Constituent elements and characteristics of ancient acupuncture and moxibustion prescriptions: taking migraine and headache as an example / 中国针灸

The basic constituent elements of ancient acupuncture prescriptions and moxibustion prescriptions for migraine and headache are extracted and summarized. The frequency and proportion of each element are counted and its characteristics are analyzed. The basic constituent elements of ancient acupuncture and moxibustion prescriptions includes five aspects: disease symptoms (main symptoms, concurrent symptoms, etiology and pathogenesis), disease type, acupuncture and moxibustion site (acupoint name, site name, meridian name), manipulation method (acupuncture method, reinforcing and reducing method, blood pricking method, moxibustion method) and curative effect. Acupuncture and moxibustion prescriptions are essential for recording the disease symptoms, while the acupuncture and moxibustion site and manipulation methods are the two core elements of ancient acupuncture and moxibustion prescriptions, which are also the premise to ensure that acupuncture and moxibustion prescriptions have good reference value.

Bloodletting at auricular dorsal vein combined with auricular point sticking for menstrual migraine of qi stagnation and blood stasis and its effect on serum levels of E2 and 5-HT / 中国针灸

OBJECTIVE@#To observe the clinical effect of bloodletting at auricular dorsal vein combined with auricular point sticking on menstrual migraine (MM) of qi stagnation and blood stasis, and explore its possible mechanism.@*METHODS@#A total of 102 cases of MM with qi stagnation and blood stasis were randomly divided into an observation group (51 cases, 3 cases dropped off) and a control group (51 cases, 2 cases dropped off). The patients in the observation group were treated with bloodletting at auricular dorsal vein combined with auricular point sticking. The bloodletting was performed at vein at upper 1/3 of the dorsalis near the ear helix; the auricular point sticking was performed at Pizhixia (AT4), Neifenmi (CO18), Jiaogan (AH6a), Nie (AT2), Zhen (AT3), Shenmen (TF4) and Yidan (CO11). The auricular points of both ears were alternate used. From 7 days before the onset of menstruation, bloodletting at auricular dorsal vein was given once every 7 days, 3 times were taken as a course of treatment, and 1 course of treatment was given; the auricular point sticking was given once every 3 days, and 6 times of treatment were given. The patients in the control group were treated with oral administration of flunarizine hydrochloride capsules. From 7 days before the onset of menstruation, flunarizine hydrochloride was given 2 capsules per time, once a day for 3 weeks. The menstrual headache index and visual analogue scale (VAS) score of the two groups were observed before treatment, one menstrual cycle into treatment and the first and the second menstrual cycle after treatment; the migraine-specific quality of life questionnaire (MSQ) score and the serum levels of estradiol (E2) and 5-hydroxytryptamine (5-HT) were compared before treatment and one menstrual cycle into treatment; the clinical efficacy was evaluated at one menstrual cycle into treatment.@*RESULTS@#Compared before treatment, the menstrual headache index and VAS scores were reduced at one menstrual cycle into treatment and the first and second menstrual cycle after treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). Compared before treatment, the MSQ scores and the serum levels of E2 and 5-HT in the two groups were increased at one menstrual cycle into treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). The total effective rate was 95.8% (46/48) in the observation group, which was higher than 73.5% (36/49) in the control group (P<0.05).@*CONCLUSION@#Bloodletting at auricular dorsal vein combined with auricular point sticking could relieve headache intensity, improve the quality of life in patients with MM of qi stagnation and blood stasis, which may be achieved by raising the serum levels of E2 and 5-HT to improve the level of hormone in the body.

Acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache (CH).@*METHODS@#One hundred and eighty patients with episodic CH were randomly divided into a combined group (60 cases, 3 cases dropped off)，an acupuncture group (60 cases, 2 cases dropped off) and a sphenopalatine ganglion group (60 cases, 2 cases dropped off and 1 case was removed). The patients in the acupuncture group were treated with conventional acupuncture at Touwei (ST 8), Yintang (GV 24+), Yangbai (GB 14), Hegu (LI 4), etc., once a day, 6 times a week. The patients in the sphenopalatine ganglion group were treated with acupuncture at sphenopalatine ganglion, once every other day, 3 times a week. On the basis of the conventional acupuncture, the combined group was treated with acupuncture at sphenopalatine ganglion once every other day. Two weeks were taken as a course of treatment, and 3 courses of treatment were required in the 3 groups. The score of visual analogue scale (VAS), the number of headache attacks per week, the duration of each headache attack and the score of migraine-specific quality of life questionnaire version 2.1 (MSQ) were observed before and after treatment and in follow-up of 3 months after treatment. The clinical efficacy of each group was compared.@*RESULTS@#After treatment and in follow-up, the VAS score of headache, the number of headache attacks per week, the duration of each headache attack, and each various scores and the total score of MSQ of each group were lower than those before treatment (P<0.01). Except that the number of headache attacks per week in the combined group was lower than the sphenopalatine ganglion group (P<0.01), other indexes in the combined group were lower than the other two groups (P<0.05, P<0.01). The total effective rate in the combined group was 93.0% (53/57), which was higher than 75.9% (44/58) in the acupuncture group and 73.7% (42/57) in the sphenopalatine ganglion group（P<0.05, P<0.01).@*CONCLUSION@#Acupuncture at sphenopalatine ganglion combined with conventional acupuncture could reduce the degree of pain in patients with episodic CH, reduce the number and duration of headache attacks, and improve the quality of life of patients. It is more effective than simple conventional acupuncture or acupuncture at sphenopalatine ganglion alone.

Effects of therapeutic and aerobic exercise programs in temporomandibular disorder-associated headaches

Abstract Objective To assess the effects of three 8-week exercise programs on the frequency, intensity, and impact of headaches in patients with headache attributed to temporomandibular disorder (TMD). Methodology Thirty-six patients diagnosed with headache attributed to TMD participated in the study and were divided into three groups of 12 patients: a therapeutic exercise program (G1, mean age: 26.3±5.6 years), a therapeutic and aerobic exercise program (G2, mean age: 26.0±4.6 years), and an aerobic exercise program (G3, 25.8±2.94 years). Headache frequency and intensity were evaluated using a headache diary, and the adverse headache impact was evaluated using the Headache Impact Test (HIT-6). The intensity was reported using the numerical pain rating scale. These parameters were evaluated twice at baseline (A01/A02), at the end of the 8-week intervention period (A1), and 8-12 weeks after the end of the intervention (A2). Results At A1, none of the G2 patients reported having headaches, in G1, only two patients reported headaches, and in G3, ten patients reported headache. The headache intensity scores (0.3 [95% CI: -0.401, 1.068]), (0.0 [95% CI: -0.734, 0.734]) and HIT-6 (50.7 [95% CI: 38.008, 63.459]), (49.5 [95% CI: 36.808, 62.259]), significantly decreased in G1 and G2 at A1. At A2 headache intensity scores (0.5 [95% CI: -0.256, 1.256]), (0.0 [95% CI: -0.756, 0.756]) and HIT-6 (55.1 [95% CI: 42.998, 67.268]), (51.7 [95% CI: 39.532, 63.802]) in G1 and G2 haven't change significantly. The effects obtained immediately after the completion of the intervention programs were maintained until the final follow-up in all groups. Conclusion The programs conducted by G1 (therapeutic exercises) and G2 (therapeutic and aerobic exercise) had significant results at A1 and A2.

Profile and generalist physician knowledge about neurology in emergency department: headache management / Perfil e conhecimento em neurologia do médico generalista no setor de emergência: abordagem de cefaleias

Abstract Background: Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. Objective: To assess general practice physicians' level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. Methods: We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants' general knowledge on headache, neurological approach, demographic profile, and workplace profile. Results: 159 physicians answered the questionnaire. The professionals' profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. Conclusions: General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.

Resumo Introdução: Queixas neurológicas são frequentes na rotina de setores de emergência. Entre elas, a cefaleia é um distúrbio comum, que por seu diagnóstico diferencial amplo, exige certo grau de conhecimento em Neurologia. Objetivo: Avaliar o nível de conhecimento em cefaleias de médicos generalistas, além de traçar o perfil dos profissionais que atendem em setores de emergência nesta função, assim como de seus respectivos locais de trabalho em termos de abordagem neurológica. Métodos: Foram incluídos na avaliação médicos que atendem em unidades de pronto-atendimento para público adulto, na função de generalista. Um questionário foi aplicado com perguntas referentes ao conhecimento geral dos participantes sobre cefaleia, abordagem neurológica, perfil demográfico e perfil do local de trabalho. Resultados: 159 médicos responderam ao questionário. O perfil dos profissionais presentes na amostra correspondeu a indivíduos graduados recentemente (média de 6,31 anos). O conhecimento a respeito da abordagem de cefaleias foi regular. Aqueles que não possuem nenhuma especialização, nem estão cursando uma residência, se mostraram, de forma estatisticamente significativa, mais seguros no atendimento de pacientes neurológicos (p=0,006). Apenas 18,24% referiram ter acesso à Ressonância Magnética e 35,85% não tiveram acesso a nenhum tipo de neuroimagem. Conclusão: Médicos generalistas frequentemente não sentem segurança ao realizar atendimento e exame neurológicos, demonstrando pouco conhecimento acerca do assunto. O perfil dos profissionais que atuam nesses setores é predominantemente de recém graduados, o que pode impactar de alguma forma na qualidade de atendimento. Verificou-se também falta de estrutura para um atendimento adequado.

Horizontal penetration needling method for headache / 中国针灸

The manipulation and key points of professor

Prevalência de cefaleia e seus impactos em estudantes de medicina em uma universidade pública / Prevalence of headach and its effects in medical students in a public university

Cefaleia é um sintoma de alta prevalência, com importante impacto nas atividades da vida diária. Estudante de medicina é uma população vulnerável à cefaleia, tanto devido a uma carga de trabalho exaustiva, como hábitos favoráveis como a privação do sono, alimentação irregular, sedentarismo e estresse. O objetivo foi avaliar a prevalência da cefaleia e seu impacto nos estudantes de medicina de uma universidade pública de Alagoas. Foram selecionados, de forma aleatória, 97 estudantes de medicina regularmente matriculados do 1º ao 6º ano. Foi aplicado um questionário padronizado e validado contendo questões objetivas e subjetivas sobre condições sociodemográfcas e aspectos clínico-epidemiológicos. A prevalência de cefaleia foi de 95,9%. A maioria do gênero feminino (55,3%). Todos que alegaram cefaleia, a relataram em algum momento, como causa de absenteísmo e comprometimento de rendimento nos estudos. A maioria dos casos positivos afrmaram nunca ter realizado tratamento com neurologista (95,9%). 76,5% alegaram automedicação com analgésicos comuns, apresentando relevância estatística (p:0,0). Foi encontrado um percentual de prevalência maior no sexo feminino, corroborando com a literatura. Houve uma atribuição da cefaleia a períodos de maior estresse durante o semestre letivo, logo é sabido que são vários os fatores descritos como desencadeantes ou atenuantes no aparecimento. Tendo em vista o relato de absenteísmo e comprometimento de rendimento, bem como a não procura de especialista e automedicação, é necessário que haja uma orientação a estes estudantes a fm de incentivá-los à busca pelo tratamento adequado, a fm de terem uma melhor qualidade de vida.

Headache is a symptom of high prevalence, with important impact on the activities of daily living. Medical student is a vulnerable population to headache due to an exhausting workload, as well as favorable habits like sleep deprivation, irregular eating, physical inactivity and stress. The objective was to evaluate the prevalence of headache and its impact on medical students at a public university in Alagoas. 97 medical students from the 1st to the 6th grade were randomly selected. A standardized and validated questionnaire containing objective and subjective questions about sociodemographic conditions and clinical-epidemiological aspects was applied. The prevalence of headache was 95.9%. The majority was female gender (55.3%). All the positives cases reported the headache as a cause of absenteeism and impaired performance in the studies, it at some point. Most of the positive cases reported never having treated with a neurologist (95.9%). 76.5% claimed self-medication with common analgesics, presenting statistical relevance (p: 0.0). A higher prevalence rate was found in females, corroborating with the literature. There was an attribution of headache to periods of greater stress during the school semester, so it is well known that several factors are described as triggering or attenuating. In view of the report of absenteeism and academic performance impairment, added to a non-search of medical care and and self-medication, it is necessary to provide guidance in order to encourage these students to seek appropriate treatment and then achieve a better quality of life.

A review of 50 cases of bath-related headache: clinical features and possible diagnostic criteria / Uma revisão de 50 casos de cefaleia relacionada ao banho: características clínicas e possíveis critérios diagnósticos

ABSTRACT Objective: To describe clinical features and possible diagnostic criteria of the 50 bath-related headache (BRH) cases that have been published in the literature to date. Methods: Based on a literature search in the major medical databases, we analyzed all case reports or case series on BRH that were published between 2000 and 2017. Results: We describe 48 women and two men diagnosed with BRH. Of these 50 patients, 90% were from Asian countries. The average age was 49.3 years. There was an association of BRH with migraine (28%), tension-type headache (12%) and cold stimulus headache (4%). Headache was bilaterally localized, had an explosive or pulsating quality and a severe intensity. The pain lasted from five minutes to four days. Associated manifestations were nausea, vomiting, photophobia or phonophobia. There was a good therapeutic response with nimodipine and when avoiding a hot bath. Conclusions: Bath-related headache is a benign headache that is not associated with a structural lesion.

RESUMO Objetivo: Descrever as características clínicas e possíveis critérios diagnósticos dos 50 casos de cefaleia relacionada ao banho (CRB) que foram publicados na literatura até agora. Métodos: Com base em uma pesquisa de literatura nas principais bases de dados médicos, analisamos todos os relatos de casos ou séries de casos sobre BRH que foram publicados entre 2000 e 2017. Resultados: Descrevemos 48 mulheres e 2 homens diagnosticados com CRB. Destes 50 pacientes, 90,0% eram asiáticos. A média de idade foi 49,3 anos. Houve associação com migrânea (28,0%), cefaleia do tipo tensional (12,0%) e cefaleia por estímulo frio (4,0%). A cefaleia foi localizada bilateralmente, explosiva ou pulsátil e de forte intensidade. A dor durou de 5 minutos a 4 dias.As manifestações associadas foram náuseas, vômitos, fotofobia ou fonofobia. Houve uma boa resposta terapêutica com nimodipina e evitando-se banho quente. Conclusões: CRB é uma cefaleia benigna não associada com lesão estrutural.

Angiomas venosos y cefalea en pediatría: un caso clínico / Venous angiomas and headache in children: A case report

Introducción: Los angiomas venosos (AV) son entidades benignas que infrecuentemente presentan síntomas. Objetivo: Reporte de un caso y revisión del tema. Caso clínico: Escolar, de sexo femenino, 6 años, que inicia cefaleas bifrontales frecuentes 3-4 veces por semana, en relación con trabajo académico, de carácter opresivo, no pulsátil, sin náuseas ni vómitos, rango de intensidad entre 4-6/10. Se inició manejo con calendario de cefaleas, apoyo escolar y evaluación psicológica. La tomografía computarizada cerebral solicitada informó de angioma venoso de núcleo caudado izquierdo, razón por la cual se realizó una resonancia magnética cerebral más angiorresonancia que confirmó angioma venoso y excluyó complicación o asociación a otra malformación vascular. La cefalea respondió bien a terapia psicopedagógica y psicológica. La frecuencia de cefaleas disminuyó a 10-12 al año, agrupadas en periodos de mayores demandas académicas. La paciente es controlada durante 12 años, hasta el egreso de la enseñanza media, sin complicaciones y con un buen manejo de la cefalea tensional. Conclusión: En el estudio de una cefalea el hallazgo de un AV puede ser incidental; una vez reunidos los criterios internacionales de cefalea tensional e iniciado el tratamiento para ello, la monitorización de los AV debe ser clínica. Las complicaciones del AV son infrecuentes y el tratamiento quirúrgico es excepcional.

Introduction: Venous angiomas (VA) are benign entities; however infrequent symptomatic cases may occur. Objective: Case report and literature review. Case report: A 6 year old girl was referred with a history of bi-frontal, non-pulsatile, headache with no nausea or vomiting. Headache intensity was 4-6/10. The episodes were frequent, 3-4 times per week. Triggers include academic work. Computed tomography showed a small VA in left caudate nucleus, which was confirmed by a brain MRI, with no evidence of inflammatory or ischaemic changes, or another vascular malformation. Psychological and psycho-pedagogic techniques were used, combined with relaxation and cognitive-behavioural techniques to reduce the intensity and frequency. There was a good outcome, and the headache decreased to 10 episodes per year. The patient was monitored for 12 years until graduation from high school. The VA remained without complications. Conclusions: In the study of a headache, a VA usually is an incidental finding. The International Classification of Headache Disorders III provides specific criteria of frequent episodic tension-type headache, and allows us begin specific therapy for it. Monitoring of non-symptomatic VA cases should be clinical. The surgical management of these entities is exceptional.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain / Tratamento com radiofrequência pulsada para gânglio esfenopalatino em pacientes com dor crônica de face e cabeça

PURPOSE: There are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. METHODS: Infrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25-0.5 ms pulse width was applied for sensory stimulation at frequencies from 50 Hz to 1 V. Paraesthesias were exposed at the roof of the nose at 0.5-0.7 V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2 Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120 s at a temperature of 42 °C. RESULTS: Pain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. CONCLUSION: Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

OBJETIVO: Existem várias síndromes de dor facial, incluindo neuralgia trigeminal, dor neuropática trigeminal e síndromes atípicas de dor facial. A eficácia da radiofrequência pulsada (RFP) para o manejo de várias síndromes de dor foi claramente demonstrada. Há um número limitado de estudos sobre o tratamento com RFP para gânglio esfenopalatino (GEP) em pacientes que sofrem de dor facial e de cabeça. O objetivo deste estudo foi avaliar a satisfação do tratamento com PRF em nossos pacientes, retrospectivamente. MÉTODOS: A abordagem infrazigomática foi usada para a RFP do GEP sob orientação fluoroscópica. Depois de a ponta da agulha atingir o ponto alvo, pulsos de 0,25 a 0,5 ms foram aplicados para a estimulação sensorial em frequências de 50 Hz a 1 V. Parestesias foram expostas no teto do nariz em 0,5 a 0,7 V. Para excluir o contato trigeminal que levou à contração mandibular rítmica, a estimulação motora foi aplicada na frequência de 2 Hz. Em seguida, quatro ciclos de RFP foram feitos durante 120 segundos a uma temperatura de 42 °C. RESULTADOS: O alívio da dor não foi obtido em 23% dos pacientes (inaceitável); enquanto a dor foi totalmente aliviada em 35% dos pacientes (excelente) e o alívio de leve a moderado da dor foi obtido em 42% dos pacientes (bom), com o tratamento RFP-GEP. CONCLUSÃO: RFP para GEP é eficaz no tratamento de pacientes que sofrem de dor crônica intratável, facial e de cabeça, como mostrado por nossas descobertas. Estudos prospectivos, randômicos e controlados são necessários para confirmar a eficácia e segurança dessa nova modalidade de tratamento para dor crônica facial e de cabeça.

Cefalea y síndromes equivalentes en Medicina Tradicional China: abordaje y manejo / Headache and equivalent syndromes in Traditional Chinese Medicine: boarding and management

La cefalea es una patología muy común que aqueja a la humanidad, afectando la calidad de vida y potencialmente llevando en muchos casos a desenlaces fatales como apoplejía y muerte; fuera de la medicina occidental, hay otros sistemas médicos complejos que la abordan de manera particular, en este caso la Medicina tradicional China, que es una medicina con aproximadamente dos mil años de existencia que ha tenido creciente aceptación en occidente en los últimos años. La medicina occidental, enraizada en el método determinista cartesiano de cuatrocientos años de evolución, va al origen neurobiológico de la cefalea determinando su causa y por ende dando corrección; la medicina China que es un sistema holístico, se centra en determinar el desequilibrio energético de todo un organismo. La medicina occidental se basa últimamente en la medicina de evidencia para dar el tratamiento a cada uno de los componentes de la cefalea, mientras que la medicina tradicional China se basa en el tratamiento del desequilibrio visto en la fase de abordaje del paciente. En la medicina occidental, la cefalea es tratada con medicamentos químicos; en la medicina China, la cefalea es tratada por variados métodos como son la acupuntura, la herbolaria, el Qigong entre otros. También se puede utilizar la acupuntura de forma alopática utilizando otros medios complementarios como la auriculopuntura; Es necesario desarrollar estudios de buena calidad para demostrar a la luz del conocimiento occidental la efectividad de la medicina tradicional China en el manejo de la cefalea.

Caracterización clínica del brote epidémico de dengue en el Hospital Militar Central " Luis Díaz Soto" / Clinical characterization of an epidemic dengue outbreak in ¨Luis Diaz Soto ¨ central military hospital

INTRODUCCIÓN: ante un paciente febril, la sospecha de dengue depende de los elementos clínicos, por lo que debe existir un claro dominio de los síntomas y signos que caracterizan esta enfermedad. OBJETIVO: determinar el patrón febril que caracteriza a estos pacientes, al definir los síntomas y signos más frecuentes y caracterizar el movimiento de los parámetros hematológicos empleados. MÉTODOS: se realizó un estudio observacional, transversal y retrospectivo. Se incluyeron pacientes ingresados con sospecha de dengue en la sala del Hospital Militar Central "Luis Díaz Soto", de noviembre de 2013 a febrero 2014. Se dividieron en dos grupos según fuera positiva o no la prueba de IgM (IgM+, IgM-). Se compararon ambos grupos de acuerdo a variables clínicas y de laboratorio. RESULTADOS: se estudiaron 75 pacientes; 38 resultaron positivos para IgM. La fiebre en el grupo IgM+ duró como promedio 3,3 días (desviación estándar de 1,11) contra 2,9 días en el grupo IgM- (desviación estándar 1,44). La curva febril fue semejante en ambos grupos. La cefalea (38 casos, 100 %), el dolor retro-orbitario (28 casos, 73,7 %) y las artromialgias (34 casos, 89,5 %) fueron más frecuentemente observados entre los pacientes con dengue. La prueba del lazo positiva (12 casos, 31,6 %) fue el único signo que mostró un predominio entre los casos con dengue. El conteo de leucocitos y plaquetas fue menor en los pacientes IgM+. CONCLUSIONES: la fiebre tuvo un comportamiento indistinguible de otras virosis inespecíficas. La prueba del lazo fue el único elemento clínico significativamente asociado al dengue. El conteo de leucocitos y plaquetas presentó valores inferiores entre los pacientes con dengue.

INTRODUCTION: when faced with a febrile patient, the suspicion of dengue depends on the clinical elements, so it is necessary to have good knowledge of the symptoms and signs of this disease. OBJECTIVE: to determine the febrile pattern of these patients, to define the most frequent symptoms and signs and to characterize the shift of the hematological parameters. METHODS: a retrospective, observational and cross-sectional study was conducted. It included those patients admitted to ¨Luis Díaz Soto¨ military hospital wards, who were suspected of dengue in the period of November 2013 to February 2014. They were divided into 2 groups according to the positivity or negativity results of the IgM testing (IgM+, IgM-). Both groups were compared on account of clinical and laboratory variables. RESULTS: seventy five patients were tested; 38 showed positive to IgM. The IgM-positive group fever lasted 3.3 days as average (SD 1.11) compared to that of the IgM-negative group with 2.9 days (SD 1.44). The febrile curve was similar in both groups. Headache (38 cases, 100%), retrorbital pain (28, 73.7%) and arthromyalgia (34, 89.5%) were the most frequently observed symptoms. The positive tourniquet test was the only predominant sign in these patients. The leukocyte and platelet count was lower in IgM-positive patients. CONCLUSIONS: fever behaved in a similar way as in other unspecific virus epidemics. The Rumpel-Leede tourniquet test was the only clinical element that significantly related to dengue. The leukocyte and platelet counts were lower in dengue patients.

Autoavaliação do estado de saúde e fatores associados: um estudo em trabalhadores bancários / Self-assessment of health status and associated factors: a study in bank workers / Autoevaluación del estado de salud y factores asociados: un estudio en empleados del banco

O objetivo deste trabalho foi verificar como trabalhadores bancários avaliam seu estado de saúde e os principais fatores associados a esse indicador nessa população. Trata-se de um estudo transversal com 525 funcionários de uma rede bancária do Estado do Espírito Santo, Brasil. A magnitude das associações foi avaliada através de regressão logística hierarquizada em níveis. Verificou-se que 17% (n = 87) dos bancários autoavaliaram seu estado de saúde como regular ou ruim. Estiveram associados à pior autoavaliação de saúde o reduzido nível socioeconômico (OR = 1,80; IC95%: 1,06-3,05), o estilo de vida sedentário (OR = 2,64; IC95%: 1,42-4,89), o excesso de peso (OR = 3,18; IC95%: 1,79-5,65), o baixo apoio social (OR = 3,71; IC95%: 2,10-6,58) e a presença de doenças crônicas (OR = 5,49; IC95%: 2,46-12,27). Concluiu-se que, comparado com outras localidades, houve um expressivo número de bancários que autoavaliaram seu estado de saúde como regular ou ruim, e que a presença de doenças crônicas apresentou-se como o fator de maior impacto sobre a forma como o indivíduo avalia sua própria saúde.

The aim of this study was to determine how bank employees assess their health status and risk factors associated with this indicator in this population. This is a cross-sectional study involving 525 workers of a banking system in the State of Espírito Santo, Brazil. The magnitude of the associations was assessed using logistic regression hierquizada in levels. It was found that 17% (n = 87) of bank self-rated their health status as fair or poor. Were associated with worse self-assessed health of the low socioeconomic level (OR = 1.80; 95%CI: 1.06-3.05), the sedentary lifestyle (OR = 2.64; 95%CI: 1.42-4.89), the excess weight (OR = 3.18; 95%CI: 1.79-5.65), low social support (OR = 3.71; 95%CI: 2.10-6.58), and the presence of chronic diseases (OR = 5,49; 95%CI: 2.46-12.27). It is concluded that, compared with other locations, there was a significant number of banking that self-rated their health status as fair or poor, and that the presence of chronic diseases was presented as the factor with the greatest impact on how the individual evaluates their own health.

El objetivo de este estudio fue investigar cómo los empleados del banco a evaluar su estado de salud y factores de riesgo asociados a este indicador en esta población. Se trata de un estudio transversal con 525 trabajadores de un sistema bancario en el estado de Espírito Santo, Brasil. La magnitud de las asociaciones se evaluó mediante regresión logística hierquizada en niveles. Se encontró que 17% (n = 87) de los trabajadores del banco auto-calificaron su estado de salud como regular o mala. Se asociaron con la salud autopercibida peor del bajo nivel socio-económico (OR = 1,80; IC95%: 1,06-3,05), el sedentarismo (OR = 2,64; IC95%: 1,42-4,89), el exceso de peso (OR = 3,18; IC95%: 1,79-5,65), el baja apoyo social (OR = 3,71; IC95%: 2,10-6,58), y la presencia de enfermedades crónicas (OR = 5,49; IC95%: 2,46-12,27). Se concluye que, en comparación con otros lugares, hubo un número significativo de la banca que la auto-calificaron su estado de salud como regular o mala, y que la presencia de enfermedades crónicas se presenta como el factor de mayor impacto en cómo los evalúa individuales su propia salud.

Cefaleia em salvas: uma cefaleia desafiante / Cluster headache: a challenging headache

Introdução: a cefaleia em salvas (CS) é um subtipo de cefaleia primária caracterizado por crises de dor entre 15 e 180 minutos diárias por semanas a meses, geralmente intercalados por períodos de remissão. As crises álgicas são muito intensas, de localização orbital ou periorbital, associadas à sintomatologia de disfunção autonômica. Apesar de sua singular apresentação clínica, a CS permanece afecção pouco reconhecida e subdiagnosticada. Objetivos: descrever e discutir os desafios diagnósticos e terapêuticos da CS a partir de casos clínicos. Material e método: trata-se de uma série de cinco casos de CS em acompanhamento clínico. Resultados: dos 467 pacientes assistidos em ambulatório neurológico, cinco possuíam diagnóstico de CS, correspondendo a 1,07% do total. A apresentação clínica variou pouco em relação à descrição da literatura, com predomínio em homens e da forma episódica, além de haver grande latência entre seu surgimento e o diagnóstico. Conclusão: mesmo em centro terciário de atendimento neurológico, o número de pacientes diagnosticados é pequeno, colaborando para o desconhecimento a respeito da CS, o que contribui para o seu atraso diagnóstico e tratamento específico.

Introduction: cluster headaches (CS) are a subtype of primary headache disorder characterized by daily pain attacks of 15-180 minutes for weeks to months, usually interspersed with periods of remission. Painful crises are very intense, of periorbital or orbital location, associated with symptoms of autonomic dysfunction. Despite its unique clinical presentation, CS remains under-recognized and underdiagnosed. Objectives: To describe and discuss the diagnostic and therapeutic challenges of CS based on clinical cases. Methods: this is a series of fivecases of CS under clinical monitoring. Results: Of the 467 patients treated at the neurological clinic five had a diagnosis of CS, corresponding to 1.07% of the total. The clinical presentation varied little in relation to the description in the literature; it affected predominantly men, episodically. Time elapsed between onset and diagnosis was usually long. Conclusion: Even in a tertiary care neurological center, the number of diagnosed patients is small, which reflects on ignorance about CS and contributes to late diagnosis and lack of specific treatment.

Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses. AIM: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques. METHOD: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure. DISCUSSION: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months. CONCLUSION: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective...

Cefaleias na infância e adolescência / Headaches in childhood and adolescence

A cefaleia é uma das queixas mais frequentes em crianças e adolescentes e possui dificuldades diagnósticas específicas na população pediátrica. Nesta revisão é apresentada uma síntese dos conhecimentos disponíveis sobre a classificação, diagnóstico e tratamento das cefaleias na infância, com ênfase nas formas mais prevalentes e suas peculiaridades na população pediátrica.

Evaluation of the analgesic activity of the methanolic stem bark extract of dialium guineense (wild)

Background: Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State; Nigeria for treatment of fever; headache and other diverse ailments. Objectives: The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Method: Acetic acid-induced abdominal constriction or writhing; tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250; 500; 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug; acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. Result: In the acetic acid-induced writhing reflex model; D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0in the negative control group to 71at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Conclusion: Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism

Cefaléia hípnica em adulto jovem: relato de caso / Hypinic headache in young adult: case report

A cefaléia hipnica é um distúrbio extremamente raro, com critérios diagnósticos bem estabelecidos e que apresenta resposta terapêutica a medicações que não são de emprego usual no tratamento de cefaléia. Relatamos o caso de um paciente masculino de 46 anos que foi tratado com carbonato de lítio com excelente resultado.

The hypnic headache is extremely rare, with established diagnostic criteria, and has therapeutic response to medications that have unusual employment in the treatment of headache. We report a case of a 46 years old male patient who was treated with lithium with excellent results.

General practice physician knowledge about headache: evaluation of the municipal continual medical education program / Conhecimento dos médicos generalistas sobre cefaléias: avaliação de um programa municipal de educação médica continuada

OBJECTIVE: Headache is a common condition not always managed satisfactorily by primary care providers (PCPs). In an effort to improve headache care, the Curitiba City Hall in consortia with Hospital de Clínicas da Universidade Federal do Paraná - Brazil developed an educational program directed to the PCPs. The goal of the project was to evaluate, to update and to train the PCP on headache knowledge and care. METHOD: The program was designed to have a theoretical phase and a practical phase. Knowledge on headache and medical care of headache were surveyed before and after the theoretical phase thorough a specific questionnaire. RESULTS: Significant improvement in post-CME scores on headache prevalence (p<0.001), migraine diagnosis (p<0.001) and management (p=0.01), secondary headache diagnosis (p=0.005) and management (p=0.005) was reached by the respondents. CONCLUSION: Improvement in post-CME scores confirms that the program had a significant immediate impact on the PCPs knowledge directly affecting the patient's health.

OBJETIVO: Cefaléia é uma condição comum nem sempre tratada de forma adequada pelos médicos generalistas (MG). Com o objetivo de melhorar essa situação, a Prefeitura de Curitiba em parceria com o Hospital de Clínicas da Universidade Federal do Paraná - Brasil desenvolveu um programa para os MG. O objetivo principal desse projeto foi avaliar, atualizar e capacitar médicos a respeito do conhecimento e manejo das cefaléias. MÉTODO: O programa consistiu de uma fase teórica e uma fase prática. O conhecimento sobre cefaléia e seu manejo foi avaliado através de um questionário específico antes e depois da fase teórica. RESULTADOS: Significativa melhora no pós-teste nos itens de prevalência de cefaléias (p<0,001), diagnóstico de migrânea (p<0,001) e seu manejo (p=0,01), diagnóstico de cefaléia secundária (p=0,005) e seu manejo (p=0,005) foram alcançados pelos participantes. CONCLUSÃO: Melhorias na pontuação dos pós-testes confirmam que o programa teve um impacto imediato e significante no conhecimento dos MG afetando diretamente a saúde dos pacientes.