Estratégias para o treino da mastigação e deglutição em indivíduos com disfunção temporomandibular e dor orofacial: uma revisão de escopo / Strategies to train mastication and swallowing in individuals with temporomandibular disorder and orofacial pain: a scoping review

RESUMO Objetivo identificar e sintetizar evidências sobre estratégias utilizadas no treino da mastigação e deglutição em indivíduos com disfunção temporomandibular e dor orofacial. Estratégia de pesquisa revisão de escopo desenvolvida com consulta nas bases de dados MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS e ColecionaSUS (via BVS), Scopus, CINAHL, Embase, Web of Science, Cochrane e na literatura cinzenta: Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), OpenGrey e Google Acadêmico. Critérios de seleção estudos quantitativos ou qualitativos, sem limite temporal e sem restrição de idioma, que continham os seguintes descritores ou palavras-chave: Articulação Temporomandibular, Síndrome da Disfunção da Articulação Temporomandibular, Transtornos da Articulação Temporomandibular, Dor Facial, Mastigação, Deglutição, Terapêutica, Terapia Miofuncional e Fonoaudiologia. Na primeira etapa, dois revisores fizeram a triagem independente dos estudos, por meio da leitura dos títulos e resumos. Na segunda etapa, os revisores leram, independentemente, os documentos pré-selecionados na íntegra. Em caso de divergência, um terceiro pesquisador foi consultado. Resultados as 11 publicações incluídas foram publicadas entre 2000 e 2018. As estratégias mais utilizadas foram o treino da mastigação bilateral simultânea, seguido da mastigação bilateral alternada. Na deglutição, foi proposto aumento do tempo mastigatório para reduzir o alimento em partículas menores e lubrificar melhor o bolo alimentar e treinos com apoio superior de língua. Conclusão o treinamento funcional demonstrou efetividade na reabilitação dos pacientes, embora não siga uma padronização e não seja realizado de forma isolada. Os estudos encontrados apresentam baixo nível de evidência. Considera-se fundamental a realização de estudos mais abrangentes e padronizados, como ensaios clínicos randomizados.

ABSTRACT Purpose To identify and synthesize evidence on strategies used to train chewing and swallowing in individuals with temporomandibular disorder and orofacial pain. Research strategy Scoping review conducted by search in MEDLINE, LILACS, BBO, IBECS, BINACIS, CUMED, SOF, DeCS, Index Psi, LIPECS, and ColecionaSUS (via VHL), Scopus, CINAHL, Embase, Web of Science, Cochrane, and the grey literature: Brazilian Digital Theses and Dissertations Library (BDTD), OpenGrey, and Google Scholar. Selection criteria Quantitative or qualitative studies, with no restriction on time or language of publication, with the following descriptors or keywords: Temporomandibular Joint; Temporomandibular Joint Dysfunction Syndrome; Temporomandibular Joint Disorders; Facial Pain; chewing (Mastication); swallowing (Deglutition); Therapeutics; Myofunctional Therapy; Speech, Language and Hearing Sciences. In the first stage, two reviewers independently screened the studies by title and abstract reading. In the second stage, the reviewers independently read the preselected documents in full text. In case of divergences, a third researcher was consulted. Results The 11 documents included in the review were published between 2000 and 2018. The mostly used training strategies were simultaneous bilateral mastication/chewing, followed by alternating bilateral mastication. In swallowing, increased mastication time was proposed to break food into smaller bits and better lubricate the bolus; training with upper tongue support was also indicated. Conclusion Functional training proved to be effective in rehabilitation, although it was not standardized or performed alone. The studies had low levels of evidence. It is essential to conduct more encompassing and standardized studies, such as randomized clinical trials.

Can fatigue predict walking capacity of patients with Parkinson's disease? / A fadiga pode predizer a mobilidade e a capacidade de marcha em pacientes com doença de Parkinson?

ABSTRACT Although fatigue is an expressive symptom of Parkinson's disease (PD), few studies have investigated the association between fatigue, mobility and walking capacity of these patients. Objective: To investigate whether fatigue is an independent factor associated with mobility and the walking capacity in patients with PD. Methods: Forty-eight patients with PD (22 with fatigue) were tested for mobility and their walking capacity: Timed Up and Go (TUG), 10-Meter Walk Test (10MWT) at usual and fastest speed, and 6-Minute Walk Test (6MWT). Fatigue was measured with Parkinson's Fatigue Scale (PFS-16). Linear regression analysis was used to investigate if fatigue is an independent factor contributing to variance in mobility and walking capacity. Results: There was a positive correlation between PFS-16 and TUG (rs=0.385; p=0.007). There was a negative correlation between PFS-16 and 10MWT at comfortable (r=-0.385; p=0.007) and fast speeds (r=-0.396; p=0.005), and 6MWT (r=-0.472; p=0.001). Linear regression analysis revealed that fatigue did not explain the variance of TUG and 10MWT. PFS-16, age and section III of UPDRS explained 49.6% (adjusted R2; p<0.001) variance in the 6MWT, and fatigue was the most significant predictor (F=-32.1; p=0.022). Conclusions: Fatigue is an independent factor contributing to the distance covered during 6MWT in patients with PD. Our results highlight the importance of recognition and management of this symptom.

RESUMO Embora a fadiga seja um sintoma importante na doença de Parkinson (DP), poucos estudos investigaram a associação entre fadiga, mobilidade e capacidade de marcha nesses pacientes. Objetivo: Investigar se a fadiga é um fator independente associado à mobilidade e à capacidade de marcha em pacientes com DP. Métodos: Quarenta e oito pacientes com DP (22 com fadiga) foram avaliados com testes de mobilidade e capacidade de marcha: Timed Up and Go (TUG), Teste de Caminhada de 10 metros (T10m) na velocidade usual e máxima, Teste de Caminhada de Seis Minutos (TC6m). A fadiga foi medida pela Escala de Fadiga no Parkinson (PFS-16). A análise de regressão linear foi utilizada para investigar se a fadiga é um fator independente que contribui para a variação na mobilidade e capacidade de marcha. Resultados: Houve correlação positiva entre PFS-16 e TUG (rs=0,385; p=0,007). Houve correlação negativa entre PFS-16 e T10m na velocidade usual (r=-0,385; p=0,007) e máxima (r=-0,396; p=0,005) e TC6m (r=-0,472; p=0,001). Análise de regressão linear revelou que a fadiga não explicava a variância do TUG e T10m. A PFS-16, a idade e a seção III da UPDRS explicaram 49,6% (R2 ajustado, p<0,001) da variância no TC6m e a fadiga foi o preditor mais significativo (F=-32,1; p=0,022). Conclusões: A fadiga é um fator independente que contribui para a distância percorrida durante o TC6m em pacientes com DP. Nossos resultados destacam a importância do reconhecimento e manejo desse sintoma.

Caracterização da dor em pacientes com doença de Parkinson / Pain characterization of Parkinson's disease patients

FUNDAMENTO: A dor é um sintoma não motor frequente em indivíduos com doença de Parkinson (DP). Pode estar associada aos sinais motores ou surgir no início da doença. Os mecanismos subjacentes à dor na DP ainda não são bem elucidados e muitos fatores podem influenciá-la, como o uso de levodopa e a presença de outros sintomas não motores, como depressão. OBJETIVOS: Descrever a prevalência e caracterizar a dor em pacientes com DP de um centro terciário referência em pesquisa e assistência clínica. MÉTODOS: Foram recrutados pacientes com diagnóstico de DP idiopática a partir do ambulatório de neurologia do Centro de Especialidades Médicas (CEM) da Santa Casa de Belo Horizonte/MG. Um questionário para coleta de dados sociodemográficos e clínicos foi aplicado. A função cognitiva, gravidade dos sinais e sintomas, depressão, distúrbios de sono e fadiga foram avaliados. A dor foi mensurada por meio do Questionário de McGill e Escala Visual Numérica. RESULTADOS: Participaram do estudo 45 pacientes, sendo que 19 (42,2%) apresentavam queixa de dor e, em sua maioria, após o diagnóstico de DP (74%). Não houve diferença entre os grupos com dor e sem dor para os parâmetros clínicos avaliados, com exceção da fadiga que foi mais prevalente (p=0,036) e mais grave (p=0,031) nos pacientes com dor. CONCLUSÃO: A dor é um sintoma prevalente em pacientes com DP atendidos no CEM. A partir dos resultados obtidos pelo McGill, observou-se que a dor crônica e profunda, acometendo principalmente os membros inferiores, com importantes aspectos sensoriais e afetivos, foi comum nos pacientes avaliados.

BACKGROUND: Pain is a common non-motor symptom in Parkinson´s Disease (PD). It can be associated to motor signs or can arise in the beginning of the disease. Mechanisms of pain in PD are not completely understood. Moreover, many factors can interfere, such as use of levodopa and presence of other non-motor symptoms as depression. OBJECTIVES: The aim of this study was to describe prevalence and characterization of pain in PD patients from a research and clinical terciary care center in Belo Horizonte, Minas Gerais, Brazil. METHODS: PD patients from the Neurology Center of Santa Casa Hospital (Belo Horizonte, MG, Brazil) were recruted. Socio-demographic and clinical data were collected. Cognitive function, severity of PD signs and symptoms, depression, sleep disturbance and fatigue were evaluated. Pain was measured by McGill Pain Questionnaire and Visual Numeric Scale (VNS). RESULTS: Forty-five PD patients participated in the study and 42,2% had pain complaints, mostly (74%) after PD diagnosis. No difference between group with pain or without pain for clinical parameters was detected, except for fatigue, which was more prevalent (p=0,036) and more severe (p=0.031) in patients with pain. CONCLUSION: Pain was very prevalent in PD patients from CEM. Results obtained from McGill showed that chronic and deep pain, mostly in lower limbs, with important physical and affective features was very common in this sample of PD patients.

Sympathetic glial cells and macrophages develop different responses to Trypanosoma cruzi infection or lipopolysaccharide stimulation

Nitric oxide (NO) participates in neuronal lesions in the digestive form of Chagas disease and the proximity of parasitised glial cells and neurons in damaged myenteric ganglia is a frequent finding. Glial cells have crucial roles in many neuropathological situations and are potential sources of NO. Here, we investigate peripheral glial cell response to Trypanosoma cruzi infection to clarify the role of these cells in the neuronal lesion pathogenesis of Chagas disease. We used primary glial cell cultures from superior cervical ganglion to investigate cell activation and NO production after T. cruzi infection or lipopolysaccharide (LPS) exposure in comparison to peritoneal macrophages. T. cruzi infection was greater in glial cells, despite similar levels of NO production in both cell types. Glial cells responded similarly to T. cruzi and LPS, but were less responsive to LPS than macrophages were. Our observations contribute to the understanding of Chagas disease pathogenesis, as based on the high susceptibility of autonomic glial cells to T. cruzi infection with subsequent NO production. Moreover, our findings will facilitate future research into the immune responses and activation mechanisms of peripheral glial cells, which are important for understanding the paradoxical responses of this cell type in neuronal lesions and neuroprotection.

Short-term therapy with simvastatin reduces inflammatory mediators and heart inflammation during the acute phase of experimental Chagas disease

Trypanosoma cruzi infection induces progressive cardiac inflammation that leads to fibrosis and modifications in the heart architecture and functionality. Statins, such as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, have been studied due to their pleiotropic roles in modulating the inflammatory response. Our goal was to evaluate the effects of simvastatin on the cardiac inflammatory process using a cardiotropic strain of T. cruzi in a murine model of Chagas cardiomyopathy. C57BL/6 mice were infected with 500 trypomastigotes of the Colombian strain of T. cruzi and treated with an oral dose of simvastatin (20 mg/Kg/day) for one month and inflammatory and morphometric parameters were subsequently evaluated in the serum and in the heart, respectively. Simvastatin reduced the total cholesterol and inflammatory mediators (interferon-gamma, tumour necrosis factor-alpha, CCL2 and CCL5) in the serum and in the heart tissue at 30 days post-infection. Additionally, a proportional reduction in heart weight and inflammatory infiltration was observed. Simvastatin also reduced epimastigote proliferation in a dose-dependent manner in vitro and was able to reduce blood trypomastigotes and heart amastigote nests during the acute phase of Chagas disease in vivo. Based on these data, we conclude that simvastatin exerts a modulatory effect on the inflammatory mediators that are elicited by the Colombian strain of T. cruzi and ameliorates the heart damage that is observed in a murine model of Chagas disease.