Automatic chronic degenerative diseases identification using enteric nervous system images.

Studies recently accomplished on the Enteric Nervous System have shown that chronic degenerative diseases affect the Enteric Glial Cells (EGC) and, thus, the development of recognition methods able to identify whether or not the EGC are affected by these type of diseases may be helpful in its diagnoses. In this work, we propose the use of pattern recognition and machine learning techniques to evaluate if a given animal EGC image was obtained from a healthy individual or one affect by a chronic degenerative disease. In the proposed approach, we have performed the classification task with handcrafted features and deep learning-based techniques, also known as non-handcrafted features. The handcrafted features were obtained from the textural content of the ECG images using texture descriptors, such as the Local Binary Pattern (LBP). Moreover, the representation learning techniques employed in the approach are based on different Convolutional Neural Network (CNN) architectures, such as AlexNet and VGG16, with and without transfer learning. The complementarity between the handcrafted and non-handcrafted features was also evaluated with late fusion techniques. The datasets of EGC images used in the experiments, which are also contributions of this paper, are composed of three different chronic degenerative diseases: Cancer, Diabetes Mellitus, and Rheumatoid Arthritis. The experimental results, supported by statistical analysis, show that the proposed approach can distinguish healthy cells from the sick ones with a recognition rate of 89.30% (Rheumatoid Arthritis), 98.45% (Cancer), and 95.13% (Diabetes Mellitus), being achieved by combining classifiers obtained on both feature scenarios.

Correction of adult-type VSD causing aortic valve endocarditis through aortotomy.

Ventricular septal defects are the most common congenital abnormality diagnosed in children but account for only 10 percent of congenital heart defects in adults. Although many defects close spontaneously before adulthood, many others persist, predisposing to endocarditis, and other complications. Herein, we report a case of a known, asymptomatic, perimembranous ventricular septal defects that has complicated at 53 years of age with the need for surgery due to native aortic valve endocarditis and concomitant severe aortic regurgitation. We opted to surgically repair the ventricular septal defects with a pericardial patch through the necessary aortotomy used for aortic valve replacement (Figure 1 and 2). The surgery was straightforward. Postoperative course was only marked by the need of a permanent pacemaker implantation due to a sick sinus syndrome, which was diagnosed before the surgery. Thus, we emphasize the role of surgery in repairing ventricular septal defects and the importance of choosing the appropriate approach, especially when concomitant heart lesions are present.

As comunicações interventriculares são a lesão congénita mais comummente diagnosticada em idade pediátrica mas representam apenas 10% dos defeitos cardíacos congénitos em idade adulta. Apesar da maioria das comunicações interventriculares encerrarem espontaneamente antes da idade adulta, muitas persistem predispondo a endocardite e outras complicações. Apresentamos um caso de comunicação interventricular perimembranosa assintomática até à idade adulta, que complicou aos 53 anos com endocardite da válvula aórtica nativa associada a regurgitação aórtica severa, necessitando, por isso, de correção cirúrgica. Optamos pela correção cirúrgica implantando um retalho de pericárdio heterólogo através da aortotomia necessária para a substituição valvular aórtica (Figure 1 and 2). A cirurgia decorreu sem intercorrências. De referir apenas, no pós-operatório, a necessidade de implantação de um pacemaker permanente dado existência prévia de doença do nó sinusal. É de salientar a importância do papel da cirurgia na correção de comunicações interventriculares e a necessidade de escolher a abordagem cirúrgica mais apropriada, especialmente, quando existem lesões cardíacas concomitantes.

Isolated tricuspid valve Staphylococcus lugdunensis endocarditis in patient with a KBG syndrome.

Both KBG syndrome (approximately 50 patients worldwide) and isolated tricuspid valve Staphylococcus lugdunensis endocarditis are very rare entities. The KBG syndrome is a multiple congenital anomaly characterized by short stature, distinctive craniofacial features, and neurologic/developmental/cognitive delay and is only associated to congenital heart defects in 9% of patients. Staphylococcus lugdunesis is an aggressive cause of infective endocarditis. Herein is described a case of a patient presenting both diseases, despite the absence of any known infection, congenital heart defect, heart device or any other entry port which could explain this scenario. The unusual findings in this young patient raised questions regarding the, as-yet unexplained, etiopathogenesis of the KBG syndrome, the possibility of it being related to this rare and concerning clinical presentation and the unclear and undefined management and surgical approach associated to right side endocarditis.

O síndrome KBG (aproximadamente 50 casos a nível mundial) e a endocardite tricúspide isolada causada por Staphylococcus lugdunensis são entidades raríssimas. O síndrome KBG é uma anomalia congénita caracterizada por baixa estatura, características craniofaciais típicas e atrasos neurológicos, cognitivos e de desenvolvimento. Apenas 9% estão associados a patologia cardíaca congénita. O Staphylococcus lugdunesis é um agente associado a quadros de endocardite infeciosa com péssimo prognóstico. O presente caso clínico refere-se a um jovem adulto com ambas as patologias, apesar de não apresentar nenhuma lesão, anomalia ou dispositivo cardíaco, infeção ou outra porta de entrada que justificasse este desenvolvimento clínico. Estes achados incomuns levantaram questões quanto à, ainda mal esclarecida, etiopatogenia do síndrome KBG, a possibilidade deste estar associado ao quadro de endocardite e qual a melhor abordagem médica e/ou cirúrgica aquando de uma infecção limitada às câmaras direitas.

O conhecimento de deficientes visuais em relação à saúde bucal / The knowledge of the visually impaired about oral health

Introdução: A visão é uma das principais maneiras de interagir com o mundo. Em função desse déficit, os deficientes visuais desenvolvem mecanismo compensatório noutros sentidos como olfato, tato, audição e propriocepção. Objetivo: Investigar o nível de conhecimento em saúde bucal de 33 deficientes visuais matriculados no Instituto de Educação e Reabilitação de Cegos do Rio Grande do Norte (IERC-RN), conhecendo experiências que essas pessoas vivenciaram durante atendimento odontológico. Metodologia: Trata-se de estudo transversal, quanti-qualitativo usando entrevista. O material textual obtido pelas perguntas abertas gerou um corpus processado pelo Software IRAMUTEQ. Nesse contexto, o IRAMUTEQ categorizou o corpus através da classificação hierárquica descendente em seis classes distintas. Nas classes emergiram temas como acessibilidade, nervosismo e ansiedade no atendimento odontológico. A análise de similitude e a nuvem de palavras, também geradas pelo software possibilitaram perceber as principais expressões utilizadas, suas dificuldades, além de conexões com a saúde bucal e o ambiente odontológico. Resultados: As respostas das perguntas fechadas revelaram que a maioria dos entrevistados acredita que os dentes não duram para sempre, 90,09% escovam os dentes duas ou mais vezes por dia, utilizando principalmente escova e pasta, deixando o fio dental em segundo plano. Equívocos no conhecimento poderão ser superados pelo acesso a informação, criação de materiais educativos direcionados a essa clientela para enfrentamento das suas ansiedades e estímulo ao autocuidado. Conclusão: Paralelamente, a equipe de saúde bucal deve se preparar/capacitar para o atendimento desse segmento, pois pacientes com necessidades especiais exige habilidades diferenciadas, muita sensibilidade e conhecimento profissional adequado (AU).

Introduction: Eyesight is one of the main ways of interacting with the world. Due to this deficiency, visually impaired people develop compensatory mechanisms in other forms such as olfaction, tact, hearing and proprioception. Aim: This work investigated the level of knowledge in dental care from 33 visually impaired enrolled at Instituto de Educação e Reabilitação de Cegos do Rio Grande do Norte (IERC-RN) and understood experiences these people had during dental treatment. Methods: It is a transversal, quantitative-qualitative study that used interviews. The data collected from the open questions provided a corpus processed by IRAMUTEQ software. Thus, this software categorized the data through hierarchical classification descending on six separate classes. In the classes, questions such as accessibility, nervousness, and anxiety emerged. The analysis of similitude and the cloud of words, both generated by the software, made possible to perceive the main expressions used, difficulties, as well as the connections with dental care and the dental treatment office. Results: The answer to the closed questions revealed that most of the interviewees believe teeth do not last forever; 90% brush their teeth twice or more times a day using specifically a toothbrush and toothpaste; they use dental floss as a secondary procedure. Misconceptions might be surpassed by having them accessing information, creation of educational material directed to this clientele to face their anxieties and stimulating their self-dental care. Conclusion: Simultaneously, the dental care team must be prepared for the assistance to this clientele for patients with special needs demand different skills, much sensitiveness and adequate professional knowledge (AU).

Trifecta Bioprothesis for Aortic Valve Replacement: Our Experience.

INTRODUCTION: Bioprosthesis are increasingly used for aortic valve replacement (AVR), as a result of increasing elderly patients, as well as, continuous improvements in durability and hemodynamic performance of pericardial prosthesis. The Trifecta aortic prosthesis is a latest-generation trileaflet stented pericardial valve designed for supra-annular placement in the aortic position. This study establishes the safety and early clinical and hemodynamic performance of the Trifecta valve. METHODS: We retrospectively analyzed the data of 373 consecutive patients that underwent surgical implantation of the pericardial stented aortic prosthesis (Trifecta valve; St Jude Medical, St Paul, Minn) at our institution from March 2014 (first implant) to March 2017 (3 years). Pre-operative, operative and post-operative parameters and clinical outcomes, as well as, echocardiography data were evaluated. RESULTS: The mean age was 73,96 years ± 51, 176 (47,18%) patients were male, mean body mass index of 28,14 ± 12 and 75 (20,11%) were 380-years old. Concomitant procedures were performed in 123 (32,98%) patients. Isolated AVR was undertaken through conventional sternotomy (62,5%), partial sternotomy (35%) or anterior right minithoracotomy (2,5%). Prosthesis sizes implanted were: 19 mm (n=37), 21 mm (n=138), 23 mm (n=196) and 25 mm (n=2). The overall follow-up included 669 late patient-years. Early (≤ 30 day) mortality occurred in 20 patients (5.36%), and there were 4 (1.07%) late (≥ 31 days) deaths yielding a linearized mortality rate of 2.98% per late patient-year. For isolated AVR, mortality occurred in 12 (3.22%) patients. The incidence of new onset atrial fibrillation/flutter was of 28.95% (n=108). Five patients had necessity for implantation of postoperative permanent pacemaker (1,34%), and four mediastinitis/ sternal dehiscence (1.07%) and thirty nine cases of major bleeding required surgery (10.46%). There were 2 early thromboembolic events, including 1 (0,27%) stroke and 1 (0,27%) systemic embolic event. There were no instances of early valve thrombosis, endocarditis, or clinically significant haemolysis. There were no late thromboembolic events or valve structural deterioration. In total, there was 1 late valve explant due to an endocarditis. Overall, freedom from valve explant was 99,77% per late patient- -year. At postoperative echocardiography, average mean gradients across all valve sizes was 10.63mmHg. Mean follow-up was 4± 2 months. No severe aortic regurgitation was observed. CONCLUSION: The present systematic review demonstrated that AVR with this prosthesis provided excellent early safety and hemodynamic outcomes with acceptable mean gradients; nevertheless, their timing, pathological characteristics, and clinical presentation mandate continued follow-up.

Percepção das pessoas surdas sobre a comunicação no atendimento odontológico / Perception of deaf people about communication in dental care

Introdução: Para que os pacientes surdos se sintam confortáveis no consultório odontológico é preciso conhecer o ambiente e interagir com a equipe de saúde bucal. Dessa maneira, é importante que os profissionais estejam atentos e abertos para compreender as necessidades dessa clientela. Objetivo: Avaliar a percepção das pessoas com deficiência auditiva sobre o processo de comunicação no atendimento por cirurgiões-dentistas. Trata-se de um estudo quantitativo e qualitativo no qual participaram do estudo 30 surdos, sendo 17 homens e 13 mulheres com média de idade de 33 anos. Os dados foram obtidos por meio de questionários semi-estruturados com perguntas abertas e fechadas. As variáveis quantitativas foram pareadas e analisadas através da estatística descritiva, enquanto o material textual sobre o significado do assunto comunicação no atendimento odontológico foi processado com auxílio do software IRAMUTEQ 0.7 alpha 2. Resultados: Os resultados obtidos demonstraram que os surdos compartilham entre si significados centralizados nas necessidades dessa população, suas dificuldades e expectativas ao dirigir-se a um consultório odontológico. Isso é ainda mais evidenciado, pois 70% deles considera que os cirurgiões-dentistas não estão preparados para atender usuários com deficiência auditiva. Conclusão: Fica explicita a importância do incentivo a adesão ao componente curricular da Língua Brasileira de Sinais (Libras) na graduação e a formação continuada dos cirurgiões-dentistas, tendo como base a atenção integral à saúde do surdo, a fim de aumentar o nível de satisfação desses sujeitos nos serviços de saúde e na comunicação com a equipe odontológica (AU).

Introduction: To deaf patients feel comfortable in the dental office is necessary to know the environment and interact with the oral health team. In this way it is important for professionals to be attentive and open to understand the needs of this clientele. Aim: The aim of this study was to evaluate the perception of people with hearing loss on the communication process in dentistry service. Methods: It is a quantitative and qualitative study which was which was attended by 30 deaf, 17 men and 13 women with an average age of 33 years. Data were collected through semi-structured questionnaires with open and closed questions. Quantitative variables were matched and analyzed using the R software version 3.2.3, while the textual material about the meaning of the issue communication in dental care was processed with the aid of IRAMUTEQ software version 0.7 alpha 2. Results: The results showed that deaf people share with each other meanings centered on the needs of this population, their difficulties and expectations to go to a dental clinic. This is even more evident because 70% of them consider that dentists are not prepared to meet users with hearing impairment. Conclusion: Therefore, it is evident the importance of encouraging adherence to curricular component of Brazilian Sign Language (Libras) in undergraduate and continuing education of dentists, based on integral care for deaf to increase the level of satisfaction of them in health service and the communication with the dental team (AU).

A rare cause of hoarseness in a young patient.

Syphilis is nowadays a rare cause of aortic aneurysms in developed countries. Commonly saccular, syphilitic aneurysms are frequently single, involving the ascending aorta and arch and are frequently asymptomatic unless large enough to cause symptoms due to compression of surrounding structures or death from rupture. In this paper, the authors present the case of a 32-years old patient presenting with progressive weakness, anorexia, weight loss and hoarseness, who was diagnosed with a multiple saccular aortic aneurysms, which were syphilitic in nature. The patient underwent surgery for a hemiarch replacement after receiving a cycle of antibiotics and had an uneventful recovery. This case illustrates that, although rare, syphilis must be recognized as a potential source of aneurismal disease as it warrants antibiotic therapy and screening of involvement of other organs.

A sífilis é atualmente uma causa rara de aneurisma da aorta em países desenvolvidos. Normalmente saculares, os aneurismas sifilíticos são frequentemente simples, envolvendo a aorta ascendente e arco. São frequentemente assintomáticos a menos que grandes o suficiente para causar sintomas devido à compressão das estruturas vizinhas, ou morte por ruptura. Neste artigo, os autores apresentam o caso de um paciente de 32 anos de idade com queixas de fraqueza progressiva, anorexia, perda de peso e rouquidão, a quem lhe foi diagnosticado múltiplos aneurismas saculares da aorta, de natureza sifilítica. O paciente foi submetido a uma cirurgia de substituição do hemiarco aórtico depois de receber um ciclo de antibióticos e teve uma recuperação sem intercorrências. Este caso ilustra que, embora rara, a sífilis deve ser reconhecida como uma fonte potencial de doença aneurismática, tanto aórtica como também de outros órgãos.

Tratamento odontológico na gravidez: o que mudou na concepção das gestantes? / Dental Treatment in Pregnancy: What Changed in opinion of Pregnant Women?

Objetivo: Investigar se houve modificação na percepção das gestantes sobre a atenção odontológica no pré-natal, comparando os resultados das pesquisas realizadas nos últimos anos do século XX e primeiras décadas do início do século XXI com os resultados encontrados na presente pesquisa. Métodos: Estudo de natureza qualitativa com uma amostra de 30 gestantes na Maternidade Escola Januário Cicco da Universidade Federal do Rio Grande do Norte, usando uma entrevista estruturada, cujas respostas foram processadas pelo software IRAMUTEQ, para se abstrair as percepções que estão embutidas no imaginário das participantes. Resultados: 80% das entrevistadas responderam que vão ao dentista durante o pré-natal. Dessas 76,6% acham muito importante ir ao dentista nesse período para criar uma atmosfera saudável em torno do bebê. Percebeu-se que apesar das crenças que persistiram, algumas gestantes gostariam de ter atendimento odontológico atrelado ao Pré-natal, porém, as condições financeiras e acesso limitado aos serviços, dificultam a realização desse desejo. Conclusões: Houve uma mudança nos hábitos das gestantes e uma maior procura ao dentista no pré- natal, apesar do acesso limitado. Mesmo assim ainda é necessário desenvolver um trabalho educativo com essa clientela, esclarecendo dúvidas e melhorando o acesso ao serviço público odontológico neste período (AU).

Objective: Investigate whether there was change in the perception of pregnant women about dental attention at the prenatal care, comparing the Results of research made the Last year the XX century and first decades of the XXI century with the results found in the present research. Methods: was made an Cross- sectional study of the qualitative nature with a sample of 30 pregnant women in the Maternity School Januário Cicco the UFRN. In Which, applied a structured interview, Whose answers Were processed through IRAMUTEQ software, to abstract the perceptions that are embedded of imaginary participants. Results: 80% of interviewed answered that go to the dentist during the prenatal period. Being that 76.6% think it very important go to the dentist this period, to create a healthy atmosphere around the baby does. Through the reports it was realized despite the beliefs that still persist, many pregnant women would like to go to the dental care during the Prenatal. However, as financial conditions and to access conditions, difficult the realization of this desire. Conclusions: There was a change the habits of pregnant women in relation the looking the Dentist during the prenatal care, despite the limited access. Even so, is still necessary develop a educational work with this public, answering questions and improving access to dental Public service this period (AU).

Paraplegia due to spinal cord infarction following cardiac surgery.

Paraplegia is an extremely rare complication following any surgery, especially cardiac surgery. The underlying mechanisms remain poorly understood and even though spinal infarction has been reported previously, it is almost always associated with the use of intra-aortic balloon pump. We report the clinical case of a 75 year-old male, who developed paraplegia secondary to spinal infarction, following cardiac surgery (coronary artery bypass grafting and aortic valve replacement) in whom the intra-aortic balloon pump was not used and few other predisposing factors were present that could anticipate that complication.

[Giant tumoral lesion in the left atrium: an uncommon case of undifferentiated cardiac sarcoma]. / Lesão tumoral gigante na aurícula esquerda: um caso incomum de sarcoma cardíaco indiferenciado.

Primary cardiac tumors are rare, with an incidence ranging from 0.0001% to 0.030%; 80% are benign, while sarcomas account for 95% of malignant tumors. The authors report the case of a 75-year-old patient with a giant mass in the left atrium. The final diagnosis was of an undifferentiated cardiac sarcoma. This tumor represents a real challenge not only for timely diagnosis, but especially the therapeutic approach to adopt.

[Primary myxoma of the pulmonary artery. Clinical report]. / Mixoma do tronco daartéria pulmonar. Caso clínico.

The cardiac myxoma is a benign clinical entity, characterised by the growth of a gelatinous mass composed by primary connective tissue and stroma, representing the most common cardiac tumour. Usually found within one of the cardiac chambers, it affects the left atrium in 75% of the cases. Rare cases in literature describe extra-cardiac locations of myxomas. In this paper, the authors report the clinical case of a patient with a primary myxoma of the pulmonary artery.