Clinical evaluation and prevalence of fibromyalgia in hepatitis C patients / Avaliação clínica e prevalência de fibromialgia em pacientes portadores de hepatite C

ABSTRACT BACKGROUND AND OBJECTIVES: The worldwide distribution and etiology of fibromyalgia are poorly understood. It is believed that different factors are involved, such as hepatitis C virus infection. The aim of this study was to estimate the prevalence of fibromyalgia in hepatitis C virus infected patients, trying to identify the occurrence of liver injury, extrahepatic clinical manifestations, anxiety, depression, and the impact on the quality of life. METHODS: This is a cross-sectional study of patients (n=118) with hepatitis C virus infection who were compared with a group of clinically stable patients not infected with the hepatitis C virus (n=118). The Anxiety and Depression Questionnaire was applied, and for those diagnosed with fibromyalgia, the Fibromyalgia Impact Questionnaire. Liver biopsies were analyzed according to the METAVIR classification. The Schirmer test was performed to investigate abnormal tear production in the studied patients. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, v.10.0. RESULTS: The prevalence of fibromyalgia in infected patients was 7.6%. In patients infected with fibromyalgia, a significant prevalence of anxiety and depression was observed. Fibromyalgia Impact Questionnaire scores were higher in infected patients with fibromyalgia. When comparing the complementary tests in infected patients with and without fibromyalgia, no significant differences were found for the Schirmer test, viral genotype, and degree of fibrosis and liver inflammation. CONCLUSION: In females, there was a positive relationship between hepatitis C virus infection, fibromyalgia, and extrahepatic symptoms, which translates into a higher prevalence of anxiety and depression and impaired quality of life.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia tem distribuição mundial e etiologia pouco comprendida. Acredita-se no envolvimento de diferentes fatores, como a infecção pelo vírus da hepatite C. O objetivo deste estudo foi estimar a prevalência de fibromialgia em pacientes infectados pelo vírus da hepatite C, procurando identificar a ocorrência de lesão hepática, manifestações clínicas extra-hepáticas, ansiedade, depressão e o impacto na qualidade de vida. MÉTODOS: Trata-se de um estudo de corte transversal com pacientes (n=118) portadores de infecção pelo vírus da hepatite C que foram comparados a um grupo composto de pacientes clinicamente estáveis e não infectados pelo vírus da hepatite C (n=118). Foi aplicado o Questionário de Ansiedade e Depressão, e para os que obtivessem o diagnóstico de fibromialgia, o Questionário de Impacto da Fibromialgia. As biopsias hepáticas foram analisadas de acordo com a classificação METAVIR. Foi realizado o teste de Schirmer para a pesquisa de lacrimejamento anormal nos pacientes estudados. A análise dos dados foi realizada através do programa Statistical Package for Social Sciences (SPSS) v.10.0. RESULTADOS: A prevalência de fibromialgia em pacientes infectados foi de 7,6%. Nos pacientes infectados com fibromialgia observou-se prevalência significativa de ansiedade e depressão. A pontuação do Questionário de Impacto da Fibromialgia foi maior nos pacientes infectados e com fibromialgia. Quando se relacionou os exames complementares em infectados com e sem fibromialgia, não foram constatadas diferenças significativas para o teste de Schirmer, genótipo viral e grau de fibrose e inflamação hepática. CONCLUSÃO: Nos indivíduos do sexo feminino, observou-se uma relação positiva entre a infecção pelo vírus da hepatite C, fibromialgia e sintomas extra-hepáticos, que se traduz em maior prevalência de ansiedade e depressão e em comprometimento na qualidade de vida.

Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care

SUMMARY INTRODUCTION Structural disparities between different Brazilian regions in public health system cause patients to migrate in search of better conditions to treat their diseases. Besides patient's discomfort, there is a concentration of care in large centres, causing overload to current capacity. OBJECTIVE To evaluate migratory flow and associated factors in a reference service in oncology. METHODS Cross-sectional study conducted at a referral oncology service in Great ABC region of São Paulo. Patients were interviewed, and clinical and demographic data collected. RESULTS Between March-July 2016, 217 patients were included. Analysis showed a divergence between the postal code registered in the medical record and that recorded during the interview in approximately 10% of cases. Of these, 42.9% were residents of other states. Search for treatment motivated most patients to seek service outside their city. CONCLUSION Results reflect the informal search for medical care outside the home area. Besides the direct impact on patients' quality of life, migratory flow has an economic-social impact because these patients place a burden and impose costs on services of cities where they do not perform their responsibilities as citizens. Confirmation of the existence of a significant migratory flow demonstrates the need to discuss restructuring public health policies.

RESUMO INTRODUÇÃO As disparidades estruturais entre diferentes regiões brasileiras no sistema de saúde pública fazem com que os pacientes migrem em busca de melhores condições para tratar suas doenças. Além do desconforto do paciente, há uma concentração de cuidados em grandes centros, causando sobrecarga da capacidade atual. OBJETIVO Avaliar o fluxo migratório e fatores associados em um serviço de referência em oncologia. MÉTODOS Estudo transversal realizado em um serviço de oncologia de referência na região do Grande ABC, em São Paulo. Os pacientes foram entrevistados e dados clínicos e demográficos coletados. RESULTADOS Entre março e julho de 2016 foram incluídos 217 pacientes. A análise mostrou uma divergência entre o código de endereçamento postal registrado no prontuário médico e o registrado durante a entrevista em aproximadamente 10% dos casos. Desses, 42,9% eram residentes de outros estados. A busca de tratamento motivou a maioria dos pacientes a buscar serviços fora de sua cidade. CONCLUSÃO Os resultados refletem a busca informal de cuidados médicos fora da área de residência. Além do impacto direto na qualidade de vida dos pacientes, o fluxo migratório tem um impacto econômico-social porque esses pacientes colocam um fardo e impõem custos aos serviços das cidades onde não executam suas responsabilidades como cidadãos. A confirmação da existência de um fluxo migratório significativo demonstra a necessidade de discutir a reestruturação das políticas de saúde pública.

Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care.

INTRODUCTION: Structural disparities between different Brazilian regions in public health system cause patients to migrate in search of better conditions to treat their diseases. Besides patient's discomfort, there is a concentration of care in large centres, causing overload to current capacity. OBJECTIVE: To evaluate migratory flow and associated factors in a reference service in oncology. METHODS: Cross-sectional study conducted at a referral oncology service in Great ABC region of São Paulo. Patients were interviewed, and clinical and demographic data collected. RESULTS: Between March-July 2016, 217 patients were included. Analysis showed a divergence between the postal code registered in the medical record and that recorded during the interview in approximately 10% of cases. Of these, 42.9% were residents of other states. Search for treatment motivated most patients to seek service outside their city. CONCLUSION: Results reflect the informal search for medical care outside the home area. Besides the direct impact on patients' quality of life, migratory flow has an economic-social impact because these patients place a burden and impose costs on services of cities where they do not perform their responsibilities as citizens. Confirmation of the existence of a significant migratory flow demonstrates the need to discuss restructuring public health policies.

Evaluation of the Effects of Music and Poetry in Oncologic Pain Relief: A Randomized Clinical Trial.

BACKGROUND: Various forms of art therapy have been tested as adjuvants in the treatment of physical and emotional disorders, including music and poetry. OBJECTIVE: To evaluate the effect of passive listening to music and poetry on the variation in pain, depression, and hope scores. METHODS: This was a randomized trial, with multiple aspects and an allocation ratio of 1:1:1, in which one group listened to music, one group listened to poetry, and another group received no intervention over a period of three days. A total of 75 adult patients experiencing pain and hospitalized in a cancer facility were included. The study was conducted over a period of three months. The primary outcome consisted of pain evaluation using a Visual Analog Scale, and the secondary outcomes consisted of evaluations of depression (Beck Depression Inventory) and hope (Herth Hope Scale). RESULTS: The final sample consisted of 65 participants, with 22 in the music group, 22 in the poetry group, and 21 controls. Music promoted an improvement in pain (p < 0.001) and depression (p = 0.004), while poetry promoted an improvement in pain (p < 0.001), depression (p = 0.001), and hope (p = 0.009). However, a difference between the music and poetry groups and the control group after the study was only observed for the pain outcome (p < 0.001) (confidence interval = 95%). CONCLUSIONS: Both music and poetry produced a similar improvement in the pain intensity. The two therapies also affected depression scores, and only poetry increased hope scores. Further investigation of the effects and comparisons between the two therapies should be performed.

Revisiting methadone: pharmacokinetics, pharmacodynamics and clinical indication / Revisitando a metadona: farmacocinética, farmacodinâmica e uso clínico

BACKGROUND AND OBJECTIVES: Methadone is a synthetic long-duration opioid with pharmacological properties qualitatively similar to morphine for its action on µ-opioid receptor. It is primarily used to treat cancer pain refractory to morphine. This study aimed at presenting a review of this drug with focus on pharmacokinetic and pharmacodynamic aspects, in addition to its clinical indication. CONTENTS: Articles available in Medline, Scielo, Cochrane library and Pubmed platforms until July 2014 were reviewed using the following descriptors: Methadone; Acute Pain; Chronic Pain; Cancer Pain; and Opioids. CONCLUSION: Its pharmacological properties make methadone a unique opioid analgesic, since it is less susceptible to tolerance, prevents hyperalgesia, is less conducive to abusive consumption and has a possible better action on neuropathic pain. However, risks of accidental death due to overdose, of arrhythmias and of pharmacological interactions should not be overlooked. In addition, there is lack of conclusive clinical trials comparing methadone to other analgesics with regard to risks and benefits. .

JUSTIFICATIVA E OBJETIVOS: Metadona é um opioide sintético de longa duração com propriedades farmacológicas qualitativamente semelhantes às da morfina por ação sobre o receptor µ-opioide. É utilizada principalmente no tratamento de dor oncológica refratária à morfina. O objetivo deste estudo foi apresentar uma revisão desse fármaco com foco nos aspectos farmacocinéticos e farmacodinâmicos, além de seu uso clínico. CONTEÚDO: Foi realizada uma revisão dos artigos disponíveis nas plataformas Medline, Scielo, biblioteca Cochrane e Pubmed até julho de 2014, por meio dos seguintes descritores: Metadona; Dor Aguda; Dor Crônica; Dor Oncológica; e Opioides. CONCLUSÃO: Foi realizada uma revisão dos artigos disponíveis nas plataformas Medline, Scielo, biblioteca Cochrane e Pubmed até julho de 2014, por meio dos seguintes descritores: Metadona; Dor Aguda; Dor Crônica; Dor Oncológica; e Opioides. .