Research progress of pharmacologic therapy in obstructive sleep apnea / 中国临床药理学与治疗学

Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder. As a major global public health problem, untreated OSA can lead to a variety of adverse health outcomes, including various cardiovascular and cerebrovascular diseases, metabolic disorders, and psychiatric disorders such as anxiety and depression. Traditional OSA therapies such as positive airway pressure (PAP), weight loss, oral appliance, upper airway surgery, and postural therapy focus on the anatomical factors of OSA. However, the pathogenesis of OSA is heterogeneous, and non-anatomical factors also play an important role in most patients. Although there is no drug with exact efficacy for the treatment of OSA, with the deepening understanding of the pathophysiological mechanism of OSA, more and more clinical studies are devoted to the study of drug treatment of OSA and its complications, and a series of results have been achieved. The following is a review of the relevant studies on drug treatment of OSA in recent years, hoping to provide literature support and theoretical basis for future research on drug treatment of OSA.

Influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas / 中国实用护理杂志

Objective:To investigate the influence of the upright position delivery in the second stage of labour on delivery outcomes in primiparas, so as to provide reference for the formation of systematic delivery management strategies.Methods:This study was a cohort study, 454 primiparas who delivered in Beijing Hospital from January 2022 to December 2022 were selected. In the second stage of labour, according to the willingness of the primiparas, they were divided into the upright group(delivered in upright position, 222 cases) and the supine group(delivered in supine position, 232 cases). The duration of the second stage of labour, perineal injury, vaginal midwifery, neonatal asphyxia, and the effect of pharmacological analgesia on delivery outcomes in two groups of primiparas were observed and compared.Results:The duration of the second stage of labour was 30 (22, 50) min in the upright group, which was shorter than 48 (30, 80) min in the supine group, with statistically significant difference ( Z=-5.90, P < 0.05). The rate of lateral episiotomy was 17.6% (39/222) in the upright group, which was lower than 28.0% (65/232) in the supine group, with statistically significant difference ( χ2=7.02, P <0.05). There was no significant difference in the incidence of second degree perineal injury, vaginal midwifery, shoulder difficulty rate and neonatal asphyxia in the two groups ( P>0.05). The incidence of vaginal midwifery was 10.9% (14/129) and 2.2% (2/93) respectively in the upright group with pharmacological analgesia and non pharmacological analgesia, and the difference was statistically significant (Fisher's exact test, P<0.05). The duration of the second stage of labour was 53 (32, 85), 41 (27, 59) min in the supine group with pharmacological analgesia and non pharmacological analgesia, and the difference was statistically significant ( Z=-3.28, P<0.05). Conclusions:The adoption of upright position in the second stage of labour for primiparas can shorten the duration of the second stage, and reduce the rate of lateral episiotomy which can optimize the delivery outcome. For primiparas with pharmacological analgesia, it is recommended to use an upright position for delivery if conditions permit.

Research progress on pharmacological mechanism of polygona-polysaccharose / 国际中医中药杂志

Polygona-polysaccharose is an important indicator to measure the quality of Polygonati Rhizoma. The polygona-polysaccharose has the effect of lowering blood sugar, regulating blood lipid, anti-fatigue, improving learning and memory ability. The Polygonati Rhizoma, as a Chinese herbal medicine with homology of medicine and food, has a good prospect and application value in the development of food and health products.

Research progress in chemical constituents and pharmacological action of Chinese medicine pair of Coptidis Rhizoma- Cinnamomi Cortex / 国际中医中药杂志

Coptidis Rhizoma- Cinnamomi Cortex is a classic couplet medicine of Traditional Chinese Medicine, which has the function of communicating heart and kidney, and has been widely used in clinic. At present, the chemical composition of Coptidis Rhizoma- Cinnamomi Cortex before and after compatibility, in terms of nature, quality and in vivo processes to carry out research. The drug pair has sedative hypnotic, hypoglycemic, antidepressant, antiarrhythmic and other pharmacological effects, involving regulation of neurotransmitters, regulation of inflammatory cytokines, antioxidant, regulation of intestinal flora and other mechanisms. The existing research is still insufficient, such as the study on the changes of material basis after the compatibility of Coptidis Rhizoma- Cinnamomi Cortex, as well as the pharmacological effects of cardiovascular system, lipid metabolism and perimenopausal syndrome. The best compatibility ratio of Coptidis Rhizoma- Cinnamomi Cortex in sedation, hypnosis, hypoglycemic and antidepressant needs further analysis.

Research progress on the pharmacological effects and pharmacokinetics of linarin / 国际中医中药杂志

Linarin, as a natural coumponent belongs to flavonoid glycoside, is widely existed in herbal plants such as chrysanthemum indicum and Mongolian flower, which has a variety of pharmacological effects, such as anti-inflammation, anti-cancer, liver protection, analgesia, antipyretic, anti-oxidation, anti-apoptosis, sedation and sleep, neuroprotection, preventing and treating hypertension, treatingdiabetes, preventing and treating osteoporosis, whitening, skin care and sunscreen. It is difficult to dissolve in water and has poor oral efficacy, but when combined with different substances or combined (forming phospholipid complex), its bioavailability can be improved, so as to improve its pharmacological efficacy.

Research progress of Guizhi Shaoyao Zhimu Decoction in the treatment of rheumatoid arthritis / 国际中医中药杂志

Guizhi Shaoyao Zhimu Decoction combined with drugs taken internally or external therapy show the benefits for rheumatoid arthritis patients. It can control the clinical symptoms such as swelling and pain of the joints, reduce inflammatory indicators, and has less adverse reactions. Modern pharmacological researches show that it can regulate a variety of inflammatory signaling pathways to achieve anti-inflammatory and analgesic effects, induce apoptosis of synovial cells, resist bone damage, and regulate immunity with multiple treatment targets to rheumatoid arthritis.

Pharmacological action and clinical evaluation of difelikefalin, a new drug for the treatment of uremic pruritus / 中国基层医药

Uremic pruritus is one of the skin complications that perplex patients with end-stage renal disease undergoing hemodialysis or peritoneal dialysis. Because the specific pathogenesis is not clear, there is no unified treatment plan in the world. In August 2021, the US Food and Drug Administration approved the use of difelikefalin (under the trade name Korsuva) for the treatment of moderate to severe pruritus associated with chronic kidney disease in adult patients undergoing hemodialysis. Studies have shown that difelikefalin can remarkably reduce the intensity of pruritus and improve sleep and pruritus-related quality of life. The recommended dose of difelikefalin is 0.5 μg/kg, and difelikefalin is well tolerated and has high safety. This paper reviews the pharmacological effects, pharmacokinetics, clinical efficacy and safety of difelikefalin.

Mastalgia in medical students: a prospective and multicentric study

Introduction: Mastalgia or breast pain affects most women, especially those of reproductive age. Of organic or nonorganic cause and variable intensity, it is related to factors such as hormonal, dietary, metabolic, and emotional changes, making it difficult to understand its pathophysiology and the definition of care conduct. It can influence the quality of life. The aim of this study was to identify, classify, and know the treatments and their effectiveness for breast pain in university students, relating their interference in the quality of life. Methods: A total of 1,064 students from two medical schools in the interior of São Paulo were interviewed and evaluated using a standardized and specific questionnaire with the aim of characterizing breast pain. Results: Mastalgia was reported in 1,034 students (p=0.0003), body mass index >25 increased breast tenderness by 4.3 times (RR=4.3; p=0.001; 95%CI 2.5­6.73), and sedentary lifestyle increased by 10.82 times (p=0.02). It was more common in the premenstrual cycle (p=0.002), and the greater the intensity, the smaller the number of students who performed the self-examination (p=0.02). The greater the pain, the greater the chance of being absent from classes (RR=15.82; p=0.0003; 95%CI 13.23­17.3). Drug treatment was applied in 15.54% of the cases, with satisfactory results in 92.16% of them (p=0.000004). Conclusions: The study showed a high incidence of breast pain in medical students, impairing their academic activities, making it clear the importance of investigating any symptom related to the hormonal axis and showing significant efficiency of the pharmacological treatment.

Utilización de pentoxifilina en fase aguda de enfermedad de La Peyronie / Use of Pentoxifylline in the acute phase of Peyronie's disease

INTRODUCCIÓN: existe una gran variedad de tratamientos orales para la Enfermedad de La Peyronie (EP), pero ninguno demostró ser efectivo. En los últimos años se ha propuesto a la Pentoxifilina (PTX) como un potencial agente para su tratamiento. OBJETIVO: evaluar la evolución clínica de los pacientes que recibieron PTX al menos 3 meses durante la fase aguda de la EP. MATERIALES Y MÉTODOS: estudio de cohorte retrospectivo y observacional. Los datos se obtuvieron de las historias clínicas de pacientes con diagnóstico de EP entre enero y octubre de 2017. Para la evaluación objetiva, se utilizaron autofotografías y técnica de Kelami. RESULTADOS: 93 hombres cumplieron con los criterios de inclusión. El tiempo medio de tratamiento con PTX fue de 7,9 meses, y el de seguimiento, 10,8 meses. El 59,1% de los pacientes no tuvo modificaciones en su curvatura, el 9,7% mejoró, mientras que el 31,2% empeoró. De 49 pacientes que penetraban sin dificultad, 34 (69,4%) no tuvieron cambios, 12 (24,5%) pasaron a tener dificultad y 3 (6,1%) se convirtieron en no penetradores (p 0,0001). De los 41 pacientes que tenían dificultad en la penetración, 13 (31,7%) pudieron penetrar sin dificultad, 7 (17,1%) pasaron a no poder hacerlo, mientras que el resto (21 pacientes) se mantuvo sin cambios (p 0,0001). La correlación entre la curvatura inicial y la curvatura luego del tratamiento medido en todos los pacientes fue significativa (p 0,028). CONCLUSIÓN: la PTX podría tener un efecto positivo en estabilizar la enfermedad, y los hombres con EP en fase aguda podrían beneficiarse con el tratamiento.

INTRODUCTION: There is a wide variety of oral treatments for Peyronie's Disease (PD) but none proved to be effective. In recent years, Pentoxifylline (PTX) has been proposed as a potential agent for the treatment. Objective: To evaluate the clinical evolution of patients who received PTX at least 3 months during the acute phase of PD. MATERIALS AND METHODS: Retrospective and observational cohort study. The data were obtained from the clinical records of patients diagnosed with PE between January 2007 and October 2017. For their objective evaluation, autographs and the Kelami technique were used. RESULTS: 93 men met the inclusion criteria. The mean time of treatment with PTX was 7.9 months and the follow-up time was 10.8 months. 59.1% of patients had no changes in their curvature, 9.7% improved, while 31.2% worsened. Of 49 patients who entered without difficulty in penetrating, 34 (69.4%) had no changes, 12 (24.4%) had difficulty and 3 (6.1%) became non-penetrators (p 0.0001). Of the 41 patients who had difficulty in penetrating, 13 (31.7%) could penetrate without difficulty, 7 (17.1%) were unable to do so, while the rest (21 patients) remained unchanged (p. 0.0001). The correlation between initial curvature and curvature after treatment measured in all patients was significant (p 0.028). CONCLUSION: PTX could have a positive effect in stabilizing the disease and men with acute phase PE could benefit with treatment.

Premature birth: topics in physiology and pharmacological characteristics

SUMMARY OBJECTIVE: To review the main physiological and pharmacological changes related to prematurity, to promote the evidence-based clinical practice. METHODS: This is a narrative review whose research was carried out in the ScienceDirect and Medline databases via PubMed, searching for articles in any language from January 2000 to February 2020. RESULTS: Premature newborns are born before completing the maturation process that prepares them for extrauterine life, which occurs especially in the last weeks of pregnancy. Therefore, they have their own characteristics in development. Several physiological peculiarities stand out, such as disturbances in glucose regulation, adrenal function, thermoregulation, immunity, in addition to changes in liver, renal and respiratory functions. Pharmacological aspects were also highlighted, involving pharmacokinetics and pharmacodynamics. CONCLUSIONS: Despite the recent advances in prematurity, it is still an area with many uncertainties, since several changes occur quickly and there are ethical issues that make studies difficult. Thus, it is clear that the therapeutic management of premature infants is still very much based on clinical practice.

Literature study on herbal medicine of Borneol / 国际中医中药杂志

As a collective noun of incense and medicine, fragrant medicine has long been integrated into Chinese culture. It is not only a symbol of the cultural exchange between China and foreign countries in the middle ancient times, but also plays a very important role in medicine and other fields. Among them, Borneol can not only be used for medicinal purposes, but also for incense and fumigation, as well as food, tea, wine and other applications. This paper intends to sort out the medicinal properties, effects and other applications of Borneol recorded in ancient books of traditional Chinese herbs in the past dynasties, focusing on summarizing its medicinal properties, meridians, effects, compatibility and application characteristics. In addition, modern pharmacological action was included as a supplement, in order to provide reference for the clinical use of Borneol in medicinal aspects.

Review of pharmacological effects of Paeoniae Radix Rubra / 药学实践杂志

Paeoniae Radix Rubra has the effects of clearing heat, cooling blood, dissipating blood stasis and pain relieving (in terms of Chinese medicine). Paeoniae Radix Rubra and its active ingredients have significant pharmacological effects in anti-tumor，protecting liver, nerve and heart. By reviewing the relevant literatures published in recent years, we found that the studies on Paeoniae Radix Rubra are mainly focused in the mechanism of action, drug development and clinical application. In this review, we summarize the research results of the pharmacological effects of Paeoniae Radix Rubra and its active ingredients in order to provide the reference for the future research and clinical application of Paeoniae Radix Rubra.

Effectiveness of non-pharmacologic strategies for parental smoking cessation to protect children: A meta-analytic review

@#<p style="text-align: justify;"><strong>Aims:</strong> This meta-analysis aims to synthesize available evidence from published studies on the effectiveness of parental non-pharmacologic smoking cessation programs which aim to reduce children's exposure to secondhand smoke.</p><p style="text-align: justify;"><strong>Methodology:</strong> A database search using The Cochrane Library, PubMed®, Medline, Embase, and Google Scholar, was done by the investigators. This study included 20 randomized controlled trials published up to 2020. Pooled estimates of risk ratio (RR) for quit rates were computed using the random effects model.</p><p style="text-align: justify;"><strong>Results:</strong> Overall, the quit rate among those who underwent parental smoking cessation was 13.4% while the quit rate for controls was 11.9%. The pooled RR demonstrated that the parental smoking cessation program was significantly associated with higher quit rates (RR = 1.22, 95%CI = 1.01 to 1.46, p-value = 0.04). The studies demonstrated moderate heterogeneity only (I2 = 54%). Among studies published prior to year 2000, no significant difference was observed between parental smoking cessation program and control (RR = 1.02, 95% CI = 0.62 to 1.70, p-value = 0.93). On the other hand, the pooled RR demonstrated that among studies published after 2020, parental smoking cessation program was significantly associated with higher quit rates (RR = 1.27, 95%CI = 1.03 to 1.56, p-value <0.0001). Among studies with self-help interventions, parental smoking cessation program has no additional benefit on quit rates (RR = 1.20, 95%CI = 0.94 to 1.58, p-value = 0.14). Among studies with biofeedback intervention also, no significant difference was observed (RR = 1.27, 95% CI = 0.86 to 1.89, p-value = 0.23).</p><p style="text-align: justify;"><strong>Conclusions:</strong> This meta-analysis demonstrated sufficient evidence that non-pharmacologic interventions for parental smoking cessation are effective.</p>

Diagnosis, treatment, and notification of syphilis during pregnancy in the state of Goiás, Brazil, between 2007 and 2017 / Diagnóstico, tratamento e notificação da sífilis durante a gestação em Goiás, de 2007 a 2017

ABSTRACT OBJECTIVE To analyze the evolution of syphilis during pregnancy notification regarding clinical classification, diagnosis and treatment in the state of Goiás, Brazil, between 2007 and 2017. METHODS This is a time-series study, analyzing data provided by the Health Secretariat of the state of Goiás. The variables related to the diagnosis and treatment of pregnant women and their partners were analyzed, and their evolution trend during the years. Descriptive statistics and percentage calculation were used. Cochran-Armitage test with a significance level α = 0.05 was used to determine increase and decrease trends. RESULTS During the period, 7,774 cases were notified. The highest percentage of notifications occurred in the second trimester of pregnancy (39.8%) and corresponded to primary syphilis (34.1%). The most frequent treatment prescribed was benzathine benzylpenicillin with a dosage of 7.2 million (43.8%). Between 2007 and 2017, there was an increasing trend in the notification percentage of latent (14.1% to 30.7%), secondary (5.2% to 19%), and tertiary syphilis (4.4% to 11.4%). The treatment with benzathine benzylpenicillin with a dosage of 7.2 million also increased (19.3% to 59.6%). The percentages of primary syphilis decreased (43.4% to 22.1%), as well as other treatments' percentages. CONCLUSIONS Latent syphilis notification of pregnant women and treatment with penicillin at the dosage of 7,200,000 IU increased. Notification forms' data completeness also increased for the variables clinical classification and treatment, suggesting improvements in the notification process.

RESUMO OBJETIVO Analisar a evolução das notificações da sífilis durante a gestação em relação à classificação clínica, ao diagnóstico e ao tratamento no estado de Goiás, entre 2007 e 2017. MÉTODOS Estudo de série temporal com análise de dados fornecidos pela Secretaria Estadual de Saúde de Goiás. Foram analisadas as variáveis relacionadas ao diagnóstico e tratamento das gestantes e seus parceiros, e sua tendência evolutiva ao longo dos anos. Utilizou-se estatística descritiva, cálculo de porcentagens e verificação das tendências de aumento e diminuição por meio do teste de Cochran-Armitage com nível de significância α = 0,05. RESULTADOS Ao todo, 7.774 casos foram notificados no período. A maior porcentagem das notificações ocorreu no segundo trimestre de gestação (39,8%) e correspondeu à sífilis primária (34,1%). O tratamento prescrito com maior frequência foi a penicilina benzatina em dose de 7,2 milhões (43,8%). Entre 2007 e 2017, observou-se tendência crescente nas porcentagens de notificações de sífilis latente (14,1% para 30,7%), secundária (5,2% para 19%) e terciária (4,4% para 11,4%), assim como no tratamento com penicilina benzatina em dose de 7,2 milhões (19,3% para 59,6%). Tendência decrescente foi observada nas porcentagens de notificação de sífilis primária (43,4% para 22,1%) e nos demais esquemas de tratamento. CONCLUSÕES Houve aumento no número de notificações de sífilis latente em gestantes e no tratamento com penicilina na dose de 7.200.000 UI. Também foi observado aumento na completitude dos dados da ficha de notificação nas variáveis de classificação clínica e tratamento, sugerindo melhora no processo de notificação.

Stuttering priapism post C-spine schwannoma excision: case report

Priapism is prolonged penile erection that persists beyond or is unrelated to sexual stimulation and this is associated with significant psychological, socioeconomic and physical morbidity. It is a urologic emergency as delayed intervention may result in penile fibrosis and consequent erectile dysfunction. The aim of this paper is to present our experience in the management of the rare occurrence of stuttering priapism in a 32 years old man following surgical excision of cervical schwannoma during the early postoperative period and review relevant literature on management of this urologic entity. Stuttering priapism may complicate cervical spine tumor excision but may demonstrate complete patient recovery.

A vancomicina administrada na dose empírica garante a cobertura de pacientes pediátricos contra patógenos Gram-positivos? / Does vancomycin administered at an empirical dose ensure coverage of pediatric patients against gram-positive pathogens?

RESUMO Objetivo: Investigar a efetividade da vancomicina contra Gram-positivos com concentração inibitória mínima de 1mg/L em pacientes pediátricos com base na razão entre área sob a curva e concentração inibitória mínima > 400. Métodos: População de 22 pacientes pediátricos (13 meninos) internados no centro de terapia intensiva pediátrica, com função renal preservada, que foram distribuídos em dois grupos (G1 < 7 anos e G2 ≥ 7 anos). Após a quarta dose de vancomicina (10 - 15mg/kg a cada 6 horas), duas amostras de sangue foram colhidas (terceira e quinta horas), seguidas da dosagem sérica por imunoensaios para investigação da farmacocinética e da cobertura do antimicrobiano. Resultados: Não se registrou diferença entre os grupos com relação à dose, ao nível de vale ou ainda na área sob a curva. A cobertura contra Gram-positivos com concentração inibitória mínima de 1mg/L ocorreu em apenas 46% dos pacientes em ambos os grupos. A farmacocinética se mostrou alterada nos dois grupos diante dos valores de referência, mas a diferença entre grupos foi registrada pelo aumento da depuração total corporal e pelo encurtamento da meia-vida biológica, mais pronunciados nos pacientes mais novos. Conclusão: A dose empírica mínima de 60mg/kg ao dia deve ser prescrita ao paciente pediátrico de unidade de terapia intensiva com função renal preservada. A utilização da razão entre área sob a curva e concentração inibitória mínima na avaliação da cobertura da vancomicina é recomendada para se atingir o desfecho desejado, uma vez que a farmacocinética está alterada nesses pacientes, podendo impactar na efetividade do antimicrobiano.

Abstract Objective: To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400. Methods: A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage. Results: There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients. Conclusion: A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.

Interpretation of the Guidelines for Acute Non-variceal Upper Gastrointestinal Bleeding / 胃肠病学

Since 2015, the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), the Digestive Endoscopy Specialized Committee of Chinese Medical Doctor Association Endoscopy Physician Branch, the Asia-Pacific working group and the International Consensus Group have updated the guidelines for acute non-variceal upper gastrointestinal bleeding (ANVUGIB). This article summarized these recently published guidelines and made a systematic comparison from the aspects of pre-endoscopic management, endoscopic management, post-endoscopic management and secondary prophylaxis for providing a reference for standardizing the management process of ANVUGIB.

Research progress of pharmacological activities of Polygonum hydropiper / 国际中医中药杂志

The Polygonum hydropiper are dried whole grasses of Polygonum hydropiper L., which mainly contains the following chemical components, such asflavonoids, sesquiterpenoids, and volatile oils. The recent research of the pharmacological effects of Polygonum hydropiper showed that its effects include anti-oxidation, anti-inflammation, analgesic.

Notalgia paresthetica and neuropathic itch. Case report / Notalgia parestésica e prurido neuropático. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Notalgia paresthetica is a neuropathic sensory syndrome located in the dorsal region between T2-T6 dermatomes and is characterized by a chronic evolution with periods of remission and exacerbation. The objective of this study was to demonstrate a case of notalgia paresthetica, from its clinical and laboratory investigation to the treatment adopted. CASE REPORT: A 77-year-old female patient, retired, attended the Outpatient Pain Service of the University Hospital of the Federal University of Maranhão. The main complaint was severe pruritus in the right dorsal region with extension to the breasts, associated with intermittent pain, burning, shock and tingling, worsening with physical effort and movement. Her sleep quality worsened because of the pain. At the physical examination, no pain was reported on palpation of the site, with mild hypoesthesia in T5 and T6 dermatomes, without altering the thermal sensitivity. She denied a history of skin lesions. The patient received conservative pharmacological treatment, with significant improvement in pain and sleep quality after six months. CONCLUSION: Notalgia paresthetica is a syndrome of unknown etiology, and the lack of studies makes it difficult to optimize the indications and recommendations to direct the treatment. This report illustrates the handling of a case of paresthetica notalgia where gabapentin was used as therapeutic management for pain control, for which it proved to be efficient.

RESUMO JUSTIFICATIVA E OBJETIVOS: A notalgia parestésica é um distúrbio neuropático sensitivo que acomete a região dorsal entre os dermátomos de T2 a T6, caracterizando-se por uma evolução crônica com períodos de remissão e exacerbação. O objetivo deste relato foi descrever um caso de notalgia parestésica, desde a sua investigação clínica e laboratorial até a conduta adotada. RELATO DO CASO: Paciente do sexo feminino, 77 anos, aposentada, compareceu para atendimento no Serviço Ambulatorial de Dor do Hospital Universitário da Universidade Federal do Maranhão, tendo como queixa principal prurido intenso em região dorsal direita com extensão para as mamas, associada a dor intermitente, em queimação, choque e pontadas, piorando com esforço físico e movimento. Seu sono não era reparador. Ao exame físico, não referiu dor à palpação do local, com discreta hipoestesia em dermátomos T5 e T6, não havendo alteração de sensibilidade térmica. Negava histórico de lesões de pele. A paciente recebeu tratamento conservador farmacológico, havendo melhora importante do prurido, da dor e da qualidade do sono após seis meses. CONCLUSÃO: A notalgia parestésica é uma síndrome de etiologia ainda desconhecida, em que a escassez de estudos dificulta uma otimização das recomendações para direcionar o tratamento. Este relato ilustrou o manuseio de um caso de notalgia parestésica onde o tratamento com gabapentina foi empregado para o controle de dor, para o qual se mostrou eficiente.

Adherence to fibromyalgia treatment: challenges and impact on the quality of life / Adesão ao tratamento da fibromialgia: desafios e impactos na qualidade de vida

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a chronic and idiopathic syndrome, characterized by a general distributed pain, more prevalent in women. Its pathophysiology remains unclear. Its chronicity implies an exclusively symptomatic treatment, often unsatisfactory. The lack of adherence to the established treatment is quite common. The objective of this study is to present a review of the adherence to the fibromyalgia syndrome treatment. CONTENTS: The concept of adherence to the fibromyalgia syndrome treatment, its classification, the identification of its measurement options, and the detection of its causes are detailed, revised and updated. CONCLUSION: The review of the literature regarding the adherence to the fibromyalgia syndrome treatment points to a large number of nonconformity of prescription, in general with the prevalence of the adoption of the reduction of the recommended dose and the interruption of the treatment, over possible overdoses and self-medication. The study of the causes that led to the non-adherence to the treatment elects the characteristics of the syndrome as the great villain for its occurrence. However, other associated factors such as the age of the subject with fibromyalgia, the intensity of the pain, the established polypharmacy, the quality of the doctor-patient relationship and the socioeconomic variables were also listed. The patient's quality of life was always higher in patients with higher adherence to treatment and persistence. Patients' quality of life indices may indicate the level of commitment to treatment adherence, and vice versa.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome crônica e idiopática, caracterizada por queixa dolorosa de distribuição generalizada, mais prevalente em mulheres. A sua fisiopatologia continua não totalmente esclarecida. Sua cronicidade implica em tratamento exclusivamente sintomático e muitas vezes insatisfatório. A falta de adesão ao tratamento instituído é bastante comum. O objetivo deste estudo foi apresentar uma revisão sobre a adesão do tratamento da síndrome fibromiálgica. CONTEÚDO: O conceito de adesão ao tratamento da síndrome fibromiálgica, sua classificação, a identificação das opções de sua mensuração, e a detecção de suas causas são detalhados, revisados e atualizados. CONCLUSÃO: A revisão da literatura referente à adesão ao tratamento da síndrome fibromiálgica mostra um grande contingente de inconformidade de prescrição, em geral predominando a adoção da redução da dose orientada e a interrupção do próprio tratamento, sobre possíveis sobredoses e automedicações. O estudo das causas que levaram à falta de adesão ao tratamento elege as características da própria síndrome como a grande vilã para sua ocorrência; embora, tenham sido também elencados outros fatores associados como a idade do portador da síndrome fibromiálgica, a intensidade da dor, a polifarmácia instituída, a qualidade da relação médico-paciente, e as variáveis socioeconômicas. A qualidade de vida dos pacientes sempre foi maior naqueles cuja adesão e persistência ao tratamento foram maiores. Os índices de qualidade vida dos pacientes podem indicar o nível de comprometimento com a adesão ao tratamento, e vice-versa.