Comparação de diferentes procedimentos de estimulação elétrica neuromuscular utilizados no tratamento da incontinência urinária de esforço feminina: ensaio clínico randomizado

BACKGROUND: Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. OBJECTIVE: To compare two NMESintra-vaginal protocols for the treatment of SUI in women. METHODS: The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5% was set for all data analysis. RESULTS: No significant differences (p&gt;0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. CONCLUSION: The two NMES protocols applied were equally effective in the treatment of SUI.CONTEXTUALIZAÇÃO: A estimulação elétrica neuromuscular (EENM) é amplamente utilizada no tratamento da incontinência urinária de esforço (IUE), no entanto não há consenso na literatura sobre os parâmetros de tratamento mais eficazes. OBJETIVO: Avaliar os procedimentos de EENM intravaginal no tratamento de mulheres com IUE. MÉTODOS: Participaram do estudo 20 voluntárias com idade média de 55,55±6,51 anos, com diagnóstico clínico de IUE. As voluntárias foram divididas aleatoriamente em dois grupos: grupo 1 (G1), que recebeu EENM com corrente de média frequência, e grupo 2 (G2), com corrente de baixa frequência. A avaliação funcional dos músculos do assoalho pélvico (MAP) foi realizada por meio de perineometria, e a severidade dos sinais e sintomas da IUE foi avaliada, objetivamente, pelo pad test de uma hora e, subjetivamente, pela Escala Visual Analógica (EVA), que mediu o desconforto causado pela incontinência. Para a análise de normalidade dos dados, utilizou-se o teste Shapiro-Wilk, seguido do teste de Friedman para dados não paramétricos. Para a análise dos sintomas relacionados à IUE, usaram-se os testes Exato de Fisher e Mann-Whitney. Em todas as análises, considerou-se o nível de significância de 5%. RESULTADOS: Não houve diferença significativa (p&gt;0,05) entre os grupos em nenhuma variável avaliada. Na comparação intragrupos das avaliações iniciais e finais (após EENM), houve diferença significativa (p<0,05) na quantidade de urina perdida, no desconforto causado pela incontinência urinária e na pressão perineal. CONCLUSÃO: Os procedimentos de EENM utilizados neste estudo foram igualmente eficazes no tratamento da IUE

Comparação de diferentes procedimentos de estimulação elétrica neuromuscular utilizados no tratamento da incontinência urinária de esforço feminina : ensaio clínico randomizado

Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. OBJECTIVE: To compare two NMESintra-vaginal protocols for the treatment of SUI in women. The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann-Whitney test were used. Significance level of 5% was set for all data analysis. No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p0,05) entre os grupos em nenhuma variável avaliada. Na comparação intragrupos das avaliações iniciais e finais (após EENM), houve diferença significativa (p<0,05) na quantidade de urina perdida, no desconforto causado pela incontinência urinária e na pressão perineal. Os procedimentos de EENM utilizados neste estudo foram igualmente eficazes no tratamento da IU

Dilp8 requires the neuronal relaxin receptor Lgr3 to couple growth to developmental timing

We thank C. Mirth, C. Ribeiro and A. Jacinto for their comments and suggestions; I. Miguel-Aliaga, A. Jacinto, P. Leopold, P. Domingos, C. Mirth, R. Teodoro, M. Dominguez, M.L. Vasconcelos, J.C. Yin and M. O'Connor, for reagents. Stocks obtained from the Bloomington Drosophila Stock Center (NIH P40OD018537) were used in this study. A.M.G., F.H., A.M., A.R.M.D. and T.K. are supported by the FCT, under the FCT Investigator Programme and FCT fellowships SFRH/BPD/94112/2013, PD/BD/52421/2013, SFRH/BD/94931/2013 and SFRH/BPD/74313/2010, respectively. A.G. is supported by the CONICET and UNS, and Y.A.V. holds a CONICET fellowship. The work in the laboratory of A.M.G. is funded by the CEDOC and the European Commission FP7 (PCIG13-GA-2013-618847). A.G. thanks N.P. Rotstein and L.E. Politi for providing funds and space to develop a part of this project in their lab.How different organs in the body sense growth perturbations in distant tissues to coordinate their size during development is poorly understood. Here we mutate an invertebrate orphan relaxin receptor gene, the Drosophila Leucine-rich repeat-containing G protein-coupled receptor 3 (Lgr3), and find body asymmetries similar to those found in insulin-like peptide 8 (dilp8) mutants, which fail to coordinate growth with developmental timing. Indeed, mutation or RNA intereference (RNAi) against Lgr3 suppresses the delay in pupariation induced by imaginal disc growth perturbation or ectopic Dilp8 expression. By tagging endogenous Lgr3 and performing cell type-specific RNAi, we map this Lgr3 activity to a new subset of CNS neurons, four of which are a pair of bilateral pars intercerebralis Lgr3-positive (PIL) neurons that respond specifically to ectopic Dilp8 by increasing cAMP-dependent signalling. Our work sheds new light on the function and evolution of relaxin receptors and reveals a novel neuroendocrine circuit responsive to growth aberrations.publishersversionpublishe

Comparação das forças ativa e passiva dos músculos do assoalho pélvico de mulheres com e sem incontinência urinária de estresse

Background: The reduction of the pelvic floor muscles (PFM) strength is a major cause of stress urinary incontinence (SUI). Objective: To compare active and passive forces, and vaginal cavity aperture in continent and stress urinary incontinent women. Method: The study included a total of thirty-two women, sixteen continent women (group 1 - G1) and sixteen women with SUI (group 2 - G2). To evaluate PFM passive and active forces in anteroposterior (sagittal plane) and left-right directions (frontal plane) a stainless steel specular dynamometer was used. Results: The anteroposterior active strength for the continent women (mean +/- standard deviation) (0.3 +/- 0.2 N) was greater compared to the values found in the evaluation of incontinent women (0.1 +/- 0.1 N). The left-right active strength (G1=0.43 +/- 0.1 N; G2=0.40 +/- 0.1 N), the passive force (G1=1.1 +/- 0.2 N; G2=1.1 +/- 0.3 N) and the vaginal cavity aperture (G1=21 +/- 3 mm; G2=24 +/- 4 mm) did not differ between groups 1 and 2. Conclusion: The function evaluation of PFM showed that women with SUI had a lower anteroposterior active strength compared to continent women.Contextualização: A redução da força dos músculos do assoalho pélvico (MAP) é a maior causa da incontinência urinária de estresse \ud (IUE). Objetivo: Comparar as forças ativa e passiva e a abertura da cavidade vaginal em mulheres continentes e com IUE. Método: O \ud estudo incluiu um total de 32 mulheres, 16 mulheres continentes (grupo 1 - G1) e 16 mulheres com IUE (grupo 2 - G2). Um espéculo \ud dinamométrico de aço inoxidável foi usado para avaliar as forças ativa e passiva dos MAP nas direções ântero-posterior (plano \ud sagital) e látero-lateral (plano frontal). Resultados: A força ativa ântero-posterior nas mulheres continentes (0,3±0,2 N) foi maior que \ud nas mulheres com IUE (0,1±0,1 N). Não houve diferença entre o G1 e o G2 nos valores de força ativa látero-lateral (G1=0,43±0,1 N; \ud G2=0,40±0,1 N), força passiva (G1=1,1±0,2 N; G2=1,1±0,3 N) e abertura da cavidade vaginal (G1=21±3 mm; G2=24±4 mm). \ud Conclusão: A avaliação da função dos MAP mostrou que mulheres com IUE tiveram uma menor força ativa ântero-posterior quando \ud comparadas com as mulheres continentes

Ghrelin plasma levels, gastric ghrelin cell density and bone mineral density in women with rheumatoid arthritis.

Generalized bone loss can be considered an extra-articular manifestation of rheumatoid arthritis (RA) that may lead to the occurrence of fractures, resulting in decreased quality of life and increased healthcare costs. The peptide ghrelin has demonstrated to positively affect osteoblasts in vitro and has anti-inflammatory actions, but the studies that correlate ghrelin plasma levels and RA have contradictory results. We aimed to evaluate the correlation between total ghrelin plasma levels, density of ghrelin-immunoreactive cells in the gastric mucosa, and bone mineral density (BMD) in twenty adult women with established RA with 6 months or more of symptoms (mean age of 52.70?11.40 years). Patients with RA presented higher ghrelin-immunoreactive cells density in gastric mucosa (P=0.008) compared with healthy females. There was a positive relationship between femoral neck BMD and gastric ghrelin cell density (P=0.007). However, these same patients presented a negative correlation between plasma ghrelin levels and total femoral BMD (P=0.03). The present results indicate that ghrelin may be involved in bone metabolism of patients with RA. However, the higher density of ghrelin-producing cells in the gastric mucosa of these patients does not seem to induce a corresponding elevation in the plasma levels of this peptide

Constituintes químicos de Vernonia scorpioides (Lam) Pers. (Asteraceae)

The chemical investigation of hexane and ethanol extracts from the aerial parts of Vernonia scorpioides resulted in the isolation and characterization of a new polyacetylene lactone, rel-4-dihydro-4β-hydroxy-5a-octa-2,4,6-triynyl-furan-2-(5H)-one, along with the new ethyl 3,4-dihydroxy-6,8,10-triynyl-dodecanoate, and seven known compounds: taraxasteryl acetate, lupeyl acetate, lupeol, lupenone, β-sitosterol, stigmasterol and luteolin. The structure of all compounds was determined by spectrometric techniques (HR-ESI-MS, ¹H and 13C NMR and IV) and comparison with published spectral data

Contribuição das universidades na revisão da Política Nacional de Promoção da Saúde

Resumo Em 2014, a Política Nacional de Promoção da Saúde passou por um processo participativo de revisão, que teve como colaboradores gestores públicos, participantes de movimentos sociais, professores e pesquisadores de universidades. Nesse processo, foi necessário conhecer e analisar como se deram as contribuições dos diferentes atores envolvidos e como elas foram incorporadas à nova versão da Política. O objetivo deste estudo é discutir a contribuição das universidades na revisão da Política Nacional de Promoção da Saúde. Utilizando-se a técnica Delphi, questionários foram enviados, por correio eletrônico, a líderes de grupos de pesquisa das universidades brasileiras; o envio foi organizado em duas rodadas, tendo a última sido realizada somente após a análise dos consensos e dissensos da primeira. A partir da análise dos formulários, concluiu-se que as contribuições das universidades à nova Política Nacional de Promoção da Saúde estão relacionadas à sua estrutura, princípios e valores, objetivos, temas prioritários e eixos operacionais

Latin American anaphylaxis registry

Background: Recent data about clinical features, triggers and management of anaphylaxis in Latin America is lacking. Objective: To provide updated and extended data on anaphylaxis in this region. Method: An online questionnaire was used, with 67 allergy units involved from 12 Latin-American countries and Spain. Among data recorded, demographic information, clinical features, severity, triggering agents, and treatment were received. Results: Eight hundred and seventeen anaphylactic reactions were recorded. No difference in severity, regardless of pre-existing allergy or asthma history was found. Drug induced anaphylaxis (DIA) was most frequent (40.6%), followed by food induced anaphylaxis (FIA) (32.9%) and venom induced anaphylaxis (VIA) (12%). FIA and VIA were more common in children-adolescents. Non-steroidal anti-inflammatory drugs (NSAIDs) and beta-lactam antibiotics (BLA) were the most frequent drugs involved. Milk (61.1% of FIA) and egg (15.4% of FIA) in children, and shellfish (25.5% of FIA), fresh fruits (14.2% of FIA), and fish (11.3% of FIA) in adults were the most common FIA triggers. Fire ants were the most frequent insect triggers, and they induced more severe reactions than triggers of FIA and DIA (p < 0.0001). Epinephrine was used in 43.8% of anaphylaxis episodes. After Emergency Department treatment, epinephrine was prescribed to 13% of patients. Conclusions: Drugs (NSAIDs and BLA), foods (milk and egg in children and shellfish, fruits and fish in adults) and fire ants were the most common inducers of anaphylaxis. Epinephrine was used in less than half of the episodes emphasizing the urgent need to improve dissemination and implementation of anaphylaxis guidelines.Revisión por pare

Climate change, malaria and neglected tropical diseases: a scoping review

To explore the effects of climate change on malaria and 20 neglected tropical diseases (NTDs), and potential effect amelioration through mitigation and adaptation, we searched for papers published from January 2010 to October 2023. We descriptively synthesised extracted data. We analysed numbers of papers meeting our inclusion criteria by country and national disease burden, healthcare access and quality index (HAQI), as well as by climate vulnerability score. From 42 693 retrieved records, 1543 full-text papers were assessed. Of 511 papers meeting the inclusion criteria, 185 studied malaria, 181 dengue and chikungunya and 53 leishmaniasis; other NTDs were relatively understudied. Mitigation was considered in 174 papers (34%) and adaption strategies in 24 (5%). Amplitude and direction of effects of climate change on malaria and NTDs are likely to vary by disease and location, be non-linear and evolve over time. Available analyses do not allow confident prediction of the overall global impact of climate change on these diseases. For dengue and chikungunya and the group of non-vector-borne NTDs, the literature privileged consideration of current low-burden countries with a high HAQI. No leishmaniasis papers considered outcomes in East Africa. Comprehensive, collaborative and standardised modelling efforts are needed to better understand how climate change will directly and indirectly affect malaria and NTDs