Medición del dolor durante el trabajo de parto: evaluación de la usabilidad de un nuevo dispositivo / Pain measurement during labor: usability evaluation of a new device

Objetivo: Evaluar la usabilidad de un dispositivo para medir el dolor durante el trabajo de parto a través de siete ítems: tamaño, textura, facilidad de uso, peso, resistencia, comodidad y seguridad. Método: Estudio descriptivo. Se solicitó a 60 pacientes usar el sensor manual durante el transcurso de seis contracciones uterinas (aproximadamente 10-20 minutos) y al día siguiente se aplicó una encuesta en la que las pacientes evaluaron la usabilidad del dispositivo en cuanto a textura, peso, resistencia, comodidad, facilidad de uso, tamaño del sensor, seguridad de uso, peso del sensor, resistencia y comodidad, mediante una escala de Likert de 1 a 7. La seguridad fue evaluada con una escala de 1 a 5. Resultados: Se realizaron gráficos de caja. Con respecto a la seguridad, un 86% de las usuarias marcaron 5 puntos en la escala, percibiendo el dispositivo como seguro. Conclusiones: El dispositivo fue percibido como seguro, liviano, fácil de usar y cómodo.

Objective: To evaluate the usability of a device to measure pain during labor through seven items: size, texture, ease of use, weight, resistance, comfort, and safety. Method: Longitudinal observational study. 60 patients were asked to use the manual sensor during the course of six uterine contractions (approximately 10-20 minutes) and the following day a survey was applied where the patients evaluated the usability of the device in terms of texture, weight, resistance, comfort, easiness of use, sensor size, safety of use, sensor weight, resistance and comfort through a Likert scale from 1 to 7. Safety was evaluated with a scale from 1 to 5. Results: They were schematized with a box plot. Regarding safety, 86% of the users scored 5 points on the scale, perceiving the device as safe. Conclusions: It can be seen that the device was perceived as safe, light, easy to use and comfortable.

Perception and sensory acceptance of sweet taste by individuals that who work/study on different shifts / Percepção e aceitação sensorial do gosto doce por indivíduos que trabalham/estudam em diferentes turnos

ABSTRACT Objective This study aimed to evaluate the perception and sensory acceptance of sweet taste by individuals who work/study on different shifts. Methods Three groups of individuals were recruited: the Control group (individuals that study during the day and do not work at night), Group 1 (individuals that study in the evening) and Group 2 (individuals that work overnight). The individuals were submitted to a detection threshold test using sucrose solutions and a sensory acceptance test using a structured hedonic scale and a Just-About-Right scale for sweet taste in blancmange. Results The detection thresholds were significantly higher for Groups 1 and 2. Individuals of Group 2 had a preference by blancmanges when having high sucrose concentrations, as well as had an ideal concentration of 10.50% sucrose against 5.95% sucrose for the Control group. Conclusion Our study shows a relationship between changes in the circadian cycle and the sensory perception and acceptance of sweet taste. More studies need to be performed to understand such relationships and their repercussions better.

RESUMO Objetivo O objetivo deste estudo foi avaliar a percepção e a aceitação sensorial do gosto doce por indivíduos que trabalham/estudam em diferentes turnos. Métodos Foram recrutados três grupos de indivíduos: Grupo Controle (indivíduos que estudam durante o dia e não trabalham à noite), Grupo 1 (indivíduos que estudam à noite) e Grupo 2 (indivíduos que trabalham de madrugada). Os indivíduos foram submetidos ao teste de limiar de detecção utilizando soluções de sacarose e aos testes de aceitação sensorial utilizando escala hedônica estruturada e escala do ideal para o gosto doce em manjar branco. Resultados Os limiares de detecção foram significativamente maiores para os Grupos 1 e 2, sendo certo que os indivíduos do Grupo 2 tiveram preferência pelos manjares com altas concentrações de sacarose, assim como apresentaram uma concentração ideal de 10,50% de sacarose contra 5,95% de sacarose para o grupo Controle. Conclusão Este estudo mostra uma relação entre mudanças no ciclo circadiano e a percepção e a aceitação sensorial do gosto doce, mostrando que estudos mais aprofundados precisam ser realizados para entender melhor tais relações e suas repercussões.

Sex and age differences in sensory threshold for transcutaneous electrical stimulation / Diferenças de sexo e idade no limiar sensitivo para estimulação elétrica transcutânea

Abstract Introduction Pain is one of the main symptoms prevalent in most pathologies. Transcutaneous Electrical Nerve Stimulation (TENS) represents not only a therapeutic measure, but also a mean to quantify the neurosensory and pain perception in patients with chronic pain. Objective To evaluate the relationship between sex and age with neurosensory thresholds (sensory threshold and tolerance threshold) in the application of therapeutic current in patients with chronic pain. Methods Forty-five patients with chronic pain (30 women and 15 men) aged between 24 and 87 years were selected. Each patient answered the Individual Questionnaire, McGill Pain Questionnaire (MPQ) and Beck Depression Inventory (BDI). Subsequently, the electric current was applied, through which the sensory and pain thresholds were analyzed, as well as the perception of activation of the neurosensory pathways for each individual. Data were analyzed using the SPSS 24.0 for Windows. Results There was no significant correlation (p > 0.05) between a possible depressive diagnosis and the perception of current by the sensory and pain thresholds. Regarding sex, there was a significant difference in sensory thresholds (p = 0.003) between men and women, while no statistical differences were observed between sexes for pain complaint and pain threshold (p > 0.05). For the correlational analysis, a significant correlation (p = 0.05) was identified between the variables BMI and pain tolerance threshold (r = 0.68) for females and age and sensory threshold (r = 0.65) for males. Conclusion The sex and age variables are important in the measurement of TENS parameters because they lead to significant differences in sensory and pain thresholds.

Resumo Introdução A dor é um dos principais sintomas preva-lentes na maioria das patologias. A estimulação elétrica ervosa transcutânea (TENS) se apresenta não apenas como medida terapêutica, como também um meio de quantificar a percepção neurossensitiva e dolorosa em pacientes com dores crônicas. Objetivo Avaliar a relação entre sexo e idade com os limiares neurossensitivos (limiar sensitivo e limiar de tolerância) na aplicação da corrente terapêutica TENS, em pacientes com dores crônicas. Métodos Foram selecionados 45 pacientes com dores crônicas (30 mulheres), com idade entre 24 e 87 anos. Cada paciente respondeu ao Questionário Individual, ao Questionário McGill de Dor (MPQ) e ao Inventário de Depressão de Beck (BDI). Posteriormente, aplicou-se a corrente elétrica TENS, pela qual foram analisados o limiar sensitivo e doloroso, bem como a percepção de acionamento das vias neurossensitivas para cada indivíduo. Os dados foram analisados pelo pacote SPSS 24.0 for Windows. Resultados Não houve correlação significativa (p > 0,05) entre possível diagnós-tico depressivo e a percepção da corrente pelos limiares de sensibilidade e dor. Em relação ao sexo, houve diferença significativa nos limiares sensitivos (p = 0,003) entre homens e mulheres. Já para a queixa de dor e limiar de dor, não foram observadas diferenças estatísticas entre os sexos (p > 0,05). Para as análises correlacionais, identificou-se correlação significativa (p = 0,05) entre as variáveis de índice de massa corporal e limiar de tolerância à dor (r = 0,68) para o sexo feminino e idade e limiar sensitivo (r = 0,65) paro o sexo masculino. Conclusão As diferenças identificadas entre os limiares de sensibilidade entre os sexos, onde as mulheres identificaram o estímulo elétrico significativamente primeiro que os homens, podem auxiliar nas doses de intensidade ou tipo de corrente terapêutica dos pacientes.

Caracterización neurofisiológica de la función de fibra pequeña en mujeres heterocigotas con enfermedad de Fabry / Neurophysiologic characterization of small fiber function in heterozigous women with Fabry disease

RESUMEN INTRODUCCIÓN: La enfermedad de Fabry (EF) es una enfermedad genética, causada por el déficit de la enzima alfa galactosidasa A (α-Gal A), lo que provoca la acumulación de glicoesfingolípidos en los tejidos. Sus manifestaciones clínicas son variables. Estudios en mujeres heterocigotas reportan la existencia de dolor neuropático como manifestación de neuropatía de fibra pequeña. OBJETIVO: Determinar la presencia de neuropatía de fibra pequeña en mujeres heterocigotas para la EF, mediante la prueba cuantitativa sensorial. MATERIALES Y MÉTODOS: Se evaluaron 33 mujeres heterocigotas para EF y 33 mujeres sanas, con características demográficas similares. A todas se les aplicó la prueba cuantitativa sensorial (Quantitative Sensory Testing por medio de la detección de umbrales de frío (Colà Detection Threshold), calor (Warm Detection Threshold), dolor inducido por calor (Heat-pain Detection Thresholds) y vibración (Vibratory Detection Threshold) en los miembros superior e inferior, utilizando un sistema asistido por computador versión IV (CASE IV, WR Medical Electronics Co., Stillwater, MN). Adicionalmente, al grupo de mujeres heterocigotas para EF, se le evaluó la percepción subjetiva de dolor neuropàtico mediante el cuestionario de síntomas sensitivos neuropáticos positivos (Positive Neuropathic Sensory Symptom). Los resultados de la prueba cuantitativa sensorial se compararon entre los grupos. También se estableció la correlación entre la prueba cuantitativa sensorial y los resultados del cuestionario de síntomas sensitivos neuropáticos positivos. RESULTADOS: Se encontró una diferencia estadísticamente significativa en las pruebas de vibración (p = 0,008), calor (p = 0,017) y dolor inducido por calor (p = 0,04) en el miembro inferior en las mujeres heterocigotas para EF, comparado con el grupo control. Se encontró una correlación inversa estadísticamente significativa entre la intensidad del dolor quemante y el dolor inducido por calor en el miembro inferior (p = 0,018, r = -0,48) y entre la intensidad del dolor al ser rozado o tocado y el dolor inducido por calor en el miembro inferior (p = 0,006, r = -0,49). CONCLUSIÓN: En las mujeres heterocigotas para EF, las pruebas objetivas para establecer la presencia de neuropatía de fibra pequeña son anormales en miembros inferiores y se correlacionan con los síntomas sensitivos.

SUMMARY INTRODUCTION: Fabry disease is a genetic condition caused by alpha-galactosidase A deficiency triggering glycosphingolipid accumulation in tissues. Clinical manifestations are variable. Studies in heterozigous females report the existence of neuropathic pain as manifestation of small fiber neuropathy. OBJECTIVE: To determine presence of small fiber neuropathy in heterozigous females with Fabry disease through Quantitative Sensory Testing (QST). MATERIALS AND METHODS: 33 heterozigous females with fabry disease and 33 healthy females with similar demographic characteristics were evaluated. QST was performed to every female evaluating Cold detection Threshold (CDT), Warm Detection Threshold (WDT), Heat-pain Detection Threshold (HPDT) and Vibratory Detection Threshold (VDT) in upper and lower limbs through Computer Assisted Sensory Examination software (CASE IV, WR Medical Electronics Co., Stillwater, MN). Subjective perception of neuropathic pain was measured through Positive Neuropathic Sensory Symptom questionnaire (P-NSS) in heterozigous females with Fabry disease. QST results were compared between groups. Correlations between QST and P-NSS were established. RESULTS: Statistically significant differences were observed in VDT (p= 0,008), WDT (p= 0,017) and HPDT (p= 0,04) in lower limbs of heterozigous females with Fabry disease compared with control group. Negative correlation was found among burning pain intensity and HPDT at lower limbs (p= 0,018, r= -0,48) and among pain intensity to light touch and HPDT in lower limbs (p= 0,006, r=-0,49). CONCLUSIONS: Objective tests to establish presence of small fiber neuropathy in heterozigous females with Fabry disease are abnormal at lower limbs and correlate with sensory symptoms.

Detection of oropharyngeal sensory function in normal population / 中华耳鼻咽喉头颈外科杂志

Objective: To study the oropharyngeal sensory function by Current Perception Threshold(CPT) detection, to explore the detection method of oropharyngeal sensory function in normal population, and to analyze the possible influencing factors. Methods: Fifty-eight normal subjects were included prospectively in this study. Age, gender, body mass index (BMI) were collected. The age of the subjects ranged from 20 to 76 (43.27±13.52) years old. There were 34 females with 17 in childbearing period and 17 in menopause; and 24 males were included.In all the cases, 6 cases were in low BMI, 39 cases were in normal BMI, 10 cases were overweight and 3 cases were suffering from obesity. The CPT system of Neurometer was used to stimulate bilateral palatoglossal arch and tongue base.The current used was 2000 Hz, 250 Hz and 5 Hz respectively.The function of type Aβ, Aδ and C sensory nerve fibers were tested and the CPT values were recorded.The values were inversely proportional to pharyngeal sensation function.To evaluate the oropharyngeal sensory function of the subjects, the CPT values of each frequency at each testing point were compared. SPSS 25.0 software was used for statistical analysis. Results: The CPT value of palatoglossal arch was significantly lower than that of tongue base (t=-2.58,-2.65,-2.54,-2.47,-2.37,-2.77,P<0.05), 2 000 Hz>250 Hz>5 Hz, and there was no significant difference between left and right sides(t=-0.03,-0.51,-0.49,0.06,-0.16,0.13,P>0.05). The CPT value of male was slightly higher than that of female (t=0.92,1.55,0.27,0.78,1.44,1.26,0.35,0.77,1.27,0.24,0.78,0.96,P>0.05). The CPT values of women in childbearing period were significantly less than those in menopausal women (t=-3.90,-3.64,-2.14,-4.20,-4.28,-4.28,-3.52,-4.46,-3.41,-3.63,-4.66,-2.86,P<0.05). The CPT value increased with age, and the values of all frequency of 20 to 30 years old group was significantly lower than those of subjects over 40 years old at each point (The t values of bilateral palatoglossal arch at 2 000 Hz were -5.57,-6.22,-10.18,-11.00;the t values of bilateral palatoglossal arch at 250 Hz were -6.39,-8.79,-6.39,-15.61;the t values of bilateral palatoglossal arch at 5 Hz were -7.09, -5.57, -9.26, -15.23;the t values of tongue base at 2 000 Hz were -3.11,-3.88,-7.60,-8.55;the t values of tongue base at 250 Hz were -6.31,-10.59,-8.52,-10.60;the t values of tongue baseat 5 Hz were -6.69,-5.09,-8.70,-7.07,P<0.05).The values at all frequencies and testing points of 30-40 years old group were significantly lower than those of all subjects over 60 years old (The t values of bilateral palatoglossal arch at 2 000 Hz were -10.91,-12.42;the t values of bilateral palatoglossal arch at 250 Hz were -6.25,-10.87;the t values of bilateral palatoglossal arch at 5 Hz were -5.53,-11.01;the t values of tongue base at 2 000 Hz were -8.62,-10.12;the t values of tongue base at 250 Hz were -6.89,-7.82;the t values of tongue base at 5 Hz were -6.13,-6.48,P<0.05). Conclusions: CPT can be used to evaluate oropharyngeal sensory function. The sensitivity of tongue base is lower than that of palatoglossal arch, there is no significant difference in oropharyngeal sensory function between male and female,between left and right sides. There are many factors influencing oropharyngeal sensory function. Age, hormone level changes may affect the sensitivity of oropharyngeal sensory function.

Clinical effects of two combinations of olfactory agents on olfactory dysfunction after upper respiratory tract infection during olfactory training

SUMMARY OBJECTIVE To compare two combinations of olfactory agents for olfactory training therapy of olfactory dysfunction after upper respiratory tract infection (URTI) and investigate the influencing factors on clinical effects. METHODS 125 patients with olfactory dysfunction were randomly divided into two groups: test and control. During the olfactory training, four odors were used in both groups. The olfactory training lasted for 24 weeks. Then, participants were tested using Sniffin' Sticks and threshold-discrimination-identification (TDI) composite scoring before treatment and at 1, 3, and 6 months after treatment. The TDI scores were compared at different time points between the groups and within them, and influence factors were analyzed. RESULTS There was no significant difference in TDI scores between both groups. Furthermore, TDI scores did not significantly change after one month of treatment in either of the groups. After 3 and 6 months of treatment, TDI scores both significantly increased, and the odor discrimination and identification abilities significantly strengthened in both groups; however, the odor thresholds did not improve. The course of the disease was a significant influencing factor on the therapeutic effect of olfactory training for both groups. CONCLUSION The combination of essential balm, vinegar, alcohol, and rose perfume for olfactory training, which are scents commonly found in daily life, can effectively cure URTI-induced olfactory dysfunction, and significantly improve the odor discrimination and identification abilities. Furthermore, prolonging the treatment time can help with the recovery of olfactory functions, and earlier olfactory training can improve the therapeutic effect.

RESUMO OBJETIVO Comparar duas combinações de agentes olfativos para uso em terapia de treinamento olfativo no tratamento de disfunção olfatória após infecção do trato respiratório superior (ITRS) e investigar os fatores que influenciam os efeitos clínicos. METODOLOGIA 125 pacientes com disfunção olfativa foram divididos aleatoriamente em dois grupos: teste e controle. Durante o treinamento olfativo, quatro odores foram utilizados em ambos os grupos. O treinamento olfativo durou 24 semanas. Em seguida, os participantes foram testados usando Sniffin' Sticks e o escore de discriminação, limiar e identificação (TDI) antes do tratamento e 1, 3 e 6 meses após o ele. Os escores de TDI foram comparados em momentos diferentes, entre os grupos e dentro deles, e os fatores de influência foram analisados. RESULTADOS Não houve diferença significativa nos escores de TDI entre os dois grupos. Além disso, os escores de TDI não demonstração nenhuma alteração significa após um mês de tratamento em ambos os grupos. Após 3 e 6 meses de tratamento, ambos os escores de TDI aumentaram significativamente, e as habilidades de identificação e discriminação de odores melhoraram significativamente em ambos os grupos; contudo, os limiares de odor não demonstraram melhora. O curso da doença foi um importante fator de influência no efeito terapêutico do treinamento olfativo em ambos os grupos. CONCLUSÃO A combinação de bálsamo essencial, vinagre, álcool, e perfume de rosas no treinamento olfativo, todos aromas comumente encontrados na vida cotidiana, podem efetivamente curar disfunção olfativa induzida por ITRS e melhorar significativamente as habilidades de discriminação e identificação de odores. Além disso, a prolongamento do tempo de tratamento pode ajudar na recuperação das funções olfativas, e o início antecipado do treinamento olfativo pode melhorar o efeito terapêutico.

Tradução, adaptação cultural e validação do School Companion Sensory Profile 2 para crianças brasileiras / Translation, cultural adaptation and validation of the School Companion Sensory Profile 2 for Brazilian children

Avaliar os padrões de disfunção sensorial através de instrumentos que possam mensurar os resultados é de extrema importância para a avaliação e a elaboração do plano terapêutico com ações e estratégias de intervenção, tanto no contexto clínico como domiciliar e escolar. Estudos para tradução e validação cultural dos instrumentos são essenciais e cada vez mais difundidos no campo da terapia ocupacional, para que os profissionais possam incorporar em sua avaliação instrumentos confiáveis que possam mensurar os resultados da intervenção e que estejam adequados ao público-alvo. Este é um estudo metodológico, transversal, de abordagem quantitativa, que teve como objetivo descrever o processo de tradução, adaptação cultural e validação das propriedades psicométricas do instrumento School Companion Sensory Profile 2 (SCSP 2) para crianças brasileiras. A pesquisa foi realizada em escolas públicas e particulares de Franca/ SP e conduzida no Laboratório de Ensino e Pesquisa de Terapia Ocupacional na Infância e Adolescência (LEPTOI) da Universidade de São Paulo. A amostra total incluiu 74 professores de crianças e adolescentes de 3 a 14 anos e 11 meses, que responderam ao questionário referente a 146 crianças. Método: A versão em português para o Brasil foi obtida através de duas etapas principais: a primeira consistiu do processo de tradução, retrotradução e estudo de validade de face; na segunda etapa, foram realizados estudos psicométricos por meio da consistência interna, fidedignidade teste-reteste, análise fatorial confirmatória, e análise de pontos de corte de escores. Para a primeira etapa, os resultados revelaram que, a partir da validade de face, houve adequação semântica e compreensibilidade do instrumento por parte dos respondentes. Para a segunda etapa, o software STATA auxiliou nas análises, e o SCSP 2 apresentou consistência interna total > 0.96, mas quando analisado por áreas sensoriais a consistência foi entre 0.7 e 0.9 para todas as áreas com exceção da área comportamental. Os quadrantes "procura sensorial" e "sensibilidade sensorial" apresentaram a média dos valores de alfa de 0.8 e os quadrantes "evita sensorial" e "registro sensorial" apresentaram a média dos valores de alfa de 0.9. Os fatores escolares apresentaram a média dos valores de alfa de 0.9, com exceção do fator 2 que apresentou a média de 0.8. Sobre o teste-reteste, houve alta concordância com valor de Kappa ponderado na categoria quase perfeita. Entretanto, a análise fatorial não confirma a estrutura atual desse instrumento. A rotação da matriz mostrou que itens poderiam ser alocados em domínios diferentes aos que pertencem originalmente, mostrando correlações distintas entre os itens e dimensões. Os pontos de corte dos escores brasileiros foram pouco diferentes dos americanos. Algumas questões a serem exploradas são em relação à equivalência da estrutura do instrumento, a equivalência das cargas, a quantidade de itens, a covariância entre os fatores do instrumento e os erros de medida. Estudos futuros poderão verificar a validade e confiabilidade do SCSP 2 entre diferentes populações com uso de instrumentos que possam avaliar o mesmo constructo, observando validades convergentes e discriminantes.

Assessing patterns of sensory dysfunction through instruments that can also measure the results is of extremely importance for the evaluation and development of the therapeutic plan with intervention actions and strategies, both in the clinical, family and school contexts. Studies of translation and cultural validation of instruments are essential and are being increasingly widespread in the field of Occupational Therapy in a way that professionals can incorporate in their assessments reliable instruments that can also measure the results of the intervention and that are suitable for the target audience. This is a methodological, cross-sectional study with a quantitative approach, which aimed to describe the process of translation, cultural adaptation and validation of the psychometric properties of the School Companion Sensory Profile 2 (SCSP 2) for Brazilian children. The research was carried out in public and private schools in Franca/SP and conducted at the Teaching and Research Laboratory of Occupational Therapy in Childhood and Adolescence (LEPTOI) at the University of São Paulo. The total sample included 74 teachers of children and adolescents aged 3 to 14 years and 11 months, who answered the questionnaire about 146 children. Method: The Portuguese version for Brazil was obtained through two main steps: the first consisted of the translation process, back-translation, content validity study and pre-test phase in a pilot study. In the second step, psychometric studies were carried out using internal consistency, test- retest reliability, confirmatory factor analysis, and analysis of cut-off points for scores. First stage results revealed that, from the face validity, there was semantic adequacy and comprehensibility of both instruments by the respondents. The STATA software aided in the analysis in the second stage, in which the SCSP 2 showed total internal consistency > 0.96, but when analyzed by sensory areas, the consistency was between 0.7 and 0.9 for all areas except the behavioral area. The quadrants "sensory seeking" and "sensory sensitivity" presented the average of the alpha values of 0.8 and the quadrants "sensory avoidance" and "sensory registration" had the average of the alpha values of 0.9. School factors had an average of alpha values of 0.9, with the exception of factor 2, which had an average of 0.8. Regarding the test-retest for both instruments, there was a high level of agreement with the weighted Kappa value in the almost perfect category. However, factor analysis does not confirm the current structure of this instrument. The matrix rotation showed that items could be allocated in different domains to those they originally belong, showing distinct correlations between the items and dimensions. The cut-off points for Brazilian scores were slightly different when compared with the American scores. Some questions to be explored are in relation to the equivalence of the instrument's structure, the equivalence of the loads, the number of items, the covariance between the factors of the instrument and the measurement errors. Future studies will be able to verify the validity and reliability of SCSP 2 among different populations using instruments that can assess the same construct, observing convergent and discriminating validities.

Utilização de monofilamentos para avaliação sensorial em pacientes com sequela de Acidente Vascular Encefálico (AVE) - uma revisão sistemática / Use of monofilaments for sensory evaluation in patients with sequelae of stroke - a systematic review

FUNDAMENTO: A estesiometria é um teste quantitativo para avaliar o desempenho tátil sensorial, verificar o grau de sensibilidade cutânea por meio dos monofilamentos de nylon ao toque leve e à pressão. OBJETIVO: Verificar a utilização dos monofilamentos como instrumento de avaliação da sensibilidade de pacientes com sequela de AVE na literatura. MÉTODO: Estudo de revisão sistemática, realizado com artigos indexados na base de dados PubMed, Lilacs e Scielo, sem limitação por data de publicação, sendo a busca realizada no mês de outubro de 2018. RESULTADOS: Foram elencados dezessete estudos, após análise destes, nove foram excluídos por não preencherem os critérios de inclusão, e oito foram lidos na íntegra. Após leitura dos artigos, foram obtidos os dados referentes a: número da amostra, instrumentos de avaliação, se houve ou não intervenção, e a conclusão do estudo. CONCLUSÃO: Por mais promissor que seja o uso dos monofilamentos para avaliação sensorial, esta revisão mostrou que existem poucos estudos avaliando os pacientes com sequela de AVE com este método de avaliação, principalmente estudos clínicos.

BACKGROUND:The esthesiometry is a quantitative test to evaluate the tactile sensory performance, to verify the degree of cutaneous sensitivity through nylon monofilaments to light touch and pressure. OBJECTIVE: To verify the use of monofilaments as a tool to assess the sensitivity of patients with a sequel to stroke in the literature. METHOD: A systematic review study was carried out with articles indexed in the PubMed, Lilacs and Scielo database, without limitation by date of publication. The search was carried out in October 2018. RESULTS: Seventeen studies were analyzed, after analyzing nine were excluded because they did not meet the inclusion criteria, and eight were read in full. After reading the articles, data were obtained regarding: sample number, evaluation instruments, whether or not there was intervention, and the conclusion of the study. CONCLUSION: As promising as it may be the use of monofilaments for sensory evaluation, this review showed that there are few studies evaluating patients with sequelae of stroke with this method of evaluation, mainly clinical studies.

Quantitative sensory testing in elderly: longitudinal study / Teste sensitivo quantitativo em idosos: estudo longitudinal

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

RESUMO Objetivo: Avaliar pacientes idosos em um serviço de geriatria, juntamente com as características sensitivas e sua associação com aspectos clínicos. Métodos: Este é um estudo longitudinal descritivo. Foram avaliados 36 sujeitos saudáveis de ambos os sexos. Os seguintes instrumentos e avaliações foram realizados: Avaliação clínica, Mini Exame de Estado Mental (Mini-Mental) e testes sensitivos quantitativos. Resultados: Durante o acompanhamento houve redução do volume corpuscular médio (VCM) em cada avaliação (P < 0,001) e aumento significativo das concentrações de hemoglobina corpuscular média (CHCM) (P < 0,001). Houve aumento dos limiares olfativos (p < 0,001), salgado (p = 0,024), azedo (p = 0,020), amargo (p = 0,001), frio face (p = 0,019), frio mão (p = 0,004), tato face (p < 0,001), tato mão (p = 0.012) e vibração face (p = 0,018). Morbidades prévias foram associadas às alterações de sensibilidade nos indivíduos desta amostra. Conclusão: Este estudo longitudinal sugere que a perda de sensibilidade no envelhecimento pode estar associada à presença de morbidades em idosos.

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

BACKGROUND: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

Comparison of Electroacupuncture and Mild-Warm Moxibustion on Brain-Gut Function in Patients with Constipation-Predominant Irritable Bowel Syndrome: A Randomized Controlled Trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To compare the effects of electroacupuncture (EA) and mild-warm moxibustion (Mox) therapies for constipation-predominant irritable bowel syndrome (C-IBS) patients.</p><p><b>METHODS</b>Sixty C-IBS patients were assigned to 2 groups by simple randomized method, i.e. EA group (30 cases) and Mox group (30 cases). Both EA and Mox treatments were performed on bilateral Tianshu (ST 25) and Shangjuxu (ST 37) for 30 min each time, 6 times per week, for 4 consecutive weeks. The gastrointestinal symptoms and psychological symptoms of the two groups were scored before and after treatment. The effects on the corresponding functional brain areas, namely the anterior cingulate cortex (ACC), insular cortex (IC) and prefrontal cortex (PFC) were observed by functional magnetic resonance imaging (fMRI) before and after treatment.</p><p><b>RESULTS</b>Compared with the Mox group, greater improvements in abdominal distension, defecation frequency, diffificulty in defecation and stool features were observed in the EA group (all P<0.01), both Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale scores were signifificantly decreased in the EA group (all P<0.01). Finally, decreased activated voxel values were observed in the ACC, right IC and PFC brain regions of EA group with 150 mL colorectal distension stimulation (P<0.05 or P<0.01).</p><p><b>CONCLUSIONS</b>Both EA and Mox could signifificantly improve some of the most intrusive symptoms of C-IBS patients, and EA was more effective than Mox. The therapeutic effect of these two therapies might through modulating of the brain-gut axis function. (Registration No. ChiCTRTRC-11001349).</p>

Organic solvent exposure and contrast sensitivity: comparing men and women

The goal of this study was to compare the visual contrast sensitivity (CS) of men and women exposed and not exposed to organic solvents. Forty-six volunteers of both genders aged between 18 and 41 years (mean±SD=27.72±6.28) participated. Gas station attendants were exposed to gas containing 46.30 ppm of solvents at a temperature of 304±274.39 K, humidity of 62.25±7.59% and ventilation of 0.69±0.46 m/s (a passive gas chromatography-based sampling method was used considering the microclimate variables). Visual CS was measured via the psychophysical method of two-alternative forced choice using vertical sinusoidal gratings with spatial frequencies of 0.2, 0.5, 1.0, 2.0, 5.0, 10.0, and 16.0 cpd (cycles per degree) and an average luminance of 34.4 cd/m2. The results showed that visual CS was significantly lower (P<0.05) in the following groups: i) exposed men compared to unexposed men at frequencies of 0.2, 0.5, 1.0, and 2.0 cpd; ii) exposed women compared to unexposed women at a frequency of 5.0 cpd; and iii) exposed women compared to exposed men at a frequency of 0.5 cpd, even at exposures below the tolerance limit (300 ppm). These results suggest that the visual CS of exposed men was impaired over a wider range of spatial frequencies than that of exposed women. This difference may have been due to the higher body fat content of women compared to that of men, suggesting that body fat in women can serve as a protective factor against neurotoxic effects.

Influence of skin cold sensation threshold in the occurrence of dental sensitivity during dental bleaching: a placebo controlled clinical trial

Abstract Objective This study verified the occurrence of dental sensitivity in patients submitted to a 35% hydrogen peroxide based product (Whiteness HP Maxx 35% - FGM), skin cold sensation threshold (SCST) and its influence on dental sensitivity. Material and Methods Sixty volunteers were divided into 4 groups (n = 15), according to SCST (low: GI and GIII, and high: GII and IV) and bleaching treatment (hydrogen peroxide: GI and GII, and placebo: GIII and GIV). SCST was determined in the inner forearm for 6 different times using a neurosensory analyzer, the TSA II (Medoc Advanced Medical Systems, Ramat Yishai, Northern District, Israel). Dental sensitivity measurements were performed 10 different times using a thermal stimulus and an intraoral device attached to TSA II, positioned in the buccal surface of the upper right central incisor. Spontaneous dental sensitivity was also determined using the Visual Analogue Scale (VAS). Data were submitted to Student's t-test and Pearson's Correlation Test (α=0.05). SCST remained the same during bleaching treatment. Results Distinct responses of dental sensitivity were found in patients with low and high SCST during the first and third bleaching session (p≤0.05). The teeth submitted to the bleaching treatment became more sensitive to cold than those treated with placebo. Moreover, data obtained with TSA and VAS presented moderate correlation. Conclusions Bleaching treatment increased dental sensitivity and skin cold sensation threshold might represent a determining factor in this occurrence, since low and high SCST patients had different responses to the thermal stimulus in the teeth.

Are people who have a better smell sense, more affected from satiation? / As pessoas que têm melhor olfato são mais afetadas pela saciedade?

Abstract Introduction: The olfactory system is affected by the nutritional balance and chemical state of the body, serving as an internal sensor. All bodily functions are affected by energy loss, including olfaction; hunger can alter odour perception. Objective: In this study, we investigated the effect of fasting on olfactory perception in humans, and also assessed perceptual changes during satiation. Methods: The "Sniffin' Sticks" olfactory test was applied after 16 h of fasting, and again at least 1 h after Ramadan supper during periods of satiation. All participants were informed about the study procedure and provided informed consent. The study protocol was approved by the local Ethics Committee of Gaziosmanpaşa Taksim Education and Research Hospital (09/07/2014 no: 60). The study was conducted in accordance with the basic principles of the Declaration of Helsinki. Results: This prospective study included 48 subjects (20 males, 28 females) with a mean age of 33.6 ± 9.7 (range 20-72) years; their mean height was 169.1 ± 7.6 (range 150.0-185.0) cm, mean weight was 71.2 ± 17.6 (range 50.0-85.0) kg, and average BMI was 24.8 ± 5.3 (range 19.5-55.9). Scores were higher on all items pertaining to olfactory identification, thresholds and discrimination during fasting vs. satiation (p < 0.05). Identification (I) results: Identification scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). Threshold (T) results: Threshold scores were significantly higher during the fasting (median = 7.3) vs. satiation period (median = 6.2). Discrimination (D) results: Discrimination scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). The total TDI scores were 35.2 (fasting) vs. 32.6 (satiation). When we compared fasting threshold value of >9 and ≤9, the gap between the fasting and satiety thresholds was significantly greater in >9 (p < 0.05). Conclusion: Olfactory function improved during fasting and declined during satiation. The olfactory system is more sensitive, and more reactive to odours, under starvation conditions, and is characterised by reduced activity during satiation. This situation was more pronounced in patients with a better sense of smell. Olfaction-related neurotransmitters should be the target of further study.

Resumo Introdução: O sistema olfatório é afetado pelo equilíbrio nutricional e estado químico do corpo, que serve como um sensor interno. Todas as funções corporais são afetadas pela perda de energia, inclusive o olfato; a fome pode alterar a percepção do odor. Objetivo: Neste estudo, investigamos o efeito do jejum sobre a percepção olfativa em seres humanos, e também avaliamos as mudanças de percepção durante a saciedade. Método: O teste olfatório Sniffin Sticks foi aplicado após 16 horas de jejum e novamente pelo menos 1 hora após a ceia do Ramadã durante os períodos de saciedade. Todos os participantes foram informados sobre os procedimentos do estudo e forneceram o consentimento informado. O protocolo do estudo foi aprovado pelo Comitê de Ética do Gaziosmanpaşa Taksim Education e Research Hospital (2014/09/07 n° 60). O estudo foi conduzido de acordo com os princípios básicos da Declaração de Helsinki. Resultados: Foram incluídos 48 pacientes (20 homens, 28 mulheres) com média de 33,6 ± 9,7 aos (variação 20-72); a altura média deles era de 169,1 ± 7,6 cm (variação 150-185), o peso médio era de 71,2 ± 17,6 kg (variação de 50-85) e o IMC médio era de 24,8 ± 5,3 (variação de 19,5-55,9). Os escores foram maiores em todos os itens correspondentes à identificação olfativa, limiares e discriminação durante jejum vs. saciedade (p < 0,05). Resultados da identificação (I): os escores de identificação foram significativamente maiores durante o jejum (mediana = 14) vs. período de saciedade (mediana = 13). Resultados limiares (T): os escores limiares foram significativamente maiores durante o jejum (mediana = 7,3) vs. período de saciedade (mediana = 6,2). Resultados de discriminação (D): os escores de discriminação foram significativamente maiores durante o jejum (mediana = 14) vs. período de saciedade (mediana = 13). Os escores totais de TDI foram de 35,2 (jejum) vs. 32,6 (saciedade). Quando comparamos o valor do limiar de jejum de > 9 e ≤ 9, a diferença entre os limiares de jejum e de saciedade foi significativamente maior em > 9 (p < 0,05). Conclusão: A função olfatória melhorou durante o jejum e diminuiu durante a saciedade. O sistema olfatório é mais sensível e mais reativo aos odores em condições de fome e é caracterizado por atividade reduzida durante a saciedade. Essa situação foi mais pronunciada em pacientes com um melhor sentido olfativo. Os neurotransmissores relacionados com o olfato devem ser alvo de um estudo mais aprofundado.

Effects of plantar foot sensitivity manipulation on postural control of young adult and elderly / Efeitos da manipulação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos

ABSTRACT Introduction: Subjects with sensorial losses present balance deficits. Although such condition is often observed among elderly, there is discussion concerning the dependence on sensorial information for body sway control in the elderly without sensorial losses. Purpose: We investigated the effects of foot sensitivity manipulation on postural control during upright standing in young adults and independent elderly (n = 19/group). Methods: Plantar sensitivity was evaluated by esthesiometry, and speed of center of pressure shift data during upright posture were evaluated for each foot using a baropodometer while the subjects were standing with eyes open or closed. The young adult group was evaluated for center of pressure in normal conditions and after plantar sensitivity disturbance, by immersing their feet in water and ice. Results: Young adults did not show alterations in their center of pressure after sensorial perturbation and presented, even under sensorial perturbation, better postural control than elderly subjects. The elderly showed lower foot sensitivity and greater center of pressure oscillation than young adults. Conclusion: Elderly subjects seem to rely more on foot sensitivity for control of body sway than young adults. In the elderly, a clinical intervention to improve foot sensitivity may help in upright posture maintenance.

RESUMO Introdução: Pessoas com perdas sensoriais apresentam déficits de equilíbrio. Embora esse quadro seja comum em idosos, ainda se discute o quanto idosos sem doenças que afetam as vias sensoriais dependem dessa informação para controlar oscilações corporais durante o controle da postura. Objetivo: Investigar os efeitos da perturbação da sensibilidade plantar sobre o controle da postura ereta em adultos jovens e idosos independentes (n = 19/grupo). Métodos: A sensibilidade plantar foi avaliada com estesiômetro e dados de velocidade e deslocamento do centro de pressão durante a postura de pé foram avaliados para cada pé com um baropodômetro, em condições de olhos abertos e fechados. O grupo de adultos jovens foi avaliado quanto ao centro de pressão nas condições normal e pós-perturbação da sensibilidade plantar, pela imersão dos pés em água e gelo. Resultados: Adultos não apresentaram alterações no centro de pressão em resposta à perturbação sensorial e tiveram, mesmo na condição de perturbação sensorial, melhor controle postural do que idosos. Idosos apresentaram menor sensibilidade plantar e maior oscilação do centro de pressão do que os adultos jovens. Conclusão: Idosos pareceram depender mais da sensibilidade plantar para manter o controle postural do que adultos jovens. Em idosos, intervenções clínicas que melhorem a sensibilidade plantar podem auxiliar na tarefa de manter a postura de pé.

A artroplastia total do cotovelo provoca déficit proprioceptivo / Total Elbow Arthroplasty Causes Proprioceptive Deficits

A artroplastia total é necessária no tratamento de casos graves de fraturas, artrite reumatoide e osteoartrose do cotovelo. Durante o procedimento, a cápsula articular é parcialmente ressecada, levando à perda de mecanorreceptores que seriam importantes para a percepção do movimento passivo em condições normais. Acreditamos que o desenvolvimento de um equipamento capaz de realizar a medição da cinestesia, através do limiar de percepção do movimento passivo (LPMP), ajudará a esclarecer o quanto este procedimento impacta negativamente a propriocepção, e se esse efeito repercute na esfera clínica. O Propriomaq II foi criado nesse contexto, permitindo a mobilização passiva da articulação e o acionamento de um botão pelos sujeitos examinados ao perceberem o movimento, viabilizando o cálculo do seu limiar de percepção. Vinte e um pacientes hígidos foram submetidos ao teste, repetindo as medidas após ao menos um dia, visando validar o método. Com o objetivo de esclarecer o efeito da artroplastia total sobre o LPMP do cotovelo, oito pacientes portadores de prótese total foram submetidos ao exame, comparando o lado operado ao contralateral. Os resultados demonstraram latência significativamente maior para a percepção do movimento passivo nos cotovelos operados, ou seja, pior propriocepção quando comparados ao lado contralateral. Não foi encontrado, entretanto, correlação significativa entre o LPMP e os resultados funcionais no lado artroplastia. O Propriomaq II apresentou boa reprodutibilidade (R2=0,94) na medição do LPMP do cotovelo, e evidenciou conclusivamente o prejuízo proprioceptivo presente em cotovelos submetidos a artroplastia total. Esses resultados demonstram a necessidade de maior preservação das partes moles periarticulares durante a artroplastia total do cotovelo, e uma ênfase da reabilitação fisioterapêutica visando recuperação da propriocepção

Total elbow arthroplasty is necessary in the treatment of severe fractures, rheumatoid arthritis and degenerative elbow arthritis. During the procedure, the articular capsule is partially resected, leading to loss of mechanoreceptors that would be important for the perception of articular motion in normal conditions. We believe that the creation of an equipment capable of assessing kinesthesia through the measurement of threshold to detection of passive motion (TDPM) will help quantify the negative effects this procedure has on elbow proprioception, and understand if this has any relevant impact in the clinical sphere. The Propriomaq II was created in this context, allowing passive mobilization of the elbow joint and the activation of a button by the examined subjects when motion is perceived, thus providing a means of calculating it's detection threshold. Twenty-one healthy patients were subjected to the test, repeating the measurements after at least one day, so the method could be validated. In order to clarify the effects of total arthroplasty on elbow TDPM, eight patients were subjected to the test, comparing the total elbow side to the contralateral side. The results revealed significantly higher thresholds to detection of motion, or worse proprioception, on the prosthesis side in comparison to the contralateral side. These results held no correlation, however, to the clinical outcome of the elbow replacement. The Propriomaq II proved reproducible (R2=0,94) in the measurement of elbow TDPM and has conclusively exposed the proprioceptive deficits present in total arthroplasty elbows. These results demonstrate the need for greater preservation of peri-articular soft tissues during total elbow arthroplasty, and an emphasis of rehabilitation on the recovery of proprioception

Avaliação da percepção sensorial ao gosto doce em pessoas com Diabetes Mellitus tipo 2 / Evaluation of the sensory perception of sweet taste in people with Diabetes Mellitus type 2

Avaliar a percepção sensorial de pacientes com Diabetes Mellitus tipo 2, por meio do teste de índicelimiar para o gosto doce. Métodos: estudo transversal, composto por 80 adultos de ambos os sexos, divididosem dois grupos: controle, composto por não diabéticos, e teste, formado por pacientes diabéticos. Avaliação dapercepção sensorial realizada pelo teste de sensibilidade para determinação do índice limiar. Testes conduzidosem cinco sessões, contendo as concentrações diferentes de sacarose. Análise estatística por meio do teste t,adotado p˂0,05. Resultados: ao comparar a média dos limiares para detecção do gosto doce entre diabéticos enão diabéticos foi notório que os diabéticos são menos sensíveis ao estímulo doce. Conclusão: indivíduos comDiabetes Mellitus 2 apresentam valor de índice limiar maior para o gosto doce, o que pode contribuir para oaumento do consumo de açúcar.

Objective: to evaluate the perception of patients with type 2 diabetes through the threshold index test for the sweet taste. Methods: a cross-sectional study with 80 adults of both genders, divided into two groups: control, composed of non-diabetics, and test, with diabetic patients. The evaluation of sensory perception held by the sensitivity test to determine the threshold index. The tests were conducted on five sections containing different concentrations of sucrose. Statistical analysis was held using the t test, adopted P<0.05. Results: when comparing the average of the thresholds to detect sweet taste between diabetics and non-diabetics, it was known that diabetics are less sensitive to sweet stimuli. Conclusion: individuals with Diabetes Mellitus 2 have higher threshold index value for the sweet taste, which may contribute to the increase in sugar consumption.

Conceptos actuales de patología anorrectal funcional / Current concepts in functional anorectal disorders

The purpose of the present article is to highlight relevant aspects of anorectal pathology, mainly fiber resistant constipation, fecal incontinence and fecal soiling. A high percentage of patients with fiber resistant constipation correspond to dyssynergic defecation cases. In addition, most patients with dyssinergia and slow colonic transit return to normal after correction of the dyssyinergic condition. For these reasons, the current recommendation is to consider the evaluation of dyssynergic defecation as the initial diagnostic approach in patients with laxative-resistant constipation. Rectal hyposensitivity is an important pathophysiological mechanism involved in both constipation and fecal incontinence. About 80% of fecal incontinence cases present multiple pathological mechanisms, including sphincter insufficiency, rectal hyposensitivity, poor rectal emptying and impaired rectal compliance. Soling and seepage are usually in the context of poor rectal emptying and not in the context of sphincter insufficiency.

El siguiente artículo pretende destacar aspectos relevantes en patología anorrectal funcional, principalmente constipación resistente a fibra, incontinencia fecal y ensuciamiento. Entre los pacientes con constipación resistente a fibra, un alto porcentaje corresponde a defecación disinérgica. Además, la mayoría de los pacientes con defecación disinérgica y tránsito colónico enlentecido normalizan el tránsito tras mejoría de la disinergia. Por estos motivos, la recomendación actual es la evaluación de defecación disinérgica como primera estrategia diagnóstica en los pacientes con constipación refractaria a laxantes. La hiposensibilidad rectal es un mecanismo importante en casos de constipación e incontinencia fecal. Alrededor de 80% de los casos de incontinencia fecal tienen múltiples mecanismos descritos, incluyendo insuficiencia esfinteriana, hiposensibilidad rectal, mal vaciamiento rectal y alteraciones de la complianza rectal. El ensuciamiento suele estar en el contexto de mal vaciamiento rectal y no en el contexto de insuficiencia esfinteriana.

Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

BACKGROUND/AIMS: In patients with neuroendocrine tumors, excessive production of serotonin and other amines may cause the carcinoid syndrome, which is mainly characterized by diarrhea and flushing. Little is known about the pathophysiology of carcinoid diarrhea. In several other groups of patients, diarrhea may be associated with rectal hypersensitivity and increased rectal tone. Therefore, the aim of the present study was to compare rectal sensitivity and compliance in patients with carcinoid diarrhea and in healthy subjects. METHODS: Twelve patients (6 males, aged 54-78 years, median 65 years), with carcinoid diarrhea and 19 healthy subjects (7 males, aged 50-78 years, median 61 years) were included. Rectal mechanical and heat stimulation was used for assessment of rectal mechano-sensory properties. RESULTS: Overall, 5.3% higher temperatures were needed to elicit sensory responses in patients with carcinoid diarrhea than in healthy subjects (P = 0.015). Posthoc analyses revealed that the sensory threshold to heat was 48.1 ± 3.1℃ in patients vs 44.7 ± 4.7℃ in healthy subjects (P = 0.041). In contrast, patients and healthy subjects showed no overall differences in rectal sensory response to mechanical distension (P = 0.731) or rectal compliance (P = 0.990). CONCLUSIONS: Patients with carcinoid diarrhea have higher sensory thresholds to heat stimulation in comparison to healthy subjects, but normal rectal sensation to mechanical distension and normal compliance. Therefore, treatment of carcinoid diarrhea should aim at prolonging gastrointestinal transit and decreasing secretion, rather than modifying rectal mechano-sensory function.

A influência da dupla tarefa no controle postural de adultos jovens / La influencia de doble tarea en el control postural de adultos jóvenes / The influence of dual-tasking on postural control in young adults

O objetivo deste estudo foi verificar a influência da dupla tarefa no equilíbrio postural de adultos jovens. Fizeram parte do estudo 20 universitários (10 homens e 10 mulheres) com idade média de 25 anos. O equilíbrio postural foi avaliado pelo Sensory Organization Test (SOT), utilizando o Smart Equitest(tm) da NeuroCom(r) International, que avalia a habilidade do indivíduo para usar os diferentes sistemas do controle postural (somatossensorial, vestibular e visual) para se manter em equilíbrio nas 6 condições de conflito sensorial apresentadas pelo sistema. Os sujeitos foram avaliados em tarefa única (manutenção do equilíbrio) e dupla tarefa (manutenção do equilíbrio em conjunto com tarefa cognitiva de cálculo mental), de modo randomizado. O equilíbrio foi mensurado através do escore de equilíbrio, comparando diferenças angulares entre os deslocamentos anterior e posterior máximos. Foi utilizado o teste de Wilcoxon com nível de significância p(0,05 para comparar as médias dos escores de equilíbrio entre a situação sem e com dupla tarefa. Os escores de equilíbrio nas condições do SOT evidenciaram diferença estatisticamente significativa na condição 1 (olhos abertos, plataforma e entorno visual fixos; p=0,018) e na condição 6 (olhos abertos, plataforma oscila e entorno visual fixo; p=0,008), com redução do equilíbrio com a dupla tarefa em ambas. Os resultados mostraram que durante a dupla tarefa, composta pelas quatro operações aritméticas, o controle postural é influenciado negativamente com maior oscilação dos sujeitos. Assim, a complexidade da tarefa secundária pode ter sido o principal motivo para os menores escores de equilíbrio encontrados.

Este artículo tuvo por objetivo verificar la influencia de doble tarea en el equilibrio postural de adultos jóvenes. Se han hecho parte del estudio 20 universitarios (10 hombres y 10 mujeres) con promedio de edad de 25 años. El equilibrio postural se evaluó por el Sensory Organization Test (SOT), con uso del Smart Equitest(tm) de la NeuroCom(r) International, el que evalúa la habilidad del sujeto en el uso de los distintos sistemas de control postural (somatosensorial, vestibular y visual) con el fin de mantenerse en equilibrio en las 6 condiciones de conflicto sensorial presentadas por el sistema. Se han evaluados los sujetos en una sola tarea (manutención del equilibrio) y de doble tarea (manutención del equilibrio en relación con la tarea cognitiva de cálculo mental), del modo aleatorizado. Se midió el equilibrio a través de la puntuación de equilibrio, al comparar diferencias angulares entre el desplazamiento anterior y posterior máximos. Se ha hecho la prueba de Wilcoxon con el nivel de significancia p(0,05 para comparar las medias de las puntuaciones de equilibrio entre la situación sin o con doble tarea. Las puntuaciones de equilibrio en las condiciones del SOT han mostrado diferencias estadísticas significativas en la Condición 1 (ojos abiertos, plataforma y entorno visual fijos; p=0,018) y en la Condición 6 (ojos abiertos, plataforma que oscila y entorno visual fijo; p=0,008), con la reducción de equilibrio con doble tarea en ambas las condiciones. Los resultados mostraron que durante la doble tarea, que consiste en las cuatro operaciones aritméticas, el control se influyó negativamente con mayor oscilación de los sujetos. De esa manera, la complejidad de la tarea secundaria puede ser la principal razón para las menores puntuaciones de equilibrio encontradas.

The aim of this study was to investigate the influence of dual-tasking on postural balance in young adults. Participants were 20 college students (10 men and 10 women) with a mean age of 25 years. Postural balance was evaluated by the Sensory Organization Test (SOT), using the Smart Equitest(tm) NeuroCom(r) International, which evaluates the individual's ability to use the different systems of postural control (somatosensory, vestibular and visual) to keep in balance in the 6 conditions of sensory conflict presented by the system. The subjects were evaluated while single-tasking (maintaining balance) and dual-tasking (maintaining balance in conjunction with cognitive mental calculation task) in randomized order. Balance was measured by using the balance score, comparing the angular differences between the maximum anterior and posterior displacements. The Wilcoxon test with significance level of p(0.05 was used to compare the mean scores of balance between the situation with and without dual task. The balance scores in SOT conditions were analyzed and demonstrated statistically significant differences in condition 1 (eyes open, fixed platform and visual surroundings; p=0.018) and condition 6 (eyes open, platform swings and fixed visual surroundings; p=0.008), with reduced balance when dual-tasking in both conditions. The results showed that while performing dual tasks, consisted of four arithmetic operations, the posture control is negatively affected, resulting in a greater oscillation of the subjects. Thus, the complexity of the secondary task may have been the main reason for the lower balance scores found.