RESUMO

Despite all the development of modern medicine, around 100 compounds derived from natural products were undergoing clinical trials only at the end of 2013. Among these natural substances in clinical trials, we found the resveratrol (RES), a pharmacological multi-target drug. RES analgesic properties have been demonstrated, although the bases of these mechanisms have not been fully elucidated. The aim of this study was to evaluate the involvement of opioid and cannabinoid systems in RES-induced peripheral antinociception. Paw withdrawal method was used and hyperalgesia was induced by carrageenan (200 µg/paw). All drugs were given by intraplantar injection in male Swiss mice (n = 5). RES (100 µg/paw) administered in the right hind paw induced local antinociception that was antagonized by naloxone, non-selective opioid receptor antagonist, and clocinnamox, µOR selective antagonist. Naltrindole and nor-binaltorfimine, selective antagonists for δOR and kOR, respectively, did not reverse RES-induced peripheral antinociception. CB1R antagonist AM251, but not CB2R antagonist AM630, antagonized RES-induced peripheral antinociception. Peripheral antinociception of RES intermediate-dose (50 µg/paw) was increased by: (i) bestatin, inhibitor of endogenous opioid degradation involved-enzymes; (ii) MAFP, inhibitor of anandamide amidase; (iii) JZL184, inhibitor of 2-arachidonoylglycerol degradation involved-enzyme; (iv) VDM11, endocannabinoid reuptake inhibitor. Acute and peripheral administration of RES failed to affect the amount of µOR, CB1R and CB2R. Experimental data suggest that RES induces peripheral antinociception through µOR and CB1R activation by endogenous opioid and endocannabinoid releasing.

Assuntos

Analgésicos/farmacologia , Endocanabinoides/metabolismo , Hiperalgesia/prevenção & controle , Dor Nociceptiva/prevenção & controle , Peptídeos Opioides/metabolismo , Receptor CB1 de Canabinoide/agonistas , Receptores Opioides mu/agonistas , Resveratrol/farmacologia , Animais , Comportamento Animal/efeitos dos fármacos , Antagonistas de Receptores de Canabinoides/farmacologia , Carragenina , Modelos Animais de Doenças , Hiperalgesia/induzido quimicamente , Hiperalgesia/metabolismo , Hiperalgesia/psicologia , Masculino , Camundongos , Antagonistas de Entorpecentes/farmacologia , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/metabolismo , Dor Nociceptiva/psicologia , Receptor CB1 de Canabinoide/metabolismo , Receptores Opioides mu/metabolismo , Transdução de Sinais

RESUMO

Psychological factors including pain catastrophizing and resilience associate with adjustment and quality of life in people living with chronic pain. Nevertheless, their presentation among females living with HIV and chronic pain has been poorly studied. Given that chronic pain in those living with HIV might occur due to different mechanisms (nociceptive or neuropathic), we hypothesize that the associated psychological states could also differ between these groups. We aimed to compare pain frequency and interference, psychological factors and sleep quality between females living with chronic nociceptive or neuropathic pain. Also, we explored correlations between psychological factors, pain severity and interference in females living with HIV and chronic pain. We performed a cross sectional study assessing females living with HIV and chronic pain, and compared it with a female HIV-positive, pain-free control sample in Brazil. To discriminate the most likely underlying mechanism for the chronic pain, we applied the Leeds Assessment for Neuropathic Signs and Symptoms (LANSS). Forty-nine females living with HIV and chronic pain were assessed, and divided in control (n = 12), nociceptive (n = 10) and neuropathic pain (n = 27) groups. Using validated scales, their pain catastrophizing, resilience, depression, anxiety and sleep disorders were assessed between May 2014 and August 2015. Compared to controls, females living with HIV and neuropathic chronic pain had higher pain frequency (p<0.001), interference on activities (p = 0.002), interference with emotions (p<0.001), catastrophizing (p<0.001), depression (p = 0.015), and lower resilience (p = 0.011). Catastrophizing was also significantly correlated to the burden of chronic pain. The type of chronic pain in females living with HIV should raise concerns regarding significant burden in psychological states in this population (particularly neuropathic pain). Using scales such as the LANSS to identify the type of choric pain, could be of use to address relevant issues for the patients, and to propose tailored therapies.

Assuntos

Infecções por HIV/complicações , Neuralgia/complicações , Dor Nociceptiva/complicações , Adolescente , Adulto , Idoso , Brasil , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Infecções por HIV/psicologia , Humanos , Pessoa de Meia-Idade , Neuralgia/psicologia , Dor Nociceptiva/psicologia , Psicologia , Adulto Jovem

RESUMO

CONTEXT: (-)-α-Bisabolol (BISA) is a sesquiterpene alcohol widely used as scent in cosmetic preparations, perfumes, shampoos, toilet soaps and other toiletries with potential for use in the pharmaceutical area. OBJECTIVE: To evaluate the corneal antinociceptive efficacy of BISA and to analyze the best solubilizing agent. MATERIALS AND METHODS: Acute corneal nociception was induced by the local application of hypertonic saline (5 M NaCl; 20 µL) to the corneal surface of Swiss mice (n = 8/group) 60 min after topical treatment with solutions or ointment containing BISA (50-200 mg/mL). The number of eye wipes performed with the ipsilateral forepaw was counted for a period of 30 s. Control groups (vehicles) were included. RESULTS: BISA (50, 100 or 200 mg/mL) solubilized with Tween 80 did not reduce the number of eye wipes. Animals treated with the ointment (BISA 50, 100 or 200 mg/mL; p < 0.001), as well the solution containing propylene glycol (BISA 100 mg/mL; p < 0.05), showed significant reduction in the number of nociceptive behaviours. Solutions containing propylene glycol and isopropyl myristate had no effects. DISCUSSION AND CONCLUSION: BISA possess corneal antinociceptive activity. Although the ointment presented antinociceptive effect, it is concluded that BISA when associated with propylene glycol has better potential for corneal nociceptive pain since it is more comfortable to use, leading to greater acceptance by patients.

Assuntos

Analgésicos/farmacologia , Córnea/efeitos dos fármacos , Dor Ocular/prevenção & controle , Dor Nociceptiva/prevenção & controle , Sesquiterpenos/farmacologia , Administração Oftálmica , Analgésicos/administração & dosagem , Analgésicos/química , Animais , Comportamento Animal/efeitos dos fármacos , Córnea/inervação , Modelos Animais de Doenças , Composição de Medicamentos , Excipientes/química , Dor Ocular/induzido quimicamente , Dor Ocular/fisiopatologia , Dor Ocular/psicologia , Camundongos , Sesquiterpenos Monocíclicos , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/fisiopatologia , Dor Nociceptiva/psicologia , Pomadas , Medição da Dor , Propilenoglicol/química , Solução Salina Hipertônica , Sesquiterpenos/administração & dosagem , Sesquiterpenos/química , Solubilidade

RESUMO

CONTEXT: Linalool oxide (OXL) (a monoterpene) is found in the essential oils of certain aromatic plants, or it is derived from linalool. The motivation for this work is the lack of psychopharmacological studies on this substance. OBJECTIVE: To evaluate OXL's acute toxicity, along with its anticonvulsant and antinociceptive activities in male Swiss mice. MATERIAL AND METHODS: OXL (50, 100 and 150 mg/kg, i.p.) was investigated for acute toxicity and in the Rota-rod test. Antinociceptive activity was evaluated by the acetic acid-induced writhing test, and by formalin testing. Anticonvulsant effects were demonstrated by testing for pentylenetetrazol (PTZ)-induced seizures and by Maximum Electroshock headset (MES) test. OXL was administered to the animals intraperitoneally 30 min before for pharmacological tests. RESULTS: OXL showed an LD50 of ∼721 (681-765) mg/kg. In the Rota-rod test, it was observed that OXL caused no damage to the animal's motor coordination. OXL significantly reduced (p < .001) the number of writhings. OXL also significantly decreased (p < .05, p < .01 or p < .001) paw-licking time in the two phases of the formalin test. OXL significantly reduced (p < .01 or p < .001) the duration of tonic seizures in the MES test, and at the dose 150 mg/kg, significantly increased (p < .01) the latency to first seizure in the PTZ test. CONCLUSION: The tested doses of OXL were safe, with no motor impairment, and show clear antinociceptive and anticonvulsant potential. Future investigations with this monoterpene may lead to the development of a new molecule with even higher potency and selectivity.

Assuntos

Analgésicos/farmacologia , Anticonvulsivantes/farmacologia , Comportamento Animal/efeitos dos fármacos , Cicloexanóis/farmacologia , Monoterpenos/farmacologia , Nociceptividade/efeitos dos fármacos , Dor Nociceptiva/prevenção & controle , Convulsões/prevenção & controle , Compostos de Tritil/farmacologia , Ácido Acético , Monoterpenos Acíclicos , Analgésicos/toxicidade , Animais , Anticonvulsivantes/toxicidade , Cicloexanóis/toxicidade , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Eletrochoque , Formaldeído , Dose Letal Mediana , Masculino , Camundongos , Monoterpenos/toxicidade , Atividade Motora , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/fisiopatologia , Dor Nociceptiva/psicologia , Pentilenotetrazol , Tempo de Reação/efeitos dos fármacos , Teste de Desempenho do Rota-Rod , Convulsões/induzido quimicamente , Fatores de Tempo , Compostos de Tritil/toxicidade

RESUMO

AIM: To investigate the antinociceptive, antiedematogenic and chondroprotective effects of diacerein (DIA) in a model of joint inflammation induced by complete Freund's adjuvant (CFA), as well as to investigate the involvement of metalloproteinase (MMP)-9, transient receptor potential vanilloid 1 (TRPV1) and glial cells in DIA's action mechanism. METHODS: Complete Freund's adjuvant was injected into the knee joint of male rats. We observed mechanical and cold hypersensitivity, vocalization and spontaneous pain-related behaviors, as well as edema of the knee. Tissue samples of the knee were stained with Cason`s technique and the thickness of the condilus cartilage was measured. Immunohistochemical analysis was performed on the spinal cord using anti-GFAP (glial fibrillary acidic protein), anti-MMP and anti-TRPV1 antibodies. Sections of the dorsal horns of the spinal cord were captured and an optical density was obtained. RESULTS: Complete Freund's adjuvant induced mechanical and thermal hypersensitivity, as well as joint edema and changes in the synovial membrane and cartilage. DIA (30 mg/kg, orally, daily) significantly inhibited mechanical (58 ± 10-87 ± 3%) and thermal (66 ± 12-87 ± 8%) hypersensitivity, vocalization (83 ± 5-41 ± 11%), spontaneous pain score, joint swelling (60 ± 6-40 ± 9%), as well as the histological changes induced by CFA. In addition, DIA inhibited astrocyte activation, and prevented the increase of MMP-9 and TRPV1 expression in the spinal cord of the animals subjected to CFA injections. CONCLUSIONS: In short, this study shows that DIA reduces joint damage and hypersensitivity associated with inflammation induced by CFA through the inhibition of astroglial activation and decreases the expression of TRPV1 and MMP-9 in the rat spinal cord.

Assuntos

Analgésicos/farmacologia , Antraquinonas/farmacologia , Antirreumáticos/farmacologia , Artrite Experimental/prevenção & controle , Comportamento Animal/efeitos dos fármacos , Articulações/efeitos dos fármacos , Metaloproteinase 9 da Matriz/metabolismo , Inibidores de Metaloproteinases de Matriz/farmacologia , Neuroglia/efeitos dos fármacos , Medula Espinal/efeitos dos fármacos , Canais de Cátion TRPV/antagonistas & inibidores , Animais , Artrite Experimental/enzimologia , Artrite Experimental/patologia , Artrite Experimental/psicologia , Edema/enzimologia , Edema/patologia , Edema/prevenção & controle , Adjuvante de Freund , Articulações/patologia , Masculino , Neuroglia/enzimologia , Neuroglia/patologia , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/enzimologia , Dor Nociceptiva/patologia , Dor Nociceptiva/psicologia , Ratos Wistar , Medula Espinal/enzimologia , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Canais de Cátion TRPV/metabolismo , Sensação Térmica/efeitos dos fármacos , Fatores de Tempo , Vocalização Animal/efeitos dos fármacos

RESUMO

The purposes of this study were to evaluate the anti-nociceptive effect of oral and topical administration of (-)-α-bisabolol (BISA) in rodent models of formalin- or cinnamaldehyde-induced orofacial pain and to explore the inhibitory mechanisms involved. Orofacial pain was induced by injecting 1.5% formalin into the upper lip of mice (20 µL) or into the temporomandibular joint (TMJ) of rats (50 µL). In another experiment, orofacial pain was induced with cinnamaldehyde (13.2 µg/lip). Nociceptive behavior was proxied by time (s) spent rubbing the injected area and by the incidence of head flinching. BISA (100, 200, or 400 mg/kg p.o. or 50, 100, or 200 mg/mL topical) or vehicle was administered 60 min before pain induction. The two formulations (lotion and syrup) were compared with regard to efficacy. The effect of BISA remained after incorporation into the formulations, and nociceptive behavior decreased significantly in all tests. The high binding affinity observed for BISA and TRPA1 in the molecular docking study was supported by in vivo experiments in which HC-030031 (a TRPA1 receptor antagonist) attenuated pain in a manner qualitatively and quantitatively similar to that of BISA. Blockers of opioid receptors, NO synthesis, and K+ ATP channels did not affect orofacial pain, nor inhibit the effect of BISA. In conclusion, BISA had a significant anti-nociceptive effect on orofacial pain. The effect may in part be due to TRPA1 antagonism. The fact that the effect of BISA remained after incorporation into oral and topical formulations suggests that the compound may be a useful adjuvant in the treatment of orofacial pain.

Assuntos

Analgésicos/farmacologia , Comportamento Animal/efeitos dos fármacos , Dor Facial/prevenção & controle , Nociceptividade/efeitos dos fármacos , Dor Nociceptiva/prevenção & controle , Sesquiterpenos/farmacologia , Articulação Temporomandibular/efeitos dos fármacos , Acroleína/análogos & derivados , Administração Oral , Administração Tópica , Analgésicos/administração & dosagem , Analgésicos/química , Analgésicos/metabolismo , Animais , Sítios de Ligação , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Composição de Medicamentos , Dor Facial/induzido quimicamente , Dor Facial/fisiopatologia , Dor Facial/psicologia , Formaldeído , Masculino , Camundongos , Simulação de Acoplamento Molecular , Sesquiterpenos Monocíclicos , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/fisiopatologia , Dor Nociceptiva/psicologia , Ligação Proteica , Conformação Proteica , Ratos Wistar , Sesquiterpenos/administração & dosagem , Sesquiterpenos/química , Sesquiterpenos/metabolismo , Canal de Cátion TRPA1 , Canais de Cátion TRPC/antagonistas & inibidores , Canais de Cátion TRPC/química , Canais de Cátion TRPC/metabolismo , Articulação Temporomandibular/metabolismo , Articulação Temporomandibular/fisiopatologia , Canais de Potencial de Receptor Transitório/antagonistas & inibidores , Canais de Potencial de Receptor Transitório/química , Canais de Potencial de Receptor Transitório/metabolismo

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Plinia edulis (Vell.) Sobral (Myrtaceae) is native and endemic to the Brazilian Atlantic Rainforest. Popularly known as "cambucá", it has been used in folk medicine for the treatment of stomach disorders, diabetes, bronchitis, inflammation and as tonic. Although there are numerous records concerning its popular use as analgesic and anti-inflammatory, scientific information regarding these pharmacological activities is limited. Therefore, the aim of this study was to characterize the anti-inflammatory and antinociceptive activity of P. edulis leaf infusion (AEPe) in mice. MATERIALS AND METHODS: The acetic acid-induced writhing response and mechanical nociceptive paw tests were used to evaluate the antinociceptive activity. Carrageenan-induced paw edema and lipopolysaccharide-induced peritonitis were used to investigate the anti-inflammatory activity. The substances in AEPe were identified by HPLC-MS analysis. RESULTS: At the test doses 30-300mg/kg p.o., AEPe has clearly exhibited anti-inflammatory effects, reducing carrageenan-induced paw edema and inhibiting leukocyte recruitment into the peritoneal cavity. The infusion has shown significant antinociceptive activity in both models of nociception. Gallic acid, myricitrin, guaijaverin, quercitrin, quercetin, corosolic acid, maslinic acid, oleanolic acid and ursolic acid were identified in AEPe. CONCLUSION: P. edulis infusion presented antinociceptive and anti-inflammatory activities in all experiments realized in this study, which could be related to the presence of triterpenoids and flavonoids. These results provide scientific support for the traditional use of this species in the management of pain and inflammation.

Assuntos

Analgésicos/farmacologia , Anti-Inflamatórios/farmacologia , Edema/prevenção & controle , Myrtaceae/química , Nociceptividade/efeitos dos fármacos , Dor Nociceptiva/prevenção & controle , Peritonite/prevenção & controle , Extratos Vegetais/farmacologia , Folhas de Planta/química , Ácido Acético , Analgésicos/isolamento & purificação , Animais , Anti-Inflamatórios/isolamento & purificação , Comportamento Animal/efeitos dos fármacos , Carragenina , Quimiotaxia de Leucócito/efeitos dos fármacos , Cromatografia Líquida de Alta Pressão , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Edema/induzido quimicamente , Edema/imunologia , Lipopolissacarídeos , Masculino , Camundongos , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/fisiopatologia , Dor Nociceptiva/psicologia , Peritonite/induzido quimicamente , Peritonite/imunologia , Compostos Fitoquímicos/isolamento & purificação , Compostos Fitoquímicos/farmacologia , Fitoterapia , Extratos Vegetais/isolamento & purificação , Plantas Medicinais , Espectrometria de Massas por Ionização por Electrospray , Fatores de Tempo

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Tabernaemontana catharinensis (Apocynaceae) is a medicinal plant used for the treatment of painful and inflammatory disorders. Here, we investigated the antinociceptive potential of the ethyl acetate fraction (Eta) from T. catharinensis leaves and assessed its toxic effects in mice to validate its popular use. MATERIALS AND METHODS: Adult male Swiss mice (30-35g) were used. The Eta antinociceptive effect (200-800mg/kg, oral route (p.o.)) was evaluated in the acetic acid, formalin, capsaicin and tail-immersion tests. Adverse effects were analyzed using rotarod and open-field tests, body temperature, biochemical analysis and gastric lesions assessment. To evaluate the acute (OECD 423) or sub-acute (OECD 407) toxicity of the Eta, it was administered orally at a single (2000mg/kg) or repeated doses (100-400mg/kg/day for 28 days), respectively. Mortality, behavioral changes, biochemical and hematological parameters were evaluated. The Eta effect on cellular viability also was evaluated. RESULTS: Eta (200-800mg/kg) inhibited the nociception caused by acetic acid (93.9±1.5%), formalin (86.2±10.8%) or capsaicin (75.4±3.3%) without inducing gastric lesions. Moreover, Eta neither altered the body temperature, biochemical parameters, nor forced or spontaneous locomotor activity of mice. The acute administration of the Eta (2000mg/kg) promoted a decrease in blood glucose levels and alanine aminotransferase activity. In the sub-acute toxicity study, Eta increased the aspartate aminotransferase activity (400mg/kg) and platelet distribution width (200mg/kg). Furthermore, Eta did not alter the cellular viability in cortical slices. CONCLUSIONS: Eta presents antinociceptive effects and mild toxicity in mice. These results support its traditional use as a potential analgesic.

Assuntos

Acetatos/química , Analgésicos/farmacologia , Apocynaceae/química , Nociceptividade/efeitos dos fármacos , Dor Nociceptiva/prevenção & controle , Extratos Vegetais/farmacologia , Solventes/química , Ácido Acético , Administração Oral , Analgésicos/administração & dosagem , Analgésicos/isolamento & purificação , Analgésicos/toxicidade , Animais , Comportamento Animal/efeitos dos fármacos , Capsaicina , Sobrevivência Celular , Cromatografia Líquida de Alta Pressão , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Formaldeído , Masculino , Camundongos , Atividade Motora , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/fisiopatologia , Dor Nociceptiva/psicologia , Limiar da Dor/efeitos dos fármacos , Fitoterapia , Extratos Vegetais/administração & dosagem , Extratos Vegetais/isolamento & purificação , Extratos Vegetais/toxicidade , Folhas de Planta/química , Plantas Medicinais , Medição de Risco , Teste de Desempenho do Rota-Rod , Fatores de Tempo , Testes de Toxicidade

RESUMO

Temporomandibular disorder (TMD) is prevalent in dental clinics and can involve problems with the masticatory muscles or the temporomandibular joints (TMJ). The pain of TMD is frequently associated with inflammation in the TMJs, but it's etiology is considered to be multifactorial and includes biologic, behavioral, environmental, social, emotional and cognitive factors. The purpose of this investigation was to evaluate the anxiety-like behavior in rats exposed to temporomandibular inflammation via injection of Freund's Adjuvant (CFA) with the elevated plus maze (EPM) and light/dark box (LDB) tests and to evaluate nociceptive behavior with the von Frey test at different periods. Moreover, this study measured TMJ inflammation using plasma extravasation (Evans blue test) and the intraarticular infiltration of polymorphonuclear neutrophils (myeloperoxidase quantification). The results showed that rats that were submitted to TMJ inflammation exhibited a decreased number of entries into the open arms of the EPM and a decrease in the time spent in the light compartment and in the number of transitions in the LDB. Additionally, the number of entries in closed arms in the EPM, used as indicator of locomotor activity, did not alter between treatments. Furthermore, increases in mechanical sensitivity and increases in plasma extravasation in the joint tissue occurred throughout the inflammation process, along with an increase in myeloperoxidase in the synovial fluid of TMJ. Our results suggest that the temporomandibular inflammation induced by CFA produced anxiety-like behaviors in rats and induced nociceptive behavior across different periods of inflammation.

Assuntos

Ansiedade/psicologia , Inflamação/patologia , Inflamação/psicologia , Dor Nociceptiva/patologia , Dor Nociceptiva/psicologia , Transtornos da Articulação Temporomandibular/patologia , Transtornos da Articulação Temporomandibular/psicologia , Animais , Ansiedade/complicações , Comportamento Animal , Extravasamento de Materiais Terapêuticos e Diagnósticos/patologia , Adjuvante de Freund , Inflamação/induzido quimicamente , Inflamação/complicações , Masculino , Infiltração de Neutrófilos , Dor Nociceptiva/induzido quimicamente , Dor Nociceptiva/complicações , Peroxidase/metabolismo , Ratos , Líquido Sinovial/metabolismo , Transtornos da Articulação Temporomandibular/induzido quimicamente , Transtornos da Articulação Temporomandibular/complicações , Fatores de Tempo

RESUMO

OBJECTIVE: To identify and compare perceptions of pain and how it is faced between men and women with central post-stroke pain. METHODS: The participants were 25 men and 25 women of minimum age 30 years-old and minimum schooling level of four years, presenting central post-stroke pain for at least three months. The instruments used were: Mini-Mental State Examination; structured interview for the Brief Psychiatric Scale; Survey of Sociodemographic and Clinical Data; Visual Analogue Scale (VAS); Ways of Coping with Problems Scale (WCPS) in Scale; Revised Illness Perception Questionnaire (IPQ-R); and Beck Depression Inventory (BDI). RESULTS: A significantly greater number of women used the coping strategy "Turn to spiritual and religious activities" in WCPS. They associated their emotional state with the cause of pain in IPQ-R. "Distraction of attention" was the strategy most used by the subjects. CONCLUSION: Women used spiritual and religious activities more as a coping strategy and perceived their emotional state as the cause of pain.

Assuntos

Adaptação Psicológica/fisiologia , Cognição/fisiologia , Dor Nociceptiva/etiologia , Acidente Vascular Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Nociceptiva/psicologia , Medição da Dor , Religião e Psicologia , Fatores Sexuais , Fatores Socioeconômicos , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Fatores de Tempo