Testicular alterations and semen quality in a selected group of breeding buffaloes.

Testicular ultrasound enables the evaluation of changes in the testicular parenchyma. This study aimed to report the occurrence of hypoechogenic testicular alterations and their relationship with semen quality in five breeding buffaloes. Two buffaloes presented with hyperechoic points characteristic of fibrosis and anechoic density content between the parietal and visceral tunica. The two bulls without ultrasonographic changes showed higher average trajectory speed, linear velocity, curvilinear velocity, amplitude of lateral displacement of the spermatic head, total motility, progressive motility, fast speed, and acrosomal membrane values within the normal range. The number of spermatozoa with major and total defects was higher in the group of animals without alterations. The three buffaloes that presented with testicular alterations produced semen within established freezing standards.

Percepção dos profissionais do Programa Mais Médicos quanto à adesão aos instrumentos de comunicação entre as Redes de Atenção à Saúde e a Atenção Primária / he professionals' perception of the "More Doctors" program regarding communication instruments' adherence between healthcare networks and primary care

O artigo objetiva analisar a percepção dos profissionais do Programa Mais Médicos quanto à adesão aos instrumentos de comunicação entre os pontos de atenção das Redes de Atenção à Saúde. Sua importância diz respeito à necessidade de se analisar o grau de adesão aos instrumentos e qualificar a ocorrência da comunicação entre os entes da rede, na medida em que se reconhece a necessidade de manter informado o profissional detentor da coordenação do cuidado e devolver a ele a responsabilidade pela condução dos indivíduos usuários da rede. Os resultados demonstraram a baixa percepção do retorno dos registros dos usuários da rede aos pontos de atenção, independentemente da macrorregião (P = 0,094). Esse resultado demonstra a necessidade de trabalhar a qualificaçãodas atividades da rede de atenção a fim de valorizar a necessidade das informações oriundas do processo de contrarreferência.

The article's purpose is to analyze professionals' perceptions of the "More Doctors" program regarding communication instruments' adherence among the different points inside the healthcare network. It is important to analyze the instruments' adherence degree and qualify the occurrence of communication inside the network entities, recognizing the need to keep care coordinators well informed and to make them responsible for the care of individuals who are users of the network. The results showed a low perception of users' network records arriving at the proper care points, independent of the macroregion (P = 0,094). This result demonstrates the need to work on qualifying the activities of the care network to value the need for information coming from the counter-reference processes.

Vaginal Microbiome Components as Correlates of Cervical Human Papillomavirus Infection.

BACKGROUND: Interplay between vaginal microbiome and human papillomavirus (HPV) remains unclear, partly due to heterogeneity of microbiota. METHODS: We used data from 546 women enrolled in a cross-sectional study in 5 Brazil. We genotyped vaginal samples for HPV and sequenced V3-V4 region of 16S rRNA gene for vaginal microbiome analysis. We used stepwise logistic regression to construct 2 linear scores to predict high-risk HPV (hrHPV) positivity: one based exclusively on presence of individual bacterial taxa (microbiome-based [MB] score) and the other exclusively on participants' sociodemographic, behavioral, and clinical (SBC) characteristics. MB score combined coefficients of 30 (of 116) species. SBC score retained 6 of 25 candidate variables. We constructed receiver operating characteristic curves for scores as hrHPV correlates and compared areas under the curve (AUC) and 95% confidence intervals (CI). RESULTS: Overall, prevalence of hrHPV was 15.8%, and 26.2% had a Lactobacillus-depleted microbiome. AUCs were 0.8022 (95% CI, .7517-.8527) for MB score and 0.7027 (95% CI, .6419-.7636) for SBC score (P = .0163). CONCLUSIONS: The proposed MB score is strongly correlated with hrHPV positivity-exceeding the predictive value of behavioral variables-suggesting its potential as an indicator of infection and possible value for clinical risk stratification.

Mapping of endometriosis in patients with unilateral endometrioma.

ABSTRACT: To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas.A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm.Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively.Unilateral endometriomas are important markers of the severity of endometriosis.

Predictive factors of response in radial Extracorporeal Shock-waves Therapy for Myofascial and Articular Pain: A retrospective cohort study.

BACKGROUND: Myofascial Pain Syndrome causes disability in daily life activities and despite all efforts, it continues to be a challenge, perpetuating suffering, overloading services and costs. New treatment options need to be tested. OBJECTIVE: We aimed to quantify the rESWT short-term analgesic effect and identify the predictors of success through comparing results achieved in MPS and Articular Pain (AP). METHOD: Retrospective cohort study of 1,580 patients with Myofascial Pain Syndrome or Articular Pain underwent two weekly radial Extracorporeal Shock-wave Therapy sessions. The pain intensity was measured by Visual Analog Scale before and one week after the end of the treatment (3 weeks). RESULTS: The therapy decreases pain by 62.50% (p< 0.0001), with a high success rate (91.59%) and a low worsening of baseline conditions rate (2.1%). The best recommendation is for patients with intense myofascial pain (Visual Analog Scale ⩾ 70 mm), using high shock-wave frequency (⩾ 15 Hz). CONCLUSIONS: Two rESWT sessions promote pain relief, with a high success rate and low rates of treatment abandonment and worsening. The best results are obtained in myofascial pain patients with high pain intensity, treated with high-frequency dosage.

Characterization of the Vaginal Microbiome in Women of Reproductive Age From 5 Regions in Brazil.

BACKGROUND: Composition of the vaginal microbiome is strongly related to a woman's reproductive health and risk of sexually transmitted infections. Ethnoracial, behavioral, and environmental factors can influence microbiome. The Brazilian population is unique in terms of miscegenation of ethnic groups and behavioral characteristics across different regions. We aimed to characterize the vaginal microbiome of women from 5 geographical regions of Brazil. METHODS: We sequenced V3-V4 regions of 16S rRNA gene in vaginal samples of 609 reproductive-aged women. We performed logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between sociodemographic and behavioral factors with Lactobacillus-depleted microbiome (community state type [CST] IV). RESULTS: Vaginal samples were grouped into 5 CST: CST I (L. crispatus predominant, 30.5%), CST II (L. gasseri predominant, 4.4%), CST III (Lactobacillus iners predominant, 36.5%), CST IV (Lactobacillus-depleted, 27.4%), and CST V (L. jensenii predominant, 1.2%). Several factors were independently associated with CST IV, such as smoking (OR, 1.80; 95% CI, 1.02-3.18), number of partners (OR, 2.11; 95% CI, 1.20-3.70), and vaginal douching (OR, 2.24; 95% CI, 1.34-3.74). A protective effect was observed for milk/dairy intake (OR, 0.47; 95% CI, 0.27-0.82) and sitz bathing (OR, 0.43; 95% CI, 0.19-0.98). CONCLUSIONS: Nearly two thirds of Brazilian women may be at an increased risk for adverse outcomes associated with a vaginal microbiota characterized by the depletion of Lactobacillus or dominance by L. iners, whose protective role has been widely questioned. Several factors related to sexual behavior and intimate hygiene were associated with CST IV.

Ovarian function after the use of various hemostatic techniques during treatment for endometrioma: protocol for a randomized clinical trial.

BACKGROUND: Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma. METHODS: An open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069. DISCUSSION: Bearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used. TRIAL REGISTRATION: ClinicalTrials.gov, NTC03430609 . Registered on XX.10/31/2017. ISRCTN Registry, ISRCTN11469394 . Registered on XX.17/12/2017. Unique Protocol ID: U1111-1203-2508.

Histologic chorioamnionitis does not modulate the oxidative stress and antioxidant status in pregnancies complicated by spontaneous preterm delivery.

BACKGROUND: Infection induced-inflammation and other risk factors for spontaneous preterm birth (PTB) and preterm premature rupture of membranes (pPROM) may cause a redox imbalance, increasing the release of free radicals and consuming antioxidant defenses. Oxidative stress, in turn, can initiate intracellular signaling cascades that increase the production of pro-inflammatory mediators. The objective of this study was to evaluate the oxidative damage to proteins and antioxidant capacity profiles in amniochorion membranes from preterm birth (PTB) and preterm premature rupture of membranes (pPROM) and to determine the role of histologic chorioamnionitis in this scenario. METHODS: We included 27 pregnant women with PTB, 27 pPROM and 30 at term. Protein oxidative damage was assayed by 3-nitrotyrosine (3-NT) and carbonyl levels, using enzyme-linked immunosorbent assay (ELISA) and modified dinitrophenylhydrazine assay (DNPH), respectively. Total antioxidant capacity (TAC) was measured by ELISA. RESULTS: Protein oxidative damage determined by carbonyl levels was lower in PTB group than pPROM and term groups (p < 0.001). PTB group presented higher TAC compared with pPROM and term groups (p = 0.002). Histologic chorioamnionitis did not change either protein oxidative damage or TAC regardless of gestational outcome. CONCLUSION: These results corroborates previous reports that pPROM and term birth exhibit similarities in oxidative stress- induced senescence and histologic chorioamnionitis does not modulate oxidative stress or antioxidant status.

Estudo do tratamento da lombalgia crônica por meio da escola de postura / Study of chronic low back pain treatment using the back school

O objetivo do presente trabalho foi analisar a resposta ao tratamento dos pacientes com dor lombar crônica, atendidos pela ?Escola de Postura? do IMREA-HCFMUSP. Os questionários utilizados para avaliação da resposta terapêutica foram a escala ?Oswestry Low Back Pain Disability Questionnaire?, a Escala Visual Analógica (EVA), e um diagrama corporal de dor. A amostra foi composta por 43 pacientes com lombalgia crônica encaminhados, avaliados e tratados pela Escola de Postura. Observou-se que os indivíduos que concluíram a Escola apresentaram melhora significativa com relação às três escalas de avaliação aplicadas. Cabe ressaltar que o período de estudo de avaliação da Escola de Postura foi de dois meses, sendo que os resultados não possibilitam afirmar que tal método terapêutico também é eficaz em longo prazo. Mais estudos, quantitativos e qualitativos, devem ser realizados de modo a oferecer subsídios à equipe multiprofissional da Escola que permitam operar mudanças e ampliar recursos terapêuticos no tratamento de pacientes com lombalgia crônica.

The aim of the present study was to quantitatively analyze the response of patients with chronic low back pain to treatment at the Back School at the IMREA-HCFMUSP. The following scales were used to measure the therapeutic response: the Oswestry Low Back Pain Disability Questionnaire, a Visual Analog Scale (VAS), and a corporal diagram of the pain. The sample was composed of 43 patients with chronic low back pain evaluated, treated, and referred to by the Back School program. The results showed significant improvement among those who completed the program in all three scales applied. Since the period of study was only two months, the results do not support any claim that the Back School is also this effective on long-term treatment of chronic low back pain. Further qualitative and quantitative studies must be carried out in order to support the development of specialized multi-professional teams, who will carry out alterations and improvements in therapeutic resources to the management of chronic low back pain.

Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature.

OBJECTIVE: To conduct a systematic review and meta-analysis to quantify the efficacy of invasive and noninvasive brain stimulation for the treatment of chronic pain. METHODS: MEDLINE and other databases were searched as data sources. Reference lists and conference abstracts were examined for further relevant articles. We included studies that evaluated the effects of invasive and noninvasive brain stimulation of motor cortex on chronic pain using the visual analogue scale. Eleven studies using noninvasive brain stimulation and 22 studies using invasive brain stimulation met our inclusion criteria. The results showed that weighted responder rate was 72.6% (95% CI, 67.7-77.4) for the invasive stimulation studies and 45.3% (95% CI, 39.2-51.4) for the noninvasive stimulation studies. This difference was significant. For the noninvasive stimulation studies, the random effects model revealed that the number of responders in the active group was significantly higher as compared with sham stimulation group (risk ratio of 2.64) (95% CI, 1.63-4.30). CONCLUSIONS: This meta-analysis shows that two different techniques of brain stimulation of motor cortex--invasive and noninvasive--can exert a significant effect on pain in patients with chronic pain. We discuss potential reasons that invasive brain stimulation showed a larger effect in this meta-analysis. Our findings encourage continuation of research in this area and highlight the need for well-designed clinical trials to define the role of brain stimulation in pain management.

Estimulação cerebral para o tratamento de dor neuropática / Brain stimulation for the neuropathic pain’s treatment

As alternativas terapêuticas para o tratamento da dor neuropática ainda são insatisfatórias apesar de a terapia farmacológica ter avançado muito nas últimas décadas. O completo restabelecimento do paciente em suas atividades diárias ainda é um desafio e tem como base uma abordagem interdisciplinar e o uso de outras intervenções além dos fármacos. Um dos desafios no tratamento de dor crônica é que esse distúrbio leva a modificações plásticas no cérebro que sustentam o quadro. O desenvolvimento das técnicas de estimulação cerebral demonstra que esses métodos podem ser uma opção importante no manejo da dor. Estudos recentes têm mostrado que essas técnicas revertem modificações plásticas por um longo período de tempo. Uma técnica de estimulação cerebral simples, de baixo custo e segura é a estimulação transcraniana por corrente contínua de baixa intensidade. Trata-se de procedimento não-invasivo e indolor capaz de modular a atividade cerebral localmente, apresentando efeitos terapêuticos. Pelo fato de a dor crônica ser um sintoma debilitante, contribuir com a diminuição da qualidade de vida e estar associada a uma disfunção do sistema nervoso central, a estimulação cerebral pode ter um resultado benéfico nesse grupo de pacientes.(AU)

Despite of the advance of pharmacological therapies in the last decades, therapeutic approaches to the treatment of neuropathic pain are still non-satisfactory. The patient full recovery in their daily activities is still a challenge and is based on an interdisciplinary approach involving others interventions than pharmacological one. One of the challenges in treating chronic pain is that the disorder leads to plastic changes in the brain that support this condition. The development of brain stimulation techniques shows that these methods can be an important option in pain management. Recent studies have shown that these techniques revert plastic alterations for a long period of time. One simple, low-cost and secure technique of brain stimulation is the transcranial direct current stimulation. It is a non-invasive and painless procedure able to modulate locally the brain activity, providing therapeutic effects. Because of chronic pain is a debilitating symptom, one of the most important in the quality of life and is associated with a dysfunction of the central nervous system, brain stimulation may have a beneficial effect in this group of patients.(AU)

Aunque la terapia farmacológica haya avanzado mucho em las últimas décadas, las alternativas terapéuticas para el tratamiento del dolor neuropático todavia son insatisfatorias. El completo reestablecimiento del paciente en sus actividades diarias todavia es un desafio y tiene como base un abordaje interdisciplinario y el uso de otras intervenciones además de los fármacos. Uno de los desafíos en el tratamiento del dolor crónico es que ese trastorno lleva a modificaciones plásticas en el cerebro que sustentan el cuadro. El desarrollo de las técnicas de estimulación cerebral demuestra que esos métodos pueden ser una opción importante en el manejo del dolor. Estudios recientes han mostrado que esas técnicas se revierten en modificaciones plásticas por un largo período de tiempo. Una técnica de estimulación cerebral simple, de bajo costo y segura es la estimulación transcraneana por corriente contínua de baja intensidad. Se trata de un procedimiento no invasivo e indoloro capaz de modular la actividad cerebral localmente, apresentando efectos terapéuticos. Debido al hecho del dolor crónica ser un síntoma debilitante, contribuir con la disminución de la calidad de vida y estar asociado a una disfunción del sistema nervioso central, la estimulación cerebral puede tener un resultado benéfico en ese grupo de pacientes.(AU)

Estimulação cerebral para o tratamento de dor neuropática / Estimulacion cerebral para el tratamiento del dolor neuropatico / Brain stimulation for the neuropathic pain’s treatment

As alternativas terapêuticas para o tratamento da dor neuropática ainda são insatisfatórias apesar de a terapia farmacológica ter avançado muito nas últimas décadas. O completo restabelecimento do paciente em suas atividades diárias ainda é um desafio e tem como base uma abordagem interdisciplinar e o uso de outras intervenções além dos fármacos. Um dos desafios no tratamento de dor crônica é que esse distúrbio leva a modificações plásticas no cérebro que sustentam o quadro. O desenvolvimento das técnicas de estimulação cerebral demonstra que esses métodos podem ser uma opção importante no manejo da dor. Estudos recentes têm mostrado que essas técnicas revertem modificações plásticas por um longo período de tempo. Uma técnica de estimulação cerebral simples, de baixo custo e segura é a estimulação transcraniana por corrente contínua de baixa intensidade. Trata-se de procedimento não-invasivo e indolor capaz de modular a atividade cerebral localmente, apresentando efeitos terapêuticos. Pelo fato de a dor crônica ser um sintoma debilitante, contribuir com a diminuição da qualidade de vida e estar associada a uma disfunção do sistema nervoso central, a estimulação cerebral pode ter um resultado benéfico nesse grupo de pacientes.

Despite of the advance of pharmacological therapies in the last decades, therapeutic approaches to the treatment of neuropathic pain are still non-satisfactory. The patient full recovery in their daily activities is still a challenge and is based on an interdisciplinary approach involving others interventions than pharmacological one. One of the challenges in treating chronic pain is that the disorder leads to plastic changes in the brain that support this condition. The development of brain stimulation techniques shows that these methods can be an important option in pain management. Recent studies have shown that these techniques revert plastic alterations for a long period of time. One simple, low-cost and secure technique of brain stimulation is the transcranial direct current stimulation. It is a non-invasive and painless procedure able to modulate locally the brain activity, providing therapeutic effects. Because of chronic pain is a debilitating symptom, one of the most important in the quality of life and is associated with a dysfunction of the central nervous system, brain stimulation may have a beneficial effect in this group of patients.

Aunque la terapia farmacológica haya avanzado mucho em las últimas décadas, las alternativas terapéuticas para el tratamiento del dolor neuropático todavia son insatisfatorias. El completo reestablecimiento del paciente en sus actividades diarias todavia es un desafio y tiene como base un abordaje interdisciplinario y el uso de otras intervenciones además de los fármacos. Uno de los desafíos en el tratamiento del dolor crónico es que ese trastorno lleva a modificaciones plásticas en el cerebro que sustentan el cuadro. El desarrollo de las técnicas de estimulación cerebral demuestra que esos métodos pueden ser una opción importante en el manejo del dolor. Estudios recientes han mostrado que esas técnicas se revierten en modificaciones plásticas por un largo período de tiempo. Una técnica de estimulación cerebral simple, de bajo costo y segura es la estimulación transcraneana por corriente contínua de baja intensidad. Se trata de un procedimiento no invasivo e indoloro capaz de modular la actividad cerebral localmente, apresentando efectos terapéuticos. Debido al hecho del dolor crónica ser un síntoma debilitante, contribuir con la disminución de la calidad de vida y estar asociado a una disfunción del sistema nervioso central, la estimulación cerebral puede tener un resultado benéfico en ese grupo de pacientes.

Low and high frequency repetitive transcranial magnetic stimulation for the treatment of spasticity.

The development of non-invasive techniques of cortical stimulation, such as transcranial magnetic stimulation (TMS), has opened new potential avenues for the treatment of neuropsychiatric diseases. We hypothesized that an increase in the activity in the motor cortex by cortical stimulation would increase its inhibitory influence on spinal excitability through the corticospinal tract and, thus, reduce the hyperactivity of the gamma and alpha neurons, improving spasticity. Seventeen participants (eight males, nine females; mean age 9y 1mo [SD 3y 2mo]) with cerebral palsy and spastic quadriplegia were randomized to receive sham, active 1Hz, or active 5Hz repetitive TMS of the primary motor cortex. Stimulation was applied for 5 consecutive days (90% of motor threshold). The results showed that there was a significant reduction of spasticity after 5Hz, but not sham or 1Hz, stimulation as indexed by the degree of passive movement; however this was not evident when using the Ashworth scale, although a trend for improvement was seen for elbow movement. The safety evaluation showed that stimulation with either 1Hz or 5Hz did not result in any adverse events as compared with sham stimulation. Results of this trial provide initial evidence to support further trials exploring the use of cortical stimulation in the treatment of spasticity.

Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson's disease.

Electrical stimulation of deep brain structures, such as globus pallidus and subthalamic nucleus, is widely accepted as a therapeutic tool for patients with Parkinson's disease (PD). Cortical stimulation either with epidural implanted electrodes or repetitive transcranial magnetic stimulation can be associated with motor function enhancement in PD. We aimed to study the effects of another noninvasive technique of cortical brain stimulation, transcranial direct current stimulation (tDCS), on motor function and motor-evoked potential (MEP) characteristics of PD patients. We tested tDCS using different electrode montages [anodal stimulation of primary motor cortex (M1), cathodal stimulation of M1, anodal stimulation of dorsolateral prefrontal cortex (DLPFC), and sham-stimulation] and evaluated the effects on motor function--as indexed by Unified Parkinson's Disease Rating Scale (UPDRS), simple reaction time (sRT) and Purdue Pegboard test--and on corticospinal motor excitability (MEP characteristics). All experiments were performed in a double-blinded manner. Anodal stimulation of M1 was associated with a significant improvement of motor function compared to sham-stimulation in the UPDRS (P < 0.001) and sRT (P = 0.019). This effect was not observed for cathodal stimulation of M1 or anodal stimulation of DLPFC. Furthermore, whereas anodal stimulation of M1 significantly increased MEP amplitude and area, cathodal stimulation of M1 significantly decreased them. There was a trend toward a significant correlation between motor function improvement after M1 anodal-tDCS and MEP area increase. These results confirm and extend the notion that cortical brain stimulation might improve motor function in patients with PD.

A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury.

Past evidence has shown that motor cortical stimulation with invasive and non-invasive brain stimulation is effective to relieve central pain. Here we aimed to study the effects of another, very safe technique of non-invasive brain stimulation--transcranial direct current stimulation (tDCS)--on pain control in patients with central pain due to traumatic spinal cord injury. Patients were randomized to receive sham or active motor tDCS (2mA, 20 min for 5 consecutive days). A blinded evaluator rated the pain using the visual analogue scale for pain, Clinician Global Impression and Patient Global Assessment. Safety was assessed with a neuropsychological battery and confounders with the evaluation of depression and anxiety changes. There was a significant pain improvement after active anodal stimulation of the motor cortex, but not after sham stimulation. These results were not confounded by depression or anxiety changes. Furthermore, cognitive performance was not significantly changed throughout the trial in both treatment groups. The results of our study suggest that this new approach of cortical stimulation can be effective to control pain in patients with spinal cord lesion. We discuss potential mechanisms for pain amelioration after tDCS, such as a secondary modulation of thalamic nuclei activity.

Transcranial direct current stimulation of the unaffected hemisphere in stroke patients.

Recovery of function after a stroke is determined by a balance of activity in the neural network involving both the affected and the unaffected brain hemispheres. Increased activity in the affected hemisphere can promote recovery, while excessive activity in the unaffected hemisphere may represent a maladaptive strategy. We therefore investigated whether reduction of the excitability in the unaffected hemisphere by cathodal transcranial direct current stimulation could result in motor performance improvement in stroke patients. We compared these results with excitability-enhancing anodal transcranial direct current stimulation of the affected hemisphere and sham transcranial direct current stimulation. Both cathodal stimulation of the unaffected hemisphere and anodal stimulation of the affected hemisphere (but not sham transcranial direct current stimulation) improved motor performance significantly. These results suggest that the appropriate modulation of bihemispheric brain structures can promote motor function recovery.

Donovanose / Granuloma inguinale

A donovanose é uma infecção causada pela Calymmatobacterium granulomatosis, que afeta principalmente a região genital. De caráter progressivo e destrutivo, vem aumentando sua incidência nos últimos anos, despertando grande interesse pela necessidade de diagnóstico precoce, com a finalidade de evitar estádios avançados que limitam a vida do indivíduo. Os autores, após algumas considerações sobre os antecedentes da enfermidade e seus aspectos clínico-patológicos, relatam o case de um paciente do sexo feminino, 33 anos, com donovanose de caráter insidioso, progressivo e evolução de 10 anos. No momento da admissão, a paciente apresentava lesões ulcerovegetantes nas regiões vulvar, crural e abdominal baixa, que após manejo terapêutico adequado, obteve melhora satisfatória do quadro clínico. Nos comentários fazemos breve referência às complicações e terapêutica atual realizada para cura da patologia e das infecções secundárias, dando melhoria de condições vitais dos pacientes

Útero didelfo: relato de quatro casos / Didelphys uterus

Atualmente o estudo das malformações uterinas tem despertado grande interesse nos autores, em função do aumento no diagnóstico ultrs-sonográfico destas patologias, em especial útero didelfo. Esta anomalia mülleriana é caracterizada por apresentar dois corpos e dois cérvices uterinos. O útero didelfo é uma patologia que representa 26 por cento das malformações uterinas. Os autores apresentam quatro casos de útero didelfo, sendo um de importância obstétrica, e os demais, ginecológica

Pseudocisto de pâncreas e gravidez / Pancreatic pseudocyst and pregnancy

A associaçao de gravidez e pseudocisto de pâncreas é extremamente rara. Os autores descrevem o caso de uma paciente com epilepsia e que apresentou pseudocisto de pâncreas diagnosticado durante o período gestacional, enfatizando a raridade da associaçao e o tipo de tratamento utilizado.

Colangiopancreatografia retógrada e papilotomia endoscópia no segundo trimestre da gravidez: relato de caso

Os autores apresentam um caso de una paciente na 26ª semana de gestaçåo , com quadro de colelitíase e coledocolitíase que foi submetida a uma colangiopancreatografia retrógada por via endoscópica associada a papilotomia. A gravidez da paciente evoluiu entåo sem outras anormalidades, tendo a mesma, quatro meses após o parto, sido submetida a uma colecistectomia. O motivo da apresentaçåo é a demonstraçåo de que procedimentos menos arriscados podem ser utlilizados durante a gestaçåo em pacientes com doenças das vias biliares, o que permite a estas mulheres a continuaçåo em pacientes com doenças das vias biliares, o que permite a estas mulheres a continuaçåo normal da gestaçåo sem riscos para si e para o feto