RESUMO
Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Conclusion: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Assuntos
Eletromiografia , Endometriose , Síndromes da Dor Miofascial , Diafragma da Pelve , Dor Pélvica , Humanos , Feminino , Estudos Transversais , Adulto , Síndromes da Dor Miofascial/fisiopatologia , Diafragma da Pelve/fisiopatologia , Endometriose/complicações , Endometriose/fisiopatologia , Dor Pélvica/fisiopatologia , Dor Pélvica/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/etiologia , Pessoa de Meia-Idade , Adulto Jovem , Pontos-Gatilho/fisiopatologiaRESUMO
6-Cyanodopamine is a novel catecholamine released from rabbit isolated heart. However, it is not known whether this catecholamine presents any biological activity. Here, it was evaluated whether 6-cyanodopamine (6-CYD) is released from rat vas deferens and its effect on this tissue contractility. Basal release of 6-CYD, 6-nitrodopamine (6-ND), 6-bromodopamine, 6-nitrodopa, and 6-nitroadrenaline from vas deferens were quantified by LC-MS/MS. Electric-field stimulation (EFS) and concentration-response curves to noradrenaline, adrenaline, and dopamine of the rat isolated epididymal vas deferens (RIEVD) were performed in the absence and presence of 6-CYD and /or 6-ND. Expression of tyrosine hydroxylase was assessed by immunohistochemistry. The rat isolated vas deferens released significant amounts of both 6-CYD and 6-ND. The voltage-gated sodium channel blocker tetrodotoxin had no effect on the release of 6-CYD, but it virtually abolished 6-ND release. 6-CYD alone exhibited a negligible RIEVD contractile activity; however, at 10 nM, 6-CYD significantly potentiated the noradrenaline- and EFS-induced RIEVD contractions, whereas at 10 and 100 nM, it also significantly potentiated the adrenaline- and dopamine-induced contractions. The potentiation of noradrenaline- and adrenaline-induced contractions by 6-CYD was unaffected by tetrodotoxin. Co-incubation of 6-CYD (100 pM) with 6-ND (10 pM) caused a significant leftward shift and increased the maximal contractile responses to noradrenaline, even in the presence of tetrodotoxin. Immunohistochemistry revealed the presence of tyrosine hydroxylase in both epithelial cell cytoplasm of the mucosae and nerve fibers of RIEVD. The identification of epithelium-derived 6-CYD and its remarkable synergism with catecholamines indicate that epithelial cells may regulate vas deferens smooth muscle contractility.
Assuntos
Dopamina , Contração Muscular , Ducto Deferente , Masculino , Animais , Ducto Deferente/efeitos dos fármacos , Ducto Deferente/metabolismo , Ducto Deferente/fisiologia , Contração Muscular/efeitos dos fármacos , Ratos , Dopamina/metabolismo , Dopamina/farmacologia , Ratos Wistar , Norepinefrina/farmacologia , Norepinefrina/metabolismo , Músculo Liso/efeitos dos fármacos , Músculo Liso/metabolismo , Músculo Liso/fisiologia , Estimulação Elétrica , Epinefrina/farmacologia , Tirosina 3-Mono-Oxigenase/metabolismoRESUMO
Abstract Objective: To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Methods: Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. Results: There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Conclusion: Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.
Assuntos
Humanos , Feminino , Orgasmo , Dor Pélvica , Diafragma da Pelve , Endometriose , Pontos-Gatilho , Tono Muscular , Síndromes da Dor MiofascialRESUMO
In squamate reptiles, extensive innervation of the heart and vascular beds allows for continuous modulation of the cardiovascular system by the autonomic nervous system. The systemic vasculature is the main target of excitatory sympathetic adrenergic fibers, while the pulmonary circulation has been described as less responsive to both nervous and humoral modulators. However, histochemical evidence has demonstrated the presence of adrenergic fibers in pulmonary circulation. Besides, reduced responsiveness is intriguing since the balance of regulation between systemic and pulmonary vascular circuits has critical hemodynamic implications in animals with an undivided ventricle and consequent cardiovascular shunts. The present study investigated the role and functional relevance of α and ß-adrenergic stimulation in regulating systemic and mainly the pulmonary circulations in a decerebrate, autonomically responsive rattlesnake preparation. The use of the decerebrate preparation allowed us to observe a new diverse functional modulation of vascular beds and the heart. In resting snakes, the pulmonary vasculature is less reactive to adrenergic agonists at 25 °C. However, the ß-adrenergic tone is relevant for modulating resting peripheral pulmonary conductance, while both α- and ß-adrenergic tones are relevant for the systemic circuit. Active dynamic modulation of both pulmonary compliance and conductance effectively counterbalances alterations in the systemic circulation to maintain the R-L shunt pattern. Furthermore, we suggest that despite the great attention given to cardiac adjustments, vascular modulation is sufficient to support the hemodynamic adjustments needed to control blood pressure.
Assuntos
Adrenérgicos , Crotalus , Animais , Adrenérgicos/farmacologia , Ventrículos do Coração , América do SulRESUMO
Cardiac rhythm disorders are diagnosed through electrocardiography, which is an important tool to investigate other systemic conditions that may be related to the cardiac conduction system. Cardiac regulation is controlled by the autonomic nervous system, and in dogs, it is mainly modulated by a parasympathetic action exerted by the vagus nerve, called vagal tone. Increased vagal tone can occur physiologically or pathologically, leading to the occurrence of bradyarrhythmias. However, some studies report that airway diseases can exacerbate this tone, together with the reduction of sympathetic pathway activities. This study aimed to analyze the cardiac rhythms in dogs presenting with electrocardiographic alterations related to respiratory diseases, in connection with the exacerbation of vagal tone. Medical records of animals whose diagnoses involved at least one respiratory condition and who underwent electrocardiographic assessment between March 2017 to March 2021 were compiled. Data obtained were compiled in Microsoft Excel®1 spreadsheets and evaluated using descriptive statistics through the BioEstat®2 software. Pearson's correlation was used for quantitative data. A correlation between autonomic regulation and vagal exacerbation was observed in cases with obstructive airways diseases.(AU)
Os distúrbios do ritmo cardíaco são diagnosticados por meio da eletrocardiografia, que é uma importante ferra-menta para investigar outras condições sistêmicas que podem estar relacionadas ao sistema de condução cardíaco. A regulação cardíaca é controlada pelo sistema nervoso autônomo e, em cães, é modulada principalmente pela ação parassimpática exer-cida pelo nervo vago, denominada tônus vagal. O aumento do tônus vagal pode ocorrer fisiologicamente ou patologicamente, levando à ocorrência de bradiarritmias. No entanto, alguns estudos relatam que as doenças das vias aéreas podem exacerbar esse tônus, juntamente com a redução das atividades das vias simpáticas. Este estudo teve como objetivo analisar os ritmos cardíacos em cães com alterações eletrocardiográficas relacionadas a doenças respiratórias, relacionadas à exacerbação do tônus vagal. Foram compilados os prontuários dos animais cujos diagnósticos envolvessem pelo menos uma condição respiratória e que realizaram avaliação eletrocardiográfica, no período entre março de 2017 a março de 2021. Os dados obtidos foram com-pilados em planilhas do Microsoft Excel®1 e avaliados por meio de estatística descritiva por meio do software BioEstat®2. A correlação de Pearson foi usada para dados quantitativos. Foi observada correlação entre regulação autonômica e exacerbação vagal em casos com doenças obstrutivas das vias aéreas.(AU)
Assuntos
Animais , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Cães/anormalidades , Eletrocardiografia/veterinária , Eletrocardiografia/instrumentação , Frequência CardíacaRESUMO
AbstractUnderstanding the basis of vascular tonus regulation is fundamental to comprehending cardiovascular physiology. In the present study, we used the recently developed decerebrate rattlesnake preparation to investigate the role of nitric oxide (NO) in the control of vascular tonus in a squamate reptile. This preparation allowed multiple concomitant cardiovascular parameters to be monitored, while avoiding the deleterious effect of anesthetic drugs on autonomic modulation. We observed that both systemic and pulmonary circuits were clearly responsive to NO signaling. NO increased vascular conductance in the systemic and pulmonary systems. Vasodilation by NO of the systemic circulation was compensated by cardiovascular alterations involving venous return, cardiac output, and cardiac shunt adjustments. The cardiac shunt seemed to be actively used for hemodynamic adjustments via modulation of the pulmonary artery constriction. N(ω)-nitro-L-arginine methyl ester injection demonstrated that NO contributes to modulating resting vasodilation in the systemic circuit. In contrast, NO-mediated vasodilation did not have an important role in the pulmonary circulation in inactive decerebrated snakes at 25°C. These responses vary importantly from those described for anesthetized snakes.
Assuntos
Sistema Cardiovascular , Crotalus , Animais , Óxido Nítrico , América do Sul , VasodilataçãoRESUMO
ABSTRACT BACKGROUND AND OBJECTIVES: Massage is described as an effective complementary therapy for relieving muscle tension and pain. The aim of this study was to verify the benefits of quick massage on muscle tension and pressure pain tolerance threshold (PPT). METHODS: A randomized clinical study in which 40 professors participated and were randomly divided into control (CG) and experimental (EG) groups. They were assessed for the level of muscle tension in the shoulder and neck regions using the visual analogue scale (VAS). PPT was assessed through algometry at the upper trapezius and sternocleidomastoid muscles and at the following anatomical areas: base of the occipital, scapular spine, thoracic (T6-T7) and lumbar (L4-L5) regions. The EG received a single session of quick massage for 20 minutes on the shoulders, neck and spine. RESULTS: Regarding pain, a significant difference was observed only at the base of the occipital, the EG presented greater tolerance to pressure pain both before and after the intervention when compared to the CG. Regarding muscle tension, after the intervention, there was a reduction in the perception in the EG compared to the CG group. CONCLUSION: Quick massage was efficient to decrease the perception of muscle tension assessed by VAS, however, PPT did not increase after the intervention.
RESUMO JUSTIFICATIVA E OBJETIVOS: A massagem é descrita como terapia complementar efetiva no alívio de dor e tensão muscular. O objetivo deste estudo foi verificar os benefícios da Quick Massage sobre a tensão muscular e o limiar de tolerância de dor à pressão (LTDP). MÉTODOS: Estudo clínico randomizado que incluiu 40 docentes divididos aleatoriamente em grupo controle (GC) e grupo experimental (GE). Eles foram avaliados quanto ao nível de tensão muscular na região dos ombros e pescoço por meio da escala analógica visual (EAV). O LTDP foi avaliado por algometria sobre os músculos trapézio superior e esternocleidomastóideo e nos seguintes pontos anatômicos: base do occipital, espinha da escápula, região torácica (T6-T7) e região lombar (L4-L5). O GE recebeu uma única sessão de Quick Massage por 20 minutos na região dos ombros, pescoço e coluna vertebral. RESULTADOS: Em relação à dor, somente na base do occipital foi verificada diferença significante, o GE apresentou maior tolerância de dor à pressão tanto antes quanto após a intervenção em relação ao GC. Em relação à tensão muscular, após a intervenção, houve redução da percepção no GE em relação ao grupo GC. CONCLUSÃO: A Quick Massage foi eficiente para diminuir a percepção da tensão muscular, contudo, o limiar de tolerância de dor à pressão não aumentou após a intervenção.
RESUMO
ABSTRACT Introduction: Parkinson's disease is a common neurodegenerative disease in middle-aged and older people. Some studies have shown that sports can reduce its impact on physical functions. Objective: Based on the abovementioned research background, this paper explores the effect of moderate physical exercise on muscle tone and body posture of patients with Parkinson's disease. Methods: The article selected 72 Parkinson patients admitted to our hospital's Parkinson's Medical Center from 2019 to 2020. These were divided into a basic drug treatment group and a sports intervention group. The Ashworth score, walking speed, walking cycle, and walking distance of the two groups were recorded. At the same time, we performed statistical data analysis on the two sets of data obtained. Results: Compared with the basic treatment group, the modified Ashworth score of the sports intervention group decreased after treatment (P<0.01). The walking speed of the sports intervention group increased, the walking cycle was shortened, and the distance of repeated steps increased (P<0.01). Conclusion: Appropriate physical exercise can reduce muscle tone in patients with Parkinson's disease. It helps them increase their pace and improve small gait symptoms. Sports can help Parkinson patients adjust their body posture and promote their clinical treatment. Level of evidence II; Therapeutic studies - investigation of treatment results.
RESUMO Introdução: A doença de Parkinson é uma doença neurodegenerativa comum em pessoas de meia idade ou idade avançada. Alguns estudos mostram que o esporte pode reduzir seu impacto nas funções físicas das pessoas. Objetivo: Com base em pesquisas sobre o contexto mencionado acima, este estudo explora o efeito de exercício físico moderado no tônus muscular e postura corporal de pacientes com a doença de Parkinson. Métodos: O artigo selecionou 72 pacientes com Parkinson, internados no Centro Médico de Parkinson em nosso hospital, de 2019 a 2020. Estes foram divididos em dois grupos: um de tratamento medicamentoso básico e outro de intervenção esportiva. O escore Ashworth, velocidade de caminhada, ciclo de caminhada e distância de caminhada dos dois grupos foram registrados. Ao mesmo tempo, fizemos uma análise estatística de dados no conjunto de dados obtidos nos dois grupos. Resultados: Ao compararmos o grupo de intervenção esportiva com o de tratamento básico, o escore Ashworth modificado do primeiro grupo diminuiu após o tratamento (P<0.01). A velocidade de caminhada do grupo de intervenção esportiva aumentou, o ciclo de caminhada foi reduzido e a distância de passos repetidos aumentou (P<0.01). Conclusão: Exercícios físicos adequados podem diminuir o tônus muscular em pacientes com a doença de Parkinson. Auxilia no aumento de passos e melhora os sintomas dos passos curtos. Os esportes podem ajudar os pacientes ajustar sua postura e promover seu tratamento clínico. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.
RESUMEN Introducción: La enfermedad de Parkinson es una enfermedad neurodegenerativa común en personas de mediana edad o edad avanzada. Algunos estudios muestran que el deporte puede reducir su impacto en las funciones físicas de las personas. Objetivo: Con base en investigaciones sobre el contexto mencionado antes, este estudio explora el efecto de ejercicio físico moderado en el tono muscular y postura corporal de pacientes con la enfermedad de Parkinson. Métodos: El artículo seleccionó 72 pacientes con Parkinson, internados en el Centro Médico de Parkinson en nuestro hospital, de 2019 a 2020. Se los dividió en dos grupos: uno de tratamiento medicamentoso básico y otro de intervención deportiva. Se registró la escala Ashworth, velocidad de caminata, ciclo básico de caminata y distancia de caminata de los dos grupos. Al mismo tiempo, hicimos un análisis estadístico de datos en el conjunto de datos obtenidos en los dos grupos. Resultados: Al comparar el grupo de intervención deportiva con el de tratamiento básico, la escala Ashworth modificada del primer grupo disminuyó tras el tratamiento (P<0.01). La velocidad de caminata del grupo de intervención deportiva aumentó, el ciclo de caminata se redujo y la distancia de pasos repetidos disminuyó (P<0.01). Conclusión: Ejercicios físicos adecuados pueden disminuir el tono muscular en pacientes con la enfermedad de Parkinson. Auxilia en el aumento de pasos y mejora los síntomas de los pasos cortos. Los deportes pueden ayudar a los pacientes a ajustar su postura y promover su tratamiento clínico. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.
RESUMO
RESUMEN Introducción: uno de los antisépticos comúnmente empleado en Estomatología desde el pasado siglo y que mantiene su uso hasta la actualidad, lo constituye el Camphenol Plus. Son escasos los reportes científicos de su efecto sobre el endotelio y la dinámica contráctil del músculo liso vascular, en especial de tejidos venosos como la vena porta hepática. Objetivo: determinar el efecto del Camphenol Plus sobre el músculo liso vascular de la vena porta. Métodos: se realizó una investigación experimental preclínica, con la utilización de 21 venas porta obtenidas de ratas Wistar. Las preparaciones realizadas se colocaron en baño de órganos, se registró la tensión desarrollada por el músculo liso vascular tras la adición de diez microlitros de Camphenol Plus, en diferentes concentraciones y durante diferentes intervalos de tiempo. Resultados: el Camphenol Plus, tras la preactivación del musculo liso vascular de la vena porta, indujo vasorelajación, la que se incrementó durante todo el tiempo de estudio y según el incremento de las concentraciones del medicamento. Existieron diferencias significativas entre los valores de tensión promedios registrados en los diferentes intervalos de tiempo con los de la tensión espontánea basal y la tensión base inicial. Conclusiones: el Camphenol Plus, indujo "in vitro", relajación de la musculatura lisa de la vena porta a través de un acoplamiento excitación-contracción de tipo farmacomecánico.
ABSTRACT Introduction: Camphenol Plus is one of the antiseptics commonly used in Dentistry since the last century and still in use today. There are few scientific reports of its effect on the endothelium and contractile dynamics of vascular smooth muscle, especially in venous tissues such as the hepatic portal vein. Objective: to determine the effect of Camphenol Plus on the vascular smooth muscle of the portal vein. Methods: a preclinical experimental investigation was carried out using 21 portal veins obtained from Wistar rats. The preparations were placed in an organ bath and the tension developed by the vascular smooth muscle was recorded after the addition of ten microliter of Camphenol Plus, at different concentrations and during different time intervals. Results: Camphenol Plus, after the preactivation of the vascular smooth muscle of the portal vein, induced relaxation, which increased throughout the study time and according to the increase in drug concentrations. There were significant differences between the average tension values recorded in the different time intervals with those of the basal spontaneous tension and the initial baseline tension. Conclusions: Camphenol Plus induced "in vitro" relaxation of portal venous smooth muscles through a pharmacomechanical excitation-contraction coupling.
RESUMO
SUMMARY OBJECTIVE: Few physical exercise programs for children with limb loss have been described in detail recently. We provided information regarding the characteristics and effectiveness of an alternative rehabilitation exercise developed for children with lower-limb amputation. METHODS: An 8-year-old boy with a below-knee amputation and a 9-year-old bilateral amputee girl performed an exercise program of one 2-h session per week for 20 weeks, aimed at developing muscular strength and coordination. Walking ability and walking speed were assessed by using the L-test of functional mobility and 10-m walk test, respectively. Mechanical and neuromuscular muscle function was assessed by using tensiomyography. RESULTS: In case 1, a decrement of 9.5% and 10.5% was found in the L-test (42 s vs. 38 s) and in the 10-m test (19 s vs. 17 s) scores, respectively. In case 2, walking ability remained unchanged (L-test score: 38 s), while a 5.2% reduction in walking speed was observed (10-m test score: 19 s vs. 18 s). No relevant changes were observed in the muscular tone in both cases. CONCLUSIONS: Practitioners should be aware that, contrary to what could be expected, a multidisciplinary training program held once per week for 5 months had a minimal impact on the gait pattern and neuromuscular function of two children with lower-limb amputation.
Assuntos
Humanos , Masculino , Feminino , Criança , Membros Artificiais , Amputados , Exercício Físico , Caminhada , Terapia por Exercício , Amputação CirúrgicaRESUMO
Introdução: Durante sua carreira o cantor lírico sofre grande demanda e consequente alteração da coordenação dos músculos respiratórios, porém não se sabe se estas exigências podem alterar a mobilidade e tonicidade no principal músculo da respiração, o diafragma. Objetivos: Avaliar e comparar a tonicidade e a mobilidade do diafragma de cantores líricos profissionais e de não-cantores. Participaram do estudo 15 cantores líricos profissionais em plena carreira e 24 adultos não-cantores com idades e IMCs equivalentes. Métodos: Duas avaliações foram empregadas: para avaliar a mobilidade costal foi utilizada a parte referente a avaliação desse parâmetro da Manual Evaluation of the Diaphragm Scale (MED Scale); para avaliar a tonicidade diafragmática a avaliação descrita por Rial e Pinsach em 2015. Resultados: Os resultados mostraram que a distribuição da avaliação manual do diafragma no grupo dos cantores apresentou distribuição significativamente diferente, tendo p < 0,05, com relação à tonicidade bilateral do diafragma, apresentando maior hipertonicidade em relação ao grupo controle, e que não houve diferenças significativas em relação à mobilidade. Conclusão: Os gestos artísticos usados pelos cantores líricos profissionais afetam a tonicidade do diafragma. (AU)
Introduction: The professional lyrical singers during their careers suffer great demand and consequent alteration of the coordination of the respiratory muscles, however it is not known if these requirements can alter the mobility and tonicity in the main muscle of the breath, the diaphragm. Objectives: To evaluate and compare diaphragm tonicity and mobility of professional lyric singers and non-singers. The study included 15 professional lyric singers in their full careers and 24 non-singing adults of equivalent ages and BMIs. Methods: Two forms of manual evaluation of the diaphragm were used: to assess costal mobility, the part of the manual evaluation to evaluate this parameter was used the Manual Evaluation of the Diaphragm Scale (MED Scale); and to evaluate the diaphragmatic tonicity the evaluation described by Rial and Pinsach in 2015. Results: The results showed that the distribution of the manual evaluation of the diaphragm in the group of singers presented a significantly different distribution, with p < 0,05, in relation to the bilateral diaphragm tonicity, presenting them with greater hypertonicity in relation to the control group, and that there were no significant differences regarding mobility. Conclusion: The artistic gestures used by professional lyric singers affect the tone of the diaphragm. (AU)
Assuntos
Humanos , Diafragma , Tono Muscular , CantoRESUMO
Introdução: A paralisia cerebral (PC) é uma condição permanente causada por uma lesão encefálica estática, multifatorial e não progressiva dos movimentos e postura. A equoterapia aparece como método terapêutico e educacional que utiliza o cavalo para melhoria do desenvolvimento de pessoas portadoras de necessidades especiais. Objetivos: Revisar sistematicamente os efeitos da equoterapia sobre o desempenho funcional em crianças com paralisia cerebral. Métodos: Trata-se de uma revisão sistemática revisada por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a equoterapia em pacientes com paralisia cerebral publicados em português e na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. Resultados: Foram incluídos cinco artigos, publicados entre os anos 2012 e 2019. Todos estudos evidenciaram resultados satisfatórios em pacientes com paralisia cerebral após o tratamento com a equoterapia, melhorando a marcha, o equilíbrio, o tônus, a simetria e a qualidade de vida independente se ela foi associada a outro método. Conclusão: A equoterapia é uma modalidade terapêutica eficaz no tratamento das crianças com paralisia cerebral, melhorando os déficits motores e neurológicos, além da espasticidade muscular. (AU)
Introduction: Cerebral palsy (CP) is a permanent condition caused by a static, multifactorial and non-progressive brain injury of the movements and posture. Equine therapy is a therapeutic and educational method that uses horse to improve the development of people with special needs. Methods: This is a systematic review reviewed by two independent reviewers, according to PRISMA recommendations, in the PubMed and Cochrane Library databases. Including original studies that used equine therapy in patients with cerebral palsy published in Portuguese and in the English language. The PEDro Scale was used to analyze the methodological quality of the studies and the Cochrane Collaboration for bias risk analysis. Results: Five articles published between the years 2012 and 2019 were included. All studies showed satisfactory results in patients with cerebral palsy after treatment with equine therapy, improving gait, balance, tone, symmetry and quality of life whether it was associated with another method. Conclusion: Equine therapy is an effective therapeutic modality in the treatment of children with cerebral palsy, improving motor and neurological deficits, as well as muscle spasticity, favors balance, postural control, reduction of joint deformities and gross motor function. (AU)
Assuntos
Humanos , Paralisia Cerebral , Criança , Terapia Assistida por Cavalos , Desempenho Físico Funcional , Equilíbrio Postural , Tono MuscularRESUMO
Manual tests in clinical investigation must be supported by anatomical and physiological findings in order to obtain an objective information. The application of different mandibular positions in children obtains a variation in the 'hip rotators test' (p < 0.001). The possible relationships behind the muscle tone of the external rotators of the hips and the stomatognathic system are exposed, with special attention on the fascial tissue and its morphological characteristics. Despite these anatomical and physiological connections, there is no further evidence of a strong cause-effect relationship in this test.
Las pruebas manuales en la investigación clínica deben estar respaldadas por hallazgos anatómicos y fisiológicos para obtener una información objetiva. La aplicación de diferentes posiciones mandibulares en niños muestra una variación en la "prueba de rotadores de cadera" (p <0,001). Se exponen las posibles relaciones del tono muscular de los rotadores externos de las caderas y el sistema estomatognático, con especial atención en el tejido fascial y sus características morfológicas. A pesar de estas conexiones anatomofisiológicas, no existe una evidencia mayor de una relación importante causa-efecto en esta prueba.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Sistema Estomatognático/anatomia & histologia , Fáscia/anatomia & histologia , Quadril/fisiologia , Tono Muscular , PosturaRESUMO
Abstract Introduction: The impairment of muscle strength and fatigue in leprosy remains a problem that requires careful attention to avoid or minimize its progression, as well as prevention of disabilities and deformities. Objective: To investigate the maximum voluntary contraction and time to muscle fatigue in leprosy patients. Method: A total of 21 leprosy patients and 21 healthy subjects completed the sample. The method used to determine the maximum voluntary contraction (MVC) of the handgrip followed the recommendation of the American Society of Hand Therapists with the use of a hydraulic hand grip dynamometer. The test was performed three times with each hand, with a time interval of 60 seconds between successive trials. The subject was instructed to perform a maximal isometric force against the dynamometer for 5 seconds. The peaks were recorded and used for the fatigue test. For the fatigue test, we recorded the electromyogram of the forearm muscles to offline determine the onset time for the muscle contraction (14 bits, Miograph 2 USB®, Miotec, Brazil). Results: Leprosy patients had lower MVC compared with healthy subjects (p > 0.05), both in the dominant and the non-dominant hands. The time to fatigue in the leprosy and control groups was similar (p < 0.05). We observed that leprosy patients had more contractions than the healthy subjects (22.6 ± 11.8 contractions for the leprosy group vs. 12.3 ± 6.9 contractions for the control group, p > 0.05). Conclusion: Multibacillary leprosy patients lost muscle force without modifying the resistance to fatigue.
Resumo Introdução: O comprometimento da força muscular e a fadiga na hanseníase continuam sendo problemas que requerem cuidadosa atenção para evitar ou minimizar sua progressão, bem como prevenir incapacidades e deformidades. Objetivo: Avaliar a força muscular e o tempo até a fadiga em pacientes com hanseníase Método: Vinte e um pacientes com hanseníase e 21 indivíduos saudáveis completaram a amostra. O método utilizado para determinar a contração voluntária máxima (CVM) da força de preensão palmar seguiu a recomendação da Sociedade Americana de Terapeutas da Mão com o uso de um dinamômetro de preensão manual. O teste foi realizado três vezes em cada mão, com intervalo de tempo de sessenta segundos entre tentativas sucessivas. O sujeito foi instruído a realizar força isométrica máxima contra o dinamômetro durante cinco segundos. Os picos foram registrados e usados para o teste de fadiga. Para o teste de fadiga, registrou-se o eletromiograma dos músculos do antebraço para determinar off-line o tempo de início da contração muscular (14 bits, Miograph 2 USB ® , Miotec, Brasil). Resultados: Os pacientes com hanseníase apresentaram menor CVM em relação aos saudáveis (p < 0,05) nas mãos dominante e não dominante. Não houve diferença no tempo de fadiga entre os grupos hanseníase e controle (p > 0,05). Foi observado que os pacientes com hanseníase tinham mais contrações do que os saudáveis (22,6 ± 11,8 contrações para o grupo com hanseníase vs. 12,3 ± 6,9 para o grupo controle, p < 0,05). Conclusão: Pacientes com hanseníase multibacilar apresentaram perda de força muscular sem modificação da resistência à fadiga.
Resumen Introducción: El compromiso de la fuerza muscular y la fatiga en la lepra sigue siendo un problema que requiere atención cuidadosa para evitar o minimizar su progresión, así como la prevención de incapacidades y deformidades. Objetivo: Evaluar la fuerza muscular y el tiempo hasta la fatiga de pacientes con lepra. Método: Veintiún pacientes con lepra y 21 sujetos sanos completaron la muestra. El método utilizado para determinar la contracción voluntaria máxima (CVM) de la fuerza de asimiento palmar siguió la recomendación de la Sociedad Americana de Terapeutas de la Mano con el uso de un dinamómetro de asimiento manual. La prueba se realizó tres veces con cada mano, con un intervalo de tiempo de 60 segundos entre intentos sucesivos. El sujeto fue instruido a realizar una fuerza isométrica máxima contra el dinamómetro durante 5 segundos. Los picos se registraron y se utilizaron para la prueba de fatiga. Para la prueba de fatiga, registramos el electromiograma de los músculos del antebrazo para determinar fuera de línea el tiempo de inicio de la contracción muscular (14 bits, Miograph 2 USB ® , Miotec, Brasil). Resultados: Los pacientes con lepra presentaron menor CVM con relación a los sanos (p < 0,05) en las manos dominante y no dominante. No hubo diferencia en el tiempo de fatiga entre los grupos de lepra y control (p > 0,05). Se observó que los pacientes con lepra tenían más contracciones que los sanos (22,6 ± 11,8 contracciones para el grupo con hanseniasis frente a 12,3 ± 6,9 para el grupo control, p < 0,05). Conclusión: Pacientes con hanseniasis multibacilar presentaron pérdida de fuerza muscular sin modificación de la resistencia a la fatiga.
Assuntos
Humanos , Masculino , Feminino , Fadiga Muscular , Hanseníase , Sistema Musculoesquelético , Força Muscular , Tono MuscularRESUMO
A dexmedetomidina é um fármaco agonista a-2 adrenérgico utilizado na anestesiologia veterinária, devido a suas propriedades sedativas e analgésicas. Existem preocupações quanto aos seus efeitos colaterais, principalmente cardiovasculares, dentre eles arritmias. As quais podem comprometer o débito cardíaco e a perfusão tecidual. As arritmias que podem ser observadas com o uso da dexmedetomidina são: bloqueio átrio ventricular de 1º, 2º e 3º grau; arritmia sinusal, e pausa sinusal. Dentre elas a de maior ocorrência é o bloqueio atrioventricular, principalmente o de 2º grau. Essas alterações são dose-dependentes, estudos demonstram que doses de 1 µg /kg podem desencadear a ocorrência de bradiarritmias. O tratamento das arritmias atrioventriculares envolve a administração de anticolinérgicos, antiarrítmicos e no caso de alterações desencadeadas pelo uso da dexmedetomidina a aplicação de um antagonista a-2 adrenérgico. Esta revisão tem como objetivo discorrer sobre as arritmias em cães ocasionadas pelo uso da dexmedetomidina.
Dexmedetomidine is a α-2 adrenergic agonist drug used in veterinary anesthesiologydue to its sedative and analgesic properties. There are concerns about its side effects, especially cardiovascular, among them arrhythmias. These may compromise cardiac output and tissue perfusion. The arrhythmias that may be observed with the use of dexmedetomidine are: ventricularatrium blockade of 1st, 2nd and 3rd degree; sinus arrhythmia, and sinus pause. Among them, the most frequent occurrence is atrioventricular block, especially the second degree. These changes are dose-dependent, studies have shown that doses of 1 μg/kg can trigger the occurrence of bradyarrhythmias. Treatment of atrioventricular arrhythmias involves the administration of anticholinergics, antiarrhythmics and in the case of changes triggered by the use of dexmedetomidinethe application of a α-2 adrenergic antagonist. This review aims to discuss the arrhythmias in dogs caused by the use of dexmedetomidine.
Assuntos
Animais , Cães , Agonistas alfa-Adrenérgicos , Anestésicos , Arritmias Cardíacas/veterinária , Doenças do CãoRESUMO
Objective: To evaluate the short-term effect of two hydrokinesiotherapy protocols on muscle tone and stress levels in children with SCZ. Method: A crossover, randomized, blinded study with children with microcephaly/SCZ between 3-36 months of age. Was evaluated by the Modified Tardieu Scale(EMT), analyzing the degree of muscle tone and the range of articular movement(ROM); the level of stress, through a visual analogue scale of faces ranging from a state without stress(1) to intense stress(4). Two hydrocinesotherapy protocols(PI and PII) were applied in a restricted aquatic environment, for 15 minutes with water temperature at 37ºC. Results: Twelve children participated in the study (mean age in months: 23.9+3.97), 58.7% female. After PI, we observed a reduction in the degree of tone of the extensor muscles of the elbow(p = 0.03) and knee(p = 0.04); in PII, there were no significant changes in the degree of tone. There were no significant changes in the level of stress in PI and PII, however 83.3% were without stress or mild stress before the interventions. Conclusions: Protocol I reduced the degree of muscle tone in the short term when compared to PII. It is emphasized that the protocols applied are of low cost, and can be a viable non-pharmacological technique option in the therapeutic follow-up of these children. It should be noted that the physiotherapist's experience should guide the choice of the appropriate protocol for the therapeutic objective of each child and the advantage of being a technique easily replicable in a therapeutic and home environment.
Objective: To evaluate the short-term effect of two hydrokinesiotherapy protocols on muscle tone and stress levels in children with SCZ. Method: A crossover, randomized, blinded study with children with microcephaly/SCZ between 3-36 months of age. Was evaluated by the Modified Tardieu Scale(EMT), analyzing the degree of muscle tone and the range of articular movement(ROM); the level of stress, through a visual analogue scale of faces ranging from a state without stress(1) to intense stress(4). Two hydrocinesotherapy protocols(PI and PII) were applied in a restricted aquatic environment, for 15 minutes with water temperature at 37ºC. Results: Twelve children participated in the study (mean age in months: 23.9+3.97), 58.7% female. After PI, we observed a reduction in the degree of tone of the extensor muscles of the elbow(p = 0.03) and knee(p = 0.04); in PII, there were no significant changes in the degree of tone. There were no significant changes in the level of stress in PI and PII, however 83.3% were without stress or mild stress before the interventions. Conclusions: Protocol I reduced the degree of muscle tone in the short term when compared to PII. It is emphasized that the protocols applied are of low cost, and can be a viable non-pharmacological technique option in the therapeutic follow-up of these children. It should be noted that the physiotherapist's experience should guide the choice of the appropriate protocol for the therapeutic objective of each child and the advantage of being a technique easily replicable in a therapeutic and home environment.
Assuntos
Reabilitação , Zika virus , Hidroterapia , Tono MuscularRESUMO
A dexmedetomidina é um fármaco agonista a-2 adrenérgico utilizado na anestesiologia veterinária, devido a suas propriedades sedativas e analgésicas. Existem preocupações quanto aos seus efeitos colaterais, principalmente cardiovasculares, dentre eles arritmias. As quais podem comprometer o débito cardíaco e a perfusão tecidual. As arritmias que podem ser observadas com o uso da dexmedetomidina são: bloqueio átrio ventricular de 1º, 2º e 3º grau; arritmia sinusal, e pausa sinusal. Dentre elas a de maior ocorrência é o bloqueio atrioventricular, principalmente o de 2º grau. Essas alterações são dose-dependentes, estudos demonstram que doses de 1 µg /kg podem desencadear a ocorrência de bradiarritmias. O tratamento das arritmias atrioventriculares envolve a administração de anticolinérgicos, antiarrítmicos e no caso de alterações desencadeadas pelo uso da dexmedetomidina a aplicação de um antagonista a-2 adrenérgico. Esta revisão tem como objetivo discorrer sobre as arritmias em cães ocasionadas pelo uso da dexmedetomidina.(AU)
Dexmedetomidine is a α-2 adrenergic agonist drug used in veterinary anesthesiologydue to its sedative and analgesic properties. There are concerns about its side effects, especially cardiovascular, among them arrhythmias. These may compromise cardiac output and tissue perfusion. The arrhythmias that may be observed with the use of dexmedetomidine are: ventricularatrium blockade of 1st, 2nd and 3rd degree; sinus arrhythmia, and sinus pause. Among them, the most frequent occurrence is atrioventricular block, especially the second degree. These changes are dose-dependent, studies have shown that doses of 1 μg/kg can trigger the occurrence of bradyarrhythmias. Treatment of atrioventricular arrhythmias involves the administration of anticholinergics, antiarrhythmics and in the case of changes triggered by the use of dexmedetomidinethe application of a α-2 adrenergic antagonist. This review aims to discuss the arrhythmias in dogs caused by the use of dexmedetomidine.(AU)
Assuntos
Animais , Cães , Doenças do Cão , Arritmias Cardíacas/veterinária , Anestésicos , Agonistas alfa-AdrenérgicosRESUMO
Canine Monocytic Ehrlichiosis (CME) is a disease of worldwide distribution caused by the bacteria Ehrlichia canis, appearing primarily in hot climates due to the massive prevalence of its vector, the tick Rhipicephalus sanguineus. Previous studies have shown that dogs afflicted by CME in the chronic phase can develop infectious myocarditis, arrhythmias, and alterations in heart rate variability (HRV), but there are few studies correlating cardiac diseases with the acute phase of CME. This study aims at assessing electric cardiac alterations and HRV in the time and frequency domains during the acute phase of CME. This study assessed 22 animals divided into 2 distinct groups: the control group, comprised by 10 healthy dogs, and the sick group, comprised of 12 dogs infected naturally with ehrlichiosis which presented clinical and hematological signs compatible with the acute phase of the disease. The animals underwent conventional and Holter electrocardiographic evaluations, systolic blood pressure measurement, complete blood count and biochemical assays (urea, creatinine, alanine aminotransferase (ALT), alkaline phosphatase (AP), and gamma glutamyl transferase (GGT)). The sick group presented higher activity in the sympathetic nervous system than in the parasympathetic nervous system, manifest as a significant increase in mean heart rate and a reduction in the HRV indexes for the time and frequency domains. The frequency-domain HRV indexes presented sympathetic prevalence during the sleep and vigilance states. Sinus tachycardia was the predominant heart rhythm in 58.33% of the animals. The mean systolic blood pressure diverged between the groups and no significant arrhythmias were observed during monitoring. The serum concentrations of urea, creatinine, AP, ALT, and GGT were within the established reference values for the species. We observed no indication that there was enough time during the acute phase for the disease to evolve in a way that resulted in arrhythmias, as is common in the chronic phase, but we observed that animals in the acute phase already present reduced HRV indexes.
Assuntos
Doenças do Cão/microbiologia , Ehrlichiose/veterinária , Eletrocardiografia/veterinária , Animais , Arritmias Cardíacas/veterinária , Pressão Sanguínea , Estudos de Casos e Controles , Cães , Ehrlichia canis , Ehrlichiose/complicações , Eletrocardiografia Ambulatorial/veterinária , Feminino , Frequência Cardíaca/fisiologia , Masculino , Taquicardia Sinusal/veterináriaRESUMO
BACKGROUND: Based on the premise that spasticity might affect gait post-stroke, cryotherapy is among the techniques used to temporarily reduce spasticity in neurological patients. This effective technique would enhance muscle performance, and ultimately, functional training, such as walking. However, understanding whether a decrease in spasticity level, if any, would lead to improving muscle performance and gait parameters is not based on evidence and needs to be clarified. OBJECTIVES: to investigate the immediate effects of cryotherapy, applied to spastic plantarflexor muscles of subjects post-stroke, on tonus level, torque generation capacity of plantarflexors and dorsiflexors, and angular/spatiotemporal gait parameters. METHODS: Sixteen chronic hemiparetic subjects participated in this randomized controlled crossover study. Cryotherapy (ice pack) or Control (room temperature sand pack) were applied to the calf muscles of the paretic limb. The measurements taken (before and immediately after intervention) were: 1) Tonus according to the Modified Ashworth Scale; 2) Torque assessments were performed using an isokinetic dynamometer; and 3) Spatiotemporal and angular kinematics of the hip, knee, and ankle (flexion/extension), obtained using a tridimensional movement analysis system (Qualisys). RESULTS: Cryotherapy decreased plantarflexor tonus but did not change muscle torque generation capacity and did not affect spatiotemporal or angular parameters during gait compared to control application. These findings contribute to the evidence-based approach to clinical rehabilitation post-stroke. CONCLUSIONS: The findings of this study suggest that cryotherapy applied to the calf muscles of subjects with chronic hemiparesis reduces muscle hypertonia but does not improve dorsiflexors and plantarflexors performance and gait parameters.
Assuntos
Crioterapia , Marcha/fisiologia , Espasticidade Muscular/terapia , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Articulação do Tornozelo/fisiopatologia , Fenômenos Biomecânicos , Estudos Cross-Over , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Espasticidade Muscular/fisiopatologia , Paresia/complicações , Paresia/fisiopatologia , Paresia/reabilitação , Amplitude de Movimento Articular , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodosRESUMO
ABSTRACT BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient's complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient's management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient's history was blinded for the examiner's knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.
RESUMO CONTEXTO: Exame anorretal digital (EAD) faz parte do exame físico, também é essencial para a avaliação do cirurgião colorretal. Um bom EAD oferece informações preciosas relacionadas às queixas do paciente, que auxiliam na tomada de decisões. Sua realização é simples, rápida e minimamente invasiva. Em diversos centros ao redor do mundo, o toque retal ainda é o único método para avaliar o esfíncter anal antes do tratamento. Por outro lado, a manometria anorretal (MAR) é o principal método para avaliação funcional objetiva das pressões esfincterianas. A discrepância entre o EAD, dependendo do examinador para determinar o tônus esfincteriano em comparação à MAR motivou este estudo. OBJETIVO: Comparar o EAD com os parâmetros de pressão esfincteriana obtidos na MAR, dependendo da experiência dos examinadores. MÉTODOS: Trinta e seis pacientes consecutivos com queixas de incontinência fecal ou constipação crônica, do ambulatório de Fisiologia Anorretal da Faculdade de Medicina da Universidade de São Paulo, foram prospectivamente incluídos. Cada paciente foi submetido a MAR e EAD realizados por dois cirurgiões colorretais seniores e um júnior antes da MAR. A história dos pacientes propositalmente omitida dos examinadores, e os resultados de cada examinador foram cegos dos demais. Para o EAD, as pressões de repouso e contração foram classificadas por uma escala objetiva (EAD Scoring System), realizada pelos examinadores seniores e pelo júnior em todos os pacientes, que foi comparada com os parâmetros da MAR para a análise. ANÁLISE ESTATÍSTICA: A análise descritiva foi feita para todos os parâmetros. Para as pressões de repouso e contração, o índice Gamma foi utilizado para a comparação entre o EAD e a MAR, que variou de 0 a 1. Quanto mais próximo de 1 melhor a concordância entre os dois métodos de avaliação. RESULTADOS: A idade média foi de 48 anos e 55,5% dos pacientes eram do sexo feminino. A concordância das pressões anais de repouso entre a MAR e o EAD realizadas pelos examinadores seniores, proficientes, foi de 0,7 (IC 95%; 0,32-1,0), enquanto para o examinador júnior, menos experiente, foi de 0,52 (IC95%; 0,09-0,96). A concordância das pressões de contração foi de 0,96 (IC 95%; 0,87-1,0) para os examinadores seniores e de 0,52 (IC 95%; 0,16-0,89) para o júnior. CONCLUSÃO: Cirurgiões colorretais mais experientes, o EAD teve concordância mais significativa com a MAR, o que poderia levar a um manejo terapêutico mais adequado aos pacientes portadores de doença anorretais funcionais. A manometria anorretal permanece, portanto, como método de avaliação objetiva da função esfincteriana.