Developing a consensus-based motivational care pathway for individuals with lower limb fractures: a Delphi protocol.

Older adults with lower limb fractures often harbor concerns about losing their mobility, fearing a loss of independence. It is vital to develop strategies that foster their active engagement in the rehabilitation process. The present protocol aims to create a care pathway tailored to motivate individuals with lower limb fractures to adhere to rehabilitation. We will develop an observational, cross-sectional, and descriptive study using the Delphi data-gathering approach. Purposive sampling will recruit a panel of healthcare professionals and experts who care for patients with lower limb fractures. Aligned with the Delphi method, a series of iterative rounds will be developed to gather consensus around the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We will employ the Qualtrics platform for data collection and analysis, and a consensus target of 75% has been predetermined. For quantitative data analysis, we will use descriptive statistics encompassing a range of measures, including count, mean, standard deviation, median, minimum, maximum, and range. An inductive thematic analysis procedure will be employed to extract meaningful themes and patterns from qualitative data. The study results are expected to significantly impact clinical practice by creating a specialized care pathway to motivate individuals with lower limb fractures to adhere to rehabilitation. Adopting these explicit standards by professionals will ensure uniform and high-quality care.

Absolute permeability estimation from microtomography rock images through deep learning super-resolution and adversarial fine tuning.

The carbon capture and storage (CCS) process has become one of the main technologies used for mitigating greenhouse gas emissions. The success of CCS projects relies on accurate subsurface reservoir petrophysical characterization, enabling efficient storage and captured CO 2 containment. In digital rock physics, X-ray microtomography ( µ -CT) is applied to characterize reservoir rocks, allowing a more assertive analysis of physical properties such as porosity and permeability, enabling better simulations of porous media flow. Estimating petrophysical properties through numeric simulations usually requires high-resolution images, which are expensive and time-inefficient to obtain with µ -CT. To address this, we propose using two deep learning models: a super-resolution model to enhance the quality of low-resolution images and a surrogate model that acts as a substitute for numerical simulations to estimate the petrophysical property of interest. A correction process inspired by generative adversarial network (GAN) adversarial training is applied. In this approach, the super-resolution model acts as a generator, creating high-resolution images, and the surrogate network acts as a discriminator. By adjusting the generator, images that correct the errors in the surrogate's estimations are produced. The proposed method was applied to the DeePore dataset. The results shows the proposed approach improved permeability estimation overall.

Motivational strategies used by health care professionals in stroke survivors in rehabilitation: a scoping review of experimental studies.

Introduction: Cognitive and motor impairments are common among stroke survivors. Physical therapy is often used to improve the functional capacity of stroke survivors. However, limited adherence to rehabilitation programs is a challenge. Motivation plays a crucial role in the success of rehabilitation programs as it influences individual adherence to treatment and overall health outcomes. This review aims to identify current trends in motivational strategies used by healthcare professionals for stroke survivor rehabilitation. Methods: Following the framework developed by Arksey and O'Malley, a scoping review was conducted. We performed a literature search using MEDLINE, CINAHL, the Cochrane Central Register of Controlled Trials, Nursing & Allied Health, and MedicLatina databases. Results: A total of 906 papers were identified. After selecting and analyzing the articles, 17 papers were included in this review. Health professionals use various strategies to motivate stroke survivors. These approaches include establishing a therapeutic alliance, improving patients' health literacy, defining realistic goals, fostering problem-solving skills, personalizing the rehabilitation program, showcasing success stories, utilizing persuasive techniques, offering encouragement and compliments, providing emotional support, and effectively managing symptoms. Conclusion: The knowledge gathered in this review can guide healthcare professionals in helping patients overcome barriers to rehabilitation, improve their motivation, and ultimately enhance their recovery outcomes.

Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials.

BACKGROUND: Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify current trends in gait rehabilitation for stroke survivors. METHODS: The review followed the methodological framework suggested by Arksey and O'Malley. Electronic databases, such as CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection, were systematically searched in November 2023. Inclusion criteria comprised papers published in either English or Portuguese from 2013 to 2023. RESULTS: From the initial search, a total of 837 papers were identified; twenty-one papers were incorporated into this review. Thirteen distinct categories of gait rehabilitation interventions were identified, encompassing diverse approaches. These categories comprise conventional rehabilitation exercises, traditional gait training with integrated technology, and gait training supported by modern technologies. CONCLUSIONS: Although traditional rehabilitation exercises have historically proven effective in aiding stroke survivors, a recent trend has emerged, emphasizing the development and integration of innovative therapeutic approaches that harness modern technologies.

Nursing Interventions to Prevent Secondary Injury in Critically Ill Patients with Traumatic Brain Injury: A Scoping Review.

Background: Traumatic brain injury is a prevalent health issue with significant social and economic impacts. Nursing interventions are crucial in preventing secondary injury and improving patient prognosis. This scoping seeks to map and analyze the existing scientific evidence on nursing interventions aimed at preventing secondary injuries in critically ill patients with traumatic brain injury. Methods: The review was conducted according to Arksey and O'Malley's methodological framework. The electronic databases Pubmed, MEDLINE Complete, CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers were consulted in May 2023. We included articles published in English and Portuguese between 2010 and 2023. Results: From the initial search, 277 articles were identified, with 15 meeting the inclusion criteria for the review. Nursing interventions for TBI patients include neuromonitoring, therapeutics, analytical surveillance, professional training, and family support. Nurses play a crucial role in detecting neurological changes, administering treatments, monitoring metabolic markers, training staff, and involving families. These interventions aim to prevent secondary injury and improve patient outcomes. Conclusions: By prioritizing evidence-based practice and utilizing innovative technologies, nurses enhance TBI patient care and contribute to overall well-being.

Exploring barriers and educational needs in implementing dual-task training for Parkinson's disease: insights from professionals.

Introduction: There is growing evidence suggesting that dual-task training benefits people with Parkinson's disease (PD) on both physical and cognitive outcomes. However, there is no known data regarding professionals' educational needs and barriers to its implementation. This study aimed to explore the barriers and educational needs of healthcare and exercise professionals to integrate dual-task training into their practice with people with PD. Methods: We conducted a study based on a web survey. Social media channels were used to recruit a convenience sample of exercise and healthcare professionals working with people with PD. Results: Of the 185 eligible responses, the majority were physiotherapists (68.1%) followed by occupational therapists (10.8%). Most participants attended Parkinson specific training (88.6%) and employed the treatments set up in individual one on-one sessions (58.9%). We identified several barriers to dual-task training implementation, with lack of time (to prepare materials), staying creative and/ or accessing new ideas, unreliable tools for measuring gains, and insufficient expertise as the most referred by participants. The educational needs most referred included accessing examples of interventions in general, knowing what strategies to apply and their application for people with different symptoms. Discussion: Our results highlight that professionals remain challenged to integrate dualtask training into PD clinical care mainly due to knowledge gaps, difficulties in accessing new ideas, and lack of time.

Development of New Resolvin D1 Analogues for Osteoarthritis Therapy: Acellular and Computational Approaches to Study Their Antioxidant Activities.

In osteoarthritis (OA), oxidative stress plays a crucial role in maintaining and sustaining cartilage degradation. Current OA management requires a combination of pharmaceutical and non-pharmacological strategies, including intraarticular injections of hyaluronic acid (HA). However, several lines of evidence reported that HA oxidation by reactive oxygen species (ROS) is linked with HA cleavage and fragmentation, resulting in reduced HA viscosity. Resolvin D1 (RvD1) is a lipid mediator that is biosynthesized from omega-3 polyunsaturated fatty acids and is a good candidate with the potential to regulate a panoply of biological processes, including tissue repair, inflammation, oxidative stress, and cell death in OA. Herein, newly designed and synthesized imidazole-derived RvD1 analogues were introduced to compare their potential antioxidant properties with commercially available RvD1. Their antioxidant capacities were investigated by several in vitro chemical assays including oxygen radical absorbance capacity, 2,2-diphenyl-1-picrylhydrazyl radical scavenging, ferric ion reducing antioxidant power, hydroxyl radical scavenging, and HA fragmentation assay. All results proved that imidazole-derived RvD1 analogues showed excellent antioxidant performance compared to RvD1 due to their structural modifications. Interestingly, they scavenged the formed reactive oxygen species (ROS) and protected HA from degradation, as verified by agarose gel electrophoresis and gel permission chromatography. A computational study using Gaussian 09 with DFT calculations and a B3LYP/6-31 G (d, p) basis set was also employed to study the relationship between the antioxidant properties and chemical structures as well as calculation of the molecular structures, frontier orbital energy, molecular electrostatic potential, and bond length. The results showed that the antioxidant activity of our analogues was higher than that of RvD1. In conclusion, the findings suggest that imidazole-derived RvD1 analogues can be good candidates as antioxidant molecules for the treatment of oxidative stress-related diseases like OA. Therefore, they can prolong the longevity of HA in the knee and thus may improve the mobility of the articulation.

Use of sarolaner in the treatment of tungiasis in naturally infested dogs.

Tungiasis is an endemic dermatological parasitic zoonosis in Latin America, caused by the sand flea Tunga spp. (Siphonaptera, Tungidae), which promotes intense discomfort, swelling, erythema, itching, pain, secondary bacterial infection, cellulitis and necrosis. Sarolaner has been used to control different ectoparasites, but there is no record of its use for the treatment of tungiasis in dogs. The objective of this study was to evaluate the effectiveness of sarolaner for the treatment dogs naturally infested by Tunga spp. kept in the same infested environment. Three of four animals were medicated with sarolaner orally with a single dose of 2 mg/kg, as recommended by the manufacturer, and one animal remained without medication. After 24 hours, the fleas from all four dogs were mechanically removed. The animals were reevaluated on days +15 and +30 to assess possible reinfestation. The medicated animals remained free of fleas, while the untreated animal had fleas on the days previously defined for reevaluation. We can thus conclude that the use of sarolaner is an effective choice for tungiasis treatment.

Tungíase é uma zoonose parasitária dermatológica endêmica na América Latina, causada pela pulga da areia Tunga spp. (Siphonaptera, Tungidae), que promove intenso desconforto, edema, eritema, prurido, dor, infecção bacteriana secundária, celulite e necrose. Sarolaner tem sido utilizado no controle de diversos ectoparasitas, mas não existem registros de seu uso no tratamento de tungíase em cães. O objetivo deste estudo foi avaliar a eficácia do sarolaner no tratamento de cães naturalmente infestados por Tunga spp. mantidos no mesmo ambiente infestado. Três dos quatro animais foram medicados com sarolaner por via oral em dose única de 2 mg/kg, conforme recomendação do fabricante, e um animal permaneceu sem medicação. Após 24 horas, as pulgas dos quatro cães foram removidas mecanicamente. Os animais foram reavaliados nos dias +15 e +30 para avaliar uma possível reinfestação. Os animais medicados permaneceram livres de pulgas, enquanto o animal não tratado apresentou pulgas nos dias previamente definidos para reavaliação. Podemos assim concluir que o uso do sarolaner é uma escolha eficaz para o tratamento da tungíase.

Current trends in psychotherapies and psychosocial interventions for people with dementia: a scoping review of randomized controlled trials.

An outcome of dementia is a progressive decline in cognitive function. Implementing psychotherapies and psychosocial interventions is crucial for bolstering cognitive abilities, promoting independence, and elevating the quality of life for individuals with dementia. This review aims to identify current trends in psychotherapies and psychosocial interventions for people with dementia. A Scoping review was developed based on the framework proposed by Arksey and O'Malley. The literature search was conducted on electronic databases, including Scopus, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Nursing & Allied Health Collection, and MedicLatina. Executed in June 2023, the search focused on articles published in English, Portuguese, and Spanish between 2013 and 2023. Through this search, 1409 articles were initially identified. After selecting and analyzing the reports, sixteen trials were included in this review. Eight distinct categories were identified, covering different strategies. These categories run from computerized game-based cognitive training and reminiscence therapy to compensatory and restorative strategies, memory and attention training, calculation training, dual-task training, counseling, and personalized goal attainment. The findings of this scoping review highlight the diverse landscape of psychotherapies and psychosocial interventions for people with dementia.

Condutas e intercorrências na reconstrução de grandes defeitos do couro cabeludo / Protocols and complications in the reconstruction of major scalp defects

Introdução: Estudar as condutas e as complicações em quatro casos infrequentes de grandes e complexas deformidades do couro cabeludo, em que retalhos convencionais, não microcirúrgicos, foram empregados. Métodos: Análise crítica e retrospectiva de três casos de carcinomas espinocelulares (CEC) em pacientes imunossuprimidos (transplantado renal, hepático e paciente com artrite reumatoide) e um caso de sequela de trauma cranioencefálico, decorrente de múltiplas neurocirurgias com emprego de acrílico autopolimerizável, seguido de osteomielite e fístula. Resultados: Os casos de extensos carcinomas, foram reconstruídos com a rotação de grandes retalhos de couro cabeludo, havendo em dois deles epidermólise/necrose em pequena porção distal dos retalhos, que foram tratadas com excelente resultado estético. O caso sequela de trauma, foi reconstruído com retalho expandido de couro cabeludo, avançado sobre cranioplastia com costelas, que apesar da extrusão de uma osteossíntese, cicatrizou sem recidiva da fístula com excelente resultado estético. Conclusão: A análise destes casos complexos e invulgares, indica preferencialmente os pedículos temporais no planejamento de retalhos para a reconstrução convencional de grandes defeitos do couro cabeludo. As possíveis epidermólises e necroses distais nestes retalhos, tratadas da forma apresentada, levaram a gratificantes resultados estéticos e funcionais.

Introduction: This study aimed to analyze the protocols and complications in four unusual cases of large and complex scalp defects, in which conventional, non-microsurgical flaps were used. Methods: This was a critical and retrospective analysis of four cases. Three immunosuppressed patients had squamous cell carcinomas (SCC) (one underwent liver transplant, one underwent renal transplant, and one had rheumatoid arthritis). The other patient had sequelae of head trauma and multiple neurosurgeries using self-polymerizing acrylic, followed by osteomyelitis and fistula. Results: The cases of large carcinoma were reconstructed with rotation large scalp flaps. Two of them had epidermolysis/necrosis in a small distal portion of the flaps, which were treated, with excellent aesthetic results. The case of sequelae of trauma was reconstructed with expanded advancement scalp flap over cranioplasty using ribs. Despite the extrusion of one osteosynthesis, the patient healed without recurrence of the fistula, with an excellent aesthetic result. Conclusion: The analysis of these complex and unusual cases indicates that temporal pedicles are preferred in the planning of flaps for the conventional reconstruction of large scalp defects. The treatment employed for the possible epidermolyses and distal necroses in these flaps led to satisfying aesthetic and functional results.

Efficacy of afoxolaner in the flea control in experimentally infested cats / Eficácia do afoxolaner no controle de pulgas em gatos experimentalmente infestados

Abstract The aim of this study was to evaluate the efficacy of a single dose of oral afoxolaner in controlling fleas in cats. Fourteen cats were used. The cats were given identification numbers, housed individually, artificially infested with Ctenocephalides felis felis, and treated (or not) with afoxolaner. Were divided into a treatment group and a control group (n = 7/group), on the basis of the fleas count hours after an infestation applied on Day (one-by-one allocation after ordering by count). At the start of the experimental protocol (designated day 0), the treated group received afoxolaner in a single dose of 2.5 mg/kg and the control group animals received a placebo. All animals were infested with 100 C. felis felis fleas two days before day 0, as well as on days 5, 12, 19, 26, 33, 40, 47, 54, and 63, parasite loads being evaluated at 48 h after each infestation. The efficacy of afoxolaner was 100% on day 2 and remained above 98% until day 42, decreasing to 95.3% by day 63. The findings confirm that a single dose of oral afoxolaner was effective in controlling C. felis felis in cats, and there were no observed adverse events.

Resumo O objetivo do estudo foi avaliar a eficácia de uma dose única de afoxolaner oral no controle de pulgas em gatos. Foram utilizados 14 gatos. Os animais foram identificados, alojados individualmente, infestados artificialmente com C. felis felis e tratados (ou não) com afoxolaner. Foram divididos em um grupo de tratamento e um grupo controle (n = 7/ grupo), com base na contagem de pulgas, horas após a infestação aplicada no dia (alocação de um por um após o período por contagem). No início do protocolo experimental (dia 0), o grupo tratado recebeu afoxolaner em dose inicial de 2,5 mg / kg e os animais do grupo controle receberam um placebo. Todos os animais foram infestados com 100 pulgas C. felis felis dois dias antes do dia 0, assim como nos dias 5, 12, 19, 26, 33, 40, 47, 54 e 63, sendo avaliadas as cargas parasitárias às 48 h após cada infestação. A eficácia do afoxolaner foi de 100% no dia 2 e permaneceu acima de 98% até o dia 42, diminuindo para 95,3% no dia 63. Os resultados confirmam que uma dose única de afoxolaner oral foi eficaz no controle de C. felis felis em gatos, e não houve eventos adversos observados.

Dirofilaria immitis infection in dogs in Algodoal Island, Brazilian Amazon / Infecção por Dirofilaria immitis em cães na Ilha de Algodoal, Amazônia brasileira

Dirofilaria immitis, a parasite that mainly infects domestic or wild canids, but can infect felines or humans as well, is frequent in many Brazilian areas. The main objective of this research was to determine the prevalence of natural canine infection at the Algodoal-Maiandeua Island complex, in the coastal region of the state of Pará, Brazil. A total of 67 dogs were sampled for blood microfilariae detection and for D. immitis DNA detection. Microfilaria and D. immitis DNA could be detected in 35.8% (24/67) of the animals. In one dog's sample no microfilariae were detected, but the PCR was positive, suggesting that either larvae recently were eliminated or adults died shortly before sample collecting. Therefore, it can be concluded that the occurrence of D. immitis is a health threat for domestic and wild canids at the Island of Algodoal, as well as for feline or human health.(AU)

Dirofilaria immitis, um parasito que infecta principalmente canídeos domésticos ou selvagens, embora também possa infectar felinos e humanos, é frequente em muitas áreas do Brasil. O objetivo deste estudo foi determinar a ocorrência da infecção natural em cães provenientes do complexo da Ilha de Algodoal-Maiandeua, região litorânea do estado do Pará, Brasil. Um total de 67 cães tiveram o sangue coletado para detecção de microfilárias de D. immitis e seu DNA. Microfilárias e o DNA de D. immitis foram detectados em 35,8% (24/67) dos animais. Na amostra de um animal, não foram observadas microfilárias, mas o seu DNA foi detectado, sugerindo que as larvas tenham sido recentemente eliminadas ou os adultos tenham morrido antes da coleta da amostra. Portanto, pode-se concluir que a ocorrência de D. immitis é uma ameaça à saúde de canídeos domésticos no complexo da Ilha de Algodoal-Maiandeua, bem como para felinos e seres humanos.(AU)

Canine sporotrichosis: report of 15 advanced cases / Esporotricose canina: descrição de 15 casos avançados

Sporotrichosis is a chronic, granulomatous and usually lymphocutaneous infection of animals and humans, caused by a dimorphic fungus, Sporothrix schenckii complex. The disease in dogs is considered rare, however, in the last years a crescent registration of cases was observed in Brazil, especially in the city of Rio de Janeiro. Fifteen dogs with ulcerated cutaneous lesions were seen at the Dermatology Service in the Small Animal's Hospital at Universidade Federal Rural do Rio de Janeiro, between January 2014 and October 2015. Most lesions were located on the head, mainly the nose. Lesions were even seen on the chest, disseminated on the body and on the limbs. Three dogs (20%) exhibited the cutaneous-lymphatic form, with lesions initially on the distal aspect of one leg and ascending via lymphatics up the leg to the trunk and head. It was not ruled out the disseminated form in at least 3 dogs (20%). They had consistent signs of generalized or disseminated disease exhibiting respiratory symptoms (nasal discharge, sneezing, stertorous breathing), anorexia and weight loss. Draining tracts and cellulitis were very common. Some had large areas of skin necrosis with exposure of muscle and bone. Definitive diagnosis was obtained by cytological examination of exudates, histological examination, and/or isolation of S. schenckii complex by fungal culture. Because of the severity of the lesions that mimic other disorders like neoplasms or autoimmune skin diseases, and due to the difficulties of getting an accurate diagnosis, this study describes 15 advanced cases of canine sporotrichosis.(AU)

A esporitricose é uma doença infecciosa crônica, granulomatosa e frequentemente linfocutânea, causada por um fungo dimórfico do Complexo Sporothrix schenckii. A doença em cães é considerada rara, no entanto, nos últimos anos, um número crescente de casos foi registrado no Brasil, especialmente no Rio de Janeiro. Quinze cães com lesões cutâneas ulceradas foram atendidos no Setor de Dermatologia do Hospital Veterinário de Pequenos Animais da Universidade Federal Rural do Rio de Janeiro, entre Janeiro de 2014 e Outubro de 2015. Todos os animais foram submetidos ao exame clínico e dermatológico. A maioria das lesões estava localizada na cabeça, principalmente no plano nasal. Havia também lesões no tórax, disseminada pelo corpo e nos membros. Três cães (20%) apresentaram a forma cutâneo-linfática, com lesões inicialmente nos membros e se propagavam via vasos linfáticos para o tronco e a cabeça. Não foi descartada a forma disseminada em pelo menos 3 cães (20%). Estes cães apresentaram sinais consistentes de doença generalizada ou disseminada, exibindo sinais respiratórios (descarga nasal, espirros, estertoração), anorexia e perda de peso. Fístulas e celulite eram muito comuns. Alguns tinham grandes áreas de necrose que desencadearam a exposição de músculo e osso. O diagnóstico definitivo da infecção foi obtido por exame citológico de exsudato e por exame histológico, e/ou apenas isolamento do complexo S. schenckii pela cultura de fungos. Por causa da severidade das lesões que imitam outras enfermidades, principalmente neoplasias e doenças autoimunes, e pela dificuldade de se obter o diagnóstico correto, este estudo descreve 15 casos avançados de esporotricose canina.(AU)

Use of an algorithm in choosing abdominoplasty techniques / Emprego de um algoritmo na escolha de técnicas de abdominoplastia

ABSTRACT Objective: to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. Methods: we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. Results: according to the algorithm used, the most frequently chosen technique was "Technique IV" (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. "Technique I" (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, "Technique III", dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients' expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. Conclusion: the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature.

RESUMO Objetivo : validar um algoritmo para a escolha da técnica cirúrgica de abdominoplastia, entre as cinco abordagens consagradas na literatura, de acordo com as características da parede abdominal. Método: estudo retrospectivo de 245 pacientes submetidos à abdominoplastias, em que o método de escolha da técnica cirúrgica teve como ferramenta o algoritmo proposto, baseado no grau de flacidez abdominal determinado por manobra bimanual. Foram estudadas suas aplicações e conveniências, bem como identificadas as complicações inerentes a cada grupo estudado. Resultados: de acordo com o algoritmo empregado, a técnica mais frequentemente eleita foi a "Técnica IV" (dermolipectomia transversa à Pitanguy - ou com incisão de Baroudi-Kepke), em 25,71% dos casos. A "Técnica I" (miniabdominoplastia) demonstrou a menor incidência e a menor taxa de complicações. A "Técnica III", dermolipectomia com cicatriz vertical remanescente, ao contrário, apresentou maior incidência de complicações, requerendo extrema cautela na sua indicação, particularmente frente às expectativas dos pacientes quanto à cicatriz resultante e seus aspectos legais. Entre todas as condutas, a complicação mais frequente foi o seroma, com 10,2% de ocorrência entre os 245 casos operados, resolvido pela simples aspiração com seringa, e uso de malha compressiva elástica. Conclusão: o algoritmo proposto contribuiu para facilitar a escolha das técnicas na abdominoplastia, oferecendo resultados satisfatórios, que se alinham com as taxas de complicações publicadas na literatura mundial.

Punch grafts to treat lower limb intractable sores / "Punch grafts" nas úlceras de membros inferiores de difícil tratamento

ABSTRACT Lower limb recurrent ulcers, usually caused by prolonged decubitus, trauma, diabetes or burns, may not heal with conventional clinical or surgical treatment. Frequently, laminated skin grafts do not integrate with the recipient layer, and the only alternatives are neighbor microsurgical flaps. These have higher morbidity and create secondary defects, to be corrected with skin grafts, when fasciocutaneous or miocutaneous segments are removed for the treatment of the primary defect. We describe the non-conventional use of punch grafts in the treatment of lower limb ulcers, when conventional skin laminated graft failed, without the use of flaps. Since this is a very successful technique, its use should be considered as a valuable alternative for the treatment of recurrent lower limb ulcers. It is a simple and easy-learned technique that may be used by different surgeons, even in remote places without correct specialized hospital facilities.

RESUMO As ulcerações recidivantes de membros inferiores, decorrentes de decúbito prolongado, trauma, diabetes ou queimaduras, podem não responder adequadamente aos tratamentos convencionais, clínicos e cirúrgicos. Frequentemente, nestes casos, enxertos de pele laminada não se integram ao leito receptor, deixando o uso de retalhos de vizinhança e microcirúrgicos como únicas alternativas. Estes retalhos implicam em maior morbidade e criam defeitos secundários, a serem reparados por enxertos de pele, após fornecerem o segmento cutâneo, fasciocutâneo ou miocutâneo para o tratamento do defeito primário. Descrevemos o uso não convencional de enxertos em punch ("punch grafts") no tratamento de ulcerações de membros inferiores, em situações em que a enxertia de pele laminada convencional não teve sucesso e retalhos não foram empregados. Pelo êxito desta técnica, seu uso deve ser considerado como uma valiosa alternativa no tratamento de úlceras recidivantes de membros inferiores. Sendo uma técnica simples e de fácil aprendizado, pode ser empregada por cirurgiões de diferentes especialidades, mesmo em locais remotos, onde inexistam as facilidades de um centro médico-hospitalar especializado.

Critérios práticos para uma lipoaspiração mais segura: uma visão multidisciplinar / Practical criteria for a safer liposuction: a multidisciplinary approach

O Capítulo de Cirurgia do Contorno Corporal da Sociedade Brasileira de Cirurgia Plástica realizou em 2012 um amplo estudo dos parâmetros de segurança para a realização de uma lipoaspiração, antecedendo ao curso do Capítulo, realizado em 2013, no Rio de Janeiro, durante o 50º Congresso Brasileiro de Cirurgia Plástica, com a presença do ilustre Dr. Yves Gérard Illouz e grande número de participantes. Os autores realizaram uma revisão e atualização destes parâmetros, incorporando recentes avanços e sistematizando de forma prática as informações relevantes para a realização de uma lipoaspiração mais segura. Com a colaboração de anestesiologista, intensivista e cirurgião vascular, experientes no suporte ao procedimento, são apresentadas novas orientações práticas para o pré-operatório, trans e pós-operatório de uma lipoaspiração mais segura.

In 2012, the Research Group on Body Contouring Surgery of the Brazilian Society of Plastic Surgery conducted an extensive study on the safety of liposuction before the initiation of the course of the Group, held in 2013 in Rio de Janeiro during the 50^th Brazilian Congress of Plastic Surgery, with the presence of the illustrious Dr. Yves Gérard Illouz and a large number of participants. The authors performed a review and update of the safety parameters, incorporating recent advances and systematizing relevant information for the execution of a safer liposuction. With the collaboration of anesthesiologist, intensive care physician, and vascular surgeon, all with extensive experience in supporting the procedure, new practical guidelines were presented for a safer liposuction on the preoperative, transoperative, and postoperative periods.

Efficacy of oral doramectin as treatment for Psoroptes ovis and Leporacarus gibbus in naturally infested rabbits / Eficácia de doramectin no tratamento oral para Psoroptes ovis e Leporacarus gibbus em coelhos naturalmente infestados

The present study evaluated the efficacy of a single oral dose of doramectin in the control of Psoroptes ovis and Leporacarus gibbus in naturally infested rabbits. Sixteen adult rabbits were selected and distributed in two experimental groups. The treated group received 200 µg/Kg of oral doramectin and the control group received the same volume of saline solution. The diagnosis of the mites was made with a stereoscopic microscope. Hairs from the dorsal part of the neck, lumbar right, lumbar left, ventral side of the tail and ventral abdomen were evaluated for L. gibbus, and ear wax evaluated for P. ovis. The evaluation of the efficiency and the clinical assessment of the lesions was made in days 0, +3, +7, +14, +21, +28, and +35 after treatment. An efficacy of 75% and 87,5% was observed for L. gibbus in days +3 and +7 after treatment, an efficacy of 100% was observed in days +14, + 21, +28 e +35. An efficacy of 100% for the control of P. ovis was observed following day +7. The clinical lesion score of the control group remained unaltered, except for one animal which conditions worsened during experimentation. In the treated group animals, regression of the lesions was observed following day +3, and on day +21 no signal of infestation by P. ovis was present. None of the animals from the treated group presented secondary collateral effects caused by the doramectin, which proved itself as an optimal alternative for mite control in naturally infested rabbits.(AU)

O objetivo do trabalho foi avaliar a eficácia da doramectina administrada por via oral no controle de Psoroptes ovis e Leporacarus gibbus em coelhos naturalmente infestados. Foram selecionados 16 coelhos adultos, distribuídos em dois grupos experimentais, compondo oito animais por grupo. O grupo tratado foi medicado com 200µg/kg de doramectina por via oral, enquanto que no grupo controle foi administrado o mesmo volume de solução salina. O diagnóstico dos ácaros foi realizado com auxílio de microscópio estereoscópico. Foram coletados pelos das regiões do pescoço dorsal, lombar direita, lombar esquerda, cauda ventral e abdômen ventral para avaliação de L. gibbus e para P. ovis foi coletado cerúmen das orelhas com auxílio de zaragatoas. A avaliação da eficácia e a avaliação clínica das lesões, mensuradas em escores (grau 0 a 4), foi realizada nos dias 0, +3, +7, +14, +21, +28 e +35, após o tratamento. Foi observada eficácia de 75% e 87,5% no controle de L. gibbus nos dias +3 e +7 após o tratamento, sendo observada eficácia de 100% nos dias +14, + 21, +28 e +35. Foi observada eficácia de 100% no controle de P. ovis a partir do dia +7, permanecendo até o final do período observacional. O escore das lesões clínicas no grupo controle permaneceu de forma inalterada, exceto em um animal que piorou ao longo dos dias experimentais, enquanto nos animais do grupo tratado regrediu a partir do dia +3 e já no dia +21 após o tratamento, os animais apresentavam-se sem sinais da infestação por P. ovis. Nenhum animal do grupo tratado apresentou quaisquer efeitos colaterais secundários causados pela doramectina, que se mostrou uma ótima alternativa para o controle dos ácaros em coelhos naturalmente parasitados.(AU)

O Ensino da Cirurgia Plástica na Graduação em Medicina no Contexto da Realidade Brasileira / Plastic Surgery Training at Medical School in the Context of Brazil

RESUMO Apesar do grande número de cirurgiões plásticos no Brasil, o formando egresso/médico generalista necessita conhecimentos de Cirurgia Plástica que possibilitem sua adequada atuação em situações de emergência ou eletivas, referindo pacientes ou proporcionando proteção e suporte básico da vida. Esta educação deve ainda considerar o ambiente socioeconômico brasileiro, suas necessidades e limitações na escolha das atitudes, habilidades e conhecimentos em Cirurgia Plástica que o aluno deve absorver na escola médica. O ensino da Cirurgia Plástica na graduação requer esta ótica particular, além de levar ao estudante de Medicina o espectro integral da especialidade, estimulando vocações para a adequada residência médica e posterior titulação como especialista. Este artigo apresenta o programa de Cirurgia Plástica e a metodologia de ensino que vêm sendo oferecidos aos alunos do curso de Medicina da Universidade Positivo, em Curitiba, há dez anos, por meio da integração das disciplinas Clínica Cirúrgica II e Cirurgia Ambulatorial. As avaliações institucionais discentes, relatos pedagógicos de situações extracurriculares vivenciadas por alunos e a existência de cinco especialistas/residentes em Cirurgia Plástica entre 265 ex-alunos inicialmente formados sugerem uma produtiva funcionalidade do programa apresentado.

ABSTRACT Despite the large number of qualified plastic surgeons in Brazil, young doctors and general practitioners need to have a basic knowledge of plastic surgery to enable them to act appropriately in first aid, emergency or elective clinical situations, either to refer patients or provide basic life support and protection. Plastic surgery training for undergradutate medical students has to consider the aforementioned situations as well as the socioeconomic environment of Brazil and the requirements and restrictions on the choice of plastic surgery skills and knowledge that the student must absorb at medical school. Furthermore, such programs should encourage plastic surgery-inclined students to pursue the adequate residence training and later board examination. This article reports on 10 years of experience in plastic surgery education for medical students, at Universidade Positivo in Curitiba, Brazil. The integration between the disciplines of Outpatient Surgery and Clinical Surgery resulted in the students’ positive evaluation of the program, interesting feedback regarding its successful application outside the medical school and at least five specialists/plastic surgery residents out of the 265 students who graduated in the first five classes.

Dor lombar em escolares: um estudo transversal em uma cidade do oeste de São Paulo, Brasil / Low back pain in schoolchildren: a cross-sectional study in a western city of São Paulo State, Brazil

Objetivo: Analisar a prevalência de dor na coluna lombar em escolarese sua relação com o sexo, idade, prática de exercícios eas atividades sedentárias (tempo na TV e no computador e/ou videogame).Métodos: Realizou-se um estudo transversal com umaamostra 1.461 escolares, sendo 754 do sexo masculino e 707 dofeminino, matriculados na 5ª a 8ª séries de todas as cinco escolasmunicipais de ensino fundamental urbanas do município de Ourinhos,SP, Brasil, na faixa etária entre 10 e 14 anos, de quem foramcoletados dados sóciodemográficos e tempo gasto em atividadessedentárias como TV e computador e/ou videogame. Realizou-seuma análise descritiva, bivariada e multivariada por regressão logísticabinária. Resultados: Notou-se que a prevalência de dor lombarfoi de 18,5%, sendo 15,5% nos meninos e 21,6% nas meninas.A dor lombar foi associada ao sexo feminino, faixa etária de 12 a14 anos e ao hábito de assistir TV acima de três vezes na semanae acima de 3 horas por dia. Conclusão: Os estudantes analisadosmostraram alta prevalência de dor lombar relacionadas ao sexo,faixa etária e hábito de assistir televisão. Intervenções adequadasdevem ser realizadas para reduzir a ocorrência das mesmas emestudantes. Nível de Evidência III, Corte Transversal.

Objective: To determine the prevalence of low back pain in childrenand its relationship with gender, age, exercise practice andsedentary activities (time on TV and on computer and/or videogame). Methods: We conducted a cross-sectional study witha sample of 1,461 students, being 754 males and 707 femalesenrolled in the 5th to 8th grades of all five local elementaryschools of urban Ourinhos, SP, Brasil, aged 10-14 years old,from whom sociodemographic data, time spent on sedentaryactivities such as TV and computer and/or video game werecollected. We conducted a descriptive, bivariate and multivariatebinary logistic regression. Results: The results showed that theprevalence of low back pain in the sample was 18.5%, being15.5% in boys and 21.6% in girls. Low back pain was associatedto the female gender, age range between 12-14 years and thehabit of watching TV more than three times a week and over 3hours per day. Conclusion: The students analyzed showed highprevalence of low back pain related to gender, age and habit ofwatching TV. Appropriate interventions should be implementedto reduce the occurrences of back pain in schoolchildren. Levelof Evidence III, Cross Sectioning.