Prevalence of myofascial dysfunction in patients with low back pain

Objective: This study aimed to examine the prevalence of myofascial dysfunction in patients with low back pain, which is the area most frequently afflicted, and to quantify the pain threshold for these evaluations using an algometer. Method: We evaluated 70 patients with a history of chronic low back pain in search of trigger points that would elicit the patient’s pain. The muscles tested were the quadratus lumborum, iliopsoas, gluteus maximus, medius, minimus, and piriformis. The prevalence of myofascial dysfunction was determined by the percentage of patients with trigger points. The pain threshold was determined by the average of three assessments of pressure for each trigger point. Results: The results showed that 90% of patients had myofascial dysfunction, 76% of whom had trigger points in the quadratus lumborum, 69% in the gluteus medius, 56% in the piriformis, 40% in the gluteus minimus, 31% in the iliopsoas, and 29% in the gluteus maximus. The pressure pain threshold of the quadratus lumborum was 1.71 kg/cm2, 2.39 kg/cm2 for the gluteus medius, 2.34 kg/cm2 for the piriformis, 2.58 kg/cm2 for the gluteus minimus, 2.11 kg/cm2 for the iliopsoas and 2.19 kg/cm2 for the gluteus maximus. Conclusion: Our data demonstrate the high prevalence of this disorder and suggest that it deserves specific attention in the treatment of low back pain in patients with chronic pain.Objetivo: Examinar a prevalência da disfunção miofascial em indivíduos com dor lombar e quantificar limiar de dor destes através do algômetro. Método: Foram avaliados 70 indivíduos com idade média de 48 (± 11,76) com história de dor lombar crônica, sendo investigada a presença de pontos-gatilho nos músculos: quadrado lombar, iliopsoas, glúteos máximo, médio e mínimo, e piriforme. A prevalência foi determinada pela porcentagem de indivíduos com pontos gatilhos presentes e o limiar de dor foi determinado pela média de três avaliações de pressão de cada ponto-gatilho. Resultados: Demonstraram que 90% dos indivíduos apresentaram disfunção miofascial, dentre eles, 76% no músculo quadrado lombar, 69% no glúteo médio, 56% no piriforme, 40% no glúteo mínimo, 31% no íliopsoas e 29% no glúteo máximo. O limiar de dor por pressão dos músculos quadrado lombar foi de 1,71 Kg/cm2, de 2,39 Kg/cm2 para o glúteo médio, de 2,34 Kg/cm2 para o piriforme, de 2,58 Kg/cm2 para o glúteo mínimo, de 2,11 Kg/cm2 para o iliopsoas e de 2,19 Kg/cm2 para o glúteo máximo. Conclusão: Na amostra analisada, os dados deste estudo demonstram a grande prevalência desta disfunção e sugere que a mesma merece atenção específica no tratamento da lombalgia em indivíduos com dor crônica

DOENÇA TROFOBLÁSTICA GESTACIONAL: ASPECTOS FISIOPATOLÓGICOS E TRATAMENTO

In this literature review, the general objective is to provide a comprehensive and updated analysis of the pathophysiological aspects and treatment of Gestational Trophoblastic Disease (GTD). The specific objectives seek to present a critical discussion of the results found to inform health professionals and contribute to more effective approaches in the management of this clinical condition, in addition to increasing awareness about GTD and improving emotional and psychosocial support for women facing this disease. GTD is a rare but serious condition that requires accurate diagnosis and a multidisciplinary approach. The main initial detection methods are serum hCG measurement and ultrasound, with histopathological analysis of endometrial biopsy necessary for diagnostic confirmation. The type of DTG identified is crucial in determining the most appropriate therapeutic approach. Treatment involves surgery to remove the molar placenta in complete hydatidiform moles and chemotherapy for choriocarcinoma and trophoblastic tumor of the placental site, generally presenting positive results with high remission and cure rates, although long-term follow-up is essential to detect recurrences. and complications. In addition to the pathophysiological and therapeutic aspects, emotional and psychological support is essential throughout the treatment and recovery process, considering the significant impact on patients' emotional health. Knowledge gaps were identified in the reviewed literature, highlighting the need for additional research to deepen the understanding of GTD, including risk factors, pathogenesis, more accurate biomarkers and new therapeutic approaches, in order to improve the management and prognosis of the disease. In conclusion, this bibliographical review contributes to the knowledge of GTD, highlighting its characteristics, diagnosis and treatment, and emphasizes the importance of a multidisciplinary approach to ensure adequate care, considering clinical, emotional and practical aspects of patients, in addition to encouraging new research to improve the care of these women facing this complex condition.Neste trabalho de revisão bibliográfica, o objetivo geral é fornecer uma análise abrangente e atualizada dos aspectos fisiopatológicos e tratamento da Doença Trofoblástica Gestacional (DTG). Os objetivos específicos buscam apresentar uma discussão crítica dos resultados encontrados para informar profissionais de saúde e contribuir com abordagens mais eficazes no manejo dessa condição clínica, além de aumentar a conscientização sobre a DTG e melhorar o suporte emocional e psicossocial às mulheres enfrentando essa doença. A DTG é uma condição rara, mas grave, que requer diagnóstico preciso e abordagem multidisciplinar. Os principais métodos de detecção inicial são a dosagem sérica de hCG e a ultrassonografia, sendo a análise histopatológica de biópsia endometrial necessária para confirmação diagnóstica. O tipo de DTG identificado é crucial para determinar a abordagem terapêutica mais adequada. O tratamento envolve cirurgia para remoção da placenta molar em molas hidatiformes completas e quimioterapia para o coriocarcinoma e o tumor trofoblástico do sítio placentário, apresentando geralmente resultados positivos com altas taxas de remissão e cura, embora o acompanhamento a longo prazo seja essencial para detecção de recorrências e complicações. Além dos aspectos fisiopatológicos e terapêuticos, o suporte emocional e psicológico é fundamental durante todo o processo de tratamento e recuperação, considerando o impacto significativo na saúde emocional das pacientes. Identificaram-se lacunas de conhecimento na literatura revisada, ressaltando a necessidade de pesquisas adicionais para aprofundar a compreensão da DTG, incluindo fatores de risco, patogênese, biomarcadores mais precisos e novas abordagens terapêuticas, a fim de melhorar o manejo e o prognóstico da doença. Em conclusão, esta revisão bibliográfica contribui para o conhecimento da DTG, destacando suas características, diagnóstico e tratamento, e enfatiza a importância de uma abordagem multidisciplinar para garantir cuidado adequado, considerando aspectos clínicos, emocionais e práticos das pacientes, além de incentivar novas pesquisas para aprimorar o cuidado dessas mulheres enfrentando essa condição complexa

A Presença De Fluorose Dentária Estaria Associada Ao Traumatismo Dentário Entre Escolares?

Our objective was to evaluate whether there is an association with the different levels of dental fluorosis and the presence of dental trauma amongst school children. A transversal study was conducted amongst school children from the age of 12. Dental examinations were conducted by 24 well trained and fully qualified dental surgeons. Data was collected from 36 randomly selected public schools amongst 89 schools in a municipality. The criteria used to diagnose dental fluorosis was based on the Dean's fluorosis Index and for diagnosing dental trauma we looked for clinical signs of crown fractures and dental avulsions. Multiple descriptive analysis, which was bivariate, was carried out. Amongst the 2,755 school children that took part in the study 1,089 (39.6%) were diagnosed with dental fluorosis and 106 (3.8%) had one tooth or more with dental trauma. We noted a high prevalence of dental fluorosis, independent of the level of severity, amongst individuals with one tooth or more who had dental trauma. This association was even more evident where there were severely high levels of fluorosis. We also noted that the presence of fluorosis was greater amongst those that actively paid more attention to discoloration on their teeth and who received treatment from a dental professional at their schools. Nevertheless dental fluorosis was associated with the presence of dental trauma, independent of its severity.21396797

12,500+ and counting: biodiversity of the Brazilian Pampa

Knowledge on biodiversity is fundamental for conservation strategies. The Brazilian Pampa region, located in subtropical southern Brazil, is neglected in terms of conservation, and knowledge of its biodiversity is fragmented. We aim to answer the question: how many, and which, species occur in the Brazilian Pampa? In a collaborative effort, we built species lists for plants, animals, bacteria, and fungi that occur in the Brazilian Pampa. We included information on distribution patterns, main habitat types, and conservation status. Our study resulted in referenced lists totaling 12,503 species (12,854 taxa, when considering infraspecific taxonomic categories [or units]). Vascular plants amount to 3,642 species (including 165 Pteridophytes), while algae have 2,046 species (2,378 taxa) and bryophytes 316 species (318 taxa). Fungi (incl. lichenized fungi) contains 1,141 species (1,144 taxa). Animals total 5,358 species (5,372 taxa). Among the latter, vertebrates comprise 1,136 species, while invertebrates are represented by 4,222 species. Our data indicate that, according to current knowledge, the Pampa holds approximately 9% of the Brazilian biodiversity in an area of little more than 2% of Brazil’s total land. The proportion of species restricted to the Brazilian Pampa is low (with few groups as exceptions), as it is part of a larger grassland ecoregion and in a transitional climatic setting. Our study yielded considerably higher species numbers than previously known for many species groups; for some, it provides the first published compilation. Further efforts are needed to increase knowledge in the Pampa and other regions of Brazil. Considering the strategic importance of biodiversity and its conservation, appropriate government policies are needed to fund studies on biodiversity, create accessible and constantly updated biodiversity databases, and consider biodiversity in school curricula and other outreach activities

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ~30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death