Which Patients With Chronic Pain Do The Primary Care Refers to a Tertiary Hospital in a Developing Country? Experience From a University Hospital.

Purpose: The study aimed to profile patients with uncontrolled chronic pain referred from primary care to a tertiary hospital in a developing country, and identify factors associated with pain intensity, interference, and its link with mental health.

Design: Cross-sectional design.

Methods: Data from 906 adult patients with nonmalignant chronic pain during their first visit to the multidisciplinary pain center at the State University of Rio de Janeiro in 2019 were used.

Challenges in measuring sleep quality among women with endometriosis: A comparison of two questionnaires.

Objective: This study aimed to underscore the issues associated with the dichotomization of categories in sleep questionnaires among women diagnosed with endometriosis and sleep disturbances, as well as their potential impact on the validity of the research findings.

Background: A range of questionnaires is employed across settings from primary care to research to classify sleep disturbances. Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) are two frequently utilized instruments for evaluating sleep.

Evaluation of Pain Prevalence in Children Who Experienced Perinatal Hypoxia-Ischemia Events: Characteristics and Associations With Sociodemographic Factors.

Introduction: Pain in children who suffer from hypoxia-ischemia (HI) events is still not widely studied. Hypoxia-ischemia is characterized by the momentary or permanent cessation of blood flow and, consequently, of oxygen supply, becoming the main cause of encephalopathy in children. Hyperalgesia was identified in animals undergoing prenatal hypoxia-ischemia by researchers from the Universidade do Estado do Rio de Janeiro (UERJ).

Brain stimulation for treatment-resistant depression.

Depression is one of the main public health problems in the world, having a high prevalence and being considered the main cause of disability. An important portion of patients does not respond to treatment with the initial trial of conventional antidepressants in the current depressive episode of moderate to severe intensity, which characterizes treatment-resistant depression. In this context, non-invasive neuromodulation procedures use an electric current or magnetic field to modulate the central nervous system, and they represent a new option for patients with treatment-resistant depression.

Case report: Injected corticosteroids for treating leprosy isolated neuritis.

One of the main manifestations of leprosy is peripheral nerve impairment. Early diagnosis and treatment are important to reduce the impact of neurological impairment, which can cause deformities and physical disabilities. Leprosy neuropathy can be acute or chronic, and neural involvement can occur before, during, or after multidrug therapy, and especially during reactional episodes when neuritis occurs.

Impact of chronic pelvic pain and painful bladder syndrome on the Pittsburgh Sleep Quality Index on women with deep endometriosis: a cross-sectional study.

Introduction And Hypothesis: Painful bladder syndrome (PBS) is frequently associated with deep endometriosis (DE), and both conditions cause chronic pelvic pain (CPP), which often impairs sleep quality. This study was aimed at analyzing the impact of CPP plus PBS in women with DE on the global sleep quality index using the Pittsburgh Sleep Quality Index (PSQI) and subsequently examine each sleep dimension.

Methods: One hundred and forty women with DE were included and answered the PSQI and the O'Leary-Sant Interstitial Cystitis Symptoms and Problem Index questionnaires with or without CPP.

Prevalence of chronic pain in Brazil: A systematic review and meta-analysis.

Objective: This review synthesized existing studies on the prevalence of chronic pain in Brazil and its associated factors to produce a recent estimation to guide public health politics.

Methods: A search was carried out in the Ovid Medline, Embase, Web of Science, and BVS Regional/Lilacs databases to identify population-based cross-sectional studies from 2005 to 2020, which reported the prevalence of benign chronic pain in Brazil (more than three months). The risk of bias was assessed using design, sample size determination, and random selection as essential issues.

Anesthetic therapy for acute pain relief after laparoscopic cholecystectomy: systematic review.

Inappropriate therapy of postoperative pain in laparoscopic cholecystectomy may lead to late mobilization, patient dissatisfaction, delayed hospital discharge, and chronic pain development. Our objective was to identify the best therapeutic strategy available to the anesthesiologist for the acute postoperative pain of patients submitted to elective laparoscopic cholecystectomy. This is a systematic review that included 36 complete articles indexed in the Medline, Scopus, Web of Science and LILACS databases, with a five-year time cut (2012 to 2016), resulting from controlled and randomized studies that were submitted to qualitative analysis.

Sevoflurane, Compared With Isoflurane, Minimizes Lung Damage in Pulmonary but Not in Extrapulmonary Acute Respiratory Distress Syndrome in Rats.

Background: Volatile anesthetics modulate inflammation in acute respiratory distress syndrome (ARDS). However, it is unclear whether they act differently depending on ARDS etiology. We hypothesized that the in vivo and in vitro effects of sevoflurane and isoflurane on lung damage would not differ in pulmonary (p) and extrapulmonary (exp) ARDS.

Increment of body mass index is positively correlated with worsening of endothelium-dependent and independent changes in forearm blood flow.

Obesity is associated with the impairment of endothelial function leading to the initiation of the atherosclerotic process. As obesity is a multiple grade disease, we have hypothesized that an increasing impairment of endothelial and vascular smooth muscle cell functions occurs from lean subjects to severe obese ones, creating a window of opportunities for preventive measures. Thus, the present study was carried out to investigate the grade of obesity in which endothelial dysfunction can be detected and if there is an increasing impairment of endothelial and vascular smooth muscle cell functions as body mass index increases.

The Effects of Short-Term Propofol and Dexmedetomidine on Lung Mechanics, Histology, and Biological Markers in Experimental Obesity.

Background: Administering anesthetics to the obese population requires caution because of a variety of reasons including possible interactions with the inflammatory process observed in obese patients. Propofol and dexmedetomidine have protective effects on pulmonary function and are widely used in short- and long-term sedation, particularly in intensive care unit settings in lean and obese subjects. However, the functional and biological effects of these drugs in obesity require further elucidation.

Milrinone attenuates arteriolar vasoconstriction and capillary perfusion deficits on endotoxemic hamsters.

Background And Objective: Apart from its inotropic property, milrinone has vasodilator, anti-inflammatory and antithrombotic effects that could assist in the reversal of septic microcirculatory changes. This paper investigates the effects of milrinone on endotoxemia-related microcirculatory changes and compares them to those observed with the use of norepinephrine.

Materials And Methods: After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.

Fluid resuscitation therapy in endotoxemic hamsters improves survival and attenuates capillary perfusion deficits and inflammatory responses by a mechanism related to nitric oxide.

Background: Relative hypovolemia is frequently found in early stages of severe sepsis and septic shock and prompt and aggressive fluid therapy has become standard of care improving tissue perfusion and patient outcome. This paper investigates the role of the nitric oxide pathway on beneficial microcirculatory effects of fluid resuscitation.

Methods: After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg x kg(-1)), male golden Syrian hamsters were fluid resuscitated and then sequentially treated with L-Nω-Nitroarginine and L-Arginine hydrochloride (LPS/FR/LNNA group).

Nonobese Young Females with Polycystic Ovary Syndrome have Nutritive Microvascular Dysfunction: A Pilot Study.

Objective: To investigate nutritive microvascular function in young nonobese females with polycystic ovary syndrome (PCOS) and to correlate microvascular reactivity with sex steroids, inflammatory markers, and metabolic variables.

Methods: Fourteen nonobese females with PCOS (24.6 ± 2.

Evaluation of sublingual microcirculation in children with dengue shock.

Objective: To report the sublingual microcirculation observed using Sidestream Dark Field imaging in two children with dengue shock.

Method: Two children, aged 9 and 10 years, were admitted to the pediatric intensive care unit with dengue shock and multiple organ dysfunction. Sublingual microcirculation was assessed in each patient on the first and second days of shock and was assessed a final time when the patients were no longer in shock (on the day prior to extubation) using Sidestream Dark Field technology.

Changing sedative infusion from propofol to midazolam improves sublingual microcirculatory perfusion in patients with septic shock.

Purpose: The goal of this study was to explore possible microcirculatory alterations by changing sedative infusion from propofol to midazolam in patients with septic shock.

Materials And Methods: Patients (n=16) were sedated with propofol during the first 24 hours after intubation, then with midazolam, following a predefined algorithm. Systemic hemodynamics, perfusion parameters, and microcirculation were assessed at 2 time points: just before stopping propofol and 30 minutes after the start of midazolam infusion.

Microcirculatory effects of selective receptor blockade during hemorrhagic shock treatment with vasopressin: experimental study in the hamster dorsal chamber.

Hemorrhagic shock is a major cause of death in modern societies. Some patients, when treated, fail to sustain normal cardiovascular parameters, requiring fluid therapy and vasoactive drugs. Among drugs with cardiovascular profile other than catecholamine, vasopressin (VP) is emerging as an option.

Evaluation of endothelial function in patients with limited systemic sclerosis by use of brachial artery Doppler ultrasound.

Objectives: The aim of this study was to compare the brachial artery endothelium-dependent and endothelium-independent dilating responses in patients with limited systemic sclerosis (LSSc) with those of healthy subjects of the same gender, age and color.

Methods: Twenty adult, non-obese, non-smoker, non-diabetic, non-dyslipidemic, and non-hypertensive women, who fulfilled the American College of Rheumatology criteria for the diagnosis of SSc, were submitted to right brachial artery Doppler ultrasound. The vasodilating responses were analyzed as follows: the endothelium-dependent dilating response, after a 5-minute ischemia in the right arm; and the endothelium-independent dilating response, after administering 300 mcg of nitroglycerin (NTG) sublingually.

High fat diet induces central obesity, insulin resistance and microvascular dysfunction in hamsters.

Microvascular dysfunction is an early finding in obesity possibly related to co-morbidities like diabetes and hypertension. Therefore we have investigated changes on microvascular function, body composition, glucose and insulin tolerance tests (GTT and ITT) on male hamsters fed either with high fat (HFD, n=20) or standard (Control, n=21) diet during 16 weeks. Total body fat and protein content were determined by carcass analysis, aorta eNOS and iNOS expression by immunoblotting assay and mean blood pressure (MAP) and heart rate (HR) by an arterial catheter.

Microcirculatory effects of fluid therapy and dopamine, associated or not to fluid therapy, in endotoxemic hamsters.

Classically septic shock treatment takes into consideration only systemic parameters but failure in retaining arteriolar blood flow and functional capillary density (FCD) during sepsis worsens the outcome. Thus, we have investigated the effects of vigorous volume resuscitation (VR), two doses of dopamine and their combination upon the microcirculation during endotoxemia to evaluate if improvement on FCD and arteriolar blood flow would increase survival time. Sixty-seven adult male hamsters were studied using the window chamber model.

Improved resuscitation from hemorrhagic shock with Ringer's lactate with increased viscosity in the hamster window chamber model.

Background: Infusion of large volume of fluid is practiced in the treatment of hemorrhagic shock although resuscitation with small fluid volumes reduces the risks associated with fluid overload. We explored the hypothesis that reduced Ringer's lactate (RL) volume restoration in hemorrhage is significantly improved by increasing its viscosity, leading to improved microvascular conditions.

Methods: Awake hamsters were subjected to a hemorrhage of 50% of blood volume followed by a shock period of 1 hour.

The role of KATP channels on propofol preconditioning in a cellular model of renal ischemia-reperfusion.

Background: Propofol (2,6-diisopropylphenol) has been shown to protect several organs, including the kidneys, from ischemia-reperfusion (I-R)-induced injury. Although propofol affects adenosine triphosphate-sensitive potassium (K(ATP)) channels in nonrenal tissues, it is still not clear by which mechanisms propofol protects renal cells from such damage. In this study, we investigated whether propofol induces renal preconditioning through renal K(ATP) channels.

Metabolic disturbances linked to obesity: the role of impaired tissue perfusion.

Associated with elevated risk of cardiovascular events and cancer, obesity is a worldwide problem affecting developed and developing countries. Microcirculatory vessels, represented by arterioles, capillaries and venules (mean internal diameter < 100 microm), are the place where blood/tissue nutrition and exchange effectively take place. Microvascular dysfunction is an early event in obesity probably secondary to endothelial dysfunction and capillaries rarefaction.

Microcirculatory effects of intravenous fluids in critical illness: plasma expansion beyond crystalloids and colloids.

Purpose Of Review: Plasma expanders are reviewed to determine their ability to restore microvascular function as a means for extending the transfusion trigger and delaying the use of blood transfusions. This outcome is currently achievable because of the emergence of a new understanding of optimal tissue function that prioritizes maintenance of functional capillary density, which results from the normalization of blood viscosity via the increase in plasma viscosity with new viscogenic colloids.

Recent Findings: Use of viscous plasma expanders in experimental models of extreme hemodilution, hemorrhagic shock and endotoxemia shows that the limiting factor in anemia is not oxygen-carrying capacity but the decline of microvascular function due to the lowering of functional capillary density.

Microcirculatory effects of changing blood hemoglobin oxygen affinity during hemorrhagic shock resuscitation in an experimental model.

Microvascular responses to blood volume restitution using red blood cells (RBCs) with modified hemoglobin (Hb) oxygen affinity were studied in the hamster window chamber model during resuscitation from hemorrhagic shock. Allosteric effectors inositol hexaphosphate and 5-hydroxymethyl-2-furfural were introduced into the RBCs by electroporation to decrease and increase Hb-oxygen affinity. In vitro P50s (partial pressure of oxygen at 50% Hb saturation) were modified to 10 and 50 mmHg (normal P50, 32 mmHg).