Enfoque terapéutico para el síndrome de boca urente / Therapeutic approach for burning mouth syndrome

INTRODUCCIÓN: el síndrome de boca urente (SBU), también conocido como estomatodinia o glosodinia, es una situación de dolor crónico que varía en su intensidad de moderado a severo y que se manifiesta como una disestesia ardiente relacionada a la lengua, pero también afecta frecuentemente la cara interna de los labios y la porción anterior del paladar duro. corresponde a una sensación de ardor continua, con una mucosa oral normal y de la cual no se puede encontrar ninguna causa dental o médica evidente. el SBU se divide en dos tipos: uno primario o idiopático, el cual no se puede asociar a ninguna otra patología, siendo un diagnóstico de exclusión; y uno secundario, el cual puede relacionarse a factores locales o generales, que puedan estar generándolo y que el tratamiento de esta causa conlleva a la resolución del problema. en esta revisión nos enfocaremos al tratamiento del SBU primario, del cual su fisiopatología aún no está clara, y la cual podría estar relacionada a factores periféricos como centrales, teniendo también un rol los problemas psicológicos. al no tener clara en su totalidad la fisiopatología de esta enfermedad, se hace muy difícil el poder tratarla. el objetivo de esta revisión es poder entregar herramientas actuales para su correcto diagnóstico y cuáles son los enfoques terapéuticos actuales que se están utilizando hoy para poder tratar esta enfermedad.

INTRODUCTION: burning mouth syndrome (BMS), also known as stomatodynia or glossodynia, is a chronic pain condition that ranges from moderate to severe, manifesting as a burning dysesthesia usually related to the tongue, but also frequently affects the inner face of the lips and the anterior portion of the hard palate. it corresponds to a continuous burning sensation, derived from a normal oral mucosa and from which no dental or medical cause can be found. the SBU is divided into two types: a primary or idiopathic one that cannot be associated with any other pathology, being a diagnosis of exclusion and a secondary one, which can be related to local or general factors that may be generating it and that the treatment of this cause leads to the resolution of the problem. in this review we will focus on the treatment of the primary SBU, of which its pathophysiology is still unclear, could be related to peripheral or central factors, with psychological problems also related. not being fully aware of the pathophysiology of this disease, it is very difficult to treat it. the objective of this review is to be able to deliver current tools that are being done to treat this disease

Papel da capsaicina de uso tópico em modelo murino de alergia alimentar / Topical use of capsaicin in murine model of food allergy

A alergia alimentar é uma reação de hipersensibilidade imediata mediada por lgE que ocorre com a ingestão de alimentos alergênicos após sensibilização prévia. t: considerada um importante problema de saúde pública mundial, afetando cerca de 7% de crianças e 2% de adultos, com crescente prevalência em países desenvolvidos e em desenvolvimento. Hipoteticamente, agentes anti-inflamatórios poderiam contribuir para o controle de algumas manifestações da alergia. Um candidato a tal efeito e a capsaicina (8-metil-N-6-vanilil-nonenamida), principal componente picante da pimenta, que possui ação analgésica e anti-inflamatória quando aplicada topicamente. Este estudo avaliou o efeito do uso t6pico de capsaicina nas manifestações da alergia alimentar. Para tanto, camundongos BALB/c foram sensibilizados com ovalbumina (OVA) com posterior desafio oral com solução de clara de ovo a 20%. A partir do desafio oral até a eutanásia, animais do grupo capsaicina (ALE-CAP) foram tratados com creme capsaicina a 0,075%, enquanto que animais alérgicos (ALE) foram tratados apenas com o creme base. Os resultados mostram o aumento da concentração sérica de lgE e lgG1 anti-OVA em ambos os grupos, como esperado pelo protocolo de sensibilização. Porém, em relação ao grupo alérgico(ALE), animais do grupo ALE CAP apresentaram um perfil mais favorável, como visto pela maior ingestão do alérgeno, menor perda de peso, redução da infiltração de eosinófilos e neutrófilos (avaliados indiretamente pela atividade de enzimas EPO eMPO, respectivamente) e menor produção de muco pelas células caliciformes. Os resultados sugerem que o tratamento t6pico com capsaicina leva a uma melhora de algumas das manifestações mais importantes da alergia como a inflamação intestinal e a perda de peso. Esse fato pode estar relacionado a inibição do canal TRPV1, atuando indiretamente em vias de sinalização de células TC04•, mast6citos e basófilos, aumentando o limiar de ativação de tais células e, assim...

Food allergy is an immediate hypersensitivity reaction mediated by lgE whichoccurs with the ingestion of allergenic foods after previous sensitization. It is considered a major problem of public health worldwide, affecting about 7% of childrenand 2% of adults, with increasing prevalence in developed and developing countries. Hypothetically, anti-inflammatory agents could contribute to the control some allergy symptoms. A candidate for this purpose is the capsaicin (8-methyl-N-vanillyl-6-nonenamide), the main pungent component of red pepper, having analgesic and anti- inflammatory actions when applied topically. This study evaluated the effect of topical treatment of capsaicin in some food allergy maniestations. For this purpose BALB/c mice were sensitized with ovalbumin (OVA) with subsequent oral challenge with 20% egg yolk solution. From the oral challenge to euthanasia, animals of capsaicin group(CAP) were topically treated with a capsaicin cream (0.075% in cream base) while the allergic group (ALE) were treated with the cream base (without capsaicin). The results showed that there was an increase in serum lgE and anti-OVA lgG1 in both groups, as expected with this from sensitization protocol. However, compared to allergic group(ALE), animals from CAP group presented a more favorable profile, as suggested by the higher intake of allergen, reduced weight loss, reduced eosinophil and neutrophilinfiltrations (assessed indirectly by the activity of the enzymes EPO and MPO, respectively) and lower production of mucus by goblet cells. The results suggest that topical treatment with capsaicin leads to an improvement of some of the most important manifestations allergy such as intestinal inflammation and weight loss. These effects may be related to inhibition of TRPV1 channel, acting indirectly on CD4+ T cell, mastcells and basophils signaling, increasing their activation thre shold and thus decreasing the inflammatory process...

Canales iónicos Receptores de Potencial Transitorio y su papel protagónico en la terapia analgésica / Transient receptor potential ion channels and their leading role in analgesic therapy

En la búsqueda de nuevas opciones terapéuticas para el tratamiento del dolor, se ha llegado al descubrimiento de canales iónicos que actúan como receptores y están presentes en neuronas nociceptoras aferentes primarias. Entre estos receptores, se encuentran los canales iónicos receptores de potencial transitorio que regulan las vías involucradas en el dolor y la nocicepción. Se realizó una revisión actualizada de los principales canales iónicos receptores de potencial transitorio implicados en la fisiopatología del dolor. Se hace una reseña histórica del descubrimiento de estas moléculas y sus estudios avanzados. A continuación se revisan las diferentes familias de estos canales con su clasificación, nomenclatura, estructura y funciones celulares. También se hace un recuento de la relación de estos canales con la analgesia, así como el mecanismo de acción de algunos analgésicos que actúan sobre ellos. Finalmente, se detallan importantes consideraciones a tomar en cuenta, que pudieran influir sobre la utilización de estos medicamentos en la clínica. Por tal motivo, el trabajo procura ser una revisión que abarque el rol de los canales TRP como nuevas dianas farmacológicas en el tratamiento del dolor.

In the search for new therapeutic options for pain treatment, new ion channels have been discovered, which act as receptors and are present in primary afferent nociceptor neurons. Some of them are the transient receptor potential ion channels that regulate the pathways involved in pain and nociception. An updated review of the main transient potential receptors ion channels involved in pain physiopathology and a historical review of the discovery of these molecules and advanced studies on them were also made. Then the different families of these channels with their classification, nomenclature, structure and cell functions were also examined. An account of the relationships of these channels with analgesia as well as the mechanism of action of some analgesics acting upon them was also presented. Finally, important considerations were given, which should be taken into account since they might influence on the clinical use of these drugs. For these reasons, the paper intends to be a review covering the role of the transient receptor potential channels as new pharmacological targets in the pain treatment.

Intervenções nutricionais na promoção da perda de peso: faseolamina - revisão sistemática com metanálise e alimentos com possíveis benefícios - revisão sistemática para construção de tecnologia educacional / Nutritional interventions in weight loss promotion: phaseolamine - systematic review with meta-analysis and foods with possible benefits - systematic review for building educational technology

A obesidade é uma doença crônica não transmissível e considerada epidemia mundial com prevalência alarmante. Está associada à morbimortalidade e é fator de risco para doença cardiovascular (DCV), diabetes mellitus tipo 2 (DM2), hipertensão arterial sistêmica(HAS), dislipidemias, osteoartrite e alguns tipos de câncer. As Diretrizes Brasileiras de Obesidade 2009/2010 da Associação Brasileira para o Estudo da Obesidade e da Síndrome Metabólica referem ser pequeno o número de estudos que comprovem os efeitos termogênicos, anorexígenos ou redutores de peso de suplementos nutricionais de cafeína e capsaicina e mencionam poucos alimentos. No entanto a mídia cita rotineiramente vários alimentos como tratamento consolidado para perda de peso, sem que existam evidências científicas que suportem esta indicação. Com o objetivo de elaborar uma tecnologia educacional para indivíduos obesos de um hospital universitário, com esclarecimento sobre intervenções nutricionais efetivas para promoção da perda de peso foram conduzidas duas revisões sistemáticas. A busca de referências foi feita nas Bases eletrônicas ­ Pubmed, Cochrane Central de Ensaios Clínicos, Cinhal e Lilacs. Uma das revisões incluiu metanálise de ensaios clínicos randomizados sobre a utilização da faseolamina na promoção de perda ponderal e redução de massa gorda. A outra revisão incluiu apenas revisões sistemáticas com metanálise avaliando a efetividade de alimentos ou substâncias extraídas destes na promoção da perda de peso. Na metanálise foram incluídos 5 ensaios clínicos. A perda ponderal foi maior e estatisticamente significativa com a utilização da faseolamina -1,70Kg (IC de -2,44 a -0,97) e também a redução de massa gorda foi superior e estatisticamente significativa nos pacientes tratados com faseolamina -1,85Kg (IC de -2,49 a -1,21). Na outra revisão sistemática foram incluídos 7 artigos ,4 sobre chá verde ( na forma de infusão ou como suplemento), 2 sobre pimenta vermelha ( nos alimentos ou como suplemento) e 1 sobre peixes fonte de ômega 3 ou suplemento de ômega 3. De acordo com o resultado da metanálise, o uso da faseolamina promove perda ponderal e de massa gorda em pacientes obesos e com sobrepeso. A utilização da faseolamina é alternativa auxiliar no tratamento da obesidade. Considerando a revisão sistemática, a utilização de peixes fonte de ômega 3 pode auxiliar a perda de peso, assim como o consumo de pimenta vermelha em dosagem de pelo menos 2mg/dia de capsaicina antes das refeições. O consumo de chá verde não promoveu perda de peso clinicamente relevante. O presente estudo levou a elaboração de uma tecnologia educacional descrita como uma cartilha, para ser utilizada na educação em saúde da população obesa, com orientações no tratamento da obesidade e foi intitulada "Perda de Peso: Alimentos e Fitoterápicos que realmente podem ajudar você"

Obesity is a chronic nontransmissible disease that is considered a worldwide epidemic with alarming prevalence. It is associated with morbidity and mortality and is a risk factor for cardiovascular disease (CVD), diabetes mellitus type 2 (DM2), systemic hypertension (SHT), dyslipidemias, osteoarthritis and some types of cancer. Brazilian Obesity Guidelines 2009/2010 of the Brazilian Association for the Study of Obesity and Metabolic Syndrome report that there is a scarcity of studies that confirm the thermogenic, anorexigenic and weight reducing effects of nutritional supplements of caffeine and capsaicin and mention few food items. However, the media routinely cites a number of foods as treatment for weight loss, with no scientific evidence to support these allegations. Two systematic reviews were conducted to create an educational technology for obese individuals from a university hospital, with information about effective nutritional interventions that promote weight loss. The search for references was carried out in the following electronic databases: Pubmed, Cochrane Central Register of Controlled Trials, Cinhal and Lilacs. One of the reviews included meta-analysis of randomized clinical trials on the use of phaseolamin to promote weight loss and a reduction in fat mass. The other review involved only systematic reviews with meta-analysis, assessing the effectiveness of foods or substances extracted from them in the promotion of weight loss. Meta-analysis included 5 clinical trials. Weight loss was greater and statistically significant with the use of phaseolamin -1.70Kg (CI between -2.44 and -0.97) and the reduction in fat mass was higher and statistically significant in patients treated with phaseolamin -1.85Kg (CI between -2.49 and -1.21). The other systematic review involved 7 articles, 4 on green tea (in the form of infusion or a supplement), 2 on red pepper (in food or as supplement) and 1 on omega-rich fish or omega 3 supplement. According to the results of meta-analysis, the use of phaseolamin promotes weight and fat mass loss in obese and overweight patients. The use of phaseolamin is an auxiliary alternative in the treatment of obesity. The systematic review revealed that the use of omega 3-rich fish can contribute to weight loss, as well as consuming red pepper in a dose of at least 2mg/dia of capsaicin before meals. Green tea intake did not promote clinically relevant weight loss. The present study led to the creation of an educational technology in the form of a booklet, to be used in health education for obese individuals, with orientation regarding the treatment of obesity, and entitled "Weight Loss: Foods and Phytotherapics that can really help you"

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .

Combination Effects of Capsicum Plaster at the Korean Hand Acupuncture Points K-D2 with Prophylactic Antiemetic on Postoperative Nausea and Vomiting after Gynecologic Laparoscopy

PURPOSE: This study was done to evaluate the combination effects of capsicum plaster at the Korean hand acupuncture points K-D2 with prophylactic antiemetic on Postoperative Nausea and Vomiting (PONV). METHODS: An experimental research design (a randomized, a double-blinded, and a placebo-control procedure) was used. The participants were female patients undergoing gynecologic laparoscopy; the control group (n=34) received intravenous prophylactic ramosetron 0.3mg, while the experimental group (n=34) had Korean Hand Therapy additionally. In the experimental group, capsicum plaster was applied at K-D2 of both 2nd and 4th fingers by means of Korean Hand Therapy for a period of 30 minutes before the induction of anesthesia and removed 8 hours after the laparoscopy. RESULTS: The occurrence of nausea, nausea intensity and need for rescue with antiemetic in the experimental group was significantly less than in the control group 2 hours after surgery. CONCLUSION: Results of the study show capsicum plaster at K-D2 is an effective method for reducing PONV in spite of the low occurrence of PONV because of the prophylactic antiemetic medication.

Inhibition of virulence potential of Vibrio cholerae by natural compounds.

The rise in multi-drug resistant Vibrio cholerae strains is a big problem in treatment of patients suffering from severe cholera. Only a few studies have evaluated the potential of natural compounds against V. cholerae. Extracts from plants like ‘neem’, ‘guazuma’, ‘daio’, apple, hop, green tea and elephant garlic have been shown to inhibit bacterial growth or the secreted cholera toxin (CT). However, inhibiting bacterial growth like common antimicrobial agents may also impose selective pressure facilitating development of resistant strains. A natural compound that can inhibit virulence in V. cholerae is an alternative choice for remedy. Recently, some common spices were examined to check their inhibitory capacity against virulence expression of V. cholerae. Among them methanol extracts of red chili, sweet fennel and white pepper could substantially inhibit CT production. Fractionation of red chili methanol extracts indicated a hydrophobic nature of the inhibitory compound(s), and the n-hexane and 90 per cent methanol fractions could inhibit >90 per cent of CT production. Purification and further fractionation revealed that capsaicin is one of the major components among these red chili fractions. Indeed, capsaicin inhibited the production of CT in various V. cholerae strains regardless of serogroups and biotypes. The quantitative reverse transcription real-time PCR assay revealed that capsaicin dramatically reduced the expression of major virulence-related genes such as ctxA, tcpA and toxT but enhanced the expression of hns gene that transcribes a global prokaryotic gene regulator (H-NS). This indicates that the repression of CT production by capsaicin or red chili might be due to the repression of virulence genes transcription by H-NS. Regular intake of spices like red chili might be a good approach to fight against devastating cholera.

Capsaicin: A novel chemopreventive molecule and its underlying molecular mechanisms of action.

Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is the a principal pungent ingredient of hot red and chili peppers that belong to the plant genus Capsicum (Solanaceae). Capsaicin is a cancer-suppressing agent. It blocks the translocation of nuclear factor kappa B (NF-kB), activator protein 1 (AP-1), and signal transducer and activator of transcription (STAT3) signaling pathway that are required for carcinogenesis. The anti-inflammatory potential of capsaicin is attributed to its inhibitory effect on inducible COX-2 mRNA expression. Cytochrome P4502E1 mediates the activation of xenobiotics such as vinyl carbamate and dimethyl nitrosamine to their toxic metabolites. This metabolic activation of xenobiotics by Cytochrome P4502E1 has been shown to be inhibited by capsaicin. Capsaicin also generates reactive oxygen species in cells with resultant induction of apoptosis and cell cycle arrest, which is beneficial for cancer chemoprevention. Therefore, the use of capsaicin as a chemopreventive agent is of immense benefit for cancer chemoprevention. The search strategy included printed journals, pubmed, and medline, using the terms 'capsaicin' and 'anticancer' citations, relevant to anticancer properties of capsaicin.

Notalgia parestésica / Notalgia paresthetica

La notalgia parestésica es una neuropatía sensorial caracterizada clínicamente por una mancha hiperpigmentada bien circunscrita localizada en la espalda, que afecta las áreas correspondientes a los dermatomos D2 a D6. El prurito es el síntoma más común, aunque algunos pacientes describen otras sensaciones, incluyendo ardor, parestesia, hiperestesia o dolor. Los hallazgos histopatológicos son inespecíficos. Su etiología no ha sido claramente demostrada, pero en algunos casos existe una llamativa correlación con patología de la columna vertebral, incluyendo cambios degenerativos y/o hernias del núcleo pulposo. El diagnóstico diferencial incluye la neurodermitis y la amiloidosis macular. No existe un tratamiento definitivo para la enfermedad. Se han empleado diversas terapias incluyendo capsaicina tópica, bloqueo anestésico para vertebral, oxcarbazepina, gabapentina y toxina botulínica.

Notalgia paresthetica is a sensory neuropathy characterizd clinically by a well-circumscribed hyperpigmented patch located on the back, affecting the areas corresponding to dermatomes D2-D6. Pruritus is its most common symptom, but some patients describe other sensations including burning, paresthesia, hypeesthesia or pain. Histopathological findings are not specific. The etiology of this condition has not be en clearly demonstrated but in some cases there exists a striking correlation with spinal pathology, including degenerative changes or a herniated nucleous pulposus. Differential diagnoses include neurodermitis and maclular amyloidosis There is no definitive treatment for the disease diverse therapies have been employed including topical capsaicin paravertebral local anesthetic block, oxcarbazepine, gabapentir and botulinum toxin type A.

Capsaicina e sua aplicação em odontologia / Capsaicin and its odontological application

A capsaicina é o princípio ativo presente na pimenta vermelha responsável pela sua ação picante. Possui várias propriedades farmacológicas como a ação mucolítica, termogênica e analgésica. Atua sobre afisiopatologia da dor, principalmente nos mediadores químicos que induzem algesia, inibindo temporariamente a substância P. É empregada no tratamento de vários tipos de dores como a dor orofacial crônica, a dor pós-herpética e a dor por desaferentação.

Capsaicin effects on blinking

Blinking is a normal human phenomenon involving trigeminal and facial pathways. To gain understanding on the neurobiology of blinking, five normal subjects were investigated before and after application of transdermal capsaicin at the forehead for two weeks. No effects of topical capsaicin were detected in eye blink rates. However, when capsaicin was applied to a female subject with blepharospasm, she showed a dramatic restoration of her vision subsequent to blinking modification. Deactivation of abnormal A-to-C fibers cross talks at the trigeminal-facial pathways seems to be the most likely mechanism of such improvement.

El parpadeo es un fenómeno normal en los humanos que involucra las vías trigéminas faciales. Con el fin de conocer un poco más la neurobiología de este fenómeno estudiamos cinco individuos normales antes y después de aplicar capsaicina trasdérmica en la frente de cada uno de ellos, por dos semanas. La frecuencia de parpadeo no se alteró con la aplicación de capsaicina tópica. Sin embargo, cuando la misma sustancia se aplicó a una paciente con blefaroespasmo hubo dramática restauración de su visión, la cual fue secundaria a la modificación de la actividad muscular palpebral. La desactivación del cruce patológico de información que pasa de las fibras A a las fibras C, pertenecientes a las vías trigémino-faciales, parece ser el mecanismo de acción relacionado con la aplicación de capsaicina, el que estaría directamente relacionado con la recuperación clínica observada en la paciente con blefaroespasmo.

The applied physiology of cough.

The cough reflex is such an important defense mechanism of the respiratory tract that a thorough knowledge of its applied physiology in respiratory disease is essential for clinicians. It is a well-integrated reflex, which has afferent limb consisting of receptors and afferent nerves, the central cough center in the brainstem and the efferent limb consisting of motor nerves supplying the muscles of coughing. The cough process consists of inspiratory phase, compressive phase and expiratory phase. Stimuli that can initiate the cough process can be central or peripheral in the lungs or outside the lungs. The important function of the cough reflex is to maintain the airways and alveoli clear and healthy. The mechanisms by which it achieves this are (i) high velocity of expiratory gas flows produced in the expiratory phase (ii) the compression of the lungs and airways by high positive pleural pressure generated in the compressive phase. Cough threshold can be determined by giving acetic acid, citric acid or capsaicin inhalation challenge test. This has practical application in clinical research. The pathophysiological basis of different types of cough encountered in clinical practice is discussed.

Actualizaciones en la terapia médica de la neuralgia postherpética (NPH) / Updating in the therapy of the post-herpetic neuralgia (PHN)

El Herpes Zoster es una neuritis sensitiva causada por reactivación del virus Varicela-Zoster, latente en uno o más ganglios de las raíces dorsales. Se presenta generalmente con hiperalgia y dolor lancinante en la superficie cutánea inervada por la raíz afectada, durante 3 a 4 días; seguido de la aparición de una erupción vesicular, con base eritematosa, habitualmente en el mismo dermatomo. El dolor suele ser de tipo urente; se acompaña de anestesia, hiperestesia (80 por ciento de los casos) o de alodinia (50 por ciento de los casos). En el 90 por ciento de los pacientes el curso es autolimitado, desapareciendo las lesiones dérmicas y el dolor en 4 a 6 semanas. La persistencia del dolor, posterior a la curación de las lesiones cutáneas, por más de 6 semanas constituye la principal complicación del Herpes-Zoster: La Neuralgia Postherpética (NPH)