Edson Silva-Filho

Menopause is characterized by the permanent cessation of menstrual cycles due to ovarian failure. This leads to a decrease in female sex steroid levels and the onset of various symptoms and signs a...

Pelvic floor dysfunctions are highly prevalent among women, yet many remain unaware of their condition. While conservative treatment is the first-line approach for urinary incontinence, surgical intervention is often necessary in severe cases. However, its effectiveness becomes less predictable when incontinence is associated with pelvic organ prolapse (POP). This cohort study aimed to evaluate pelvic floor muscle function in women undergoing surgical correction of POP, either alone or in combination with urinary incontinence repair. Women aged 18 to 65 years with no prior history of POP or urinary incontinence surgery were enrolled and divided into two groups: an isolated POP group (POPg, N.=47) and a group with urinary incontinence associated with POP (UI+POPg, N.=53). A blinded researcher evaluated participants at three time points: before surgery, three months postoperatively, and twelve months postoperatively. Assessments included manometry, the Urogenital Distress Inventory, the Pelvic Organ Prolapse Distress Inventory, and the Colorectal-Anal Distress Inventor. The results demonstrated improvements in pelvic floor muscle function across both groups, emphasizing the positive impact of surgical intervention on pelvic floor performance in women with POP, regardless of the presence of urinary incontinence. Pelvic floor muscle performance and symptoms in women treated surgically for pelvic organ prolapse whether isolated or accompanied by urinary incontinence correction showed comparable improvement throughout the 12-month follow-up.

Background The prevalence of women with primary dysmenorrhoea is high and negatively impacts physical and mental health. The intense cyclic episodes of pain generate central nervous system dysfunctional processing. In this sense, strategies focused on the central nervous system are important to re-establish normal functioning. Home-based self-administered transcranial direct current stimulation (tDCS) emerges as a strategy to modulate dysfunctional brain areas and improve the symptoms. This protocol aims to evaluate the effects of home-based self-administered tDCS for pain, premenstrual symptoms, physical performance, quality of life, electroencephalography and patient global impression in women affected by primary dysmenorrhoea. Methods and analysis This is a single-centre, parallel, randomised, double-blinded clinical trial protocol. 40 women affected by primary dysmenorrhoea will be randomised into two groups (active-tDCS or sham-tDCS). Then, 20 consecutive sessions of home-based self-administered tDCS will be performed. The assessments will occur at five time points: baseline, after the 20th sessions, at the first, second and third cycles after tDCS interventions (follow-ups). Primary outcome will be pain according to visual analogue scale. Quality of life, premenstrual symptoms screening, depression, anxiety, physical performance, electroencephalography and participants’ satisfaction will be the secondary outcomes. A mixed analysis of variance will calculate the effect of stimulation. Ethics and dissemination The study was approved by the ethics committee of the Federal University of Rio Grande do Norte (No. 6.037.756) and registered in the Brazilian Clinical Trials Registry (n° RBR-747k8vb). Participants may withdraw at any time without penalty. Free support will be available from the lead researcher if needed. All procedures will follow Good Clinical Practice and international ethical standards. Trail registration https://ensaiosclinicos.gov.br/rg/RBR-747k8vb

Improving pain management and physical function remains a significant challenge for patients affected by end-stage renal disease (ESRD) undergoing hemodialysis. Non-pharmacological interventions, such as transcranial direct current stimulation (tDCS), have gained attention for their potential to alleviate pain and improve functional outcomes. This study explored the effects of tDCS on pain, fatigue, and functional performance in patients affected by ESRD undergoing hemodialysis and experiencing chronic pain. Thirty-four participants were randomized to receive either active or sham tDCS, with 15 sessions administered over five weeks. Anodal tDCS over C3 with an intensity of 2 mA was administered in 15 sessions, 3 times per week. Visual Analogue Scale for pain (VAS), fatigue, functional performance (sit-to-stand test, stationary walk, timed up and go test (TUG), elbow flexion test, and manual dynamometry) were assessed. We found a significant difference in VAS (p < 0.001) between groups and across time (fifteenth session p < 0.001; at the first, p < 0.001; and second follow-up, p < 0.001). TUG showed significant differences between-group analysis (p = 0.009). No significant differences between groups were observed for fatigue (p = 0.21) and all others functional tests. These findings suggest that tDCS may be a promising, non-invasive intervention for managing pain and improving mobility in patients affected by ESRD undergoing hemodialysis. Future studies with larger samples and extended follow-ups are warranted to further validate these findings and explore the long-term benefits of tDCS. Trial registration: The study is registered on the Brazilian Clinical Trials Registry (ID: RBR-7kym6v8).

Background: Transcranial direct current stimulation (tDCS) has gained significant attention in both academic and clinical settings due to its potential benefits in treating various neurological conditions. However, the accessibility and accuracy of information on social media platforms, such as TikTok, can greatly influence public perception and understanding of this technology. Therefore, because the information on the platform is not peer‐reviewed, the analysis of the TikTok content is essential for the audience. Objective: To assess the reliability, accuracy, quality of consumer health information and overall quality of the videos on TikTok pertaining to tDCS. Methods: We conducted a search from 10 to 30 June 2024 using the terms ‘transcranial direct current stimulation’ and/or ‘tDCS’ to identify relevant videos on the TikTok platform. The videos were analysed based on the JAMA benchmark criteria, DISCERN, global quality score and the Patient Education Materials Assessment Tool. Results: A total of 53 videos were included for analysis, with an average of approximately 40.000 views each. Most videos were uploaded by private users detailing their personal experiences. According to the JAMA benchmark, the majority of the videos lacked reliability and accuracy. The DISCERN assessment indicated that most videos were classified as very poor or poor. The global quality assessment revealed that the videos provided minimal useful information to the audience. However, the Patient Education Materials Assessment Tool results showed that most videos had moderate to high understandability but low actionability. Conclusion: Most tDCS‐related videos on the TikTok platform exhibited low accuracy, reliability and overall quality. Additionally, the understandability and actionability for viewers were limited.

RESUMO JUSTIFICATIVA E OBJETIVOS A doença renal crônica (DRC) é uma preocupação significativa de saúde pública. Pacientes com problemas renais crônicos frequentemente apresentam sintomas como dor e transtornos do humor enquanto aguardam um transplante. Intervenções não farmacológicas, sem efeitos adversos, são necessárias para o manejo desses sintomas. O objetivo deste estudo foi avaliar os efeitos da estimulação transcraniana por corrente contínua (ETCC) na dor, ansiedade e depressão em pacientes com DRC. MÉTODOS Trata-se de um ensaio clínico randomizado, controlado por placebo, paralelo, duplo-cego e conduzido em um único centro. As intervenções consistiram em 10 sessões não consecutivas de ETCC anódica sobre o córtex pré-frontal dorsolateral esquerdo, com o cátodo posicionado sobre a região supraorbital contralateral. Cada sessão teve duração de 20 minutos, com intensidade de 2 mA. O ensaio clínico incluiu pacientes com DRC que apresentavam dor crônica e estavam em hemodiálise há mais de três meses. Foram realizadas quatro avaliações: na linha de base, após a primeira e última intervenção e sete dias após a última intervenção (follow-up). RESULTADOS Houve interação significativa entre grupo e tempo em relação à dor (p=0,0005; η2 parcial=0,362) e interação significativa com o tempo (p=0,0005; η2 parcial=0,659), com diferenças significativas entre os grupos no dia 10 (p=0,004; η2 parcial=0,37) e no follow-up (p=0,03; η2 parcial=0,22). Além disso, foi observada diferença significativa entre os grupos quanto à ansiedade. CONCLUSÃO Após 10 sessões de ETCC, pacientes com DRC apresentaram diminuição de dor, ansiedade e depressão.

RESUMO JUSTIFICATIVA E OBJETIVOS A doença renal crônica (DRC) é uma preocupação significativa de saúde pública. Pacientes com problemas renais crônicos frequentemente apresentam sintomas como dor e transtornos do humor enquanto aguardam um transplante. Intervenções não farmacológicas, sem efeitos adversos, são necessárias para o manejo desses sintomas. O objetivo deste estudo foi avaliar os efeitos da estimulação transcraniana por corrente contínua (ETCC) na dor, ansiedade e depressão em pacientes com DRC. MÉTODOS Trata-se de um ensaio clínico randomizado, controlado por placebo, paralelo, duplo-cego e conduzido em um único centro. As intervenções consistiram em 10 sessões não consecutivas de ETCC anódica sobre o córtex pré-frontal dorsolateral esquerdo, com o cátodo posicionado sobre a região supraorbital contralateral. Cada sessão teve duração de 20 minutos, com intensidade de 2 mA. O ensaio clínico incluiu pacientes com DRC que apresentavam dor crônica e estavam em hemodiálise há mais de três meses. Foram realizadas quatro avaliações: na linha de base, após a primeira e última intervenção e sete dias após a última intervenção (follow-up). RESULTADOS Houve interação significativa entre grupo e tempo em relação à dor (p=0,0005; η2 parcial=0,362) e interação significativa com o tempo (p=0,0005; η2 parcial=0,659), com diferenças significativas entre os grupos no dia 10 (p=0,004; η2 parcial=0,37) e no follow-up (p=0,03; η2 parcial=0,22). Além disso, foi observada diferença significativa entre os grupos quanto à ansiedade. CONCLUSÃO Após 10 sessões de ETCC, pacientes com DRC apresentaram diminuição de dor, ansiedade e depressão.

Background: Frequently, the women affected by the genitourinary syndrome of menopause experience genitourinary dysfunctions that profoundly influence their overall health. Even though the symptoms do not jeopardize the women’s lives, the urinary and sexual dysfunctions significantly impact their quality of life. Isolated treatments focused on the main causes of the dysfunctions, such as pelvic floor muscle training (PFMT) and photobiomodulation have shown significant improvements in genitourinary dysfunctions. So, the association of PFMT with photobiomodulation may generate additional effects in the genitourinary area. This study aims to create a PFMT protocol isolated and associated with photobiomodulation therapy in women affected by the genitourinary syndrome of menopause. Methods: It is a randomized, controlled, double-blind clinical trial protocol study that will include women experiencing genitourinary symptoms related to menopause, sexually active, never practiced pelvic floor muscle exercise or photobiomodulation treatment, and do not use hormone replacement therapy for at least 3 months. The randomization will allocate the women to three groups: PFMT group, PFMT associated with active intracavitary photobiomodulation group, and PFMT associated with sham intracavitary photobiomodulation group. A total of 16 sessions will be conducted twice a week. The assessments will occur before interventions, after the sixteenth session, and 1 month after the sixteenth session (follow-up). The evaluation will include the pelvic floor muscle vaginal manometry as the primary outcome. Also, the international consultation on incontinence questionnaire—short form, the female sexual function index, the Utian Quality of Life scale, the patient global impression of improvement, the modified Oxford scale, and the vaginal health index will be the secondary outcomes. Discussion: Despite there are gold standard treatments such as PFMT, to alleviate genitourinary symptoms, interventions mirroring clinical practice are needed. This study protocol might show a groundbreaking and viable method to potentiate the effects of a gold-standard treatment associated with photobiomodulation. Conclusion: We expect this protocol to demonstrate that the use of PFMT and photobiomodulation strategies is feasible and able to potentiate the recovery of women affected by the genitourinary syndrome of menopause. The Ethics Committee of the Federal University of Rio Grande do Norte approved the study (n° 6.038.283), and the clinical trials platform registered the protocol (n° RBR-5r7zrs2).

Introduction: Similar to chronic pain conditions, individuals with endometriosis can be affected by central sensitization syndrome (CSS), which is characterized by a loss of analgesia and central amplification of pain. Transcranial direct current stimulation (tDCS) has shown potential as an effective intervention to improve pain generated by other chronic pain conditions impacted by CSS, such as fibromyalgia and chronic pelvic issues. This study aims to evaluate the effectiveness of tDCS on pain, fatigue, and quality of life among patients affected by endometriosis.Methods: This is a single-center, parallel, double-blinded, randomized, controlled clinical trial protocol study. We aim to recruit 40 participants affected by endometriosis (active group, n = 20; sham group, n = 20). Anodal tDCS will be delivered at an intensity of 2mA, applied over the primary motor cortex for 20 minutes per day for 10 consecutive days. There will be four assessment times: 1 week before beginning the intervention; on the 10^thday following the last tDCS session; and 1 and 2 months after the last tDCS session. Pain evaluated by the algometry will be the primary outcome. Pain intensity, quality of life, fatigue, and global perception of change will be the secondary outcomes. We will calculate the effects of the active versus sham stimulation on primary and secondary outcomes by using generalized estimated equations or mixed model analysis. The effect size calculation will represent the effect measure. We expect that only the active group show reductions in pain, fatigue, and quality of life. The results of this trial will produce an important first step in providing evidence on the effectiveness of neuromodulation for the management of pain and will provide data to support new studies on tDCS.Registration: Brazilian Clinical Trials Registry (RBR-4q69573).

Introduction: Craving is a multifactorial behavior caused by central circuit imbalance. The proposed treatments involve exercise and reduced food intake. However, the treatments frequently fail. This study aimed to investigate the effect of 10 consecutive sessions of anodal transcranial direct current stimulation over the right dorsolateral prefrontal cortex on food craving and eating consumption of women affected by overweight and obesity. Methods: A randomized double-blind controlled trial with 50 volunteers was divided into two groups (active-tDCS: n = 25 and sham-tDCS: n = 25). There were a total of 10 consecutive tDCS sessions (2 mA, for 20 min) with an F4 anodal-F3 cathodal montage. We evaluated the effects on eating behavior (food craving, uncontrolled eating, emotional eating, and cognitive restriction), food consumption (calories and macronutrients), and anthropometric and body composition variables (weight, body mass index, waist circumference, and body fat percentage). Results: There were no statistically significant results between groups at the baseline regarding sociodemographic and clinical characteristics. Also, there was no significant interaction between time versus group for any of the variables studied. Treatment with tDCS was well tolerated and there were no serious adverse effects. Conclusions: In women affected by overweight and obesity with food cravings, 10 sessions of F4 (anodal) and F3 (cathodal) tDCS did not produce changes in eating behavior, food consumption, and anthropometric and body composition.