The combined effect of acupuncture and Tanacetum parthenium on quality of life in women with headache: randomised study

Background The aim of the present study was to investigate the efficacy and tolerability of acupuncture (AC), Tanacetum (TAN) or combined treatment on quality of life in women with chronic migraine (CM). Methods A total of 69 women volunteers were randomly divided into 3 groups: AC, acupuncture administered in 20 sessions over 10 weeks (n=22); TAN, at 150 mg/day (n=23); and AC+TAN (n=23). The primary outcome was Short-Form 36 (SF-36) quality of life assessment score. Secondary outcomes included the Migraine Disability Assessment (MIDAS) and visual analogue scale (VAS) score experienced after randomisation. Results AC+TAN was statistically significantly more effective than AC or TAN alone in overall health-related quality of life (SF-36; p<0.05), on MIDAS score (-35.1 (10.6) AC vs -24.8 (11.7) TAN vs -42.5 (9.8) AC+TAN; p<0.05) and in reducing the mean score of pain on VAS (-5.6 (2.4) AC vs -3.7 (2.1) TAN vs -6.4 (3.1) AC+TAN; p<0.05). Conclusions The present work shows an improvement of the quality of life and better analgesic effect of acupuncture combined with TAN treatment on migraine pain in women when compared with acupuncture or TAN alone.

Clinical Effects of Scalp Electrical Acupuncture in Stroke: A Sham-Controlled Randomized Clinical Trial

Objectives: The majority of individuals who survive a stroke are disabled because of persisting neurological impairments. The objective of this study was to evaluate the efficacy of subcutaneous electrical stimulation of the scalp in spontaneous functional recovery of patients with chronic ischemic stroke, by evaluating clinical, neurological, and functional findings. Subjects and methods: Sixty-two (62) subjects who were at least 18 months postdiagnosis of ischemic stroke were randomized to receive 10 sessions of placebo or active low-frequency electrical stimulation (2/100 Hz) using subcutaneous acupuncture needles over the scalp. Functional and neurological evaluations were indexed by the Barthel, Rankin, and National Institutes of Health Stroke Scale (NIHSS). Results: Results show that there was a significant difference in functional improvement between the sham and active group as indexed by NIHSS scale. The active group had a larger functional improvement after 10 sessions of scalp electrical acupuncture. The other two functional scales (Rankin and Barthel) failed to show significant differences between the two treatment groups. Conclusions: These results support further testing of scalp electrical acupuncture for the treatment of stroke as well further mechanistic studies to understand mechanisms associated with the observed improvement. Further studies need to consider longer follow-up assessments to investigate potential functional changes associated with electrical acupuncture.

Amitriptyline prolongs the antihyperalgesic effect of 2- or 100-Hz electro-acupuncture in a rat model of post-incision pain

The mechanisms through which electro-acupuncture (EA) and tricyclic antidepressants produce analgesia seem to be complementary: EA inhibits the transmission of noxious messages by activating supraspinal serotonergic and noradrenergic neurons that project to the spinal cord, whereas tricyclic antidepressants affect pain transmission by inhibiting the reuptake of norepinephrine and serotonin at the spinal level. This study utilized the tail-flick test and a model of post-incision pain to compare the antihyperalgesic effects of EA at frequencies of 2 or 100 Hz in rats treated with intraperitoneal or intrathecal amitriptyline (a tricyclic antidepressant). A gradual increase in the tail-flick latency (TFL) occurred during a 20-min period of EA. A strong and long-lasting reduction in post-incision hyperalgesia was observed after stimulation; the effect after 2 Hz lasting longer than after 100-Hz EA. Intraperitoneal or intrathecal amitriptyline potentiated the increase in TFL in the early moments of 2- or 100-Hz EA, and the intensity of the antihyperalgesic effect of 100-Hz EA in both the incised and non-incised paw. In contrast, it did not significantly change the intensity of the antihyperalgesic effect of 2-Hz EA. The EA-induced antihyperalgesic effects lasted longer after intraperitoneal or intrathecal amitriptyline than after saline, with this effect of amitriptyline being more evident after 100-than after 2-Hz EA. The synergetic effect of amitriptyline and EA against post-incision pain shown here may therefore represent an alternative for prolonging the efficacy of EA in the management of post-surgical clinical pain.

SLEEP QUALITY OF OBESE WORKERS OF A TEACHING HOSPITAL: ACUPUNCTURE AS A COMPLEMENTARY THERAPY

The objective of this study was to verify the effect of acupuncture on the sleep quality of obese workers in a teaching hospital. Data were collected from July to October 2009, focusing on 37 workers who attended eight weekly acupuncture sessions. The Pittsburgh Sleep Quality Index was used to assess their sleep quality before and after the intervention. Results show that before the intervention, five (13.5%) people experienced good quality of sleep whereas at the end of the study 14 (37.8%) showed this condition. Statistic significance (p=0.0001) was found in comparing the mean scores obtained before and after acupuncture. Acupuncture had effects on the quality of sleep in the studied sample, presenting itself as a complementary technique for treating sleep disorders and consequently improving the quality of life in this population.

The immediate effects of local and adjacent acupuncture on the tibialis anterior muscle: a human study

Abstract Background This study compares the immediate effects of local and adjacent acupuncture on the tibialis anterior muscle and the amount of force generated or strength in Kilogram Force (KGF) evaluated by a surface electromyography. Methods The study consisted of a single blinded trial of 30 subjects assigned to two groups: local acupoint (ST36) and adjacent acupoint (SP9). Bipolar surface electrodes were placed on the tibialis anterior muscle, while a force transducer was attached to the foot of the subject and to the floor. An electromyograph (EMG) connected to a computer registered the KGF and root mean square (RMS) before and after acupuncture at maximum isometric contraction. The RMS values and surface electrodes were analyzed with Student's t-test. Results Thirty subjects were selected from a total of 56 volunteers according to specific inclusion and exclusion criteria and were assigned to one of the two groups for acupuncture. A significant decrease in the RMS values was observed in both ST36 (t = -3.80, P = 0,001) and SP9 (t = 6.24, P = 0.001) groups after acupuncture. There was a decrease in force in the ST36 group after acupuncture (t = -2.98, P = 0.006). The RMS values did not have a significant difference (t = 0.36, P = 0.71); however, there was a significant decrease in strength after acupuncture in the ST36 group compared to the SP9 group (t = 2.51, P = 0.01). No adverse events were found. Conclusion Acupuncture at the local acupoint ST36 or adjacent acupoints SP9 reduced the tibialis anterior electromyography muscle activity. However, acupuncture at SP9 did not decrease muscle strength while acupuncture at ST36 did.

Interferência da circulação extracorpórea no despertar da anestesia de pacientes submetidos à revascularização do miocárdio

JUSTIFICATIVA E OBJETIVOS: A circulação extracorpórea (CEC) pode alterar a farmacocinética dos fármacos, assim como a função cerebral. Os objetivos deste estudo foram comparar o tempo de despertar e a intensidade da sedação pós-operatória avaliada pelo índice bispectral (BIS) e pela escala de sedação de Ramsay, em pacientes submetidos à revascularização miocárdica (RM) com ou sem CEC. MÉTODO: Dez pacientes submetidos à RM com CEC (Grupo CEC) e 10 sem CEC (Grupo sem CEC) foram anestesiados com sufentanil, infusão alvo-controlada de propofol 2,0 µg.mL-1 e pancuronio. Após a cirurgia diminuiu-se a infusão de propofol para 1 µg.mL-1 que foi suspensa quando da indicação da extubação. Foram avaliados o BIS, a escala de Ramsay e o tempo de despertar dos pacientes. RESULTADOS: O grupo CEC apresentou valores menores de BIS desde 60 minutos após a cirurgia (sem CEC = 66 ± 13 e CEC = 53 ± 14, p = 0,01) até 120 minutos após a infusão (sem CEC = 85 ± 8 e CEC = 73 ± 12, p = 0,02). O nível de sedação pela escala de Ramsay foi maior no grupo CEC nos momentos 30 minutos após o final da cirurgia (sem CEC = 5 ± 1 e CEC = 6 ± 0, p = 0,021), no final da infusão (sem CEC = 5 ± 1 e CEC = 6 ± 1, p = 0,012) e 5 minutos após o final da infusão (sem CEC = 4 ± 1 e CEC = 5 ± 0,42, p = 0,039). O tempo de despertar foi maior no grupo CEC (sem CEC = 217 ± 81 e CEC = 319 ± 118, p = 0,038). CONCLUSÕES: Houve maior intensidade da sedação após o final da cirurgia e o maior tempo de despertar no grupo com CEC, sugerindo alteração na farmacocinética do propofol ou efeitos da CEC sobre o sistema nervoso central.

Body temperature, Aldrete-Kroulik index, and patient discharge from the Post-Anesthetic Recovery Unit

Patient discharge from post-anesthetic recovery (PAR) depends, among other factors, on normothermia and the patient's score on the Aldrete-Kroulik index. The objective of this study was to verify the relationship between the Aldrete-Kroulik index and body temperature in patients. This study was performed at the University of Sao Paulo University Hospital. Convenience sampling was used, and the sample consisted of 60 patients of ages between 18 and 60 years who underwent general anesthesia. The patients' body temperature was obtained by tympanic measurement, and the Aldrete-Kroulik index was measured on admission and at discharge from post-anesthetic recovery. The data were processed using SPSS, considering a significance level of 5%, and the Spearman and Wilcoxon tests were applied. In conclusion, no significant correlation was found between the two parameters for discharge.

Cleft lip and palate: recommendations for dental anesthetic procedure based on anatomic evidences

Patients with cleft lip and palate usually present dental anomalies of number, shape, structure and position in the cleft area and the general dentist is frequently asked to restore or extract those teeth. Considering that several anatomic variations are expected in teeth adjacent to cleft areas and that knowledge of these variations by general dentists is required for optimal treatment, the objectives of this paper are: 1) to describe changes in the innervation pattern of anterior teeth and soft tissue caused by the presence of a cleft, 2) to describe a local anesthetic procedure in unilateral and bilateral clefts, and 3) to provide recommendations to improve anesthetic procedures in patients with cleft lip and palate. The cases of 2 patients are presented: one with complete unilateral cleft lip and palate, and the other with complete bilateral cleft lip and palate. The patients underwent local anesthesia in the cleft area in order to extract teeth with poor bone support. The modified anesthetic procedure, respecting the altered course of nerves in the cleft maxilla and soft tissue alterations at the cleft site, was accomplished successfully and the tooth extraction was performed with no pain to the patients. General dentists should be aware of the anatomic variations in nerve courses in the cleft area to offer high quality treatment to patients with cleft lip and palate.

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment

Purpose: The objective of this study was to compare the estimated cost of clinical and surgical treatment for basl cell carcinoma of the eyelid. Methods: This was a pilot study of 12 patients with basal cell carcinoma receiving treatment with 5% imiquimod cream at the ocular plastic surgery center, medical school University of Sao Paulo (HC-FMUSP, Brazil). The cost of clinical treatment was estimated based on the time of treatment and amount of medication consumed by patients in the home setting. The cost of surgical treatment was estimated by ophthalmologists with experience in reconstructive plastic surgery based on analysis of images of the same patients. Surgeons responded to a questionnaire with four questions about surgical technique, surgical materials required, estimated duration of surgery and type of anesthesia. Results: Immunotherapy lasted from 8 to 12 weeks. All patients reported each cold-stored sachet with 5% imiquimod cream lasted 3 days. According to the institution, a box with 12 sachets costs BRL 480.00. Patients required 1.58-3.11 boxes for complete treatment, corresponding to a total cost of BRL 758.40-1,492.80. Based on image analysis, surgeons evaluated surgery would require 1-3 hours. The estimated cost of surgery room and staff was BRL 263.00, to which the cost of supplies was added. Thus, the total cost of surgical treatment was BRL 272.61-864.82. On the average, immunotherapy was 57,64% more costly than surgical treatment. Conclusions: Malignant eyelid tumors are a common finding in clinical ophthalmology. Surgery is still the treatment of choice at our institution, but immunotherapy with 5% imiquimod cream may be indicated for patients with multiple lesions or high surgical risk and for patients declining surgery for reasons of fear or esthetic concerns. The ability to estimate costs related to the treatment of malignant eyelid tumors is an important aid in the financial planning of health care institutions. Further studies should evaluate the possibility of institutions equating the cost of immunotherapy and surgical treatment by acquiring similar but less expensive medications.

THE APPLICABILITY OF AURICULOTHERAPY WITH NEEDLES OR SEEDS TO REDUCE STRESS IN NURSING PROFESSIONALS

This clinical randomized trial was performed with the objective to evaluate the stress levels of the nursing staff of a hospital and analyze the effectiveness of auriculotherapy with needles and seeds. The 75 participants with mean (44/58.7%) and high (31/41.3%) scores according to the Stress Symptoms List were divided into groups (control, needles, and seeds), who received eight sessions on the Shenmen, Kidney and Brainstem points and were evaluated at the baseline, fourth and eighth sessions and on the 15-day follow-up session. The analysis of variance (ANOVA) showed significant differences among the groups at the third assessment (F=3.963/P=0.023) and follow-up (F=6.136/P=0.003). These differences occurred between the control and needle groups. The 'seeds' and needles groups both showed differences (p < 0.05) at the second assessment when compared within the same group. In conclusion, auriculotherapy reduced the stress in the nursing staff, with needles showing better results than seeds for high scores, maintaining the effects for 15 days.

Eficácia da auriculoterapia para diminuição de estresse em estudantes de enfermagem: ensaio clínico randomizado

Trata-se de estudo clínico randomizado, simples cego, com o objetivo de avaliar a eficácia da auriculoterapia verdadeira e placebo na diminuição dos níveis de estresse em alunos de nível médio, da Escola de Enfermagem do Hospital Beneficência Portuguesa. Setenta e um estudantes com escores médio, alto e altíssimo, pela Lista de Sintomas de Estresse de Vasconcellos, foram divididos em 3 grupos: controle (25), auriculoterapia (24) e placebo/Sham (22). Foram avaliados, no início, com 8, 12 sessões e follow-up (15 dias) e receberam os pontos Shen Men, tronco cerebral (auriculoterapia) e punho e ouvido externo (placebo/Sham). Na análise de variância (Anova) constataram-se diferenças estatísticas significativas entre os grupos controle/auriculoterapia a partir de 8 sessões, mantendo-se após a terceira e a quarta avaliação (p=0,000) e entre controle/placebo (p<0,05), nas três avaliações. Concluiu-se que a auriculoterapia verdadeira obteve melhores respostas (45,39%) do que o placebo (34,18%) na redução do estresse, mas recomendam-se mais estudos para reavaliação de pontos Sham para estresse. ClinicalTrials.gov Identifier: NCT01420848.

Morphological and Biometric Study of the Infraorbital Foramen (E2-Sibai Point) in Adult Skulls

The objective of this work was to study the morphology and biometry of the infraorbital foramen (FIO), variations in its shape, size and number as well as to obtain measurements of its location. 60 dry skulls were analyzed. The test of Qui-quadrant and the T Test were used in measurements with a 5% significance. On the right side, the FIO was measured at a distance of 6.49(+/- 1.68) mm from the lower, 39.65(+/- 3) mm from the upper, 17.7(+/- 2.97) mm from the medial and 20.46(+/- 2.9) mm from the lateral margin of the orbit; its pear-shaped opening distance was 13.67(+/- 2.17) mm. On the left side, the distance of the FIO to the lower margin of the orbit was 6.52(+/- 1.82) mm; to the upper margin was 39.9(+/- 2.62) mm and to the lateral and medial margin were 17.93(+/- 2.58) mm and 21.12(+/- 3) mm, respectively; its distance to the pear-shaped opening was 14.26(+/- 1.83) mm. It was found predominately in an oval shape, in 39 (65%) of the skulls, on both sides. Accessory foramens were present in 11 samples on the right and in 15 samples on the left side. The FIO was most frequently found on the side of, or laterally to the sagittal plane that passes through the middle of the supraorbital foramen/incisures, in 38 skulls (63.3%) on the right side and in 45 skulls (75%) on the left and middle to the zigomatic-maxillary suture, in 41 skulls (68.3%) on right and in 42 skulls (70%) on the left side, besides being most frequently found in a region between the first and second premolars, in 22 skulls (36.7%) on the right side and in 17 skulls (28.3%) on the left.

AURICULOTHERAPY EFFECTIVENESS IN THE REDUCTION OF ANXIETY IN NURSING STUDENTS

The objective of this single-blinded randomized controlled trial was to assess anxiety levels in nursing school students of the Beneficencia Portuguesa Hospital (Sao Paulo) and the effectiveness of auriculotherapy in the reduction of these levels. The Trait-Anxiety Inventory State was applied at the beginning of the study, after 8 and 12 sessions, and at follow-up (15 days). The sample was comprised of 71 students divided into 3 groups: control without intervention (25), auriculotherapy (24), and placebo (22). The analysis of variance (ANOVA) showed statistically significant differences post hoc between the control and auriculotherapy groups at 2nd (p=0.000), 3rd (p=0.012) and 4th assessments (p=0.005), and between placebo and control groups at 2nd assessment (p=0.003). Auriculotherapy with Shenmen and Brain Stem points was more effective (20.97%) than sham points (13.74%) for reduction of anxiety levels in Nursing students, but studies with more representative samples are recommended.

Aplicabilidade da auriculoterapia para reduzir estresse e como estratégia de coping em profissionais de enfermagem

OBJETIVOS: trata-se de ensaio clínico randomizado com o objetivo de avaliar a auriculoterapia, para diminuição de níveis de estresse, em 75 profissionais de enfermagem de um hospital e analisar os principais domínios de coping que se modificaram após o tratamento. METODOLOGIA: os sujeitos foram divididos em grupos (controle, agulhas, sementes), receberam 8 sessões nos pontos Shenmen, rim e tronco cerebral. O grupo controle não recebeu nenhuma intervenção. RESULTADOS: constataram-se diferenças significativas pela ANOVA, para níveis de estresse entre o grupo agulha/controle na terceira e quarta avaliações, segundo escores de estresse da Lista de Sintoma de Stress de Vasconcelos. Para o Inventário de Folkman e Lazarus, obteve-se diferença estatística para o domínio afastamento entre os grupos agulha/controle, após tratamento; e, na análise dentro do mesmo grupo, obtiveram-se diferenças significativas para o domínio confronto, na quarta avaliação entre grupos agulha/controle e para suporte social, na terceira avaliação para os grupos agulha/semente. CONCLUSÕES: a auriculoterapia com agulhas diminuiu os níveis de estresse significativamente e houve diminuição da utilização dos domínios afastamento, confronto e suporte social para os grupos de intervenção, após o tratamento, sugerindo que a auriculoterapia tanto com agulhas quanto com sementes pode produzir impacto positivo para melhorar a estratégia de coping na equipe de enfermagem. Mais estudos, porém, fazem-se necessários para que se possa conhecer o alcance da técnica.

Punção aspirativa guiada por ultrassom endobrônquico no diagnóstico e estadiamento de linfadenopatia mediastinal: experiência inicial no Brasil

OBJETIVO: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um método novo em diagnóstico e estadiamento linfonodal mediastinal. O objetivo do estudo foi avaliar os resultados preliminares obtidos com EBUS-TBNA no diagnóstico de lesões e no estadiamento linfonodal mediastinal. MÉTODOS: Foram avaliados pacientes com tumores ou adenopatias mediastinais e com diagnóstico ou suspeita de câncer de pulmão. Os procedimentos foram realizados com os pacientes sob sedação ou anestesia geral. O material coletado foi preparado em lâminas fixadas em álcool absoluto para citologia e em formol para bloco de células. RESULTADOS: Foram incluídos 50 pacientes (30 do sexo masculino), com média de idade de 58,3 ± 13,5 anos. Foram realizadas 201 punções em 81 linfonodos ou massas mediastinais (média de 2,5 punções). O material obtido foi considerado adequado para análise citológica em 37 pacientes (74%), dos quais 21 (57%) foram diagnosticados com malignidade. Nos 16 pacientes remanescentes, 1 teve diagnóstico de tuberculose, 6 tiveram seguimento clínico, e 9 foram submetidos a investigação adicional (2 diagnosticados com neoplasia - resultados falso-negativos). O rendimento do exame foi maior nos procedimentos com objetivo diagnóstico, em pacientes com lesões em múltiplas estações, e nas punções da estação linfonodal subcarinal. Um paciente apresentou sangramento endobrônquico resolvido com medidas locais. Não houve mortalidade na série. CONCLUSÕES: Esta experiência preliminar confirmou que o EBUS-TBNA é procedimento seguro, e que o nosso rendimento diagnóstico, inferior ao da literatura, foi compatível com a curva de aprendizado do método.