Determinar magnitud y posibles factores determinantes de enfermedad osteomuscular en hipertensos de la Región Metropolitana, bajo el Programa de Salud Cardiovascular.

Objetivos: determinar la presencia de cervicalgia y el índice de discapacidad cervical en los estudiantes del Conservatorio Nacional de Música, así como evaluar sus factores asociados. Materiales y métodos: se realizó un estudio de corte transversal en Lima, Perú. La población fue conformada por estudiantes del conservatorio nacional de música, a quienes se les evaluó mediante encuesta de auto reporte de cervicalgia en los últimos 3 meses, discapacidad cervical, además de evaluar la presencia de trastornos temporomandibulares. Se evaluó la asociación calculando las razones de prevalencia ajustadas. Resultados: Se incluyó a 211 personas, cuya edad media ± desviación estándar fue de 22,0 ± 2,0 años y la mayoría fueron varones (70,0%). La prevalencia de cervicalgia fue de 69,4%; el 45,6% presentó discapacidad moderada y 45,0% presentó discapacidad leve. Tocar instrumentos de cuerda frotada estuvo asociado a cervicalgia (RP 1,34 IC 95% 1,15 – 1,57). Se encontró asociación entre Trastornos Temporomandibulares (TTM) y cervicalgia (TTM moderada-grave (RP 1,65 IC 95% 0,99 – 2,75). Se evidencio la asociación entre TTM con discapacidad cervical (TTM ausente- leve: RP 2,81 IC95% 1,00-7,84 y p=0,048; TTM Moderado/Grave: RP 3,86 IC95%: 1,39-10,70 y p=0,009) Conclusión: Se corroboró la asociación de cervicalgia asociada a la práctica con instrumentos de cuerda frotada, se halló asociación de TTM con cervicalgia y con discapacidad cervical. Así también se corroboro la asociación entre discapacidad cervical. La elaboración de pausas activas y programas de actividad física son herramientas que ayudan en la disminución de la cervicalgia conllevando así que menos personas sean predispuestas a padecer discapacidad cervical. / Objectives: to determine the presence of neck pain and the neck disability index in the students of the National Conservatory of Music as well as to evaluate their associated factors. Materials and methods: A cross-sectional study was conducted in Lima, Peru. The population was formed by students from the National Conservatory of Music, who were evaluated through a self-report survey of neck pain in the last 3 months, neck disability, as well as evaluating the presence of temporomandibular disorders. The association was assessed by calculating the adjusted prevalence ratios. Results: A total of 211 individuals were included, mean age ± standard deviation was 22.0 ± 2.0 years and the majority were male (70.0%). The neck pain prevalence was 69.4%; 45.6% had moderate disability and 45.0% presented mild disability. Playing bowed string instruments was associated with neck pain (RP 1.34 95% CI 1.15 - 1.57). An association between Temporomandibular Disorders (TMD) and neck pain(TMD moderate-severe) was found (RP 1.65 95% CI 0.99 - 2.75). The association between TMD with neck disability (TMD (absent-slight) was demonstrated: RP 2.81 CI 95% 1.00-7.84 and p = 0.048; TMD Moderate / Severe: RP 3.86 CI 95%: 1.39- 10.70 and p = 0.009) Conclusion: The association between neck pain and the practice with bowed string instruments was corroborated. An association of TMD with neck pain and neck disability was found. This also supports the association with neck disability. The active pauses and physical activity programs are tools that help to reduce neck pain. This leads to have less people predisposed to suffer neck disability. / Tesis

Made available in DSpace on 2016-01-26T12:51:20Z (GMT). No. of bitstreams: 1 marilitafalangolaaccioly_tese.pdf: 2076302 bytes, checksum: 922e6d60d30a7543a522073d3b9c0607 (MD5) Previous issue date: 2007-10-25 / Statins are used to treat dislipidemias with great tolerance, however, several side effects can occur, specially myopathies. The regular practice of physical exercise (PE) produce beneficial alteration in the lipidic profile, however can generate muscle injuries. OBJECTIVE -To evaluate the effect of PE in the lipidic profile; the efficacy of the assocciation between PE and statins in the control of the lipidic profile and evaluate the effect of the association between PE and statins in the muscular function through histological analysis. MATERIAL/METHOD- It was used 80 male Wistar rats , distributed in 8 groups, including animals submitted to a hypercholesterolemic diet (HD), simvastatin with (G1) and without (G2) PE; HD and fluvastatin with (G3) and without PE (G4); fed with comercial ration (CR) in presence (G5) and absence (G6) of PE; HD submitted (G7) or not to PE (G8). The HD was administered for 90 days, statins and practice of PE in the treadmill for 8 weeks. It was measured in the beginning (T0) and at the end (T2) of the experiment the level of total cholesterol (TC) , the fraction of cholesterol of high density lipoprotein (HDLc), triglycerides (TG), piruvic glutamic transaminase (TGP) and the fraction of the cholesterol non-HDLc (non-HDLc) was calculated. The animals were sacrificed, the soleus muscle removed for histological analysis. The paired t test and multivaried analysis were applied with a significance level of p<0,05. RESULTS â The analysis of the groups, at the T2, showed reduction in the TC level when compared G3 with groups G1 (p=0,0414), G6 (p=0,0021) and G8 (p=0,0099) and G7 with group G8 (p<0,0001). However, G1 presented elevated levels in relation to G5 (p=0,0286), G7 (p=0,0192) and G8 (p=0,0196), as well as the G2 in comparison to G7 (p=0,0115). The PE associated with fluvastatin (G3) or simvastatin (G1) has not induced a significant increase in the levels of HDLc, when compared to G4 and G2 (p>0,05). The CR, even with sedentarism (G6) kept the levels of HDLc elevated when compared to the groups remaining. Fluvastatin, independently of the presence of PE (G3 and G4) reduced the fraction of non-HDLc in comparison to G6 (p=0,0201; p=0,0315) and G1 (p=0,0271; p=0,0390, respectively). For the triglycerides levels G1 showed elevated values compared to G3 (p=0,0278), as well as TGP (p=0,0151). The main histological alteration found were fibers of different diameter, atrophics, in degeneration, splitting, edema, inflammatory infiltrate. These alterations were observed in 90% of the animals of G1, 80% of G2, 70% of G3, 30% of G4, 40% of G5 and 30% of G7. In G6 and G8 muscular fibers with preserved morphology were identified. CONCLUSION â PE influenciates in the reduction of TC levels even with DH, becoming the differential in the reduction of TC, non-HDLc and TG with the use of fluvastatin compared to simvastatin, whilst levels of HDLc resist to increase. Conversely, the increase in TGP levels are associated with HD and the use of statins, preferably simvastatin and PE practice. Moreover, PE seems to potentialize muscle injury induced by statins. / As estatinas são utilizadas no tratamento das dislipidemias, com grande tolerância, no entanto, vários efeitos colaterais podem surgir, destacando-se miopatia. A prática regular do exercício físico (EF) produz modificações favoráveis no perfil lipídico, entretanto, pode gerar lesões musculares. OBJETIVO - Avaliar a influência do EF no perfil lipídico; a eficácia da associação entre EF e estatinas no controle do perfil lipídico e avaliar o efeito da associação entre EF e estatinas na função muscular pela análise histológica. MATERIAL e Mà TODO - Foram utilizados 80 ratos machos Wistar, distribuídos em 8 grupos, incluindo animais submetidos à dieta hipercolesterolêmica (DH), simvastatina com (G1) e sem (G2) EF; DH e fluvastatina, com (G3) e sem EF (G4); alimentados com ração comercial (RC) na presença (G5) e ausência de (G6) EF; DH submetidos (G7) ou não (G8) a EF. A DH foi administrada por 90 dias, as estatinas e prática de EF em esteira rolante por 8 semanas. Foram dosados, no início (T0) e ao final (T2) dos experimentos, os níveis de colesterol total (CT), fração de colesterol da lipoproteína de alta densidade (HDLc), triglicérides (TG), transaminase glutâmico pirúvico (TGP) e calculada a fração de colesterol não-HDLc (não-HDLc). Os animais foram sacrificados, e o músculo sóleo retirado para análise histológica. Aplicaram-se os testes t-teste pareado e análise multivariada, com nível significante para p<0,05. RESULTADOS â A análise entre os grupos, no T2, mostrou redução dos níveis de CT quando comparado G3 aos grupos G1 (p=0,0414), G6 (p=0,0021) e G8 (p=0,0099) e G7 ao grupo G8 (p<0,0001). Entretanto, G1 apresentou níveis aumentados em relação a G5 (p=0,0286), G7 (p=0,0192) e G8 (p=0,0196), assim como, o G2 em comparação ao G7 (p=0,0115). O EF associado à fluvastatina (G3) ou a simvastatina. (G1) não induziu aumento significante nos níveis de HDLc, quando comparado a G4 e G2 (p>0,05). A RC mesmo com o sedentarismo (G6) manteve os níveis de HDLc elevados quando comparados aos demais grupos. A fluvastatina independente da presença de EF (G3 e G4) reduziu a fração não-HDLc em comparação a G6 (p=0,0201; p=0,0315) e a G1 (p=0,0271; p=0,0390, respectivamente). Para os níveis de TG destacou-se G1 com valores elevados em comparação a G3 (p=0,0278), assim como para TGP (p=0,0151). As principais alterações histológicas encontradas foram fibras de diferentes diâmetros, atróficas, em degeneração, splitting, edema, infiltrado inflamatório. Essas alterações foram observadas em 90% dos animais do grupo G1, 80% de G2, 70% de G3, 30% de G4, 40% de G5 e 30% de G7. Nos grupos G6 e G8 identificaram-se fibras musculares com morfologia preservada. CONCLUSà ES â EF influencia na redução dos níveis de CT mesmo com DH, tornando-se o diferencial na diminuição dos níveis de CT, não-HDLc e TG no uso de fluvastatina comparado a simvastatina, enquanto os níveis de HDLc são resistentes a elevação. Por outro lado, o aumento nos níveis de TGP associa-se com DH e uso de estatinas, preferencialmente simvastatina e prática de EF. Além disso, o EF parece potencializar a lesão muscular induzida pelas estatinas.