Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil.

Introduction: Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil. Methods: PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units. Results: When compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability. Conclusion: Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.

Reconstrução de defeito de espessura total em asa nasal utilizando retalho de transposição do sulco nasogeniano combinado com retalho em dobradiça / Reconstruction of a full-thickness alar defect using a nasolabial flap combined with hinge flap

A região nasal é local frequente de carcinomas queratinocíticos, e sua anatomia, seu relevo e sua tridimensionalidade peculiares tornam o reparo cirúrgico desafiador. Eventualmente, em situações de maior complexidade, uma única técnica pode não ser suficiente para a restauração da anatomia original, sendo necessária a associação de métodos. Neste artigo, descrevemos uma estratégia para reconstrução de defeito de espessura total em asa nasal, incluindo margem nasal, a partir da combinação de retalho de transposição do sulco nasogeniano com retalho em dobradiça. Trata-se de um procedimento seguro, dependente da mobilização de tecido local e realizado em um único tempo cirúrgico.

The nasal region is a frequent site of keratinocyte carcinomas. Its peculiar anatomy, contour, and three-dimensionality make surgical repair challenging. Eventually, in situations of greater complexity, a single technique may not be sufficient to restore the original anatomy, requiring the association of methods. This article describes a strategy for reconstructing a full-thickness alar defect, including the nasal margin, based on the combination of a nasolabial transposition flap with a hinge flap. It is a safe procedure, dependent on the mobilization of local tissue and performed in a single surgical procedure

Resection of Pulmonary Endometriosis by Video-Assisted Thoracoscopic Surgery Using Bronchoscopy as a Preoperative Strategy.

The presence of parenchymal or intrabronchial endometrial tissue is rare and has been reported in <6% of women of childbearing age with thoracic endometriosis. Hemoptysis during the menstrual cycle is the most common clinical presentation. We report a case of pulmonary endometriosis, treated concurrently with the patient's menstrual period, with wedge resection by video-assisted thoracoscopic surgery. Bronchoscopy, immediately before the start of the surgical procedure, allowed us to identify the pulmonary segment that had active bleeding, which made the surgical procedure feasible.

Estudo das características histológicas das diferentes regiões anatômicas corporais e sua importância na cirurgia micrográfica de Mohs / Study of the histological characteristics of the different body anatomical regions and their importance in Mohs micrographic surgery

Para a interpretação precisa dos achados intraoperatórios na cirurgia micrográfica de Mohs, é fundamental conhecer a histologia normal dos tecidos nas diferentes regiões anatômicas. Os cortes de congelamento avaliados pela técnica são obtidos na horizontal, diferentemente dos cortes verticais da análise anatomopatológica convencional. A partir do acervo de casos de um serviço de formação em Dermatologia, os cortes de congelamento de interesse em histologia topográfica foram digitalizados e detalhados, conforme revisão da literatura.

To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Oral health-related quality of life in women with temporomandibular joint disk anterior displacement before and after disk repositioning and anchoring surgery assessed with the Oral Health Impact Profile (OHIP-14).

OBJECTIVES: The aim of this study was to assess and compare oral health-related quality of life (OHRQOL) in women with temporomandibular joint (TMJ) disk displacement without reduction, before disk repositioning and anchoring surgery, in short-term follow-up, in different age groups, and with use of the Oral Health Impact Profile (OHIP-14). STUDY DESIGN: Fifty women ages between 17 and 60 years were divided into 4 age groups: 17-27, 28-38, 39-49, and 50-60 years. All the patients were asked to answer the OHIP-14 form before surgery and during their short-term follow-up. Seven domains of OHRQOL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domains' scores and total OHIP-14 were compared between times by using Student's t test in the whole sample and in the 4 age groups. RESULTS: Both the whole sample and the age groups (17-27, 28-38, 39-49 years) showed a statistically significant decrease in all scores (P < .01). The age group 50-60 years showed a decrease in scores significant only in functional limitation (P = .05) CONCLUSIONS: TMJ disk anterior displacement had a negative impact on women's OHRQOL because of physical pain, physical disability, and psychological discomfort. TMJ disk repositioning and anchoring surgery improved overall OHRQOL in patients between 17 and 49 years of age; however, in patients between 50 and 60 years of age, there was improvement only in physical pain.

Histological and inflammatory analysis to diagnostic method of proximal gingivitis by flossing.

OBJECTIVES: The aim of this study was to assess with histological and inflammatory analysis the use of flossing as a diagnostic method for detecting proximal gingivitis. MATERIAL AND METHODS: This is a diagnostic accuracy paper composed of two different studies. In the first study, three groups were identified based on papilla status: bleeding (+) with both methods (N = 26); bleeding (+) with dental floss, but no bleeding (-) with probing (N = 26); and no bleeding (-) with either method (N = 26). One papilla from all 78 participants was biopsied and analyzed for the determination of inflammatory infiltrate and percentage of collagen fibers. Sensibility, specificity, positive and negative predictive, and accuracy values were analyzed. In the second study, the volume of gingival crevicular fluid (GCF) was analyzed in 49 participants with flossing+/probing- and flossing-/probing- at contralateral proximal sites. The GCF volume was compared between these sites (n = 172). RESULTS: Significantly greater frequencies of moderate/intense inflammation were found in the flossing+/probing+ (100%) and flossing+/probing- (92.3%) groups compared to those in the flossing-/probing- (0%) group. Significantly different percentages of collagen fibers were found among the three groups (flossing+/probing+ (40.90 ± 3.68); flossing+/probing- (45.78 ± 4.55); flossing-/probing- (60.01 ± 36.66)) (P < 0.001). Dental floss increased the balance between sensitivity and specificity values and showed highest positive predictive (100%) and accuracy (97%) values. Among the 172 sites evaluated, positive bleeding sites had a significantly greater volume of GCF (38 (27-68)) than negative sites (25 (16-51)) (P < 0.001). CONCLUSIONS: The findings suggest that flossing can be used as a diagnostic method for proximal gingivitis in subjects with no history of periodontitis. CLINICAL RELEVANCE: Dental floss can be used as a complementary diagnostic method for proximal gingivitis in adults without clinical attachment loss in clinical practice as well as epidemiology studies.

Juvenile Nasopharyngeal Angiofibroma With Sphenoid Sinus Invasion and Protrusion: Treatment Approach With Le Fort I Osteotomy.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor that occurs predominantly in young males. The authors report the case of a 22-year-old male patient who presented with a painless, exophytic tumor mass protruding through the right nostril, with anterior lateral extension associated with severe posterior involvement, erosion of the sphenoid bone to the right of the pterygoid process, and significant epistaxis. The preoperative evaluation, surgical approach, postoperative results, and a review of the literature are presented. The surgical approach with Le Fort I osteotomy was designed to facilitate surgical access to the tumor in the nasal cavity. Before down-fracture of the maxilla, plates were placed for fixation and holes were made to produce reference points for restoration of normal anatomy after tumor removal. Although the literature describes the use of nonsurgical therapies, it is well established that surgical treatment is the best option for patients with JNA. Treatment also requires preoperative embolization to avoid bleeding and ensure safety during tumor resection. Long-term imaging follow-up every 6 to 8 months for at least 3 years after surgery is needed for detection of residual tumor/recurrence. The modified technique used here together with preoperative embolization was essential to successful outcome.

Soro do leite em substituição ao leite na cria de bezerros / Use of whey in substitution to milk in holstein calves / Suero de leche en sustitución a la leche en cría de terneros

O uso de leite na alimentação de bezerras representa o maior custo na fase de cria. Com o objetivo de avaliar a viabilidade técnica da utilização de diferentes quantidades de dieta líquida na alimentação de bezerros da Raça Holandês, utilizou-se 160 ou 240 litros de dieta líquida, durante um período de 53 dias (do quarto ao 56o dia de vida) de aleitamento com diferentes níveis de inclusão de soro de leite em substituição ao leite integral (0, 10 e 20%), em esquema fatorial 2x3 (160 ou 240 litros de dieta líquida e 0, 10 ou 20% de inclusão de soro do leite), conduzido no Laboratório de Bovinocultura Leiteira da Universidade Federal de Santa Maria. Os animais foram distribuídos inteiramente ao acaso em seis tratamentos, com quatro repetições por tratamento. Foram avaliados o consumo de matéria seca do concentrado (CMSC), da matéria seca total (CMST), ganho médio diário (GMD), conversão alimentar (CA), peso vivo final (PVF) e o comportamento dos animais. Para os níveis de soro do leite, ocorreu uma resposta quadrática (p<0,05) para o CMSC, CMST, GMD e CA. Os bezerros que receberam 160 litros de leite apresentaram maior (p<0,05) CMSC, porém pior CA. O CMST, o GMD e o PVF foram superiores (p<0,05) para os bezerros que consumiram 240 litros de leite durante o período experimental, com melhor CA para esse grupo de animais. Na análise do comportamento não foi determinada diferença significativa para os parâmetros avaliados (p>0,05).(AU)

The use of milk in the calves feed represents the largest cost in the calf production system. The aim was to evaluate the technical feasibility of using different amounts of liquid diet in feeding of Holstein calves. It was used 160 or 240 liters of milk during 53 days (from the fourth to the 56th day of life) of feeding with different levels of milk serum included to whole milk (0, 10 and 20%), in a factorial 2x3 model conducted at the Dairy Cattle Laboratory of the Federal University of Santa Maria. The animals were randomly assigned to six treatments with four replicates per treatment. The dry matter intake of concentrate (DMIC), of the total dry matter (TDM), average daily gain (ADG), feed conversion (FC), final body weight (FBW) and the behavior of animals. For milk serum levels, there was a quadratic response (p<0.05) for the DMIC, TDM, ADG and FC. DMIC and FC were higher (p<0.05) for calves received 160 liters of milk. The ADG, TDM and FBW were higher for calves that consumed 240 liters of milk during the experimental period, while FC was lower (p<0.05) for this group of calves. There was no difference in the behavior of calves for the evaluated parameters (p>0.05).(AU)

El uso de leche en la alimentación de terneros representa el costo más grande en la fase de creación. Con el fin de evaluar la viabilidad técnica de utilizar diferentes cantidades de dieta líquida en la alimentación de terneros de la raza holandesa, se utilizaron 160 o 240 litros de dieta líquida por un período de 53 días (desde el cuarto hasta el día 56º día de vida), alimentación con diferentes niveles de adición de suero de leche entera (0, 10 y 20%), en un estudio factorial 2x3 (160 0 240 litros de dieta líquida y 0, 10 o 20% de inclusión de suero de leche), llevado a cabo en el Laboratorio de Ganado Lechero de la Universidad Federal de Santa María. Los animales se distribuyeron completamente al azar en seis tratamientos con cuatro repeticiones por tratamiento. Se evaluó el consumo de materia seca del concentrado (CMSC), de la materia seca total (CMST), ganancia media diaria (GMD), conversión alimenticia (CA), el peso vivo final (PVF) y el comportamiento de los animales. Para los niveles de suero de leche, hubo una respuesta cuadrática (p<0,05) para el CMSC, CMST, GMD y CA. Los terneros que recibieron 160 litros de la leche presentaron mayor (p<0,05) CMSC, sin embargo con peor CA. Las variables CMST, GMD y PVF fueran mayores (p<0,05) para los terneros que consumieron 240 litros de leche durante el período experimental, mientras con mejor CA para ese grupo de animales. En el análisis del comportamiento no ha sido determinada diferencia significativa para los parámetros evaluados (p>0,05).(AU)

Análise microbiológica da ocorrência da contaminação bacteriana da mesa cirúrgica comparando o TNT gramatura 20 e gramatura 40 / Microbiological analysis of occurrence of bacterial contamination of surgical table comparing 20 thickness and 40 thicknes

A limpeza e desinfecção das superfícies operatórias fixas e partes expostas do equipo odontológico reduzem, significativamente, a contaminação. Este estudo teve como objetivo avaliar se há contaminação da mesa cirúrgica, ao se utilizar o TNT esterilizado nas gramaturas 20 g/m² e 40 g/m². Materiais e Métodos: O trabalho constituiu-se de 2 grupos, compostos por 30 amostras (campos cirúrgicos) para cada grupo. Após a desinfecção prévia das mesas cirúrgicas, foram colocados campos de TNT. No grupo 1, foi utilizado TNT gramatura 20, e no grupo 2, gramatura 40. A coleta das amostras dos dois grupos foi realizada logo após a colocação dos campos cirúrgicos (tempo 1) e 1 hora após (tempo 2). Resultados: Em relação à ocorrência de contaminação bacteriana, não houve diferença estatisticamente significativas entre tempo de coletas. Mesmo com os cuidados de desinfecção da mesa e paramentação adequada, esses campos não foram totalmente eficazes. Conclusão: A amostra do TNT gramatura 40, tanto no início da cirurgia quanto 1 hora após, obteve melhores resultados, comparando-se com o TNT gramatura 20 sem diferenças estatísticas... (AU)

The cleaning and disinfecting fixed operative surfaces and exposed parts of the dental unit significantly reduces contamination. This study aimed to assess whether there is contamination of the surgical table to use the TNT sterilized in the weights 20 g/m² and 40 g/m². Materials and Methods: The study consisted of two groups, composed of 30 samples (drapes) for each group. After prior disinfection of surgical tables were placed TNT fields. Group 1 was used TNT weight and 20 in group 2 weight 40. The sample collection from both groups was held soon after the placement of surgical fields (time 1) and 1 hour after (time 2). Results: Regarding the occurrence of bacterial contamination, there was no statistically significant difference between time of collection. Even with the disinfecting care of the table and adequate scrub, these fields have not been fully effective. Conclusion: Thus, the sample weight of the TNT 40, both at the beginning of surgery, as 1 hour, better results compared to the TNT weight 20 without statistical differences... (AU)

Efeitos da torçäo do cordäo espermático sobre os parâmetros seminais do testículo contralateral em ratos pré-puberais / Seminal effects on contralateral testis following spermatic cord torsion in prepubertal rats

A torçäo do cordäo espermático é muito discutida principalmente quando ao seu efeito contralateral e à influência do testículo isquêmico. Tem sido bastante estudada em animais adultos embora, no homem, incida mais na infância e adolescência. O estudo tem o objetivo de avaliar o testículo contralateral de ratos pré-puberais submetidos à torçäo do cordäo espermático, mantendo-se ou näo o testículo torcido. Foram utilizados 120 ratos Wistar, com idade de 35 dias, divididos em 3 grupos: anestesia, simulado e torçäo. A avaliaçäo foi feita aos 70 ou 105 dias de vida, estudando-se o peso testicular, a motilidade e a concentraçäo dos espermatozóides. O sêmen do rato foi obtido pela microaspiraçäo do túbulo seminífero na cauda do epidídimo. A motilidade dos espermatozóides diminuiu nos animais maduros quando o testículo torcido foi mantido. A concentraçäo de espermatozóides foi sempre superior nos animais com idade de 105 dias, embora näo tenha sido significativa quando o testículo torcido foi retirado. O peso do testículo näo mostrou diferença em relaçäo ao procedimento ou às diferentes idades. A avaliaçäo desses animais em idades jovens, de aproximadamente 70 dias, näo é recomendável pois näo representa a sua maturidade sexual completa. A obtençäo de esperma do túbulo seminífero através da microaspiraçäo permitiu avaliar o potencial reprodutivo do rato, de acordo com os parâmetros seminais estudados