steep flux decrease was observed at the same time as the cessation of the VHE γ-ray flare. In the high-energy (HE, E> 100 MeV) γ-ray band, only a moderate flux increase was observed with Fermi-LAT, while the HE γ-ray spectrum significantly hardens up to a photon index of 1.6. A search for broad-line region (BLR) absorption features in the γ-ray spectrum indicates that the emission region is located outside of the BLR. Radio very-long-baseline interferometry observations reveal a fast-moving knot interacting with a standing jet feature around the time of the flare. As the standing feature is located ∼50 pc from the black hole, the emission region of the flare may have been located at a significant distance from the black hole. If this is indeed a true correlation, the VHE γ rays must have been produced far down in the jet, where turbulent plasma crosses a standing shock

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

VHE γ-ray discovery and multiwavelength study of the blazar 1ES 2322-409

A hotspot at a position compatible with the BL Lac object 1ES 2322-409 was serendipitously detected with H.E.S.S. during observations performed in 2004 and 2006 on the blazar PKS 2316-423. Additional data on 1ES 2322-409 were taken in 2011 and 2012, leading to a total live-time of 22.3 h. Point-like very-high-energy (VHE; E> 100 GeV) γ-ray emission is detected from a source centred on the 1ES 2322-409 position, with an excess of 116.7 events at a significance of 6.0σ. The average VHE γ-ray spectrum is well described with a power law with a photon index Γ = 3.40 ± 0.66stat ± 0.20sys and an integral flux Φ (E> 200 GeV) = (3.11± 0.71_stat± 0.62_sys)× 10^{-12} cm^{-2} s^{-1}, which corresponds to 1.1 {{ per cent}} of the Crab nebula flux above 200 GeV. Multiwavelength data obtained with Fermi LAT, Swift XRT and UVOT, RXTE PCA, ATOM, and additional data from WISE, GROND, and Catalina are also used to characterize the broad-band non-thermal emission of 1ES 2322-409. The multiwavelength behaviour indicates day-scale variability. Swift UVOT and XRT data show strong variability at longer scales. A spectral energy distribution (SED) is built from contemporaneous observations obtained around a high state identified in Swift data. A modelling of the SED is performed with a stationary homogeneous one-zone synchrotron-self-Compton leptonic model. The redshift of the source being unknown, two plausible values were tested for the modelling. A systematic scan of the model parameters space is performed, resulting in a well-constrained combination of values providing a good description of the broad-band behaviour of 1ES 2322-409

Detection of very-high-energy {\gamma}-ray emission from the colliding wind binary {\eta} Car with H.E.S.S

Aims. Colliding wind binary systems have long been suspected to be high-energy (HE; 100 MeV < E < 100 GeV) {\gamma}-ray emitters. {\eta} Car is the most prominent member of this object class and is confirmed to emit phase-locked HE {\gamma} rays from hundreds of MeV to ~100 GeV energies. This work aims to search for and characterise the very-high-energy (VHE; E >100 GeV) {\gamma}-ray emission from {\eta} Car around the last periastron passage in 2014 with the ground-based High Energy Stereoscopic System (H.E.S.S.). Methods. The region around {\eta} Car was observed with H.E.S.S. between orbital phase p = 0.78 - 1.10, with a closer sampling at p {\approx} 0.95 and p {\approx} 1.10 (assuming a period of 2023 days). Optimised hardware settings as well as adjustments to the data reduction, reconstruction, and signal selection were needed to suppress and take into account the strong, extended, and inhomogeneous night sky background (NSB) in the {\eta} Car field of view. Tailored run-wise Monte-Carlo simulations (RWS) were required to accurately treat the additional noise from NSB photons in the instrument response functions. Results. H.E.S.S. detected VHE {\gamma}-ray emission from the direction of {\eta} Car shortly before and after the minimum in the X-ray light-curve close to periastron. Using the point spread function provided by RWS, the reconstructed signal is point-like and the spectrum is best described by a power law. The overall flux and spectral index in VHE {\gamma} rays agree within statistical and systematic errors before and after periastron. The {\gamma}-ray spectrum extends up to at least ~400 GeV. This implies a maximum magnetic field in a leptonic scenario in the emission region of 0.5 Gauss. No indication for phase-locked flux variations is detected in the H.E.S.S. data.Comment: 9 pages, 4 figures, 3 tables, in press with A&

Observation of a sudden cessation of a very-high-energy gamma-ray flare in PKS 1510-089 with H.E.S.S. and MAGIC in May 2016

The flat spectrum radio quasar (FSRQ) PKS 1510-089 is known for its complex multiwavelength behavior, and is one of only a few FSRQs detected at very high energy (VHE, E >100 GeV) -rays. VHE -ray observations with H.E.S.S. and MAGIC during late May and early June 2016 resulted in the detection of an unprecedented flare, which reveals for the first time VHE -ray intranight variability in this source. While a common variability timescale of 1.5 hr is found, there is a significant deviation near the end of the flare with a timescale of ∼ 20 min marking the cessation of the event. The peak flux is nearly two orders of magnitude above the low-level emission. For the first time, curvature is detected in the VHE -ray spectrum of PKS 1510-089, which is fully explained through absorption by the extragalactic background light. Optical R-band observations with ATOM reveal a counterpart of the -ray flare, even though the detailed flux evolution differs from the VHE lightcurve. Interestingly, a steep flux decrease is observed at the same time as the cessation of the VHE flare. In the high energy (HE, E >100 MeV) -ray band only a moderate flux increase is observed with Fermi-LAT, while the HE -ray spectrum significantly hardens up to a photon index of 1.6. A search for broad-line region (BLR) absorption features in the -ray spectrum indicates that the emission region is located outside of the BLR. Radio VLBI observations reveal a fast moving knot interacting with a standing jet feature around the time of the flare. As the standing feature is located ∼ 50 pc from the black hole, the emission region of the flare may have been located at a significant distance from the black hole. If this correlation is indeed true, VHE rays have been produced far down the jet where turbulent plasma crosses a standing shock.Accepted manuscrip