ABSTRACT
The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5 percent. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.
O objetivo deste estudo piloto foi avaliar a eficácia do uso de uma terapia cognitivo comportamental (TCC) e da amitriptilina, um antidepressivo tricíclico, no tratamento de pacientes portadores de disfunções temporomandibulares (DTM) crônicas. Quarenta e sete mulheres (com 35,4 anos em média) diagnosticadas com DTM crônica foram selecionadas e divididas em 4 grupos: amitriptilina; amitriptilina + TCC; placebo + TCC; e placebo (controle) e controle. As pacientes foram submetidas às terapias por 7 semanas consecutivas. As reavaliações aconteceram 1, 7 e 11 semanas após o início da terapia (11 semanas de avaliações). Foram avaliados a presença e severidade de dor, o nível de depressão, a qualidade de vida e do sono. Os dados foram avaliados através de ANOVA, Qui-quadrado e teste de Cochran, considerando um nível de significância de 5 por cento. Foram observadas melhoras significantes em todos os fatores avaliados para todos os grupos, porém não foram observadas diferenças entre os grupos. Após o final da terapia, os resultados positivos persistiram apenas para o grupo amitriptilina + TCC. Os resultados sugerem que o uso associado de amitriptilina e TCC no tratamento de pacientes portadores de DTM crônicas pode ser efetivo na melhora da dor, nível de depressão, qualidade de vida e do sono.
Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Amitriptyline/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Cognitive Behavioral Therapy , Temporomandibular Joint Disorders/therapy , Chronic Pain/classification , Chronic Pain/drug therapy , Chronic Pain/therapy , Depression/classification , Depression/drug therapy , Depression/therapy , Follow-Up Studies , Pain Measurement , Pilot Projects , Placebos , Quality of Life , Sleep Initiation and Maintenance Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/therapy , Sleep/drug effects , Sleep/physiology , Treatment Outcome , Temporomandibular Joint Disorders/classification , Temporomandibular Joint Disorders/drug therapyABSTRACT
CONTEXT: There is still controversy as to the use and dosage of antimicrobial prophylaxis of the urinary infection associated with urethral catheterization in the post renal transplant period. OBJECTIVE: To determine whether patients develop urinary infection during short-term urethral catheterization after renal transplant without routine antimicrobial prophylaxis. DESIGN: Prospective study. SETTING: Kidney Transplantation Unit. SAMPLE: 20 patients submitted to non-complicated kidney transplant, with a normal urinary tract and no risk factors present regarding urinary infection. Aged 15 to 65 years. MAIN MEASUREMENTS: Before the transplant, material from the urethral meatus and urine were collected for culture. After the transplant, in the period during which the patient was with short-term urethral catheterization (4 to 5 days), material from the urethral meatus and urine from the bladder and the collecting bag were taken daily from all recipients for culture. RESULTS: There was a predominance of coagulase-negative Staphylococcus and S. viridans in the normal urethral meatus flora and in the first two days of urethral catheterization. After the second day, there was a predominance of E. coli and E. faecalis. Urinary infection did not occur during the period of urethral catheterization. In the follow up only one female patient (7 percent) had asymptomatic bacteriuria caused by E.coli after the withdrawal of the urethral catheter. CONCLUSIONS: Infection urinary does not occur during the period of urethral catheterization in kidney post-transplant patients. Thus, antimicrobial prophylaxis is not recommended for these patients to prevent urinary infection