Acute outcomes of acupuncture and dry needling over peripheral acute fatigue in untrained healthy volunteers: A randomized controlled clinical trial.

Peripheral acute fatigue (PAF) is defined as when the skeletal muscle is incapable of generating power. We aimed to investigate the acute effects of traditional Chinese acupuncture (TCA) and dry needling (DN) over PAF induced on the biceps brachii of untrained healthy volunteers. We conducted a randomized, single-blind controlled clinical trial. All volunteers (n = 45) underwent fatigue induction protocols repeated before and after treatment with TCA (TCA group; TCAg; n = 15), DN (DN group; DNg; n = 15), and rest (control group; Cg; n = 15). Assessments of PAF, skin temperature, and exercise time occur before and after each event: 1st fatigue induction (FI), treatment, and 2nd FI. We used repeated measures ANOVA adjusted with Bonferroni post hoc test to determine any change in tested variables (PAF-VAS, PAF-EMG, and skin temperature) at different time points compared to the baseline. Paired Samples t-test was used for the variable exercise times. All statistical tests considered' the significance level at p ≤ 0,05. There was no difference between groups in acute fatigue recovery (p = 0.19). All intragroup analyses were significant (p ≤ 0.05) and all volunteers show a reduction in fatigue perception after treatment (p ≤ 0,05), however, exercise time did not ameliorate after TCA or DN (p > 0.77). A single session of TCA and, DN can equally reduce fatigue, temperature, and exercise time over PAF induced on biceps brachii of untrained healthy volunteers.

Inter-rater Accuracy and Reliability of a Palpation Protocol of the C7 Spinous Process Comprising a Combination of 3 Traditional Palpation Techniques.

OBJECTIVE: The purpose of this study was to determine the accuracy and intrarater reliability of a palpatory protocol based on a combination of 3 palpatory methods to identify both the C7 spinous process (C7 SP) and the factors that affect the errors and inaccuracy of palpation. METHODS: Twenty-five women between the ages of 18 and 60 years were submitted to a palpation protocol of the C7 SP, and a radiopaque marker was fixed on the skin at the possible location of the vertebrae. A radiograph and a photograph of the cervical spine were obtained in the same posture by a first rater. A second rater performed the same palpation protocol and took a second photograph. The accuracy and measurement error of the palpation protocol of C7 SP were assessed through radiographic images. The inter-rater reliability was estimated by the interclass correlation coefficient and assessed using photographs of each rater. The Pearson's correlation coefficients (r), the Fisher exact test, and the χ2 test were used to identify the factors associated with the error and inaccuracy of palpation. RESULTS: Accuracy of the C7 palpation was 76% with excellent reliability (interclass correlation coefficient = 0.99). There was a moderate correlation between weight and the measurement of palpation error (r = -0.6; P = .003). One hundred percent of inaccuracy palpation was related to the increased soft-tissue thickness (P = .005) in the cervical region. CONCLUSION: The palpation protocol described in this study was accurate and presented excellent reliability in identifying the C7 SP. Increased weight and dorsocervical fat pad were associated to error and palpation inaccuracy, respectively.

Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial.

Background: Cupping therapy is used to treat musculoskeletal conditions, including low back pain. Objectives: The study assessed the effects of dry cupping on pain and functional disability from persistent nonspecific low back pain. Methods: This was a randomized controlled trial, where participants were allocated to a cupping therapy (n = 19) or sham (n = 18) group, for five 10-minute sessions of cupping therapy, twice a week, to stimulate the acupoints related to low back pain (GV4, BL23, BL24, BL25, and BL30, BL40 and BL58) and emotional aspects (HT3 and ST36). All participants were assessed at baseline, post-treatment and follow up (a finalization period of four weeks) using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Groups were compared using the analysis of covariance (ANCOVA) and the effect size was calculated using Cohen̓s d. Results: The cupping therapy group presented a lower mean VAS when compared to the sham, at post-treatment (mean difference: -2.36; standard error [SE]: 0.58; p < 0.001; "large" effect size: -0.94) and follow up (mean difference: -1.71; SE: 0.81; p < 0.042; 'large' effect size: -0.83). The cupping therapy group presented a lower mean ODI when compared to the sham post-treatment (mean difference: -4.68; SE: 1.85; p: 0.017; 'large' effect size: -0.87), although in follow-up, there was no difference between the groups (mean difference: 4.16; SE: 2.97; p: 0.17; "medium" effect size: -0.70). Conclusion: Dry cupping was more effective in improving pain and functional disability in people with persistent nonspecific low back pain when compared to the sham.

Acupuncture and Dry Needling in the Reduction of Peripheral Acute Fatigue Induced in the Biceps Braquii: Protocol for a Single-blinded Randomized Controlled Clinical Trial.

The present study aims to propose a protocol to verify the efficacy and acute effects of traditional Chinese acupuncture, dry needling, and the rest in peripheral acute fatigue (PAF) induced by intermittent isometric contractions of the nondominant biceps brachii (BB) of nonphysically active men in a randomized, single-blind clinical trial assessed with surface electromyography, contraction time in seconds, infrared thermal imaging, and visual analog scale applied to the PAF. These instruments will evaluate the median frequency, endurance time, temperature (°C), and perceived fatigue in BB of the volunteers. The measurements will be collected in four moments (Test 0, 01, 02, and 03) divided between the beginning and the end of two sets of exercises (Exercises 01 and 02) of intermittent isometric contractions. TRIAL IDENTIFIER: NCT03448120 in www.clinicaltrials.gov.

MRI in migraineurs: are there abnormalities in the area where the myofascial trigger points are palpable and in volume measurements?

INTRODUCTION: Patients with migraine may present a higher quantity of myofascial trigger points (MTrP) and alterations in the cervical muscles when compared to non-migraineurs. The magnetic resonance imaging (MRI) is a robust method for the study of human soft tissues and could be useful to investigate these points. OBJECTIVES: To identify the presence of MTrP in the descending fibers of the trapezius muscle in women with migraine and to quantify the muscle volume by MRI, correlating it with the headache characteristics. METHODS: A cross-sectional analytic study was conducted among 14 women, eight in migraine group, and six in without migraine group. The presence of MTrP was evaluated using Simons' criteria, and linolenic acid capsules subsequently marked the areas. MRI was performed with 1.5T, T1-weighted sequence, and T2 in the axial, sagittal, and coronal planes. The T1-weighted sequences were performed with and without gadolinium contrast. RESULTS: The T1-weighted image analysis with and without gadolinium did not show any signal alteration in the MTrP areas in both groups. The migraine group presented more MTrP in the trapezius muscle (MD [95%CI] = 1[1; 3]; MD [95%CI] = 1[0; 2] right and left side, respectively), and a smaller muscle volume (MD [95%CI] = -198.1[-338.7;-25.6], MD [95%CI] = -149.9[-325.05;-0.13] right and left side, respectively) than non-migraineurs. The migraine frequency presented a negative strong correlation with the trapezius volumes (r = -0.812; p = 0.014). CONCLUSION: Migraineurs present more MTrP and a smaller muscle volume than non-migraineurs. The trapezius volume is negatively correlated with migraine frequency. MRI is not a suitable outcome measure for assessing MTrP.

Avaliação da sensibilidade em áreas de enxerto cutâneo do membro superior de pacientes queimados e sua repercussão na qualidade de vida / Assessment of skin graft areas sensibility of upper limb of burned patients and its repercussion on quality of life

OBJETIVO: Avaliar a sensibilidade de áreas que receberam enxerto de pele nos membros superiores de pacientes queimados e sua percepção de como a sensibilidade está relacionada à sua qualidade de vida. MÉTODO: Foram avaliados 30 indivíduos, com queimadura em membro superior, tratados com enxertia. Foram obtidos dados pessoais e histórico da lesão. Aplicava-se a escala de Vancouver para avaliar a sensibilidade da área enxertada e a mesma era medida. A sensibilidade tátil foi avaliada por meio de um estesiômetro, já a sensibilidade térmica foi avaliada por meio de um tubo de ensaio com água a 40°C, com água temperatura ambiente e aplicava-se gelo. Por meio da utilização do TENS, no modo convencional e com variação de intensidade e frequência (VIF), avaliou-se a sensação de prurido e sensibilidade nociceptiva, respectivamente. A qualidade de vida foi avaliada através do BSHS-R. RESULTADOS E CONCLUSÃO: Queimaduras nos membros superiores tratadas com enxerto de pele precisam de estímulos de intensidades maiores para despertar sensação nas áreas queimadas quando comparadas às sadias. A sensibilidade térmica tende a retornar mais rápido. As alterações da sensibilidade na área do enxerto interferem na qualidade de vida do paciente.

OBJECTIVE: To evaluate the sensitivity of areas that received skin grafts on the upper limbs of burned patients and their perception of how the sensitivity is related to their quality of life. METHODS: Thirty individuals with burns on the upper limbs, treated with grafting, were evaluated. Personal data and history of the injury were obtained. The Vancouver scale was applied to assess the sensitivity of the grafted area and it was measured. The tactile sensitivity was assessed by means of a stoichiometer, whereas the thermal sensitivity was assessed by means of a test tube with water at 40°C, with water at room temperature and ice was applied. Through the use of TENS, in the conventional way and with varying intensity and frequency (VIF), itching sensation and nociceptive sensitivity were evaluated, respectively. Quality of life was assessed using the BSHS-R. RESULTS AND CONCLUSION: Burns in the upper limbs treated with a skin graft need stimuli of greater intensity to arouse sensations when compared to healthy areas. Thermal sensitivity tends to return faster. Sensitivity changes in the graft area interfere with patients quality of life.

Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study.

BACKGROUND: Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. OBJECTIVES: To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. METHODS: This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. RESULTS: Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. CONCLUSIONS: People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used.

Use of russian and aussie current in isometric tetanization of the quadriceps femoris / Uso das correntes russa e aussie na tetanização isométrica do quadríceps femoral / Uso de las corrientes rusa y aussie en la tetanización isométrica del cuádriceps femoral

ABSTRACT Objectives: To qualitatively and quantitatively analyze the interaction of Russian and Aussie currents in isometric contraction of the quadriceps femoris muscle in the sensory, motor and pain tolerance spectra in healthy young women. Methods: The subjects were studied at a single point in time. A lower limb was selected at random to receive each current, and the electrodes were placed simultaneously on both legs, respecting 10 minutes between individual stimulation. Sensory, motor and pain-tolerance thresholds were assessed in quantitative (current density in mA/cm²) and qualitative (VAS) terms. Results: Subjects were 19 volunteers, aged 22.31 (1.29), with a BMI of 21.79 (1.78). The Aussie current reached the sensory threshold with significantly lower current density when compared with the Russian current for the same threshold. The results were significant in the overall group (treatment) for the two currents studied in terms of current density needed to reach the three thresholds. However, in the blocks (individually), there was significance only for the sensory threshold (p = 0.0126). Analysis of the perception of discomfort, assessed by VAS, was significant at the three time points for both currents, but in the comparison between these there was no significant difference. Conclusion: The Russian and Aussie currents are adequate in terms of the current density required to reach each threshold studied, and present differences between one another during interaction with the biological system, with the Aussie current necessitating less energy. However, in terms of perception of discomfort there are no significant differences between the two currents. Level of evidence III; Therapeutic studies - Investigating the results of treatment.

RESUMO Objetivos: Analisar qualitativa e quantitativamente a interação das correntes Russa e Aussie na contração isométrica do músculo quadríceps femoral, nos no âmbito sensitivo, motor e de desconforto em mulheres jovens saudáveis. Métodos: As voluntárias foram analisadas em um único momento. Sorteou-se qual membro inferior receberia cada corrente e os eletrodos foram posicionados simultaneamente nos dois membros inferiores, respeitando-se 10 minutos entre a estimulação de cada um. Foram avaliados os limiares sensitivo, motor e de desconforto em termos quantitativos (densidade de corrente em mA/cm²) e qualitativos (EVA). Resultados: Participaram 19 voluntárias, na faixa etária de 22,31 (1,29) e IMC de 21,79 (1,78). A corrente Aussie alcançou o limiar sensitivo com menor densidade de corrente de forma significativa com relação à Russa para o mesmo limiar. Os resultados foram significativos no grupo geral (tratamento) para as duas correntes estudadas quanto à densidade de corrente necessária para atingir os três limiares. Já nos blocos (individualmente), houve significância apenas para o limiar sensitivo (p=0,0126). A análise da percepção de desconforto, avaliada através da EVA, foi significativa nos três momentos para ambas as correntes, mas na comparação entre elas não houve diferença significativa. Conclusão: As correntes Russa e Aussie são adequadas quanto à densidade de corrente necessária para atingir cada limiar estudado e apresentam diferenças entre si durante a interação com o sistema biológico, necessitando a Aussie de menos energia. No entanto, em termos de percepção de desconforto não há diferenças significativas entre as duas correntes. Nível de evidência III; Estudos terapêuticos-Investigação dos resultados do tratamento.

RESUMEN Objetivos: Analizar cualitativa y cuantitativamente la interacción de las corrientes Rusa y Aussie, en la contracción isométrica del músculo cuádriceps femoral, en el ámbito sensitivo, motor y de incomodidad en mujeres jóvenes sanas. Métodos: Las voluntarias se analizaron en un solo momento. Se sorteó cuál miembro inferior recibiría cada corriente y los electrodos fueron colocados simultáneamente en los dos miembros inferiores, respetándose 10 minutos entre la estimulación de cada uno. Se evaluaron los umbrales sensitivo, motor y de incomodidad en términos cuantitativos (densidad de corriente en mA/cm²) y cualitativos (EVA). Resultados: Participaron 19 voluntarias, en el grupo de edad de 22,31 (1,29) e IMC de 21,79 (1,78). La corriente Aussie alcanzó el umbral sensitivo con menor densidad de corriente de forma significativa con respecto a la rusa para el mismo umbral. Los resultados fueron significativos en el grupo general (tratamiento) para las dos corrientes estudiadas en cuanto a la densidad de corriente necesaria para alcanzar los tres umbrales. En los bloques (individualmente), hubo significancia sólo para el umbral sensitivo (p = 0,0126). El análisis de la percepción de incomodidad, evaluada a través de la EVA, fue significativo en los tres momentos para ambas corrientes, pero en la comparación entre ellas no hubo diferencia significativa. Conclusión: Las corrientes Rusa y Aussie son adecuadas en cuanto a la densidad de corriente necesaria para alcanzar cada umbral estudiado y presentan diferencias entre sí durante la interacción con el sistema biológico, necesitando la Aussie de menos energía. Sin embargo, en términos de percepción de incomodidad no hay diferencias significativas entre las dos corrientes. Nivel de evidencia III; Estudios terapéuticos-Investigación de los resultados del tratamiento.

Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2)

RESUMEN Se presenta la segunda parte de las recomendaciones latinoamericanas para el manejo de la Hipertensión Arterial (HTA) en adultos. En una primera fase se han descripto los aspectos más relevantes de la epidemiología, aspectos fisiopatológicos, cómo hacer diagnóstico, pautas terapéuticas, urgencias y emergencias hipertensivas, poblaciones especiales, hipertensión refractaria y la aplicación de las guías en la vida real. En esta segunda parte, se emiten recomendaciones respondiendo a preguntas específicas para prevención primaria, secundaria, terciaria y cuaternaria. En general pocas recomendaciones al respecto del manejo de la hipertensión arterial surgen desde la clínica médica/ medicina interna, a pesar de dos situaciones: la mayoría de los pacientes con hipertensión arterial son evaluados y manejados por los clínicos, y la clínica médica es la especialidad que permite la mirada holística e integrada de los problemas de salud del adulto, permitiendo agregar el enfoque biográfico al biológico, comprender e interpretar no solo el problema de salud sino sus causas y consecuencias (que muchas veces suelen corresponder a diferentes parénquimas, lo cual en el modelo fragmentado haría transitar al paciente por distintas especialidades). El bajo porcentaje de pacientes hipertensos controlados obliga a todos los profesionales involucrados en el manejo de los mismos a optimizar recursos y detectar problemas que se asocien a un control deficitario como la sub utilización del tratamiento farmacológico, baja tasa de pacientes tratados con estrategia combinada (la mayoría de los pacientes actualmente recibe monoterapia), falta de prescripción adecuada de los cambios en el estilo de vida, baja adherencia terapéutica e inercia clínica. En la presente publicación se presentan recomendaciones efectuadas por especialistas en clínica médica / medicina interna para el manejo de la hipertensión arterial en adultos, respondiendo preguntas de prevención primaria, secundaria, terciaria, y cuaternaria.

ABSTRACT The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

Funcionalidade e qualidade de vida em indivíduos com linfedema unilateral em membro inferior: um estudo transversal / Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study

O linfedema de membros inferiores é uma doença crônica decorrente de dano no sistema linfático que influencia a mobilidade, a funcionalidade e a qualidade de vida dos indivíduos. Questionários e o teste físico são métodos bastante práticos, de fácil aplicação e baixo custo, que fornecem dados importantes para a avaliação desses pacientes. Objetivos Avaliar a influência do linfedema unilateral de membro inferior na funcionalidade e na qualidade de vida, correlacionando três ferramentas de avaliação. Métodos Estudo descritivo com 25 indivíduos com linfedema unilateral em membro inferior, de ambos os sexos. Foi avaliada a perimetria e foram aplicados The Medical Outcome Study Short Form-36 Health Survey (SF-36) para avaliação da qualidade de vida, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) para estudo das habilidades físicas, mentais e sociais relacionadas ao linfedema e o Timed Up and Go (TUG) para avaliação da funcionalidade. Resultados Houve a presença de linfedema em todo o membro inferior dos participantes. Os domínios mais prejudicados pelo linfedema foram os aspectos físicos (25,0 ± 31,4) e emocionais (36,0 ± 42,9) no SF-36 e o domínio mobilidade (6,0 ± 2,6) no Lymph-ICF-LL. O TUG foi realizado em 9,88 ± 1,98 s. Houve correlação entre o TUG e os questionários e entre os dois questionários utilizados. Conclusões Indivíduos com linfedema unilateral em membro inferior apresentam um impacto negativo na qualidade de vida e na funcionalidade avaliadas através de questionários, que correlacionam entre si. Não foi encontrada alteração no TUG, mas houve correlação entre ele e os questionários utilizados

Lymphedema of the lower limbs is a chronic disease caused by damage to the lymphatic system that influences people's mobility, functionality, and quality of life. Questionnaires and physical test are very practical, easy to apply, and low cost methods that provide important data for evaluation of these patients. Objectives To evaluate the influence of unilateral lower limb lymphedema on functionality and quality of life, correlating 3 assessment tools. Methods This was a descriptive study investigating 25 patients of both sexes with unilateral lymphedema in a lower limb. Limb volume was assessed using circumferential tape measurements, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) was used to assess quality of life, the Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) was used to assess physical, mental, and social skills related to lymphedema, and the Timed Up and Go (TUG) test was used for functional assessment. Results Lymphedema was present throughout the affected lower limb of participants. The domains most affected by lymphedema were physical aspects (25.0 ± 31.4) and emotional aspects (36.0 ± 42.9) from the SF-36 and the mobility domain (6.0 ± 2.6) from the Lymph -ICF-LL. Patients performed the TUG in 9.88 ± 1.98 seconds. The TUG was correlated with the questionnaires and the questionnaires were correlated with each other. Conclusions People with unilateral lower limb lymphedema exhibited negative impacts on quality of life and functionality, as evaluated by questionnaires, which were correlated with each other. TUG performance was within normal limits, but results correlated with the questionnaires used

Ação das ondas curtas pulsada na dor aguda induzida pela hipotermia: um estudo piloto / Action of pulsed short wave on the acute pain induced by cold induced pain test: a pilot study

A terapia por campo eletromagnético é bastante utilizada pela fisioterapia no tratamento adjuvante dos sintomas álgicos associados às desordens articulares degenerativas e musculoesqueléticas. Esse estudo teve como objetivo avaliar a ação das ondas curtas pulsada de 100Hz e intensidade de campo elétrico de 25V/m, na latência do limiar de dor e na intensidade da dor em adultos saudáveis. Vinte e quatro voluntários foram recrutados e alocados em dois grupos experimentais, o grupo intervenção (GI), com 12 voluntários de média de idade 22±2,65 anos e o índice de massa corporal (IMC) de 23,72 ±3,07 e o grupo placebo (GP), também com 12 voluntários com 22,08±2,71 anos e IMC de 23,66 ±3,36. Os grupos foram submetidos a 3 ciclos com estimulação álgica através da hipotermia. No ciclo de intervenção o grupo GI contou com a aplicação da OCP (Ondas Curtas Pulsadas) na face anterior e posterior do antebraço ipsilateral submetido à hipotermia por 20 minutos, enquanto que no GP o aparelho foi ligado, mas sem emissão. Na análise intragrupo, a latência do limiar de dor obteve um aumento significativo nos momentos durante e após a intervenção em relação ao momento de pré-intervenção no GI, enquanto que no GP o momento durante a pós-intervenção foi significativamente maior que no pré- intervenção. Quando comparados, o GI apresentou uma latência significativamente maior durante o momento de intervenção e a pós-intervenção em relação aos mesmos momentos no GP. A intensidade dolorosa não apresentou resultados significativos em nenhum dos grupos. Observou-se que as ondas curtas no modo pulsada promove o aumento na latência do limiar doloroso durante a sua aplicação em processos agudos....(AU)

The electromagnetic field therapy is frequently used by physical therapy in the adjuvant treatment of pain symptoms associated with degenerative joint and musculoskeletal disorders. This study aimed to evaluate the effects of pulsed short-wave with 100Hz and intensity of the electric field 25V/m in latency threshold of pain and pain intensity in healthy adults. Twenty-four volunteers were recruited and divided into two experimental groups, the intervention group (GI), with average age of 12 volunteers 22 ± 2.65 years and body mass index (BMI) of 23.72 ± 3.07 and the placebo group (GP), also with 12 volunteers, with 22.08 ± 2.71 years and 23.66 ± 3.36 BMI. The groups were submitted to cycles with cold induced pain, in the intervention cycle the group GI included the application of OCP in the front and back of the ipsilateral forearm subjected to cold induced pain for 20 minutes while in the GP unit remained off. In the intra-group analysis, the latency pain threshold achieved a significant increase in the time during and after the intervention relative to the time of pre-intervention in GI, while in the GP time postintervention was significantly higher than the pre-intervention. When compared, the GI has a significantly higher latency during the intervention and post-intervention compared to the same time in the GP. Pain intensity did not show significant results. It was observed that the pulsed short wave promotes an increase in pain threshold during its application in acute processes....(AU)

Obesidad en la tercera edad / Obesity in the elderly

Los adultos mayores (AM) no están exentos de padecer sobrepeso u obesidad, alcanzando en el Perú porcentajes de 21,4% y 11,9% respectivamente, menor que en gente de menor edad. El sobrepeso y laobesidad están peligrosamente asociadas a otras enfermedades crónicas no transmisibles, por lo que el riesgo de morbimortalidad se incrementa. Si bien no existen datos confiables sobre el índice de masa corporal óptimo en el AM, la seguimos utilizando como guía tanto como la medición de la cintura abdominal. Se debería hacer todos los esfuerzos por prevenir este problema antes de que se llegue a la tercera edad. Su manejo debe ser lento y seguro, principalmente con intervenciones de tipo conductual (nutrición y actividad física adecuadas) y utilizando fármacos con mucho cuidado y solo si es indispensable.

Older people are not exempt of being overweight or obese; in Peru this occurs respectively in 21.4% and 11.9% of the elderly, less than in people of younger age. Overweight and obesity are associated to noncommunicable chronic diseases, and to increase in morbidity and mortality. There is no trustworthy data on the optimum body-mass index in the elderly, but we use both the body-mass index and measurement of the abdominal circumference. Best efforts should be done to prevent this problem before subjects become seniors. Management should be gradual and safe, consisting mainly in behavioral interventions (adequate nutrition and physical activities) and drugs only when necessary.

[Strategies to optimize pharmacological management in older adults]. / Estrategias para optimizar el manejo farmacológico en el adulto mayor.

Population aging increases the prevalence of chronic and multiple morbid illnesses and increases the consumption of multiple medications and related problems accordingly. It is reported that >50% of dispensed medications are consumed by older adults; in fact, >80% of older adults take at least one medication daily and 75% do not inform their doctor that they are using unconventional treatments. Appropriate medication prescription to older adults is challenging and it requires the consideration of risks and benefits of the indicated medications, for which clear evidence of their efficacy is often lacking due to the limited inclusion of elderly populations in randomized clinical trials on which clinical guides are based for chronic disease management. However, general guidelines and recommendations must be comprehensively implemented and supported by a multidisciplinary team whenever pharmacological management is provided for older adults. Here we focus on promoting proper prescriptions according to evidence-based recommendations to reduce inappropriate prescriptions, polypharmacy, and self-medication.

Estrategias para optimizar el manejo farmacológico en el adulto mayor / Strategies to optimize pharmacological management in older adults

RESUMEN El envejecimiento de la población tiene como consecuencia incrementos en la prevalencia de enfermedades crónicas y de multimorbilidad, en el consumo de múltiples fármacos y los problemas relacionados con los mismos. Se reporta que más del 50% de todos los medicamentos expendidos son consumidos por adultos mayores; más del 80% de las personas adultas mayores toman al menos una medicación diaria y 75% no informa a su médico que usa tratamientos no convencionales. Prescribir de forma apropiada en el adulto mayor es un trabajo difícil que requiere considerar un balance entre los riesgos y beneficios de las medicinas indicadas, las cuales suelen no tener una evidencia clara de su eficacia, dada la poca representatividad de la población adulta mayor en los ensayos clínicos randomizados sobre los cuales se basan las guías clínicas para el manejo de las enfermedades crónicas, condiciones altamente prevalentes en la población adulta mayor. Sin embargo, existen directrices y recomendaciones generales que deben de aplicarse de forma integral, apoyados por un equipo multidisciplinario, toda vez que se realice un manejo farmacológico en el adulto mayor. En este artículo, nos enfocamos en promover la prescripción adecuada sobre la base de recomendaciones basadas en evidencia para disminuir la medicación inapropiada, la polifarmacia y la automedicación.

ABSTRACT Population aging increases the prevalence of chronic and multiple morbid illnesses and increases the consumption of multiple medications and related problems accordingly. It is reported that >50% of dispensed medications are consumed by older adults; in fact, >80% of older adults take at least one medication daily and 75% do not inform their doctor that they are using unconventional treatments. Appropriate medication prescription to older adults is challenging and it requires the consideration of risks and benefits of the indicated medications, for which clear evidence of their efficacy is often lacking due to the limited inclusion of elderly populations in randomized clinical trials on which clinical guides are based for chronic disease management. However, general guidelines and recommendations must be comprehensively implemented and supported by a multidisciplinary team whenever pharmacological management is provided for older adults. Here we focus on promoting proper prescriptions according to evidence-based recommendations to reduce inappropriate prescriptions, polypharmacy, and self-medication.

Effect of low frequency transcutaneous electrical nerve stimulation of TE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain.

[Purpose] This study assesse the effect of low frequency transcutaneous electrical nerve stimulation (TENS) of theTE5 (waiguan) and PC6 (neiguan) acupoints on cold-induced pain. [Subjects and Methods] Forty-eight subjects were divided by convenience into three groups: TENS with electrodes of 1 cm(2) area, TENS with electrodes of area 15 cm(2) and a placebo group. The study consisted of three phases: cold-induced pain without electroanalgesia, cold-induced pain with electroanalgesia or placebo, and cold-induced pain post-electroanalgesia or placebo. [Results] Acupuncture like TENS increased the pain threshold latency during treatment (45.7 ± 11.7s) compared to pre-treatment (30.9 ± 8.9s) in the TENS group with 1 cm(2) electrodes. In the TENS group with 15 cm(2) electrodes, the pain threshold latency increased at post-treatment (36.2 ± 12.9s) compared to pre-treatment (25.5 ± 7.4s). The placebo group showed no significant changes. The group with 1 cm(2) electrodes showed a significantly higher pain threshold latency (45.7 ± 11.7s) than the other two groups. At post-treatment, the pain threshold latencies of both the 1 cm(2) (39.4 ± 11.5s) and 15 cm(2) (36.2 ± 12.9s) TENS group were higher than that of the placebo group (22.4 ± 7.4s). [Conclusion] Acupuncture like TENS applied to PC6 and TE5 acupoints increased the pain threshold latency. The pain intensity was reduced by TENS with an electrode area of 1 cm(2).

Isomeric signatures in the fragmentation of pyridazine and pyrimidine induced by fast ion impact.

We present fast proton impact induced fragmentations of pyrimidine and pyridazine as an experimental resource to investigate isomeric signatures. Major isomeric imprints are identified for few fragment ions and differences of more than an order of magnitude for the cross sections of fragments of the same mass were measured. The observation of the molecular structure of these isomers gives no apparent indication for the reasons for such substantial differences. It is verified that the simple displacement of the position of one nitrogen atom strongly inhibits or favors the production of some ionic fragment species. The dependency of the fragmentation cross sections on the proton impact energy, investigated by means of time of flight mass spectroscopy and of a model calculation based in first order perturbation theory, allows us to disentangle the complex collision dynamics of the ionic fragments. The proton-induced fragmentation discriminates rather directly the association between a molecular orbital ionization and the fragment-ions creation and abundance, as well as how the redistribution of the energy imparted to the molecules takes place, triggering not only single but also double vacancy and leads to specific fragmentation pathways.

Fragilidad y sarcopenia en adultos mayores / Fragility and sarcopenia in older adults

En las últimas décadas se está presentando un incremento de la población adulta mayor en todo el mundo y sobre todo en los países latinoamericanos, los cuales no están preparados para enfrentar a este aumento poblacional, ya que este grupo presenta problemas frecuentes de incapacidad funcional para la realización de las actividades de la vida diaria y muchas veces presentando problemas de morbimortalidad incrementada. No debemos olvidar, que la capacidad de vivir independientemente es crucial para la calidad de vida en todas las edades y este estado de independencia a su vez, depende del buen estado físico y mental, así como del psicológico y de las condiciones socio-económicas de la persona...(AU)

In recent decades there has been an increase in the older adult population throughout the world and especially in Latin American countries, which are not prepared to face this population increase, since this group presents frequent problems of functional disability for carrying out activities of daily living and often presenting problems of increased morbidity and mortality. We must not forget that the ability to live independently is crucial for the quality of life in all ages and this state of independence, in turn, depends on the good physical and mental state, as well as the psychological and socio-economic conditions of the person ... (AU)

The effects of different TENS frequencies applied to LU7 acupoint on cold-induced pain test / Ação de variadas frequências de TENS aplicadas no acuponto P7 na dor induzida pela hipotermia

Introduction Pain represents a frequent phenomenon among the general population with great socio-economic impact. TENS is one of the most common forms of electroanalgesia. However, totally effective stimulation parameters remain uncertain. Thus, this study aims to assess the effects of 4 Hz, 10 Hz and 100 Hz TENS applied to the LU7 (Lieque) acupoint on cold-induced pain in young healthy subjects. Methods 100 volunteers, divided into five groups (three TENS groups, one electrode group and one placebo group), completed six experimental cycles. Each cycle comprised three phases: pretreatment, treatment and post-treatment. In each cycle, pain was induced by immersion of the hand into ice water and the pain threshold latency was measured. For the analysis of results, we used the one-way ANOVA test, followed by the Student-Newman-Keuls post hoc test. The level of significance was p < 0.05. Results The 4 Hz TENS group the pain showed elevation of the pain threshold during the treatment phase, when compared to pretreatment (p < 0.05). This elevation was maintained in the post-treatment phase. The other groups showed no changes in the pain threshold. Conclusion 4 Hz TENS applied with 1x1 cm electrodes to LU7 acupoint increases hypothermia-induced pain threshold latency in young healthy subjects.

Introdução A dor é um fenômeno frequente na população e pode gerar grande impacto socioeconômico. A TENS é um dos meios mais comuns de eletroanalgesia, mas parâmetros de estimulação totalmente eficazes permanecem incertos. Neste cenário, o presente estudo objetiva verificar a influência da TENS de 4, 10 e 100 Hz na dor induzida pela hipotermia quando aplicada no acuponto P7 (Lieque) em sujeitos jovens saudáveis. Metodologia Cem voluntários distribuídos em cinco grupos (três TENS, um apenas com Eletrodo e um Placebo) passaram por seis ciclos experimentais divididos em três etapas (Pré-tratamento, Tratamento e Pós-tratamento), em cada ciclo houve indução de dor pela imersão da mão do sujeito em água gelada, onde foi medida a variável da latência do limiar da dor. Utilizou-se o Teste de ANOVA de um critério seguido do Teste post hoc de Student-Newman-Keuls para análise dos resultados. O nível de significância adotado foi p < 0,05. Resultados O grupo TENS de 4 Hz obteve aumento do limiar de dor durante o tratamento quando comparado com o pré-tratamento (p < 0,05) e no pós-tratamento este aumento foi mantido. Os outros grupos não apresentaram alterações na latência do limiar da dor. Conclusão A TENS de 4 Hz aplicada com eletrodos de 1 cm2 no acuponto P7 aumenta a latência do limiar de dor induzida pela hipotermia em sujeitos jovens saudáveis.

Absolute total and partial dissociative cross sections of pyrimidine at electron and proton intermediate impact velocities.

Absolute total non-dissociative and partial dissociative cross sections of pyrimidine were measured for electron impact energies ranging from 70 to 400 eV and for proton impact energies from 125 up to 2500 keV. MOs ionization induced by coulomb interaction were studied by measuring both ionization and partial dissociative cross sections through time of flight mass spectrometry and by obtaining the branching ratios for fragment formation via a model calculation based on the Born approximation. The partial yields and the absolute cross sections measured as a function of the energy combined with the model calculation proved to be a useful tool to determine the vacancy population of the valence MOs from which several sets of fragment ions are produced. It was also a key point to distinguish the dissociation regimes induced by both particles. A comparison with previous experimental results is also presented.

Efeito da eletroestimulação no músculo desnervado de animais: revisão sistemática / The effect of electrical stimulation on animals denervated muscle: a systematic review

INTRODUÇÃO: A recuperação funcional após a lesão nervosa periférica está relacionada a fatores intrínsecos e extrínsecos ao sistema nervoso periférico, tais como a gravidade da lesão e a condição dos órgãos-alvo. A atrofia constitui uma das principais alterações do músculo após a lesão nervosa e, uma vez instalada, atua como barreira ao crescimento axonal durante a reinervação muscular. O uso da eletroestimulação é rotineiro no campo da fisioterapia e tem o objetivo de minimizar ou impedir a atrofia muscular e, assim, favorecer a recuperação da lesão nervosa periférica. OBJETIVO: Avaliar os efeitos da eletroestimulação sobre as características tróficas do músculo desnervado. MÉTODOS: Artigos publicados entre 1990 e 2010 e indexados aos bancos de dados da PUBMED foram selecionados utilizando os seguintes descritores: "muscle denervation AND electric stimulation" e "muscular atrophy AND electric stimulation". Foram considerados como critério de inclusão os estudos experimentais em animais (ratos) que utilizassem a lesão nervosa periférica como modelo de desnervação e que avaliassem o efeito da eletroestimulação muscular sobre a área de secção transversa e/ou a massa muscular de músculos desnervados. RESULTADOS: Nove artigos foram selecionados para a revisão. CONCLUSÕES: O efeito da eletroestimulação está diretamente relacionado à característica do protocolo de intervenção, que, quando aplicado de maneira adequada, apresenta o efeito de retardar e, em alguns casos, impedir a atrofia do músculo desnervado.

INTRODUCTION: The functional recovery after peripheral nerve injury is related to extrinsic and intrinsic factors of peripheral nervous system, like trauma severity and conditions of the end-organs. The atrophy is a major change of muscles after nerve injury, and once installed, it acts as a barrier to axonal growth during muscle reinnevation. The use of electrical stimulation is routine in the field of physical therapy and aims to minimize or prevent muscle atrophy and facilitate recovery from peripheral nerve injury. OBJECTIVE: The aim of this review is to evaluate the effects of electrical stimulation on tropics characteristics of denervated muscle. METHODS: Articles published between 1990 and 2010 from periodicals indexed in the PUBMED database were selected, using the following keywords: "muscle denervation AND electric stimulation" and "muscular atrophy AND electric stimulation". Were included experimental studies in animals (rats) that had used a peripheral nerve lesion as a model of muscle denervation and that had evaluated the effect of electrical muscle stimulation on cross-sectional area and/or muscle mass weight of denervated muscles. RESULTS: 9 articles were selected for this review. CONCLUSION: The effect of electrical stimulation is directly related to the intervention protocol's characteristics, which when applied properly had the effect of delaying, in some cases, or prevents the atrophy of denervated muscle.