Reverse Potts for the Treatment of Severe Idiopathic Pulmonary Hypertension in Children.

Idiopathic pulmonary arterial hypertension is a rare and progressive disease with poor prognosis. Many patients progressively worsen even when using combinations of specific drugs for its treatment. Herein, we present our experience in the management of three children with severe pulmonary arterial hypertension refractory to clinical treatment who underwent Potts surgery in addition to clinical treatment.

Reverse Potts for the Treatment of Severe Idiopathic Pulmonary Hypertension in Children

ABSTRACT Idiopathic pulmonary arterial hypertension is a rare and progressive disease with poor prognosis. Many patients progressively worsen even when using combinations of specific drugs for its treatment. Herein, we present our experience in the management of three children with severe pulmonary arterial hypertension refractory to clinical treatment who underwent Potts surgery in addition to clinical treatment.

Retrospective Investigation in Horses with Encephalitis Reveals Unnoticed Circulation of West Nile Virus in Brazil.

During these past years, several studies have provided serological evidence regarding the circulation of West Nile virus (WNV) in Brazil. Despite some reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the country. Recently, genomic monitoring activities in horses revealed the circulation of WNV in several Brazilian regions. These findings on the paucity of genomic data reinforce the need for prompt investigation of WNV infection in horses, which may precede human cases of encephalitis in Brazil. Thus, in this study, we retrospectively screened 54 suspicious WNV samples collected between 2017 and 2020 from the spinal cord and brain of horses with encephalitis and generated three new WNV genomes from the Ceará and Bahia states, located in the northeastern region of Brazil. The Bayesian reconstruction revealed that at least two independent introduction events occurred in Brazil. The first introduction event appears to be likely related to the North American outbreak, and was estimated to have occurred in March 2013.The second introduction event appears to have occurred in September 2017 and appears to be likely related to the South American outbreak. Together, our results reinforce the importance of increasing the priority of WNV genomic monitoring in equines with encephalitis in order to track the dispersion of this emerging pathogen through the country.

Is dental caries associated with liver transplantation? A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the experience of dental caries in individuals pre- or postliver transplant. MATERIALS AND METHODS: Searches in PubMed, Scopus, Web of Science, Ovid, and Lilacs from databases' inception date up to April 2020 were undertaken. Gray literature and manual searches were also conducted. Observational studies were eligible. The retrieved references were evaluated by two independent reviewers. Meta-analysis and risk of bias assessment using the University of Adelaide tool were conducted. The strength of the evidence was assessed with GRADE. RESULTS: The search retrieved 1990 references. Twenty-four cross-sectional studies were included. One subgroup analysis demonstrated no significant difference in the number of teeth with dental caries between pre-liver transplant and healthy individuals (mean difference = 1.65, confidence interval = -0.87 to 4.17). The prevalence of dental caries among pre-liver transplant individuals was 73.82% and in the post-transplant individuals was 72.83%. In the included studies, the main concern regarding risk of bias was the absence of control for confounding variables. The strength of the evidence was very low. CONCLUSIONS: Dental caries may be a relevant issue in pre- and postliver transplant individuals. Oral health counseling should be included in the care of pre- and/or postliver transplant individuals.

Neuroinflammatory effects of tDCS in ovariectomized rats with chronic inflammation

Introduction: Postmenopausal women are more susceptible to chronic conditions, such as osteoporosis, arthritis, and other inflammatory diseases. We investigated the effects of transcranial direct current stimulation (tDCS) on biomarker levels in ovariectomized rats subjected to an inflammatory model. Methods: Twenty adult female Wistar rats underwent ovariectomy and complete Freund's adjuvant (CFA)-induced inflammation. We divided them into 2 groups: OAS (sham tDCS) and OAT (active tDCS). Fifteen days later, the rats underwent bimodal tDCS treatment (20 min, 0.5 mA, 8 days). After 24 h of the last tDCS session, we killed the rats and collected tissue samples (hypothalamus, cerebral cortex, and brainstem) for biomarker analysis by ELISA. We removed the paws for histological analysis. Results: Active tDCS increased hypothalamic and cortical TNF-α and NGF levels, hypothalamic and brainstem IL-1ß levels, and hypothalamic IL-10 levels. Histology of paws showed an inflammatory profile. We observed a small tDCS effect, not statistically significant. Discussion: Bimodal tDCS had an effect on the central inflammatory axis, with a small effect on the peripheral site as evaluated by histology in the current study. (AU)

Cárie dentária em pacientes de transplante de células tronco hematopoiéticas, fígado e rim: aspectos clínicos, epidemiológicos e salivares / Dental caries in patients of hematopoietic stem cell, liver and kidney transplants: clinical, epidemiological and salivary aspects

Este estudo objetivou avaliar a experiência de cárie dentária e fatores associados, em indivíduos de transplante de células tronco hematopoiéticas, fígado e rim. Avaliou-se também o impacto da saúde bucal na qualidade de vida desses indivíduos e sua associação com a experiência de cárie e fluxo salivar. Um estudo transversal analítico controlado, com 40 indivíduos de transplante e 40 controles não indicados ao transplante, pareados por idade e sexo, atendidos na Faculdade de Odontologia da UFMG (Brasil) foi conduzido. Dados sociodemográficos e econômicos, medicações em uso e tempo de pós-transplante foram coletados. Avaliou-se a experiência de cárie pelos índices CPOS e COR (superfície). O impacto da saúde bucal na qualidade de vida foi mensurado pelo instrumento Oral Health Impact Profile (OHIP-14). Coletou-se saliva para obtenção do fluxo, pH, composição química e capacidade tampão. Avaliou-se a ingestão de açúcares livres pelo recordatório de 24 horas. A análise de regressão mostrou que o aumento de um indivíduo morador na casa do paciente aumenta as chances de ter alta experiência de cárie (OR = 1,35; IC95% 1,02-1,79). O aumento de um ponto do fluxo salivar diminuiu as chances de alta experiência de cárie dentária (OR = 0,14; IC95% 0,03-0,72). Quanto ao impacto da saúde bucal na qualidade de vida, os indivíduos em condição de transplante de fígado apresentaram valores significativamente maiores de medianas (4,0 [0-7,0]) comparados aos de transplante de rim (0,5 [0-5]) (p=0,043), para o domínio desconforto psicológico. As medianas do número de superfícies perdidas foram significativamente maiores nos indivíduos de transplante de fígado (45,0 [0-81,0]), comparados aos de rim (12,0 [0-65,0]) (p=0,045). Os indivíduos de transplante de rim (32,5 [1,0-58,0]) apresentaram número de superfícies restauradas significativamente maiores, comparados aos de fígado (13,0 [0-32,0]) (p=0,049). A faixa etária entre 56 e 61 anos (13,0 [7,0-25,0]) apresentou maiores valores do OHIP- 14, comparada à faixa de 25 a 40 anos (4,5 [0-29,0]) (p=0,013). Os valores de OHIP-14 apresentaram correlação positiva moderada significativa, com o número de superfícies dentárias perdidas (ρ=0,433; p=0,005). Não houve correlação entre o valor de OHIP-14 e o fluxo salivar. Concluiu-se que o aumento do fluxo salivar diminuiu as chances de o indivíduo apresentar uma alta experiência de cárie. O aumento do número de indivíduos moradores da casa aumentou as chances de ocorrência de alta experiência de cárie. Indivíduos de transplante de fígado apresentaram maior desconforto psicológico e um maior número de superfícies dentárias perdidas, comparados aos de transplante renal. A maior perda dentária foi correlacionada com um pior impacto da saúde bucal na qualidade de vida dos indivíduos de transplante. Indivíduos a partir de 56 anos de idade demonstraram um maior impacto na qualidade de vida relacionada à saúde bucal.

The aim of this study was evaluate the experience of tooth decay and associated factors in hematopoietic stem cell, liver and kidney transplant patients. The impact of oral health on the quality of life of these individuals and its association with the experience of caries and salivary flow were also evaluated. A controlled analytical cross-sectional study with 40 transplant individuals and 40 controls not indicated for transplantation, matched for age and sex, attended at the UFMG School of Dentistry (Brazil) was conducted. Sociodemographic and economic data, medications in use and post-transplant time were collected. The caries experience was evaluated using the CPOS and COR (surface) indexes. The impact of oral health on quality of life was measured using the Oral Health Impact Profile (OHIP-14). Saliva was collected to obtain flow, pH, chemical composition and buffering capacity. The intake of free sugars was evaluated by the 24-hour recall. The regression analysis showed that the increase of an individual living in the patient's home increases the chances of having a high caries experience (OR =1.35; 95% CI 1.02-1.79). The increase of one point in the salivary flow decreased the chances of high experience of dental caries (OR=0.14; 95% CI 0.03-0.72). As for the impact of oral health on quality of life, individuals in conditions of liver transplantation had significantly higher median values (4.0 [0-7.0]) compared to those of kidney transplantation (0.5 [0- 5]) (p = 0.043), for the psychological discomfort domain. The medians of the number of surfaces lost were significantly higher in the liver transplant subjects (45.0 [0-81.0]), compared to the kidney (12.0 [0-65.0]) (p = 0.045). The kidney transplant individuals (32.5 [1.0-58.0]) had significantly higher number of restored surfaces, compared to the liver (13.0 [0-32.0]) (p = 0.049). The age group between 56 and 61 years old (13.0 [7.0-25.0]) presented higher OHIP-14 values, compared to the age group from 25 to 40 years old (4.5 [0-29.0]) (p=0.013). The OHIP-14 values showed a significant moderate positive correlation, with the number of missing dental surfaces (ρ = 0.433; p = 0.005). There was no correlation between the OHIP-14 value and the salivary flow. It was concluded that the increase in salivary flow decreased the chances of the individual having a high experience of caries. The increase in the number of individuals living in the home increased the chances of high caries experience. Individuals with liver transplantation had greater psychological discomfort and a greater number of missing dental surfaces, compared to those of kidney transplantation. The greater tooth loss was correlated with a worse impact of oral health on the quality of life of transplant individuals. Individuals over 56 years of age demonstrated a greater impact on quality of life related to oral health.

Integrative proteomics and pharmacogenomics analysis of methylphenidate treatment response.

Transcriptomics and candidate gene/protein expression studies have indicated several biological processes modulated by methylphenidate (MPH), widely used in attention-deficit/hyperactivity disorder (ADHD) treatment. However, the lack of a differential proteomic profiling of MPH treatment limits the understanding of the most relevant mechanisms by which MPH exerts its pharmacological effects at the molecular level. Therefore, our aim is to investigate the MPH-induced proteomic alterations using an experimental design integrated with a pharmacogenomic analysis in a translational perspective. Proteomic analysis was performed using the cortices of Wistar-Kyoto rats, which were treated by gavage with MPH (2 mg/kg) or saline for two weeks (n = 6/group). After functional enrichment analysis of the differentially expressed proteins (DEP) in rats, the significant biological pathways were tested for association with MPH response in adults with ADHD (n = 189) using genome-wide data. Following MPH treatment in rats, 98 DEPs were found (P < 0.05 and FC < -1.0 or > 1.0). The functional enrichment analysis of the DEPs revealed 18 significant biological pathways (gene-sets) modulated by MPH, including some with recognized biological plausibility, such as those related to synaptic transmission. The pharmacogenomic analysis in the clinical sample evaluating these pathways revealed nominal associations for gene-sets related to neurotransmitter release and GABA transmission. Our results, which integrate proteomics and pharmacogenomics, revealed putative molecular effects of MPH on several biological processes, including oxidative stress, cellular respiration, and metabolism, and extended the results involving synaptic transmission pathways to a clinical sample. These findings shed light on the molecular signatures of MPH effects and possible biological sources of treatment response variability.

Ser além dos muros: fenomenologia da liberdade para idosos institucionalizados / Being beyond walls: a phenomenology of freedom for institutionalized elderly / Más allá de las paredes: fenomenología de la libertad para ancianos institucionalizados

O estudo objetivou compreender os significados da liberdade para nove idosos que foram entrevistados individualmente numa Instituição de Longa Permanência para Idosos localizada na região do Alto Tietê. Às suas narrativas foi procedida análise qualitativa considerando a narrativa como uma técnica em pesquisa fenomenológica. Na análise, os significados da liberdade para os idosos entrevistados se desvelaram relacionados à sua abertura e suas experiências para além das restrições institucionais e de seu momento de vida articulados nos seus modos de ser-no-mundo e ser-com-os-outros. O estudo revelou que é possível aos idosos serem livres ante as restrições que enfrentam, o que os destina às suas possibilidades de existir numa realidade transformadora de sua história pessoal para além de quaisquer fronteiras.

The study aims to understand the meanings of freedom for nine elderly individuals who were interviewed individually in a home for old people located in the Alto Tietê. Its narratives were made by qualitative analysis, considering the narrative as a technique in phenomenological research. In the analysis, the meanings of freedom for the elderly people respondents proved to be related to your opening and your experiences in addition to the institutional constraints and your moment of life hinged on their ways of being-in-world and being-with-the-others. The study showed that it is possible for the elderly are free before the restrictions they face, what is intended by their ability to exist in processing of your reality personal history beyond any borders.

El estudio buscó comprender los significados de la libertad para nueve ancianos que han sido entrevistados individualmente en un asilo de ancianos ubicado en Alto Tietê. Sus narrativas se analizaron cualitativamente considerando la narrativa una técnica en la investigación fenomenológica. En el análisis, los significados de libertad para los ancianos entrevistados se revelaron relacionados con su apertura y experiencias más allá de las limitaciones institucionales y momento de vida articulado en sus modos de ser en o mundo y ser con los otros. El estudio reveló que la libertad es posible para los ancianos incluso frente las restricciones que enfrentan, que señala sus posibilidades de existir en una realidad transformadora de su biografía más allá de cualquier frontera.

Cafeteria diet increases liquid intake and serum creatinine levels in rats

Introduction: Important changes in human dietary pattern occurred in recent decades. Increased intake of processed foods leads to obesity, which is related with the development of chronic diseases such as type 2 diabetes mellitus, hypertension, as well as cardiovascular and chronic kidney diseases. The prevalence of hypertension has also dramatically increased in recent years, and high sodium intake contributes to this scenario. In healthy individuals, kidneys are the primary end-organs that regulate sodium homeostasis. This study aims to evaluate renal function parameters and systolic blood pressure measurements in an animal model of obesity. Methods: Sixty-day-old male Wistar rats (n=30) were divided into two groups: standard (SD) and cafeteria diet (CD). Cafeteria diet was altered daily and was composed by crackers, wafers, sausages, chips, condensed milk, and soda. All animals had free access to water and chow and the experiment was carried out for 6 weeks. Weight gain, sodium and liquid intake control, systolic blood pressure measurements, and renal function parameters were evaluated. Results: Animals exposed to cafeteria diet had an increase of 18% in weight compared to the control group. Sodium intake was increased by cafeteria diet and time (F(1,28)=773.666, P=0.001 and F(5,28)=2.859, P=0.02, respectively) and by the interaction of both factors (F(6,28)=2.859, P=0.02). On liquid intake occurred only effect of cafeteria diet and time (F(1,28)=147.04, P=0.001 and F(5,28)=3.996, P=0.003, respectively). Cafeteria diet exposure also induced an increase on creatinine serum levels (P=0.002), however this effect was not observed on creatinine urine levels (P>0.05) nor on systolic pressure measurements (Students' t test, P>0.05). Conclusions: Obesity induced by cafeteria diet exposure increases liquid intake and alters creatinine serum levels, an important renal function marker. Considering the high consumption of hypercaloric food currently in the world, further studies are required to elucidate the modifications on renal function triggered by this diet over time (AU)

Evaluation of different procedure involved in the Transcranial Direct Current Stimulation (tDCS) technique experimental application

Introduction: The transcranial direct current stimulation (tDCS) is a non-invasive technique, which induces neuroplastic changes in the central nervous system of animals and humans. Furthermore, tDCS has been suggested as a therapeutic tool for pain management. The aim of this study was to standardize a non-invasive tDCS technique indexed by the nociceptive response of rats submitted to different conditions necessary to the tDCS application. Method: 60-day-old male Wistar rats (n=65), divided into 6 groups: control(C); non-active sham (NAS); active-sham (AS); active-sham restrained (ASR); non-active sham restrained (NASR); active tDCS treatment. Animals received treatment during 30 seconds (sham-active) or 20 minutes (restraint and tDCS)/8 days. Nociceptive threshold was assessed by Hot Plate test at baseline, immediately and 24h after the first session, immediately and 24h after the last session. Variance analysis of repeated measurements followed by Bonferroni was performed for intra-group comparison. Results: Physical restraint and 30 seconds stimulation (sham-tDCS) increased pain sensitivity (P≤0.05), and tDCS treatment was able to prevent the thermal hyperalgesia. Our original tDCS montage is similar to that used in the procedure with humans, because it is not an invasive technique. The electrodes are positioned on the head, and the animals are immobilized during the 20-minute treatment. As this procedure could involve behavior and neurochemical alterations due to stress induced by restriction (thus, it creates a research bias), we hypothesized that a 30-second electrical stimulus application (sham-tDCS) and the physical restriction used during tDCS treatment might alter nociceptive response in rats. Conclusion: There are methodological limitations in the present tDCS-technique. Although active-tDCS treatment is able to prevent these harmful effects, interference of these factors has to be considered during the results' analysis. Future adaptations of the tDCS-technique in rats are required to evaluate its therapeutic effects (AU)

Melatonin as a potential counter-effect of hyperalgesia induced by neonatal morphine exposure.

Morphine administration in the neonatal period can induce long-term effects in pain circuitry leading to hyperalgesia induced by the opioid in adult life. This study explored a new pharmacological approach for reversing this effect of morphine. We focused on melatonin owing its well-known antinociceptive and anti-inflammatory effects, and its ability to interact with the opioid system. We used the formalin test to assess the medium and long-term effects of melatonin administration on hyperalgesia induced by morphine in early life. Newborn rats were divided into two groups: the control group, which received saline, and the morphine group, which received morphine (5µg subcutaneously [s.c.]) in the mid-scapular area, once daily for 7days, from P8 (postnatal day 8) until P14. At postnatal days 30 (P30) and 60 (P60), both groups were divided in two subgroups, which received melatonin or melatonin vehicle 30min before the formalin test. The nociceptive responses were assessed by analyzing the total time spent biting, flicking, and licking the formalin-injected hind paw; these responses were recorded during the first 5min (neurogenic/acute phase) and from 15 to 30min (inflammatory/tonic phase). Initially, animals in the morphine/vehicle group showed increased nociceptive behavior in phase II (inflammatory) of the formalin test at P30, and in the neurogenic and inflammatory phases at P60. These increased nociceptive responses were fully reversed by melatonin administration at either age. These findings show that melatonin administration is a potential means for countering hyperalgesia induced by neonatal morphine exposure in young and adult rats.

Appendicular fractures of traumatic etiology in dogs: 955 cases (2004-2013) / Fraturas apendiculares de etiologia traumática em cães: 955 casos (2004-2013)

ABSTRACT: Orthopedic diseases are common in dogs and cats, especially, those caused by traumatic injury. Overall, among the significant changes in this group, the fractures are the major cause of pain and dysfunction in dogs of all ages, sizes and breeds. Therefore, a retrospective study of dogs examined between January 2004 and December 2013 at the University Veterinary Hospital of Universidade Federal de Santa Maria, was conducted aiming to identify and determine the prevalence of appendicular fractures caused by trauma and characterizing the population/etiology. In a population of 1,200 dogs with suspected traumatic orthopedic diseases in the locomotor system, 955 (79.6%) had appendicular fractures. Of the dogs 23.5% had fractures on the femur (n=225), 23.4% had pelvic fractures (n=223), 22% had tibial and fibular fractures (n=210), 17.6% had radius and ulna fractures (n=168), 7.5% had humeral fractures (n=72) and 6% had distal limb fractures (tarsus, carpus, metacarpus, metatarsus and phalanges (n=57)). The most frequent cause was car accidents (72.2%). Most affected dogs were male (52.5%), juvenile (42%), mixed breed (51.4%) and small size (42.7%). In conclusion, the profile of dogs with fractures in the Central Region of Rio Grande do Sul State is: male dogs, mixed breed, immature and small size, presenting femoral fractures by car accident.

RESUMO: Doenças ortopédicas são comuns em cães e gatos, especialmente, aquelas causadas por lesões traumáticas. De forma geral, dentre as alterações significativas desta margem, apontam-se as fraturas como causa importante de dor e disfunção em cães de todas as idades, tamanhos e raças. Diante disso, um estudo retrospectivo de cães atendidos entre janeiro de 2004 e dezembro de 2013 no Hospital Veterinário Universitário da Universidade Federal de Santa Maria, foi realizado, objetivando identificar e determinar a prevalência das fraturas apendiculares decorrentes de traumatismo, caracterizando a população e a etiologia. De um total de 1.200 cães com suspeita de doença ortopédica de origem traumática no sistema locomotor, 955 (79,6%) apresentaram fraturas apendiculares, sendo que 23,5% foram fraturas do fêmur (n=225), 23,4% fraturas da pelve (n=223), 22% fraturas da tíbia e da fíbula (n=210), 17,6% fraturas do rádio e da ulna (n=168), 7,5% fraturas do úmero (n=72) e 6% fraturas distais dos membros (tarso, carpo, metacarpo, metatarso e falanges (n=57)), decorrentes principalmente de acidentes automobilísticos (72,2%). Os cães mais afetados foram machos (52,5%), filhotes (42%), sem raça definida (51,4%), de porte pequeno (42,7%). Conclui-se que o perfil de cães com fraturas na Região Central do Rio Grande do Sul é: cães machos, sem raça definida, imaturos, de pequeno porte, apresentando fratura de fêmur por acidente automobilístico.

Hypercaloric diet modulates effects of chronic stress: a behavioral and biometric study on rats.

Obesity is a chronic disease that has been associated with chronic stress and hypercaloric diet (HD) consumption. Increased ingestion of food containing sugar and fat ingredients (comfort food) is proposed to "compensate" chronic stress effects. However, this eating habit may increase body fat depositions leading to obesity. This study evaluated behavioral/physiological parameters seeking to establish whether there is an association between the effects of HD intake and stress, and to test the hypothesis that the development of anxious behavior and obesity during chronic stress periods depends on the type of diet. Sixty-day-old male Wistar rats (n = 100) were divided into four groups: standard chow, hypercaloric diet, chronic stress/standard chow and chronic stress/hypercaloric diet. Chronic stress was induced by restraint stress exposure for 1 h/day, for 80 d. At the end of this period, rat behavior was evaluated using open-field and plus-maze tests. The results showed that HD alone increased weight gain and adipose deposition in subcutaneous and mesenteric areas. However, stress reduced weight gain and adipose tissue in these areas. HD also increased naso-anal length and concurrent stress prevented this. Behavioral data indicated that stress increased anxiety-like behaviors and comfort food reduced these anxiogenic effects; locomotor activity increased in rats fed with HD. Furthermore, HD decreased corticosterone levels and stress increased adrenal weight. The data indicate that when rats are given HD and experience chronic stress this association reduces the pro-obesogenic effects of HD, and decreases adrenocortical activity.

Não adesão ao tratamento da hipertensão arterial no pronto atendimento de Nova Santa Rita

A escolha desta temática se deu ao observar os pacientes na hora do acolhimento e ver os resultados dos Sinais Vitais, me impressionando com o número de pacientes Hipertensos com pressão arterial alterada que não aderem ao tratamento, que procuram atendimento no Pronto Atendimento 24 horas de Nova Santa Rita. As doenças crônicas não transmissíveis, segundo a Organização Mundial de Saúde (OMS), são atualmente a principal causa de mortalidade no mundo. A hipertensão arterial, além de ser um dos principais problemas de saúde no Brasil, eleva o custo médico-social, principalmente pelas complicações que causa como as doenças cerebrovasculares, arterial coronariana, vascular de extremidades, insuficiência cardiaca e insuficiência renal crônica. (DOSSE, 2009). Diagnosticar a HAS não é suficiente. O essencial é conduzir corretamente e convencer o paciente sobre a necessidade da adesão e do controle da doença. (LESA,2006). Cerca de 40% a 60% dos pacientes não fazem uso da medicação prescrita. Essa porcentagem aumenta quando a falta de adesão relaciona-se a itens como estilo de vida, ressaltando-se dieta, sedentarismo, tabagismo, etilismo, entre outros fatores, (BARBOSA, 2006). Sendo a HAS uma doença sem manifestações clínicas, os pacientes também podem apresentar sentimentos naturais de negação frente à doença, com uma consequente não adesão ao tratamento anti-hipertensivo. (MANFROI,2006). Para concretizar essa questão estabeleço os seguintes objetvos:- Conhecer a percepção sobre Hipertensão dos pacientes hipertensos com pressão arterial alterada sem adesão ao tratamento em um Pronto Atendimento 24 horas da Cidade de Nova Santa Rita; conhecer o porquê que estes pacientes não usam a medicação prescrita e não seguem as orientações. Para o desenvolvimento da pesquisa, visando alcançar os objetivos, será utilizado um estudo, exploratório e descritivo, com uma abordagem qualitativa. Para alcançar os objetivos, será utilizado um estudo, exploratório e descritivo, com ....

Tratamento cir£rgico de seio frontal atrav‚s da cranializa‡Æo e utiliza‡Æo do acesso bicoronal – relato de caso / Surgical treatment of frontal sinus through cranialization using bicoronal access – case report

O trauma maxilofacial ‚ um dos grandes desafios para os servi‡os de sa£de e representa um dos problemas mais importantes devido … elevada taxa de incidˆncia e alto custo financeiro. A frequente associa‡Æo entre trauma craniofacial e maxilofacial exige abordagens e tratamento multiprofissional e sÆo cada vez mais complexos, com tempo de interna‡Æo mais longo e altos custos para o sistema p£blico de sa£de. Este estudo apresenta um relato de caso cl¡nico de um paciente admitido no servi‡o de emergˆncia do Hospital Municipal Salgado Filho (HMSF) – RJ, v¡tima de agressÆo f¡sica por pedra no ter‡o superior de face e submetido ao tratamento cir£rgico por equipe multiprofissinal (neurocirurgiÆo e cirurgiÆo bucomaxilofacial), com cranializa‡Æo do seio frontal e reparo do defeito ¢sseo com tela de titƒnio de reconstru‡Æo. Conclui-se neste trabalho que a proposta cir£rgica, que consistiu na cranializa‡Æo do seio frontal pelo acesso bicoronal, como tratamento proposto para o paciente, apresentou- -se satisfat¢ria, segundo as referˆncias liter rias consultadas. Sugere-se acompanhamento p¢s-operat¢rio cl¡nico e radiogr fico do paciente, uma vez que neste relato foi mencionado apenas o tratamento cir£rgico do caso.

TMaxillofacial trauma is a major challenge for health services and represents a serious problem due to its high incidence and high costs. The frequent association between craniofacial and maxillofacial trauma requires multidisciplinary approaches and treatment, and it i salso very complex, with longer hospitalization time and high costs to the public health system. This study presents a case report of a patient assisted in the emergency department of the Salgado Filho Municipal Hospital (HMSF) – RJ, victim of physical assault by stone in the upper third of the face, who underwent surgery conducted by multiprofissinal team (neurosurgeons and maxillofacial surgeon) with cranialization of the frontal sinus and repair of bone defect reconstruction with titanium screen. It was concluded that the surgical approach, which consisted of the frontal sinus cranialization using bicoronal access was satisfactory as treatment according to the researched literature. It is suggested post-operative clinical and radiographic follow-up of the patient since in this report only the surgical treatment of the case was approached.

Interrelação entre síndrome metabólica, estresse crônico e ritmos circadianos de marcadores adipogênicos: uma revisão / Interrelation between metabolic syndrome, chronic stress and circadian rhythms of adipogenic markers: a review

Alterações de ritmos circadianos são relacionadas ao desenvolvimento de transtornos metabólicos como obesidade e síndrome metabólica. Além disto, a disponibilidade e o consumo de alimentos altamente palatáveis ricos em gordura e a exposição a situações estressantes podem contribuir na incidência e na severidade destas doenças crônicas, provocando modificações no balanço energético, alterações no metabolismo de lipídeos e adipogênese. Nesta revisão, abordaremos os aspectos cronobiológicos que podem ser influenciados pela exposição a estresse crônico e a obesidade, além dos mecanismos que contribuem para o crescimento de doenças metabólicas (AU)

Alterations in circadian rhythms are associated with the development of metabolic disorders, such as obesity and metabolic syndrome. Moreover, the availability and consumption of highly palatable foods rich in fat and the exposure to stressful situations may contribute to the incidence and severity of these chronic diseases, leading to changes in energy balance, alterations in lipid metabolism and adipogenesis. This review aimed to discuss the chronobiological aspects that can be influenced by the response to chronic stress and obesity, as well as the mechanisms that contribute to the development of metabolic diseases (AU)

As alterações não-evasivas da mucosa esofágica devem ser valorizadas na caracterização endoscópica da esofagite por refluxo? / Non erosive alterations of esophageal mucosa should be considered as endoscopic reflux esophagitis?

Racional - A doença do refluxo gastroesofágico representa afecção de grande importância médico social pela sua elevada e crescente prevalência e por poder prejudicar, de modo considerável, a qualidade de vida do paciente acometido, contudo, existem controvérsias quanto a caracterização da esofagite e sua correlação clínica. Objetivo - Avaliar dados demográficos e características manométricas e pH-métricas do esôfago em diferentes grupos de esofagite e, verificar se as alterações não-erosivas da mucosa esofágica (esofagite não-erosiva) devem ou não ser valorizadas na caracterização endoscópica da esofagite por refluxo. Casuística e Métodos - Foram estudados 238 pacientes com sintomas típicos (pirose e/ou regurgitação) da doença do refluxo gastroesofágico, classificados de acordo com o estudo endoscópico do esofâgo em três grupos:I- sem esofagite; II- com esofagite não-erosiva e III- com esofagite erosiva. Foram correlacionados dados clínicos e o grau da esofagite valorizando-se pirose, regurgitação e manifestações extra-esofágicas. Resultados - Cento e dezesseis pacientes (48,7%) eram do sexo masculino e 122 (51,3%) do feminino. A idade variou de 16 a 80 anos. Cinqënta e oito pacientes não apresentaram esofagite erosiva. Os resultados quanto a pirose, regurgitação e manifestações extra-esofágicas não mostraram diferença significante nos 3 grupos. O estudo manométrico apresentou diferença entre grupos estudados em relação a extensão e o tônus pressórico do esfíncter inferior. No estudo phmétrico, o refluxo gastroesofágico foi caracterizado como patológico em 31 pacientes (53,4%) no grupo I, 39 (76,5%) no II e 93 (72,1%) no grupo III. Conclusões - Os pacientes com sintomatologia típica da doença do refluxo gastro-esofágico mas com alterações não-erosivas da mucosa esofágica, apresentam comportamento funcional da transição esôfago-gástrica mais parecido com aqueles de esofagite erosiva, sugerindo que tais alterações devam ser valorizadas na caracterização endoscópica da esofagite.

Biopróteses aórticas porcinas, modelo convencional e sem suporte (stentless): estudo comparativo / Stented and stentless porcine aortic bioprosthesis: comparative study

Analisar os resultados obtidos com o implante de bioprótese porcina em posiçao aórtica, comparando dois grupos de pacientes operados consecutivamente em um mesmo período: Grupo 1 (G1): pacientes com válvula aórtica sem suporte ("stentless"); Grupo 2 (G2): pacientes com válvula convencional com suporte ("standart"). Casuística e Métodos: No período de janeiro de 1990 a dezembro de 1996, foram realizadas, no Biocor Instituto, 752 operaçoes de troca valvar aórtica, cujos prontuários foram analisados retrospectivamente. Foram levantados dados relacionados às características clínicas dos dois grupos, assim como resultados relacionados à operaçao: número das próteses implantadas, tempo de circulaçao extracorpórea (CEC) e pinçamento aórtico (PINC), permanência em Centro de Tratamento Intensivo (CTI) e hospitalar, morbidade e mortalidade pós-operatória. Os ecocardiogramas dos pacientes em acompanhamento ambulatorial foram analisados e os seguintes dados obtidos: área válvular efetiva, índice de área válvular efetiva, gradiante transvalvular médio e grau de insuficiência válvular. Resultados: foram realizadas 169 operaçoes no G1 e 583 operaçoes no G2. As características clínicas dos dois grupos foram semelhantes, com exceçao da idade (38,0 + 17,5 vs 46,0 + 19,0 anos) (p<0,05) e de um número proporcionalmente maior de endocardite, primária e prostética, e de retrocas valvares no G1 (p<0,02). Quanto aos dados per e pós-operatórios, mais de 70 por cento dos pacientes nos dois grupos receberam próteses de números 19 a 25, sendo o critério para escolha da prótese a medida do anel valvar. Os tempos de CEC (99,9 + 28,8 vs 86,3 + 31,0 minutos) e de PINC (80,9 + 25,2 vs 65,0 +24,4 minutos) foram significativamente diferentes (p<0,0001). No entretanto, os tempos de permanência hospitalar e em CTI, assim como a morbimortalidade hospitalar foram semelhantes. Com relaçao ao acompanhamento ecocardiográfico, a área valvular efetiva (1,94 + 0,31 vs 1,48 + 0,33 cm2) (p<0,000001), assim como o índice de área valvular efetiva (1,15 + 0,23 vs 0,89 + 0,06 cm2/m2) (p<0,000001), foram significativamente maiores no G1, o que resultou em menores gradientes transvalvulares médios (8,3 + 4,9 vs 13,2 + 4,6 mmHg) (p<0,000001). Os índices de insuficiência valvular foram discretos e sem diferenças significativas entre os dois grupos. Conclusao: As válvulas aórticas compostas porcinas "stentless" quando comparadas às biopróteses convencionais com suporte apresentaram melhor desempenho...

Dissecçäo aguda da aorta ascendente no per-operatório / Acute dissection of the ascending aorta in the intraoperative period

Com o objetivo de demonstrar a experiência cirúrgica do Hospital Biocor com as dissecçoes agudas da aorta torácica no per-operatório, foram analisados, retrospectivamente, 7.251 pacientes submetidos a cirurgia cardíaca com o emprego de circulaçao extracorpórea, no período de janeiro de 1988 a janeiro de 1995. Onze pacientes apresentaram dissecçao aórtica no per-operatório, sendo que 54,5 por cento (6 pacientes) eram homens e 45,5 por cento (5 pacientes) mulheres. A idade variou de 54 a 80 anos (média de 66,73 ñ 7,54 anos). Os procedimentos cirúrgicos nos quais ocorreu a dissecçao incluíram: revascularizaçao miocárdica em 9 (81,8 por cento) pacientes, revascularizaçao miocárdica + aneurismectomia do VE em l (9,1 por cento) e troca valvar aórtica em l (9,1 por cento) paciente. Todos apresentavam hipertensao arterial sistêmica. Em 9 (81,8 por cento) pacientes a aorta ascendente anormal foi observada durante a cirurgia. A correçao cirúrgica da dissecçao incluiu: substituiçao da aorta ascendente por conduto tubular de pericárdio bovino em 7 (63,6 por cento) pacientes, substituiçao por conduto valvulado de pericárdio bovino em l (9,1 por cento) e plastia aórtica com retalho de pericárdio bovino em 3 (27,3 por cento) pacientes. A técnica de hipotermia profunda com parada circulatória total foi empregada em 90,9 por cento dos casos. A mortalidade hospitalar foi de 45,5 por cento (5 pacientes), sendo: em 2 casos devido à impossibilidade de descontinuaçao da CEC; hemorragia maciça em l e síndrome de baixo débito no pós-operatório imediato em 2 pacientes. Dos 6 pacientes sobreviventes, 5 encontram-se em seguimento e livres de sintomas cardíacos. Concluímos que a dissecçao aórtica aguda no per-operatório continua sendo uma complicaçao grave e altamente letal, sendo que o emprego de medidas preventivas e técnicas cirúrgicas adequadas em pacientes de risco podem diminuir a incidência dessa complicaçao.

Cirurgia da aorta descendente e tóraco-abdominal com técnica de oclusäo proximal isolada da aorta ("open distal") / Surgical treatment of descending thoraco-abdominal aorta with the open distal technique

O presente relato apresenta a experiência obtida em um período de 4 anos (jan/91 -jan/95) com a técnica "open distal" descrita por Cooley, em 1990(3), para tratamento cirúrgico de doenças da aorta torácica descendente e aorta tóraco-abdominal. Nesse período foram realizadas 35 operaçoes (25 para aorta descendente e lO para aorta tóraco-abdominal). Os aneurismas de origem degenerativa e as dissecçoes aórticas ocorreram em freqüência semelhante (48,5 por cento e 40 por cento, respectivamente); em 8 pacientes havia rotura da aorta, parcialmente tamponada pelo pulmao (5 casos), órgaos abdominais (2 casos) e esôfago (l caso). O acesso cirúrgico foi obtido por toracotomia póstero-lateral esquerda ou tóraco-freno-laparotomia. Heparina foi usada na dose de 1,5 mg/kg e todo sangue do campo cirúrgico foi coletado a um reservatório e reinfundido pela veia femoral. Houve 4 (ll.4 por cento) óbitos hospitalares e 2 (5,8 por cento) pacientes portadores de aneurisma tóraco-abdominal desenvolveram paraplegia. A morbi-mortalidade do grupo foi diretamente relacionada à condiçao clínica pér-operatória e à extensao do segmento aórtico acometido. Na nossa opiniao, a técnica "open distal" é um método alternativo simples e eficaz no tratamento cirúrgico das doenças da aorta descendente e tóraco-abdominal. Em casos de ressecçoes extensas com períodos longos de oclusao aórtica, métodos para proteçao medular deverao ser avaliados.