Hiperalgesia inducida por opioides (HIO)

BACKGROUND AND OBJECTIVES: Opioids are commonly used for pain control; however, they can cause hyperalgesia. The reason why this can happen is not known. The objective of this review was to describe the mechanisms, factors implicated, and drug modulation. CONTENTS: The factors implicated in the development of opioid-induced hyperalgesia (OIH), such as duration of use, dose, and type of opioids are described. Mechanisms involved include the glutamatergic system and N-methyl-D-aspartate receptors (NMDA), spinal cyclooxygenase (COX) activation, excitatory amino acids, dynorphin, cytokines and chemokines; prostaglandins, and descending facilitation. Modulation of hyperalgesia could be done through: NMDA receptor antagonists, alpha2-adrenergic agonists, and COX inhibitors. CONCLUSIONS: This is a very complex subject, which involves a series of pathophysiological mechanisms that could contribute for OIH and patient discomfort, bringing disastrous consequences.JUSTIFICATIVA Y OBJETIVOS: Los opioides son medicamentos a menudo usados para el control del dolor y que sin embargo pueden causar hiperalgesia. La circunstancia por la cual ese fenómeno puede ocurrir no está totalmente aclarada. El objetivo de esta revisión es describir los mecanismos, los factores que están involucrados y la modulación por medicamentos. CONTENIDO: Fueron descritos los factores involucrados en el desarrollo de la hiperalgia inducida por opioides (HIO), como la duración en el uso, la dosis y el tipo de opioide. Los mecanismos incluyen los sistemas glutamatérgico y los receptores N-metil-D-aspartato (NMDA), activación de ciclo-oxigenasa (COX) espinal, aminoácidos excitatorios, dinorfina, citocinas y quimocinas; prostaglandinas y facilitación descendiente. La modulación de la hiperalgesia se puede lograr con los antagonistas de receptores NMDA, los agonistas adrenérgicosalfa2 y con los inhibidores de (COX). CONCLUSIONES: El tema es bastante complejo, e involucra una serie de mecanismos fisiopatológicos que pueden contribuir para la HIO y la incomodidad del paciente, con consecuencias dañinas para la salud.JUSTIFICATIVA E OBJETIVOS: Opioides são medicamentos frequentemente usados para o controle da dor que, contudo, podem causar hiperalgesia. A circunstância pela qual esse fenômeno pode ocorrer não está inteiramente esclarecida. O objetivo desta revisão foi descrever os mecanismos, os fatores implicados e a modulação por medicamentos. CONTEÚDO: Foram descritos os fatores implicados no desenvolvimento da hiperalgesia induzida por opioides (HIO), como duração de uso, dose e tipo de opioide. Os mecanismos incluem o sistema glutamatérgico e receptores N-metil-D-aspartato (NMDA), ativação de ciclo-oxigenase (COX) espinal, aminoácidos excitatórios, dinorfina, citocinas e quimocinas; prostaglandinas e facilitação descendente. A modulação de hiperalgesia pode ser feita com antagonistas de receptores NMDA, agonistas adrenérgicos-alfa2 e inibidores de COX. CONCLUSÕES: O assunto é bastante complexo, envolvendo uma série de mecanismos fisiopatológicos que podem contribuir para a HIO e o desconforto do paciente, trazendo consequências que podem ser danosas.UNIFESP-EPM SBAUNIFESP-EPMUniversidade Federal do MaranhãoUNIFESP, EPM, SBAUNIFESP, EPMSciEL

Perfil da pesquisa em finanças no Brasil

UnavailableEste trabalho analisa uma amostra de 462 artigos da área de finanças publicados entre 1974 e 2000 na RAC, RAE, RAUSP, RBE e RBMEC, além de 205 artigos incluídos nos Anais do ENANPAD. A maioria dos artigos é de um único autor. Mais de 70% dos autores publicou apenas um artigo, número maior do que o previsto pela teoria bibliométrica. A produtividade dos autores nacionais está mais concentrada em poucos indivíduos e é mais baixa do que no exterior. Os artigos dos autores que publicaram três ou mais artigos em periódicos têm idade média maior do que a de artigos de autores igualmente prolíficos nos Anais. A maioria dos artigos em periódicos dos autores prolíficos vem da UFRJ, USP e PUC/RJ. O IBMEC aparece bem, mas os artigos estão concentrados na RBMEC, nas décadas de 70 e 80. Já nos Anais, os autores da UFRGS aparecem de forma expressiva junto aos da UFRJ e da PUC/RJ que, juntos, respondem por 79% da produção dos autores com três ou mais artigos publicados nos Anais

INFLUÊNCIA DOS FATORES DEMOGRÁFICOS NA DECISÃO DE COMPRA DE MEDICAMENTOS GENÉRICOS NOS CONSUMIDORES IDOSOS

O trabalho de pesquisa realizado teve como objetivo principal identificar de que forma os fatores demográficos influenciam na decisão de compra de medicamentos genéricos em consumidores idosos. A inclusão dos medicamentos genéricos no mercado nacional e o seu incrível desempenho em relação aos medicamentos de marca e similares, assim como o fato de o público idoso no Brasil ter ganho projeções de vida antes não contempladas foram os principais fatores motivacionais para a realização desse estudo. Após a realização dos testes de hipóteses concluímos que no processo de decisão de compra de medicamentos genéricos em consumidores idosos, dos fatores demográficos, aqueles que não exercem influência são o gênero e a idade

Spectrum Sharing for LTE-A and DTT: Field Trials of an Indoor LTE-A Femtocell in DVB-T2 Service Area

(c) 2016 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works.In this paper, we study a particular case which goes a step beyond the previous ones, as it aims at sharing the same frequency band in the same area between long term evolution-advance (LTE-A) and digital video broadcasting-terrestrial second generation (DVB-T2) technologies. Those geographical areas that are not covered because the useful DTT signal is obstructed by the environment or it has a limited coverage by the network design can be called micro-TVWS. We assume that a DVB-T2 transmitter provides coverage for fixed rooftop reception as a primary service, to a building in which a LTE-A femtocell is installed indoors for local coverage, as a secondary service. The results have been obtained by laboratory emulation and validated through field measurements using professional equipment. Our results provide the technical restrictions of the LTE-A femtocell, mainly on the maximum allowable effective isotropic radiated power that could transmit on the DTT band in terms of carrier separation, from co-channel to adjacent band. These results meet the need of spectrum for IMT-Advanced technologies, so spectrum sharing is proposed in this paper as a new solution to make an efficient use of this resource.This work was supported in part by the Ministerio de Educacion y Ciencia, Spain, under Grant "DEFINE5G" TEC2014-60258-C2-1-R and Grant "ARCO5G" TEC2014-56469-REDT, and in part by the European FEDER Funds.Martínez Pinzón, G.; Cardona Marcet, N.; García Pardo, C.; Fornés Leal, A.; Ribadeneira-Ramírez, JA. (2016). Spectrum Sharing for LTE-A and DTT: Field Trials of an Indoor LTE-A Femtocell in DVB-T2 Service Area. IEEE Transactions on Broadcasting. 62(3):552-561. https://doi.org/10.1109/TBC.2016.2582338S55256162

Takayasus's Arteritis in Pregnancy. Case Report and Literature Review

SummaryBackground and objectivesTakayasus's Arteritis (TA) is a chronic, inflammatory, progressive, idiopathic disease that causes narrowing, occlusion, and aneurysms of systemic and pulmonary arteries affecting especially the aorta and its branches. During pregnancy, one should pay special attention to these patients. The objective of this report was to present the peripartum anesthetic care of a patient with TA and a review of the literature.Case reportThis is a 31-year old gravida who underwent exchange of the aortic arch and placement of a metallic aortic valve for TA four years ago. She had no complications during pregnancy, and she was admitted at 34 weeks of pregnancy for anticoagulation management. Elective cesarean section was performed at 39 weeks with continuous epidural anesthesia. Fractionated doses of local anesthetic were administered to guarantee slow installation of the blockade. The patient remained hemodynamically stable and was transferred to the ICU in the postoperative period.ConclusionsSeveral complications can affect gravidas with TA. Careful patient evaluation, treatment of TA complications, and anestheticsurgical planning are fundamental. Maintenance of perfusion is the main concern in these patients, and neuraxial blocks may be used without harming the mother and fetus. In patients with compensated TA complications, monitoring does not differ from that routinely used in cesarean sections. Continuous epidural anesthesia with slow installation maintains hemodynamic stability and allows monitoring cerebral perfusion through the level of consciousness. To avoid postoperative hypoperfusion or hypertensive complications patients should be monitored in an intensive or semi-intensive care unit for 24 hours

Treatment of condylar fractures: : a retrospective cohort study

Objective: Evaluate routine alterations in patients submitted to treatment of unilateral fractures of the mandibular condyle. Patients and methods: The sample consisted of 30 patients of both sexes submitted to surgical and nonsurgical treatment. All patients answered an evaluation questionnaire on perception of the Oral Impact on Daily Performances (OIDP) and underwent physical and imaging examination. The following aspects were evaluated in temporo mandibular join (TMJ) physical examination: maximum mouth opening, left/right lateral movements and protrusive movements. Vertical height measurements of right and left mandibular branches were evaluated by means of orthopantomography. Lateromedial and anteroposterior displacements were measured using Hirtz?s axial radiography. Evaluation of diameter of the mandibular fossa and height of the glenoid fossa were measured by hypocycloidal tomography. Results: A minority (13.3%) answered the questions on OIDP positively, with a similar rate for both treatments. With regard to the vertical height variable, average vertical height was similar for both treatments. However, comparing fractured and nonfractured sides, the difference observed was statistically significant for both treatments. On the basis of the statistical results of this study, for both treatments there were no significant alterations in the maximum mouth opening variable, with an average of 43.35 mm for open treatment and 44 mm for closed treatment. Conclusion: In the present study there were no significant differences between open and closed treatment of unilateral fractures of the mandibular condyle

Relationship between mandibular fracture and impacted lower third molar

Many studies have shown that the greatest risk of fracture of the mandibular angle is related to the presence of an unerupted lower third molar, based on the hypothesis that there is a decrease in the area of bone and absorption of the impact in this area, leading some surgeons to indicate its prophylactic removal in patients most exposed to the risk factors of facial trauma. On the other hand, other authors have observed a greater frequency of condylar fractures in patients without an impacted lower third molar.Purpose: The aim of this study was to relate the condylar and angle fracture with an unerupted lower third molar, taking into account the position of the tooth.Material and Methods: Panoramic radiographs were used to determine if the presence or absence of the third molar is related to the occurrence of mandibular fractures, such as angle and condylar fractures.Results: In a total of 43 patients with angle fractures, the greatest percentage had erupted teeth, and 41.9% had impacted teeth; however there was no significant difference between the fractured side and the tooth condition (p=0.350). There were 91 condylar fractures and in 42.9% the third molar was absent and in 40.7% the tooth was erupted . There was no significant difference between the fractured side and the tooth condition (p=0.852).Conclusion: The absence of an impacted third molar may increase the risk of condylar fractures and decrease the prevalence of mandibular angle fractures

Occupational stress among Brazilian oral-maxillofacial surgeons

Purpose: The aim of the present study was to assess the stress level of oral-maxillofacial surgeons, based on the Demand-Control Model. Methods: A cross-sectional study was carried out with 128 oral-maxillofacial surgeons who participated in the Brazilian Congress of Oral-Maxillofacial Surgery held in the city of Florianópolis, State of Santa Catarina, Brazil. Data was obtained using a questionnaire that incorporated the Demand-Control Model (Job Content Questionnaire), which evaluates psychosocial experiences at work. Information on age, gender and professional qualification was also collected. The data was displayed in contingency tables. The following statistical tests were used with a 5% level of significance: chi-square test and ?Fisher exact test?. Results: Oralmaxillofacial surgeons were classified according to the Demand-Control Model as follows: High Demand (28%), Low Demand (28%); Passive Work (27%), Active Work (16.4%). Conclusion: The majority of oral-maxillofacial surgeons exercise their profession in unsatisfactory working conditions, as less than 1/3 of the population studied worked under the ideal condition of low demand

Alcohol abusive use increases facial trauma?

Trauma is among the main death causes and morbidity in the world and is often related to the use of alcohol and its abuse has reached massive proportions, no matter if the country is developed or not, being considered as public health problem. Since there are very few randomized and prospective studies in literature about the association of facial trauma and the use of alcohol, this study aims to investigate the impact of alcohol use in facial trauma. This was a prospective and cross sectional study, involving facial trauma patients attended at Oral Maxillofacial Surgery Division of a State Hospital. Variables included patient´s profile, trauma etiology, facial region involved, type of injury and treatment and days of hospitalization. AUDIT test was applied to identify risks and damages of alcohol use and chemical dependence. Absolute distribution, uni and mutilvaried percentages were made for data evaluation. Pearson´s qui-squared and Fisher´s Exact tests were also used. One hundred patients were evaluated. The patient´s mean age was 33.50 years-old, 48% had between 17 and 29 years old, 28% had 30 to 39, and 24% 40 or more. Most of them were male (86%). The most frequent etiology was traffic accident (57%), the extraoral area was most committed (62%), the most frequent type of injury was fractures (78%) and the most affected bone was the mandible (36%). More than half of the patients (53%) had surgical treatment. 38% had their discharge from hospital right after the first attendance. The AUDIT most frequent answer was ?moderate use? (46%) and use at risk (39%). There was significant difference between the use of alcohol (AUDIT) and hematoma (0.003) and number of days of hospitalization (p=0.005). In this study it was not observed association between alcohol consumption using the AUDIT and trauma etiology, but patient victims of traffic accidents were classified as with risk in the scale. Most of the trauma were caused by traffic accidents using motorcycles and occurred in young aged men