Improving Seismic Inversion Robustness via Deformed Jackson Gaussian.

The seismic data inversion from observations contaminated by spurious measures (outliers) remains a significant challenge for the industrial and scientific communities. This difficulty is due to slow processing work to mitigate the influence of the outliers. In this work, we introduce a robust formulation to mitigate the influence of spurious measurements in the seismic inversion process. In this regard, we put forth an outlier-resistant seismic inversion methodology for model estimation based on the deformed Jackson Gaussian distribution. To demonstrate the effectiveness of our proposal, we investigated a classic geophysical data-inverse problem in three different scenarios: (i) in the first one, we analyzed the sensitivity of the seismic inversion to incorrect seismic sources; (ii) in the second one, we considered a dataset polluted by Gaussian errors with different noise intensities; and (iii) in the last one we considered a dataset contaminated by many outliers. The results reveal that the deformed Jackson Gaussian outperforms the classical approach, which is based on the standard Gaussian distribution.

[Aneurysmal disease - a multifocal pathology with regard to a clinical case.] / Doença aneurismática ­ uma patologia multifocal a propósito de um caso clínico.

INTRODUCTION: True para-anastomotic aneurysms are a rare complication of arterial surgery. OBJECTIVE: This paper aims to describe the clinical case of a 73 years-old patient, with history of a left above-the- -knee amputation due to an occluded popliteal aneurysm, admitted for surgical treatment of a contralateral popliteal aneurysm. RESULTS: A bypass between the right distal superficial femoral artery (SFA) and the distal popliteal artery was performed using autologous vein. Two years after the index surgery, aneurysmatic degeneration of the native artery was found on ultrasound, with 1.7 cm at the proximal anastomosis, and 1.4 cm distally. We kept surveillance, however, 12 years after surgery, he had a proximal true para-anastomotic aneurysm of the SFA with 4.8 cm. So, resection with interposition of a prosthetic graft between the native artery and the venous conduit of the previous bypass was performed. At this time the popliteal artery at the distal anastomosis had, approximately, 1.8 cm, so we chose to remain vigilant. Seventeen years after surgery, it measured 3.2 cm, in computed tomographic angiography. Therefore, total aneurysmectomy was performed and, due to redundancy of the previous bypass venous conduit caused by progressive dilation restricted to the distal popliteal artery, we did a termino-terminal reanastomosis to the normal sized popliteal artery. After 20 months, he is asymptomatic, with distal pulses present, without clinical nor radiological signs of aneurysmal degeneration. DISCUSSION AND CONCLUSION: This work aims to highlight the relevance of the follow up, not only on a clinical basis but also radiological, since we are dealing with a diffuse pathology that can appear in any arterial segment without symptoms.

Introdução: Aneurismas para-anastomóticos verdadeiros constituem uma complicação rara da cirurgia arterial. Objetivo: Este trabalho pretende descrever o caso de um doente de 73 anos, com antecedentes de amputação pela coxa do membro inferior esquerdo por aneurisma poplíteo trombosado, admitido para tratamento cirúrgico de aneurisma poplíteo contralateral. Resultados: O doente foi submetido a exclusão do mesmo com construção de bypass femoro-poplíteo curto infragenicular com veia grande safena. Dois anos após a cirurgia índice, em controlo ecográfico, foi identificada ectasia de ambas as anastomoses com 1,7cm e 1,4cm de diâmetro máximo nas anastomoses proximal e distal, respetivamente. Manteve-se vigilância e aos 12 anos de seguimento apresentava aneurisma para-anastomótico verdadeiro na anastomose proximal com 4,8cm de diâmetro máximo. Foi submetido, então, a ressecção de aneurisma com interposição de enxerto protésico entre artéria nativa e o conduto venoso prévio. A artéria poplítea distal nesta altura apresentava, aproximadamente, 1,8cm de diâmetro, tendo-se optado por manter vigilância. Aos 17 anos de seguimento, a artéria poplítea justa anastomose distal atingiu 3,2cm em angiotomografia computorizada. Foi, portanto, submetido a abordagem poplítea distal e, devido a redundância do conduto venoso prévio provocada por uma dilatação progressiva da artéria poplítea distal, foi possível proceder a aneurismectomia total e reanastomose termino-terminal de conduto venoso à artéria poplítea distal de calibre normal. Aos cerca de 20 meses de seguimento, apresenta-se assintomático, com pulsos distais presentes, sem sinais clínicos ou radiológicos de degenerescência aneurismática. Discussão e Conclusão: Este trabalho pretende realçar a relevância do seguimento destes doentes, não só em termos clínicos, mas também radiológicos, pois estamos perante uma patologia de carácter difuso que pode surgir em qualquer segmento arterial de forma assintomática.

True Brachial Artery Aneurysm in a Patient with Vascular Access for Haemodialysis and Kidney Graft.

INTRODUCTION: True brachial artery aneurysms are rare and some of them have been described as a late complication in patients with vascular access for haemodialysis and kidney graft. The purpose of this paper is to present a clinical case of a patient with a true brachial artery aneurysm and its following treatment. METHODS: This case concerns a caucasian male patient with 43 years old who had vesicoureteral reflux at 7 years old, and subsequent end-stage renal disease, and started on haemodialysis at the age of twelve. The patient had homolateral radial and brachiocephalic arteriovenous fistulas (AVF), two sequential kidney grafts and was under immunosuppressant therapy for several years. As part of the medical history he also had bilateral amaurosis, Hepatitis B and C and was submitted to total parathyroidectomy and a following auto-transplant. In the latest years the patient presented with several aneurysms related to the vascular access. After the finding of an anastomotic false aneurysm and venous aneurysms complicating the AVF, the patient had removal of the aneurysms and ligation of the AVF. Later, he was diagnosed, in different times, with two true brachial artery aneurysms. At the time of the diagnosis of the first true aneurysm, the patient presented with local pain and occasional paraesthesias relative to compression symptoms. At physical examination the patient had a brachial pulsatile mass and a palpable radial pulse. The Doppler ultrasound exam revealed a true brachial artery aneurysm with 4,5 cm diameter. After two years, the patient was once again diagnosed with a true brachial artery aneurysm with 3,1 cm diameter. At this time the patient was asymptomatic and had palpable brachial mass and radial pulse. RESULTS: At the time of the diagnosis of the first true brachial aneurysm the patient was submitted to partial aneurysmectomy and brachiobrachial graft with PTFE 8. The patency of the graft persisted until the diagnosis of the second aneurysm. After two years, the patient was submitted to partial aneurysmectomy and axilobrachial graft with PTFE 8. During the follow-up period, the patient remained asymptomatic, had palpable radial pulse and the Doppler ultrasound exam confirmed the patency of the graft. CONCLUSION: The surveillance of patients with long duration AVF and kidney grafts might be advantageous in the early detection of arterial aneurysms. The surgical treatment in this group of patients is a first treatment option that is associated to a low morbidity.

Abdominal Aortic Aneurysm in Women: Retrospective Analysis of the Cases that Undergo Surgical Repair.

INTRODUCTION: The prevalence of infra-renal aortic abdominal aneurysms (AAA) is about 3 to 4 times higher in men, with a recommendation I 1a for screening men > 65y. Althoug women only represente 20% of the total AAAs they have a significant higher rupture rate - threefold higher - and a worse outcome after ruptured AAA repair. Screening is not consensual but can be recommended for women > 65y who have smoked or have a family history of AAA. Against screening is the fact that the AAA in women have not only a lower incidence but also a late presentation (>80y) but references have been made to the fact that smoking became popular more than 30 years after than men and so the effects just now can start to be seen. METHODS: A retrospective review was made to all women with an infra- renal AAA who undergo a surgical treatment, elective or urgent, in the past 7 years (January 2010 - August 2017) in our hospital. Information was obtained through the clinical process. It was made an evaluation of the demographic information and anatomic features. RESULTS: 15 cases were reviewed, 4 elective and 11 ruptured surgical repairs. The mean age was 74 and only 4 women were more than 80 years old, with a minium age of 57. More than half the patients were previously diagnosis with hypertension but only 30% had high cholesterol. Only one was a known smoker. None had a diagnosis of cardiac disease. One had a sintomatic cerebrovascular disease. Within the elective cases, all open repair, the intra-hospitalar mortality was zero with a mean stay of 7,5 days. The ruptured cases, 1 endovascular, had a perioperative mortality of 50% The mean aortic diametre at rupture was less than 6 cm. CONCLUSION: Data supports the evidence of the morbidity of a ruptured AAA and the high intra-hospitalar mortality in women. Early detection and elective repair should be considered. Sex-specific research is needed to provide the best medical treatment.

[Cystic adventitial disease of the popliteal artery]. / Doença Quística Adventicial da Artéria Poplítea.

Although rare, popliteal artery cystic adventitial disease (CAD) is one of the most common non-atheromatous causes of intermittent claudication. This work aims to describe the clinical case of a 50 years old male patient with symptomatic popliteal artery CAD, presenting with calf intermittent claudication for long distances on flat but 50m in ascending plane, which affected his life quality. On examination he presented with normal coloration and temperature of the lower extremities, with distal pulses present at rest. By flexing the right knee, he lost distal pulses. On ultrasound was found a cystic formation surrounding the right popliteal artery, so a MRI was done and confirmed the presence of an adventitial cystic surrounding about 50% of the artery at the popliteal fossa with 31x13x17mm. He underwent surgery with a posterior approach followed by cyst removal, preservating the media of the artery, and ligation of a ductus that seemed to extent from the articular capsule. At the fourth post-operative day he was discharged and remained without symptoms nor recurrence during the follow up. The CAD usually affects the popliteal artery (85%). It's more common in men with 35-40 years and the prevalence is estimated at 1/1200 claudicants. The symptoms are caused, usually, by extrinsic compression of the artery. Ultrasound, today, is the first line exam, and might be complemented with others to confirm the diagnosis and plan the treatment. The surgical treatment may vary from drainage to segmental arterial resection in case of significant degeneration. The prognostic is usually favorable.

A doença quística adventicial da artéria poplítea (DQAAP), apesar de rara, é uma das causas não ateromatosas mais comuns de claudicação intermitente. Os autores apresentam um caso clínico e a discussão da estratégia terapêutica. Doente de 50 anos que apresentava queixas de claudicação gemelar direita intermitente para perímetros de marcha inferiores a 50m em plano ascendente, interferindo, desta forma, com a sua qualidade de vida. Ao exame físico apresentava normal coloração e temperatura das extremidades com pulsos femorais, poplíteos e distais presentes, contudo, aquando da flexão do joelho direito com perda de pulsos distais. O estudo ecográfico revelou quisto adventicial da artéria poplítea direita, posterior- mente confirmado com RMN que identificou estrutura quística a circundar cerca de 50% do perímetro da artéria poplítea direita no cavado poplíteo com 31*13*17mm. Foi, deste modo, submetido a tratamento cirúrgico com abordagem poplítea posterior, seguida de exérese do quisto adventicial com preservação da camada média. Procedeu-se, também, ao encerramento de comunicação com cápsula articular. Ao 4o dia pós-operatório teve alta, encontrando-se sem sinais de recorrência durante o seguimento (4A). A DQAAP atinge habitualmente a artéria poplítea (85%). É mais frequente em homens entre os 35-40A e sua prevalência estima-se em 1/1200 claudicantes. A clínica, normalmente, resulta de compressão extrínseca da artéria sendo o estudo ecográfico, o exame de primeira linha, podendo ser complementado por outros para confirmação do diagnóstico e planeamento cirúrgico. A terapêutica pode variar entre aspiração ou drenagem com eventual necessidade de ressecção arterial. O prognóstico é usualmente favorável.

Popliteal artery aneurysm surgical repair: Retrospective unicenter analysis.

BACKGROUND: Popliteal artery aneurysm (PAA) thromboembolic complications may result in limb loss. We review our experience reporting outcomes in terms of complications and early and long-term patency rates. METHODS: From 2004 to 2013, 116 PAA required surgical repair at Coimbra Hospital and Universitary Centre, Portugal. Outcomes were analyzed using Kaplan-Meier method with log-rank tests, X2, and Cox proportional hazards models. RESULTS: A total of 116 PAAs with a mean diameter of 3.3 cm (1.5 to 10 cm) were followed. 40% limbs were asymptomatic and 27% presented with acute ischemia. 97% underwent medial bypass procedure (venous in 66%). Early mortality was 0.9% (1/116). 30-day and five-year cumulative limb salvage was 94.0% and 87%, respectively. There was no limb loss in asymptomatic patients and 1-3 Rutherford chronic ischemia. 62% early amputations were performed in acute ischemia, half of them with functioning bypass. 30-day primary and secondary patency rates were 91% and 97% respectively, higher with GSVs (96% and 99%) than PTFE (58% and 95%, P < .05; Fig 1). The 5-year primary and secondary patency rates were 68.1% and 73,5%, respectively, higher with GSVs (83% and 87%) than PTFE (37% and 43%, P < .05). Two recurrent PAAs (1,7%) required reintervention. Predictors for both amputation and loss of primary patency were PTFE bypass (p =0,002), and emergent surgery (p = 0,005). Acute ischemia was also predictor for amputation (p = 0,026), but not for loss of primary patency. CONCLUSIONS: Results of surgery on asymptomatic PAAs are good - significantly better than those from symptomatic PAAs. The results are similarly good in claudicants. The risks of early and late amputation were higher with prosthetic grafts and in an emergent settings.

Intermediate statistics: Addressing the thermoelectric properties of solids.

We study the thermodynamics of a crystalline solid by applying intermediate statistics obtained by deforming known solid state models using the mathematics of q analogs. We apply the resulting q deformation to both the Einstein and Debye models and study the deformed thermal and electrical conductivities and the deformed Debye specific heat. We find that the q deformation acts in two different ways-but not necessarily as independent mechanisms. First, it acts as an effective factor of disorder or impurity, modifying the characteristics of a crystalline structure, which are phenomena described by q bosons. Second, it also manifests intermediate statistics, namely, the B anyons (or B-type systems). For the latter case we have identified the Schottky effect, normally associated with high-T_{c} superconductors in the presence of rare-earth-ion impurities. We also find that it increases the specific heat of the solids beyond the Dulong-Petit limit at high temperature. Such an effect is usually related to anharmonicity of interatomic interactions. Alternatively, since in the q-boson's case the statistics are in principle maintained, the effect of the deformation acts more slowly due to a small change in the crystal lattice. On the other hand, B anyons that belong to modified statistics are more sensitive to the deformation. The results reported here may be verified experimentally, for instance, in experimental samples by inserting impurities, or changes in pressure or temperature if one assumes these tuning quantities are related with the q-deformation parameter.

Sheep Bone Ultrastructure Analyses Reveal Differences in Bone Maturation around Mg-Based and Ti Implants.

Magnesium alloys are some of the most convenient biodegradable materials for bone fracture treatment due to their tailorable degradation rate, biocompatibility, and mechanical properties resembling those of bone. Despite the fact that magnesium-based implants and ZX00 (Mg-0.45Zn-0.45Ca in wt.%), in particular, have been shown to have suitable degradation rates and good osseointegration, knowledge gaps remain in our understanding of the impact of their degradation properties on the bone's ultrastructure. Bone is a hierarchically structured material, where not only the microstructure but also the ultrastructure are important as properties like the local mechanical response are determined by it. This study presents the first comparative analysis of bone ultrastructure parameters with high spatial resolution around ZX00 and Ti implants after 6, 12, and 24 weeks of healing. The mineralization was investigated, revealing a significant decrease in the lattice spacing of the (002) Bragg's peak closer to the ZX00 implant in comparison to Ti, while no significant difference in the crystallite size was observed. The hydroxyapatite platelet thickness and osteon density demonstrated a decrease closer to the ZX00 implant interface. Correlative indentation and strain maps obtained by scanning X-ray diffraction measurements revealed a higher stiffness and faster mechanical adaptation of the bone surrounding Ti implants as compared to the ZX00 ones. Thus, the results suggest the incorporation of Mg2+ ions into the bone ultrastructure, as well as a lower degree of remodeling and stiffness of the bone in the presence of ZX00 implants than Ti.

Reactivity of nitrogen atoms from Zif-8 structure deposited over Ti3C2 MXene in the electrochemical nitrogen reduction reaction.

The electrochemical nitrogen reduction reaction (NRR) to produce NH3 is the most efficient, eco-friendly and cost-effective alternative to the Haber-Bosch process. It is crucial to investigate and develop electrocatalysts selective for NH3 synthesis. In recent studies, the Ti3C2 MXene has emerged as a highly promising electrocatalyst for the NRR process. In this work, we explore the effect of Zif-8 addition over MXene sheets in order to control the rate of hydrogen evolution reaction (HER). Despite the better result obtained for Zif-8@Ti3C2 (3.0 µg NH3 gcat-1 h-1 at -0.55 V/RHE), the ammonia produced when using Zif-8@Ti3C2 as cathode material is shown to be originated from nitrogen atoms contained in the Zif-8 structure instead of those of N2. The results shed light to the need to fully understand the N2 electroreduction process over N-containing electrocatalysts.

Vascular training does matter in the outcomes of saphenous high ligation and stripping.

OBJECTIVE: Varicose vein (VV) surgery is frequently performed by surgeons without formal vascular training. We aimed to compare the outcomes of the procedure based on the background of the surgeon. METHODS: All patients registered with VV surgery between 2004 and 2016 in Portuguese public hospitals were included in the study. Intrahospital outcomes were assessed from this administrative database. A random multicenter sample of 315 patients submitted to saphenous high ligation and stripping (175 patients from six vascular surgery departments and 140 patients from five general surgery divisions) were further queried over the phone, whereby additional nonregistered outcomes were evaluated: preoperative venous ultrasound, impact on quality of life by the 14-item Chronic Venous Insufficiency Quality of Life Questionnaire, visual analogue scale evaluation (score of 1 to 5) of the aesthetic results and general satisfaction, work absence days, and time to return to physical activities. RESULTS: In 13 years, there were 153,382 patients submitted to VV surgery. Of these, 49% were operated on by general surgeons and 40% by vascular surgeons; in 11%, it was not possible to identify the specialty performing the operation. Twenty-three deaths were registered (no differences between groups). In the general surgery group, 14% of patients were hospitalized for more than one night compared with 3% in the vascular group (P < .001). Reintervention rate during the period analyzed was significantly higher in the general surgery group (13.5% vs 8.2%; P < .001). Rate of outpatient surgery was higher in the vascular surgery group (60% vs 36%; P < .001). Phone query revealed similar overall satisfaction and improvement in quality of life in both groups (4.2 vs 4.0 [P = .275] and 35% vs 36% [P = .745], respectively). However, patients operated on by general surgeons reported worse surgical scars (2.8 vs 2.1; P = .007), higher number of residual VVs (2.4 vs 1.7; P = .006), and higher number of days absent from work (40 vs 27 days; P = .005) and took longer to resume physical activities (60 vs 41 days; P = .001). CONCLUSIONS: Despite that the majority of VV surgery in Portugal is executed by general surgeons, this study highlights important advantages when it is performed by surgeons with vascular training.

Analysis of the efficiency of an emergency network for the treatment of multiple burn victims. / Análise da eficiência de uma rede de urgência para tratamento de múltiplos queimados.

OBJECTIVE: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns. METHODS: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality. RESULTS: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature. CONCLUSION: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.

OBJETIVO: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. MÉTODOS: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. RESULTADOS: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. CONCLUSÃO: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.

Análise da eficiência de uma rede de urgência para tratamento de múltiplos queimados / Analysis of the efficiency of an emergency network for the treatment of multiple burn victims

RESUMO Objetivo: avaliar a eficácia da estratégia adotada e a qualidade do atendimento em trauma pediátrico na sobrevivência dos pacientes atendidos após desastre em uma cidade do interior de Minas Gerais, em comparação a resultados esperados por estudos sobre mortalidade infantil em grandes queimados. Métodos: análise retrospectiva observacional de dez pacientes que sofreram queimaduras e foram transferidos para um centro de referência de trauma. Utilizou-se o escore de R-Baux modificado para estimar a mortalidade esperada. Comparou-se a mortalidade esperada a partir do escore de R-Baux e a mortalidade real, a partir do teste de uma proporção. Comparou-se, também, tempo de admissão pós-trauma com mortalidade e grau de superfície corporal queimada com mortalidade. Resultados: o R-Baux médio foi de 75,2, o que significa uma mortalidade esperada para grandes queimados de 5%. No entanto, a mortalidade do grupo com grande área de superfície corporal queimada desse estudo foi de 60%, valor p=0,001. Observou-se neste caso uma mortalidade muito além da esperada pela literatura. Conclusão: apesar das inúmeras variáveis, aventa-se a hipótese de infraestrutura de atendimento em trauma pediátrico aquém da necessária no Estado. Este estudo sugere maior incentivo à políticas públicas para atendimento de trauma pediátrico, centro de referência preparado, acordos de transferência bem estabelecidos e otimização de planos de catástrofe para diminuição da morbimortalidade para os pacientes que sobrevivem à primeira hora após o trauma.

ABSTRACT Objective: to evaluate the effectiveness of the adopted strategy and the care quality for pediatric trauma in the survival of patients attended after a disaster in a city in the interior of Minas Gerais state, compared to the expected results of studies on infant mortality in major burns. Methods: retrospective observational analysis of ten patients who were burned and transferred to a trauma reference center. We used the modified R-Baux score to estimate the expected mortality. We compared the expected mortality predicted by R-Baux score and the actual mortality determined from one-ratio test. We also compared time of post-trauma admission with mortality and burned body surface area with mortality. Results: mean R-Baux score was 75.2, which means an expected mortality of 5% among major burn patients. However, in this study, mortality in the group of children with large burned body surface area was of 60%, p=0.001, a rate far beyond that expected in literature. Conclusion: despite the innumerable variables, we consider the hypothesis of the pediatric trauma care infrastructure being inferior than the one needed in the state. This study suggests a greater incentive for public policies concerning pediatric trauma care, prepared referral center, well-established transfer agreements, and optimization of catastrophe plans, in order to reduce morbimortality of patients who survive the first hour after trauma.

O grupo com autistas como instrumento psicoterapêutico / The group with autists as a therapeutic device / El grupo com autistas como instrumento psicoterapéutico

O presente artigo examina a utilização do grupo como instrumento psicoterapêutico em casos de autismo, tendo como objeto de discussão o relato de uma sessão de um grupo de autistas que acontece em uma instituição municipal na cidade de São José do Rio Preto.

This paper examines the utilization of the group as a psychotherapeutic device for cases of autism. It has as discussion object the description of a session of a group of autists, which happens in a public institution in São José do Rio Preto, Brazil.

Ese articulo investiga la utilización del grupo como un instrumento psicoterapéutico para casos de autismo, y tiene como objeto de discusión la descripción de una sesión de un grupo de autistas que acontece en una institución publica en la ciudad de Sao José do Rio Preto, Brasil.

Flutter atrial: implicações na abordagem da clínica de urgência / Atrial flutter: implications on the approach of clinical urgency

O flutter atrial é uma arritmia cardíaca do grupo das taquiarritmias supraventriculares (TSV), com prevalência estimada de 85:100.000 habitantes e surge, frequentemente, nos atendimentos de urgência clínica. Pode se manifestar por frequências atriais de 220 a 360 bpm, com episódios durando de segundos a horas. Sua apresentação clínica varia de forma oligossintomática até lipotímia, principalmente quando a frequência ventricular é alta, com risco de lesão miocárdica. Associa-se, em geral, a doenças cardíacas prévias ou a condições sistêmicas como a tireotoxicose. Ocorre de forma aroxística ou crônica, revestindo-se, algumas vezes, de grande dificuldade no diagnóstico diferencial com outras TSV. O controle do flutter atrial utiliza métodos de controle da frequência cardíaca e de cardioversões farmacológica e não farmacológica, cuja escolha baseia-se, principalmente, nas condições clínicas do paciente. Este artigo objetiva estabelecer os critérios atuais para a abordagem do flutter atrial e sua diferenciação com outras TSV.

Atrial flutter is a cardiac arrhythmia which is part of the Supraventricular Tachyarrhythmia (STs) group the estimated prevalence of 85 cases per 100,000 people, and appears frequently in the urgent care clinic. The arrhythmia can manifest atrial frequencies from 220 to 360 bpm with episodes that may last from seconds to hours. Furthermore, its clinical presentation varies from oligossymptomatic forms to presyncopes, mainly with high ventricular response, when there is significant risk of myocardial damage. It is in general associated to previous cardiac or systemic conditions (e.g. thyrotoxicosis). It occurs either in paroxysmal or chronicle forms, sometimes with great difficulty for differential diagnosis with other STs. The atrial flutter control uses methods of heart rate control and pharmacological or non-pharmacological cardio version, whose choice is based primarily on the patient’s clinical conditions. This article aims to gathering information that would provide the current criteria for the approach of atrial flutter regarding its accurate diagnosis and its differentiation from other STs.

Abordagem do Flutter atrial na urgência: relato de caso / Approach of atrial flutter in the emergency: case report

O flutter atrial é uma arritmia que ocorre predominantemente em portadores de cardiopatia. Este artigo relata o caso de paciente portador de cardiopatia reumática com duas trocas de valvas (aórtica e mitral), a última delas ocorrida há 10 anos, com palpitações e congestão sistêmica. A suspeição inicial foi de taquicardia paroxística supraventricular (TPSV), tendo sido tentada a cardioversão com adenosina, sem sustentação. O eletrocardiograma (ECG) foi revisto, e o diagnóstico estabelecido foi de flutter atrial. A cardioversão elétrica foi realizada nove dias após sua admissão, tendo sido obtida a sustentação do ritmo sinusal.

Atrial flutter is an arrhythmia that occurs predominantly in patients with previous heart disease. This article reports the case of a patient with rheumatic heart disease and with two exchanged valves, the aortic and mitral, and the last exchange procedure took place ten years ago, with the placement of metallic prostheses. The first diagnosis was paroxysmal supraventricular tachycardia (PSVT) and it was attempted cardioversion with adenosine, without success. The electrocardiogram (ECG) was revised and atrial flutter was diagnosed. Electrical cardioversion was performed after 9 days in hospital, and the rhythm was sustained.