Osteoprotective Effects of Tribulus terrestris L.: Relationship Between Dehydroepiandrosterone Levels and Ca2+-Sparing Effect.

Osteoporosis is a systemic bone disease that is characterized by impairments in bone strength that predispose an individual to a higher risk of fractures. Despite the various etiologies, undoubtedly the most important factors are aging of the population and hypogonadism. Although several therapeutic options are available, pharmacological treatments have some risks. Among these are increases in the incidence of thrombosis, breast cancer, ovarian cancer, endometrial cancer, and muscle injury, among others. Herbal medication may be an alternative for the treatment of osteoporosis. Thus, the aim of this study was to evaluate the therapeutic effect of a standardized extract of Tribulus terrestris L. (TT) on ovariectomy (OVX)-induced bone loss in rats. Female rats were first subjected to OVX and treated with TT (3, 30, and 300 mg/[kg·day]) or furosemide (25 mg/kg) orally for 28 days. Bone densitometry and tibial histology were performed, and acute renal function and testosterone, dehydroepiandrosterone (DHEA), and estradiol levels were assessed. Prolonged treatment with TT stimulated bone mass gain in all ovariectomized animals, raising bone mass to levels that were similar to sham-operated rats. DHEA levels significantly increased in TT-treated rats. The TT group also had lower calcium (Ca2+) excretion that OVX control and furosemide-treated rats. Finally, the histopathological analyses showed the maintenance of bone turnover in all TT-treated groups. Overall, the results indicate that the standardized extract of T. terrestris exerted a bone-protective effect by increasing bone mineral density. This activity may be at least partially attributable to an increase in serum DHEA levels and a Ca2+-sparing effect.

Evaluation of Reproductive Toxicology of Aqueous Extract of Yerba Mate (Ilex paraguariensis A. St.-Hil.), a Traditional South American Beverage.

Yerba mate (Ilex paraguariensis A. St.-Hil.; Aquifoliaceae) is a popular tonic and stimulant beverage that is widely consumed in different South American countries. Estimates indicate the consumption of >1 L per day in southern Brazil and Uruguay. Despite its relatively high consumption, data on reproductive toxicity during critical periods of gestation remain unclear. Thus, we evaluated the effects of an aqueous extract of I. paraguariensis leaves ("chimarrão" [IPC]) at two critical periods of gestation in Wistar rats: preimplantation embryonic stage and fetal organogenesis. Pregnant Wistar rats were orally treated with IPC (3, 30, and 300 mg/kg) from days 1 to 7 or 8 to 21 of pregnancy. The respective control groups received vehicle. During treatment, clinical signs of maternal toxicity, maternal body weight, and food and water intake were monitored. The rats were killed on days 8 and 20 of pregnancy, and the following parameters were evaluated: weight of the maternal uterus, weight of the liver, weight of the kidneys, weight of the spleen, total embryo implantation, preimplantation loss, the mean of live fetuses, the percentage of dead fetuses, fetus weight, and fetal malformation. The aqueous extract of the leaves of I. paraguariensis L. did not present any deleterious effects on preimplantation embryos or the organogenesis of offspring from female Wistar rats. These safety data provide evidence that IPC may be safe for consumption during gestation.

Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clínicas do Paraná - Curitiba.

INTRODUCTION: Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients. OBJECTIVE: To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery. MATERIALS AND METHODS: The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities. RESULTS: 98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n=29) according to the 1990 criteria and 45% (n=38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria. CONCLUSIONS: The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clínicas do Paraná - Curitiba / Prevalência de fibromialgia em pacientes acompanhados no ambulatório de cirurgia bariátrica do Hospital de Clínicas do Paraná - Curitiba

Abstract Introduction: Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients. Objective: To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery. Materials and methods: The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities. Results: 98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n = 29) according to the 1990 criteria and 45% (n = 38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria. Conclusions: The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Resumo Introdução: Fibromialgia (FM) é uma síndrome de dor crônica caracterizada por dor generalizada. Sabe-se que pacientes obesos têm mais dor músculo esquelética e disfunção física do que pacientes de peso normal. Portanto, é importante que o diagnóstico precoce da FM seja feito em pacientes obesos. Objetivo: Determinar a prevalência de FM em um grupo de pacientes obesos com indicação de cirurgia bariátrica. Materiais e métodos: Os pacientes foram captados do ambulatório de Cirurgia Bariátrica do Hospital de Clínicas da UFPR (HC-UFPR), antes de serem submetidos à cirurgia. A avaliação dos pacientes consistia em constatar a presença ou ausência de FMG pelos critérios ACR 1990 e 2011 e também a presença de comorbidades. Resultados: Foram avaliados 98 pacientes, 84 mulheres. A idade média foi de 42,07 anos e o IMC de 45,39. A prevalência de FM foi de 34% (n = 29) pelos critérios de 1990 e de 45% (n = 38) pelos de 2011. Não houve diferença em idade, IMC, escala de Epworth e prevalência de outras doenças entre pacientes que preenchiam ou não os critérios de 1990. Apenas depressão foi mais comum nas pacientes com FM (24,14% vs. 5,45%). Os mesmos achados foram vistos nas pacientes que preenchiam os critérios de 2011. Conclusões: A prevalência de FM em pacientes com obesidade mórbida é extremamente alta. Porém o IMC não difere nos pacientes com ou sem FM. A presença de depressão pode ser um fator de risco para o desenvolvimento de FM nesses pacientes.

Caracterização das plantas medicinais e medicamentos fitoterápicos para tratamento da osteoporose utilizados no Brasil / Characterization of medicinal plants and herbal medicines for the treatment of osteoporosis used in Brazil

A osteoporose é caracterizada por desordem do sistema esquelético caracterizada por baixa massa óssea e deteriorização da microarquitetura do tecido ósseo levando a fragilidade óssea com aumento da suscetibilidade a fraturas. Considerada a doença osteometabólica mais comum, de distribuição global, pode comprometer ambos os sexos, diferentes idades ou raças. As consequências relacionadas a essas doenças são as fraturas vertebrais verificadas em aproximadamente 20% das mulheres acima de 65 anos em pós-menopausa. Além disso, a consequência dessa fragilidade óssea pode levar a consequências graves como dor, deformidades, sequelas, restrições motoras e morte precoce, portanto, associada com alta morbi/mortalidade. Desta forma, sabendo que as medicações utilizadas para o tratamento da osteoporose não são isentas de risco (por exemplo, aumento do risco de tromboses, câncer de mama/ ovário/ endométrio, lesões musculares, entre outras), foi realizado uma revisão bibliográfica com o intuito de avaliar se existem plantas medicinais que possam ter efeitos ósseo protetores com menor número de efeitos adversos em relação aos fármacos sintéticos. Em síntese, verificou-se que os fármacos sintéticos podem acarretar prejuízos à saúde do paciente a longo prazo e que as plantas medicinais ou fitoterápicos utilizadas no Brasil apresentam estudos científicos com menores efeitos colaterais e, portanto, são uma alternativa viável para o tratamento e prevenção da osteoporose, visto que a Politica Nacional de Práticas Integrativas e Complementares na Atenção Básica sustenta esta tendência mediante subsídios como a Farmacopeia Brasileira e o Memento Fitoterápico.

Osteoporosis is characterized by skeletal system disorder, consisting of low bone mass and deterioration of the microarchitecture of the bone tissue, leading to bone fragility with increased susceptibility to fractures. Considered the most common osteometabolic disease worldwide, it affects both sexes, different ages and races. The consequences of these diseases are vertebral fractures in approximately 20% of postmenopausal women over 65 years of age. In addition, the consequence of this bone fragility may lead to serious consequences, such as pain, deformities, sequelae, motor restrictions and early death, being therefore associated with high morbidity/mortality. Therefore, knowing the medication used in the treatment of osteoporosis are not free of risk (for example, increased risk of thrombosis, breast/ovarian/endometrial cancer, muscle injuries, among others), a bibliographical review was made with the intent of evaluating whether there are medicinal plants that may have protective effects on the bones with a decreased number of side effects in relation to synthetic medication. In summary, we found that synthetic drugs may cause long-term health damage in the patient, and that herbal or medicinal plants used in Brazil present scientific studies with lower side effects. They are, therefore, a viable alternative for the treatment and prevention of osteoporosis, since this trend is supported by the National Policy of Integrative and Complementary Practices in Primary Care through subsidies, such as the Brazilian Pharmacopoeia and the Phytotherapeutic Memento.