OBJECTIVES: To investigate the effect of opioid receptor blockade on the myocardial protection conferred by chronic exercise and to compare exercise training with different strategies of myocardial protection (opioid infusion and brief periods of ischemia-reperfusion) preceding irreversible left anterior descending coronary ligation. INTRODUCTION: The acute cardioprotective effects of exercise training are at least partly mediated through opioid receptor-dependent mechanisms in ischemia-reperfusion models. METHODS: Male Wistar rats (n = 76) were randomly assigned to 7 groups: (1) control; (2) exercise training; (3) morphine; (4) intermittent ischemia-reperfusion (three alternating periods of left anterior descending coronary occlusion and reperfusion); (5) exercise training+morphine; (6) naloxone (a non-selective opioid receptor blocker) plus morphine; (7) naloxone before each exercise-training session. Myocardial infarction was established in all groups by left anterior descending coronary ligation. Exercise training was performed on a treadmill for 60 minutes, 5 times/week, for 12 weeks, at 60% peak oxygen (peak VO2). Infarct size was histologically evaluated. RESULTS: Exercise training significantly increased exercise capacity and ΔVO2 (VO2 peak - VO2 rest) (p<0.01 vs. sedentary groups). Compared with control, all treatment groups except morphine plus naloxone and exercise training plus naloxone showed a smaller infarcted area (p<0.05). No additional decrease in infarct size occurred in the exercise training plus morphine group. No difference in myocardial capillary density (p = 0.88) was observed in any group. CONCLUSIONS: Exercise training, morphine, exercise training plus morphine and ischemia-reperfusion groups had a smaller infarcted area than the control group. The effect of chronic exercise training in decreasing infarct size seems to occur, at least in part, through the opioid receptor stimulus and not by increasing myocardial perfusion

A cefaléia é sintoma de alta prevalência na população, sendo queixa freqüente na prática clínica. Cursa geralmente com exame físico geral e neurológico normais. A triagem de pacientes com cefaléia facilitaria o atendimento em centros médicos não especializados. No presente estudo utilizou-se um questionário baseado nos critérios da Sociedade Internacional de Cefaléias modificado pelos autores em 204 pacientes de ambulatório do Hospital das Clínicas da FMUSP. Metade destes pacientes foi submetida a consulta clínica. Os resultados do questionário foram então comparados com os resultados da consulta clínica (padrão-ouro). As cefaléias encontradas eram primárias (89,6%) na sua maioria. O questionário demonstrou sensibilidade de 90,2% para detecção das enxaquecas e especificidade de 57,9%, com coeficiente de comparação (kappa) de 0,47, e valor preditivo positivo (VPP) de 65,7% e um valor preditivo negativo (VPN) de 86,8 . A sensibilidade para detecção de cefaléia do tipotensional foi 60,8% e a especificidade foi 87,1% comkappa de 0,49, e VPP de 77,8% e VPN de 75,9. Concluímos que esse questionário pode ser utilizado como um método de triagem para o diagnóstico de cefaléias, podendo ser aplicado por pessoal não médico. Futuramente, ele poderá ser utilizado em estudos populacionais.

Headache is a common complaint with a high prevalence in ambulatory settings. The physical and neurological examinations are frequently normal. The use of questionnaires as a screening method for patients with primary headache could facilitate the diagnosis in non specialized medical centers. In the present study, we used a questionnaire , based on the IHS criteria and modified by the authors, applied to 204 patients from the outpatient clinic of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Half of the patients were submitted to a clinical interview. We compared the results of the questionnaire with the results of the medical interview (gold standard). Most of the headaches we studied were primary headaches (89.6%). The questionnaire revealed a sensitivity of 90.2% and specificity of 57.9% for migraine detection with a chance corrected agreement {kappa) of 0.47 and a positive predictive (PPV) value of 65.7% and a negative predictive value (NPV) de 86.8%. The sensitivity for tension-type headache detection was 60.8% and the specificity 87.1 % with a kappa value of 0.49 and a PPV of 77.8% and a NPV of 75.9%. We conclude that this questionnaire can be used as a screening method for diagnosing headache and that it can be applied by non-medical personnel. This questionnaire could also be used for population studies.