Spontaneous pneumothorax in a young male athlete: A case report with review of literature

Spontaneous pneumothorax (SP) is a serious and life-threatening condition often caused by ruptured apical lung bulla in young male individuals. It is commonly associated with different syndromes but also occurs in healthy individuals. In this case report, we aim to discuss the etiology, clinical course, and surgical treatment of a 21-year-old male kickboxer with a right-sided pneumothorax that occurred during a sparring session. A chest tube with negative suction was inserted to resolve the pneumothorax. Because there was no visible resolution, video-assisted thoracoscopic surgery (VATS) was performed. During VATS, a large, apically placed, ruptured lung bulla, was revealed and removed. One month after surgery, the patient is in great clinical condition. There are no signs of a recurrence of SP.

Simplified clinical algorithm for immediate antiretroviral therapy initiation: The HATI [HIV awal (early) Test & Treat in Indonesia] implementation research in Indonesia

Background & objectives: Although the World Health Organization recommends same day or rapid (< seven days) antiretroviral therapy (ART) initiation, delays in ART initiation remain common due to waiting for laboratory test results. This study employed a simplified clinical algorithm the HATI [HIV Awal (Early) Test & Treat Indonesia]-SAI (Simple ART Initiation) aimed to increase the proportion of ART uptake and decrease the time to ART initiation that can be used in various care settings. Methods: This study compared the percentage of ART uptake and retention, viral load (VL) suppression and time to ART initiation between the observation and intervention phases among newly diagnosed HIV patients from key populations. As part of the intervention, the newly diagnosed patients underwent screening using a simple form [consisting of data on age, height and weight (for body mass index calculation), questions on the presence of symptoms of HIV stages 1 and 2, tuberculosis, history of diabetes, hypertension and kidney disease], to determine eligibility for immediate ART initiation. Those who met the pre-defined criteria immediately received a combination of tenofovir lamivudine and efavirenz for two weeks. The baseline laboratory examination due to this was moved up to two weeks post ART. Factors significantly associated with ART uptake were also determined and their odds ratios were measured using logistic regression analysis. Results: A total of 2173 people newly diagnosed with HIV were recruited, with 1579 and 594 in the observation and intervention phases, respectively. In both phases, the majority were men who have sex with men, who were young (<30 yr old) and employed, with high levels of education. The intervention phase significantly increased the proportion of ART initiation [91%, 95% confidence interval (CI): 89-93% vs. 78%, 95% CI: 76-80%] but did not have any impact on the proportion of six months retention and VL suppression. The intervention also significantly decreased the time to ART initiation from median ± interquartile range: 9±20 days to 2±10 days. Interpretation & conclusions: The findings of this study suggest that the HATI-SAI intervention increased the uptake and decreased the time for immediate ART initiation. The HATI-SAI provides a simple and safe clinical approach that can readily be adopted in different settings without a costly investment in technology.

Analysis of clinical parameters as predictors of hearing recovery in patients with sudden sensorineural hearing loss

Abstract Objective: To investigate the impact of certain clinical parameters on likelihood of hearing recovery after SSNHL and to detect potential variables that predict its outcome. Methods: A retrospective study was conducted in order to identify the clinical parameters which influence hearing recovery after SSNHL. Medical charts of 87 patients diagnosed with SSNHL and treated in the clinic from January 2015 to December 2019 were retrospectively reviewed. The effects of several parameters on the success of the treatment were statistically evaluated. Such parameters studied were age, gender, the severity of hearing loss, audiometric curve pattern, the time treatment was initiated, and metabolic factors. Results: Patient categorization according to tonal audiometric curve results statistically differed in terms of recovery (complete, partial, no recovery) (x2 = 32.5; p< 0.001). There are 2× more diabetic patients in the group no recovery than in the group partial recovery (OR = 3.1; 95% CI 0.95-10; p = 0.061), and 5.3× more than in the group complete recovery (OR = 10.4; 95% CI 2.3-45; p = 0.002) (χ2 = 11.2; p = 0.004). There is a statistically significant correlation between onset of therapy and recovery on a scale of significance of 93% (χ2 = 5.3, p= 0.069). Conclusion: In our study tonal audiometry results, diabetes mellitus and onset of therapy were shown to be a statistically significant negative predictive factors for recovery. Results of pure tone audiometry suggest a flat profound curve is statistically associated with the no recovery rates, and a down sloping curve proved to be statistically associated with complete recovery rates. Level of evidence: Level 1.

Colorectal adenocarcinoma with enteroblastic differentiation: diagnostic challenges of a rare case encountered in clinical practice

Colorectal adenocarcinoma with enteroblastic differentiation (CAED) is a rare subtype of colonic adenocarcinoma characterized by increased α-fetoprotein (AFP) production and the expression of at least one enteroblastic marker including AFP, glypican 3 (GPC3), or Spalt like transcription factor 4 (SALL4). We report a case of a 26-year-old female who presented with low back pain and constipation which persisted despite supportive measures. Imaging revealed multiple liver lesions and enlarged retroperitoneal nodes. Tumor markers including AFP were markedly elevated. On biopsy, samples from the liver revealed infiltrating glands lined by columnar-type epithelium with mostly eosinophilic granular to focally clear cytoplasm. By immunohistochemistry, the tumor showed immunoreactivity with AFP, hepatocyte antigen, GPC3, SALL4, CDX2, SATB2, and cytokeratin 20. A colonoscopy performed subsequently revealed a mass in the sigmoid colon and biopsy of this mass revealed a similar histology as that seen in the liver. A diagnosis of CAED was made, following the results of gene expression profiling by the tumor with next-generation sequencing which identified pathogenic variants in MUTYH, TP53, and KDM6A genes and therefore supported its colonic origin. Cases such as this underscores the use of ancillary diagnostic techniques in arriving at the correct diagnosis in lesions with overlapping clinicopathologic characteristics.

Knowledge on food safety after a year of COVID-19 pandemic in Indonesia

OBJECTIVE@#This study aimed to determine the level of food safety knowledge, and its determinant factors during eating out settings, among Indonesian adults after one year of the COVID-19 pandemic.@*METHODS@#A cross-sectional survey was carried out from April 19 to April 26, 2021, using an online questionnaire. Participants’ socio-demographic characteristics, exposure to information, as well as knowledge towards food safety during the COVID-19 pandemic were obtained using a convenience sampling technique. Data collected were subjected to descriptive statistics, chi-square analysis, and logistic regression analysis.@*RESULTS@#From a total of 551 completed responses, the majority of respondents were female (76.8%), between the ages of 18-25 years (41.2%), had a college (bachelor) degree (65.2%), and lived in Java Island (74.0%). About 45.4% were exposed to food safety information 1-2 times per week and more than half (56.8%) claimed to get trusted sources of food safety information from social media. After adjusting with other variables, the most dominant factor associated with the food safety knowledge during eating out were age (26-32 years) (OR=1.7, 95% CI 1.0-2.7) and gender (female) (OR=1.5, 95% CI 1.0-2.4).@*CONCLUSION@#After one-year of COVID-19 pandemic, the most dominant factors related to food safety knowledge are age and gender. Food safety knowledge has no significant association with attitude and practice.

MicroRNA-146a and its target gene IRAK1 polymorphisms confer susceptibility to systemic lupus erythematosus / El microARN-146a y sus polimorfismos del gen diana IRAK1 confieren susceptibilidad al lupus eritematoso sistémico

ABSTRACT Objective: To clarify the association between miR-146a, miR-499, and IRAK1 polymorphism and systemic lupus erythematosus (SLE) predisposition. Methods: A literature search was conducted until 12 September 2020 in accordance with the PRISMA guidelines. The keywords "miRNA-146a", "miRNA-499", "IRAK1" and "SLE" were used in combination to obtain case-control studies evaluating the abovementioned gene polymorphism and the risk of SLE. Results: Patients harbouring C allele of miRNA-146a rs2431697 exhibited low SLE risk (CC vs. TC + TT, OR = .77, 95% CI = .62-.95, p = .019; TC vs. CC + TT, OR = .84, 95% CI = .71-.98, p = .027; and TC vs. TT, OR = .73, 95% CI = .61-.86, p = .000), whereas patients carrying the A allele and AA genotype of rs3027898 in IRAK1 had significantly decreased SLE susceptibility (A vs. C, OR = .73, 95% CI = .60-.87, p = .001; AA vs. CA + CC, OR = .64, 95% CI = .42-.97, p = .037; AA + CA vs. CC, OR = .71, 95% CI = .56-.88, p = .003, and AA vs. CC, OR = .49, 95% CI = .31-.77, p = .002). No association was observed between miRNA-146a rs2910164 and miRNA-499 rs3746444 with SLE risk. Conclusion: This study demonstrates associations between miRNA-146a and IRAK1 polymor phisms with SLE risk. Larger studies on these associations are needed in the future to support our results.

RESUMEN Objetivo: Aclarar la asociación entre el polimorfismo de miR-146a, miR-499 e IRAK1 y la predisposición al lupus eritematoso sistémico (LES). Métodos: Se realizó una búsqueda bibliográfica hasta el 12 de septiembre del 2020, de acuerdo con las guías PRISMA. Las palabras clave «miRNA-146a¼, «miRNA-499¼, «IRAK1¼ y «LES¼ se utilizaron en combinación para obtener estudios de casos y controles que evaluaran el polimorfismo de los genes antes mencionados y el riesgo de LES. Resultados: Los pacientes que albergan el alelo C del miRNA-146a rs2431697 mostraron un bajo riesgo de LES (CC frente a TC + TT; OR = 0,77; IC 95% = 0,62-0,95; p = 0,019; TC frente a CC + TT; OR = 0,84; IC 95% = 0,71-0,98; p = 0,027; y TC vs. TT; OR = 0,73; IC 95% = 0,61-0,86; p = 0,000), mientras que los pacientes portadores del alelo A y el genotipo AA de rs3027898 en IRAK1 redujeron significativamente la susceptibilidad al LES (A vs. C; OR = 0,73; IC 95% = 0,60 0,87; p = 0,001; AA vs. CA + CC; OR = 0,64; IC 95% = 0,42-0,97; p = 0,037; AA + CA vs. CC; OR = 0,71; IC 95% = 0,56-0,88; p = 0,003 y AA vs. CC; OR = 0,49; IC 95% = 0,31-0,77; p = 0,002). No se observó asociación entre miRNA-146a rs2910164 o miRNA-499 rs3746444 con riesgo de LES. Conclusión: Este estudio demuestra asociaciones entre los polimorfismos de miRNA-146a e IRAK1 y el riesgo de LES. En el futuro se necesitan estudios más amplios sobre estas asociaciones para garantizar nuestros resultados.

Clozapine prescribing patterns in hospitalised patients in everyday clinical practice

Aim: Clozapine is the gold standard for treatment-resistant schizophrenia. Despite clear recommendations for use, under-use and excessive delay in the use of clozapine are an ongoing findings in the literature. The aim of this study was to analyse the clozapine prescribing patterns in hospitalised patients in everyday clinical practice in Serbia. Methods: This cross-sectional study was conducted in Clinic for Mental Disorders “'Dr Laza Lazarevi?”' in Belgrade and included a sample of 238 patients, discharged from hospital treatment during 2018. Demographic, data on the clinical characteristics of the subjects, dosage and combination of clozapine with other psychopharmacs were collected retrospectively, from the patients’ medical records. Descriptive and statistical hypothesis testing methods were used to analyse the primary data. Results: The incidence of clozapine administration was 23.5%. Clozapine was introduced into therapy after average treatment duration of 7.2 years and prior administration of three different antipsychotics. 68.1% of patients were treated with dual antipsychotic therapy prior to clozapine administration. In 53.8% of patients, clozapine was prescribed as antipsychotic monotherapy, while only eight per cent were not prescribed adjuvant therapy. The most commonly used antipsychotic in combination with clozapine was haloperidol (34.9%), while the most prescribed non-antipsychotic adjuvant drug was valproate (66%). Benzodiazepines were prescribed in 55.9% of subjects. In most subjects, the dose of clozapine was less than the standard dose. Conclusion: Clozapine is prescribed less frequently than expected and is often used in an irrational manner. Additional research is needed to advance its application in everyday clinical practice.

The effect of guava juice toward haemoglobin levels in pregnant women

Background: The prevalence of anemia among pregnant women is 33-75% in developing countries. Iron deficiency is a common cause of anaemia. Absorption of iron can be achieved by increasing the content of diets containing vitamin C or ascorbic acid (AA) such as those in vegetables and fruit. The purpose of this study was to assess the effect of guava juice on the haemoglobin levels of pregnant women.Methods: The study was conducted using quasi-experiment. Sample was determined by the consecutive sampling method. 29 respondents were selected from each group. Both groups were given iron supplements of 2x1 for 2 weeks, while the control group besides receiving iron supplement therapy also consumed 200 ml/day guava juice for 2 weeks, with the inclusion criteria of  third trimester pregnant women, anemia, no pregnancy complications and willing to be a respondent by signing an informed consent. Exclusion criteria not having a routine ANC at the Kalasan primary Health. Data collection was conducted using demographic data questionnaire, Observation Sheet of the provision of Fe tablets and guava juice and the measurement of hemoglobin levels with a hemocue.Results: There was an increase in Haemoglobin levels in the group given iron supplement therapy and consumption of 200 ml guava juice/day for 2 weeks with a p value of <0.05.Conclusions: Consumption of guava juice of 200 ml/day for 2 weeks increases the haemoglobin in pregnant women with anemia.

Aesthetic outcomes after surgical repair of pectus excavatum in females: Differences between patients and professional evaluators

Background@#Pectus excavatum is less common in females than in males, and it often aggravates a coexistent breast asymmetry. We conducted a study comparing female patients’ versus medical professionals’ evaluation of pectus excavatum repair to assess differences in aesthetic outcome ratings. Moreover, we evaluated the influence of surgical correction on patients’ self-perception. @*Methods@#Of 30 female patients who were initially screened, 18 patients (mean age, 20 years) who underwent bar removal after surgical correction of pectus excavatum deformity participated in the survey (60%). They completed a questionnaire rating their appearance before and after surgery and responded to a psychological questionnaire about the changes that they had experienced. The mean interval between pectus bar removal and evaluation was 28 months. Standardized preoperative and postoperative patient photographs were evaluated using the same questionnaire by a panel of medical professionals and students (n=24) and the results were compared. @*Results@#Patients rated their preoperative deformity as more severe than the other evaluators, revealing the significant impact of the deformity on patients’ self-perception. Postoperatively, patient and professional evaluations were much better than before and were very similar. The psychological evaluation showed a clear improvement in well-being. The ratings of the medical professionals were not influenced by their degree of medical education. @*Conclusions@#Surgical correction of pectus excavatum in female patients positively influences body perception and psychological well-being. It should therefore not be considered as a merely aesthetic correction, but as an important procedure to restore a patient’s self-perception.

Aberrant anatomy in endodontically treated teeth in a Nigerian Teaching Hospital

Objective: The anatomical features of teeth show wide morphological variations. These variations include coronal and radicular aberrations. They are thought to be influenced by age, gender, race and evaluation methods. Therefore, an in-depth knowledge of both normal and unusual dental morphology is vital in the practice of endodontics. The objective of the study was to investigate the incidence of aberrant root anatomy in endodontically treated teeth among adult patients attending the Endodontic unit of a tertiary hospital in Southern Nigeria. Methods: A retrospective review of all clinical records of adult patients who attended the Endodontic unit of the Department of Restorative Dentistry, University of Benin Teaching Hospital (UBTH) Edo State, Nigeria from January 2013 to January 2018 for root canal treatment (RCT). The demographic and clinical data were retrieved from the patients' records and analyzed using IBM SPSS version 20. Results: A total of 927 patients, comprising445 (48.0%) males and 482 (52.0%) females (a ratio of 1:1.1) underwent endodontic treatment during the study period. The age range of patients was 18-80 years. The total number of teeth treated was 1016. Aberrant root anatomy was observed in 161 (15.8%) of the studied sample. It was more frequently seen in mandibular 118 (29.9%) than maxillary 43 (6.9%) teeth. Aberrant root anatomy occurred most frequently in mandibular second molars 42 (38.9%) followed by the maxillary first molars 32 (38.1%). These aberrations were observed in the roots and canal numbers of treated teeth while the occurrence of aberrant anatomy was higher in females (9.9%) than males (5.9%). Conclusion: In this study, aberrant root anatomies were mostly observed in mandibular teeth and among female patients. Clinicians should be aware of the existence of wide variations in root form and canal morphology during endodontic procedures. The alertness is helped by the use of Dental operating microscopes or other magnification devices, multiple periapical radiographs with angular cone shift or other contemporary imaging modalities in revealing tooth anatomy that would otherwise be missed

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal / A influência do extrato de folha de hera seca na secreção nasal após remoção de tampão nasal pós-septoplastia

Abstract Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. Conclusion: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Resumo Introdução: Após a remoção do tampão nasal pós-septoplastia, ocorre produção de secreção nasal, predispondo infecções locais e, por vezes, sistêmicas. Objetivo: O objetivo foi determinar se a aplicação do extrato padronizado de folhas de hera seca após a remoção do tampão nasal influencia a redução da secreção nasal e diminui a ocorrência de infecções locais. Método: O estudo incluiu 70 pacientes pós-septoplastia (divididos em dois grupos iguais) cujo tampão nasal foi retirado no terceiro dia após o procedimento. O grupo I foi tratado com xarope padronizado de extrato de folha seca de hera juntamente com irrigação nasal regular por cinco dias após a remoção do tamponamento nasal, enquanto ao grupo II foi recomendado apenas lavagem nasal. No sexto dia após a remoção do tampão nasal, a quantidade de secreção nasal foi determinada pela escala EVA (escala visual analógica) e pelo exame endoscópico nasal. Resultados: O grupo tratado com xarope de extrato seco de folhas de hera apresentou secreção nasal significativamente menor tanto pela avaliação subjetiva dos pacientes (p < 0,001) quanto pelo exame endoscópico nasal (p = 0,003). O exame de acompanhamento pós-cirúrgico no sexto dia após a remoção do tampão nasal não mostrou desenvolvimento de infecção local nos pacientes do grupo I, enquanto que no grupo II, cinco apresentaram sinais de infecção local (14,29%) com necessidade de antibioticoterapia. Conclusão: O uso do extrato padronizado de folhas secas de hera após a remoção do tampão nasal reduz significativamente a produção de secreção nasal.

Food purchasing behaviour among urban slum women in East Jakarta: a qualitative study

@# Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers. Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows). Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity. Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.

Subcostal transversus abdominis plane block can improve analgesia after laparoscopic cholecystectomy / O bloqueio do plano transverso abdominal subcostal pode melhorar a analgesia após colecistectomia laparoscópica

Abstract Background and goal of study: After laparoscopic cholecystectomy, patients have moderate pain in the early postoperative period. Some studies shown beneficial effects of subcostal transversus abdominis plane block on reducing this pain. Our goal was to investigate influence of subcostal transversus abdominis plane block on postoperative pain scores and opioid consumption. Materials and methods: We have randomized 76 patients undergoing laparoscopic cholecystectomy to receive either subcostal transversus abdominis plane block (n = 38) or standard postoperative analgesia (n = 38). First group received bilateral ultrasound guided subcostal transversus abdominis plane block with 20 mL of 0.33% bupivacaine per side before operation and tramadol 1 mg.kg−1 IV for pain breakthrough (≥6). Second group received after operation tramadol 1 mg.kg−1/6 h as standard hospital analgesia protocol. Both groups received acetaminophen 1 g/8 h IV and metamizole 2.5 g/12 h. Pain at rest was recorded for each patient using NR scale (0-10) in period of 10 min, 30 min, 2 h, 4 h, 8 h, 12 h and 16 h after the surgery. Results and discussion: We obtained no difference between groups according age, weight, intraoperative fentanyl consumption and duration of surgery. Subcostal transversus abdominis plane block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the subcostal transversus abdominis plane (24.29 ± 47.54 g) than in the standard analgesia group (270.2 ± 81.9 g) (p = 0.000). Conclusion: Our results show that subcostal transversus abdominis plane block can provide superior postoperative analgesia and reduction in opioid requirements after laparoscopic cholecystectomy.

Resumo Justificativa e objetivo: Após a colecistectomia laparoscópica, os pacientes apresentam dor moderada no pós-operatório imediato. Alguns estudos mostraram efeitos benéficos do bloqueio do plano transverso abdominal subcostal na redução dessa dor. Nosso objetivo foi investigar a influência do bloqueio do plano transverso abdominal subcostal nos escores de dor no pós-operatório e no consumo de opioides. Materiais e métodos: Foram randomizados 76 pacientes submetidos à colecistectomia laparoscópica para receber o bloqueio do plano transverso abdominal subcostal (n = 38) ou analgesia padrão no pós-operatório (n = 38). O primeiro grupo recebeu bloqueio do plano transverso abdominal subcostal bilateral guiado por ultrassom com 20 mL de bupivacaína a 0,33% em cada lado antes da operação e tramadol IV (1 mg.kg−1) para controle da dor (≥ 6). O segundo grupo recebeu tramadol (1 mg.kg−1/6 h) como protocolo-padrão de analgesia hospitalar pós-cirurgia. Ambos os grupos receberam acetaminofeno IV (1 g/8 h) e dipirona (2,5 g/12 h). A dor em repouso foi registrada para cada paciente com o uso da escala NR (0-10) nos períodos de 10 min, 30 min, 2 h, 4 h, 8 h, 12 h e 16 h após a cirurgia. Resultados e discussão: Não houve diferença entre os grupos em relação a idade, peso, consumo intraoperatório de fentanil e duração da cirurgia. O bloqueio do plano transverso abdominal subcostal reduziu significativamente o escore de dor no pós-operatório em comparação com a analgesia-padrão em todos os períodos após a cirurgia. O consumo de tramadol foi significativamente menor no grupo bloqueio do plano transverso abdominal subcostal (24,29 ± 47,54 g) do que no grupo analgesia padrão (270,2 ± 81,9 g) (p = 0,000). Conclusão: Nossos resultados mostram que o bloqueio do plano transverso abdominal subcostal pode proporcionar analgesia superior no pós-operatório e redução da necessidade de opioides após colecistectomia laparoscópica.

An old problem with a new solution: Cost-effective, easy correction of rhinophyma using a disposable razor

No abstract available.

Safety of long-term subcutaneous free flap skin banking after skin-sparing mastectomy

BACKGROUND: A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time. METHODS: All skin-sparing mastectomies and immediate autologous breast reconstructions from December 2009 until June 2013 at our institution were analysed. RESULTS: We identified 31 patients who underwent 33 free flap reconstructions in which skin banking was performed. Our median skin banking period was 7 days, with a maximum duration of 171 days. In 22.5% of cases, the banked skin was used to reconstruct overlying skin defects, and in 9.6% of cases to reconstruct the nipple-areolar complex. Microbiological and histological investigations of the banked skin revealed neither clinical infections nor malignancies. CONCLUSIONS: In situ skin banking, even for prolonged periods of time, is a safe and cost-effective method to ensure that skin defects due to necrosis or secondary oncological resection can be easily reconstructed.

Endoscopic repair of cerebrospinal fluid rhinorrhea / Reparo endoscópico de fístulas liquóricas nasais

Abstract Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula. Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Resumo Introdução: A liquorreia nasal indica uma fístula liquórica (FL), uma comunicação aberta entre o líquido cerebrospinal intracraniano e a cavidade nasal. Pode ser traumática e espontânea. Objetivo: Avaliar o desfecho do reparo endoscópico da fístula liquórica nasal com o uso de fluoresceína. Método: Este estudo retrospectivo incluiu 30 pacientes de ambos os sexos, com idade média de 48,7 anos, tratados de 2007 a 2015. Todos os pacientes foram submetidos à administração lombar de solução de fluoresceína de sódio a 5% no pré-operatório. A fístula foi fechada com enxerto de três camadas e cola de fibrina. Resultados: As fístulas de líquido cerebrospinal foram comumente localizadas no seio etmoidal (37%) e esfenoidal (33%). A maioria dos pacientes apresentou fístulas liquóricas traumáticas (2/3). A taxa de sucesso relatada para a primeira tentativa de reparo foi de 97%. Complicações ocorreram em três pacientes: um apresentou hidrocefalia aguda; um, síndrome reversível de encefalopatia no quinto dia de pós-operatório com perda bilateral da visão; e um foi diagnosticado com hidrocefalia dois anos após o reparo de fístula liquórica. Conclusão: O diagnóstico endoscópico e o reparo de fístulas liquóricas nasais com uso de fluoresceína intratecal têm alta taxa de sucesso e baixo índice de complicações.

Excesso de peso e risco cardiovascular em trabalhadores da construção civil / Overweight and cardiovascular risk in construction workers

Introdução: A construção civil é uma importante atividade produtiva no cenário econômico brasileiro. Portanto, produzir conhecimento a respeito da saúde dos trabalhadores desse ramo torna-se prioritário, principalmente considerando-se a escassez e a fragilidade das informações a respeito do processo saúde-doença-cuidado desses trabalhadores frente à necessidade de se planejar e implementar ações direcionadas à sua saúde e, nos dias atuais, particularmente sobre o seu estado nutricional. Objetivos: Avaliar o estado nutricional e o risco cardiovascular de trabalhadores da construção civil - subsetor de edificações, na cidade de João Pessoa, PB. Método: Trata-se de um estudo descritivo, realizado com trabalhadores da construção civil, de 20 a 59 anos de idade e do sexo masculino. As variáveis incluídas foram peso, altura, circunferência da cintura e índice de massa corporal. Os dados obtidos foram submetidos ao cálculo de porcentagem simples para quantificação e elaboração de gráficos. Resultados: Participaram do estudo 107 trabalhadores, com idade média de 39 anos, dos quais 72% estavam com sobrepeso ou algum grau de obesidade. Em relação à avaliação da medida da circunferência da cintura, observou-se que 43% apresentaram risco elevado ou muito elevado para doenças cardiovasculares. Conclusões: Os dados evidenciam risco para saúde dos operários e demandam a realização de estudos sobre as condições de trabalho, entendidas estas como ambientais, sociais e econômicas, as quais podem exercer forte influência no processo saúde-doença dos trabalhadores da construção civil.(AU)

Introduction: The construction industry is an important productive activity in the Brazilian economic scenario. Therefore, to produce knowledge about occupational health of workers of this sector becomes a priority, particularly considering the scarcity and fragility of information about the health-disease-care faced by these workers and the need to plan and implement targeted actions to their health and particularly on their nutritional status. Objectives: To evaluate the nutritional status and cardiovascular risk of construction workers - subsector of buildings in the city of João Pessoa, PB. Methods: This is a descriptive study with construction workers, 20-59 years old and male. The variables included were weight, height, waist circumference and body mass index. The data were submitted to simple percentage calculation for quantification and preparation of graphs. Results: The study included 107 participants with an average age of 39 years, of which 72% were overweight or some degree of obesity. Regarding the assessment of the measurement of waist circumference, it was observed that 43% had high or very high risk for cardiovascular disease. Conclusions: The data show risk to the health of workers and demand studies on working conditions, considered as environmental, social and economic, which may exert a strong influence in the health-disease construction workers.(AU)

Dynamic changes in optic disc morphology, choroidal thickness, anterior chamber parameters, and intraocular pressure during Valsalva maneuver / Mudanças dinâmicas na morfologia do disco óptico, espessura da coroide, parâmetros de câmara anterior e pressão intraocular durante a manobra de Valsalva

ABSTRACT Purpose: To investigate the effects of the Valsalva maneuver (VM) on optic disc morphology, choroidal thickness, and anterior chamber parameters. Methods: This prospective observational study included 60 eyes of 60 healthy subjects. The anterior chamber parameters, including central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), pupil diameter (PD), axial length (AL), subfoveal and peripapillary choroidal thickness, optic disc parameters, and intraocular pressure (IOP), were measured at rest and during VM. Results: VM did not have any significant influence on AL, subfoveal and peripapillary choroidal thickness, optic disc area, rim area, cup area, cup-to-disc area ratio, vertical cup-to-disc ratio, rim volume, cup volume, and nerve head volume measurements (for all; p >0.05). IOP and PD significantly increased during VM (for both; p <0.001). VM significantly decreased CCT, ACD, ACA, and ACV values (for all; p <0.001). Moreover, the optic nerve cup volume decreased and the horizontal cup-to-disc ratio significantly increased during VM (for both; p <0.05). Conclusions: VM may cause transient changes in IOP, optic disc morphology, and anterior chamber parameters.

RESUMO Objetivo: Investigar os efeitos da manobra de Valsalva (VM) sobre a morfologia do disco óptico, a espessura da coroide e parâmetros câmara anterior. Métodos: Estudo observacional, prospectivo incluiu 60 olhos de 60 indivíduos saudáveis. Os parâmetros da câmara anterior, incluindo da espessura central da córnea (CCT), profundidade da câmara anterior (ACD), ângulo da câmara anterior (ACA), volume de câmara anterior (ACV), diâmetro da pupila (PD), comprimento axial (AL), espessura da coroide subfoveal e peripapilar, parâmetros de disco óptico e pressão intraocular (IOP) foram medidos em repouso e durante VM. Resultados: A VM não apresentou influência significativa em AL, espessura da coroide subfoveal e peripapilar, área de disco óptico, área da rima neural, área da escavação, relação da área escavação-disco, a relação vertical escavação-disco, volume da rima neural, volume da escavação, medidas de volume cabeça do nervo (para todos; p >0,05). IOP e PD aumentaram significativamente durante VM (para ambos; p <0,001). A VM diminuiu os valores CCT, ACD, ACA e ACV significativamente (para todos; p <0,001). Além disso, o volume da escavação do nervo óptico diminuiu e a razão horizontal escavação-disco aumentou significativamente durante VM (para ambos; p <0,05). Conclusões: A VM pode causar alterações transitórias na pressão intraocular, na morfologia do disco óptico e em parâmetros câmara anterior.

Repeated toxicological study and cardiotoxicity of hydroalcoholic root extract of Paullinia pinnata L (Sapindaceae).

Paullinia pinnata L. is a plant widely used in African traditional medicine especially in the treatment of erectile dysfunction. This study aims to evaluate the cardiotoxicity of 50% hydroalcoholic extract of the roots of P. pinnata. The result of the acute toxicity test has shown a LD50 greater than 5000 mg/kg. During the 28 days subchronic administration, P. pinnata has increased significantly the relative weight of kidney. P. pinnata has induced also a microcytosis and an isolated hypochromia. Renal injuries were observed with doses of 400 mg/kg and 800 mg/kg; and are noted by the increase in blood urea, creatinine, potassium and chlorine. Cardiac disorders characterized by the increase of creatinine phosphokinase with P. pinnata at 800 mg/kg has been noted; as well as cholestasis, characterized by an increase in the ALP at 200, 400 and 800 mg/kg. The study conducted on the isolated auricle of guinea pigs, has shown that P. pinnata, at increasing concentrations (0.5 to 2.5 mg/mL) has caused an increase in the force of contraction (positive inotropic effect) and simultaneously a decrease in heart rate (negative chronotropic effect). The positive inotropic effect observed could justify the traditional use of this plant as an aphrodisiac.