Efeitos da dor experimental no desempenho dos músculos flexores do cotovelo após oito semanas de treinamento de força: um estudo piloto / Effects of experimental pain on elbow flexor muscles performance after eight weeks of strength training: a pilot study

INTRODUÇÃO: O treinamento de força tem sido recomendado na reabilitação clínica, bem como no condicionamento físico de atletas. Não é incomum, em ambos os casos, a presença de dor durante a prática; no entanto, até o momento, não há informação consensual em relação aos efeitos da dor muscular aguda nas adaptações ao treinamento de força. OBJETIVO: O objetivo deste estudo piloto foi avaliar os efeitos da dor induzida experimentalmente na adaptação da força muscular após um período de treinamento de 8 semanas. MÉTODO: O estudo incluiu cinco voluntários saudáveis do sexo masculino e não treinados. Os participantes foram submetidos a um protocolo de treinamento de força (3x/semana durante 8 semanas) para os músculos flexores do cotovelo. A dor muscular aguda foi induzida no início de cada sessão de treinamento, por meio de infusão intramuscular de 2,5 ml de solução salina hipertônica (6%) no ventre do músculo bíceps braquial. A força dinâmica máxima (1RM) e a contração isométrica voluntária máxima (CIVM) foram medidas antes e após quatro e oito semanas de treinamento. RESULTADOS: A força dinâmica máxima aumentou, em média, 37,3% e 78,4% após quatro e oito semanas, respectivamente. Entretanto, pouca ou nenhuma diferença foi encontrada na CIVM (-1,7% e -3,0% após quatro e oito semanas, respectivamente). CONCLUSÃO: Após 24 sessões de treinamento de força, com dor muscular aguda induzida a cada sessão, voluntários saudáveis aumentaram sua capacidade de produzir força dinâmica máxima em mais de 75%; entretanto, a força isométrica apresentou apenas pequenas variações negativas.

INTRODUCTION: Strength training has been recommended in clinical rehabilitation, as well as in the physical conditioning of athletes. It is not uncommon, in both cases, the presence of pain during practice; however, to date, there is no consensual information about the effects of acute muscle pain on strength training adaptations. OBJECTIVE: The aim of this pilot study was to evaluate the effects of experimentally induced pain on muscle strength adaptation after an 8-week training period. METHOD: The study included five untrained, healthy male volunteers. Participants were submitted to a strength training protocol (3x/week for 8 weeks) for the elbow flexor muscles. Acute muscle pain was induced at the beginning of each training session through an intramuscular infusion of 2.5 ml of hypertonic saline (6%) into the biceps brachii muscle belly. Maximal dynamic strength (1RM) and maximal voluntary isometric contraction (MVIC) were measured at pre- and after four and eight weeks of training. RESULTS: Maximal dynamic strength increased, on average, 37.3% and 78.4% after four and eight weeks, respectively. However, little, if any, difference was found in MVIC (-1.7% and ­ 3.0% after four and eight weeks, respectively). CONCLUSION: After 24 strength training sessions, with acute muscle pain induced every session, healthy volunteers increased their ability to produce maximal dynamic strength by more than 75%; however, isometric strength presented only small negative changes.

Evaluation of the effectiveness of arnica montana 6ch in the control of postoperative myalgia by isometric effort in dentistry

Arnica montana 6CH is a medicine indicated for inflammatory and painful conditions, especially in muscle structures. The RDC / TMD Axis II questionnaire is a validated tool for the diagnosis of Temporomandibular Muscle Dysfunction. Objective: This multicenter, randomized and controlled study, approved by Human or Animal Research Ethics Committee UniFOA -CAAE: 48680015.3.0000.5237 aimed to verify the clinical performance of Arnica montana 6CH in contractures and muscle pain triggered by isometric stress. Materials and Methods: 70 patients underwent prolongeddental treatment sessions, and they were selected after clinical examination and positive responses to the RDC / TMD questionnaire to confirm signs and symptoms of Temporomandibular Muscle Dysfunction at the first consultation. Randomly, Arnica montana 6CH was prescribed for 35 patients called group I, and placebo for 35 patients called group II, at a dose of 5 globules, 03 times a day, for 1 week. In the second endodontic consultation, after 15 days, a new clinical examination was performed at the beginning and end of the prolonged dental consultation with crossing of data from the RDC questionnaire, to monitor the prevalence of TMD muscle signs and symptoms. The data were tabulated and analyzed. Statistical analysis: The test t de Student was used for paired samples, significant at the level ≤ 0.05%. Results:Anamnetic data from the RDC questionnaire, 86% of the individuals in the GI had lower pain and muscle contracture rates in the second consultation, compared with 22% in the GII. Conclusion:The drug Arnica montana 6CH proved to be effective in preventing muscle changes and clinical symptoms resulting from isometric efforts with a statistically significant difference (p ≤ 0.05).

Prevalencia y factores asociados al virus Zika en embarazadas / Prevalence and associated factors with Zika virus in pregnant women

La evidencia de epidemias e infecciones se manifestó en las Américas -destacando Panamá entre los países afectados-, África y otros lugares. En el año 2016 la Organización Mundial de la Salud (OMS) declaró una emergencia internacional por la presencia de casos de microcefalia y otros trastornos neurológicos en algunas áreas afectadas por el virus Zika. Actualmente se han notificado infecciones por este virus transmitidas por mosquitos en un total de 86 países y territorios. El presente artículo tiene como objetivo estimar la prevalencia e identificar los factores de riesgo del virus Zika en embarazadas de Panamá, como grupo vulnerable ante esta afección. Si la infección por el virus del Zika es mayormente leve en adultos, en las gestantes se deben temer riesgos fetales graves en los casos de infección en el primer trimestre del embarazo. Sin embargo, todavía no hay suficientes investigaciones que aporten datos científicos para conocer el alcance de este riesgo y las consecuencias precisas de una infección fetal(AU)

The evidence of epidemics and infections was manifested in the Americas -Panama standing out among the affected countries-, Africa and other places. In 2016, the world Health Organization (WHO) declared an international emergency due to the presence of cases of microcephaly and other neurological disorders in some areas affected by the Zika virus. Mosquito-borne infections with this virus have now been reported from a total of 86 countries and territories. The objective of this article is to estimate the prevalence and identify the risk factors of the Zika virus in pregnant women in Panama, as a vulnerable group to this disease. If Zika virus infection is mostly mild in adults, serious fetal risks should be feared in pregnant women in cases of infection in the first trimester of pregnancy. However, there is still not enough research that provides scientific data to know the extent of this risk and the precise consequences of a fetal infection(AU)

Characteristics of musculoskeletal signs and symptoms during the recovery phase of patients with moderate-to-severe COVID-19 at the Philippine General Hospital

Introduction@#Musculoskeletal complaints have been observed in the recovery phase of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). We noted several referrals for physical rehabilitation at the University of the Philippines-Philippine General Hospital (UP-PGH), a designated COVID-19 referral center. These observations resembled the musculoskeletal manifestations associated with poorer outcomes reported in other coronavirus studies. @*Objectives@#The study determined the musculoskeletal signs and symptoms of adults in the recovery phase of moderate to severe COVID-19 using the COVID Musculoskeletal Assessment Tool (CMAT). @*Methods@#This was a three-phased, prospective, descriptive study of adults admitted for COVID-19 at the UP-PGH. Phase 1 was the development of the CMAT based on a review of related literature and patient charts, and patient interviews. The tool was pretested and validated in Phase 2 before it was used in the evaluation of study participants in Phase 3 of the research. Data was encoded using Microsoft® Excel 2007 and analyzed using STATA, Version 12.0 (Texas, USA). Descriptive statistics were used to summarize the variables collected for the study. @*Results@#A cohort of 40 patients admitted at the UP-PGH for moderate-to-severe COVID-19 infection was evaluated using the CMAT. Most of the patients had an average age of 55 years and were males. Majority resided in an urban area, reached high school education, and were ambulatory before their illness. The most common comorbidities were hypertension and diabetes. All patients required oxygen support. Based on the CMAT, majority of the participants complained of muscle pain, generalized weakness, and easy fatigability. Other common findings were neck-shoulder and lower limb pain, dyspnea on exertion, limited mobility in the trunk, hips, and knees, joint pains, and decreased muscle strength. Half of the participants needed a wheelchair or walker to ambulate. These findings may be due to the COVID-19 disease and to prolonged confinement in bed. Only one patient underwent physical therapy through bedside instructions. @*Conclusion@#Musculoskeletal signs and symptoms were common in the patients recovering from COVID-19 disease. The COVID-19 Musculoskeletal Assessment Tool facilitated the evaluation of patients and the recording of results. Early referral for medical rehabilitation and timely intervention are strongly recommended.

Muscle pain induced by static contraction is modulated by transient receptor potential vanilloid 1 and ankyrin 1 receptors

Abstract Molecular mechanisms involved in the development of muscle pain induced by static contraction are not completely elucidated. This study aimed to evaluate the involvement of the transient receptor potential vanilloid 1 (TRPV1) and the transient receptor potential ankyrin 1 (TRPA1) receptors expressed in peripheral and central terminals of primary afferents projected to gastrocnemius muscle and spinal cord in muscle pain induced by static contraction. An electrical stimulator provided the contraction of rat gastrocnemius muscle and mechanical muscle hyperalgesia was quantified through the pressure analgesimeter Randall-Selitto. AMG9810 and HC030031 were used. When administered in ipsilateral, but not contralateral gastrocnemius muscle, drugs prevented mechanical muscle hyperalgesia induced by static contraction. Similar results were obtained by intrathecal administrations. We propose that, in an inflammatory muscle pain, peripheral and central TRPV1 and TRPA1 work together to sensitize nociceptive afferent fibers, and that TRPV1 and TRPA1 receptors are potential target to control inflammatory muscle pain.

Placas oclusais termoplásticas para o tratamento da dor muscular mastigatória: um ensaio clínico / Thermoformed occlusal splints for the treatment of masticatory muscle pain: a clinical trial

Objective: Compare the clinical effectiveness of custom thermoformed occlusal splints (OS) alongside behavioral and self-care therapy (BST) in the management of myalgia of the masticatory muscles. Material and methods:A controlled clinical trial was conducted with a total of 46 subjects with a diagnosis of myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). All subjects were treated with BST at the beginning of the study and were then randomized into four groups: behavioral and self-care control group; Thermoformed Tough-elastic splint group; Thermoformed Soft-elastic splint group, and non-occlusive splint group. Follow-ups were carried out at 2, 6, and 10 weeks, where it was evaluated: pain in the masticatory muscles, mandibular range of motion, mandibular functional limitation, and occlusal discomfort. Data were analyzed with Doornik and Hansen, Shapiro­Wilk, and ANOVA at p=0.05. Results: All the variables showed significant improvement (p<0.05) from the first follow-up and were maintained later. BST control group, as well as groups with BST associated with OS, were able to reduce pain and increase the mandibular range of motion without significant differences between them (p>0.05), while the Thermoformed Tough-elastic splint was the most efficient in terms of the mandibular functional limitation. The occlusal discomfort decreased over time, but without statistically significant differences in terms of time and design of OS. Conclusion: The addition of thermoformed OS to behavioral and self-care therapy does not have a significant impact on myalgia of the masticatory muscles. (AU)

Objetivo: Comparar a eficácia clínica das Placas Oclusais (PO) termoplásticas personalizadas associadas à Terapia Cognitiva Comportamental (TCC) na condução da mialgia dos músculos mastigatórios. Material e Métodos: Foi realizado um ensaio clínico controlado randomizado com um total de 46 participantes com um diagnóstico de mialgia de acordo com os Critérios de Diagnóstico das Desordens Temporomandibulares (DC/TMD). Todos os participantes foram tratados com a TCC, no início do estudo, e foram, depois, randomizados em quatro grupos: grupo controle Terapia Congnitivo Comportamental; grupo de placa termoplástica dura-soft, grupo de placa termoplástica soft, e grupo de placa sem cobertura oclusal. Foram realizados controles com 2, 6, e 10 semanas, onde foi avaliado: dor nos músculos mastigatórios, amplitude de movimento mandibular, limitação funcional mandibular, e desconforto oclusal. Os dados foram analisados com Doornik e Hansen, Shapiro-Wilk, e ANOVA a p=0,05. Resultados: Todas as variáveis mostraram melhora significativa (p<0,05) desde o primeiro controle e se mantiveram posteriormente. O grupo de controlo da TCC, bem como os grupos com TCC associada a PO, foram capazes de reduzir a dor e aumentar a amplitude de movimento mandibular sem diferenças significativas entre eles (p>0,05), enquanto que, a placa termoplástica dura-soft, foi a mais eficiente em termos da limitação mandibular funcional. O desconforto oclusal diminuiu ao longo do tempo, mas, sem diferenças estatisticamente significativas em termos de tempo e design da PO. Conclusão: A inclusão da Terapia Cognitivo Comportamental à PO termoplástica não tem um impacto significativo na mialgia dos músculos mastigatórios.(AU)

Perfil clínico e fatores associados ao óbito de pacientes COVID-19 nos primeiros meses da pandemia / Perfil clínico y factores asociados a la muerte de pacientes COVID-19 en los primeros meses de la pandemia / Clinical profile and factors associated with the death of COVID-19 patients in the first months of the pandemic

RESUMO Objetivo analisar as características individuais, clínicas e os fatores associados à mortalidade de pacientes com COVID-19, em hospital público do estado do Paraná, Brasil. Métodos estudo seccional, retrospectivo, documental (n= 86), com pacientes adultos internados, de março a junho de 2020. Resultados a mortalidade foi de 12,8%, o grupo de maior risco foi de idosos com comorbidades, especialmente, cardiovasculares. A chance de óbito foi 58 vezes maior em idosos, comparada aos adultos, e oito vezes maior naqueles com comorbidades, comparadas aos hígidos. A maioria dos pacientes apresentou sintomatologia respiratória, febre e mialgia. Tratamento à base de antibióticos, anticoagulantes e antivirais, associado ao suporte ventilatório. As principais complicações foram hipóxia, insuficiência renal aguda e infecção secundária. Conclusão e implicações para a prática idosos com comorbidades cardiovasculares que necessitaram de cuidados intensivos apresentaram maior chance de óbito. Os resultados de um dos centros de referência na pandemia possibilitam discutir medidas epidemiológicas adotadas, com ênfase em conceitos restritivos nos primeiros meses.

RESUMEN Objetivo analizar las características individuales, clínicas y los factores asociados a la mortalidad en pacientes con COVID-19 en un hospital público del estado de Paraná. Métodos estudio transversal, retrospectivo, documental (n = 86), con pacientes adultos hospitalizados, de marzo a junio de 2020. Resultados la mortalidad fue del 12,8%, grupo de mayor riesgo para los ancianos con comorbilidades, especialmente enfermedades cardiovasculares. La probabilidad de muerte fue 58 veces mayor en los ancianos en comparación con los adultos y ocho veces mayor en aquellos con comorbilidades en comparación con los sanos. La mayoría de los pacientes presentaban síntomas respiratorios, fiebre y mialgia. Tratamiento a base de antibióticos, anticoagulantes y antivirales, asociado al soporte ventilatorio. Las principales complicaciones fueron hipoxia, insuficiencia renal aguda e infección secundaria. Conclusión e implicaciones para la práctica los ancianos con comorbilidades cardiovasculares que requirieron cuidados intensivos tenían una mayor probabilidad de muerte. Los resultados de uno de los centros de referencia pandémica permiten discutir las medidas epidemiológicas adoptadas, con énfasis en conceptos restrictivos en los primeros meses.

ABSTRACT Objective to analyze the individual and clinical characteristics and the factors associated with mortality in patients with COVID-19, in a public hospital in the state of Paraná, Brazil. Methods a cross-sectional, retrospective, documentary study (n= 86), with adult inpatients, from March to June 2020. Results mortality was 12.8%, the highest risk group was the elderly with comorbidities, especially cardiovascular ones. The chance of death was 58 times higher in the elderly compared to adults, and eight times higher in those with comorbidities compared to the healthy ones. Most patients presented with respiratory symptoms, fever, and myalgia. Treatment was based on antibiotics, anticoagulants and antivirals, associated with ventilatory support. The main complications were hypoxia, acute renal failure, and secondary infection. Conclusion and implications for practice elderly people with cardiovascular comorbidities who required intensive care had a higher chance of death. The results from one of the reference centers in the pandemic make it possible to discuss epidemiological measures adopted, with emphasis on restrictive concepts in the first months.

Dores musculares cervicais em pacientes com DTM e suas correlações / Cervical muscle pain in patients with TMD and its correlations

Introdução: As disfunções temporomandibulares apresentam uma variedade de sinais e sintomas que afetam a articulação temporomandibular, músculos da mastigação e estruturas relacionadas e muitos pacientes apresentam queixas cervicais. Objetivo: Verificar a correlação de dor à palpação dos músculos da mastigação (masseter, temporal anterior, pterigoideos lateral e medial) e digástrico, com a queixa de dor no pescoço; verificar a correlação de dor à palpação nos músculos da mastigação e digástrico, com dor à palpação no esternocleidomastoideo e trapézio, e se a força de correlação é diferente entre eles. Material e método: Foram avaliados 232 prontuários da clínica odontológica das Disfunções Temporomandibulares da Faculdade de Odontologia de Araçatuba, do período de 2011 a 2013. Os dados coletados foram submetidos à análise estatística, com alfa (α) = 0.01 para todos os casos, exceto digástrico quando associado ao trapézio (α) = 0.05. Resultado: A maioria dos pacientes era do sexo feminino. Houve correlação positiva entre dor à palpação nos músculos temporal, masseter, pterigoideo lateral, esternocleidomastoideo e trapézio, e queixa de dor no pescoço. Também houve correlação positiva entre a dor em todos os músculos da mastigação (masseter, temporal, pterigoideo lateral e medial) e digástrico e a dor no esternocleidomastoideo. Bem como a correlação de presença de dor nos músculos masseter, temporal, pterigoideo lateral e digástrico com dor no trapézio. A correlação de dor foi mais forte para o músculo esternocleidomastoideo, exceto para o pterigoideo lateral. Conclusão: Existe correlação positiva entre a queixa de dor à palpação nos músculos da mastigação, exceto pterigiodeo medial, e os músculos cervicais (esternocleidomastoideo e trapézio). A força de correlação entre a dor do masseter e temporal anterior com o esternocleidomastoideo é mais forte do que com o trapézio.

Introduction: Temporomandibular disorders present a variety of signs and symptoms that affect the temporomandibular joint, masticatory muscles and related structures, and many patients have cervical complaints. Objective: To verify the correlation of pain on palpation of the mastication muscles (masseter, anterior temporal, lateral and medial pterygoid), and digastric muscles with the complaint of neck pain; to verify the correlation of pain on palpation in the masticatory and digastric muscles with pain on palpation in the sternocleidomastoid and trapezius and if the correlation strength is different between them. Material and method: From 2011 to 2013, 232 medical records from the dental clinic of Temporomandibular Disorders of the Faculty of Dentistry of Araçatuba were evaluated. The data collected were submitted to statistical analysis, with alpha (α) = 0.01 for all cases, except digastric when associated with the trapezoid (α) = 0.05. Result Most patients were female. There was a positive correlation between pain on palpation in the temporal, masseter, lateral pterygoid, sternocleidomastoid and trapezius muscles, and complaints of neck pain. There was also a positive correlation between pain in all muscles of mastication (masseter, temporal, lateral and medial pterygoid), and digastric and sternocleidomastoid pain. As well as the correlation of the presence of pain in the masseter, temporal, lateral pterygoid and digastric muscles with pain in the trapezius. Pain correlation was strongest for the sternocleidomastoid muscle, except for the lateral pterygoid. Conclusion There is a positive correlation between the complaint of pain on palpation in the masticatory muscles, except Medial pterygoid, with the cervical muscles (sternocleidomastoid and trapezius). The strength of correlation between masseter and anterior temporal pain with the sternocleidomastoid is stronger than with the trapezius.

Impacto de la pandemia por COVID-19 en persona sana y físicamente activa. Reporte de un caso y actualización de los principales hallazgos / Impact of the COVID-19 pandemic on a healthy and physically active person. Case report and update of the main findings

Introducción. No todas las personas expuestas al COVID-19 desarrollan una en-fermedad respiratoria grave y el número de personas adultas jóvenes sin patologías previas, afectadas gravemente por el virus, viene en aumento. Se ha evidenciado un gran número de síntomas inespecíficos y complicaciones, posterior a la recuperación. Objetivo. Evaluar las repercusiones en un sujeto sano y físicamente activo que pre-sentó complicaciones médicas graves y complicaciones posteriores al COVID-19. Reporte de caso. Hombre de 41 años de edad, físicamente activo y sin enfermeda-des conocidas, en quien se documenta infección por SARS-CoV2 con prueba PCR positiva. Requirió 22 días en UCI, 17 días en hospitalización general, 57 días de incapacidad y posterior a doce meses presenta pérdida evidente de peso y de memo-ria, dificultad para pensar y concentrarse, pérdida de masa muscular, compromiso de la función hepática, cansancio y fatiga, dolor muscular, problemas para dormir, cambios en el estado de ánimo y alteraciones del gusto. De acuerdo con los actuales hallazgos, la producción de un tipo de anticuerpo impide que el sistema inmune ten-ga una respuesta adecuada contra la enfermedad. Sumado a esto, se ha descrito una nueva puerta de entrada del virus en el organismo: la proteína neuropilina-1 (NRP1), además de la posible disminución del surfactante que permite la flexibilidad de los pulmones. Lo anterior podría dar respuestas a las complicaciones en personas sanas y físicamente activas posterior a la infección por COVID-19. Conclusiones. Entendiendo que el COVID-19 es una enfermedad reciente, aún hay mucha información por recolectar para así entender su comportamiento en el cuerpo humano. Sin embargo, las investigaciones van dando evidencia del porqué el COVID-19 puede generar graves complicaciones médicas en personas sanas y físicamente activas. Son necesarias más investigaciones con esta población, para así realizar planteamientos de manejo clínico acordes a la enfermedad y evitar desenlaces fatales.

Introduction. Not all people exposed to COVID-19 develop a severe respiratory disease and the number of young adults without previous pathologies, seriously af-fected by the virus, is increasing. Many of non-specific symptoms and complications have been evidenced after the recovery. Objective. To evaluate the repercussions in a healthy and physically active subject who presented serious medical complications and post-COVID-19 complications.Case report. A 41-year-old man, physically active and without known diseases, in whom SARS-CoV2 infection with a positive PCR test is documented. He required 22 days in the ICU, 17 days in general hospitalization, 57 days of disability and after twelve months there is evident weight and memory loss, difficulty thinking and con-centrating, loss of muscle mass, compromised liver function, tiredness and fatigue, muscle pain, sleep problems, changes in mood, and alterations in the taste. According to the current findings, the production of a type of antibody prevents the immune system from having an adequate response against the disease. In addition to this, a new gateway for the virus into the body has been described: the protein neuropilin- 1 (NRP1), as well as the possible decrease in surfactant that allows the flexibility of the lungs. This could provide answers to complications in healthy and physically active people after COVID-19 infection. Conclusions. Understanding that COVID-19 is a recent disease, there is still a lot of information to collect to understand its behavior in the human body. However, research is providing evidence on why COVID-19 can cause serious medical compli-cations in healthy and physically active people. Understanding that it is a multifac-torial situation, more research is necessary with this population in order to carry out clinical management approaches according to the disease and avoid fatal outcomes.

Efficacy and Safety of Lianhua Qingwen for Patients with COVID-19: A Systematic Review and Meta-Analysis / 中国结合医学杂志

BACKGROUND@#Corona virus disease 2019 (COVID-19) has spread around the world since its outbreak, and there is no ascertained effective drug up to now. Lianhua Qingwen (LHQW) has been widely used in China and overseas Chinese, which had some advantages in the treatment of COVID-19.@*OBJECTIVE@#To evaluate the efficacy and safety of LHQW for COVID-19 by conducting a systematic review with meta-analysis.@*METHODS@#A comprehensive literature search was conducted in 12 electronic databases from their establishment to October 30, 2021. Note Express 3.2.0 was used for screening of trials, and the data was independently extracted in duplicate by 2 researchers. The risk of bias of randomized controlled trials (RCTs) and retrospective studies were assessed by using the Cochrane collaboration tool and Newcastle Ottawa Scale, respectively, followed by data analysis using RevMan 5.3. The RCTs or retrospective studies to treat COVID-19 using LHQW were included. The intervention measures in the experimental group were LHQW alone or combined with chemical drugs (LCWC), and that in the control group were chemical drugs (CDs). Outcome measures included computed tomography (CT) recovery rate, disappearance rates of primary (fever, cough, fatigue), respiratory, gastrointestinal and other symptoms, exacerbation rate and adverse reaction. Subgroup analysis was conducted according to whether LHQW was combined with CDs and the different treatment methods in the control group.@*RESULTS@#Nine trials with 1,152 participants with COVID-19 were included. The CT recovery rates of LHQW and LCWC were 1.36 and 1.32 times of CDs, respectively (P<0.05). Compared with CDs, LCWC remarkably increased the disappearance rates of fever, cough, fatigue, expectoration, shortness of breath, and muscle soreness (P<0.05). LHQW also obviously decreased the exacerbation rate, which was 0.45 times of CDs alone (P<0.05). There was no obvious difference between LCWC and CDs in adverse reaction (P>0.05).@*CONCLUSIONS@#LHQW was more suitable for treating COVID-19 patients with obvious expectoration, shortness of breath and muscle soreness. LHQW had advantages in treating COVID-19 with no obvious exacerbation. (PROSPERO No. CRD42021235937).

Genetic analysis of a Chinese pedigree affected with Becker muscular dystrophy with myalgia as the main feature / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis of a Chinese pedigree affected with Becker muscular dystrophy (BMD) with myalgia as the main feature.@*METHODS@#Clinical data of the patients and results of auxiliary examinations were retrospectively analyzed. Multiplex ligation-dependent probe amplification and high-throughput sequencing were used to detect potential variants. Sanger sequencing was used to verify the results.@*RESULTS@#The clinical manifestations of the proband included myalgia and elevated serum creatine kinase, which is similar to another patient from the pedigree. Genetic testing revealed that the two patients both harbored hemizygous deletions of exons 10 to 29 of the DMD gene, for which the mother was a carrier. The same deletion was not found in his father. Based on the guidelines from American College of Medical Genetics and Genomics, the deletion was predicted to be pathogenic (PVS1+PM2+PP1).@*CONCLUSION@#Myalgia with elevated serum CK may be atypical clinical manifestations of BMD and may be associated with variants in the rod domain of the DMD gene. The deletion of exons 10 to 29 of the DMD gene probably underlay the BMD in this pedigree.

Doença de McArdle: um relato de caso / McArdle's Disease: a case report

RESUMO A Doença de McArdle (DM) ou glicogenose do tipo V, é uma afecção rara que manifesta-se com intolerância ao exercício, crises de mioglobinúria por rabdomiólise e mialgia. Além disso, pode haver deterioração do quadro com insuficiência renal e isquemia muscular associada ao uso de anestésicos inalados e relaxantes musculares. Relata-se um caso clínico de uma mulher de 39 anos que apresentava mialgias em sua adolescência, porém sem diagnósitico, associado a comorbidades que prejudicaram o diagnóstico precoce da Doença de MacArdle. Diagnosticada após internação por pneumonia aspirativa, onde foram evidenciados altos níveis de creatinofosfoquinase e através da biópsia muscular com imuno-histoquímica. PALAVRA-CHAVE: McArdle, miopatia, mialgia, glicogenose tipo V

ABSTRACT McArdle Disease (MD) or glycogenosis type V is a rare condition that manifests with exercise intolerance, myoglobinuria crises caused by rhabdomyolysis, and myalgia. In addition, there may be a deterioration of the condition with renal failure and muscle ischemia associated with the use of inhaled anesthetics and muscle relaxants. We report a clinical case of a 39-year-old woman who had myalgia in her adolescence, but without a diagnosis, associated with comorbidities that hampered the early diagnosis of McArdle Disease. Diagnosed after hospitalization for aspiration pneumonia, where high levels of creatine phosphokinase were evidenced and through muscle biopsy with immunohistochemistry. KEYWORDS: McArdle disease, myopathy, myalgia, glycogenosis type V

Epidemiología de la Leptospirosis en el departamento del Huila, Colombia. 2011- 2017 / Epidemiology of leptospirosis in the department of Huila. 2011 to 2017

Resumen Objetivo: Describir la epidemiología de la Leptospirosis en el departamento del Huila durante el período 2011 -2017. Materiales y métodos: Estudio descriptivo de corte transversal, retrospectivo. La población analizada fueron pacientes de los diferentes municipios del departamento del Huila que se reportaron como casos probables o confirmados de leptospirosis. Se estructuraron registros por cada año en bases de datos recopiladas por el área de epidemiología de la Secretaría de Salud del Huila, basadas en las fichas de notificación de vigilancia en salud pública para leptospirosis y generadas por cada Unidad Primaria Generadora de Datos (UPGD) ante la presencia del evento. Los datos fueron discriminados de acuerdo a las variables de interés para el estudio en una nueva base de datos en Excel; tabuladas con el programa estadístico R - Studio 3.3.3 y Epidat 4.2, para luego ser procesados con estadísticos descriptivos y finalmente ser expresados en porcentajes y en tasas de incidencia. Resultados: Se reportaron 268 casos, de los cuales 61 (23%) fueron confirmados por laboratorio y 207 (77%) sospechosos o probables. El 69% de los pacientes presentaron fiebre, mialgias y cefalea como síntomas representativos. El grupo etario más afectado tenía entre 27 y 59 años de edad (44%). La población se caracterizó por ser del área urbana (65%), con mayor frecuencia en hombres (72%). En relación a la ocupación laboral, se encontró mayor frecuencia en agricultores (20%) y en el personal de aseo (17%). Los factores de riesgo evidenciados fueron la presencia de animales domésticos en un 67% de los casos, así como la presencia de ratas en el hogar (51%) y el posible mal manejo del agua. Conclusiones: El incremento en el número de casos de Leptospirosis probablemente está asociado a la mala manipulación del agua y a la presencia de animales en el domicilio.

Abstract Objective: Describe the epidemiology of Leptospirosis in the department of Huila during the years 2011 to 2017. Materials and methods: This article is a descriptive, cross-sectional, retrospective study. The population analyzed were patients from the different municipalities of the department of Huila who were reported as probable or confirmed cases for leptospirosis, structuring records for each year in databases compiled by the epidemiology area of ​​the department's health secretary, based on the public health surveillance notification sheets for leptospirosis, and generated by each Primary Data Generating Unit (UPGD) in the presence of the event; The data were discriminated according to the variables of interest for the study in a new database in Excel; tabulated with the statistical program R - Studio 3.3.3 and Epidat 4.2, to later be processed with descriptive statistics and finally expressed in percentages and incidence rates. Results: 268 cases were reported, which 61 (23%) were confirmed by laboratory and 207 (77%) suspicious or probable. 69% of the patients presented fever, myalgia and headache as representative symptoms. The most affected group range in ages from 27 and 59 (44%). The population was characterized for being part of the urban area (65%), and the cases were more frequent in men (72%). Regarding to employment, it was found that farmers (20%) and the cleaning staff (17%) were the most common cases. The risk factors identified were the presence of domestic animals in 67% of the cases, as well as the presence of rats at home (51%) and the possible poor water management. Conclusions: The increase in the number of cases of Leptospirosis is probably associated with the poor water management and the presence of animals at home.

Delayed onset muscle soreness intensity affects muscular performance / El Dolor muscular de aparición tardía afecta el desempeño muscular

Abstract Background: The study of functional impact of delayed onset muscle soreness has been limited to describe the decline on maximal isometric contraction, but muscular work and time to peak torque has not been examined yet. Purpose: To describe the changes induced by a session of lengthening contractions on muscle performance and delayed onset muscle soreness (DOMS). Methods: A quasi-experimental study was conducted in the Institutional laboratory; Twenty healthy men; mean age 21 SD 0.34 were recruited, all subjects performed 200 lengthening contractions of the quadriceps at 120°/s. Isometric and isokinetic peak torque, muscular work, time to peak torque, DOMS and creatine kinase activity were assessed at baseline, 48 h and 96 h post-exercise. The muscle performance was assessed with an isokinetic dynamometer and DOMS with a visual analog scale (VAS). Results: Relative to baseline, isometric and isokinetic peak torque and muscular work decreased in ~30% at 48 h post-exercise; delayed onset muscle soreness increased ~300%, which remained at 96 h post-exercise. Conclusions: These reflect that the decline in muscular performance is due to the changes in peak torque and muscular work, which has greater implications on muscle function. No changes were detected in time to peak torque. The alterations in muscular performance variables are accompanied by delayed onset muscle soreness which has also a negative impact on force production (29% of the drop on peak torque is explain by soreness intensity).

Resumen Introducción: Los estudios de impacto funcional del dolor muscular de aparición tardía (DMAT) se han limitado a describir la disminución de la contracción isométrica máxima, pero aún no se ha examinado el trabajo muscular y el tiempo del torque máximo. Objetivo: Describir los cambios inducidos por una sesión de ejercicio excéntrico sobre el rendimiento muscular y DMAT. Método: se realizó un estudio cuasi-experimental, los participantes fueron veinte hombres sanos; edad media 21 DE 0,34, todos los sujetos realizaron 200 contracciones excéntricas del cuádriceps a 120°/s. Se evaluó el torque pico isométrico e isocinético, el trabajo muscular, el tiempo hasta el torque máximo, DMAT y la actividad de la creatina quinasa al inicio, 48 h y 96 h después del ejercicio, el rendimiento muscular se evaluó con un dinamómetro isocinético y DOMS con una escala análoga visual (EAV). Resultados: en relación con la línea de base, el torque pico isométrico e isocinético y el trabajo muscular disminuyeron en ~ 30 % a las 48 h post-ejercicio; El dolor muscular de aparición tardía aumentó ~300 %, que permaneció 96 h después del ejercicio. Conclusiones: los resultados reflejan que la disminución del rendimiento muscular se debe a los cambios en el torque pico y trabajo muscular, lo que tiene mayores implicaciones en la función muscular. No se detectaron cambios en el tiempo hasta el torque máximo. Las alteraciones en las variables de rendimiento muscular se acompañan de DMAT que también tiene un impacto negativo en la producción de fuerza (el 29 % de la caída en el torque máximo se explica por la intensidad del dolor).

Manifestaciones clínicas y complicaciones de la Enfermedad por Coronavirus 2019 (COVID-19): revisión de la literatura / Clinical manifestations and complications of Coronavirus Disease 2019 (COVID-19)

La Enfermedad por Coronavirus 2019 (COVID-19) supone un reto sin precedentes para la salud pública. Los médicos deben fortalecer sus habilidades clínicas para combatir esta nueva enfermedad. El objetivo de esta revisión fue describir los signos, síntomas y complicaciones de pacientes con COVID-19. Se realizó una búsqueda en la literatura en la base de datos PubMed incluyendo publicaciones entre 1 de diciembre 2019 y 15 de agosto 2020, sin restricciones de lenguaje, utilizando las palabras clave 'COVID-19' cruzada con 'manifestaciones clínicas', 'signos y síntomas' y 'complicaciones'. Se incluyeron revisiones sistemáticas y meta-análisis, estudios epidemiológicos y series de casos. Se identificaron 1,066 artículos, de los cuales se seleccionaron 71 de acuerdo a los contenidos previamente definidos por los autores. La COVID-19 presenta un curso de leve a moderado y severo-crítico, específicamente en mayores de 65 años con o sin comorbilidades. Los signos y síntomas no son específicos y usualmente se superponen de acuerdo a la edad y a la fase de la enfermedad. Los síntomas más comunes son fiebre, tos y fatiga. Síntomas menos comunes incluyen escalofríos, dolor de garganta, cefalea, mialgias/artralgias, pérdida del gusto y del olfato, diarrea, nausea, vómitos, congestión nasal, palpitaciones, opresión precordial y dolor pleurítico. La sintomatología en niños difiere de la de los adultos y el curso es usualmente benigno y de baja mortalidad. La evaluación clínica de COVID-19 supone un reto hoy en día. Sin embargo, el conocimiento de la historia natural de la enfermedad permite situar los síntomas comunes e inespecíficos en el contexto clínico correcto.

Coronavirus disease 2019 (COVID-19) presents an unprecedented challenge to public health. Physicians must strengthen clinical skills for this new disease. This review aimed to describe the signs, symptoms and complications of patients with COVID-19. A literature search was conducted in the PubMed database, including publications between December 1, 2019, to August 15, 2020, without language restrictions, using the keywords 'COVID-19' crossed with 'clinical manifestations', 'signs and symptoms', and 'complications'. Systematic reviews, meta-analysis, epidemiological studies, and case report series were included. A total of 1,066 articles were identi¬fied, among 71 were selected according to the contents previously defined by the authors. COVID-19 has a mild to moderate or severe-critical course, specifically in over 65 years of age, with or without comorbidities. Signs and symptoms are not specific and usually overlap according to the age and stage of the disease. The most common symptoms are fever, cough, and fatigue. Less common symptoms include chills, sore throat, headache, myalgia/ arthralgia, loss of taste and smell, diarrhea, nausea, vomiting, nasal congestion, palpitations, chest tightness, and pleuritic pain. The symptomatology in children differs from that of adults, and the course is usually benign and low mortality. Clinical evaluation of COVID-19 is challenging today. However, knowledge of the disease's natural history allows placing common and nonspecific symptoms in the correct clinical context.

Características clínicas y epidemiológicas del COVID-19 en la Unidad de Emergencia del Hospital Barros Luco: los primeros 164 pacientes

Background: The clinical manifestations, mortality rates, laboratory and imaging findings of SARS-CoV-2 infection are not yet fully elucidated. Aim: To describe the clinical manifestations, imaging and laboratory findings of 164 SARS-CoV-2 (+) patients consulting at an emergency room of a public general hospital in Santiago, Chile. Material and Methods: Review of medical records, imaging and laboratory results of 164 patients aged between 16 and 92 years (57.9% males) consulting at the emergency room between March 12 and April 27, 2020. Results: The most common presenting symptom was dry cough in 47% of patients, followed by headache in 42% and myalgias in 42%. Forty five percent referred contact with an infected patient or having travelled out of town. Thirty-three (20%) required hospital admission and 5% required admission to an intensive care unit. Conclusions: These patients were predominantly young, and their most common symptoms were dry cough, headache and myalgias.

Neurological complications in patients with SARS-CoV-2 infection: a systematic review / Complicações neurológicas em pacientes infectados pelo SARS-CoV-2: uma revisão sistemática

ABSTRACT Background: As the COVID-19 pandemic unfolds worldwide, different forms of reports have described its neurologic manifestations. Objective: To review the literature on neurological complications of SARS-CoV-2 infection. Methods: Literature search performed following systematic reviews guidelines, using specific keywords based on the COVID-19 neurological complications described up to May 10th, 2020. Results: A total of 43 articles were selected, including data ranging from common, non-specific symptoms, such as hyposmia and myalgia, to more complex and life-threatening conditions, such as cerebrovascular diseases, encephalopathies, and Guillain-Barré syndrome. Conclusion: Recognition of neurological manifestations of SARS-CoV-2 should be emphasized despite the obvious challenges faced by clinicians caring for critical patients who are often sedated and presenting other concurrent systemic complications.

RESUMO Introdução: À medida que a pandemia da COVID-19 se desenvolve em todo o mundo, diferentes tipos de publicações descreveram suas manifestações neurológicas. Objetivo: Revisar a literatura sobre complicações neurológicas da infecção por SARS-CoV-2. Métodos: A pesquisa bibliográfica foi realizada seguindo diretrizes de revisões sistemáticas, usando palavras-chave específicas baseadas nas complicações neurológicas da COVID-19 descritas até 10 de maio de 2020. Resultados: Foram selecionados 43 artigos, incluindo descrições que variam de sintomas comuns e inespecíficos, como hiposmia e mialgia, a condições mais complexas e com risco de vida, como doenças cerebrovasculares, encefalopatias e síndrome de Guillain-Barré. Conclusão: O reconhecimento das manifestações neurológicas da SARS-CoV-2 deve ser enfatizado apesar dos óbvios desafios enfrentados pelos clínicos que cuidam de pacientes críticos, muitas vezes sedados e apresentando outras complicações sistêmicas concomitantes.

COVID-19: presentación clínica en adultos / COVID-19: clinical features in adult patients

Este artículo resume las diferentes formas de presentación clínica de la enfermedad COVID-19 causada por el virus SARS-Co-2 documentadas fundamentalmente en las tres principales revisiones sistemáticas disponibles. Entre las manifestaciones clínicas de frecuente aparición se destacan la fiebre (83 %), la tos (60 %) y la fatiga (38 %), seguidas por las mialgias (29 %), el aumento de la producción del esputo (27 %) y la disnea (25 %). Entre los hallazgos de laboratorio,predominan el aumento de los valores de proteína C reactiva (69 %), la linfopenia (57 %) y el aumento de los niveles de lactato-deshidrogenasa (52 %). Respecto de las manifestaciones radiológicas, tienen especial importancia las opacificaciones en vidrio esmerilado (80 %), la neumonía bilateral (73 %) y la afectación de tres lóbulos pulmonares o más (57 %).Si bien la evidencia sintetizada tiene limitaciones, permite una aproximación actualizada a los conocimientos disponibles sobre la clínica de esta nueva enfermedad en la población adulta. (AU)

This article summarizes the different forms of clinical presentation of COVID-19, caused by the SARS-Co-2 virus, synthesizing the information collected mainly by three published systematic reviews. Frequent clinical manifestations include fever(83 %), cough (60 %), and fatigue (38 %), followed by myalgia (29 %), increased sputum production (27 %) and dyspnea(25 %). Among the laboratory findings, the most common are the increase in C-reactive protein values (69 %), lymphopenia (57 %) and the increase in lactate dehydrogenase levels (52 %).. Most remarkable radiological features include ground glass opacifications (80 %), bilateral pneumonia (73 %) and the involvement of three or more lung lobes (57 %). Although the synthesized evidence has limitations, it allows an updated approach to the available knowledge about the clinical symptoms of this new disease in the adult population. (AU)

Free exercise programs for the elderly: a systematic review on adherence and abandonment / Programas gratuitos de exercício físico para idosos: uma revisão sistemática sobre adesão e desistência

ABSTRACT The elderly population in Brazil is on the rise. As a consequence, there is an equal growth in the number of free public exercise programs directed to this group. Considering the benefits of exercising and the importance of adherence to this behavior so that the benefits can be perceived, we conducted a systematic review of the existing literature on the topic, aiming to identify the reasons that lead to adherence to free public exercise programs, as well as those that lead to abandoning the same programs. Searches were conducted on SciElo, SPORTdiscus and Pubmed databases, with search phrases in Portuguese and in English. After a triage, ten studies were analyzed regarding sample characteristics, program type, data collection method and the reasons behind the subjects' adherence and abandonment. We verified that elderly people tend to enter the projects for health-related reasons, but they remain due to other factors, such as socialization and the perception of the benefits brought on by exercising. As for abandonment, it occurs due to health problems, muscle pain due to exercising, dislike for the classes and family business.

RESUMO A população idosa cresce cada vez mais no Brasil. Como consequência, há um crescimento equivalente no número de programas públicos de exercícios físicos direcionados a esse grupo. Considerando os benefícios dos exercícios físicos e a importância de se aderir a esse comportamento para que os benefícios possam ser percebidos, foi realizada uma revisão sistemática da literatura existente sobre esse assunto com o objetivo de identificar os motivos que levam à adesão a programas gratuitos de exercícios, assim como aqueles que levam à desistência dos mesmos programas. Foram realizadas buscas nas bases de dados SciElo, SPORTdiscus e Pubmed, com frases de busca em português e em inglês. Após uma triagem, dez estudos foram analisados em relação às características das amostras, tipos de programas, método de coleta de dados e as razões por trás da adesão e da desistência dos sujeitos. Verificamos que as pessoas idosas tendem a entrar nos projetos por motivos relacionados à saúde, mas permanecem devido a outros fatores, como a socialização e a percepção dos benefícios provenientes da prática de exercícios. Quanto ao abandono, o mesmo ocorreu devido a problemas de saúde, dor muscular causada pelo exercício, o desgosto pelas aulas e questões relacionadas à família.