Dispersion and diversification of Lyssavirus rabies transmitted from haematophagous bats Desmodus rotundus: a phylogeographical study.

Rabies is worldwide zoonosis caused by Lyssavirus rabies (RABV) a RNA negative sense virus with low level of fidelity during replication cycle. Nucleoprotein of RABV is the most conserved between all five proteins of the virus and is the most used gene for phylogenetic and phylogeographic studies. Despite of rabies been very important in Public Health concern, it demands continuous prophylactic care for herbivores with economic interest, such as cattle and horses. The main transmitter of RABV for these animals in Brazil is the hematophagous bats Desmodus rotundus. The aim of this study was to determine the dispersion over time and space of RABV transmitted by D. rotundus. Samples of RABV from the State of São Paulo (SP), Southeast Brazil isolated from the central nervous system (CNS) of cattle, were submitted to RNA extraction, RT-PCR, sequencing and phylogeographic analyzes with BEAST (Bayesian Evolutionary Analysis Sampling Trees) v 2.5 software. Was possible to identify high rate of diversification in starts sublineages of RABV what are correlated with a behavior of D. rotundus, the main transmitter of rabies to cattle. This study also highlights the importance of continuous monitoring of genetic lineages of RABV in Brazil.

Combining dynamic Monte Carlo with machine learning to study nanoparticle translocation.

Resistive pulse sensing (RPS) measurements of nanoparticle translocation have the ability to provide information on single-particle level characteristics, such as diameter or mobility, as well as ensemble averages. However, interpreting these measurements is complex and requires an understanding of nanoparticle dynamics in confined spaces as well as the ways in which nanoparticles disrupt ion transport while inside a nanopore. Here, we combine Dynamic Monte Carlo (DMC) simulations with Machine Learning (ML) and Poisson-Nernst-Planck calculations to simultaneously simulate nanoparticle dynamics and ion transport during hundreds of independent particle translocations as a function of nanoparticle size, electrophoretic mobility, and nanopore length. The use of DMC simulations allowed us to explicitly investigate the effects of Brownian motion and nanoparticle/nanopore characteristics on the amplitude and duration of translocation signals. Simulation results were verified with experimental RPS measurements and found to be in quantitative agreement.

Challenges faced by patients with dyslipidemia and systemic arterial hypertension in Brazil: a design of the patient journey.

BACKGROUND AND OBJECTIVE: Non-communicable diseases like systemic arterial hypertension (SAH) and dyslipidemia are poorly studied in terms of patient journey aspects. This semi-systematic review provides evidence synthesis for the management of SAH and dyslipidemia in Brazil and also discusses challenges faced by patients at the local level along with a suggested care approach by local experts. METHODS: A semi-systematic review using both structured literature databases (Embase and Medline) and unstructured scientific records (WHO, IPD, MOH and Google) on hypertension and dyslipidemia in the English language from 2010 to 2019 was performed by reviewers. After two-level screening based on pre-defined criteria, patient journey touchpoints and prevalence information were extracted from the included articles. Data gaps were bridged through the insights of local experts. RESULTS: Prevalence of hypertension and dyslipidemia in Brazil were 23% and 40.8%, respectively. Awareness of dyslipidemia was found in a larger proportion (58.1%) than in SAH (22.2%). Similarly, screening for hypertension (97%) and dyslipidemia (55.4%) were found to be effective, while treatment was (62.9%) and (30.0%) for hypertension and dyslipidemia, respectively. CONCLUSION: There were important gaps on patient awareness and treatment of dyslipidemia and hypertension. Limited patient education, regional disease distribution, and treatment allocation, along with limited resources for diagnosis and treatment are the key challenges.

Using Viral Gene Sequences to Compare and Explain the Heterogeneous Spatial Dynamics of Virus Epidemics.

Rabies is an important zoonotic disease distributed worldwide. A key question in rabies epidemiology is the identification of factors that impact virus dispersion. Here we apply new analytical methods, based on phylogeographic reconstructions of viral lineage movement, to undertake a comparative evolutionary-epidemiological study of the spatial dynamics of rabies virus (RABV) epidemics in different hosts and habitats. We compiled RABV data sets from skunk, raccoon, bat and domestic dog populations in order to investigate the viral diffusivity of different RABV epidemics, and to detect and compare the environmental factors that impact the velocity of viral spread in continuous spatial landscapes. We build on a recently developed statistical framework that uses spatially- and temporally-referenced phylogenies. We estimate several spatial statistics of virus spread, which reveal a higher diffusivity of RABV in domestic dogs compared with RABV in other mammals. This finding is explained by subsequent analyses of environmental heterogeneity, which indicate that factors relating to human geography play a significant role in RABV dispersion in domestic dogs. More generally, our results suggest that human-related factors are important worldwide in explaining RABV dispersion in terrestrial host species. Our study shows that phylogenetically informed viral movements can be used to elucidate the factors that impact virus dispersal, opening new opportunities for a better understanding of the impact of host species and environmental conditions on the spatial dynamics of rapidly evolving populations.

Phylogenetic analysis of rabies virus isolated from canids in North and Northeast Brazil.

Cases of canine rabies continue to occur in North and Northeast Brazil, and the number of notifications of rabies cases in wild canids has increased as a result of the expansion of urban areas at the expense of areas with native vegetation. In light of this, we performed molecular characterization of rabies virus isolates from dogs and Cerdocyon thous from various states in North and Northeast Brazil. In all, 102 samples from dogs (n = 56) and Cerdocyon thous (n = 46) collected between 2006 and 2012 were used. The nucleotide sequences obtained for the N gene of rabies virus were analyzed, and phylogenetic analysis revealed the presence of two distinct genetic lineages, one associated with canids and one with bats, and, within the canid cluster, two distinct sublineages circulating among dogs and Cerdocyon thous. In addition, phylogenetic groups associated with geographic region and fourteen cases of interspecific infection were observed among the isolates from canids. Our findings show that analysis of rabies virus lineages isolated from reservoirs such as canids must be constantly evaluated because the mutation rate is high.

Phylogeographic dispersion and diversification of rabies virus lineages associated with dogs and crab-eating foxes (Cerdocyon thous) in Brazil.

Genetic lineages of dog-associated RABV still circulate in some areas of the North and Northeast of Brazil. In parallel, another RABV lineage circulates among wild canids in the Northeast, particularly the crab-eating fox (Cerdocyon thous). Although previous studies and phylogenetic analyses have been carried out, the way in which these lineages are dispersed temporally and spatially remained to be elucidated. In this study, RABV N gene sequences isolated from canids in North and Northeast Brazil were analyzed by the Bayesian Markov Chain Monte Carlo Method, and the results were then used in a phylogeographic study. It was inferred from the findings that the most recent common ancestor became established at the end of the nineteenth century on the border of the Brazilian states of Paraíba and Pernambuco and diversified into the lineages associated with dogs and C. thous. Around 1910, the original C. thous lineage diversified into two main sublineages in the same area, one of which migrated to the south and the other to the north. The dog-associated lineage diversified around 1945 and moved toward the north and south. From the phylogeographic analysis it was possible to infer not only the movement of the virus lineages but also the probable location where dispersion and diversification occurred. The methodology used here enabled the phylogeographic history of RABV in the region to be reconstructed, and the dispersion pattern of the virus can be used to predict its movements, making it easier to stop the advance of a rabies epidemic.

Phylogeography of rabies virus isolated from herbivores and bats in the Espírito Santo State, Brazil.

Rabies is enzootic in the State of Espírito Santo, Brazil. Every year, cattle and horses die from rabies that is transmitted by the vampire bat Desmodus rotundus. This paper describes the spread of the rabies virus by the continuous diffusion model using relaxed random walks with BEAST software. Forty-one (41) sequences of gene G from the rabies virus that was isolated from bats and domestic herbivores from several areas of the state between 2006 and 2010 were analyzed. The phylogenetic tree showed three main clusters as well as two sub-clusters under cluster 2. A spatial analysis showed that three strains of the rabies virus spread independently. In general, central Espírito Santo, which is mountainous, was the area where separation of the virus strains occurred. This physical barrier, however, was overcome at some point in time, as samples from different lineages were found in the same microarea.

Understanding the journey of patients with depression in Brazil: A systematic review.

Despite having an organized mental health law and policy, a majority of patients with depression remain underreported and undertreated in Brazil. The study aimed to quantitatively map and identify the deficiencies in patient journey touchpoints in terms of awareness, screening, diagnosis, treatment, adherence, and control for depression in Brazil using a semi-systematic approach highlighting the knowledge gaps in the existing literature. A structured search of Embase, MEDLINE, and BIOSIS databases was conducted to identify the relevant studies published in English, Portuguese, and Spanish from 2006 to 2021. An unstructured search was also conducted on Google or government websites with no restrictions. To address the data gaps, anecdotal data were also considered. Weighted or simple means were calculated for the pooled data. Of 3175 articles retrieved, 10 articles met the inclusion criteria. Synthesized evidence indicates that the pooled prevalence of depression in Brazil ranged from 4.1% to 21.8%; 42.4% of patients had awareness of depression, 37.5% underwent screening, 18.7% had a diagnosis, and 54.4% received treatment. No data on adherence and control were available. The study findings highlight the need for more research to accurately estimate the common patient journey touchpoints for depression to achieve better clinical outcomes in Brazil.

Effectiveness of implant surface decontamination using a high-pressure sodium bicarbonate protocol: an in vitro study.

OBJECTIVES: To evaluate the effectiveness of a high-pressure sodium bicarbonate spray protocol to decontaminate implant surfaces intentionally inoculated with bacteria. MATERIALS AND METHODS: Twenty commercially pure titanium implants, 10 with machined surfaces and 10 with rough surfaces, were inoculated with Streptococcus sanguis and then submitted to a decontamination protocol using a high-pressure sodium bicarbonate spray device for 1 minute under aseptic conditions. RESULTS: After the application of the decontamination protocol, all bacterial cells were removed from the tested implants, regardless of surface roughness. CONCLUSION: The results suggest that regardless of the implant surface roughness, the protocol using high-pressure sodium bicarbonate spray for 1 minute, under aseptic conditions, was effective in removing all the viable bacterial cells.

How to initiate and develop Fracture Liaison Services (FLS). Recommendations from the IOF Capture the Fracture® FLS Mentors in Brazil.

Expected number of fragility fractures in Brazil, raising the healthcare prioritization for interventions that reduce fracture risk. An FLS is dedicated to managing patient with fragility fracture to reduce risk of another fracture. We review FLSs cost-effectiveness and describe key components to effectively set up FLS in Brazil. PURPOSE: To create a guideline to show health professionals, hospital managers, and stakeholders in Brazil the importance of secondary fracture prevention and how to implement a Fracture Liaison Service. METHODS: We review the cost-effectiveness for FLSs in Brazil. We describe the key components needed to set up an effective FLS including methods for identification, investigation, treatment indication, including bone drugs, supplementation, physical activity, fall prevention, and monitoring. The staffing of FLSs, value of regional clinical networks and quality improvement are also described as a guide for healthcare professionals and decision makers in Brazil. RESULTS: An FLS is a service dedicated to identifying, assessing, recommending treatment, and monitoring patient who present with a fragility fracture reducing the risk of another fracture. FLS has been implemented in Brazil since 2012 overcoming a large geography and a complex health system. Even the limitations, restrictions, differences, and characteristics of each region, it is possible for health institutions to initiate an FLS, adapted to own available resources and meet the stages of identification, investigation, treatment, and monitoring. CONCLUSION: The peculiarity of the Brazilian healthcare system means FLS implementation needs to be tailored to local reality. However, even with limitations, any attempt to capture patients who suffer a fracture due to bone fragility is effective and reduces the risk of further fractures.

Understanding the journey of patients with depression in Brazil: A systematic review

Abstract Despite having an organized mental health law and policy, a majority of patients with depression remain underreported and undertreated in Brazil. The study aimed to quantitatively map and identify the deficiencies in patient journey touchpoints in terms of awareness, screening, diagnosis, treatment, adherence, and control for depression in Brazil using a semi-systematic approach highlighting the knowledge gaps in the existing literature. A structured search of Embase, MEDLINE, and BIOSIS databases was conducted to identify the relevant studies published in English, Portuguese, and Spanish from 2006 to 2021. An unstructured search was also conducted on Google or government websites with no restrictions. To address the data gaps, anecdotal data were also considered. Weighted or simple means were calculated for the pooled data. Of 3175 articles retrieved, 10 articles met the inclusion criteria. Synthesized evidence indicates that the pooled prevalence of depression in Brazil ranged from 4.1% to 21.8%; 42.4% of patients had awareness of depression, 37.5% underwent screening, 18.7% had a diagnosis, and 54.4% received treatment. No data on adherence and control were available. The study findings highlight the need for more research to accurately estimate the common patient journey touchpoints for depression to achieve better clinical outcomes in Brazil.

[Frequency of atypical squamous cells of undetermined significance (ASCUS) for pregnant and non-pregnant women]. / Frequência de células escamosas atípicas de significado indeterminado (ASCUS) em mulheres grávidas e não grávidas.

PURPOSE: To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20-24, 25-29 and 30-34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75-0.97) and 25-29 years (OR=0.78; 95%CI 0.63-0.96). There was no difference in the group between 30-34 years (OR=0.76; 95%CI 0.57-1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routine.

Jornada do paciente com lombalgia crônica no Brasil: uma revisão semi-sistemática sobre a melhor abordagem / Patient journey for those with chronic low back pain in Brazil: a semi-systematic review on the best approach

Histórico -O tratamento de pacientes com lombalgia crônica (LC) em muitos países, incluindo o Brasil, é um grande desafio no nível de atendimento primário e especializado. Além disso, as informações sobre epidemiologia e tratamento de pacientes com LC são escassas. O objetivo principal desta revisão semi-sistemática foi a construção de evidências locais sobre a prevalência e o padrão de tratamento da LC. Métodos: Esta revisão semi-sistemática utilizou Medline, Embase e Biosis via plataforma Ovid e recursos adicionais (Google, Google Scholar, Banco de dados de incidência e prevalência, Organização Mundial da Saúde, Ministério da Saúde do Brasil e informações anedóticas de especialistas locais) para identificar literatura relevante entre 2002 e 2020 para mapear a jornada do paciente. Artigos de texto completos e originais do Brasil em inglês contendo dados sobre pontos de contato predefinidos na jornada do paciente (conscientização, triagem, diagnóstico, tratamento, adesão e controle) foram selecionados. Os dados foram obtidos usando uma média simples ou ponderada, conforme aplicável para os componentes da jornada do paciente. Resultados: De 297 registros, incluindo os fornecidos por especialistas locais, oito estudos foram incluídos para análise. A conscientização da LC e da LC-NeP foi de 30,4% e 12%, respetivamente. De acordo com estudos publicados, a adesão e o controle dos sintomas dos pacientes foram estimados com percentual semelhante de 38% e 18%, respetivamente para a LC e a LC-NeP. A prevalência de LC-NeP (3,6%) foi menor que a de LC (20,6%). Com exceção de uma porcentagem comparável da população tratada, para LC (39,1%) e LC-NeP (38%), a porcentagem de pontos de contato restantes foi maior no caso de LC do que no LC-NeP, o que implicava uma melhora no trajeto do paciente para a LC. Conclusão: O estudo destaca a necessidade de melhorar os resultados dos pacientes em nível nacional, medindo esses pontos de contato da jornada do paciente. O resultado deste estudo baseado em evidências é importante para preencher a lacuna de conhecimento do paciente com LC. Portanto, recomenda-se garantir a educação médica contínua, a conscientização do paciente e a restruturação do sistema de saúde brasileiro, ao mesmo tempo em que adota novas práticas sobre o gerenciamento da dor. [au]

Background: Managing patients with chronic low back pain (CLBP) in many countries, including Brazil, is a major challenge at the primary and specialty care level. Moreover, the information about epidemiology and patient management with CLBP is sparse. The primary objective of this semi-systematic review was to build local evidence about the prevalence and management pattern of CLBP. Methods: This semi-systematic review used Medline, Embase, and Biosis via Ovid the platform and additional resources (Google, Google Scholar, Incidence and Prevalence Database, World Health Organization, Brazilian Ministry of Health, and anecdotal information from local experts) to identify relevant literature between 2002­2020 to map the patient journey. Original full-text articles from Brazil in English containing data on pre-defined patient journey touchpoints (awareness, screening, diagnosis, treatment, adherence, and control) were screened. Data were synthesized using a simple or weighted mean, as applicable for patient journey components. Results. Of 297 records including those provided by local experts, eight studies were included for analysis. Awareness of CLBP and CLBP-NeP was 30.4% and 12%, respectively. According to published studies, adherence and symptoms control of patients was estimated with a similar percentage of 38% and 18%, respectively for CLBP and CLBP-NeP. CLBP-NeP prevalence (3.6%) was lower than that of CLBP (20.6%). Except for a comparable percentage of the treated population, for CLBP (39.1%) and CLBP-NeP (38%), the percentage of remaining touchpoints are higher in the case of CLBP than in CLBP-NeP, implying an improved patient journey for CLBP. Conclusion: The study highlights the usefulness to improve patient outcomes at the national level by measuring these mapping patient journey touchpoints. The outcome of this evidence-based study was fruitful to bridges the know-do gap in CLBP patients. Therefore, it is recommended to ensure continuing medical education, patient awareness, and health system preparedness while embracing the emerging insights on pain management. [au]

Frequência de células escamosas atípicas de significado indeterminado (ASCUS) em mulheres grávidas e não grávidas / Frequency of atypical squamous cells of undetermined significance (ASCUS) for pregnant and non-pregnant women

OBJETIVO: Comparar a frequência do resultado citopatológico de ASCUS em mulheres gestantes e não gestantes, estratificadas em grupos etários. MÉTODOS: Foram analisados 1.336.180 resultados de exames citopatológicos realizados de forma oportunística, no período entre 2000 e 2009 (10 anos) com a finalidade de rastreamento do carcinoma do colo do útero. Foram feitas comparações entre gestantes e não gestantes, com estratificação das amostras em três grupos etários (20-24, 25-29 e 30-34 anos). Foi utilizado o teste do χ2 e a medida da magnitude da associação foi analisada por valores estimados de Odds Ratio (OR) com intervalo de confiança de 95% (IC95%). RESULTADOS: Ao total, 447.489 amostras foram excluídas com base nos critérios adotados, totalizando uma amostra final de 37.137 mulheres gestantes e 851.554 não gestantes. O resultado citopatológico de ASCUS foi detectado em 1,2% dos casos, havendo diferença significante entre gestantes e não gestantes nas faixas etárias entre 20-24 anos (OR=0,85; IC95% 0,75-0,97) e 25-29 anos (OR=0,78; IC95% 0,63-0,96). Não houve diferença no grupo entre 30-34 anos (OR=0,76; IC95% 0,57-1,03). CONCLUSÕES: Este estudo sugeriu que mulheres não gestantes apresentam maior prevalência de ASCUS, mais evidente no grupo etário de 20 a 29 anos. A coleta do exame citopatológico não deve ser um exame compulsório na rotina do pré-natal. .

PURPOSE: To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20-24, 25-29 and 30-34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75-0.97) and 25-29 years (OR=0.78; 95%CI 0.63-0.96). There was no difference in the group between 30-34 years (OR=0.76; 95%CI 0.57-1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routine. .

Toracostomia triirradiada no tratamento do empiema pleural crônico / Triiradiated thoracostomy in the treatment of chronic pleural empyema

Empiema é uma doença comum e representa um problema cirúrgico de grande importância em virtude das dificuldades no diagnóstico e tratamento. Foram descritas três fases do empiema pleural, e o estágio final é a fase três ou crônica, a qual usualmente começa quatro a seis semanas após o desenvolvimento do empiema, quando o pulmão é encarcerado. Esta fase crônica representa a maioria das controvérsias relacionadas ao tratamento. Das diversas formas de drenagem permanente do abscesso pleural, nós concentramos mais recentemente num novo tipo de procedimento, que consiste numa toracostomia triirradiada, a qual permite posicionamento dos retalhos em qualquer porção da cavidade empiemática, assim recobrindo o espaço pleural. Este tipo de toracostomia em janela triirradiada foi descrita por Galvin em 1988. Foram analisados 27 pacientes portadores de infecção do espaço pleural tratados através de um retalho pleurocutâneo confeccionado à semelhança do emblema da marca automotiva Mercedes Bens. A idade média foi de 35,9 anos sendo 22 homens e cinco mulheres. A infecção pleural foi devido ao staphylococcus aureus em 40,7 por cento (n=11), sem crescimento bacteriano em 29,6 por cento (n=8), flora mista 11 por cento (n=3), E. coli 7,4 por cento (n=2), Proteus 3,7 por cento (n=1). O trauma foi responsável por 40,7 por cento (n=ll), pneumonia em 33,3 por cento (n=9), câncer em 11 por cento (n=3), tuberculose em 7,4 por cento (n=2), empiema pós-operatório e corpo estranho um cada, 7,4 por cento (n=2). O período de internação variou entre três meses e três dias, com uma média de 25 dias. O tempo médio para a resolução do processo foi de 35 dias (ñ 10 dias). Não houve mortalidade nesta série. Os objetivos do tratamento do empiema crônico, os quais incluem controle da infecção sistêmica e local, reexpansão do pulmão e melhoria da função pulmonar, restauração da parede torácica e mobilidade diafragmática, foram todos conseguidos com esta operação simples. Conclui-se que este método de drenagem permanente do espaço pleural feito à semelhança da estrela da Mercedes Benz permitiu a esterilização do espaço pleural em 27 pacientes e resolução do processo infeccioso em todos num espaço médio de 35 dias

Estágio atual dos métodos de descontaminação das superfícies de implante / Current stage of surface decontamination methods

O sucesso clínico de implantes dentários é orientado em parte pelas propriedades de superfície e suas interações com os tecidos circundantes e a microbiota oral. A longevidade da osseointegração dos implantes pode ser comprometida pela sobrecarga oclusal e/ou pela periimplantite induzida por biofilme bacteriano. Salienta-se também o fumo, doenças sistêmicas e a má higiene bucal como fatores predisponentes ao aumento do risco de periimplantite. O objetivo deste artigo é rever as técnicas de descontaminação da superfície de implantes osseointegráveis, utilizados na reabilitação de pacientes parcialmente ou totalmente edêntulos.

Prolapso de cúpula vaginal / Vaginal vault prolapse

O autor faz uma revisäo sobre o prolapso de cúpula vaginal (PCV), afecçäo ginecológica rara porém de grande repercussäo, tanto para o ginecologista como para sua paciente. Os fatores causais säo apresentados em suas múltiplas facetas, salientando suas relaçöes com a histerectomia prévia. O quadro clínico e o diagnóstico säo apresentados, dando ênfase aos aspectos de detecçäo das lesöes concomitantes da parede vaginal (cistocele, retocele e enterocele), que têm relevância na escolha do tratamento. As principais técnicas cirúrgicas säo apresentadas com suas nuances de execuçäo. Conclui afirmando que a colpossacro suspensäo é a técnica preferencial por seus resultados anatômicos e pela pequena incidência de recidivas a longo prazo

Avaliaçäo da acurácia da determinaçäo da idade óssea e de sua aplicaçäo na projeçäo da discrepância final do comprimento dos membros inferiores / Accuracy of bone age determination and its application in the final discrepancies projection in the lengh of lower extremities

Num estudo transversal, controlado, aleatório e encoberto, as radiografias de mäo e punho de um grupo de dez pacientes foram avaliadas por quatro examinadores, para determinaçäo da idade óssea, e aplicadas ao gráfico de Moseley, para projeçäo da discrepância final. Encontrou-se diferença significativa na comparaçäo da diferença de idade óssea pelos quatro examinadores entre as duas etapas. O limite de tolerância de +6 e +12 meses foi extrapolado, respectivamente em 34 e 12 por cento das determinaçöes. Näo houve diferença quanto às discrepâncias finais projetadas. Todas, exceto uma das projeçöes, ficaram dentro do limite de -2 centímetros a +1 centímetro. A determinaçäo da idade óssea utilizando-se o atlas de Greulich & Pyle tem pouca acurácia. Aparentemente, o gráfico de Moseley tende a minimizar as grandes dispersöes encontradas na determinaçäo da idade óssea, levando a uma aproximaçäo na projeçäo da discrepância final dos membros inferiores.

Relação do teste de Alizarol a 72 por cento (v/v) em leite "in natura" de vaca com acidez e contagem de células somáticas: análise microbiológica / Relation between test of the Alizarol 72 per cent in nature milk with acidity and somatic cells counts

Foram analisados a estabilidade ao Alizarol 72 por cento, pH, graus Dornic (ºD), prova da fervura, contagem de células somáticas e isolamento bacteriano no leite "in natura" em 847 quartos de 37 animais de uma propriedade em Campos dos Goyacazes, RJ. Observou-se que as amostras de leite positivas no teste do Alizarol não tiveram acidez detectáveis pelo pH e titulação em graus Dornic, e possuíam resistência térmica. Não ocorre o envolvimento de bactérias, como causa da instabilidade do leite examinado.

Pneumotórax espontâneo: análise de 130 casos / Spontaneous pneumothorax: report of 130 cases

Na Unidade de Cirurgia Torácica do HBDF foram internados 130 pacientes com Pneumotórax Espontâneo, no período de janeiro de 1977 a dezembro de 1992. Nestes doentes foram registrados 194 episódios. A idade variou entre 16 e 95 anos, com média de 36,87. Sexo masculino em 82 por cento. Jovens masculinos representaram maior percentual da populaçäo em estudo. Pacientes idosos apresentaram maior número de patologistas associados, levando a demora na resoluçäo do seu quadro. Sintomas principais foram dor e dispnéia. A grande maioria permaneceu em ambiente hospitalar por período inferior a dez dias e foi submetida a drenagem pleural fechada. O tipo de tratamento dependeu da sintomatologia e do volume do pneumotórax. Em fuga aérea prolongada ou Pneumotórax Espontâneo recidivante indica-se cirurgia. A abordagem transaxilar vem merecendo preferência, permite bom acesso a cavidade torácica para o procedimento de pleurodese apical e rafia de bolhas subpleurais, leva a resultado estético superior a toracotomia posterolateral. Pacientes sem condições clínicas de se submeterem a procedimento cirúrgico foi realizada pleurodese, com bons resultados. Näo houve recorrência