998 research outputs found
Sort by
Prevalence of orofacial pain attributed to temporomandibular dysfunction in professional dancers from Curitiba
Get PDFIntroduction: Orofacial pain is a debilitating condition that can often be associated with temporomandibular dysfunction (TMD), a disorder affecting the temporomandibular joint and the masticatory muscles. Professional dancers, due to intense physical demands, poor posture, and stress, may be particularly susceptible to developing TMD and consequently orofacial pain. This study aims to investigate the prevalence of orofacial pain attributed to TMD in professional dancers from Curitiba, with the goal of identifying the need for preventive and therapeutic interventions.
Methods: This cross-sectional study analyzed 44 professional dancers, all with more than two years of professional experience, from three renowned ballet schools in Curitiba, PR. Data were collected through structured interviews and clinical examinations using the DC/TMD. Additionally, postural habits, injury history, and stress levels of the dancers were assessed to identify potential risk factors associated with TMD.
Results: The average age of the dancers was 27.7 years, with an age range from 18 to 42 years. Of the 44 dancers evaluated, 72.2% (32 dancers) reported at least some sign and symptom of orofacial pain, manifesting primarily as tension headaches, pain in the masseter and temporal muscles, and difficulty chewing. A correlation was also observed between orofacial pain and poor postural habits, as well as high stress levels among the dancers.
Conclusion: The high prevalence of orofacial pain among professional dancers in Curitiba suggests a strong association with temporomandibular dysfunction. These findings highlight the need for the implementation of prevention and treatment programs targeted at this specific group of professionals. Interventions such as physiotherapy, postural adjustments, relaxation techniques, and specialized dental follow-up may be effective in reducing the incidence of orofacial pain and improving the quality of life and professional performance of dancers
English
No full textIntrodução:
A endometriose é uma condição crônica caracterizada pela presença de tecido endometrial for a do útero, o que pode resultar em dor pélvica crônica e infertilidade. Sua forma pulmonar é rara e manifesta-se com dor torácica, hemoptise, pneumotórax e hemotórax catamenial. A enxaqueca é um distúrbio neurológico caracterizado por crises intensas de cefaleia associadas a náuseas, vômitos e fotofobia, mais frequentes em mulheres em idade reprodutiva. A enxaqueca é mais comum em mulheres com endometriose, provavelmente devido à sensibilização central e amplificação da resposta dolorosa devido à inflamação e dor crônica da endometriose.
Objetivo:
Relatar um caso atípico de endometriose com pneumotórax catamenial em uma paciente cuja migrânea menstrual piorou e tornou-se crônica após o quadro pulmonar.
Relato do Caso:
Uma mulher de 35 anos passou a apresentar episódios semanais de cefaleia e piora relacionada ao ciclo menstrual. Apresentou subitamente dispneia e dor torácica durante o ciclo menstrual, que evoluiu para pneumotórax, necessitando de duas cirurgias. A biópsia do lobo pulmonar superior direito identificou enfisema subpleural que, juntamente com a apresentação clínica e a ressonância magnética pélvica, foi presumivelmente diagnosticado como pneumotórax catamenial. Após o pneumotórax, a cefaleia tornou-se diária, têmporo-occipital direita, intensa (escala subjetiva de dor 9/10), pulsátil, com irradiação para a hemiface direita, com alodínia intra e extracraniana, aura com náuseas, visão turva, escotomas, fotofobia e fonofobia. Pós-crise, alterações de humor e hiporexia. Dipirona, sumatriptano e trometamina não fornecem alívio. Ela nega consumir alimentos que desencadeiam enxaquecas. Atualmente, aos 48 anos, ela está na menopausa e infértil.
Conclusão:
A enxaqueca relacionada à endometriose geralmente ocorre durante o período menstrual e tende a diminuir no climatério devido ao declínio hormonal. Neste caso, entretanto, as cefaleias pioraram após a menopausa, sugerindo focos anômalos de endometriose, retardando o climatério. A endometriose torácica é uma apresentação rara que se manifesta com dor no ombro direito e hemoptise durante o período menstrual, consistente com o diagnóstico presuntivo de endometriose torácica profunda desta paciente. A biópsia é uma opção limitada, pois pode não detectar tecido endometrial dependendo do momento do ciclo menstrual em que é realizada. A persistência da estimulação hormonal induzida pela endometriose atua como gatilho para a enxaqueca, agravada no climatério.Introduction:
Endometriosis is a chronic condition characterized by the presence of endometrial tissue outside the uterus, which can result in chronic pelvic pain and infertility. Its pulmonary form is rare and manifests with chest pain, hemoptysis, pneumothorax, and catamenial hemothorax. Migraine is a neurological disorder characterized by intense headache attacks associated with nausea, vomiting, and photophobia, more frequent in women of reproductive age.Migraines are more common in women with endometriosis, probably due to central sensitization and amplification of the pain response due to inflammation and chronic pain from endometriosis.
Objective:
To report an atypical case of endometriosis with catamenial pneumothorax in a patient whose menstrual migraine worsened and became chronic after the pulmonary condition.
Relato do Caso:
Uma mulher de 35 anos passou a apresentar episódios semanais de cefaleia e piora relacionada ao ciclo menstrual. Apresentou subitamente dispneia e dor torácica durante o ciclo menstrual, que evoluiu para pneumotórax, necessitando de duas cirurgias. A biópsia do lobo pulmonar superior direito identificou enfisema subpleural que, juntamente com a apresentação clínica e a ressonância magnética pélvica, foi presumivelmente diagnosticado como pneumotórax catamenial. Após o pneumotórax, a cefaleia tornou-se diária, têmporo-occipital direita, intensa (escala subjetiva de dor 9/10), pulsátil, com irradiação para a hemiface direita, com alodínia intra e extracraniana, aura com náuseas, visão turva, escotomas, fotofobia e fonofobia. Pós-crise, alterações de humor e hiporexia. Dipirona, sumatriptano e trometamina não fornecem alívio. Ela nega consumir alimentos que desencadeiam enxaquecas. Atualmente, aos 48 anos, ela está na menopausa e infértil.
Conclusion:
A enxaqueca relacionada à endometriose geralmente ocorre durante o período menstrual e tende a diminuir no climatério devido ao declínio hormonal. Neste caso, entretanto, as cefaleias pioraram após a menopausa, sugerindo focos anômalos de endometriose, retardando o climatério. A endometriose torácica é uma apresentação rara que se manifesta com dor no ombro direito e hemoptise durante o período menstrual, consistente com o diagnóstico presuntivo de endometriose torácica profunda desta paciente. A biópsia é uma opção limitada, pois pode não detectar tecido endometrial dependendo do momento do ciclo menstrual em que é realizada. A persistência da estimulação hormonal induzida pela endometriose atua como gatilho para a enxaqueca, agravada no climatério
Phonatory characteristics in primary headaches: a systematic review
Get PDFINTRODUCTION: Primary headaches may be associated with phonatory manifestations, probably due to shared pathophysiological aspects with the vagus nerve, also responsible for innervating the larynx, the phonatory organ. Understanding these manifestations in such disorders is a growing and recent research area. OBJECTIVE: this study aims to discuss the phonatory characteristics in patients with primary headaches METHOD: This is a systematic review (PROSPERO - CRD42024528242), covering research in the last 5 years, involving patients aged 18 and up, published in English and Portuguese, indexed in MEDLINE/Pubmed, Lilacs/Bireme, CINAHL/Ebsco, Web of Science e Scopus/Elsevier. Studies with simultaneous interventions, reviews, pilots and case reports were excluded, aiming for a homogeneous sample of patients with primary headaches (migraine, tension type headache and cluster headache). RESULTS: Of the initial 5340 articles found, only 2 met the criteria: one studying episodic migraine, and another, episodic cluster headache, and no publications studying phonatory characteristics in tension type headache patients were found. In the included articles, all participants were exposed to high frequency pain (at least 6 pain episodes per month) and had specific phonatory characteristics when compared to healthy controls. During the interictal phase, migraineurs exhibited lower speaking and articulation rates and higher average pitch. Cluster headache patients in cluster bout period showed a significantly lower difference between the amplitude of the first harmonic and the amplitude of the second harmonic, and laryngostroboscopic examinations showed a significantly higher prevalence of chordal edema in the headache group. CONCLUSION: The selected studies provided insights on the intricate relationship between primary headache disorders and phonation, emphasizing the importance of objective assessment methods to comprehensively understand the phonatory characteristics in these patients, while highlighting the need of further research with larger sample sizes and more robust methodologies
Relationships between craniofacial pain and disability, neck disability, and orofacial myofunctional condition in patients with temporomandibular dysfunction
Get PDFIntroduction: Temporomandibular dysfunction (TMD) is a restrictive condition affecting the muscles used for chewing, the temporomandibular joint, and related structures, which impairs orofacial and cervical functions.
Objective: To investigate the presence of craniofacial and mandibular pain and disability, and to correlate these with orofacial myofunctional status in patients with temporomandibular disorders (TMD).
Methods: A cross-sectional study was conducted with a sample of 52 individuals diagnosed with TMD, aged between 18 and 40 years, of both genders. Exclusion criteria included edentulous individuals not using prostheses, those with systemic diseases, neurological disorders, recent head or neck trauma or surgery within the past year, and those unable to cooperate. Diagnosis was based on Axis I of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The Orofacial Myofunctional Evaluation with Scores Protocol (OMES), validated for TMD patients, assessed orofacial myofunctional conditions such as appearance, posture, mobility, and functions. Additionally, self-administered instruments included the Craniofacial Pain and Disability Inventory (CF-PDI) and the Neck Disability Index (NDI), which measures self-reported pain intensity and limitations in daily activities related or unrelated to work. Data were analyzed using mean, standard deviation, frequency, Spearman correlation for instrument scores, and simple linear regression to assess the influence of orofacial myofunctional disorder (OMES) on CF-PDI and NDI.
Results: Based on mean scores obtained (OMES: 79.45±5.95, CF-PDI: 23.65±23.60, NDI: 12.77±6.32), patients showed values above the cutoff for orofacial myofunctional disorder, exceeding the Minimal Detectable Change for CF-PDI, and indicating mild to moderate disability according to NDI. There was no correlation between orofacial myofunctional status measured by OMES and CF-PDI (-0.08), but there was negative correlation between OMES and NDI (-0.31), suggesting worse orofacial myofunctional status associated with greater neck disability. Linear regression indicated no significant influence of OMES on CF-PDI but showed a significant influence on NDI (P=0.015).
Conclusions: Patients with TMD demonstrated poorer orofacial myofunctional status, functional limitations, and craniofacial pain. There association between orofacial myofunctional status and neck disability
APLICAÇÃO DA RT-qPCR PARA ANÁLISE DA EXPRESSÃO DE IL1B NA MIGRANEA
No full textIntroduction: Migraine is a disabling chronic neurological disease, and its pathophysiology is still unclear. Interleukin (IL) 1β, a pro-inflammatory cytokine, influences migraine pathophysiology by affecting nociceptors and pain sensitivity. Elevated plasma levels of IL-1β in migraine patients have been reported previously. Thus, studying cytokine gene expression in migraine could promove the identification of diagnostic and therapeutic targets for the disease, particularly in relation to inflammation and vascular response modulation. Objectives: This study aimed to design primers and standardize a method for comparative analysis of IL1B expression based on reverse transcription coupled to real-time polymerase chain reaction (RT-qPCR), in patients with migraine and control patients. Methods: A pair of sense and antisense primers complementary to the human IL1B gene were designed based on a consensus sequence generated after analysis of nucleotide sequences deposited in GenBank, and PickPrimer software. Subsequently, the primers were assessed for specificity using BLASTn tool and dimer formation with DinaMelt tool. Standardized cDNA and primer concentrations were used for RT-qPCR validation on migraine patient leukocytes obtained from the peripheral blood. RNA extraction from clinical samples was performed using the Trizol®. A comparative analysis of the relative expression of IL1B transcripts was conducted on clinical samples obtained from 50 individuals (32 migraine patients and 18 controls). RT-qPCR was utilized to analyze IL1B gene expression. Results: Median IL1B expression was 10.7 times higher in migraine patients and 3.4 times in controls, though not statistically significant. Conclusion: The study identified no significant difference in IL1B transcript levels between migraine patients and controls. Nevertheless, this investigation is pioneering in its approach. RT-qPCR proved to be specific for the detection of IL1B transcripts and can be standardized for the study of other modulators. Future research involving samples from migraine patients during an acute migraine attack could further elucidate the role of IL-1β in migraine pathophysiology
Case Report: Miller Fisher Syndrome Associated with Systemic Lupus Erythematosus Activity
Get PDFIntroduction
Miller Fisher Syndrome (MFS) is characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia, representing a rare variant of Guillain-Barré Syndrome (GBS). Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple systems, including the nervous system. The coexistence of MFS and SLE is rare, posing significant diagnostic and therapeutical challenges.
Objective
To describe a case of MFS associated with SLE activity.
Case Report
A 33-year-old Caucasian woman diagnosed with SLE since 2019, with irregular treatment, was referred to University Hospital for investigation of ascending progressive muscle weakness without evidence of prior infections, occurring concurrently with SLE activity. Neurological examination revealed flaccid tetraparesis associated with right ophthalmoparesis, horizontal nystagmus, bilateral photoreactive mydriasis, trunk ataxia, and global hyporeflexia. Cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation (protein 85 mg/dL and cells 6/mm³). Cranial computed tomography and magnetic resonance imaging (brain and cervical spine) did not reveal acute lesions. She underwent a 5-day course of Intravenous Immunoglobulin (IVIG) and experienced complete recovery of neurological symptoms after two weeks.
Conclusion
This case highlights the rare coexistence of MFS during SLE activity, emphasizing complete remission of neurological symptoms following the early intervention with Intravenous Immunoglobulin (IVIG).
Keywords: Miller Fisher Syndrome, Systemic Lupus Erythematosus, Guillain-Barre syndrome.Introduction
Miller Fisher Syndrome (MFS) is characterized by the classic triad of ophthalmoplegia, ataxia, and areflexia, representing a rare variant of Guillain-Barré Syndrome (GBS). Systemic lupus erythematosus (SLE) is a complex autoimmune disease that can affect multiple systems, including the nervous system. The coexistence of MFS and SLE is rare, posing significant diagnostic and therapeutical challenges.
Objective
To describe a case of MFS associated with SLE activity.
Case Report
A 33-year-old Caucasian woman diagnosed with SLE since 2019, with irregular treatment, was referred to University Hospital for investigation of ascending progressive muscle weakness without evidence of prior infections, occurring concurrently with SLE activity. Neurological examination revealed flaccid tetraparesis associated with right ophthalmoparesis, horizontal nystagmus, bilateral photoreactive mydriasis, trunk ataxia, and global hyporeflexia. Cerebrospinal fluid (CSF) analysis showed albuminocytological dissociation (protein 85 mg/dL and cells 6/mm³). Cranial computed tomography and magnetic resonance imaging (brain and cervical spine) did not reveal acute lesions. She underwent a 5-day course of Intravenous Immunoglobulin (IVIG) and experienced complete recovery of neurological symptoms after two weeks.
Conclusion
This case highlights the rare coexistence of MFS during SLE activity, emphasizing complete remission of neurological symptoms following the early intervention with Intravenous Immunoglobulin (IVIG).
Keywords: Miller Fisher Syndrome, Systemic Lupus Erythematosus, Guillain-Barre syndrome
Analysis of hospitalizations of individuals aged 20 to 59 years for migraines and other headache syndromes in the southeastern region of Brazil from 2019 to 2023.
Get PDFIntroduction: Migraines and headaches are neurological conditions that impact quality of life and can require hospitalizations. This study analyzes hospitalizations for these conditions in individuals aged 20 to 59 years in the southeastern region of Brazil from 2019 to 2023, using data from the SIH/SUS of DATASUS.
Objective: To analyze the profile of hospitalizations for migraines and other headache syndromes in the southeastern region of Brazil, among individuals aged 20 to 59 years, from 2019 to 2023.
Method: This is an ecological, descriptive study with a quantitative approach. It was conducted using data from the Hospital Information System of SUS (SIH/SUS) from DATASUS, focusing on the panel "Migraines and Other Headache Syndromes" (ICD G43 and G44). The variables used were sex, race/color, and age group (20 to 59 years), specifically in the southeastern region of Brazil, from January 2019 to December 2023.
Results: During the analyzed period, it was found that hospitalizations of individuals aged 20 to 59 years for migraines and other headache syndromes totaled 33,656 cases. In the southeastern region, 30.18% of this total (N=10,159) were concentrated. Within the southeastern region, the year 2023 had the highest percentage, with 22.63% (N=2,299), and 2021 had the lowest, with 16.39% (N=1,665). There was a predominance among females, white individuals, and those aged 35 to 39 years, accounting for 72.04% (N=7,319), 46.96% (N=4,771), and 14.47% (N=1,470), respectively.
Conclusion: Hospitalizations for migraines and headaches in southeastern Brazil show a higher incidence among women, white individuals, and those aged 35 to 39 years. These results highlight the need for targeted health policies for the prevention and proper treatment of these conditions
The pathophysiology of the development of migraine from estrogen in women of childbearing age: review
Get PDFTÍTULO: “The pathophysiology of the development of migraine from estrogen in women of childbearing age: review”
INTRODUÇÃO: Changes in estrogen levels can trigger headaches, including estrogen-associated migraine. These changes can occur naturally (e.g., menstruation, pregnancy, menopause) or can be induced (e.g., hormonal contraceptives, hormone replacement therapy, anti-estrogen agents).
OBJETIVO: The aim of this review is to investigate the pathophysiology of the development of migraine from estrogen in women of childbearing age.
MÉTODO: This Integrative Literature Review was developed based on the steps described by Marcela Tavares de Souza, Michelly Dias da Silva and Rachel de Carvalho (Albert Einstein Israelita Hospital), in the article: “Integrative review: what is it? How to do it?”. To assess and analyze literature data we searched for the following terms: (Estrogen ) AND ("Migraine Disorders ") AND (Physiopathology) (MESH or text words) in PubMed and Medline (acess through the Biblioteca Virtual em Saúde), and yielded 19 relevant studies. We included original articles and reviews, in full, which respond to the objective of the study and which are in Portuguese or in English. We excluded research that did not reach the objective, articles that did not cover the theme or animal or in vitro testing.
RESULTADO: The studies consistently reveal a significant association between abrupt estrogen ‘‘withdrawal’’ during the late luteal phase and the pathophysiology of menstrual migraine. The drop in estrogen levels may have a pro-nociceptive effect as its main route, facilitating cortical responses to painful stimuli, through its association with ERK, modulation of the trigeminovascular system and the serotonergic, opioid, noradrenergic, glutamatergic and GABAergic neurotransmitter systems . Studies also indicate that the increase in prostaglandin levels and the vasodilatory effect mediated by estrogen withdrawal are important factors in the pathophysiology of migraine. Other studies suggest an association between mineral homeostasis and oxidative stress with the incidence of headaches mediated by female sex hormones. One study suggested that high plasma concentrations of estrogen appear to be associated with migraine attacks with aura. The action of progesterone still has ambiguous results.
CONCLUSÃO: The action of estrogen on the pathophysiology of migration occurs through many distinct pathways. Understanding these means is necessary to develop efficient treatments that increase patients\u27 quality of life.TÍTULO: “A fisiopatologia do desenvolvimento de migrânea pelo estrogênio em mulheres em idade fértil: revisão”
INTRODUÇÃO: Alterações nos níveis de estrogênio podem desencadear dores de cabeça, incluindo migrânea associada ao estrogênio. Estas alterações podem ocorrer naturalmente (por exemplo, pela menstruação, gravidez, menopausa) ou podem ser induzidas (por exemplo, por contraceptivos hormonais, terapia de reposição hormonal, agentes antiestrogênio).
OBJETIVO: O objetivo desta revisão é investigar a fisiopatologia do desenvolvimento da migrânea por estrogênio em mulheres em idade fértil.
MÉTODO: Esta Revisão Integrativa da Literatura foi desenvolvida com base nas etapas descritas por Marcela Tavares de Souza, Michelly Dias da Silva e Rachel de Carvalho (Hospital Albert Einstein Israelita), no artigo: “Revisão integrativa: o que é? Como fazer isso?". Para avaliação e análise dos dados da literatura buscamos os seguintes termos: (Estrogen ) AND ("Migraine Disorders") AND (Physiopathology) (MESH ou palavras de texto) no PubMed e Medline (acesso pela Biblioteca Virtual em Saúde), e obtivemos 19 estudos relevantes. Foram incluídos artigos originais e revisões, na íntegra, que respondam ao objetivo do estudo e que estejam em português ou em inglês. Foram excluídas pesquisas que não atingiram o objetivo, artigos que não abordavam o tema ou testes em animais ou in vitro.
RESULTADO: Os estudos revelam consistentemente uma associação significativa entre a “retirada” abrupta de estrogênio durante a fase lútea tardia e a fisiopatologia da enxaqueca menstrual. A queda dos níveis de estrogênio pode ter como principal via efeito pró-nociceptivo, facilitando respostas corticais a estímulos dolorosos, através de sua associação com ERK, modulação do sistema trigeminovascular e dos sistemas neurotransmissores serotoninérgico, opióide, noradrenérgico, glutamatérgico e GABAérgico. Estudos também indicam que o aumento dos níveis de prostaglandinas e o efeito vasodilatador mediado pela retirada do estrogênio são fatores importantes na fisiopatologia da migrânea. Outros estudos sugerem associação entre homeostase mineral e estresse oxidativo com a incidência de dores de cabeça mediadas por hormônios sexuais femininos. Um estudo sugeriu que altas concentrações plasmáticas de estrogênio parecem estar associadas a crises de enxaqueca com aura. A ação da progesterona ainda apresenta resultados ambíguos.
CONCLUSÃO: A ação do estrogênio na fisiopatologia da migração ocorre por diversas vias distintas. A compreensão desses meios é necessária para desenvolver tratamentos eficientes que aumentem a qualidade de vida dos pacientes
Semiological and epidemiological aspects of difficult-to-treat chronic migraine-resistant form
Get PDFPatients with chronic and/or resistant migraine were studied at the CHC-UFPR. Of the 99 patients, 57.6% showed resistance, often women (age 54.6 years, BMI 26.2). Prophylaxis failed in 90.9%, with 66.7% reporting worsening over a year. Premonitory symptoms were prevalent (98%).Pacientes com migrânea crônica de difícil tratamento e/ou resistentes foram estudados no CHC-UFPR. Dos 99 pacientes, 57,6% mostraram resistência, comumente mulheres (idade 54,6 anos, IMC 26,2). Profilaxia falhou em 90,9%; 66,7% com piora em um ano. Sintomas premonitórios foram prevalentes (98%).
 
Treatment of chronic migraine with long-term botulinum toxin: influence of non-pharmacological measures
Get PDFIntroduction: Botulinum toxin has proven to be a highly effective treatment for chronic migraine, although individual responses can be influenced by various factors, particularly non-pharmacological measures. Objective: report a case of long-term application of botulinum toxin for chronic migraine accompanied in a public health tertiary center with best response after optimization of non-pharmacological treatment. Case report: a 36-year woman with chronic migraine was first evaluated in our center in 2012. At that time, various pharmacologic prophylactic classes were tried, but she remained refractory. Following the PREEMPT protocol, botulinum toxin treatment was initiated, starting with the first session in November 2012, which resulted in a 50% reduction in headache days. Over the course of 34 sessions, administered at intervals ranging from 12 to 40 weeks, she experienced benefits lasting 1.5 to 2 months per session, with gradually new worsening of headaches after this period, attributed to factors such as excessive use of analgesics, psychiatric comorbidities, and extended intervals between injections during the pandemic. Medications were adjusted and occasionally peripheral nerve blocks were performed. Adverse effects were minimal, consisting mainly of transient local pain and cervical discomfort following a single session. Before the 33th session, she started on physical activities, with longer duration response (3,5 months). In the 34th session, she had intensified physical activities due to recent diabetes diagnosis. Four months later, she had a pain-free period of 3 months, with pain return in low frequency (once a week), promptly resolved after changing use of atenolol to propranolol. In the later sessions, she was also being adequately treated for psychiatric and sleep disorders, and the protocol was interrupted. Conclusion: real world studies have shown long-term efficacy and safety of botulinum toxin in chronic migraine. In this case, response to injections was influenced by excessive use of analgesic and uncontrolled psychiatric and sleep disorders, and it was decided to maintain the protocol for a long time. However, sustained response was observed only after a regular physical activity planning, illustrating how the non-pharmacological treatment can drastically affect the individual response to botulinum toxin, even in refractory cases with multiple applications