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BACKGROUND: Peripheral nerve injury caused by leprosy can lead to foot drop, resulting in an altered gait pattern that has not been previously described using 3D gait analysis. METHODS: Gait kinematics and dynamics were analyzed in 12 patients with unilateral foot drop caused by leprosy and in 15 healthy controls. Biomechanical data from patients' affected and unaffected limbs were compared with controls using inferential statistics and a standard distance, based on principal components analysis (PCA). FINDINGS: Patients walked slower than controls (0.8 ± 0.2 vs. 1.1 ± 0.2 m/s, p = 0.003), with a reduced stance and increased swing percentage. The affected limb increased (p < 0.05) plantar flexion at the initial contact (-16.8o ± 8.3), terminal stance (-29.1o ± 11.5), and swing (-12.4o ± 6.2) in the affected limb compared to unaffected (-6.6o ± 10.3; -14.6o ± 11.6; 2.4o ± 7.6) and controls (-5.4o ± 2.5; -18.8o ± 5.8; -1.4o ± 3.9). Increased pelvic tilt and knee adduction/abduction range, with lower hip adduction, were observed. The second peak of ground reaction force (98.6 ± 5.2 %BW), ankle torque (0.99 ± 0.33 Nm/kg), and net ankle work in stance (-0.03 ± 5.4 J/Kg) decreased in the affected limb compared to controls (104.1 ± 5.5 %BW; 1.24 ± 0.4 Nm/kg; -4.58 ± 5.19 J/kg; p < 0.05). There were decreasing multivariate standard distances in the affected limb compared with the unaffected and controls. PCA loading factors highlighted the major differences between groups. INTERPRETATION: Leprosy patients with foot drop presented altered gait patterns in affected and unaffected limbs. There were remarkable differences in ankle kinematics and dynamics. Rehabilitation devices, such as ankle foot orthosis or tendon transfer surgeries to increase ankle dorsiflexion, could benefit these patients and reduce deviations from normal gait.
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Órtoses do Pé , Neuropatias Fibulares , Humanos , Análise da Marcha , Análise de Componente Principal , Marcha/fisiologia , Caminhada/fisiologia , Debilidade Muscular , Articulação do Tornozelo , Fenômenos BiomecânicosRESUMO
Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = -0.83) and AOFAS and social participation (r = -0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.
Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.
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ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.
RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.
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Objective To determine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other forefoot structures. Methods Anteroposterior radiographs of 80 patients (94 feet, all weight-bearing), from the period between 2015 and 2016, were evaluated. Forty-eight had a valgus hallux angle greater than 15° (hallux valgus group) and 46 presented a hallux valgus angle lower than 15° (control group). The distances from the first metatarsus head and the lateral sesamoid bone to the second metatarsus axis were measured. Subsequently, the coefficients of these distances were determined by the length of the second metatarsus to adjust it for different foot sizes. Results Both the absolute and the relative measures from the first metatarsus head to the second metatarsus axis were significantly different between the groups, with a positive correlation with hallux valgus and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid bone to the second metatarsus was different between the groups, as they did not correlate with hallux valgus or intermetatarsal angles. Conclusion Despite the medial deviation of the first metatarsus in hallux valgus, the sesamoid bone maintains its relationship with the second metatarsus in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre-, intra-, and postoperative period of patients with hallux valgus.
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Introduction Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery ( n = 3; 25%), external carotid artery ( n = 1; 7%) or one of their branches ( n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months.
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Abstract Objective To determine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other forefoot structures. Methods Anteroposterior radiographs of 80 patients (94 feet, all weight-bearing), from the period between 2015 and 2016, were evaluated. Forty-eight had a valgus hallux angle greater than 15° (hallux valgus group) and 46 presented a hallux valgus angle lower than 15° (control group). The distances from the firstmetatarsus head and the lateral sesamoid bone to the secondmetatarsus axis weremeasured. Subsequently, the coefficients of these distances were determined by the length of the second metatarsus to adjust it for different foot sizes. Results Both the absolute and the relativemeasures from the firstmetatarsus head to the second metatarsus axis were significantly different between the groups, with a positive correlationwith hallux valgus and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid bone to the second metatarsus was different between the groups, as they did not correlate with hallux valgus or intermetatarsal angles. Conclusion Despite the medial deviation of the first metatarsus in hallux valgus, the sesamoid bone maintains its relationship with the second metatarsus in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre-, intra-, and postoperative period of patients with hallux valgus.
Resumo Objetivo Determinar se os sesamoides migramlateralmente nos pés comhálux valgo ou se apenas aparentam deslocar-se, mantendo sua relação com as demais estruturas do antepé. Métodos Foram avaliadas radiografias na incidência anteroposterior com carga dos pés de 80 pacientes (94 pés) entre o período de 2015 e 2016. Dessas, 48 tinham ângulo de hálux valgo maior do que 15º (grupo hálux valgo) e 46 tinham ângulo de hálux valgo menor do que 15º (grupo controle). Foram medidas as distâncias da cabeça do primeiro metatarso e do sesamoide lateral ao eixo do segundo metatarso. Posteriormente, forammedidos os coeficientes dessas distâncias pelo comprimento do segundo metatarso, a fim de se ajustarem aos diferentes tamanhos de pés. Resultados Tanto a medida absoluta quanto a medida relativa da cabeça do primeiro metatarso ao segundo metatarso foram significativamente diferentes nos dois grupos, tiveram correlação positiva com os ângulos de hálux valgo e intermetatarsal. Contudo, nem a distância absoluta nem a relativa do sesamoide lateral ao segundo metatarso foram diferentes nos dois grupos, bem como não se correlacionaram com os ângulos de hálux valgo e inter-metatarsal. Conclusão Apesar do desvio medial do primeiro metatarso no hálux valgo, o sesamoide mantém sua relação com o segundo metatarso no plano transverso. Esse aparente deslocamento lateral pode levar a interpretação equivocada dessas radiografias. Tal fato é de suma importância no pré-, peri- e pós-operatório dos pacientes com hálux valgo.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Ossos do Metatarso , Hallux Valgus , RadiografiaRESUMO
Introduction: Acute carotid blowout syndrome (aCBS) is a severe complication of head and neck cancer (HNC). It can be defined as a rupture of the extracranial carotid arteries, or one of their branches, that causes life-threatening hemorrhage, and which nowadays can be treated with urgent endovascular intervention. Objective: We retrospectively evaluate the endovascular management of aCBS and its outcome in years of survival. Methods: Retrospectively, we describe our experience with endovascular control of aCBS in patients treated for HNC. We review the characteristics, pathology, endovascular treatment and morbidity and assess the gain in life years. Results: Nine individuals were included in this study. Four patients had been previously diagnosed with laryngeal squamous cell carcinoma (SCC), one with paranasal SCC, one with nasopharyngeal carcinoma and three with oral or maxillary adenocarcinoma. All subjects underwent radiotherapy and surgical excision to different extents. Twelve endovascular procedures were performed for injuries to the internal carotid artery (n = 3; 25%), external carotid artery (n = 1; 7%) or one of their branches (n = 8; 67%). Deconstructive methods were used in nine procedures, and three procedures were mainly reconstructive with deployment of covered stents. Total control of bleeding was achieved in all individuals with no intraprocedural complications. Conclusion: Endovascular therapy is an effective alternative for the management of exsanguinating CBS. In our series, this palliative therapy increased the overall patient survival by an estimated 9 months (AU)
Assuntos
Pessoa de Meia-Idade , Idoso , Lesões das Artérias Carótidas/cirurgia , Procedimentos Endovasculares , Angiografia , Procedimentos de Cirurgia Plástica , Lesões das Artérias Carótidas/etiologia , Oclusão com Balão , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapiaRESUMO
El Centro de Salud Mental Comunitaria "La Casa de Ramos Mejía" se encuentra ubicado en la Localidad de Ramos Mejía, Partido de La Matanza. Funciona de lunes a viernes y cuenta con un equipo interdisciplinario conformado por psicólogos, psiquiatras, trabajadoras sociales, terapistas ocupacionales y un sociólogo. También talleristas y voluntarios que colaboran en actividades educativas, expresivas, comunicacionales, artísticas, deportivas y en espacios de socialización y terapéuticos. Este estudio se propuso identificar y analizar el aporte del taller de radio a la inclusión social de los usuarios, entendiéndola como el acceso a oportunidades para el desarrollo de una mejor calidad de vida y el ejercicio pleno de derechos individuales y sociales. Este trabajo se trata de un estudio de caso cualitativo de tipo exploratorio-descriptivo. Participaron los usuarios que concurren al taller de radio y los trabajadores profesionales y talleristas- del Centro. Las técnicas de recolección de datos utilizadas fueron: la observación participante, la entrevista etnográfica y las notas de campo. El aporte del taller de radio a la inclusión social de los usuarios se da principalmente por medio de su empoderamiento, en tanto sujetos de derechos, en su proceso de subjetivación, a través de la promoción de su autonomía y su independencia. Se busca, por un lado, fortalecer los lazos debilitados y restablecer aquellos quebrados, con sus familiares, referentes afectivos, grupos primarios y/o redes vinculares; y, por otro lado, incrementar sus capacidades para el acceso a información y servicios para el ejercicio efectivo de sus derechos individuales y sociales. Tanto el taller de radio como el programa que ahí se realiza no constituyen un fin en sí mismo, sino que son herramientas y el medio para generar un vínculo con la sociedad, buscando la interpelación y la disputa de sentidos(AU)
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Saúde MentalRESUMO
La accesibilidad a la salud desde la perspectiva de la oferta considera como la situación más deseable de ingreso pleno al sistema de salud, en el otro extremo, están las barreras al acceso: geográficas, económicas, administrativas y culturales. Otra perspectiva, define accesibilidad como el vínculo entre los sujetos y los servicios que se manifiesta en la modalidad que adquiere la utilización de los servicios. Acercarse al concepto de accesibilidad desde la perspectiva de los principales actores implicados busca aportar complejidad al análisis. Para eso, este estudio se propuso analizarla desde la perspectiva de los usuarios y trabajadores del Centro de Salud Mental Comunitaria "La Casa de Ramos Mejía" a través de la identificación y descripción de sus representaciones sociales acerca de la accesibilidad, de la caracterización de las trayectorias en el sistema de salud de los usuarios y de la identificación y descripción de los facilitadores y obstaculizadores del acceso al sistema. Se trató de un estudio de caso cualitativo de tipo exploratorio-descriptivo. Las técnicas de recolección de datos utilizadas fueron; observaciones participantes, entrevistas y notas de campo. Resultó que el sistema de salud puede (y debe) desempeñar una función activa para reducir las inequidades e intervenir directamente sobre las situaciones de vulnerabilidad, prestando especial atención a las percepciones y experiencias de los usuarios y de los trabajadores, ya que estas pueden configurarse como facilitadores u obstaculizadores de la accesibilidad. Como conclusión, este trabajo plantea que la inclusión de los principales interesados (usuarios y trabajadores) en las prácticas de atención resulta algo complejo, pero no hacerlo incrementa las inequidades. Además, un sistema de salud inclusivo y equitativo debe adecuarse a las situaciones, características y recursos de los usuarios y no viceversa
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Saúde Mental , Política de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
We previously showed that Trypanosomacruzi infection in C57BL/6 mice results in a lethal infection linked to unbalanced pro- and anti-inflammatory mediators production. Here, we examined the dynamics of CD4(+)Foxp3(+) regulatory T (Treg) cells within this inflammatory and highly Th1-polarized environment. Treg cells showed a reduced proliferation rate and their frequency is progressively reduced along infection compared to effector T (Teff) cells. Also, a higher fraction of Treg cells showed a naïve phenotype, meanwhile Teff cells were mostly of the effector memory type. T. cruzi infection was associated with the production of pro- and anti-inflammatory cytokines, notably IL-27p28, and with the induction of T-bet and IFN-γ expression in Treg cells. Furthermore, endogenous glucocorticoids released in response to T. cruzi-driven immune activation were crucial to sustain the Treg/Teff cell balance. Notably, IL-2 plus dexamethasone combined treatment before infection was associated with increased Treg cell proliferation and expression of GATA-3, IL-4 and IL-10, and increased mice survival time. Overall, our results indicate that therapies aimed at specifically boosting Treg cells, which during T. cruzi infection are overwhelmed by the effector immune response, represent new opportunities for the treatment of Chagas disease, which is actually only based on parasite-targeted chemotherapy.
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Doença de Chagas/imunologia , Linfócitos T Reguladores/imunologia , Células Th1/imunologia , Trypanosoma cruzi/imunologia , Adrenalectomia , Animais , Cardiomiopatia Chagásica/imunologia , Cardiomiopatia Chagásica/patologia , Doença de Chagas/patologia , Corticosterona/sangue , Dexametasona/farmacologia , Modelos Animais de Doenças , Fator de Transcrição GATA3/efeitos dos fármacos , Fator de Transcrição GATA3/imunologia , Glucocorticoides/farmacologia , Interferon gama/efeitos dos fármacos , Interferon gama/imunologia , Interleucina-10/imunologia , Interleucina-2/farmacologia , Interleucina-4/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Músculo Esquelético/patologia , Miocárdio/patologia , Fenótipo , Linfócitos T Reguladores/efeitos dos fármacos , Células Th1/efeitos dos fármacosRESUMO
Leprosy or Hansen's disease is a chronic infectious disease caused by the Mycobacterium leprae. Nerve injury is a central feature of the pathogenesis of leprosy that results in autonomic, sensory and motor neuropathy. One of the most common secondary disabilities caused by Hansen's disease is the drop foot and it is found in 2% to 5% of newly-diagnosed leprosy patients. Unlike the clinical picture of traumatic injury of the common peroneal nerve where both of its branches (the deep peroneal nerve and the superficial peroneal nerve) are involved, in leprosy there is the possibility of isolated involvement of the deep peroneal nerve branch, sparing the superficial peroneal branch. The article discusses the advantages of using the peroneus longus tendon transfer to the dorsum of the foot instead of the posterior tibial tendon for the correction of dropfoot in selected cases where the peroneals tendons are intact.
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Transtornos Neurológicos da Marcha/cirurgia , Hanseníase/cirurgia , Transferência Tendinosa , Tendões/cirurgia , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hanseníase/complicaçõesRESUMO
OBJECTIVE: To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). METHOD: Fifty-three calcanei from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire was quantified using the additive law of probabilities and the product law for independent events. RESULTS: The injury risk calculation according to the Licht classification showed that the highest risk of injury to the artery or vein was in zone IA (43%), in relation to injuries to nerves and tendons (13% and 0%, respectively). CONCLUSION: This study made it possible to identify the most vulnerable anatomical structures and quantify the risk of injury to the calcaneus.
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OBJETIVO: Determinar as áreas de risco em seis zonas do calcanhar e quantificar os riscos de lesão das estruturas anatômicas (artéria, veia, nervo e tendão). MÉTODO: Foram utilizados 53 calcâneos de cadáveres divididos em três zonas e subdivididas em duas áreas, superior e inferior, por meio de uma linha longitudinal do calcâneo. O risco de lesão das estruturas anatômicas em relação a cada fio de Kirschner foi determinado pelo sistema de graduação segundo a classificação de Licht. A quantificação do risco total de lesão das estruturas anatômicas na colocação de mais de um fio foi calculada pela lei aditiva das probabilidades e pela lei do produto para eventos independentes. RESULTADOS: O cálculo dos riscos de lesão, segundo a classificação de Licht, demonstrou que o risco de lesão da artéria ou veia na zona IA é mais expressivo (43%) em relação às lesões de nervo e tendão (13 e 0%, respectivamente). CONCLUSÃO: O estudo permitiu identificar as estruturas anatômicas mais vulneráveis e quantificar o risco de lesão no calcanhar.
OBJECTIVE: To determine the areas presenting risk in six zones of the calcaneus, and to quantify the risks of injury to the anatomical structures (artery, vein, nerve and tendon). METHOD: Fifty-three calcaneus from cadavers were used, divided into three zones and each subdivided in two areas (upper and lower) by means of a longitudinal line through the calcaneus. The risk of injury to the anatomical structures in relation to each Kirschner wire was determined using a graded system according to the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire was quantified using the additive law of probabilities and the product law for independent events. RESULTS: The injury risk calculation according to the Licht classification showed that the highest risk of injury to the artery or vein was in zone IA (43%), in relation to injuries to nerves and tendons (13% and 0%, respectively). CONCLUSION: This study made it possible to identify the most vulnerable anatomical structures and quantify the risk of injury to the calcaneus.
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Humanos , Pinos Ortopédicos , Calcâneo/lesões , Procedimentos Cirúrgicos Operatórios/métodos , CadáverRESUMO
INTRODUCCIÓN Numerosos estudios coinciden en la necesidad de trabajar sobre los determinantes sociales para generar cambios positivos en la salud mental de la población. OBJETIVOS Indagar si los determinantes sociales son tenidos en cuenta por el Ministerio de Salud de la Provincia de Buenos Aires a la hora de diseñar e implementar políticas públicas de salud mental en el área del conurbano bonaerense. MÉTODOS Se realizó un estudio exploratorio descriptivo, que empleó técnicas cualitativas de investigación social. Se analizaron documentos institucionales (planes, programas y proyectos) de la Dirección de Salud Mental del Ministerio de Salud de la Provincia de Buenos Aires, y se efectuaron entrevistas semiestructuradas a informantes clave y calificados. RESULTADOS El sistema de salud apareció como el determinante social de mayor relevancia, y las conductas y estilos de vida como un determinante accesible para ser abordado. Pudo observarse que la informalidad de las políticas de salud mental precarizan las respuestas del sistema. El estudio mostró que los usuarios eran mayormente personas de bajos recursos, sin cobertura de salud, con un importante incremento de la población joven en los últimos tiempos y con presencia de consumo de drogas. DISCUSIÓN Conclusiones Las políticas públicas de salud mental deben incidir directamente en el sistema de salud y las conductas y estilos de vida de las personas, dado que se trata de los principales determinantes sociales. Sobre ellos es posible accionar de forma eficiente para lograr mejores resultados y mayor impacto en la población.
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Saúde Mental , Pesquisa Qualitativa , Política de SaúdeRESUMO
This randomized, controlled, double-blind clinical study in parallel groups evaluated the safety and efficacy of an oral combination diclofenac-cholestyramine, nucleotides (uridine and cytidine) and vitamin B12 versus the oral combination of nucleotides and vitamin B12 in the treatment of acute, non-traumatic pain. Subjects received twice-daily, 10-day oral administration of diclofenac-cholestyramine + uridine + cytidine + vitamin B12 (Group DN, n=40) or uridine + cytidine + vitamin B12 (Group NB, n=41). The primary study endpoint was the number of subjects with VAS reduction of >30mm after 10 days of treatment. Secondary endpoints included the number of patients with improvement >5 points in the Patient Functionality Questionnaire after 10 days of treatment, and the number of subjects presenting adverse events. Treatment with the combination of diclofenac-cholestyramine, nucleotides and Vitamin B12 resulted in a higher number of subjects with VAS score reductions >30mm after 10 days of treatment (87.5% subjects) than in the control group administered nucleotides and Vitamin B12 (51.23% of subjects), (p>0.0006). A significantly higher number of subjects in the DN group (80%) had a score reduction of >5 points in the Patient Functionality Questionnaire at after 10 days of treatment compared to Group NB (29.3%), (p<0.001). The number of subjects presenting AEs did not vary significantly between treatment groups (p=0.587). The combination of diclofenac-cholestyramine with uridine, cytidine and vitamin B12 was well-tolerated over a 10-day treatment period. The combination reduced pain and improved functionality among subjects presenting acute, non-traumatic pain in the lower back, hips, and neck.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Resina de Colestiramina/administração & dosagem , Monofosfato de Citidina/administração & dosagem , Diclofenaco/administração & dosagem , Hidroxocobalamina/administração & dosagem , Dor/tratamento farmacológico , Uridina Trifosfato/administração & dosagem , Doença Aguda , Adulto , Resina de Colestiramina/efeitos adversos , Monofosfato de Citidina/efeitos adversos , Diclofenaco/efeitos adversos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Hidroxocobalamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Uridina Trifosfato/efeitos adversosRESUMO
The use of a combination of uridine triphosphate (UTP), cytidine monophosphate (CMP), and hydroxocobalamin was evaluated in a double-blind, randomized study in the treatment of neuralgia due to degenerative orthopedic alterations with neural compression. Following informed consent, 80 patients were randomized to a 30 day treatment period. The subjects received a thrice-daily oral treatment regimen of either the combination treatment (Group A: total daily dose of 9mg UTP, 15mg CMP, 6 mg hydroxocobalamin) or vitamin B12 alone (Group B: total daily dose of 6 mg hydroxocobalamin). Efficacy measures evaluated global patient condition from the perspective of the subject and the investigating physician pain ? measured by a visual-analog scale and functionality, using a patient-response questionnaire. The safety evaluation took into account physical evaluations and laboratory tests performed at each visit to the study center as well as the incidence and severity of adverse events. At the end of the 30-day treatment period, there were reductions in the pain scale scores in both groups, however there was a significantly larger reduction in the scores of the Group A patients. The Patient Global Evaluation scores improved in both groups but showed greater improvement in Group A, while the Physician Global Evaluation improved significantly only in Group A. A similar finding was observed in the scores of the Patient Functionality Questionnaire. Based on the findings of this clinical trial, we conclude that the combination of UTP, CMP, and vitamin B12 has a positive effect on pain and functionality improvement in the treatment of degenerative orthopedic alterations with neural compression, in the study population evaluated.
Assuntos
Adulto , Pessoa de Meia-Idade , Citidina/uso terapêutico , Uridina/uso terapêutico , /uso terapêutico , Neuralgia/tratamento farmacológicoRESUMO
A clinical trial evaluating the safety and efficacy of the use of an intramuscular combination of vitamins B1, B6, and B12 in the treatment of the signs and symptoms of trigeminal and plantar neuralgia was performed. Patients were submitted to a 9-day, open-label treatment period with three administrations of the study medication, and underwent a series of clinical and laboratory evaluations prior to the first treatment dose and at each of the three following visits to the study center. The incidence of adverse events and the use of concomitant medications was monitored at each study visit, when efficacy evaluations were also performed, including a 100mm VAS pain assessment and global and satisfaction surveys completed by the patients and investigating physician. Additionally, at the end of the treatment period, the patients were evaluated on their willingness to continue treatment with the study medication.
Assuntos
Humanos , Neuralgia , Músculo Esquelético , Piridoxina , TiaminaRESUMO
We evaluated the safety and efficacy of the use of an oral combination of vitamins B1, B6, and B12 in the treatment of osteoarthritis-related pain and loss of mobility. A 14-day, open-label treatment period was adopted for patients presenting osteoarthritis of the knee or hip. Patients underwent a series of clinical and laboratory evaluations prior to the first treatment dose, following 7 days of treatment, and at the end of the 14-day drug administration period. The incidence of adverse events and use of concomitant medication was also monitored at each study visit. At each study visit, osteoarthritis evaluations were performed, including a 100mm VAS pain assessment, and global and satisfaction surveys completed by both patients and investigating physician. At the conclusion of the study, an additional assessment was performed to evaluate the patient's willingness to continue treatment with the B-vitamin combination.Clinical safety was evaluated by comparing the differences between the pretreatment, mid-study, and end-of-study clinical and laboratory evaluations as well as the incidence and severity of any adverse events. A comparison between the patient and physician assessments at each study visit was used to evaluate efficacy.A total of 54 patients were treated with the study medication. A clinically significant change was observed from pretreatment to end-of-study efficacy evaluations, including those for pain, mobility, and global osteoarthritis condition. The physician's evaluation of global patient condition and treatment satisfaction evaluation also presented a clinically significant change from pretreatment to the final study evaluation. No clinically significant changes in the patients clinical and laboratory evaluations were observed during the study.Based on the results of this clinical study, we conclude that the combination of cyanocobalamin, thiamine mononitrate and pyridoxine chlorihydrate at the concentrations employed is safe and effective in the treatment of the pain and loss of mobility associated with osteoarthritis.
RESUMO
OBJECTIVE: Patients with intracranial atherosclerosis who fail antithrombotic therapy have a poor prognosis. The high rate of recurrent stroke warrants testing alternative treatments such as intracranial angioplasty. METHODS: We present our experience in the treatment of 104 patients (age range, 54-82 years; mean age, 67 years) with symptomatic intracranial atherosclerotic stenoses despite medical therapy who underwent stent-assisted angioplasty. Patient records were retrospectively analysed for location and degree of stenosis, regimen of antiplatelet agents, devices used, procedure-related complications and adverse events. Clinical (Modified Rankin Scale) and radiographic outcomes were obtained 24 hours, 1 month and 3-6 months after treatment. Sixty-five lesions (62.5%) were located in the posterior circulation. Mean stenosis was 75.4%. RESULTS: In all patients, the angiographic degree of stenosis was reduced to less than 30%. One stent was implanted in 66 patients (63%), and two or more in 38 patients (37%). Modified Rankin Scale (mR) was 1-2 in 67.5% of the cases, 3-4 in 25.9%, 5 in 2.8%, 6 in 3.8%. Procedural morbidity was 5.7% and procedural mortality was 3.8%. Angiographic follow-up was available in 58 patients (55.7%) and the restenosis rate was 12.5%. DISCUSSION: In selected patients, endovascular revascularization of intracranial arteries by means of stent-assisted angioplasty is technically feasible, effective and safe.
Assuntos
Arteriosclerose Intracraniana/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Angioplastia com Balão , Angiografia Cerebral , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Stroke studies in animals showed that aortic obstruction increases cerebral blood flow (CBF) and reduces infarct size. In this study we evaluate the safety and efficacy of a device providing partial and transitory aortic obstruction. METHODS: We report the results in 24 selected patients with symptomatic vasospasm by aneurysmal subarachnoid hemorrhage treated by partial and transitory aortic obstruction with a novel device (NeuroFlo, CoAxia, MN). Aneurysms were secured by coils prior to the procedure. We studied the adverse effects related to the aorta-obstructing device, and changes in CBF and neurological outcome. RESULTS: Mean flow velocity increased in both middle cerebral arteries over 15%, and the score in the National Institute of Health Stroke Scale decreased >or=2 point in 20 patients (83%). During the procedure, three patients developed symptoms that were controlled. At 30 days follow-up, three patients had 6 points (unrelated death), three had 3 points, six had 1 point, and 12 had 0 points, in the modified Rankin scale. DISCUSSION: Partial aortic obstruction was safe, the cerebral blood flow increased without inducing significant hypertension and the neurological defects improved in most of the patients. Efficacy with a better level of evidence will be determined by a randomized study.