Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Introdução: As quedas e fraturas constituem uma importante causa de hospitalização e mortalidade em indivíduos idosos, contribuindo de forma significativa para a sua perda de autonomia. O papel da vitamina D na melhoria dos distúrbios músculo-esqueléticos em doentes idosos na prevenção de quedas e fraturas é ainda controverso. Objetivos: Determinar a evidência do efeito da suplementação da vitamina D na prevenção de quedas e fraturas em idosos. Fonte de dados: MEDLINE, The Cochrane Library, NGC, NICE, DARE, TRIP Database, USPSTF, AGS e DGS. Métodos: Pesquisa de estudos publicados nos últimos 10 anos (de 01 de fevereiro de 2009 a 28 de fevereiro de 2019), escritos em Português e Inglês, utilizando os termos MeSH Vitamin D, Accidental Falls e Fractures, Bone. Para avaliação da qualidade dos estudos e força de recomendação foi utilizada a escala Strength of Recommendation Taxonomy, da American Family Physician (SORT). Resultados: Da pesquisa inicial resultaram 514 artigos, tendo sido selecionados 15 por cumprirem os critérios de inclusão definidos: seis guidelines/normas de orientação clínica (NOC), oito revisões sistemáticas (RS) e meta-análises (MA) e um ensaio clínico aleatorizado (ECA). A maioria das guidelines e NOC defende a suplementação de vitamina D na prevenção de quedas e fraturas em idosos. Contudo, a análise das RS e MA mostram resultados discordantes ao demonstrar que a suplementação de vitamina D não tem efeitos nas quedas e fraturas em idosos, nomeadamente não institucionalizados. Conclusões: Em idosos não institucionalizados e sem défice de 25(OH)D não há benefício da suplementação de vitamina na prevenção de quedas e fraturas (SORT B). Idosos institucionalizados e com défice de 25(OH)D devem ser suplementados com vitamina D isoladamente ou combinada com cálcio (SORT B). A suplementação de doses elevadas de vitamina D e de forma intermitente pode ter efeitos deletérios (SORT B).

Introduction: Falls and fractures are an important cause of hospitalization and mortality in elderly individuals, contributing significantly to their loss of autonomy. The role of vitamin D in improving musculoskeletal disorders in elderly patients in the prevention of falls and fractures is still controversial. Aim: To determine the evidence of the effect of vitamin D supplementation on the prevention of falls and fractures in the elderly. Data source: MEDLINE, The Cochrane Library, NGC, NICE, DARE, TRIP Database, USPSTF, AGS, and DGS. Methods: Research of studies published in the last 10 years (from February 1, 2009, to February 28, 2019) written in Portuguese and English using the terms MeSH ‘Vitamin D’, ‘Accidental Falls’, and ‘Fractures, Bone’. Evaluation of the quality of the studies and strength of recommendation was used in the Strength of Recommendation Taxonomy scale of the American Family Physician (SORT). Results: From the initial study, 514 articles were selected and 15 were selected because they met the defined inclusion criteria: six guidelines, eight systematic reviews (RS), and meta-analyses (MA) and one randomized clinical trial (RCT). Most guidelines and NOC advocate vitamin D supplementation in the prevention of falls and fractures in the elderly. However, the RS and MA analyzes show discordant results in demonstrating that vitamin D supplementation has no effect on falls and fractures in the elderly, particularly non-institutionalized. The effects may be greater in individuals with low baseline vitamin D levels. Conclusions: There is no benefit of vitamin supplementation in the prevention of falls and fractures (SORT B) in non-institutionalized elderly people without a deficit of 25(OH)D. Institutionalized elderly with a deficit of 25(OH)D should be supplemented with vitamin D alone or combined with calcium (SORT B). Supplementation of high doses of vitamin D and intermittently may have deleterious effects (SORT B).