ABSTRACT
La displasia fibrosa (DF) es una enfermedad infrecuente del hueso, no hereditaria, producida por una mutación activadora del gen GNAS, responsable de codificar la unidad a-estimuladora de la proteína G (Gsa). La presentación clínica de la enfermedad es muy variada, pues adopta desde formas asintomáticas hasta otras marcadamente sintomáticas. En los últimos años, el análisis exhaustivo de bases de datos de pacientes con DF ha permitido conocer más sobre su historia natural. En este artículo se revisa la información actualmente disponible sobre algunos aspectos que ayudarán al mejor enfoque clínico del paciente, como son: la utilidad clínica de los marcadores óseos, los factores pronósticos para el desarrollo de fracturas, la DF como condición predisponente para el desarrollo de tumores específicos, nuevas perspectivas sobre la fisiopatología del dolor óseo y nuevas estrategias terapéuticas. Un mayor conocimiento sobre la historia natural de esta enfermedad finalmente redundará en la mejor calidad de vida de los pacientes con DF. (AU)
Fibrous dysplasia (FD) is an infrequent, non-hereditary bone disease caused by a somatic mutation of the GNAS gene, responsible for encoding the a-subunit of the G-protein (Gsa). The clinical presentation of the disease varies greatly, with some patients being asymptomatic and others markedly symptomatic. The exhaustive analysis of the database from patients with FD has allowed to learn more about the natural history of this disease. This article reviews the current information available on the clinical utility of bone markers, the prognostic factors for the occurrence of fractures, the evidence supporting as a predisposing condition for the development of specific tumors, new perspectives on the pathophysiology of bone pain, and emerging therapeutic strategies. A greater understanding of the natural history of this disease will allow to make better medical decisions, which will ultimately contribute to improve FD patients' quality of life. (AU)
Subject(s)
Humans , Musculoskeletal Pain/physiopathology , Fibrous Dysplasia of Bone/etiology , Quality of Life , Tamoxifen/therapeutic use , Breast Neoplasms/complications , Breast Neoplasms/drug therapy , Biomarkers , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Diphosphonates/therapeutic use , Fractures, Bone/complications , Fractures, Bone/prevention & control , Musculoskeletal Pain/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Fibrous Dysplasia of Bone/diagnosis , Fibrous Dysplasia of Bone/physiopathology , Fibrous Dysplasia of Bone/therapy , Denosumab/administration & dosage , Denosumab/therapeutic use , Narcotics/therapeutic useABSTRACT
Pain is an individual and subjective experience, recognized as an important public health issue. Further, pain is a complex phenomenon which needs a transdisciplinary approach. Objective: To describe the epidemiological characteristics of patients admitted in a Pain Unit. Methods: We performed an observational prospective study that analyzed the medical records of patients who attend the Pain Clinic, at the Rehabilitation Unit in the University of Chile Clinical Hospital, between April 2012 and April 2013. Results: Women are more frequently affected by pain (78.50 percent), with a mean age of 54 years old. The mean duration of pain was 1.76 years and the most common presentation was low-backache (54.21 percent) with moderate intensity. Most of the patients were taking painkillers (75.70 percent), preferably aracetamol and NSAIDs. 47.66 percent suffered from mixed pain and a 92.52 percent manifested chronic pain. Myofascial pain and osteoarthritis were the more frequent causes. After admission, a more appropriated treatment was prescribed in all of the patients, most of them consisting in opioids and antiepileptic drugs, associated with interventional techniques (60.75 percent). As a consequence, 67.09 percent of the patients had a significant decrease in pain intensity. Conclusion: It is necessary to generate epidemiological research lines that support health policies and allows a transdisciplinary pain management...
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Aged, 80 and over , Pain Clinics/statistics & numerical data , Musculoskeletal Pain/epidemiology , Musculoskeletal Pain/drug therapy , Comorbidity , Pain Management/statistics & numerical data , Pain Measurement , Data Interpretation, StatisticalABSTRACT
PURPOSE: Although interest in the role played by vitamin D in bone health is increasing, little is known about the role of this vitamin in musculoskeletal pain in children. This study aimed to assess the prevalence of vitamin D deficiency in children presenting with nonspecific lower extremity pains. MATERIALS AND METHODS: From 2011 to 2012, 183 children underwent evaluation for nonspecific lower-extremity pains. Patients with valid causes, such as fractures or transient synovitis, were excluded, as were those with underlying medical conditions, such as cerebral palsy and metabolic disease. Ultimately, 140 patients met the inclusion criteria. Levels of serum 25-hydroxy vitamin D [25-(OH)D], the ideal indicator of vitamin D status, were measured in these children. RESULTS: Eighty-seven boys (62.1%) and 53 girls (37.9%) were included. The mean age at presentation was 5.2 years (range, 2-15). Serum 25-(OH)D levels were or =30 ng/mL in only 5.0%. Most patients visited the hospital in the winter (41.4%) (summer, 12.9%), and serum 25-(OH)D levels were also lowest in the winter (17.2+/-5.5 ng/mL). CONCLUSION: This study found a high prevalence of vitamin D deficiency or insufficiency in Korean children with nonspecific lower-extremity pains, indicating a positive association between vitamin D deficiency and growing pains. More attention should be directed toward vitamin D and its role in the optimization of bone health.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Asian People/statistics & numerical data , Calcifediol/administration & dosage , Cross-Sectional Studies , Musculoskeletal Pain/drug therapy , Prevalence , Republic of Korea/epidemiology , Retrospective Studies , Seasons , Vitamin D/analogs & derivatives , Vitamin D Deficiency/blood , Vitamins/administration & dosageABSTRACT
Os anti-inflamatórios não esteroides (AINEs) estão entre os medicamentos mais comumente prescritos em todo o mundo e são responsáveis por cerca de um quarto de todas as notificações de reações adversas. Têm sido amplamente indicados em pacientes com doença reumática e outras doenças musculoesqueléticas - população de maior risco de graves complicações gastrintestinais (GI). Os AINEs tópicos são administrados para o tratamento de diversas condições: lesões musculoesqueléticas, dor pós-operatória, neuralgia pós-herpética, periodontite, úlceras aftosas e ceratoses actínicas. Dados mostram que metade dos AINEs é indicada para osteoartrite (OA). Sua administração tópica oferece como benefício menor incidência de efeitos adversos sistêmicos, como úlcera péptica e hemorragia GI, na metabolização do medicamento nos tecidos afetados...
Nonsteroidal anti-inflammatory are among the drugs more usually prescribed in all over the world which is responsible for about a fourth of all notifications of adverse reactions. It has been widely indicated in patients with rheumatic disease and others musculoskeletal disease - high risk population of severe gastrointestinal complications (GI). The topic AINEs are managed for the treatment of many conditions: musculoskeletal injury, postoperative pain, postherpetic neuralgy, periodontic, mouth ulcer and actinic keratosis. Data show that half of AINEs are indicated for osteoarthritis (OA). Its topic administration provides benefits like less incidence of systemic adverse effects like peptic ulcer and GI bleeding in drug-metabolizing in affected tissues...
Subject(s)
Humans , Male , Female , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Musculoskeletal Pain/drug therapy , Administration, Topical , Diclofenac/therapeutic use , Rheumatic Diseases/drug therapy , Pain, Postoperative/drug therapy , Stomatitis, Aphthous/drug therapy , /therapeutic use , Neuralgia, Postherpetic/drug therapy , Osteoarthritis/drug therapy , Musculoskeletal System/injuriesABSTRACT
Objetivo: Estudar a automedicação para dor entre estudantes de cursos de medicina e enfermagem da PUCSP em comparação com estudantes das outras áreas de conhecimento. Material e métodos: Esses dados foram obtidos em dois grupos: A - estudantes da área da saúde e B - estudantes da área de ciências humanas e exatas. Utilizou-se um questionário elaborado pelos autores. A análise estatística usou o teste do qui-quadrado e de Fischer. Resultados: Na área de saúde há um predomínio do gênero feminino, e nas outras áreas um predomínio masculino. Na área de saúde a maior parte dos estudantes cursa medicina, e nas outras áreas engenharia. Observa-se um alto índice de automedicação em ambos os grupos, constatando-se que os participantes do grupo da área de saúde usam significativamente mais opioides e anti-inflamatórios que os demais estudados. Conclusão: A frequência do uso de medicamentos para dor é maior no grupo de estudantes da área de saúde, e a automedicação é praticada igualmente entre estudantes da área de saúde e das demais áreas. .
Objective: To study the self-medication for pain among students of medicine and nursing of the PUCSP compared with students from other knowledge areas. Material and methods: Data were obtained in two groups: A - students from the health knowledge area, and B - students of law and engineering. It was used a questionnaire developed by the authors. Statistical analysis used the Chi-square test and the Fischer. Results: In relation to gender, there is a predominance of women in the health group and a male majority in other one. In the health group there was a greater number of medical students, and in the control group of engineering. It is observed a high degree of selftreatment in both groups. It appears that participants in the health group have used more anti-inflammatory drugs and opioid than the others subjects studied. Conclusion: The frequency of medication for pain is higher in the group of health students, and self-medication is equally practiced among students of health and other areas. .