Ozone therapy improves early stages of osseointegration in ovariectomized rats

Abstract Objective the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats. Methodology ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg — OZ Group (n=15) — and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05). Results our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32). Conclusion it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: randomized, double-blind, and placebo-controlled clinical trial

Abstract Objective Autism spectrum disorder (ASD) is characterized by persistent deficits in social communication and social interaction and by restricted and repetitive patterns of behavior. Some studies have shown that substances derived from Cannabis sativa improve the quality of life of children with ASD without causing serious adverse effects, thus providing an alternative therapeutic option. The objective of this study was to evaluate the efficacy and safety of a cannabis extract rich in cannabidiol (CBD) in children with ASD. Methods In this randomized, double-blind, placebo-controlled clinical trial, 60 children, aged from 5 to 11 years, were selected and divided into two groups: the treatment group, which received the CBD-rich cannabis extract, and the control group, which received the placebo. They both used their respective products for a period of 12 weeks. Statistical analysis was done by two-factor mixed analysis of variance (two-way ANOVA). Results Significant results were found for social interaction (F1,116 = 14.13, p = 0.0002), anxiety (F1,116 = 5.99, p = 0.016), psychomotor agitation (F1,116 = 9.22, p = 0.003), number of meals a day (F1,116 = 4.11, p = 0.04), and concentration (F1,48 = 6.75, p = 0.01), the last of which was only significant in mild ASD cases. Regarding safety, it was found that only three children in the treatment group (9.7%) had adverse effects, namely dizziness, insomnia, colic, and weight gain. Conclusion CBD-rich cannabis extract was found to improve one of the diagnostic criteria for ASD (social interaction), as well as features that often co-exist with ASD, and to have few serious adverse effects.

Sistema de saúde e vigilância na França e a resposta à pandemia de COVID-19 / Health system, surveillance and the COVID-19 pandemic response in France

Resumo A França foi o primeiro país europeu a confirmar casos de COVID-19, sendo um dos mais afetados pela pandemia na primeira onda. Este estudo de caso analisou as medidas adotadas pelo país no enfrentamento à COVID-19 em 2020 e 2021, relacionando com as características de seu sistema de saúde e de vigilância. Como um Estado de bem-estar social, apostou em políticas compensatórias e de proteção da economia, bem como aumentou investimentos em saúde. Houve fragilidade na preparação e atraso na implantação do plano de enfrentamento. A resposta foi coordenada pelo poder Executivo nacional, adotando bloqueios rígidos nas duas primeiras ondas, flexibilizando as medidas restritivas nas demais ondas, após o aumento da cobertura vacinal e diante da resistência da população. Enfrentou problemas com testagem, vigilância dos casos e contatos e assistência aos doentes, principalmente na primeira onda. Necessitou modificar as regras do seguro de saúde para ampliar cobertura, acesso e melhorar a articulação das ações de vigilância. Indica aprendizados sobre os limites do seu sistema de seguro social, mas também as potencialidades de um Estado com capacidade de resposta forte no financiamento de políticas públicas e na regulação dos demais setores para enfrentar a crise.

Abstract France was the first European country to confirm cases of COVID-19, being one of the most affected by the pandemic in the first wave. This case study analyzed the measures adopted by the country in the fight against COVID-19 in 2020 and 2021, correlating it to the characteristics of its health and surveillance system. As a welfare state, it relied on compensatory policies and protection of the economy, as well as increased investments in health. There were weaknesses in the preparation and delay in the implementation of the coping plan. The response was coordinated by the national executive power, adopting strict lockdowns in the first two waves, mitigating restrictive measures in the other waves, after the increase in vaccination coverage and in the face of population resistance. The country faced problems with testing, case and contact surveillance and patient care, especially in the first wave. It was necessary to modify the health insurance rules to expand coverage, access and better articulation of surveillance actions. It indicates lessons learned about the limits of its social security system, but also the potential of a government with a strong response capacity in the financing of public policies and regulation of other sectors to face the crisis.

An Intraindividual Comparison of Open versus Paine Retinaculotome Release for Bilateral Carpal Tunnel Syndrome / Comparação intraindividual dos resultados da liberação aberta ou com retinaculótomo de Paine na síndrome do túnel do carpo bilateral

Abstract The main purpose of this research was to do an intraindividual comparison of outcomes between the open ulnar incision (OUI) and the Paine retinaculotome with palmar incision (PRWPI) techniques in patients with bilateral carpal tunnel syndrome (CTS). The patients underwent OUI surgery on one hand and PRWPI surgery on the contralateral hand. The patients were evaluated with the Boston carpal tunnel questionnaire, visual analogue scale for pain, palmar grip strength, and fingertip, key, and tripod pinch strengths. Both hands were examined in the preoperative and postoperative periods after 2 weeks, 1 month, and 3 and 6 months. Eighteen patients (36 hands) were evaluated. The symptoms severity scale (SSS) scores were higher, in the preoperative period, in the hands that underwent surgery with PRWPI (p-value =0,023), but lower in the 3rd month postoperative (p-value = 0.030). The functional status scale (FSS) scores were lower in the periods of 2 weeks, 3 months, and 6 months (p-value = 0,016) on the hands that underwent surgery with PRWPI. In a different two-group module study, the PRWPI group presents the SSS scores average on the 2nd week and 1st month, and the FSS scores average on the 2nd week, less 0.8 and 1.2 points respectively comported to open group. The hands that underwent surgery with PRWPI presented significantly lower SSS scores at 3 months postoperative, and lower FSS scores at 2 weeks, and 3 and 6 months postoperative, compared to open surgery group.

Resumo O principal objetivo desta pesquisa foi fazer uma comparação intraindividual dos resultados entre as técnicas de incisão ulnar aberta e retinaculótomo de Paine com incisão palmar em pacientes com síndrome do túnel do carpo (STC) bilateral. Os pacientes foram submetidos à cirurgia aberta em uma mão e cirurgia com retinaculótomo de Paine na mão contralateral. Os pacientes foram avaliados com o Boston carpal tunnel questionnaire, escala visual analógica para dor e força de preensão palmar, pinça lateral, pinça polpa-polpa e trípode. As duas mãos foram examinadas antes da cirurgia e 2 semanas, 1 mês, 3 e 6 meses após a cirurgia. Dezoito pacientes (36 mãos) foram avaliados. As pontuações da escala de gravidade dos sintomas (EGS) foram maiores no pré-operatório nas mãos submetidas à cirurgia com retinaculótomo de Paine (p = 0,023), mas menores no 3° mês após o procedimento (p = 0,030). As pontuações da escala de estado funcional (EEF) foram menores às 2 semanas, 3 meses e 6 meses (p = 0,016) nas mãos submetidas à cirurgia com retinaculótomo de Paine. Em um estudo de módulo de diferença de dois grupos, o grupo submetido à cirurgia com retinaculótomo de Paine apresentou pontuações médias de EGS na 2ª semana e 1° mês e de EEF na segunda semana inferiores a 0,8 e 1,2 pontos, respectivamente, em comparação ao grupo submetido ao procedimento aberto. As mãos submetidas à cirurgia com retinaculótomo de Paine apresentaram escores significativamente menores de EGS em 3 meses e de EEF em 2 semanas, e aos 3 e 6 meses após a cirurgia em comparação a técnica aberta.

Modelling anaerobic peak power assessed by the force-velocity test among late adolescents

SUMMARY OBJECTIVES: The aim of this study was to examine the concurrent contributions of body size, estimates of whole-body composition, and appendicular volume in addition to participation in competitive basketball to explain inter-individual variance in anaerobic peak power output during late adolescence. The study also tested non-participation versus participation in basketball as an independent predictor of peak power output. METHODS: The sample of this cross-sectional study was composed of 63 male participants (basketball: n=32, 17.0±0.9 years; school: n=31, 17.4±1.0 years). Anthropometry included stature, body mass, circumferences, lengths, and skinfolds. Fat-free mass was estimated from skinfolds and lower limbs volume predicted from circumferences and lengths. Participants completed the force-velocity test using a cycle ergometer to determine peak power output. RESULTS: For the total sample, optimal peak power was correlated to body size (body mass: r=0.634; fat-free mass: r=0.719, lower limbs volume: r=0.577). The best model was given by fat-free mass and explained 51% of the inter-individual variance in force-velocity test. The preceding was independent of participating in sports (i.e., the dummy variable basketball vs. school did not add significant explained variance). CONCLUSION: Adolescent basketball players were taller and heavier than school boys. The groups also differed in fat-free mass (school: 53.8±4.8 kg; basketball: 60.4±6.7 kg), which was the most prominent predictor of inter-individual variance in peak power output. Briefly, compared to school boys, participation in basketball was not associated with optimal differential braking force. Higher values in peak power output for basketball players were explained by a larger amount of fat-free mass.

Treatment of Wrist Dorsal Synovial Cyst with Percutaneous Sclerotherapy Using Hypertonic Saline Solution / Tratamento de cisto sinovial dorsal do punho com escleroterapia percutânea utilizando solução salina hipertônica

Abstract Objective To evaluate the efficacy of hypertonic saline infiltration as a sclerosing agent in the dorsal synovial cyst of the wrist. Method Patients of both genders, aged 18 years or older, with clinical and ultrasound diagnosis of synovial cyst, and without any previous treatment were selected. Case series in which 50 patients underwent aspiration of the contents of the cyst and infiltration of the hypertonic saline solution (2 ml sodium chloride solution 20% and 1 ml of lidocaine 2%). The patients were followed up for 24 weeks, when the parameters pain, strength, range of motion, function (quickDASH and Brief Michigan question), recurrence, and complications were evaluated. Results A total of 46 patients were evaluated for 24 weeks, 18 (39.1%) cysts evolved to resolution, and 28 (60.9%) presented recurrence. There was no statistically significant difference in the effect force or in the range of motion. There was no clinically significant difference in the scores of the questionnaires. The most frequent complications were pain and edema. Conclusion Infiltration with hypertonic saline solution for the treatment of dorsal synovial cyst of the wrist showed a recurrence rate of 60.9%.

Resumo Objetivo Avaliar a eficácia da infiltração da solução salina hipertônica como agente esclerosante no cisto sinovial dorsal do punho. Método Pacientes de ambos os sexos, com 18 anos ou mais, com diagnóstico clínico e ultrassonográfico de cisto sinovial, e sem nenhum tratamento prévio foram selectionados. Série de casos em que 50 pacientes foram submetidos a aspiração do conteúdo do cisto e infiltração da solução salina hipertônica (2 ml solução de cloreto de sódio 20% e 1 ml de lidocaína 2%). Seguimento realizado por 24 semanas, durante as quais foram avaliados os parâmetros dor, força, arco de movimento, função (questionários quick disabilities of the arm, hand, and shoulder [quickDASH] e brief Michigan), recorrência e complicações. ResultadoForam avaliados 46 pacientes por 24 semanas, 18 (39,1%) cistos evoluíram para cura e 28 (60,9%) cistos apresentaram recorrência. Não houve diferença estatisticamente significante nos quesitos força e arco de movimento. Não houve diferença clinicamente significante nos escores dos questionários. As complicações mais frequentes foram dor e edema. Conclusão A infiltração com solução salina hipertônica para tratamento do cisto sinovial dorsal do punho mostrou taxa de recorrência de 60,9%.

Prevalence of Absence of Palmaris Longus Tendon in a Population Sample from a Multiethnic Brazilian City / Prevalência de ausência de tendão palmaris longus em uma amostra populacional de uma cidade brasileira multiétnica

Abstract Objective The objective of the study was to determine the prevalence of absence of palmaris longus tendon in a population sample from a multiethnic Brazilian city. Methods A cross-sectional observational study was carried out between October 2017 and April 2018. We included male and female volunteers aged 18 years or older. The absence of palmaris longus tendon was determined by asking the volunteers to perform the Schaeffer test bilaterally. Results We prospectively collected data on 1,008 volunteers, 531 male and 477 female, with age between 18 and 74 years (mean 38.4 years). The absence of palmaris longus tendon was observed in 264 (26.2%) volunteers. Bilateral absence was detected in 123 volunteers (12.2%), 60 female (48.8%) and 63 male (51.2%). Unilateral absence was found in 141 patients (14.0%), 54 female (38.2%) and 87 male (61.8%) (p < 0.05). Conclusion The prevalence of absence of palmaris longus tendon in our study was 26.2%. There was no statistically significant difference between gender and bilaterally. The absence of palmaris longus tendon was predominant on unilateral right side in males.

Resumo Objetivo O objetivo do presente estudo foi determinar a prevalência de ausência de tendão palmaris longus em uma amostra populacional de uma cidade multiétnica brasileira. Métodos Um estudo observacional transversal foi realizado entre outubro de 2017 e abril de 2018. Incluímos voluntários dos sexos masculino e feminino com 18 anos ou mais. A ausência do tendão palmaris longus foi determinada pedindo aos voluntários que realizassem o teste de Schaeffer bilateralmente. Resultados Foram coletados prospectivamente dados de 1.008 voluntários, 531 homens e 477 mulheres, com idade entre 18 e 74 anos (média de 38,4 anos). A ausência do tendão palmaris longus foi observada em 264 (26,2%) voluntários. A ausência bilateral foi detectada em 123 voluntários (12,2%), 60 mulheres (48,8%) e 63 homens (51,2%). A ausência unilateral foi encontrada em 141 pacientes (14,0%), 54 mulheres (38,2%) e 87 homens (61,8%) (p<0,05). Conclusão A prevalência de ausência do tendão palmaris longus em nosso estudo foi de 26,2%. Não houve diferença estatisticamente significativa bilateralmente e entre gêneros. A ausência do tendão palmaris longus foi predominante no lado direito unilateral no sexo masculino.

Adolescent idiopathic scoliosis: progression of untreated cases / Escoliose idiopática do adolescente: progressão de casos não tratados / Escoliosis idiopática del adolescente: progresión de casos no tratados

ABSTRACT Objective: This study aims to evaluate angular progression of patients with a diagnosis of Adolescent Idiopathic Scoliosis (AIS), that await surgical treatment. Methods: This is an observational and descriptive study. Data were collected for age at initial surgical indication, initial date and Cobb angle, date and Cobb angle of the follow-up visit, time elapsed between the initial and follow-up visit, and type of curve. All recorded Cobb angles were reviewed by the authors. Results: 86.1% of the individuals were women, the mean age of indication for surgical treatment was 13.34 years. The most common type of curve was Lenke 3 and the one that progressed the most was Lenke 4. The general average of annual progression was 9.89 degrees for the primary curves and 12.32 for the secondary curves, and the follow-up was, on average, 35.77 months. Conclusion: The progression of the magnitude of the curve increases during the wait for the definitive treatment of AIS, no matter which group of the Lenke classification the curve belongs to. The secondary curves present a progression rate of 12.32º/year, higher than the main curve, which presents a rate of 9.89º/year. The waiting time has been increasing over the years, which is evident compared to older publications. Level of Evidence IV; Type of Study: Prognostic Study.

RESUMO: Objetivo: Este estudo tem como objetivo avaliar a progressão do valor angular de indivíduos com diagnóstico de Escoliose Idiopática do Adolescente (EIA) não tratada, aguardando procedimento cirúrgico. Métodos: Este é um estudo observacional e descritivo. Foram coletados os seguintes dados dos pacientes: idade da indicação cirúrgica inicial, data da avaliação inicial e ângulo de Cobb, data e ângulo de Cobb nas consultas de seguimento, tempo decorrido entre as consultas inicial e de seguimento, bem como os tipos de curva. Todos os ângulos de Cobb registrados foram revisados pelos autores. Resultados: 86,1% dos indivíduos eram mulheres, a idade média de indicação de tratamento cirúrgico foi de 13,34 anos. O tipo de curva mais comum foi a Lenke 3 e a que mais progrediu foi a Lenke 4. A média geral de progressão anual foi de 9,89 graus para as curvas primárias e 12,32 para as curvas secundárias e o acompanhamento foi em média de 35,77 meses. Conclusão: A progressão da magnitude da curva aumentou durante a espera pelo tratamento definitivo da EIA, não importando em qual grupo da classificação de Lenke a curva pertence. As curvas secundárias apresentaram taxa de progressão de 12,32º/ano que é maior se comparada com a curva principal que apresenta taxa de 9,89º/ano. O tempo de espera vem aumentando com o passar dos anos, sendo evidente quando comparado com as publicações mais antigas. Nível de Evidência IV; Tipo de Estudo: Estudo Prognostico.

RESUMEN: Objetivo: Este estudio tiene como objetivo evaluar la progresión del valor angular de individuos no tratados diagnosticados con Escoliosis Idiopática del Adolescente (EIA), que están en espera de un procedimiento quirúrgico. Métodos: Se trata de un estudio observacional y descriptivo. Se recogieron datos de edad de indicación quirúrgica inicial, fecha inicial y ángulo de Cobb, fecha y ángulo de Cobb de la visita de seguimiento, tiempo transcurrido entre la visita inicial y de seguimiento y tipo de curva. Todos los ángulos de Cobb registrados fueron revisados por los autores. Resultados: El 86,1% de los individuos eran mujeres, la edad media de indicación del tratamiento quirúrgico fue de 13,34 años. El tipo de curva más común fue Lenke 3 y el que más progresó fue Lenke 4. El promedio general de progresión anual fue de 9,89 grados para las curvas primarias y 12,32 para las curvas secundarias y el seguimiento fue en promedio de 35,77 meses. Conclusión: La progresión de la magnitud de la curva aumenta durante la espera del tratamiento definitivo de la EIA, independientemente del grupo de la clasificación de Lenke al que pertenezca la curva. Las curvas secundarias presentan una tasa de progresión de 12,32º/año, superior a la curva principal que presenta una tasa de 9,89º/año. El tiempo de espera ha ido aumentando a lo largo de los años, lo cual es evidente al compararlo con publicaciones más antiguas. Nivel de Evidencia IV; Tipo de Estudio: Estudio Pronostico.

Elaboration of an educational video for cardiopulmonary resuscitation with chest compressions in adults / Elaboración de un video educativo para reanimación cardiopulmonar con compresiones torácicas en adultos / Elaboração de vídeo educativo para reanimação cardiopulmonar com compressões torácicas em adultos

ABSTRACT Objectives: to develop and analyze the face and content validity of a storyboard for constructing an educational video for training laypersons in cardiopulmonary resuscitation with only chest compressions in adults. Methods: a methodological study of storyboard elaboration and validity for producing an educational health video. The storyboard was submitted to analysis of 20 judges to assess its adequacy with the proposed objective. To assess the agreement between judges, the Content Validity Index was calculated. After validating the storyboard, video production took place. Results: the Content Validity Index met expectations. Its mean in each group was ≥ 0.90 (lay judges = 0.97; expert judges = 0.90; all judges = 0.94). Conclusions: the video produced is composed of scientific information, professional expertise and laypersons' perceptions, making it important evidence for health education.

RESUMEN Objetivos: elaborar y analizar la validez de apariencia y contenido de un storyboard para la construcción de un video educativo para la formación de legos en reanimación cardiopulmonar con solo compresiones torácicas en adultos. Métodos: estudio metodológico de la elaboración y validación de un storyboard para la producción de un video educativo en salud. El storyboard fue sometido al análisis de 20 jueces, para evaluar su adecuación al objetivo propuesto. Para evaluar la concordancia entre los jueces se calculó el Índice de Validez de Contenido. Después de validar el guión gráfico, se produjo el video. Resultados: el Índice de Validez de Contenido obtenido cumplió con las expectativas. Su promedio en cada grupo fue ≥ 0,90 (jueces legos = 0,97; jueces expertos = 0,90; todos los jueces = 0,94). Conclusiones: el video producido está compuesto por información científica, experiencia profesional y percepciones de los legos, lo que lo convierte en evidencia importante para la educación en salud.

RESUMO Objetivos: elaborar e analisar a validade de face e de conteúdo de um storyboard para a construção de um vídeo educativo para treinamento de leigos em reanimação cardiopulmonar somente com compressões torácicas em adultos. Métodos: estudo metodológico de elaboração e validação de um storyboard para a produção de um vídeo educativo em saúde. O storyboard foi submetido à análise de 20 juízes, para avaliação de sua adequação com objetivo proposto. Para avaliar a concordância entre os juízes, calculou-se o Índice de Validade de Conteúdo. Após a validação do storyboard, ocorreu a produção do vídeo. Resultados: o Índice de Validade de Conteúdo obtido atendeu ao esperado. A média dele em cada grupo esteve ≥ 0,90 (juízes leigos = 0,97; juízes experts = 0,90; todos os juízes = 0,94). Conclusões: o vídeo produzido é composto por informações científicas, expertise profissional e percepções de leigos, tornando-se importante evidência para a educação em saúde.

Mental health training programs for non-health professionals and volunteers working with asylum-seekers and refugees: scoping review / Programas de treinamento em saúde mental para profissionais, que não de saúde, e voluntários que trabalham com solicitantes de asilo e refugiados: revisão de escopo / Programas de formación en salud mental para profesionales no sanitarios y voluntarios que trabajan con solicitantes de asilo y refugiados: revisión de alcance

ABSTRACT Objective: To identify and describe the mental health training programs for non-health professionals and volunteers who work, have worked, or would work with asylum seekers and/or refugees. Method: Scoping review following JBI methodology. Search carried out in MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, and websites of Clinical Trials, UNHCR, International Organization for Migration, WHO, Save the Children, International Migration, Integration and Social Cohesion in Europe, and International Federation of Red Cross and Red Crescent Societies. Studies written in English, Portuguese, French, Spanish and Swedish. Results: Of the 8954 articles identified, 16 were included reporting on 11 training programs: Mind-Spring, PM+, MHFA, Cognitive-Behavioral Training for Community and Religious Leaders, EmpaTeach, Suicide Prevention Education Program, Teaching Recovery Techniques, Handbook for Teachers of Vietnamese Refugee Students, PFA, Psychosocial support of volunteers and CBP&MHPSS. Conclusion: Training programs from scientific literature focus on mental health disorders, while non-governmental organizations' documents focus on resilience and self-care. The current mental health training programs might be insufficient.

RESUMEN Objetivo: Identificar y describir los programas de formación en salud mental para profesionales no sanitarios y voluntarios que trabajan, han trabajado o gustarían de trabajar con solicitantes de asilo y/o refugiados. Método: Revisión de alcance según la metodología JBI. Búsqueda realizada en MEDLINE, CINAHL, ERIC, SCOPUS, PsycINFO, Psychology & Behavioral Sciences Collection, RCAAP, ProQuest, y sitios web de ClinicalTrials, ACNUR, Organización Internacional para las Migraciones, OMS, Save the Children, Migración Internacional, Integración y Cohesión Social en Europa, y Federación Internacional de Sociedades de la Cruz Roja y de la Media Luna Roja. Estudios escritos en inglés, portugués, francés, español y sueco. Resultados: De los 8954 artículos identificados, se incluyeron 16 que informan sobre 11 programas de capacitación: Mind-Spring, PM+, MHFA, Capacitación cognitiva conductual para líderes comunitarios y religiosos, EmpaTeach, Programa de educación para la prevención del suicidio, Enseñanza de técnicas de recuperación, Manual para maestros de Estudiantes refugiados vietnamitas, PFA, apoyo psicosocial de voluntarios y CBP&MHPSS. Conclusión: Los programas de formación en la literatura científica se centran en los trastornos de salud mental, mientras que los documentos de las organizaciones no gubernamentales se centran en la resiliencia y el autocuidado. Los actuales programas de formación en salud mental pueden ser insuficientes.

Primary infection of BALB/c mice with a dengue virus type 4 strain leads to kidney injury

BACKGROUND Dengue is a disease caused by dengue virus (DENV-1 through -4). Among the four serotypes, DENV-4 remains the least studied. Acute kidney injury is a potential complication of dengue generally associated with severe dengue infection. OBJECTIVES The goal of this study was to investigate the alterations caused by experimental dengue infection in the kidney of adult BALB/c mice. METHODS In this study, BALB/c mice were infected through the intravenous route with a DENV-4 strain, isolated from a human patient. The kidneys of the mice were procured and subject to histopathological and ultrastructural analysis. FINDINGS The presence of the viral antigen was confirmed through immunohistochemistry. Analysis of tissue sections revealed the presence of inflammatory cell infiltrate throughout the parenchyma. Glomerular enlargement was a common find. Necrosis of tubular cells and haemorrhage were also observed. Analysis of the kidney on a transmission electron microscope allowed a closer look into the necrotic tubular cells, which presented nuclei with condensed chromatin, and loss of cytoplasm. MAIN CONCLUSIONS Even though the kidney is probably not a primary target of dengue infection in mice, the inoculation of the virus in the blood appears to damage the renal tissue through local inflammation.

Failure factors for carpal tunnel syndrome surgical treatment: When and how to perform a revision carpal tunnel decompression surgery / Fatores de insucesso do tratamento cirúrgico da síndrome do túnel do carpo: Quando e como revisar a cirurgia de descompressão do túnel do carpo

Abstract Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.

Resumo Apesar de ser um procedimento amplamente utilizado em todo o mundo e com elevadas taxas de remissão dos sintomas, o tratamento cirúrgico da síndrome do túnel do carpo pode apresentar resultados não satisfatórios ao paciente. Esse resultado não satisfatório pode se manifestar clinicamente pela não remissão dos sintomas, remissão dos sintomas mas recorrência desses após um período de tempo da cirurgia ou aparecimento de diferentes sintomas após a cirurgia. Diferentes fatores estão relacionados a esse insucesso do tratamento cirúrgico da síndrome do túnel do carpo (ITCSTC). A prevenção pode ser conseguida por meio de minuciosa avaliação clínica do paciente no período pré-operatório. Dessa forma o cirurgião poderá fazer diagnósticos diferenciais ou diagnósticos concomitantes, assim como identificar fatores ligados a insatisfação do paciente. Os fatores per-operatórios incluem a correta identificação das estruturas anatômicas para completa descompressão do nervo mediano. Inúmeros procedimentos têm sido descritos para o tratamento dos fatores que ocorrem no período pós-operatório. Desses o mais comum, a formação de aderências em torno do nervo mediano, tem sido tratado com relativo sucesso utilizando diferentes retalhos vascularizados ou cobertura com o uso de tecido autólogo ou homólogo. Descreveremos a abordagem do ITCSTC com maiores detalhes no texto.

Trabalhar de casa na pandemia: sentimentos e vivências de gestores e não-gestores públicos / Working from home in the pandemic: feelings and experiences of managers and non-public managers / Trabajar desde casa en la pandemia: sentimientos y vivencias de gestores y no gestores públicos

O objetivo do presente estudo foi comparar e discutir as percepções de gestores e não-gestores do serviço público, com e sem experiência com teletrabalho, a respeito dessa modalidade de trabalho adotada compulsoriamente em resposta à pandemia da COVID-19. Participaram 1.749 trabalhadores (26% gestores), sendo 52% sem experiência em teletrabalho. A coleta de dados ocorreu nos primeiros meses da pandemia (abril a junho de 2020), a partir de uma pergunta indutora sobre os sentimentos em relação ao teletrabalho. Foi realizada análise de classificação hierárquica descendente no Iramuteq. Foram encontradas diferenças na percepção do teletrabalho de quem tinha ou não experiência com a modalidade remota, bem como diferenças nas percepções de servidores e gestores, sendo acrescidas a estes últimos preocupações com suas equipes. A discussão apresenta implicações para o serviço público e indicações de estudos futuros.

The aim of this study was to compare and discuss perceptions of public service managers and non-managers, with and without experience working remotely, in regards to the compulsory remote work adopted in response to the covid-19 pandemic. A total of 1,749 workers participated (26% managers), 52% of them with remote work experience. Data were collected during the first months of the pandemic (April to June 2020), based on an open question about their feelings about working remotely. We applied descending hierarchical classification on the Iramuteq software. Differences were found in the perceptions about working remotely among those with remote work experience and those with no experience, as well as differences in the perceptions of non-managers and managers who, in addition, were concerned about their teams. The discussion has implications for the public service and points to the need for further studies.

El objetivo del presente estudio fue el de comparar y discutir las percepciones de gestores y no gestores del servicio público, con y sin experiencia en teletrabajo, sobre el tipo de trabajo adoptado obligatoriamente en respuesta a la pandemia de COVID-19. Participaron 1.749 trabajadores (26% gestores), 52% sin experiencia con el teletrabajo. La colecta de datos ocurrió en los primeros meses de la pandemia (abril a junio del 2020), a partir de una pregunta inductora sobre los sentimientos en relación al teletrabajo. El análisis de clasificación jerárquica descendente se realizó en el programa Iramuteq. Fueron encontradas diferencias en la percepción del teletrabajo de quien tenía o no experiencia con la modalidad remota, así como diferencias en las percepciones de no gestores y gestores, siendo agregadas a estas últimas preocupaciones con sus equipos. La discusión presenta implicaciones para el servicio público e indicaciones de estudios futuros.

Punica granatum L. Extract Antibiofilm Action against Acinetobacter baumannii Carbapenem-Resistant and Biocompatibility over Human Keratinocytes / Ação Antibiofime de Extrato dePunica granatum L Contra Acinetobacter baumannii Resistente a Carbapnêmicos e Biocompatibilidade em Queratinócitos Humanos

Acinetobacter baumannii is a multi-drug resistant microorganism. The objective of this study was to evaluate the antimicrobial and antibiofilm action of the pomegranate natural extract against eight strains of multidrug resistant Acinetobacter baumanii and to assess the extract cytotoxicity in a culture of Human Keratinocytes (HaCat). Broth microdilution method was used to determine the minimum inhibitory and minimum microbicidal concentrations of the extracts. The extract antibiofilm action was analysed by the MTT colorimetric test. The cytotoxicity evaluation was performed by the MTT colorimetric test, which analysed the mitochondrial cellular action, after contact of the extract for 5 min. The results were statistically analysed by ANOVA and Tukey test with a significance level α≤ 0.05. Punica granatum L. (pomegranate) extract had antimicrobial action on all the 8 clinical strains of Acinetobacter baumannii evaluated. The extract showed a significant reduction in metabolic action in biofilm for all the strains, with results statistically different from growth control (p≤0.05%). P. granatum extract applied for 5 min on human keratinocytes (HaCat) promoted cell viability in all the tested concentrations. The pomegranate extract is effective in reducing the multidrug-resistant clinical strains of Acinetobacter baumanni and is biocompatible. (AU)

Acinetobacter baumannii é um microrganismo multirresistente. O objetivo deste estudo foi avaliar a ação antimicrobiana e antibiofilme do extrato natural de romã contra oito cepas de A. baumanii multirresistente e avaliar a citotoxicidade do extrato em uma cultura de queratinócitos humanos (HaCat). O método de microdiluição em caldo foi utilizado para determinar as concentrações inibitórias mínimas e microbicidas mínimas dos extratos. A ação antibiofilme do extrato foi analisada pelo teste colorimétrico MTT. A avaliação da citotoxicidade foi realizada pelo teste colorimétrico MTT, que analisou a ação celular mitocondrial, após contato do extrato por 5 min. Os resultados foram analisados ​​estatisticamente por ANOVA e teste de Tukey com nível de significância α≤ 0,05. O extrato de Punica granatum L. (romã) apresentou ação antimicrobiana em todas as 8 cepas clínicas avaliadas de A. baumannii. O extrato apresentou redução significativa na ação metabólica no biofilme para todas as linhagens, com resultados estatisticamente diferentes do controle de crescimento (p≤0,05%). O extrato de P. granatum aplicado por 5 min em queratinócitos humanos (HaCat) promoveu viabilidade celular em todas as concentrações testadas. O extrato de romã é eficaz na redução das cepas clínicas multirresistentes de Acinetobacter baumanni e é biocompatível. (AU)

Human bites to the face treatment with pedicle flap technique: case report

Human bite wounds are less common than those caused by animal bites, and in general are contaminated by a wider range of microorganisms, thus increasing incidence of infectious complications. Patient management in the emergency room consists in aesthetic and functional rehabilitation and infection prevention. The aim of this article is to report a case of human bite to the face with upper lip and oral commissure tissue loss of a patient, who was a victim of assault, seen at a public emergency hospital in Rio de Janeiro, providing information on the clinical characteristics of the injury and the most appropriate treatment for the case studied.

High frequency transcutaneous electrical stimulation in the immediate postoperative period of anterior cruciate ligament reconstruction: a randomized clinical trial / Estimulação elétrica transcutânea de alta frequência no pós operatório imediato de reconstrução do ligamento cruzado anterior: um ensaio clínico randomizado

INTRODUCTION: The anterior cruciate ligament (ACL) is an important structure for knee stability. Transcutaneous electrical nerve stimulation (TENS) is an electrical current applied for significant pain relief. OBJECTIVE: To evaluate the effects of high-frequency TENS on the immediate postoperative period of ACL reconstruction. METHODS: 46 patients in the postoperative period of ACL reconstruction were randomly assigned to a control group (CG=23) and a TENS group (TG=23). Knee range of motion (ROM), pain, muscle strength, and drug intake were assessed before surgery and 24 and 48 hours after surgery. The TENS intervention protocol started in the recovery room, shortly after surgery, and was maintained continuously for the first 48 hours after surgery. RESULTS: The TENS group (TG) significantly controlled the increased level of postoperative pain (p<0.05) and significantly increased flexion ROM (p<0.05). When compared to the Control group (CG), the TENS group had a lower intake of ketoprofen (48.27%), diazepam (256.98%), and dipyrone (121.21%), morphine (320.77%), and tramadol (437.46%). CONCLUSION: Continuous high-frequency TENS significantly reduced pain intensity and significantly improved ROM, muscle strength, and drug intake in the postoperative period of ACL reconstruction.

Use of aerobic treadmill exercises on nerve regeneration after sciatic nerve injury in spontaneously hypertensive rats

Purpose: Various postoperative protocols have been proposed to improve outcomes and accelerate nerve regeneration. Recently, the use of physical exercise in a post-surgical neurorraphy procedure has shown good results when started early. We experimentally investigated the hypothesis that post-operative exercise speeds up results and improves clinical and morphologic parameters. Methods: Isogenic rats were randomly divided into four groups: 1 SHAM; 2 SHAM submitted to the exercise protocol (EP); 3 Grafting of the sciatic nerve; and 4 Grafting of the sciatic nerve associated with the EP. The EP was based on aerobic activities with a treadmill, with a progressive increase in time and intensity during 6 weeks. The results were evaluated by the sciatic functional index (SFI), morphometric and morphologic analysis of nerve distal to the lesion, and the number of spinal cord motor neurons, positive to the marker Fluoro-Gold (FG), captured retrogradely through neurorraphy. Results: Functional analysis (SFI) did not show a statistical difference between the group grafted with (­50.94) and without exercise (-65.79) after 90 days. The motoneurons count (Spinal cord histology) also showed no diference between these groups (834.5 × 833 respectively). Although functionally there is no difference between these groups, morphometric study showed a greater density (53.62) and larger fibers (7.762) in GRAFT group. When comparing both operated groups with both SHAM groups, all values were much lower. Conclusions: The experimental model that this aerobic treadmill exercises protocol did not modify nerve regeneration after sciatic nerve injury and repair with nerve graft.

Analysis of Three-Dimensional Scar Architecture and Conducting Channels by High-Resolution Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Chagas Heart Disease

ABSTRACT Background: We aimed to describe the morphology of the border zone of viable myocardium surrounded by scarring in patients with Chagas heart disease and study their association with clinical events. Methods: Adult patients with Chagas heart disease (n=22; 55% females; 65.5 years, SD 10.1) were included. Patients underwent high-resolution contrast-enhanced cardiac magnetic resonance using myocardial delayed enhancement with postprocessing analysis to identify the core scar area and border zone channels number, mass, and length. The association between border zone channel parameters and the combined end-point (cardiovascular mortality or internal cardiac defibrillator implantation) was tested by multivariable Cox proportional hazard regression analyses. The significance level was set at 0.05. Data are presented as the mean (standard deviation [SD]) or median (interquartile range). Results: A total of 44 border zone channels (1[1-3] per patient) were identified. The border zone channel mass per patient was 1.25 (0.48-4.39) g, and the extension in layers of the border zone channels per patient was 2.4 (1.0-4.25). Most border zone channels were identified in the midwall location. Six patients presented the studied end-point during a mean follow-up of 4.9 years (SD 1.6). Border zone channel extension in layers was associated with the studied end-point independent from left ventricular ejection fraction or fibrosis mass (HR=2.03; 95% CI 1.15-3.60). Conclusions: High-resolution contrast-enhanced cardiac magnetic resonance can identify border zone channels in patients with Chagas heart disease. Moreover, border zone channel extension was independently associated with clinical events.