ABSTRACT Objective: Thymidine-dependent small-colony variants (TD-SCVs) of Staphylococcus aureus are being isolated with increasing frequency from patients with cystic fibrosis (CF). The aim of this study was to evaluate the relationship between TD-SCV isolation and pulmonary function in patients with CF, as well as to determine whether the emergence of TD-SCVs was associated with trimethoprim-sulfamethoxazole (TMP-SMX) use and with coinfection with other microorganisms. Methods: This was a retrospective case-control study including patients with CF who visited the Clinical Hospital Complex of the Federal University of Paraná, in Curitiba, Brazil, between 2013 and 2022. Demographic, clinical, and spirometric data, as well as information on TD-SCVs and other isolated microorganisms, were collected from the medical records of patients with CF and TD-SCVs (TD-SCV group; n = 32) and compared with those of a matched group of patients with CF without TD-SCVs (control group; n = 64). Results: Isolation of TD-SCVs was positively associated with TMP-SMX use (p = 0.009), hospitalization (p < 0.001), and impaired pulmonary function (p = 0.04). Conclusions: The use of TMP-SMX seems to contribute to the emergence of TD-SCVs, the isolation of which was directly associated with worse pulmonary function in our sample. Objective Thymidinedependent Thymidine dependent smallcolony small colony TDSCVs TD SCVs (TD-SCVs CF. . (CF) TDSCV SCV trimethoprimsulfamethoxazole trimethoprim sulfamethoxazole TMPSMX TMP SMX (TMP-SMX microorganisms Methods casecontrol case control Paraná Curitiba Brazil 201 2022 Demographic clinical data 32 64. 64 64) Results p 0.009, 0009 0.009 , 0 009 0.009) 0.001, 0001 0.001 001 0.001) 0.04. 004 0.04 04 0.04) Conclusions TDSCVs, SCVs, sample (CF 20 202 3 6 000 0.00 00 0.0 2 0.

ABSTRACT Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic diseases that result from the deregulation of the mucosal immune system of the gastrointestinal tract. The use of biological therapies, including infliximab (IFX), is one of the strategies to treat both CD and UC. The IFX treatment is monitored by complementary tests, namely: fecal calprotectin (FC); C-reactive protein (CRP); and endoscopic and cross-sectional imaging. Besides, serum IFX evaluation and antibody detection are also used. Objective: To evaluate trough levels (TL) and antibodies in a population with inflammatory bowel (IBD) disease undergoing treatment with IFX, and the factors that might impact the treatment effectiveness. Methods: Retrospective, cross-sectional study with patients with IBD that were assessed for TL and antibody (ATI) levels in a southern Brazilian hospital, from June 2014 to July 2016. Results: The study assessed 55 patients (52.7% female) submitted to serum IFX and antibody evaluations (95 blood samples, 55 first test; 30 second test, and 10 as third testing. Forty-five (47.3%) cases were diagnosed with CD (81.8%), and ten with UC (18.2%). Serum levels were adequate in 30 samples (31.57%), subtherapeutic in 41 (43.15%), and supratherapeutic in 24 (25.26%). IFX dosages were optimized for 40 patients (42.10%), maintained for 31 (32.63%), and discontinued for 7 (7.60%). The intervals between infusions were shortened in 17.85% of the cases. In 55 tests (55.79%), the therapeutic approach was exclusively defined according to IFX and/or serum antibody levels. The assessment of patients one year later indicated that: the approach was maintained with IFX for thirty-eight patients (69.09%); the class of biological agent was changed for eight (14.54%); changes using the same class of biological agent occurred for two patients (3.63%); the medication was discontinued and not replaced for three patients (5.45%), and four patients (7.27%) were lost to follow-up. Conclusion: There were no differences in TL between groups with or without immunosuppressants, serum albumin (ALB), erythrocyte sedimentation rate (ESR), FC, CRP, and endoscopic and imaging examinations. Current therapeutic approach could be maintained for almost 70% of patients. Thus, serum and antibody levels are a useful tool in the follow-up of patients undergoing maintenance therapy and after treatment induction in patients with inflammatory bowel disease. Background Crohns Crohn s (CD (UC tract therapies , (IFX) namely FC (FC) Creactive C reactive CRP (CRP) crosssectional cross sectional Besides used Objective (TL (IBD effectiveness Methods Retrospective ATI (ATI hospital 201 2016 Results 5 52.7% 527 52 (52.7 female 95 (9 test 3 1 testing Fortyfive Forty five 47.3% 473 47 (47.3% 81.8%, 818 81.8% 81 8 (81.8%) 18.2%. 182 18.2% . 18 2 (18.2%) 31.57%, 3157 31.57% 57 (31.57%) 4 43.15%, 4315 43.15% 43 15 (43.15%) 25.26%. 2526 25.26% 25 26 (25.26%) 42.10%, 4210 42.10% 42 (42.10%) 32.63%, 3263 32.63% 32 63 (32.63%) 7.60%. 760 7.60% 60 (7.60%) 1785 17 85 17.85 55.79%, 5579 55.79% 79 (55.79%) andor thirtyeight thirty 69.09% 6909 69 09 (69.09%) 14.54% 1454 14 54 (14.54%) 3.63% 363 (3.63%) 5.45%, 545 5.45% 45 (5.45%) 7.27% 727 27 (7.27% followup. followup follow up. up Conclusion immunosuppressants ALB, ALB (ALB) ESR, ESR (ESR) examinations 70 Thus (IFX (FC (CRP 20 52.7 (52. 9 ( 47.3 (47.3 81.8 (81.8% 18.2 (18.2% 315 31.57 (31.57% 431 43.15 (43.15% 252 25.26 (25.26% 421 42.10 (42.10% 326 32.63 6 (32.63% 76 7.60 (7.60% 178 17.8 557 55.79 (55.79% 69.09 690 0 (69.09% 14.54 145 (14.54% 3.63 36 (3.63% 5.45 (5.45% 7.27 72 (7.27 (ALB (ESR 52. (52 47. (47. 81. (81.8 18. (18.2 31.5 (31.57 43.1 (43.15 25.2 (25.26 42.1 (42.10 32.6 (32.63 7.6 (7.60 17. 55.7 (55.79 69.0 (69.09 14.5 (14.54 3.6 (3.63 5.4 (5.45 7.2 (7.2 (5 (47 (81. (18. 31. (31.5 43. (43.1 25. (25.2 42. (42.1 32. (32.6 7. (7.6 55. (55.7 69. (69.0 14. (14.5 3. (3.6 5. (5.4 (7. (4 (81 (18 (31. (43. (25. (42. (32. (55. (69. (14. (3. (5. (7 (8 (1 (31 (43 (25 (42 (32 (55 (69 (14 (3 (2 (6

RESUMO Contexto: A doença de Crohn e a colite ulcerativa são doenças crônicas nas quais existem desregulação do sistema imune da mucosa do trato gastrointestinal. Uma das terapias usadas no tratamento dessas doenças são as medicações biológicas, entre elas o Infliximabe. A monitorização do tratamento dos pacientes com Iinfliximabe é feita por exames complementares: calprotectina fecal, pesquisa de atividade inflamatória, exames endoscópicos e imagem. Utiliza-se, também a dosagem do nível sérico do Infliximabe e a pesquisa de anticorpos. Objetivo: Analisar uma população com doenças inflamatórias intestinais, em tratamento com Infliximabe, submetida a avaliação do nível sérico do Infliximabe e do anticorpo, além de possíveis fatores que possam alterar ou contribuir no tratamento. Métodos: Trata-se de estudo retrospectivo, transversal, realizado por meio da revisão dos prontuários dos pacientes com doença inflamatória intestinal, em um hospital sul-brasileiro, no período de junho de 2014 até julho de 2016, que foram submetidos a avaliação dos níveis séricos de Infliximabe e do anticorpo. Resultados: Foram incluídos 55 pacientes, submetidos a dosagem do Infliximabe e do anticorpo, totalizando 95 coletas sanguíneas. Destes, 55 realizaram uma primeira coleta, 30 tiveram uma segunda amostra coletada e 10 coletaram uma terceira vez. Vinte e nove pacientes eram do sexo feminino (52,7%) e vinte e seis do sexo masculino (43.2%). Quarenta e cinco (47,3%) casos tinham diagnóstico de doença de Crohn (81,8%) e 10 de colite ulcerativa (18,2%). Em relação ao nível sérico encontrou-se nível adequado em 30 coletas (31,57%), subterapêutico em 41 coletas (43,15%) e supraterapêutico em 24 coletas (25,26%). A prescrição foi otimizada em 40 (42,10%) casos, mantida em 31 (32,63%) pacientes, suspensa em 7 (7,60%) ou que o intervalo entre as infusões fosse aumentado (17,85%). Na análise geral, em 53 coletas (55,79%) a conduta foi definida em função exclusivamente da dosagem sérica do Infliximabe e/ou do anticorpo, já em relação, apenas a primeira coleta obteve-se 33 (60%) pacientes. Avaliando-se os pacientes um ano após, obteve-se: em 38 (69,09%) pacientes a conduta foi mantida com Infliximabe e, em 8 (14,54%) foi optado por troca de classe, em 2 (3,63%) foi optado por troca da medicação na mesma classe, em 3 (5,45%) pacientes a medicação foi suspensa e não foi substituída e, em 4 (7,27%), perdeu-se o seguimento. Conclusão: Não encontrou-se diferença entre os níveis de Infliximabe entre os grupos com ou sem imunossupressor, albumina sérica, velocidade de hemossedimentação, Calprotectina, Proteína C reativa, exames endoscópicos e exames de imagem. A conduta atual pode ser mantida em quase 70% dos pacientes. Concluindo, a dosagem do nível sérico e do anticorpo é ferramenta útil no acompanhamento dos pacientes em terapia de manutenção e após a indução de tratamento em pacientes com Doença Inflamatória Intestinal. Contexto gastrointestinal biológicas complementares fecal imagem Utilizase, Utilizase Utiliza se, se Utiliza-se anticorpos Objetivo intestinais Métodos Tratase Trata retrospectivo transversal intestinal sulbrasileiro, sulbrasileiro sul brasileiro, brasileiro sul-brasileiro 201 2016 Resultados 5 9 sanguíneas Destes 1 vez 52,7% 527 52 (52,7% 43.2%. 432 43.2% . 43 (43.2%) 47,3% 473 47 (47,3% 81,8% 818 81 (81,8% 18,2%. 182 18,2% 18 (18,2%) encontrouse encontrou 31,57%, 3157 31,57% , 57 (31,57%) 43,15% 4315 15 (43,15% 25,26%. 2526 25,26% 25 26 (25,26%) 42,10% 4210 42 (42,10% 32,63% 3263 32 63 (32,63% 7,60% 760 60 (7,60% 17,85%. 1785 17,85% 17 85 (17,85%) geral 55,79% 5579 79 (55,79% eou obtevese obteve 60% (60% Avaliandose Avaliando 69,09% 6909 69 09 (69,09% 14,54% 1454 14 54 (14,54% classe 3,63% 363 (3,63% 5,45% 545 45 (5,45% 7,27%, 727 7,27% 27 (7,27%) perdeuse perdeu seguimento Conclusão imunossupressor hemossedimentação Calprotectina reativa 70 Concluindo Intestinal 20 52,7 (52,7 43.2 (43.2% 47,3 (47,3 81,8 (81,8 18,2 (18,2% 315 31,57 (31,57% 43,15 431 (43,15 252 25,26 (25,26% 42,10 421 (42,10 32,63 326 6 (32,63 7,60 76 (7,60 178 17,85 (17,85% 55,79 557 (55,79 (60 69,09 690 0 (69,09 14,54 145 (14,54 3,63 36 (3,63 5,45 (5,45 72 7,27 (7,27% 52, (52, 43. (43.2 47, (47, 81, (81, 18, (18,2 31,5 (31,57 43,1 (43,1 25,2 (25,26 42,1 (42,1 32,6 (32,6 7,6 (7,6 17,8 (17,85 55,7 (55,7 (6 69,0 (69,0 14,5 (14,5 3,6 (3,6 5,4 (5,4 7,2 (7,27 (52 (43. (47 (81 (18, 31, (31,5 43, (43, 25, (25,2 42, (42, 32, (32, 7, (7, 17, (17,8 55, (55, ( 69, (69, 14, (14, 3, (3, 5, (5, (7,2 (5 (43 (4 (8 (18 (31, (25, (42 (32 (7 (17, (55 (69 (14 (3 (1 (31 (25 (17 (2

Abstract Background High-intensity interval training (HIIT) has been suggested as an alternative for continuous training (CT) in people with diabetes mellitus (DM) due to its short duration and potential to improve adherence to exercise. However, data on its impact on heart rate variability (HRV) are scarce. Objectives To assess and compare the effects of HIIT and CT on exercise capacity, HRV and isolated hearts in diabetic rats. Methods DM (intravenous streptozotocin, 45 mg.kg -1 ) and control (C) animals performed 20 sessions (5 days/week, 50 min, for 4 weeks) of CT on a treadmill (70% of maximal exercise capacity) or HIIT (cycles of 1:1min at 50% and 90% of maximal exercise capacity). HRV was assessed by continuous electrocardiogram, and cardiac function assessed in isolated perfused hearts. For data analysis, we used the framework of the multivariate covariance generalized linear model or one-way ANOVA followed by Tukey’s test, considering p<0.05 as significant. Results Higher exercise capacity (m/min) was achieved in HIIT (DM-HIIT: 36.5 [IQR 30.0-41.3]; C-HIIT: 41.5 [37.8-44.5], both n=10) compared to CT (DM-CT: 29.0 [23.8-33.0]; C-CT: 32.0 [29.5-37.0], both n=10) (p<0.001). Heart rate (bpm) was lower in DM compared to controls (p<0.001) both in vivo (DM-HIIT:348±51, C-HIIT:441±66, DM-CT:361±70, C-CT:437±38) and in isolated hearts. There were no differences in HRV between the groups. Maximum and minimal dP/dt were reduced in DM, except +dP/dt in DM-HIIT vs. C-HIIT (mean difference: 595.5±250.3, p=0.190). Conclusion Short-term HIIT promotes greater improvement in exercise performance compared to CT, including in DM, without causing significant changes in HRV. Highintensity High intensity (HIIT (CT (DM However (HRV scarce rats intravenous streptozotocin mgkg mg kg 1 - C (C 2 5 ( daysweek days week days/week min weeks 70% 70 (70 cycles 11min 1min 90 capacity. . electrocardiogram analysis oneway one way Tukeys Tukey s test p005 p 0 05 p<0.0 m/min mmin m (m/min DMHIIT (DM-HIIT 365 36 36. IQR 30.041.3 300413 30.0 41.3 30 41 3 30.0-41.3] CHIIT 415 41. 37.844.5, 378445 37.8 44.5 , 37 8 44 [37.8-44.5] n=10 n10 n 10 DMCT (DM-CT 290 29 29. 23.833.0 238330 23.8 33.0 23 33 [23.8-33.0] CCT C-CT 320 32 32. 29.537.0, 295370 29.5 37.0 [29.5-37.0] p<0.001. p0001 p<0.001 001 bpm (bpm (p<0.001 DMHIIT348±51, DMHIIT34851 348±51, 348 51 (DM-HIIT:348±51 CHIIT441±66, CHIIT44166 441±66, 441 66 C-HIIT:441±66 DMCT361±70, DMCT36170 361±70, 361 DM-CT:361±70 CCT437±38 CCT43738 437±38 437 38 C-CT:437±38 groups dPdt dP dt vs mean difference 59552503 595 250 595.5±250.3 p=0.190. p0190 p=0.190 190 p=0.190) Shortterm Short term 7 (7 9 p00 p<0. 041 30.041. 30041 300 30. 413 30.0-41.3 844 37.844.5 37844 378 37. 445 44. [37.8-44.5 n=1 n1 833 23.833. 23833 238 23. 330 33. [23.8-33.0 537 29.537.0 29537 295 370 [29.5-37.0 p000 p<0.00 00 (p<0.00 DMHIIT348 DMHIIT348±51 DMHIIT3485 34851 348±51 34 (DM-HIIT:348±5 CHIIT441 CHIIT441±66 CHIIT4416 44166 441±66 6 C-HIIT:441±6 DMCT361 DMCT361±70 DMCT3617 36170 361±70 DM-CT:361±7 CCT437 CCT437±3 CCT4373 43738 437±3 43 C-CT:437±3 5955250 59 25 595.5±250. p019 p=0.19 19 p0 p<0 04 30.041 3004 30.0-41. 84 37.844. 3784 [37.8-44. n= 83 23.833 2383 [23.8-33. 53 29.537. 2953 [29.5-37. (p<0.0 DMHIIT34 DMHIIT348±5 3485 348±5 (DM-HIIT:348± CHIIT44 CHIIT441±6 4416 441±6 C-HIIT:441± DMCT36 DMCT361±7 3617 361±7 DM-CT:361± CCT43 CCT437± 4373 437± C-CT:437± 595525 595.5±250 p01 p=0.1 p< 30.04 30.0-41 37.844 [37.8-44 23.83 [23.8-33 29.537 [29.5-37 (p<0. DMHIIT3 DMHIIT348± 348± (DM-HIIT:348 CHIIT4 CHIIT441± 441± C-HIIT:441 DMCT3 DMCT361± 361± DM-CT:361 CCT4 C-CT:437 59552 595.5±25 p=0. 30.0-4 37.84 [37.8-4 [23.8-3 29.53 [29.5-3 (p<0 (DM-HIIT:34 C-HIIT:44 DM-CT:36 C-CT:43 5955 595.5±2 p=0 30.0- [37.8- [23.8- [29.5- (p< (DM-HIIT:3 C-HIIT:4 DM-CT:3 C-CT:4 595.5± p= [37.8 [23.8 [29.5 (p DM-CT: 595.5 [37. [23. [29. DM-CT 595. [37 [23 [29 [3 [2 [

Resumo Fundamento O treinamento intervalado de alta intensidade (HIIT) tem sido sugerido como alternativa ao treinamento contínuo (TC) em indivíduos com diabetes mellitus (DM) devido à sua curta duração e potencial para melhorar a adesão ao exercício. No entanto, dados sobre seu impacto sobre a variabilidade da frequência cardíaca (VFC) são escassos. Objetivos Avaliar e comparar os efeitos do HIIT e TC sobre a capacidade no exercício, VFC e corações isolados em ratos diabéticos. Métodos Animais diabéticos (estreptozotocina intravenosa, 45 mg.kg -1 ) e controles (C) realizaram 20 sessões de TC (5 dias/semana, 50 min, por quatro semanas) em esteira (70% da capacidade máxima de exercício) ou HIIT (ciclos de 1:1min a 50% e 90% da capacidade máxima de exercício). A VFC foi avaliada por eletrocardiograma contínuo, e a função cardíaca foi avaliada em corações isolados perfundidos. Para a análise dos dados, utilizamos a matriz do modelo linear generalizado de covariância multivariada ou o teste one-way ANOVA seguido pelo teste de Tukey, considerando um valor de p<0,05 como significativo. Resultados A capacidade de exercício (m/min) foi maior no grupo submetido ao HIIT [DM-HIIT: 36,5 (IIQ 30,0-41,3); C-HIIT: 41,5 (37,8-44,5), ambos n=10) em comparação ao grupo submetido ao TC [DM-TC: 29,0 (23,8-33,0); C-TC: 32,0 (29,5-37,0), ambos n=10) (p<0,001). A frequência cardíaca (bpm) foi mais baixa no grupo DM em comparação aos controles (p<0,001) tanto in vivo (DM-HIIT: 348±51, C-HIIT:441±66, DM-TC:361±70, C-TC:437±38) como nos corações isolados. Não houve diferenças na VFC entre os grupos. Os valores máximos e mínimos de dP/dt foram reduzidos no DM, com exceção da +dP/dt no grupo DM-HIIT vs. C-HIIT (diferença média: 595,5±250,3, p=0,190). Conclusão O HIIT de curto prazo promoveu melhora superior no desempenho no exercício em comparação ao TC, sem causar mudanças significativas na variabilidade da frequência cardíaca. (HIIT (TC (DM entanto (VFC escassos estreptozotocina intravenosa 4 mgkg mg kg 1 - C (C 2 5 ( diassemana dias semana dias/semana min semanas 70% 70 (70 ciclos 11min 1min 90 . perfundidos oneway one way Tukey p005 p 0 05 p<0,0 significativo m/min mmin m (m/min DMHIIT [DM-HIIT 365 36 36, IIQ 30,041,3 300413 30,0 41,3 30 41 3 30,0-41,3) CHIIT 415 41, 37,844,5, 378445 37,8 44,5 , 37 8 44 (37,8-44,5) n=10 n10 n 10 DMTC [DM-TC 290 29 29, 23,833,0 238330 23,8 33,0 23 33 (23,8-33,0) CTC C-TC 320 32 32, 29,537,0, 295370 29,5 37,0 (29,5-37,0) p<0,001. p0001 p<0,001 001 bpm (bpm (p<0,001 (DM-HIIT 34851 348 51 348±51 CHIIT441±66, CHIIT44166 441±66, 441 66 C-HIIT:441±66 DMTC361±70, DMTC36170 361±70, 361 DM-TC:361±70 CTC437±38 CTC43738 437±38 437 38 C-TC:437±38 grupos dPdt dP dt vs diferença média 59552503 595 250 595,5±250,3 p=0,190. p0190 p=0,190 190 p=0,190) 7 (7 9 p00 p<0, 041 30,041, 30041 300 30, 413 30,0-41,3 844 37,844,5 37844 378 37, 445 44, (37,8-44,5 n=1 n1 833 23,833, 23833 238 23, 330 33, (23,8-33,0 537 29,537,0 29537 295 370 (29,5-37,0 p000 p<0,00 00 (p<0,00 3485 34 348±5 CHIIT441 CHIIT441±66 CHIIT4416 44166 441±66 6 C-HIIT:441±6 DMTC361 DMTC361±70 DMTC3617 36170 361±70 DM-TC:361±7 CTC437 CTC437±3 CTC4373 43738 437±3 43 C-TC:437±3 5955250 59 25 595,5±250, p019 p=0,19 19 p0 p<0 04 30,041 3004 30,0-41, 84 37,844, 3784 (37,8-44, n= 83 23,833 2383 (23,8-33, 53 29,537, 2953 (29,5-37, (p<0,0 348± CHIIT44 CHIIT441±6 4416 441±6 C-HIIT:441± DMTC36 DMTC361±7 3617 361±7 DM-TC:361± CTC43 CTC437± 4373 437± C-TC:437± 595525 595,5±250 p01 p=0,1 p< 30,04 30,0-41 37,844 (37,8-44 23,83 (23,8-33 29,537 (29,5-37 (p<0, CHIIT4 CHIIT441± 441± C-HIIT:441 DMTC3 DMTC361± 361± DM-TC:361 CTC4 C-TC:437 59552 595,5±25 p=0, 30,0-4 37,84 (37,8-4 (23,8-3 29,53 (29,5-3 (p<0 C-HIIT:44 DM-TC:36 C-TC:43 5955 595,5±2 p=0 30,0- (37,8- (23,8- (29,5- (p< C-HIIT:4 DM-TC:3 C-TC:4 595,5± p= (37,8 (23,8 (29,5 (p DM-TC: 595,5 (37, (23, (29, DM-TC 595, (37 (23 (29 (3 (2

RESUMO Introdução: O bruxismo é definido como a atividade repetitiva dos músculos mastigatórios, e pode ocorrer durante o período acordado (bruxismo em vigília) ou durante o sono (bruxismo do sono). Objetivo: O presente estudo teve como objetivo avaliar a prevalência de bruxismo em vigília e seus fatores associados. Métodos: A amostra foi composta por 50 participantes, de ambos os sexos, com idades de 18 a 60 anos, avaliados por meio de minucioso exame clínico - para observar se havia presença de sinais como desgaste dentário, indentações na mucosa, hipertrofia do músculo masseter - e de questionários autoaplicáveis que visaram avaliar a presença de sinais e sintomas de disfunção temporomandibular (DTM), os comportamentos orais e hábitos de vida, o nível de ansiedade e a qualidade de sono dos participantes. Resultados: A prevalência de bruxismo em vigília foi de 48%. Sua presença foi associada, estatística e significativamente, com a presença de sinais e sintomas de DTM (p=0,002), má qualidade do sono (p=0,032), e indentações na mucosa jugal (p<0,001) e língua (p=0,011). Por outro lado, a idade, sexo, características sociais, hábitos (como ingestão de café, fumo, álcool e prática de atividade física), e o desgaste dentário foram variáveis que não tiveram associação com o bruxismo em vigília. Conclusão: Diante disso, conclui-se que o bruxismo em vigília possui uma prevalência significativa e uma associação positiva com DTM e qualidade do sono. Além disso, o bruxismo em vigília apresenta maior probabilidade de acontecer em indivíduos com indentação de mucosa jugal e com alta prevalência de hábitos e comportamentos orais.

ABSTRACT Introduction: Bruxism is defined as a repetitive activity of masticatory muscles, characterized by the clenching or grinding of the teeth, which can occur during wakefulness (awake bruxism) or during sleep (sleep bruxism). Objectives: The objectives of the present study were to determine the prevalence of awake bruxism and its associated factors. Methods: Sample was composed by 50 participants of both genders, aged between 18 and 60 years, submitted to a clinical examination - to observe the presence of tooth wear, marks on the mucosa, or masseter muscles hypertrophy - and self-applied questionnaires, which evaluated the presence of TMD signs and symptoms, oral behaviors, lifestyles, anxiety level and sleep quality. Results: The prevalence of awake bruxism was 48%. Its presence was statistically and significantly associated with the presence of signs and symptoms of TMD (p=0.002), poor sleep quality (p=0.032), buccal mucosa indentations (p<0.001) and tongue (p=0.011). Age, gender, social characteristics, habits (such as coffee ingestion, smoking, alcoholism and physical activity) and tooth wear were variables that had no significant association with awake bruxism. Conclusions: It was concluded that awake bruxism shows a high prevalence and a positive association with signs and symptoms of TMD and worst sleep quality. In addition, awake bruxism is more likely to occur in individuals who have buccal mucosa indentation and who present high rates of oral habits and oral behaviors.

ABSTRACT Objective: To evaluate the reasons for request of bone mineral density (BMD) evaluation and correlate the BMD results with previous fractures, risk factors for osteoporosis, and clinical characteristics in patients with obesity. Subjects and methods: Cross-sectional, retrospective, single-site study including adult patients with body mass index (BMI) ≥ 30 kg/m2 and BMD evaluation between January 2015 and May 2016 selected from a BMD database. Data on demographic characteristics, lifestyle habits, comorbidities, medications, risk factors, previous fractures, and indications for BMD evaluation were collected from the participants’ medical records. Results: The study included 619 patients (89.9% women, mean BMI 34.79 ± 4.05 kg/m2). In all, 382 (61.7%), 166 (26.8%), and 71 (11.5%) patients had class 1, 2, and 3 obesity, respectively. The most frequent (29.9%) reason for BMD evaluation was for osteoporosis monitoring. In all, 69.4% of the patients had low BMD. Multivariate analysis showed that age, calcium supplementation, and previous osteoporosis or osteopenia were associated with low BMD, while age, vitamin D supplementation, use of proton pump inhibitors (PPIs), and low BMD were associated with previous fractures (p < 0.05 for all). Conclusions: Among patients with obesity identified from a tertiary hospital database, those with low bone mass and risk factors traditionally associated with fractures had an increased history of fractures. Patients with greater BMI had better bone mass and fewer fractures. These findings indicate that the association between reduced weight, risk factors for osteoporosis, and fractures remained despite the presence of obesity in our population.

Abstract Objective: Correlate serum magnesium (Mg) and Calcium (Ca) levels with body composition and metabolic parameters in women with fibromyalgia (FM). Patients and methods: Cross-sectional study compared with a control group paired by age and body mass index (BMI) of adult women diagnosed with fibromyalgia. All participants went through assessment of their body composition through dual-energy X-ray absorptiometry (DXA) and had blood samples collected for dosing of Mg, Ca, C-reactive Protein (CRP), lipidogram and glycemia. Results: 53 women with FM (average age 48.1 ±8.2 years, average BMI 26.6 ±4.5 kg/m2) and 50 control women (average age 47.1 ±9.9 years, average BMI 25.6 ± 3.6 kg/m2) participated in the study. Serum levels turned out to have inverse correlation with CRP in the FM group (r = −0.29, p = 0.03) and with BMI and glycemia in the control group (r = 0.31; p = 0.02 and r = 0.48; p = 0.0004 respectively). Serum levels of calcium correlated with triglycerides (r = 0.29; p = 0.03) in the FM group and with glycemia in the control group (r = 0.64; p = 0.0001). Conclusions: In patients with FM, magnesemia turned out to have inverse correlation with CRP and calcemia had positive association with triglycerides.

Abstract INTRODUCTION: We report the results of the active surveillance of influenza infections in hospitalized patients and the evaluation of the seasonality and correlation with temperature and rainfall data. METHODS: During the 2-year study period, 775 patients were tested for 15 respiratory viruses (RVs). RESULTS: Most of the 57% of (n=444) virus-positive samples were human rhinovirus and respiratory syncytial virus. However, 10.4% (n=46) were influenza virus (80% FluA; 20% FluB). Age and SARI were significantly associated with influenza. FluB circulation was higher is 2013. CONCLUSIONS: In the post-epidemic period, influenza remains an important cause of hospitalization in SARI patients.

RESUMO Racional: As hepatectomias compreendem considerável perda sanguínea e utilização de hemoderivados, o que diretamente estão relacionados com maior morbimortalidade. A hepatectomia hemoconservadora (HH) é modificação da técnica de oclusão vascular seletiva em hepatectomia. Ela pode ser alternativa cirúrgica para evitar ou diminuir o uso de hemoderivados no perioperatório. Objetivo: Avaliar os efeitos da HH sobre o volume globular (VG), concentração de hemoglobina (HB) e sobre a regeneração hepática em ratos. Métodos: Dois grupos de ratos Wistar foram constituídos: controle (n=6) e intervenção (n=6). Os do grupo controle foram submetidos à hepatectomia parcial de Higgins e Anderson e os do grupo Intervenção à HH. VG e HB foram medidos nos dias D0, D1 e D7. A relação peso do fígado/peso do rato foi calculada em D0 e D7. A regeneração hepática foi analisada qualitativamente e quantitativamente. Resultados: Houve diminuição dos níveis de VG e HB nos ratos do grupo controle a partir de D1, atingindo decréscimo de 18% em D7 (p=0,01 e p=0,008 respectivamente); a HH permitiu a manutenção dos níveis de VG e HB nos ratos do grupo intervenção. A HH não alterou a regeneração hepática. Conclusão: HH resultou em níveis maiores de VG e HB pós-operatórios sem alterar a regeneração hepática. Pode-se considerar estes dados como a prova necessária para a translação à pesquisa clinicocirúrgica.

ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice.

RESUMO Nos últimos anos, Inteligências Múltiplas (IM – corporal-cinestésica, espacial, intrapessoal, interpessoal, linguística, lógico-matemática, musical e naturalista) e Preferências de Aprendizagem (PA – visual, auditiva, leitura/escrita, cinestésica, multimodal) vêm sendo intensamente estudadas em todo o mundo. Em tal contexto, diversas ferramentas que avaliassem tais parâmetros foram criadas e posteriormente aprimoradas ao longo das últimas décadas. Atualmente, a necessidade de se utilizar as melhores estratégias de aprendizado e a crescente necessidade de que o ensino seja individualizado reforçam a importância de que sejam mapeadas as habilidades e preferências cognitivas individuais. Objetivos analisar as distribuições de IM – e como elas se influenciam – e das PA em estudantes de medicina da Universidade Federal do Paraná (UFPR), Brasil. Espera-se que os resultados estimulem melhorias no contexto educacional. Materiais e Métodos estudo transversal e descritivo envolvendo estudantes de medicina da UFPR de todos os 12 semestres, sendo analisados através de questionários quanto às suas MI e (“Lista de verificação para avaliar inteligências múltiplas de alunos”) e PA (“Visual, Aural, Read/Write, Kinesthetic – VARK – Questionnaire”, previamente traduzido e validado para a língua Portuguesa). Resultados 1054 questionários foram coletados e processados. As IM intrapessoal (71±10,5), lógico-matemática (69,3±14) e linguística (68,4±11,8) atingiram as maiores médias gerais, enquanto a naturalista registrou a menor pontuação (47,3±19,5). Observou-se correlação positiva entre todas as IM. Quanto às PA, prevaleceu a multimodal (42,3%), seguida por visual (21,3%), auditiva (18,6%), cinestésica (11,2%) e leitura/escrita (6,6%). Quando correlacionadas ambas as teorias cognitivas, sobressaíram-se as seguintes associações: PA visual e IM intrapessoal; PA auditiva e IM interpessoal; PA leitura/escrita e IM lógico-matemática; PA cinestésica e IM lógico-matemática; e PA multimodal e IM intrapessoal. Conclusão A IM intrapessoal atingiu maiores médias, seguida por lógico-matemática e linguística. A IM naturalista, por outro lado, obteve menores pontuações em termos de semestres, ciclos e análise geral. Todas as inteligências apresentaram influência apresentaram interdependência positiva. A multimodalidade foi a PA mais prevalente, enquanto leitura/escrita foi a menos observada. Correlações inicialmente esperadas entre IM e PA foram confirmadas. Quanto às perspectivas futuras, espera-se que professores e gestores educacionais adaptem estratégias de ensino atuais de modo a melhor contemplar as preferências dos estudantes. Em conjunto, IM e PA preconizam que atualmente não mais se questione o quão inteligente alguém seja, e sim de que maneiras o seria.

ABSTRACT In recent years, Multiple Intelligences (MI – bodily-kinesthetic, spatial, intrapersonal, interpersonal, linguistic, logical-mathematical, musical, and naturalist) and Learning Preferences (LP – visual, aural, read/write, kinesthetic, and multimodal) have been intensely studied throughout the world. In this context, plenty of tools that evaluate such parameters have been created and later improved over the past decades. Nowadays, the necessity for optimal learning strategies and more individualized teaching continues to rise, reinforcing the importance of identifying individual strengths and cognitive preferences. Objectives to analyze the distribution of MI – and how they influence one another – and LP in medical students at the Federal University of Paraná (UFPR), Brazil. The results could lead to improvements in the educational setting. Methods a descriptive cross-sectional study involving UFPR medical students of all 12 semesters, who were analyzed through questionnaires with regard to both their MI (“Multiple Intelligences Checklist for Students”) and LP (“Visual, Aural, Read/Write, Kinesthetic – VARK – Questionnaire”). Results a total of 1054 questionnaires were processed (527 students). Intrapersonal (71 ± 10.5), logical-mathematical (69.3 ± 14), and linguistic (68.4 ± 11.8) intelligences predominated, whereas naturalist achieved the lowest mean score (47.3 ± 19.5). Positive correlations were identified between all of the MI. Regarding the LP, the multimodal (42.3%) was the most frequent, followed by visual (21.3%), aural (18.6%), kinesthetic (11.2%), and read/write (6.6%). When both cognitive theories were correlated, the following associations prevailed: visual LP and intrapersonal intelligence; aural LP and interpersonal intelligence; read/write LP and logical-mathematical intelligence; kinesthetic LP and logical-mathematical intelligence; and multimodal preference and intrapersonal intelligence. Conclusions intrapersonal intelligence achieved the highest overall scores, followed by logical-mathematical and linguistic. Naturalist intelligence achieved the lowest scores in terms of semester, cycle, and overall analysis. All MI were positively correlated. Multimodality was the most commonly observed LP, whereas the read/write preference was the least frequent. Correlations initially expected between MI and LP were confirmed. As for future perspectives, it is expected that teachers and education managers adapt current teaching strategies in order to meet the students’ preferences. Together, MI and LP indicate that the focus should not rely on how smart a given person is, but in which ways.

Resumo Este estudo avaliou a soroprevalência de Toxoplasma gondii, Neospora caninum e Leptospira spp. em cães de Foz do Iguaçu, Paraná, Brasil. O teste de imunofluorescência indireta foi utilizado para detectar anticorpos anti-T. gondii e anti-N. caninum. Ensaio imunoenzimático e soroaglutinação microscópica foram utilizados para pesquisa de anticorpos anti-T. gondii e anti-Leptospira spp., respectivamente. Os resultados obtidos foram: 67,02% (435/649) das amostras reativas para T. gondii e, 1,38% (9/649) para N. caninum, ambas com ausência de variáveis significativas estatisticamente. Para Leptospira spp. os resultados indicaram soroprevalência de 23,11% (153/649). A análise das variáveis sem distinção de sorovar mostraram associação para caraterísticas intrísecas como raça, idade, estado nutricional e categoria de cães. Para as variáveis extrínsecas, a região da cidade e ter acesso à rua mostraram associação estatística (p<0,05). Os sorovares mais prevalentes foram: Canicola com 59,47% (91/153); Bratislava 13,07% (20/153) e Butembo 15,68% (24/153). As variáveis que compõem o modelo de análise multivariada ajustada usando como desfecho Leptospira spp. foram: idade, raça, estado nutricional e área. Para o sorovar Canicola, as variáveis significantes (p<0,05) foram sexo, estado nutricional e área; para o sorovar Bratislava, as variáveis significantes (p<0,05) foram linfadenomegalia e presença de pulgas. Dos resultados obtidos, cães podem ser usados como sentinelas para infecção por T. gondii e Leptospira spp. na cidade de Foz do Iguaçu e em outras cidades com desfechos similares. Além disso, medidas preventivas devem ser tomadas pelas autoridades de saúde, pois são zoonoses e os seres humanos também estão em risco.

Abstract This study evaluated the seroprevalence of Toxoplasma gondii, Neospora caninum and Leptospira spp. in dogs from Foz do Iguaçu, Paraná, Brazil. Indirect immunofluorescent antibody test was used to detect antibodies anti-T.gondii and anti-N. caninum. Immunoenzymatic assay and microscopic serum agglutination were used for screening antibodies anti-T.gondii and anti-Leptospira spp., respectively. The results were: 67.02% of the samples reactive for T.gondii and 1.38% for N. caninum, both without statistically significant variables. For Leptospira spp. the results indicated seroprevalence of 23.11%. The analysis of the variables without distinction of serovar showed association for intrinsic characteristics as breed, age, nutritional status and dog category. The extrinsic variables as city region and access to the street presented association (p<0.05). The most prevalent serovars were: Canicola 59.47%; Bratislava 13.07% and Butembo 15.68%. Variables that make up the adjusted multiple analysis model using Leptospira spp. were: age, breed and nutritional status; serovar Canicola, sex, nutritional status and area (p<0.05); serovar Bratislava, lymphadenomegaly and presence of fleas (p<0.05). Given the results obtained, dogs can be used as sentinels for toxoplasmosis and leptospirosis in Foz do Iguaçu and other cities with similar outcomes. In addition, preventive measures should be taken by health authorities because they are zoonoses and humans are also at risk.

RESUMO CONTEXTO: No tratamento de doenças inflamatórias intestinais (DII) são usados imunossupressores e agentes biológicos, o que aumenta o risco de infecções pela alteração da imunidade celular e humoral. A prevenção de algumas dessas infecções pode ser feita pela vacinação, entretanto pacientes com DII apresentam baixas taxas de cobertura vacinal. OBJETIVO: Analisar a situação vacinal de pacientes com DII e comparar com a recomendação vigente na literatura para verificar se os esquemas de imunização estão sendo corretamente aplicados nessa população. MÉTODOS: Estudo transversal analítico com 239 pacientes com DII em acompanhamento no Serviço de Gastroenterologia do Hospital de Clínicas da Universidade Federal do Paraná, os quais foram submetidos a um questionário sobre dados demográficos relevantes e sobre a situação vacinal. RESULTADOS: A taxa de pacientes que declarou não ter conhecimento de sua situação vacinal é alta - entre 34,3% (dTpa) e 52% (meningocócica) - com exceção das vacinas influenza, hepatite B e HPV. As vacinas com maior taxa de pacientes que declararam ter recebido a vacina são influenza (72,4%), BCG (55,3%), hepatite B (48,3%), tríplice viral (43,8%) e DTPa (43%). As vacinas com menor taxa de pacientes que declararam ter recebido a vacina são Haemophilus influenza b (0,8%), herpes zoster (2,1%) e HPV (3,4%). Pacientes que fazem ou já fizeram tratamento com agentes biológicos têm melhor cobertura vacinal das vacinas para influenza (81%) e PP23V (25,9%), além de maior conhecimento sobre o estado vacinal para essas vacinas. CONCLUSÃO: Apesar de se tratar de um serviço especializado ligado a um hospital universitário, a cobertura vacinal e o conhecimento dos pacientes sobre as vacinas estão abaixo do desejado. A recuperação do histórico vacinal e a recomendação das vacinas necessárias devem ser realizadas logo após o diagnóstico de DII, independentemente do uso de agentes biológicos. Esses achados indicam a necessidade da criação e monitoramento constante da aplicação de um protocolo pela equipe multidisciplinar de serviços especializados em DII.

ABSTRACT BACKGROUND: Treatment for inflammatory bowel disease (IBD) includes a variety of immunosuppressants and biological agents, which increase the risk of infections due to altered cellular and humoral immunity. Prevention of these infections can be done through vaccination, however, patients with IBD are usually under-immunized. OBJECTIVE: Analyze the immunization status of patients with IBD and confront it with the current recommendations to verify if the immunization guidelines are being followed correctly. METHODS: Analytical cross-sectional study including 239 IBD patients being regularly followed in the Gastroenterology Service from Hospital de Clínicas da Universidade Federal do Paraná, which were subjected to a survey about their relevant demographic data and immunization status. RESULTS: The amount of patients that declared being unaware of their immunization status is high - between 34.3% (Tdap) and 52% (meningococcal) - excepting IIV, hepatitis B and HPV. The vaccines with the largest rates of patients declaring to have taken it are inactivated influenza vaccine (72.4%), BCG (55.3%), hepatitis B (48.3%), measles, mumps and rubella vaccine (43.8%) and DTaP (43%). The vaccines with the lowest rates of patients declaring to have taken it are Haemophilus influenza type b (0.8%), herpes zoster (2.1%) and HPV (3.4%). Patients that are being treated or have been treated with biological therapy have the largest immunization coverage for inactivated influenza vaccine (81%) and PPSV23 (25.9%), also they have the largest awareness rates for those vaccines. CONCLUSION: Although being a specialized service linked to a university hospital, vaccination coverage and patients’ awareness rates proved to be below the desirable level. Vaccination and recovery of the immunization history is recommended immediately after the diagnosis of IBD, regardless of the use of biological agents. Those findings support the need of implementing hospital guidelines and constantly verifying its application by the multidisciplinary team in specialized services in IBD.

RESUMO Objetivo Descrever as características clínicas e epidemiológicas de pacientes com sepse e sem sepse em unidades de cuidados intensivos de um hospital público. Métodos Estudo transversal realizado de maio de 2012 a abril de 2013. Os dados clínicos e laboratoriais de pacientes com sepse e sem sepse das unidades de terapia intensiva foram revisados a partir dos prontuários médicos. Resultados Avaliamos 466 pacientes, 58% homens, mediana de idade 40 anos; sendo 146 (31%) diagnosticados com sepse. A mortalidade global foi 20%, e significativamente maior para pacientes com sepse (39%). Os fatores associados à mortalidade em unidade de terapia intensiva foram a presença de sepse (OR: 6,1, IC95%: 3,7-10,5), idade (OR: 3,6, IC95%: 1,4-7,2) e tempo de internação (OR: 0,96, IC95%: 0,94-0,98). As infecções pulmonares (49%) e intra-abdominais (20%) foram os focos mais comumente identificados, e os estafilococos coagulase-negativa e bacilos entéricos Gram-negativos foram os patógenos isolados mais frequentes (66%). Conclusão Embora o impacto da sepse sobre a mortalidade esteja relacionado às características clínicas e epidemiológicas dos pacientes, uma avaliação crítica desses dados é importante, pois permitirá a implementação direta de políticas locais para gerenciar este grave problema de saúde pública.

ABSTRACT Objective To describe the clinical and epidemiological features of patients with and without sepsis at critical care units of a public hospital. Methods A cross-sectional study was carried out from May 2012 to April 2013. Clinical and laboratory data of patients with and without sepsis in the intensive care units were reviewed of medical records. Results We evaluated 466 patients, 58% were men, median age was 40 years, and 146 (31%) of them were diagnosed with sepsis. The overall mortality was 20% being significantly higher for patients with sepsis (39%). The factors associated with intensive care unit mortality were the presence of sepsis (OR: 6.1, 95%CI: 3.7-10.5), age (OR: 3.6, 95%CI: 1.4-7.2), and length of hospital stay (OR: 0.96, 95%CI: 0.94-0.98). Pulmonary (49%) and intra-abdominal (20%) infections were most commonly identified sites, and coagulase-negative staphylococci and enteric Gram negative bacilli the most frequent (66%) pathogens isolated. Conclusion Although the impact of sepsis on mortality is related to patients’ clinical and epidemiological characteristics, a critical evaluation of these data is important since they will allow the direct implementation of local policies for managing this serious public health problem.

Abstract Objective: Determine food intake and levels of serum magnesium (Mg) and calcium (Ca) and correlate these minerals with pain, quality of life and depression risk in women with and without fibromyalgia (FM). Patients and methods: Fifty-three women diagnosed with FM and 50 healthy women participated in the study, where all of them had equivalent age and body mass index (BMI). All women underwent anthropometric assessment, physical exams of pain perception threshold and tender point (TP) count, blood sample collection, and filling out of FM impact questionnaire (FIQ), Patient Health Questionnaire-9 (PHQ-9), and 3-day dietary record (DR). Results: Dietary intake of Mg and Ca was substantially lower by women with FM. There were no differences in levels of serum Mg and Ca in the groups under analysis. For the FM group, dietary intake of Mg and Ca had inverse correlation with TP and direct relation with the pain threshold. Conclusions: Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar a analgesia pós-operatória e a necessidade de tramadol nos pacientes submetidos à operação de reconstrução do ligamento cruzado anterior com raquianestesia, fentanil e bloqueio do nervo femoral. MÉTODOS: Cento e sessenta e seis pacientes foram divididos em quatro grupos (G). Todos os pacientes receberam raquianestesia com 15mg de bupivacaína isobárica a 0,5%. Nos grupos G2 e G3 foi associado 25µg de fentanil à bupivacaína e nos grupos G3 e G4 foi associado bloqueio do nervo femoral com 100mg de bupivacaína a 0,5% sem vasoconstritor. Os pacientes receberam dipirona e cetoprofeno de horário e eram orientados a solicitar tramadol caso a dor estivesse ≥4 na escala numérica. Após 6, 12 e 24 horas da raquianestesia foi registrado o escore na escala numérica, a solicitação de tramadol e eventos adversos. RESULTADOS: Os escores médios de dor 6 e 24 horas não foram diferentes. Na avaliação 12 horas houve diferença apenas no G4 em relação ao G1 (p=0,01). O tramadol foi solicitado por 46,7% no G1, 52,9% no G2, 18,6% no G3 e 36,4% no G4 (p=0,009), com diferença entre G1 e G3 e também entre G2 e G3. CONCLUSÃO: A associação de raquianestesia e bloqueio do nervo femoral no G4 proporcionou menores escores de dor na avaliação 12 horas após a anestesia, por outro lado os índices mais elevados foram observados na raquianestesia com fentanil do G2. As avaliações de dor em 6 e 12 horas foram semelhantes. O maior consumo de analgésicos ocorreu naqueles que relataram mais dor no G2.

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate postoperative analgesia and the need for tramadol in patients undergoing reconstruction of the anterior cruciate ligament with spinal anesthesia, fentanyl and femoral nerve block. METHODS: 166 patients were divided into four groups (G). All patients received spinal anesthesia with 15mg of isobaric bupivacaine at 0.5%. In the G2 and G3 groups, 25µg of fentanyl was associated with bupivacaine and in groups G3 and G4 femoral nerve block was associated with 100mg of bupivacaine at 0.5%, without vasoconstrictor. Patients received timed dipyrone and ketoprofen and were instructed to request tramadol if the pain was ≥4 on the numerical scale. After 6, 12 and 24 hours of spinal anesthesia, the score was recorded on the numerical scale, the request of tramadol and adverse events. RESULTS: Mean pain scores at 6 and 24 hours were not different. In the 12-hour evaluation, there was a difference only in G4 in relation to G1 (p=0.01). Tramadol was requested by 46.7% in G1, 52.9% in G2, 18.6% in G3 and 36.4% in G4 (p=0.009), with a difference between G1 and G3 and also between G2 and G3. CONCLUSION: The association of spinal anesthesia and femoral nerve block in G4 provided lower pain scores in the evaluation at 12 hours after anesthesia. On the other hand, the highest indices were observed in G2, spinal anesthesia with fentanyl. Pain scores at 6 and 12 hours were similar. The highest consumption of analgesics occurred in those who reported more pain in G2.

RESUMO Realizou-se estudo transversal do sofrimento mental com 1.021 professores do ensino público do Paraná. Utilizou-se o Self-Report Questionnaire para distúrbios psíquicos menores, os inventários de ansiedade e depressão de Beck, e questionário sociodemográfico e de morbidade autorreferida. Os testes Qui-quadrado, Exato de Fisher e Kruskal-Wallis foram utilizados na análise dos dados obtidos. Foram encontrados distúrbios psíquicos menores em 75%, depressão em 44% e ansiedade em 70% das pessoas observadas no presente estudo, havendo associação significativa (p<0,05) destes sintomas com o sexo feminino, outras doenças, o fato de levarem trabalho para casa e de trabalharem com o ensino fundamental. O sofrimento mental esteve presente em grande parcela da amostra estudada, apresentando relação com as condições de trabalho.

ABSTRACT A cross-sectional study of mental suffering was carried out with 1.021 professors of the public education in Paraná. The Self-Report Questionnaire was utilized for minor psychic disorders, Beck's anxiety and depression inventories, and a sociodemographic and self-reported morbidity questionnaire. The Chi-square, Exact of Fischer and the Kruskal-Wallis tests were used in the analysis of the obtained data. Minor psychic disorders were found in 75%, depression in 44% and anxiety in 70% of the people observed in the present study, with a significant association (p<0,05) of this symptoms with the female sex, other illness, the fact of taking work home and working with elementary school. Mental distress was present in a large portion of the sample studied, presenting relation with the working conditions.