Anna Paula Piovezan

Background: Pre-pregnancy obesity and GDM increase maternal–fetal oxidative stress, but their consequences for women’s health and child development are still unclear. Objectives: This paper describes the methodological design, recruitment strategy, data collection methods, and baseline characteristics of the Gerar Cohort, a prospective longitudinal study designed to investigate the relationship between pre-pregnancy obesity and gestational diabetes mellitus (GDM) with oxidative stress biomarkers and their effects on maternal and child health outcomes through 12 months postpartum. Methods: Women were recruited early in their prenatal care in a city in Southern Brazil. Sociodemographic and clinical data, as well as blood samples, were collected each trimester. At childbirth, umbilical cord blood and placental tissue were collected. Children were followed up until 12 months of age, with blood collection at 4 and 12 months. The study was approved by the Research Ethics Committee. Results: A total of 189 women were recruited in the first trimester; 136 were followed up until the third trimester; 23 pregnancy losses were recorded. Pre-gestational obesity was observed in 24.3% (95% CI 18.4–31.1), and 27% (95% CI 20.8–33.9) of women were diagnosed with gestational diabetes mellitus. Fifty-nine umbilical cord blood samples and 61 placental fragments were collected. In the children’s follow-up, 71 children were taken for ophthalmological examination at 1 month of age; 60 attended the pediatric consultation at 4 months; 56 children attended the neurological evaluation at 6 months and 50 at 12 months. Conclusions: The Gerar Cohort successfully implemented its recruitment and biospecimen collection procedures within public healthcare services.

A Síndrome da Hiperestesia Felina é uma afecção caracterizada por um conjunto de sinais clínicos e alterações comportamentais, ainda pouco compreendida e de etiologia idiopática. Acomete gatos de qualquer idade, sexo ou raça, que passam a apresentar alterações comportamentais e diversos sinais clínicos. O diagnóstico baseia-se, principalmente, na exclusão de enfermidades dermatológicas e neurológicas. Objetivou-se relatar um caso de hiperestesia felina em uma gata, fêmea, castrada, com cinco anos de idade. Após a exclusão de outras enfermidades, instituiu-se terapia farmacológica para controlar as manifestações clínicas; entretanto, não houve resposta satisfatória aos tratamentos convencionais, sendo necessária a introdução de terapia complementar com óleo de Cannabis, proporcionando uma nova perspectiva para o manejo da doença. A hiperestesia felina é uma síndrome subdiagnosticada, com escassez de informações na literatura científica e pouca abordagem durante a formação acadêmica e em cursos de atualização, o que limita a compreensão de sua fisiopatologia e tratamento. Este relato de caso contribui para ampliar o conhecimento sobre a enfermidade, favorecendo diagnósticos mais precoces e oferecendo alternativas terapêuticas que podem aumentar as chances de sucesso clínico.

Fibromyalgia is a syndrome characterized by chronic, widespread pain. Its pathogenesis is not well-defined, but cumulative evidence indicates fibromyalgia is associated with alterations in brain surface wave frequencies. This study investigated the effects of brainwave entrainment (BWE) vs. music therapy for managing fibromyalgia in women. Eighty-four female patients with fibromyalgia were randomly assigned to two groups, namely music therapy (n = 42) or BWE administered using a BrainTap headset (n = 42). The music therapy and BWE groups were treated for 20 minutes daily, five times a week, over eight weeks. Visual analog scale (VAS) for pain, McGill pain questionnaire (MPQ), fibromyalgia impact questionnaire (FIQ), and SF-36 quality of life questionnaire were applied at baseline, during the treatment, and post-intervention with a six-month follow-up. Biochemical analyses and the Hamilton Depression and Anxiety Rating Scale (HAM-A and HAM-D) were performed at baseline and at the conclusion of the treatment. BWE group reduced pain (p = 0.0001) as measured by the VAS and MPQ in the PRI total score and anxiety (p = 0.006). Furthermore, BWE improved parameters related to quality of life (BWE p = 0.002 vs MT p = 0.035), depression (BWE p = 0.0001 vs MT p = 0.006), and oxidative stress, and reduced BDNF (BWE p = 0.049 vs MT p = 0.030) levels in patients with fibromyalgia, an effect also observed with music therapy. BWE delivered through the BrainTap headset has the potential to alleviate pain and improve the quality of life in women with fibromyalgia. This effect appears to be related to oxidative stress and BDNF levels reduction.

Spent ground coffee oil (SGCO), rich in antioxidants and bioactive compounds, exhibits anti-inflammatory and analgesic properties and therefore warrants investigation in inflammatory pain models. This study aimed to investigate the topical effects of SGCO on hyperalgesia, emotional behavior, and inflammation-related mechanisms in a Complete Freund’s Adjuvant (CFA)-induced inflammation model. SGCO was extracted from spent coffee grounds via non-thermal plasma (NTP) and incorporated into a transdermal vehicle at 10%, 20%, and 30% (w/w). Female Balb/c mice (2 months old, n = 8/group) received daily topical applications of SGCO for 14 days after CFA-induced inflammation. Mechanical and cold nociception and paw edema were assessed. The concentration with the strongest antihyperalgesic effect (20%) was used in further experiments assessing mechanical conflict avoidance, anxiety- and depression-like behaviors, cytokine and oxidative parameters (paw, spinal cord, hippocampus, and prefrontal cortex), and inflammatory pathways in paw tissue. SGCO at 10%, 20%, and 30% produced significant antihyperalgesic effects without affecting paw edema, with 20% providing a sustained effect for 11 days. SGCO 20% was associated with reduced anxiety-like behavior, improved hedonic-like behavior without altering locomotion, and reduced pro-inflammatory cytokines (interleukin-1β and tumor necrosis factor), myeloperoxidase activity, phospho-Akt1/2/3, and NLRP3 in paw tissue. Additionally, it decreased protein carbonyl levels while increasing sulfhydryl group levels in the prefrontal cortex and hippocampus. These findings indicate that SGCO modulates inflammatory and oxidative pathways associated with CFA-induced inflammation and produces measurable effects on nociceptive and behavioral outcomes. Although the magnitude of the effects was generally modest, SGCO obtained via NTP technology may represent a low-cost and environmentally sustainable source of bioactive compounds for further preclinical investigation. Graphical Abstract

O estudo caracteriza o perfil sociodemográfico, clínico e jurídico de indivíduos em cumprimento de medida de segurança no período de 2020 a 2022 que realizaram perícia no Hospital de Custódia e Tratamento Psiquiátrico de Santa Catarina. Avaliou ainda fatores associados à cessação da periculosidade na população. Estudo epidemiológico transversal com análise de prontuários de todos os indivíduos inimputáveis que passaram por perícia com profissionais psiquiatras forenses da instituição quanto a este desfecho (amostra censitária). Dos 121 pacientes avaliados a maioria era do sexo masculino (87,6%), de solteiros (66,1%), sem ensino fundamental completo (48,8%). O transtorno mais comum foi esquizofrenia (51,2%). A cessação de periculosidade esteve associada a ter apoio familiar (p=0,005) e à regularidade no tratamento ambulatorial (p=0,022). Na fundamentação do laudo do perito, no grupo de solteiros houve associação com ter apoio familiar; enquanto no grupo que tem/teve parceiro houve associação com a aderência ao tratamento (p<0,001). Quanto ao uso de álcool e drogas ilícitas, houve associação com cessação condicionada ao tratamento ambulatorial (p<0,001). Estes dados buscam subsidiar o aperfeiçoamento das políticas públicas para a assistência em saúde mental da população atendida.

Photobiomodulation (PBM), presents a viable therapeutic modality for a range of medical conditions, leveraging specific wavelengths to target various clinical outcomes. Despite its potential, significant variability in dosimetric parameters, application methods, and treatment protocols persists across the literature, complicating standardization and efficacy assessment. This review aims to consolidate current findings on the effects of Violet light PBM, to inform clinical practice, identify inconsistencies, and highlight areas necessitating further investigation. We systematically searched several databases, including the Directory of Open Access Journals, EMBASE, MEDLINE, PubMed, Lilacs, Periódicos Capes, and Scielo in January 2024, applying rigorous selection criteria to identify relevant studies. From this search, 51 studies met the inclusion criteria and were subjected to a qualitative synthesis. Violet light PBM has shown notable efficacy in microbial eradication and holds promise for applications such as wound healing, neurogenesis, myopia correction, acne treatment, and vasodilation. The findings from this review underscore the therapeutic potential of Violet light PBM across various medical applications. However, the existing body of research, predominantly composed of in vitro studies, highlights the necessity for more robust pre-clinical and clinical investigations to establish standardized protocols and ensure consistent, reliable outcomes in clinical settings. Further research will be pivotal in bridging the gap between experimental results and practical, evidence-based medical interventions.

Este estudo reflexivo analisa os desafios anestésicos em gestantes obesas, abordando aspectos técnicos, farmacológicos e éticos. A metodologia baseou-se em uma revisão narrativa da literatura científica recente, com seleção criteriosa de artigos publicados entre 2019 e 2024 em bases como PubMed, SciELO e LILACS. A análise foi estruturada em três eixos: (1) alterações fisiológicas e anatômicas que interferem na anestesiologia obstétrica, (2) desafios técnicos e éticos no manejo anestésico e (3) impactos nos desfechos maternos e neonatais. A obesidade dificulta a realização de bloqueios neuraxiais, eleva o risco de falhas anestésicas e complica a monitorização intraoperatória. Além disso, influencia a farmacocinética dos anestésicos, exigindo ajustes na dosagem e monitorização rigorosa. No pós-operatório, há maior incidência de complicações respiratórias, tromboembolismo venoso e controle inadequado da dor, reforçando a necessidade de protocolos multimodais e abordagem multiprofissional. Conclui-se que a individualização do manejo anestésico e o aprimoramento de diretrizes baseadas em evidências são essenciais para minimizar riscos e otimizar a segurança materno- fetal. A capacitação contínua da equipe e a adoção de estratégias avançadas, como ultrassonografia para guiar bloqueios e medidas preventivas para complicações, são fundamentais para melhorar os desfechos obstétricos.

Purpose This updated systematic review and meta-analysis aims to evaluate the impact of a birthing ball (BB) exercises on low-risk parturients during labor, offering a more comprehensive understanding through a larger sample size, robust analysis, and focus on relevant endpoints that were underexplored in previous studies due to limited data. Methods We searched PubMed, Embase, Scopus, and Cochrane Central for randomized controlled trials (RCTs) comparing BB (also named Swiss ball) exercises with no intervention or standard care in parturients undergoing low-risk labor. Risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. I² heterogeneity was assessed. All statistical analyses were performed using Review Manager 5.4. Results We included 10 RCTs with 1,008 parturients, 51.2% of whom were assigned to BB exercises. In the pooled analysis, the BB group showed significantly lower cesarean section rates (MD 0.55, p = 0.007, I² = 32%), reduced pain scores at 4 and 8 cm dilation by approximately 20% (p < 0.001), and a reduction of over two hours in the duration of the first stage of labor (MD -130.12 min, p < 0.001). There were no significant differences between groups in the duration of the second stage of labor (p = 0.090) and in the incidence of instrumental delivery, amniotomy, labor induction, oxytocin use, or epidural analgesia. Conclusions BB exercises significantly reduced cesarean section rates, alleviated labor pain, and shortened the first stage of labor, supporting their use as a safe and effective non-pharmacological intervention in low-risk labor management.

Introduction: Complex regional pain syndrome type I (CRPS-I) is a debilitating neuropathic painful condition associated with allodynia, hyperalgesia, sudomotor and/or vasomotor dysfunctions, turning investigation of its pathophysiology and new therapeutic strategies into an essential topic. We aim to investigate the impact of ischemia/reperfusion injury on the immunocontent of CB1 and CB2 cannabinoid receptor isoforms in the paws of mice submitted to a chronic postischemia pain (CPIP) model and the effects of local administration of cannabidiol (CBD) on mechanical hyperalgesia. Methods: Female Swiss mice, 30–35 g, were submitted to the CPIP model on the right hind paw. Skin and muscle samples were removed at different periods for western blot analysis. Results: No changes in the immunocontent of CB1 and CB2 receptors in paw muscle tissues after ischemia–reperfusion were observed. CBD promoted an antihyperalgesic effect in both phases. AM281 reversed the effect of CBD, whereas ruthenium red abolished the late phase. Conclusion: Our results point to the possible beneficial effects of local administration of CBD in modulating CRPS-I in humans. As possible targets for CBD antihyperalgesia in this model, the contribution of cannabinoid receptor CB1, in addition to TRPM8 is suggested.

O presente artigo discute os conceitos dos laudos de sanidade mental e cessação de periculosidade encontrados no prontuário de um paciente com diagnóstico de esquizofrenia, que cometeu homicídio e foi judicialmente submetido a medida de segurança em regime de internação em hospital de custódia e tratamento psiquiátrico para cumprir três anos, mas que, no entanto, permaneceu internado por trinta e oito anos. Este relato demonstra a relevância da psiquiatria na prática forense, fazendo a ligação entre o contexto médico-psiquiátrico e o contexto jurídico na determinação da responsabilidade penal, bem como na institucionalização da pessoa portadora de transtorno mental em conflito com a lei. Sobretudo, busca-se aqui salientar a importância da implementação de mecanismos para a desinternação dos pacientes, conforme previsto na Lei Antimanicomial Lei 10.216 de 06 de abril de 2001, atualmente vigente.