Orientador: Beatriz Bojikian Matsubara / Banca: João Carlos Braga / Banca: Katashi Okoshi / Banca: João Carlos Hueb / Banca: Pedro Silvio Farsky / Resumo: Existe grande número de estudos mostrando preditores de mortalidade e outros desfechos desfavoráveis nas síndromes coronarianas agudas (SCA). A mortalidade é aumentada nos pacientes com insuficiência cardíaca (IC), principalmente em classe funcional III e IV de Killip. Contudo, esses pacientes representam a minoria da população internada devido a um evento coronariano agudo. Além disso, a maioria dos estudos inclui apenas pacientes com uma das apresentações das SCAs e todas as classes de Killip. Assim, seria importante estabelecer critérios de estratificação de risco em pacientes com quaisquer das SCAs e sem edema pulmonar ou falência hemodinâmica. No presente estudo, formulou-se a hipótese de que o conjunto de variáveis clínicas e laboratoriais, obtidas na internação, pode predizer desfechos desfavoráveis no paciente com síndrome coronária aguda e em classes funcionais de Killip I ou II. O objetivo primário foi identificar variáveis clínicas, laboratoriais e anatômicas coronarianas, associadas com risco de desfechos desfavoráveis nesses pacientes. Os objetivos secundários foram descrever as alterações clínicas e laboratoriais precoces e identificar as diferenças relacionadas ao sexo. Estudo observacional prospectivo e longitudinal que incluiu 370 pacientes consecutivos (224 homens e 146 mulheres, p < 0,001), admitidos com angina instável (AI), infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) ou infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMST), diagnosticados até quarenta e oito horas após o início dos sintomas. As admissões ocorreram na Unidade de Terapia Intensiva do Pronto-Socorro e na Unidade Coronariana do Hospital das Clínicas da Faculdade de Medicina de Botucatu, no período de março de 2003 a dezembro de 2006. As diferenças entre subgrupos... (REsumo completo, clicar acesso eletrônico abaixo) / Abstract: A large number of studies report mortality predictors and other unfavorable outcomes in acute coronary syndromes (ACSs). Mortality is increased in patients with heart failure (HF), particularly in Killip class III or IV. However, these patients represent the minority of the population hospitalized with acute coronary event. Furthermore, most studies analyzed only patients with one of the ACS presentations, including all Killip classes. Hence, it would be important to establish risk-stratification criteria in patients with any of the ACSs and without pulmonary edema or hemodynamic failure. In the present study, we hypothesized that the set of clinical and laboratory variables obtained at hospitalization can predict unfavorable outcomes in patients with acute coronary syndromes and in Killip classes I or II. The primary aim was to identify clinical, laboratory and coronary anatomical variables associated with the risk for unfavorable outcomes in these patients. The secondary objectives were to describe early clinical and laboratory alterations and to identify gender-related differences. This is a prospective and longitudinal observational study comprising 370 consecutive patients (224 males and 146 females, p < 0.001) admitted to hospital with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) diagnosed up to forty-eight hours after commencement of symptoms. Admissions occurred at the Intensive Care Unit of the Emergency Hospital and at the Coronary Unit of the University Hospital of the Botucatu School of Medicine from March, 2003 to December 2006. The differences between sub-groups were evaluated by Student's t or the... (Complete abstract click electronic access below) / Doutor

nÃo hà / A vincristina à um quimioterÃpico e seu uso à limitado devido a neuropatia perifÃrica, com acometimento autonÃmico, sensitivo e motor. Sulfato de vincristina ou salina foram injetados na veia da cauda, nas doses de 50 Âg/Kg (5 doses), 100 Âg/Kg (2-5 doses) ou 150 Âg/Kg (1, 2 ou 5 doses) a cada dois dias em 144 ratos Wistar machos (200-250 g). No dia seguinte, os animais receberam a refeiÃÃo-teste por gavagem e foram sacrificados 10 minutos apÃs. A recuperaÃÃo gÃstrica e intestinal de corante foi determinada por espectrofotometria. ConstipaÃÃo foi avaliada pelo peso colÃnico e neuropatia sensitiva pela latÃncia tÃrmica (51Â0,5ÂC). PressÃo arterial mÃdia (PAM) e freqÃÃncia cardÃaca (FC) basais e valores da PAM e FC apÃs a administraÃÃo de fenilefrina 5 Âg/Kg e atropina 0,5 mg/Kg foram usados para estudo dos baroreflexos. DiferenÃas foram avaliadas por One-Way ANOVA com P<0,05. Tratamentos crÃnicos com 5 doses de 50 Âg/Kg; 3, 4 e 5 doses de 100 Âg/Kg; 2 e 5 doses de 150 Âg/Kg causaram retardo do esvaziamento gÃstrico (EG) (P<0,05). Duas e 5 doses de 150 Âg/kg induziram constipaÃÃo e houve reduÃÃo da latÃncia tÃrmica apÃs 1 dose de 50 Âg/Kg, 100 Âg/Kg e 150 Âg/kg (P<0,05). O efeito da vincristina sobre o EG nÃo foi evidenciado uma e duas semanas apÃs o tratamento com 5 doses de 150 Âg/Kg (P>0,05). Houve reduÃÃo do tempo de latÃncia ao calor por atà duas semanas apÃs 5 doses de 150 Âg/Kg (P<0,05). Vincristina potencializou a reduÃÃo da FC induzida pela fenilefrina e aumentou a resposta cardÃaca à atropina (P<0,05). A neuropatia autonÃmica induzida pela vincristina cursa com retardo do EG, alteraÃÃes na resposta baroreflexa e aumento do peso colÃnico. A neuropatia sensitiva precede o surgimento das alteraÃÃes autonÃmicas e persiste apÃs a reversÃo destas. / Vincristine is a chemotherapy drug and its use is limited by peripheral neuropathy with autonomic, sensory and motor involvement. Vincristine sulphate or saline was injected into the tail vein at doses of 50 Âg/Kg (5 doses), 100 Âg/Kg (2-5 doses) or 150 Âg/Kg (1, 2 or 5 doses) QOD in 144 male Wistar rats (200-250g). Next day, they were gavage-fed with a test meal and sacrificed 10 minutes later. Gastric and intestinal dye recovery was determined by spectrophotometry. Basal mean arterial pressure (MAP) and heart rate (HR) and peak values of MAP and HR after i.v. phenylephrine 5 Âg/Kg and atropine 0.5 mg/Kg were used to evaluate the baroreflex responses. Differences were evaluated by One-Way ANOVA with P<0.05. Chronic treatment with 5 doses of 50 Âg/Kg; 3, 4 and 5 doses of 100 Âg/Kg; 2 and 5 doses of 150 Âg/Kg delayed gastric emptying (GE) (P<0.05). Two and 5 doses of 150 Âg/Kg induced constipation and reduction in withdrawal latencies occurred after 1 dose of 50 Âg/Kg, 100 Âg/Kg and 150 Âg/Kg (P<0.05). Vincristine (150 Âg/Kg) immediately decreased fecal output (P<0.05). The effect of vincristine on the GE was not present in rats treated with 5 doses of vincristine 150 Âg/kg one week and two weeks after the last dose (P>0.05). The withdrawal latency decrease lasted for at least 2 weeks after 5 doses of 150 Âg/Kg (P<0.05). Vincristine enhanced the HR reduction induced by phenylephrine and enhanced cardiac response to atropine (P<0.05). Vincristine-induced autonomic neuropathy courses with delayed GE, altered baroreflex responses and increased colonic weight. Sensory neuropathy preceded and outlasted these autonomic changes.

M.Tech. (Chiropractic) / Myofascial trigger points are very common and can become a painful part of most people’s life at one time or another. According to Travell and Simons (1999), active upper trapezius myofascial trigger points are common in patients presenting with neck pain. Myofascial pain syndrome is a regional muscle disorder that is one of the most common causes of persistent pain in the head, face and neck regions (Rachlin, 2002). The PAIN®GONE pen is a device that produces a high voltage, low frequency pulse for only a brief period of time. The electrical stimulation activates endorphins in the hypothalamus which plays a role in pain relief (Puskas, 2004). The technical system of the device is clinically proven and uses Transcutaneous Electric Nerve Stimulation (TENS), based on the pain gate control theory of Melzack and Wall (1965). The purpose of this study was to determine the efficacy of treating active upper trapezius trigger points with PAIN®GONE therapy combined with cervical spine chiropractic adjustments.This study consisted of two groups, the PAIN®GONE therapy group (Group 1) with fifteen participants and the placebo PAIN®GONE therapy group (Group 2) with fifteen participants. The participants were between the ages of 18 and 40 years of age. Prior to becoming a participant of this study, individuals were assessed according to the inclusion and exclusion criteria, a case history, physical examination, cervical regional examination and upper trapezius muscle palpation to assess for upper trapezius myofascial trigger points. Treatment was applied to the cervical spine by Chiropractic adjustments, and to the upper active trapezius myofascial trigger points via PAIN®GONE therapy or placebo PAIN®GONE therapy, from which the subjective and objective data were based.Each participant was treated six times over a period of three weeks. Prior to the initiation of treatment, each participant was requested to complete a Vernon-Mior Neck Pain and Disability Index questionnaire and Numerical Pain Rating Scale. Algometer readings were obtained for the active upper trapezius myofascial trigger points. The Cervical Range of Motion (CROM) goniometer was used to obtain numerical values for the participant’s active cervical spine ranges of motion in flexion, extension, lateral flexion androtation. Both groups, received treatment to the active upper trapezius trigger points and Chiropractic adjustments to the cervical spine for a total of six treatment sessions. Both subjective and objective data readings were obtained before the 1st, 4th and 7th final consultation...

M. Tech. / Background: No substantiated theory exists by which chiropractic adjustments are known to correct myofascial trigger points (MTrPs). Myofascial trigger points are theorized to be either a primary muscle dysfunction or a secondary manifestation to central/ peripheral neurological mechanisms. Chiropractic adjustments are theorized to exert their therapeutic influence either primarily through biomechanical effects and/ or via neurophysiological mechanisms. Objective: The objective of this study was to investigate the effects of chiropractic adjustments on chronic, active rhomboid MTrPs, by comparing the clinical effects attained with rhomboid attachment-segment (C7-T5) relative to rhomboid innervation-segment (C4 and/ or C5) chiropractic adjustments. Setting: University of Johannesburg Chiropractic Day Clinic in Johannesburg, Gauteng. Participants: Thirty female subjects selected from the general population (from 18 to 40 years) were randomly divided into two different treatment groups of 15 each. Methods: The subjective information required the completion of the Subjective Pain and Discomfort Questionnaire, including the Numerical Pain Rating Scale (NPRS). The objective measures collected were pressure-pain threshold (PPT) and range of motion measurements using the algometer and digital inclinometer, respectively. Additionally, the change in the number of active MTrPs over the treatment period was recorded. All measurements were recorded at the first, third and fifth consultations, over a 3 to 4 week period. The data gathered were then statistically analyzed with the use of a 95% confidence interval. The nonparametric Friedman and Wilcoxon Signed Rank tests were used for the intragroup comparisons, and the Mann Whitney- U test was used for the intergroup comparisons. Interventions: Treatment group 1 received upper-thoracic/ attachment- segment chiropractic adjustments, and treatment group 2 received mid-cervical/ innervation-segment chiropractic adjustments. The research project was carried out so that both groups received 5 treatment sessions over 3 to 4 weeks. Results: There were no statistically significant results obtained for intergroup comparisons. Attachment-segment chiropractic adjustments revealed statistically significant changes in NPRS values (p=0.000), PPT values (p=0.000), cervical spine right lateral flexion range (p=0.004), thoracic spine extension (p=0.005) and left rotation range (p=0.003) over time. Innervationsegment chiropractic adjustments revealed statistically significant changes in NPRS values v ii (p=0.001), cervical spine right rotation (p=0.003), thoracic spine flexion (p=0.001) right lateral flexion (p=0.001) and left rotation (p=0.005) over time. Conclusions: This study does not suggest that attachment-segment or innervation-segment chiropractic adjustments possess greater clinical efficacy relative to one another in terms of improving the clinical picture associated with chronic, active rhomboid MTrP activity. In a further study, a larger sample size will be necessary to identify subtle changes in measurement parameters.

M. Tech. / OBJECTIVE: The aim of the study was to explore whether dry needle therapy delivered to latent myofascial trigger points of the biceps brachii muscle had an immediate effect on muscle activity and strength . DESIGN: One hundred participants with latent myofascial trigger points of the biceps brachii muscle and who were suitable for the study were drawn from the community. They were al located in to either a controlor treatment group so that each group contained fifty participants . The control and treatment group were divided in such a way to ensure that the two groups were comparable with one another un terms of age and gender. The International Physical Activity Questionnaire was completed by each participant to ensure that the two groups were also comparable with one another in terms of the total amount of physical activity performed per week. The results of this study were statistically analysed by STATKON at the University of Johannesburg.

M.Tech. / This study was conducted to investigate the efficacy of Chiropractic cervicothoracic spinal adjustment therapy in the treatment of active Trapezius myofascial trigger point dysfunction. Thirty participants were recruited and placed into one of two groups. Participants were between the ages of 18 and 30 years and selected based on the inclusion criteria being met. Participants had to present with active upper Trapezius trigger points and a restriction of the cervicothoracic junction. The experimental group received a Chiropractic adjustment to the cervicothoracic junction and the control group received detuned ultrasound as their respective treatments. The participants were treated six times over a 3-week period and measurements were taken on the first, fourth and seventh visits. A case history, physical examination and cervical regional examination were conducted at the first visit. Objective measurements included pressure algometry readings of Trapezius trigger points 1 and 2 and cervical spine goniometry readings. Subjective measurements included the Vernon Mior Pain Disability Index and the Numerical Pain Rating Scale. The results were interpreted by Statcon at the University of Johannesburg. The data was analysed using the Mann Whitney test and the Friedman test. According to the tests, the experimental group improved significantly in both the objective and subjective measurements over the seven visits. The control group showed an increase in the objective measurements and a decrease in the subjective measurements over the seven visits. This was found to be statistically insignificant. This study concluded that a Chiropractic adjustment to the cervicothoracic junction is effective in the treatment of upper Trapezius trigger points

Thesis (M.Tech.:Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005. / The aim of this study was to evaluate the Myofascial Diagnostic Scale, for its inter-examiner reliability and to assess its reliability and validity as an assessment tool in the diagnosis and treatment of Myofascial Pain Syndrome. / M

Abstract Autonomic nervous system (ANS) disturbances are common in Parkinson's disease (PD), but also in other Parkinsonian syndromes, especially in multiple system atrophy (MSA). The differentiation between various Parkinsonian syndromes may be difficult, but it is important for prognostic and therapeutic purposes. The aim of this study was to determine the ability of different analysis methods to reveal cardiovascular regulation disturbances in PD and to evaluate the diagnostic capacity of autonomic tests to differentiate between various Parkinsonian syndromes. Furthermore, this study aimed to evaluate the relationships between ANS disturbances and the clinical characteristics of PD. In addition, the cardiac autonomic function was evaluated during various sleep stages for the first time in untreated PD patients by using spectral heart rate variability (HRV) measures to determine possible sleep stage specific cardiovascular regulation disturbances. Cardiovascular autonomic reflexes were evaluated in 62 untreated and newly diagnosed PD patients, 34 PD patients under antiparkinsonian medication, 47 MSA patients and 15 patients with progressive supranuclear palsy (PSP). The usefulness of different analysis methods was evaluated in a subgroup of 32 untreated PD patients. A further 21 untreated PD patients underwent one-night polysomnography for nocturnal heart rate variability analysis. PD patients with hypokinesia/rigidity as their initial onset sign had a significantly lower max-min ratio in the deep breathing test than those patients with tremor as the initial sign. MSA patients showed significant reductions in both HRV and blood pressure responses during orthostatic provocation, whereas PSP patients had normal results. Absolute spectral measures yielded the clearest indicators separating the PD patients from the controls, while the cardiovascular reflexes proved more useful than the normalised spectral HRV measures in revealing the differences between the two groups. HRV was abnormally decreased during non-REM sleep in PD patients but not during REM sleep or the S1 sleep stage. The normalized high frequency power was significantly decreased in PD patients during sleep stages S2-4, while the standard deviation of the R-R intervals was increased during the same sleep stages, possibly corresponding to the increased motility of PD patients during these sleep stages. The clinical characteristics of PD deserve particular attention in connection with ANS disturbances, since autonomic failure seems to be more pronounced in PD patients with hypokinesia/rigidity as their initial sign. The evaluation of the autonomic function may also be helpful in the differential diagnosis of Parkinsonian syndromes. Spectral analysis methods should be implemented in the evaluation of ANS dysfunction to achieve the best possible efficacy in the differentiation of pathological responses from normal ones. Nocturnal analysis of cardiovascular regulation revealed new and interesting features of pathologic HRV in PD patients, thus when HRV is evaluated, the different sleep stages should be analysed separately.

A dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Chiropractic, Durban Institute of Technology, 2003. / The purpose of this study was to determine the relative effectiveness of a home programme of ischaemie compression, sustained stretch and a combination of the two, in terms of subjective and objective clinical findings for the treatment of Myofascial Pain Syndrome. / M

M.Tech. (Chiropractic) / PURPOSE: Shoulder pain has been identified to be one of the most common musculoskeletal problems found in a variety of different countries, showing characteristics of chronicity and recurrence. It is considered to be a main contributor towards nontraumatic upper limb pain. One of the identifiable causes of chronic or reoccuring shoulder pain may be attributed to myofascial pain syndrome which is caused by MTrP’s and produces symptoms that are similar to that of other shoulder pain syndromes. The infraspinatus muscle as an integral component of the rotator cuff complex is subject to high tension biomechanical strain as well as neuromuscular tension. While therapeutic interventions have been devised to treat varying degrees of biomechanical and neuomuscular tension, little evidence exists establishing which of these treatment regimes is most effective in treating myofascial trigger points. The purpose of this study was to compare different regional chiropractic adjustments relative to the attachment site and the innervation segment of the infraspinatus muscle and to identify the most effective treatment protocol with regard to chronic, active infraspinatus myofascial trigger point dysfunction. DESIGN: A selection of thirty participants were recruited for this study. The participants were divided into two groups of fifteen participants each. Group A received a chiropractic adjustment to the glenohumeral joint, the attachment site for infraspinatus muscle. Group B received a chiropractic adjustment to the cervical spine segments associated with the innervation to the infraspinatus muscle. Cervical spine restrictions specific to levels C4/C5 and/or C5/C6, and glenohumeral joint restrictions were determined using motion palpation techniques. All participants received a total of six treatments over a three-four week period. MEASUREMENTS: Subjective measurements were obtained by the Functional Rating Index Questionnaire and the Numerical Pain Rating Scale. Objective measurements were obtained using the hand-held pressure algometer and counting the number of active infrapsinatus myofascial trigger points. The data was collected on the first, fourth and seventh consultations. OUTCOME: With regards to the subjective readings, the results from the Functional Rating Index Questionnaire for the intragroup analysis indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (15.5%). No statistically significant differences were noted for the intergroup analysis. The intragroup analysis of the Numerical Pain Rating Scale indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (68.8%). The intergroup analysis indicated that there were no statistically significant differences. vii With regard to the objective measurements, the intragroup analysis of the pressure algometer readings indicated that the glenohumeral joint adjustment group showed the greatest improvement over time (21.7%). There were no statistically significant differences with the intergroup analysis. The intragroup and intergroup analysis of the number of active infraspinatus myofascial trigger point dysfunction showed no statistically significant differences between the groups or within each of the groups over time. CONCLUSION: The results showed that both treatment groups protocols were effective in reducing chronic, active infraspinatus myofascial trigger point dysfunction. Small differences were noted between the two treatment groups with regards to the subjective and objective findings. The glenohumeral joint adjustment group showed the greatest clinical and statistical improvements over the three-four week trial period.