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Assessment of the regenerative potential of macro-porous chitosan-calcium simvastatin scaffolds on bone cells
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GALLINARI, Marjorie de Oliveira

; BORDINI, Ester Alves Ferreira

; STUANI, Vitor de Toledo

; CASSIANO, Fernanda Balestrero

; MELO, Camila Correa da Silva Braga de

; ALMEIDA, Juliano Milanezi de

; CINTRA, Luciano Tavares Ângelo

; DE SOUZA COSTA, Carlos Alberto

; SOARES, Diana Gabriela

Brazilian Oral Research

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2023, Volume 37 elocation e018

Abstract: En | Text: En | PDF: En

Abstract This study evaluated the bioactive potential of a macro-porous chitosan scaffold incorporated with calcium hydroxide (CH-Ca) and functionalized with bioactive doses of simvastatin (SV) for bone tissue regeneration. Initially, the bioactive dose of SV in osteoblastic cells (SAOS-2) was determined. For the direct contact experiment, SAOS-2 cells were plated on scaffolds to assess cell viability and osteogenic differentiation. The second assay was performed at a distance using extracts from scaffolds incubated in culture medium to assess the effect of conditioned medium on viability and osteogenic differentiation. The initial screening showed that 1 μM SV presented the best biostimulating effects, and this dose was selected for incorporation into the CH-Ca and pure chitosan (CH) scaffolds. The cells remained viable throughout the direct contact experiment, with the greatest cell density in the CH-Ca and CH-Ca-SV scaffolds because of their higher porosity. The CH-Ca-SV scaffold showed the most intense bio-stimulating effect in assays in the presence and absence of osteogenic medium, leading to an increased deposition of mineralized matrix. There was an increase in the viability of cells exposed to the extracts for CH-Ca, CH-SV, and CH-Ca-SV during the one-day period. There was an increase in ALP activity in the CH-Ca and CH-Ca-SV; however, the CH-Ca-SV scaffold resulted in an intense increase in the deposition of mineralized nodules, approximately 56.4% at 7 days and 117% at 14 days, compared with CH (control). In conclusion, functionalization of the CH-Ca scaffold with SV promoted an increase in bioactivity, presenting a promising option for bone tissue regeneration.

https://doi.org/10.1590/1807-3107bor-2023.vol37.0018

Bioactivity effects of extracellular matrix proteins on apical papilla cells
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LEITE, Maria Luísa

; SOARES, Diana Gabriela

; ANOVAZZI, Giovana

; Filipe Koon Wu, MON

; BORDINI, Ester Alves Ferreira

; HEBLING, Josimeri

; DE SOUZA COSTA, Carlos Alberto

Journal of Applied Oral Science

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2021, Volume 29 elocation e20210038

Abstract: En | Text: En | PDF: En

Abstract Potent signaling agents stimulate and guide pulp tissue regeneration, especially in endodontic treatment of teeth with incomplete root formation. Objective This study evaluated the bioactive properties of low concentrations of extracellular matrix proteins on human apical papilla cells (hAPCs). Methodology Different concentrations (1, 5, and 10 µg/mL) of fibronectin (FN), laminin (LM), and type I collagen (COL) were applied to the bottom of non-treated wells of sterilized 96-well plates. Non-treated and pre-treated wells were used as negative (NC) and positive (PC) controls. After seeding the hAPCs (5×103 cells/well) on the different substrates, we assessed the following parameters: adhesion, proliferation, spreading, total collagen/type I collagen synthesis and gene expression (ITGA5, ITGAV, COL1A1, COL3A1) (ANOVA/Tukey; α=0.05). Results We observed greater attachment potential for cells on the FN substrate, with the effect depending on concentration. Concentrations of 5 and 10 µg/mL of FN yielded the highest cell proliferation, spreading and collagen synthesis values with 10 µg/mL concentration increasing the ITGA5, ITGAV, and COL1A1 expression compared with PC. LM (5 and 10 µg/mL) showed higher bioactivity values than NC, but those were lower than PC, and COL showed no bioactivity at all. Conclusion We conclude that FN at 10 µg/mL concentration exerted the most intense bioactive effects on hAPCs.

https://doi.org/10.1590/1678-7757-2021-0038 94 downloads

Simvastatin-Enriched Macro-Porous Chitosan-Calcium-Aluminate Scaffold for Mineralized Tissue Regeneration
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Cassiano, Fernanda Balestrero

; Soares, Diana Gabriela

; Bordini, Ester Alves Ferreira

; Anovazzi, Giovana

; Hebling, Josimeri

; Costa, Carlos Alberto de Souza

Brazilian Dental Journal

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aug 2020, Volume 31 N. 4 Pages 385 - 391

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O presente estudo avaliou o potencial odontogênico de células da polpa dental humana (HDPCs) em contato com scaffolds de quitosana contendo aluminato de cálcio (CHAlCa) associado ou não à baixas dosagens de sinvastatina (SV). Scaffolds de quitosana receberam uma suspensão de aluminato de cálcio e foram imersos em soluções contendo a droga. Foram estabelecidos três grupos experimentais: scaffolds de quitosana e aluminato de cálcio (CHAlCa - controle), scaffolds de quitosana-aluminato de cálcio com 0.5 µM SV (CHAlCa-SV0.5), e quitosana-aluminato de cálcio com 1.0 µM SV (CHAlCa-SV1.0). A morfologia e composição foram avaliados por MEV e EDS, respectivamente. Após 14 dias do cultivo das HDPCs sobre os scaffolds, foram avaliados a viabilidade celular, adesão e espalhamento, deposição de matriz mineralizada e expressão gênica de marcadores odontogênicos. Observou-se que as partículas de aluminato de cálcio foram incorporadas à matriz de quitosana, a qual exibiu poros regulares distribuídos por toda sua estrutura. As dosagens selecionadas de sinvastatina foram biocompatíveis com as HDPCs. A concentração de 1 µM de SV induziu intensa expressão de fenótipo odontoblástico pelas HDPCs, demonstrando aumento da deposição de matriz mineralizada e maior expressão de ALP, Col1A1 e DMP-1. Portanto, podemos concluir que a incorporação de aluminato de cálcio e sinvastatina em scaffolds de quitosana apresentou um efeito sinérgico nas HDPCs, favorecendo a diferenciação celular e deposição de matriz mineralizada.

Abstract The present study evaluated the odontogenic potential of human dental pulp cells (HDPCs) exposed to chitosan scaffolds containing calcium aluminate (CHAlCa) associated or not with low doses of simvastatin (SV). Chitosan scaffolds received a suspension of calcium aluminate (AlCa) and were then immersed into solutions containing SV. The following groups were established: chitosan-calcium-aluminate scaffolds (CHAlCa - Control), chitosan calcium-aluminate with 0.5 µM SV (CHAlCa-SV0.5), and chitosan calcium-aluminate with 1.0 µM SV (CHAlCa-SV1.0). The morphology and composition of the scaffolds were evaluated by SEM and EDS, respectively. After 14 days of HDPCs culture on scaffolds, cell viability, adhesion and spread, mineralized matrix deposition as well as gene expression of odontogenic markers were assessed. Calcium aluminate particles were incorporated into the chitosan matrix, which exhibited regular pores homogeneously distributed throughout its structure. The selected SV dosages were biocompatible with HDPCs. Chitosan-calcium-aluminate scaffolds with 1 µM SV induced the odontoblastic phenotype in the HDPCs, which showed enhanced mineralized matrix deposition and up-regulated ALP, Col1A1, and DMP-1 expression. Therefore, one can conclude that the incorporation of calcium aluminate and simvastatin in chitosan scaffolds had a synergistic effect on HDPCs, favoring odontogenic cell differentiation and mineralized matrix deposition.

https://doi.org/10.1590/0103-6440202003252 853 downloads

Increased whitening efficacy and reduced cytotoxicity are achieved by the chemical activation of a highly concentrated hydrogen peroxide bleaching gel
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SOARES, Diana Gabriela

; MARCOMINI, Natália

; DUQUE, Carla Caroline de Oliveira

; BORDINI, Ester Alves Ferreira

; ZUTA, Uxua Ortecho

; BASSO, Fernanda Gonçalves

; HEBLING, Josimeri

; COSTA, Carlos Alberto de Souza

Journal of Applied Oral Science

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2019, Volume 27 elocation e20180453

Abstract: En | Text: En | PDF: En

Abstract Objective This study was designed for the chemical activation of a 35% hydrogen peroxide (H2O2) bleaching gel to increase its whitening effectiveness and reduce its toxicity. Methodology First, the bleaching gel - associated or not with ferrous sulfate (FS), manganese chloride (MC), peroxidase (PR), or catalase (CT) - was applied (3x 15 min) to enamel/dentin discs adapted to artificial pulp chambers. Then, odontoblast-like MDPC-23 cells were exposed for 1 h to the extracts (culture medium + components released from the product), for the assessment of viability (MTT assay) and oxidative stress (H2DCFDA). Residual H2O2 and bleaching effectiveness (DE) were also evaluated. Data were analyzed with one-way ANOVA complemented with Tukey’s test (n=8. p<0.05). Results All chemically activated groups minimized MDPC-23 oxidative stress generation; however, significantly higher cell viability was detected for MC, PR, and CT than for plain 35% H2O2 gel. Nevertheless, FS, MC, PR, and CT reduced the amount of residual H2O2 and increased bleaching effectiveness. Conclusion Chemical activation of 35% H2O2 gel with MC, PR, and CT minimized residual H2O2 and pulp cell toxicity; but PR duplicated the whitening potential of the bleaching gel after a single 45-minute session.

https://doi.org/10.1590/1678-7757-2018-0453 1589 downloads

Recommendations for the treatment of migraine attacks - a Brazilian consensus
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Bordini, Carlos Alberto

; Roesler, Célia

; Carvalho, Deusvenir de Souza

; Macedo, Djacir Dantas P.

; Piovesan, Élcio

; Melhado, Eliana Meire

; Dach, Fabiola

; Kowacs, Fernando

; Silva Júnior, Hilton Mariano da

; Souza, Jano Alves de

; Maciel Jr, Jayme Antunes

; Carvalho, João José de Freitas de

; Speciali, José Geraldo

; Barea, Liselotte Menke

; Queiroz, Luiz Paulo

; Ciciarelli, Marcelo Cedrinho

; Valença, Marcelo Moraes

; Lima, Márcia Maria Ferreira

; Vincent, Maurice Borges

; Jurno, Mauro Eduardo

; Monzillo, Paulo Helio

; Moreira Filho, Pedro Ferreira

; Domingues, Renan

Arquivos de Neuro-Psiquiatria

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mar 2016, Volume 74 N. 3 Pages 262 - 271

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Neste artigo um grupo de especialistas no tratamento de cefaleia da Sociedade Brasileira de Cefaleia através de um consenso elaborou medidas estratérgicas para tratar uma crise de migrânea tanto na criança como no adulto. Uma enfase particular foi dada no tratamento da migranea na mulher, incluindo gravidez, lactação e período perimenstrual.

ABSTRACT In this article, a group of experts in headache management of the Brazilian Headache Society developed through a consensus strategic measurements to treat a migraine attack in both the child and the adult. Particular emphasis was laid on the treatment of migraine in women, including at pregnancy, lactation and perimenstrual period.

https://doi.org/10.1590/0004-282X2015021 10965 downloads

Latin American consensus on guidelines for chronic migraine treatment
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Giacomozzi, Alex Rodrigo Espinoza

; Vindas, Alexander Parajeles

; Junior, Ariovaldo Alberto da Silva

; Bordini, Carlos Alberto

; Buonanotte, Carlos Federico

; Roesler, Célia Aparecida de Paula

; Brito, Cláudio Manoel

; Perez, Cristina

; Carvalho, Deusvenir de Souza

; Macedo, Djacir Dantas Pereira de

; Piovesan, Elcio Juliato

; Sarmento, Elder Machado

; Melhado, Eliana Meire

; Éckeli, Fabíola Dach

; Kowacs, Fernando

; Sobrino, Fidel

; Rabello, Getúlio Daré

; Rada, Grisel

; Souza, Jano Alves de

; Casanovas, Juana Rosa

; Durán, Juan Carlos

; Calia, Leandro Cotoni

; Medina, Luis Roberto Partida

; Queiroz, Luiz Paulo de

; Ciciarelli, Marcelo Cedrinho

; Valença, Marcelo Moraes

; Cusicanqui, Maria

; Jimenez, Maria Karina Velez

; Goycochea, Maria Tereza

; Peres, Mário Fernando Prieto

; Sandoval, Mario Victor Fuentealba

; Vincent, Maurice Borges

; Gomes, Michel Volcy

; Diez, Mónica

; Aranaga, Nayeska

; Barrientos, Nelson

; Kowacs, Pedro André

; Filho, Pedro Ferreira Moreira

Arquivos de Neuro-Psiquiatria

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jul 2013, Volume 71 N. 7 Pages 478 - 486

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

https://doi.org/10.1590/0004-282X20130066 11632 downloads

Pressure pain threshold in the craniocervical muscles of women with episodic and chronic migraine: a controlled study
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Grossi, Débora Bevilaqua

; Chaves, Thais Cristina

; Gonçalves, Maria Claudia

; Moreira, Viviane Coimbra

; Canonica, Alexandra Carolina

; Florencio, Lidiane Lima

; Bordini, Carlos Alberto

; Speciali, José Geraldo

; Bigal, Marcelo Eduardo

Arquivos de Neuro-Psiquiatria

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aug 2011, Volume 69 N. 4 Pages 607 - 612

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Estimar os valores de limiar de dor por pressão (LDP) dos músculos craniocervicais de mulheres com migrânea episódica (ME) n=15 e crônica (MC) n=14, e em voluntários controles saudáveis (C) n=15. MÉTODO: O LDP foi obtido bilateralmente por examinadores cegos através da algometria de pressão nos seguintes músculos: frontal, temporal, masseter, trapézio e esternocleidomastóideo. Para análise estatística foi utilizada a ANOVA (p<0.05). RESULTADOS: Em relação aos controles, pacientes com ME apresentaram redução significativa do LDP para os músculos: frontal (ME: 2,01±0,67 vs. C: 2,85±0,71), temporal posterior bilateralmente (direito e esquerdo, respectivamente) (ME: 2,72±0,89 vs. C: 3,36±0,72 e ME: 2,60±1,00 vs. C: 3,35±0,85), trapézio superior bilateralmente (ME: 2,69±1,00 vs. C: 3,49±0,83 e ME: 2,54±0,93 vs. C: 3,32±0,97) e mulheres com MC: no músculo frontal bilateralmente (MC: 2,16±0,52 vs. C: 2,79±0,71 e MC: 2,01±0,67 vs. C: 2,85±0,71) e trapézio superior (MC: 2,66±0,84 vs. C: 3,32±0,97). Entretanto não foram verificadas diferenças entre os valores de LDP entre os grupos ME e MC. CONCLUSÃO: O LDP mostrou-se reduzido em mulheres com migrânea episódica ou crônica em relação aos controles. Em estudos futuros, esse parâmetro pode ser estudado como marcador da migrânea e indicador de efeito de tratamento.

OBJECTIVE: To estimate the pressure pain threshold (PPT) of the craniocervical muscles in women with episodic migraine (EM) n=15 and chronic migraine (CM) n=14, and in healthy volunteers (C) n=15. METHOD: A blinded examiner obtained the PPT bilaterally, by pressure algometry, for the following muscles: frontalis, temporalis, masseter, trapezius and sternocleidomastoid. ANOVA (p<0.05) was used for statistical purposes. RESULTS: Contrasted to controls, individuals with EM had significantly decreased PPT values for frontal muscle (EM: 2.01±0.67 vs. C: 2.85±0.71), posterior temporalis bilaterally (right and left, respectively) (EM: 2.72±0.89 vs. C: 3.36±0.72 and EM: 2.60±1.00 vs. C: 3.35±0.85), upper trapezius bilaterally (EM: 2.69±1.00 vs. C: 3.49±0.83 and EM: 2.54±0.93 vs. C: 3.32±0.97) and women with CM: on frontal muscle bilaterally (CM: 2.16±0.52 vs. C: 2.79±0.71 and CM: 2.01±0.67 vs. C: 2.85±0.71) and upper trapezius (CM: 2.66±0.84 vs. C: 3.32±0.97), however, it was not verified differences between PPT values between EM and CM groups. CONCLUSION: PPT is decreased in women with migraine relative to controls. Future studies should explore this parameter as a biological marker of the disease and a predictor of treatment.

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SUNCT syndrome: report of a possible symptomatic case
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Rodrigues, Guilherme Gustavo Riccioppo

; Bordini, Carlos Alberto

; Dach, Fabíola

; Eckeli, Alan

; Speciali, José Geraldo

Arquivos de Neuro-Psiquiatria

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sep 2007, Volume 65 N. 3b Pages 852 - 854

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

SUNCT é uma das mais raras e menos conhecidas cefaléias primárias. Embora sua patogênese esteja parcialmente compreendida por neuroimagem funcional e relatos de casos secundários, há insuficiente conhecimento a respeito de sua causa. Nós relatamos um caso de SUNCT em um homem de 54 anos, que não poderia ser estritamente classificado como SUNCT secundário; entretanto, o lapso de tempo para o início da dor sugere uma nova hipótese na qual a neuroplasticidade possa esta envolvida na origem e duração da dor na síndrome SUNCT.

SUNCT is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of SUNCT in a 54-years-old man, that could not be strictly classified as secondary SUNCT; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in SUNCT syndrome.

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Ventricular arteriovenous malformation bleeding: a rare cause of headache in children. Case report
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Silva, Hilton Mariano da

; Silva, Luciano Ricardo França da

; Paschoal, Eric Homero Albuquerque

; Chaddad Neto, Feres Eduardo Aparecido

; Bordini, Carlos Alberto

; Speciali, José Geraldo

Arquivos de Neuro-Psiquiatria

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jun 2004, Volume 62 N. 2b Pages 528 - 530

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Cefaléia como queixa principal raramente ocorre num serviço de emergência pediátrica. Quando isso acontece, casos de cefaléia secundária que trazem risco de vida, tais como a hemorragia subaracnóide são raramente relatados. Apresentamos o caso de uma criança que apresentou cefaléia de forte intensidade associada a rigidez de nuca, sem outras anormalidades no exame físico. A angioressonância e angiografia digital evidenciaram malformação arteriovenosa na topografia do plexo coróide do ventrículo lateral direito, nutrida pela artéria coroidéia anterior, grau III na classificação de Spetzler (drenagem venosa profunda: 1; área de eloqüência: 0 e tamanho: 2). Nós discutimos as diferenças na apresentação clínica das malformações arteriovenosas encefálicas nas crianças e adultos.

Headache as a chief complaint is rare in the paediatric emergency room. Actually, very seldom cases secondary to life threatening conditions as non-traumatic subarachnoid haemorrhage have been reported. A child with severe headache and nuchal rigidity and no other abnormalities on the physical examination is reported. Magnetic resonance angiography and cerebral angiography disclosed a ventricular arteriovenous malformation in the choroid plexus, supplied by the anterior choroidal artery, classified according to Spetzler grading system as grade 3 (deep venous drainage: 1; eloquence area: 0 and size: 2). The differences in the clinical presentations of the central nervous system arteriovenous malformation between children and adults are discussed.

4549 downloads

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Intravenous chlorpromazine in the acute treatment of episodic tension-type headache: a randomized, placebo controlled, double-blind study
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Bigal, Marcelo Eduardo

; Bordini, Carlos Alberto

; Speciali, José Geraldo

Arquivos de Neuro-Psiquiatria

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sep 2002, Volume 60 N. 3A Pages 537 - 541

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Cefaléia aguda é queixa frequente, responsável por percentual significativo dos casos atendidos em unidades básicas de saúde e unidades de emergência. A clorpromazina é droga usualmente disponível nessas unidades. Apresentamos dados de estudo randomizado, controlado por placebo e com mascaramento duplo, que avaliou a eficácia da clorpromazina no tratamento agudo da cefaléia do tipo tensional episódica. Trinta pacientes foram randomizados para receber placebo (10 ml de solução salina endovenosa) e 30 pacientes para receber clorpromazina endovenosa, na dose de 0,1 mg/Kg. Foram usados 7 parâmetros de avaliação analgésica. Pacientes que receberam clorpromazina mostraram significativa redução da dor quando comparados com o grupo placebo (p < 0,05 and p < 0,01), 30 minutos após a administração da droga. O ganho terapêutico foi de 36,7% em 30 minutos e 56,6 % em 60 minutos. O número que se necessita tratar (NNT, a recíproca do ganho terapêutico) foi 2,7 em 30 minutos e 1,8 em 60 minutos. Houve redução nos índices de recorrência e de utilização de medicação de resgate no grupo que recebeu clorpromazina. Podemos concluir que clorpromazina em administração parenteral é droga efetiva para o alívio da dor de pacientes com cefaléia do tipo tensional, seu uso sendo justificado nesses casos.

Acute headache is a very frequent symptom, responsible for a significant percentage of caseload at primary care units and emergency rooms. Chlorpromazine is easily available in such settings. The aim of this study is to conduct a randomized, placebo-controlled, double-blind study to assess the efficacy of chlorpromazine on the acute treatment of episodic tension-type headache. We randomized 30 patients to receive placebo (10 ml of saline intravenous injections) and 30 patients to receive 0.1 mg/Kg chlorpromazine intravenously. We used 7 parameters of analgesic evaluation. Patients receiving chlorpromazine showed a statistically significant improvement (p < 0.05 and p < 0.01) of pain compared to placebo, far up to 30 minutes after the drug administration. The therapeutic gain was 36.7% in 30 minutes and 56.6 % in 60 minutes. The number needed to treat (NNT, the reciprocal or the therapeutic gain) was 2.7 in 30 minutes and 1.8 in 60 minutes. There were reductions in the recurrence and in the use of rescue medication in the chlorpromazine group. We can conclude that intravenous chlorpromazine is an effective drug to relief the pain in tension-type headache.

3538 downloads

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Avaliação da utilização do placebo nas crises agudas de migrânea sem aura, migrânea com aura e cefaléia do tipo tensional episódica
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Bigal, Marcelo Eduardo

; Bigal, Janaína Oline Maciel

; Bordini, Carlos Alberto

; Speciali, José Geraldo

Arquivos de Neuro-Psiquiatria

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sep 2001, Volume 59 N. 3A Pages 552 - 558

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O presente estudo apresenta a avaliação do efeito placebo no tratamento agudo da migrânea sem aura, migrânea com aura e cefaléia do tipo tensional episódica. Foram estudados pacientes que deram entrada entre 1 de março de 1997 a 31 de novembro de 1999 em dois pronto-socorros. Definiram-se três grupos, cada um com 30 pacientes: 1 - migrânea sem aura (MSA); 2 -- migrânea com aura (MCO); 3 -- cefaléia do tipo tensional episódica (CTTE). Os pacientes participavam de estudo randomizado para avaliar a eficácia de 4 drogas; aqueles randomizados para o placebo foram incluídos também. Os parâmetros avaliados foram: 1 -- dor; 2 - sintomas associados. Avaliados uma hora após a administração do placebo, 50% dos pacientes do grupo MSA, 23,3% dos pacientes do grupo MCA e 26,7% dos pacientes do grupo CTTE apresentavam melhora da dor. A melhora, avaliada pela escala numérica da dor foi, em média, de 41,6%, 23,1% e 36%, respectivamente. Houve também redução significativa de todos os sintomas associados. A utilização do placebo é, portanto, essencial na avaliação de drogas utilizadas no tratamento de cefaléias agudas.

This study presents an evaluation of placebo response in the acute treatment of migraine with or without aura and episodic tension type headache. We studied patients admitted between March 1st,1997 and November 31st,1999 in two Emergency Room Units. Three groups had been defined, each one with 30 participants: migraine without aura (MWOA), migraine with aura (MWA) and episodic tension-type headache (ETTH). Patients were participating of a randomized study to evaluate efficacy of 4 different drugs; those randomized to receive placebo were included. We evaluated pain and associated symptoms. After one hour of placebo administration, 50% of MWOA patients, 23.3% of MWA and 26.7% of ETTH had presented pain relief. The mean of this relief, evaluated by the numerical pain scale, was 41.6%, 23.1% and 36%, respectively. Use of placebo is essential in evaluating the therapeutic role of drugs used in the treatment of acute headache.

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12.

Prevalência e impacto da migrânea em funcionários do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP
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BIGAL, MARCELO EDUARDO

; FERNANDES, LUCIANA CAMPANER

; MORAES, FÁBIO A.

; BORDINI, CARLOS ALBERTO

; SPECIALI, JOSÉ GERALDO

Arquivos de Neuro-Psiquiatria

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jun 2000, Volume 58 N. 2B Pages 431 - 436

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Cefaléia é sintoma comum na população, com prevalência ao longo da vida superior a 90%. Acarreta importante impacto na qualidade de vida de seus portadores. O presente estudo tem por objetivo avaliar a prevalência da migrânea entre trabalhadores de um hospital universitário, bem como mensurar a intensidade, interferência e impacto dela em algumas atividades cotidianas. Um total de 1890 funcionários respondeu a questionário que possibilitava o diagnóstico da migrânea. A prevalência dessa cefaléia ao longo da vida foi 30,4%. A dor foi considerada como intensa, na maioria das vezes, por 86% dos migranosos. Verificou-se impacto importante em aspectos da vida cotidiana tanto durante como no intervalo das crises de dor. Conclui-se que a migrânea representa problema de saúde pública entre os funcionários do HC. Por acarretar importante impacto na qualidade de vida desses trabalhadores, é possível haver diminuição da capacidade laborativa deles, com prejuízo econômico considerável. Cremos que este problema mereça, portanto, atenção especial, através de melhor diagnóstico e tratamento.

Headache is a common symptom in the population, with a life prevalence around 90%. It results in an important impact in the life quality of sufferers. The aim of this study is to evaluate the prevalence of migraine among employees of an university hospital (HC), as well as to measure the headache intensity, interference and impact in the daily activities. A total of 1890 employees had answered to a questionnaire which made possible to carry out diagnosis of migraine. Life prevalence of this headache type was 30.4%. Pain was considered intense, most of the time, by 86% of the migraneurs . It was verified an important impact in the daily life aspects as much during as between the headache attacks. It can be concluded that migraine represents a public health problem among the HC employees. Because migraine brings about an important impact in the life quality of those workers, it is possible that a reduction of working capacity with considerable economic burden exists. This problem deserves, thus, special attention, through a better diagnostic and treatment.

3142 downloads Cited 4 times in SciELO

13.

Headache in an emergency room in Brazil
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Bigal, Marcelo

; Bordini, Carlos Alberto

; Speciali, José Geraldo

Sao Paulo Medical Journal

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may 2000, Volume 118 N. 3 Pages 58 - 62

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO: Quando em crise de cefaléia, pacientes brasileiros geralmente dirigem-se a uma unidade básica de saúde, onde são atendidos por clínicos gerais. Na cidade de Ribeirão Preto, os clínicos rotineiramente referem os pacientes para a Unidade de Emergência (UE) do Hospital das Clínicas. OBJETIVO: Avaliar a qualidade do serviço primário, analisando retrospectivamente o prontuário de pacientes que procuraram a EU, no ano de 1996, com queixa de cefaléia. TIPO DE ESTUDO: Estudo retrospectivo. LOCAL: Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. PARTICIPANTES: 1.254 pacientes. Os pacientes da Unidade de Emergência do hospital da Universidade de Ribeirão Preto durante o ano de 1996 com crise de cefaléia foram estudados retrospectivamente. VARIÁVEIS ESTUDADAS: Etiologia, idade, diagnóstico, causa secundária e testes laboratoriais. RESULTADOS: Dos 1254 pacientes vistos (61% mulheres), 1190 (94,9%) tiveram alta, após a administração de analgésicos parenterais, com menos de 12 horas da admissão. Apenas 64 pacientes (5,1%) permaneceram mais de 12 horas. Dos que ficaram menos de 12 horas, 71,5% apresentavam migrânea ou cefaléia tipo tensional e não necessitaram exames subsidiários. Dos que permaneceram mais de 12 horas, 70,3% apresentavam cefaléias secundárias. CONCLUSÃO: Concluímos que o serviço primário é ineficaz, para a cefaléia, na região de Ribeirão Preto. Muitos pacientes com cefaléia primária são referidos para centros terciários, indicando a necessidade urgente da divulgação dos critérios diagnósticos da Sociedade Internacional de Cefaléia para clínicos gerais.

CONTEXT: When experiencing a headache attack, Brazilian patients usually look for a primary care service, where they are seen by general clinicians. In the town of Ribeirão Preto, these clinicians routinely refer patients to the Emergency Room of the University Hospital. OBJECTIVE: The objective of this study was to evaluate the quality of primary care by analyzing retrospectively the medical records of patients with a complaint of headache seen in this emergency room during the year of 1996. DESIGN: retrospective study. SETTIING: Emergency Room of the Universital Hospital, Ribeirão Preto, São Paulo, reference unit. PARTICIPANTS:1254 patients. The patients who sought the Emergency Room (ER) of the University Hospital of Ribeirão Preto, during the year of 1996 with a complaint of headache were studied retrospectively. MAIN MEASUREMENTS: Etiology, age, diagnosis, secondary cause, laboratory tests. RESULTS: Of the 1254 patients seen (61% women), 1190 (94.9%) were discharged after the administration of parenteral analgesics before they had spent 12 hours in the room. Only 64 (5.1%) patients remained for more than 12 hours. Of the patients who spent less than 12 hours in the room, 71.5% had migraine or tension type headache and did not require subsidiary exams for diagnosis. Of the patients who spent more than 12 hours in the room, 70.3% had secondary headaches. CONCLUSIONS: We conclude the primary care for headache is unsatisfactory in the Ribeirão Preto region. Many patients with primary headache are referred to tertiary care services, indicating the need for the dissemination of the diagnostic criteria of the International Headache Society to general practitioners.

2746 downloads Cited 4 times in SciELO

14.

Tratamento da cefaléia em uma unidade de emergência da cidade de Ribeirão Preto
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BIGAL, MARCELO EDUARDO

; BORDINI, CARLOS ALBERTO

; SPECIALI, JOSÉ GERALDO

Arquivos de Neuro-Psiquiatria

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sep 1999, Volume 57 N. 3B Pages 813 - 819

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Cefaléia é dos sintomas mais comuns na prática clínica. Acarreta considerável impacto econômico e sobrecarrega as unidades de emergência. A maioria destas, em nosso país, não dispõe de triptans. O presente estudo analisa o tratamento instituído na Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto. Em 1996, 1254 pacientes foram atendidos com esta queixa e 64 necessitaram de internação. Dos pacientes não internados (NI), 77% apresentavam cefaléias primárias, contra 29,7% dos pacientes internados (I). A percentagem de melhora nos pacientes com migrânea com a dipirona endovenosa foi 83,8%, com o diclofenaco intramuscular 66,7% e com a clorpromazina (endovenosa) 81,8%. As percentagens de pacientes com cefaléia do tipo tensional que melhoraram, frente às mesmas drogas foram, respectivamente 77,8%, 80% e 100%. Dos NI 16,3% tiveram melhora sem qualquer tratamento medicamentoso. Concluímos que as drogas utilizadas apresentam perfis semelhantes de eficácia e custo, podendo ser utilizadas em unidades básicas de saúde. O maior inconveniente é a administração parenteral.

Headache is one of the most common symptoms observed in clinical practice. It has a considerable economic impact and overburdens emergency rooms. In Brazil, most emergency rooms have no tryptans. The present study analyses the treatment provided by the Emergency Room of the University Hospital of Ribeirão Preto. In 1996, 1254 patients were treated for headache and 64 of them required hospitalization. Of the non-hospitalized (NH) patients, 77% had primary headache, as opposed to 29.7% of hospitalized patients. Of the patients with migraine, 83.6% improved with intravenous dipyrone, 66.7% improved with intramuscular diclofenac and 81.8% improved with intravenous chlorpromazine. The percentages of patients with tension-type headache who improved with the same drugs were 77.8%, 80% and 100%, respectively. Among NH patients, 16.3% improved without any medication. We conclude that the drugs used have similar efficacy profiles and costs and can be used at basic health unities. The major drawback is parenteral administration.

5340 downloads Cited 8 times in SciELO

15.

Propranolol vs flunarizine vs flunarizine plus propranolol in migraine without aura prophylaxis. a double-blind trial
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Bordini, Carlos Alberto

; Arruda, Marco Antônio

; Ciciarelli, Marcelo Cedrinho

; Speciali, José Geraldo

Arquivos de Neuro-Psiquiatria

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sep 1997, Volume 55 N. 3B Pages 536 - 541

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Quarenta e cinco pacientes com migrânea sem aura submeteram-se a ensaio paralelo e duplo-cego visando comparar os efeitos de propranolol (PPN), flunarizina (FNZ) e uso associado de propranolol mais flunarizina. Foram divididos em três grupos de 15 indivíduos. Após período preliminar de 20 dias sem a administração de qualquer droga, um grupo recebeu PPN 60 mg/dia, outro grupo FNZ 10 mg/dia, e o terceiro grupo PPN 60 mg/dia associado à FNZ 10 mg/dia. O tempo de tratamento foi 120 dias. O índice de dor no grupo sob PPN passou de 39,3 para 23,4 (p<0,05) no grupo sob FNZ de 33,7 para 18,7 (p<0,05) e no grupo recebendo ambas as drogas de 33,5 para 14,4 (p<0,05). Não houve diferenças entre os índices de dor dos três grupos após o tratamento. A frequência de crises no grupo sob PPN passou de 2,8 para 1,26 (p<0,01) no grupo sob FNZ de 2,6 para 1,2 (p<0,01) e no grupo recebendo ambas as drogas de 2,9 para 1,13 (p<0,01). Não houve diferenças entre as frequências de crises dos três grupos após o tratamento. Foram confirmadas as eficácias dessas drogas na profilaxia da migrânea sem aura. A associação das drogas não logrou benefício ulterior no que concerne à diminuição dos índices de dor ou da frequência de crises. Entretanto, na avaliação global por parte do paciente, os melhores resultados estavam entre os que usaram duas drogas. Nos grupos que usaram FNZ (isolada ou associada ao PPN), as melhoras alcançadas persistiram mesmo após 45 dias da retirada dos fármacos.

Fourty-five migraine without aura patients underwent a parallel double-blind trial aiming the comparison of the effects of propranolol 60 mg/day to flunarizine 10 mg/day and to propranolol 60 mg/day plus flunarizine 10 mg/day simultaneously. There were 3 groups, each one with 15 patients. After a 20-day-baseline period, each group received one kind of treatment during 120 days. Migraine index on propranolol was 23.4*. on flunarizine 18.7* and on both drugs 14.4*, mean frequency of attacks on propranolol was 1.26**, on flunarizine 1.2** and on both drugs 1.13** (*p<0.05, ** p < 0.01 compared to baseline) and global evaluation was reduced with all forms of treatment. It was not found statistical differences between groups, nevertheless there was a trend in the group using two drugs reaching lower values in migraine index, frequency of attacks and global evaluation. In individuals using flunarizine (alone or associated with propranolol) the therapeutic effect was largely maintained up to 45 days after drug withdrawal.

6265 downloads Cited 1 time in SciELO

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