The immediate effect of transcranial direct current stimulation combined with peripheral electrical stimulation in the control of temporomandibular pain in subjects with sickle cell disease: A protocol for one session randomized, crossover, double-blind clinical trial

INTRODUCTION: Temporomandibular disorder (TMD) is currently considered a central sensitization syndrome that belongs to the orofacial nociplastic pain group and offers great challenges for clinical practice. It can also be identified in individuals with sickle cell disease. Neuromodulation is a promising therapy that can help individuals with refractory chronic pain. To our knowledge, there is no treatment proposal for these individuals with chronic orofacial pain resulting from sickle cell disease. OBJECTIVE: This is a protocol of a randomized, double-blind, cross-over clinical trial. The purpose of this protocol is to investigate whether the immediate effect of transcranial direct current stimulation can be increased by adding the effect of peripheral sensory electrical stimulation. METHODS: Twenty women between 18 and 49 years of age will be screened to participate in this cross-over study where they will all receive the three types of protocol with a one-week washout. Active transcranial Direct Current Stimulation (tDCS) + active Peripheral Electrical Stimulation (PES); Active tDCS + PES sham and tDCS sham + PES sham. Stimulation with tDCS will be at 2 mA anodic over the motor cortex for 20 minutes ipsilateral to the most painful temporomandibular joint (TMJ). Peripheral electrical stimulation will be at 100 Hz over the most painful TMJ masseter muscle for 30 min. OUTCOME: The main outcome will be pain intensity assessed by VAS scale and by a pressure algometer in grams. In addition, endogenous pain modulation will be analyzed through the temporal summation of pain with Aesthesio precision tactile sensory filaments and conditioned pain modulation (CPM) evaluated by an algometer and thermal conditioned stimulus, as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables

Effect of neuromodulation on pain and functional mobility in people with HTLV-1: randomized clinical trial protocol

BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion.  Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions.  OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP.  METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients.  Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included.  Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded.  The protocol will be applied for 10 consecutive days with eight months of follow-up.  Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect.  CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life

Aspectos sociodemográficos e clínicos de pacientes com doenças falciformes dos centros de referência em Salvador, Bahia

The centralization of care for patients with sickle cell diseases through the creation of reference centers through the Ministry of Health Ordinance No. 1,018/2005, enabled better monitoring of these patients. This study characterized the sociodemographic and clinical profile of patients with sickle cell diseases treated at reference centers in the city of Salvador. Women represented the largest portion of patients registered at the centers and were older and more educated than men. More than 90.0% of patients are single, demonstrating the difficulty of people with sickle cell disease to socialize due to the stigma of the disease. The most common clinical manifestations were pain crises and jaundice, and the most common complications were hospitalizations due to pain crises and blood transfusion. Associations were observed between sex and stroke, between genotype and lower limb ulcers and blood transfusion. A low percentage of patients with osteonecrosis (8.8%) was also observed, indicating possible underreporting. The low percentages of patients who use morphine and hydroxyurea point to the need to expand the offer of these drugs to reduce pain crises and improve the quality of life of patients.La centralización de la atención a los pacientes con anemia falciforme mediante la creación de centros de referencia a través de la Ordenanza del Ministerio de Salud Nº 1.018 / 2005, permitió un mejor seguimiento de estos pacientes. Este estudio caracterizó el perfil sociodemográfico y clínico de los pacientes con drepanocitosis atendidos en centros de referencia de la ciudad de Salvador. Las mujeres representaban la mayor parte de los pacientes registrados en los centros y eran mayores y tenían más educación que los hombres. Más del 90,0% de los pacientes son solteros, lo que demuestra la dificultad de las personas con anemia falciforme para socializar debido al estigma de la enfermedad. Las manifestaciones clínicas más frecuentes fueron crisis de dolor e ictericia, y las complicaciones más frecuentes fueron hospitalizaciones por crisis de dolor y transfusión de sangre. Se observaron asociaciones entre sexo y accidente cerebrovascular, entre genotipo y úlceras de miembros inferiores y transfusión de sangre. También se observó un bajo porcentaje de pacientes con osteonecrosis (8,8%), lo que indica un posible subregistro. Los bajos porcentajes de pacientes que utilizan morfina e hidroxiurea apuntan a la necesidad de ampliar la oferta de estos fármacos para reducir las crisis de dolor y mejorar la calidad de vida de los pacientes.A centralização do atendimento dos pacientes com doenças falciformes através da criação de centros de referência possibilitou um melhor acompanhamento desses pacientes. Este estudo caracterizou o perfil sociodemográfico e clínico dos pacientes com doenças falciformes atendidos nos centros de referência no município de Salvador. Os resultados deste estudo corroboram com a literatura e podem ajudar a melhorar os serviços oferecidos nos centros de referência pesquisados. As mulheres representaram a maior parcela dos pacientes registrados nos centros e com maior faixa etária e escolaridade do que os homens. Mais de 90,0% dos pacientes são solteiros, demonstrando a dificuldade das pessoas com doenças falciformes se socializarem devido ao estigma da doença. As manifestações clínicas mais comuns foram as crises álgicas e a icterícia e as intercorrências mais comuns foram internações devido as crises álgicas e hemotransfusão. Foram observadas associações entre sexo e acidente vascular cerebral, entre o genótipo e úlceras de membros inferiores e hemotransfusão. Também foi observado um percentual baixo de pacientes com osteonecrose indicando possível subnotificação. Os percentuais baixos de pacientes que fazem uso da morfina e hidroxiureia apontam para a necessidade de ampliar a oferta desses medicamentos para diminuir as crises álgicas e melhorar a qualidade de vida dos pacientes

Aspectos sociodemográficos e clínicos de pacientes com doenças falciformes dos centros de referência em Salvador, Bahia / Sociodemographic and clinical aspects of patients with sickle cell disease at referral centers in Salvador, Bahia

Introdução. Este estudo caracterizou o perfil sociodemográfico e clínico dos pacientes com doenças falciformes atendidos nos centros de referência no município de Salvador (BA). Métodos. Trata-se de um estudo transversal com abordagem quantitativa e caráter descritivo. As análises estatísticas foram realizadas no SPSS versão 25.0. Resultados. As mulheres representaram a maior parcela dos pacientes. Mais de 90,0% são solteiros, demonstrando a dificuldade das pessoas com doenças falciformes se socializarem devido o estigma da doença. As manifestações clínicas mais comuns foram as crises álgicas e a icterícia e as intercorrências mais comuns foram internações devido às crises álgicas e hemotransfusão. Foi observado associação entre o sexo masculino e acidente vascular cerebral, genótipo SS e úlceras de membros inferiores e hemotransfusão. O baixo número de pacientes com osteonecrose e que fazem uso de morfina e hidroxiureia indicam, respectivamente, possível subnotificação e a necessidade de ampliar a oferta de medicamentos para diminuir as crises álgicas e melhorar a qualidade de vida dos pacientes. Conclusão. A centralização do atendimento de pessoas com doenças falciformes através da criação de centros de referência no Brasil possibilitou um melhor acompanhamento desses indivíduos, mas ainda existem desafios a serem superados

Sickle Cell Disease Chronic Joint Pain: Clinical Assessment Based on Maladaptive Central Nervous System Plasticity

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulationmaymanage disorders associated with COVID- 19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-relatedmental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-tobe- determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non- COVID-19 patients) can be investigated in the management of patients with COVID-19

Screening for Structural Hemoglobin Variants in Bahia, Brazil

Brazil was the country that received the largest number of Africans during the time of colonization, and Bahia was the Brazilian state that received the largest number of slaves from Africa. The purpose of this study was to evaluate the coverage of the newborn screening program for sickle cell disease in the Recôncavo Baiano region of the state of Bahia, and to show the frequency of the subjects with hemoglobin variants in the 2006–2009 period. Blood samples from neonates in twelve cities in the Recôncavo Baiano region were analyzed by High Performance Liquid Chromatography. A total of 16,402 children were born in this period, 14,773 of which underwent newborn screening. In this period 1416 children were born carrying hemoglobin variants HbS and HbC. Forty-seven patients—20 HbSS genotype and 27 HbSC genotype—were diagnosed in eleven of the twelve cities surveyed. The proportion of children born with sickle cell disease in the Recôncavo Baiano region was 1/314, which was higher than the 1/650 rate for the state of Bahia. The data presented in this study confirm the high frequency of sickle cell disease in Recôncavo Baiano, demonstrating the need to create a referral center for the care of patients with sickle cell diseases in the region

A new approach to assess function after sciatic nerve lesion in the mouse—Adaptation of the sciatic static index

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2016-07-04T17:30:40Z No. of bitstreams: 1 Batista AF A new aproach to assess......pdf: 398143 bytes, checksum: 2681ad3389c39178e4f588bd7ae03e9b (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2016-07-04T17:54:15Z (GMT) No. of bitstreams: 1 Batista AF A new aproach to assess......pdf: 398143 bytes, checksum: 2681ad3389c39178e4f588bd7ae03e9b (MD5)Made available in DSpace on 2016-07-04T17:54:15Z (GMT). No. of bitstreams: 1 Batista AF A new aproach to assess......pdf: 398143 bytes, checksum: 2681ad3389c39178e4f588bd7ae03e9b (MD5) Previous issue date: 2007Made available in DSpace on 2016-07-14T19:07:29Z (GMT). No. of bitstreams: 3 Batista AF A new aproach to assess......pdf.txt: 30533 bytes, checksum: f642238d7fa4d2895ade3d42be875500 (MD5) Batista AF A new aproach to assess......pdf: 398143 bytes, checksum: 2681ad3389c39178e4f588bd7ae03e9b (MD5) license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) Previous issue date: 2007Universidade Federal do Rio de Janeiro. Departamento de Histologia e Embriologia. Rio de Janeiro, RJ, Brasil / Fundação Bahiana para Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Fundação Gonçalo Moniz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilFundação Bahiana para Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, BrasilFundação Bahiana para Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, BrasilFundação Bahiana para Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, BrasilFundação Gonçalo Moniz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilUniversidade Federal do Rio de Janeiro. Departamento de Histologia e Embriologia. Rio de Janeiro, RJ, BrasilAmong the numerous ways of assessing regeneration after peripheral nerve lesions, the analysis of gait is one of the most important, because it shows the recovery of function, which is the ultimate goal of the repair machinery. The sciatic function index was introduced as a method to assess reinnervation after an experimental sciatic nerve lesion, and was adapted to the mouse model. The sciatic static index (SSI), is more simple and practical to perform, and is not so influenced by gait’s velocity, but this method has not yet been adapted to the mouse model of sciatic lesion. We used 63 male Swiss mice (Mus musculus) to develop a formula to the sciatic static index in mice (SSIm). The animals were divided on three groups (control, transection and crush). They were evaluated at the preoperative and 7th, 14th, 21st, 28th, 35th and 42nd days postoperative by the ink track method (SFI), and by the acquisition of photographs of the plantar aspects of the injured and uninjured hind paws. The parameters evaluated were the 1–5 toe spread (TS), the 2–4 toe spread (ITS) and the distance between the tip of the third toe and the most posterior aspect of the paw (PL), on both methods. After verifying the temporal pattern of function, correlation and reproducibility of the measurements, we performed a multiple regression analysis using SFI values as dependent variable, and the TS, ITS and PL measured with the photo method as independent variables, and found the formula of the SSI for mice (SSIm). The three groups (control, transection and crush) had a characteristic pattern of dysfunction. The parameters measured in the ink and photo method had variable but significant correlations between them (P < 0.000), but photo method of measurement showed a better reproducibility. The correlation between SFI and SSIm showed a high correlation coefficient (r = 0.892, P < 0.000), and demonstrates that SSIm can be used as an alternative method to assess the functional status relative of sciatic nerve activity in mice

Pharmacological treatment of central neuropathic pain: consensus of the Brazilian Academy of Neurology

International audienceABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.RESUMO Introdução: A dor neuropática central (DNC) é frequentemente refratária às estratégias terapêuticas disponíveis e há poucas opções de tratamento baseado em evidência. Muitos pacientes com dor neuropática não são diagnosticados ou tratados adequadamente. Desse modo, recomendações baseadas em consenso, adaptadas à disponibilidade de medicamentos no país, são necessárias para guiar decisões clínicas. Objetivo: Desenvolver recomendações para o tratamento da DNC no Brasil. Métodos: Revisão sistemática, metanálise e discussão dos resultados entre especialistas e pesquisadores da área, considerando eficácia, perfil de eventos adversos, custo e disponibilidade do fármaco na saúde pública. Resultados: Foram encontrados 44 estudos sobre tratamento da DNC, dos quais 20 foram incluídos na análise qualitativa e 15, na quantitativa. Classificaram-se as medicações em primeira, segunda e terceira linhas de tratamento, baseando-se em revisão sistemática, meta-análise e opinião de especialistas. Como primeira linha, foram incluídos gabapentina, duloxetina e antidepressivos tricíclicos. Como segunda, venlafaxina, pregabalina para DNC secundária à lesão medular, lamotrigina para DNC pós-acidente vascular cerebral e, em associação aos fármacos de primeira linha, opioides fracos, em particular tramadol. Para os pacientes refratários, opioides fortes (metadona e oxicodona) e canabidiol/delta-9-tetrahidrocanabinol foram classificados como terceira linha de tratamento, em associação com drogas de primeira ou segunda linha, e, para DNC na esclerose múltipla, dronabinol. Conclusões: Os estudos que abordam o tratamento da DNC são escassos e heterogêneos, e parte significativa das recomendações é baseada em opiniões de especialistas. A abordagem da DNC deve ser individualizada, levando em conta a disponibilidade de medicação, o perfil de efeitos adversos, incluindo risco de dependência e as comorbidades do paciente