-Objective: Tropical Spastic Paraparesis/HTLV-I Associated Myelopathy (TSP/HAM) is a chronic myelopathy, and pain has been mentioned as a frequent sensory symptom in this condition. The authors aimed at analyzing this symptom in a TSP/HAM patients series. Method: For this, 46 patients were analyzed considering demographic and clinical characteristics and complaint of pain as to verbal description, time of onset and classification, correlated with the degree of motor disability and type of pain. Results: Among the 46 TSP/HAM patients, 28 (60.8%) complained of pain, predominant in the early phase of the disease. Most of the patients exhibited neuropathic characteristics of pain, correlated with increased motor disability. Conclusion: Pain in TSP/HAM patients is a frequent and early symptom, and the neuropathic type is predominant (57.1%) and paralleled with increased incapacitation. The pathogenic involvement of cytokines may possibly be involved in the meaning of this symptom in this condition.Key wordS: TSP/HAM, HTLV-I, pain, inflammatory nociceptive and neuropathic, cytokines.dor em pacientes com paraparesia espástica tropical/mielopatia associada ao HTlV-i resumo -Objetivo: A Paraparesia espástica Tropical/Mielopatia Associada ao HTLV-I (PeT/MAH) é uma mielopatia crônica, e a dor tem sido mencionada como um sintoma sensitivo freqüente nessa condição. os autores objetivam analisar esse sintoma numa série de pacientes com PeT/MAH. Método: Para isso, 46 pacientes foram analisados considerando características demográficas e clínicas, e queixa de dor do ponto de vista da descrição verbal, tempo de início e classificação, correlacionados com o grau de incapacitação motora e o tipo de dor. Resultados: dentre os 46 pacientes com PeT/MAH, 28 (60,8%) se queixavam de dor, predominando na fase inicial da doença. A maioria dos pacientes evidenciou características de dor neuropática, correlacionada com aumento da incapacitação motora. Conclusão: A dor em pacientes com PeT/MAH é um sintoma freqüente e inicial, sendo o tipo neuropático predominante (57,1%) e em paralelo com maior incapacitação. o envolvimento patogênico das citocinas poderá possivelmente estar relacionado com o significado desse sintoma nessa condição clínica.PALAVrAS-CHAVe: PeT/MAH, HTLV-I, dor, nociceptiva inflamatória e neuropática, citocinas.
How to handle Western blot (WB) seroindeterminate individuals for Human T-lymphotropic Virus 1/2 (HTLV-1/2) constitutes a challenge for blood banks and families. We made a cross-sectional study of 191 enzyme linked immunoassay (EIA) reactive individuals from the hematological center (HEMOCE) of Fortaleza (Brazil), examining their serological (WB) and molecular (PCR) diagnosis, and demographic profiles, as well as a possible association of their condition with other infectious pathologies and risk factors. Ethical institutional approval and personal consent were obtained. Out of 191 EIA reactive individuals, 118 were WB seroindeterminate and 73 were seropositive for HTLV-1/2. In the PCR analysis of 41 WB seroindeterminate individuals, 9 (22%) were positive and 32 (78%) were negative for HTLV-1/2. The demographic analysis indicated a trend towards a predominance of males among the seroindeterminate individuals and females in the seropositive ones. The seroindeterminate individuals were younger than the seropositive ones. We did not find any association of these conditions with syphilis, Chagas disease or HIV or hepatitis, and with risk factors such as breast-feeding, blood transfusion, STD (syphilis) and IDU.
This was a descriptive cross-sectional study on patients with spinal cord injuries living in Curitiba, Paraná, Brazil. The aim was to evaluate the pain characteristics among such patients seen at referral care centers for spinal cord injury patients in Curitiba. A total of 109 adults with spinal cord injury in this city were evaluated regarding the presence of pain, especially neuropathic pain. Neuropathic pain was evaluated using the DN4 questionnaire, a universal instrument that has been translated and validated for Portuguese. A visual analog scale (VAS) was used to evaluate the intensity of pain. The prevalence of pain among these 109 patients was 31.2% (34 patients). The nociceptive pain presented was classified as musculoskeletal pain (nine patients), visceral pain (four patients) and mixed pain (one patient), thus totaling 14 patients (12.8%). Another 20 patients (18.3%) showed symptoms of neuropathic pain and fulfilled the criteria for neuropathic pain with scores greater than 4 out 10 in the DN4 questionnaire. Regarding the characteristics of the patients with neuropathic pain, most of them were male, younger than 40 years of age and paraplegic with incomplete lesions. They had become injured from 1 to more than 5 years earlier.The predominant etiology was gunshot wounds, and the intensity of their pain was high, with VAS scores greater than 5. This study partially corroborates other studies conducted on this subject. Studies of this type are important for understanding the profile of these patients, for the purpose of designing strategies for their rehabilitation, with a focus on the appropriate treatment and management of pain. Key words: neuropathic pain, spinal cord injury, DN4 questionnaire. Dor neuropática em pessoas com lesão medular residentes em Curitiba (Brasil) RESUMO Estudo transversal descritivo em pacientes com lesão medular que residem em Curitiba, Paraná, Brasil. O objetivo foi avaliar as características da dor em pacientes com lesão medular acompanhados em Centros de Reabilitação de referência na cidade. Os sujeitos envolvidos na pesquisa foram 109 pacientes adultos com lesão medular. Foi avaliada a presença de dor, principalmente dor neuropática, mediante aplicação do Questionário DN4, um instrumento universal traduzido e validado para o português. A Escala Visual Analógica (EVA) também foi usada para avaliar a intensidade da dor. A prevalência de dor nos 109 pacientes avaliados foi de 31,2%, ou seja, 34 pacientes. Destes, nove apresentaram dor nociceptiva classificada como músculo-esquelética, quatro dor visceral e um paciente apresentou dor mista, totalizando 14 pacientes (12,8%). Além disso, 20 pacientes (18,3%) apresentaram dor neuropática, cumprindo os critérios para este tipo de dor com uma contagem superior a 4/10 para o DN4. Sobre as características dos pacientes com dor neuropática, a maioria era do sexo masculino, abaixo de 40 anos, paraplégico com lesão incompleta e tempo de evolução entre um e cinco anos de lesão. A etiologia Correspondence Janaína Vall
-The scurvy shows an inflammatory disease and gingival bleeding. Nevertheless, in an animal model for guinea pigs, described by Den Hartog Jager in 1985, scurvy was associated with a motor neuron disease with demyelinization of the pyramidal tract, provoking neurogenic atrophy of muscles. Aiming at searching the protective role of vitamin C in nervous system, a pharmacological, morphological and behavioral study was conducted. Three experimental groups were used: A100, animals receiving 100 mg/ vitamin C/ day; A5.0, animals receiving 5.0 mg/vitamin C/ day; and A0, animals without vitamin C. We analyzed the weight gain, muscular diameter and behavioral tests. In all tests examined, we found significant differences between the supplemented groups in comparison with scorbutic group (p<0.05). Thereafter, the animals were killed for histopathology of gastrocnemius muscle, spinal cord and tooth tissues. In addition, a morphometric study of periodontal thickness and α-motor neuron cell body diameter were done. The vitamin C-diet free regimen seemed to induce a disruption in spinal cord morphology, involving the lower motor neuron, as confirmed by a significant reduction in neuron perycaria diameter and muscular atrophy, complicated by increased nutritional deficit.KEY WORDS: vitamin C, ascorbic acid, motor neuron disease, guinea pig, motor behavior.Análise farmacológica, morfológica e comportamental do comprometimento motor em cobaios com Análise farmacológica, morfológica e comportamental do comprometimento motor em cobaios com Análise farmacológica, morfológica e comportamental do comprometimento motor em cobaios com Análise farmacológica, morfológica e comportamental do comprometimento motor em cobaios com Análise farmacológica, morfológica e comportamental do comprometimento motor em cobaios com deficiência de vitamina C induzida experimentalmente deficiência de vitamina C induzida experimentalmente deficiência de vitamina C induzida experimentalmente deficiência de vitamina C induzida experimentalmente deficiência de vitamina C induzida experimentalmente RESUMO -O escorbuto se caracteriza por doença inflamatória e sangramento gengival. Contudo, num modelo animal em cobaios, descrito por Den Hartog Jager em 1985, o estado escorbútico foi associado à doença do neurônio motor com desmielinização do trato piramidal, provocando atrofia neurogênica dos músculos. Objetivando investigar o papel protetor da vitamina C no sistema nervoso, um estudo farmacológico, morfológico e comportamental foi conduzido. Três grupos experimentais foram usados: A100, animais recebendo 100 mg/ vitamina C/ dia; A5,0, animais recebendo 5,0 mg/ vitamina C/ dia; e A0, animais sem vitamina C. Nós avaliamos o ganho de peso, diâmetro muscular e realizamos testes comportamentais. Em todos os testes examinados, detectamos diferenças significantes dos grupos suplementados em relação ao grupo escorbútico (p<0,05). Os animais foram sacrificados para histopatologia do músculo gastrocnemius, medula espinhal e tecidos dentários. Também foi realiz...
-We report on a neuropathological analysis of two cases of TSP/HAM originating from Brazil. These two cases had, respectively, an evolution of 13 and 40 years. The main neuropathological findings consisted of spinal cord atrophy, mainly the lower thoracic cord, diffuse degeneration of the white and grey matter, rare foci of mononuclear and perivascular cuffs, and hyaline hardening of arteriolae. The supraspinal structures were normal, excepting for a slight gliosis in the cerebellum. An analysis on the long evolutive cases as described in the literature is outlined in this study.KEY WORDS: TSP/HAM long evolution, neuropathological findings, spinal cord, rare inflammatory infiltration.Neuropatologia de dois casos brasileiros autopsiados de paraparesia espástica tropical / mielopatia Neuropatologia de dois casos brasileiros autopsiados de paraparesia espástica tropical / mielopatia Neuropatologia de dois casos brasileiros autopsiados de paraparesia espástica tropical / mielopatia Neuropatologia de dois casos brasileiros autopsiados de paraparesia espástica tropical / mielopatia Neuropatologia de dois casos brasileiros autopsiados de paraparesia espástica tropical / mielopatia associada ao HTL associada ao HTL associada ao HTL associada ao HTL associada ao HTLV V V V V-I (PET/MAH) de longa evolução -I (PET/MAH) de longa evolução -I (PET/MAH) de longa evolução -I (PET/MAH) de longa evolução -I (PET/MAH) de longa evoluçãoRESUMO -Relatamos a análise neuropatológica de dois casos de PET/MAH originários do Brasil. Estes dois casos tinham, respectivamente, uma evolução de 13 e 40 anos. O principais achados neuropatológicos consistiam de atrofia da medula espinhal, principalmente da medula torácica baixa, degeneração difusa das substâncias branca e cinzenta, raros focos de infiltrado mononuclear e perivascular, e endurecimento hialínico das arteriolae. As estruturas supra-espinhais eram normais, exceto por uma ligeira gliose do cerebelo. Uma análise dos casos de longa evolução descritos na literatura é salientada neste estudo.PALAVRAS-CHAVE: PET/MAH longa evolução, achados neuropatólogicos, medula espinhal, infiltração inflamatória rara.
-Baclofen (β-p-chlorophenyl-GABA) has been used in humans to treat spasticity, as well as trigeminal neuralgia. Since GABA (gamma-aminobutyric acid) has been implicated in inhibitory and analgesic effects in the nervous system, it was of interest to study the effect of baclofen in experimental neuropathic pain. With this purpose, experiments were carried out in 17 neuropathic rats with constrictive sciatic injury, as described by Bennet and Xie (1988), taking as pain parameters scratching behaviour and the latency to the thermal nociceptive stimulus. The results showed that baclofen induces, in a dose-dependent manner, significant decrease (p < 0.05) of scratching behaviour and significant increase (p < 0.05) of the latency to the nociceptive thermal stimulus. The absence of antagonism of naloxone suggested a non-participation of an opioid-mediated mechanism in this analgesic effect of baclofen on experimental neuropathic pain.KEY WORDS: baclofen, experimental neuropathic pain, Bennet's model, scratching behaviour, thermal stimulus, analgesia.Efeito do baclofeno sobre a expressão comportamental espontânea e evocada da dor crônica neuropática experimental RESUMO -O baclofeno (β-p-clorofenil-GABA) é usado em seres humanos para tratar espasticidade, assim como neuralgia do trigêmeo. Como o GABA (ácido amino-gama-butírico) tem sido implicado em efeitos inibitórios e analgésicos no sistema nervoso, tornou-se de interesse estudar o efeito do baclofeno em dor neuropática experimental. Com esse objetivo, foram realizados experimentos em 17 ratos neuropáticos com lesão constritiva do nervo ciático, como descrito por Bennet e Xie (1988), tomando como parâmetros de dor o comportamento de coçar-se (scratching) e a latência ao estímulo térmico nociceptivo. Os resultados mostraram que o baclofeno induziu, de forma dose-dependente, diminuição significativa (p < 0,05) do comportamento de coçar-se e aumento significativo (p < 0,05) da latência ao estímulo térmico nociceptivo. A ausência de antagonismo pela naloxona sugere a não participação de mecanismo opióide-mediado nesse efeito analgésico do baclofeno em dor neuropática experimental.PALAVRAS-CHAVE: baclofeno, dor neuropática experimental, modelo de Bennet, comportamento de coçar-se (scratching), estímulos térmicos, analgesia.The study of neuropathic pain remains a serious challenge, since its underlying mechanisms have not yet been elucidated and consequently there is currently a lack of effective treatment. Among the different attempts to alleviate this kind of chronic pain in humans, baclofen (β-p-chlorophenyl-
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