Crossover randomized controlled trial of bumetanide to rescue an attack of exercise induced hand weakness in hypokalaemic periodic paralysis.

The aim of this study was to establish whether bumetanide can abort an acute attack of weakness in patients with HypoPP. This was a randomised, double-blind, cross-over, placebo-controlled phase II clinical trial. Focal attack of weakness was induced by isometric exercise of ADM followed by rest (McManis protocol). Participants had two study visits and received either placebo or 2 mg bumetanide at attack onset (defined as 40 % decrement in the abductor digiti minimi CMAP amplitude from peak). CMAP measurements assessed attack severity and duration. Nine participants completed both visits. CMAP percentage of peak amplitudes in the bumetanide (40.6 %) versus placebo (34.9 %) group at 1hr following treatment did not differ significantly (estimated effect difference 5.9 % (95 % CI: (-5.7 %; 17.5 %), p = 0.27, primary outcome). CMAP amplitudes assessed by the area under the curve for early (0-2hr post-treatment) and late (2-4 h post-treatment) efficacy were not statistically different between bumetanide and placebo (early effect estimate 0.043, p = 0.3; late effect estimate 0.085, p = 0.1). Two participants recovered from the attack following bumetanide intake; none recovered following placebo. Bumetanide was well tolerated but not efficacious to rescue a focal attack in an immobilised hand in the majority of patients, although data supports further studies of this agent.

Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study.

Previous studies have shown the efficacy of foot-ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot-ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot-ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot-ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot-ankle kinematic outcomes in people with DPN.

Practical evaluation of the R.E.N.A.L. score system in 150 laparoscopic nephron sparing surgeries

ABSTRACT Introduction: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. Materials and Methods: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. Results: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). Conclusions: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.

Practical evaluation of the R.E.N.A.L. score system in 150 laparoscopic nephron sparing surgeries.

INTRODUCTION: Nephrometric scores play an interesting role in nephron sparring surgery (NSS) planning. The aim of this study is to evaluate if R.E.N.A.L. score (RS) is capable to predict the occurrence of adverse events in laparoscopic NSS. MATERIALS AND METHODS: We prospectively studied 150 laparoscopic NSS between 2015 and 2018 to evaluate the relationship between RS and incidence of adverse events. Clavien 3 or superior complications, warm ischemia time (WIT) over 30 minutes, tumor violation, positive surgical margins (PSM) and necessity of amplification of renal parenchyma during the resection of the masses to obtain free margins were considered as adverse events. We compared each item of the RS isolated and divided the patients between low risk and high risk. RESULTS: Adverse results occurred in 48 cases (32%). Amplification of the margin of resection was observed in 28 cases (19%). WIT exceeded 30 minutes in 9 cases (6.1%), complications Clavien 3 or superior occurred in 13 cases (9%) and PSM were detected en 6 cases (4%). Comparing the patients with adverse outcomes and each item of the RS we did not find any statistical difference, but when divided into high risk and low risk, we found that patients in the high risk group had a higher tendency to present ad-verse results - 25.84% vs. 44.26% (p=0.03). CONCLUSIONS: RS system is a good way to predict adverse outcomes in NSS, especially in cases over 7. Further studies should focus on robotic approach and patient's characteristics other than the masses' aspects.

Perspectives for a new drug candidate for Chagas disease therapy

Chagas disease (CD), a neglected tropical illness caused by the protozoan Trypanosoma cruzi, affects more than 6 million people mostly in poor areas of Latin America. CD has two phases: an acute, short phase mainly oligosymptomatic followed to the chronic phase, a long-lasting stage that may trigger cardiac and/or digestive disorders and death. Only two old drugs are available and both present low efficacy in the chronic stage, display side effects and are inactive against parasite strains naturally resistant to these nitroderivatives. These shortcomings justify the search for novel therapeutic options considering the target product profile for CD that will be presently reviewed besides briefly revisiting the data on phosphodiesterase inhibitors upon T. cruzi.

Teoría sindémica como un enfoque para explicar la interacción entre problemas de salud pública / A teoria sindêmica como abordagem para explicar a interação entre problemas de saúde pública / Syndemics framework as an approach to explain the interaction between public health problems

La teoría sindémica proporciona un marco innovador que permite comprender ¿por qué ciertos problemas de salud pública se concentran geográfica y temporalmente?, y ¿cómo estos problemas interactúan biológica y socialmente?, generando efectos nocivos en grupos vulnerables. Sin embargo, la evidencia empírica que pone a prueba esta teoría aún es escasa y la existente tiene ciertas limitaciones en el enfoque y medición de conceptos claves. Por este motivo, este artículo tiene como propósito generar una discusión sobre algunas implicaciones conceptuales y metodológicas del uso de la teoría sindémica. El correcto abordaje de la teoría sindémica permite direccionar futuras investigaciones en este tema y promueve su importancia para el estudio de problemas de salud en el contexto de Latinoamérica.

A teoria sindêmica fornece um modelo inovador que nos permite entender por que determinados problemas de saúde pública estão geograficamente e temporalmente concentrados e como esses problemas interagem biológica e socialmente, gerando efeitos nocivos sobre grupos vulneráveis. No entanto, as evidências empíricas que testam essa teoria ainda são escassas e a existente apresenta certas limitações na abordagem e mensuração de conceitos-chave. Por esse motivo, este artigo tem como objetivo gerar uma discussão sobre algumas implicações conceituais e metodológicas do uso da teoria sindêmica. A correta abordagem da teoria sindêmica permite direcionar pesquisas futuras sobre o tema e promove sua importância para o estudo dos problemas de saúde no contexto da América Latina.

The syndemics theory provides an innovative framework that allows to understand why some public health problems are geographically and temporarily concentrated?, and how these problems interact biologically and socially?, generating harmful effects on vulnerable groups. However, the empirical evidence that supports this theory is still scarce and the existing has certain limitations in the approach and measurement of key concepts. For this reason, this article aims to generate a discussion about some conceptual and methodological implications of the use of syndemics theory. The correct approach to syndemics theory allows directing future research on this topic and promotes its importance for the study of health problems in the Latin American context.

Recommendations for improving photo quality in close range photogrammetry, exemplified in hand bones of chimpanzees and gorillas / Recomendaciones para mejorar la calidad de las fotos en fotogrametría de corto alcance, ejemplificado en huesos de las manos de chimpancés y gorillas

SUMMARY: Photogrammetry is becoming increasingly popular in morphological research and teaching due to its portability, ability to reliably render 3D models, and quality-to-price relationship relative to some popular surface scanners. Compared to surface scanners, however, the learning process in photogrammetry can be very time consuming. Here we describe common mistakes of photo capture in close-range photogrammetry that greatly affect 3D output and tips to improve them. Problems were identified after the 3D model construction of 780 hand bones of chimpanzees and gorillas from museum collections. Their hands are composed of 27 bones which vary in length and complexity. We show how lighting, object position and orientation, camera angle, and background affect the 3D output. By taking these factors into account, time and error rates for beginners can be greatly reduced and 3D model quality can be considerably improved.

RESUMEN: La fotogrametría está siendo cada vez más popular en la investigación y enseñanza morfológica. Esto debido a su portabilidad, confiabilidad de los modelos 3D y buena relación calidadprecio. Comparada con los escáneres de superficie, sin embargo, el proceso de aprendizaje de la fotogrametría puede llevar mucho tiempo. Aquí se describen errores comunes en la toma de fotos para fotogrametería que afectan de manera importante la creación de los modelos 3D, así como consejos para superarlos. Los problemas descritos fueron identificados luego de la construcción de 780 modelos 3D de huesos de la mano de chimpancés y gorillas depositados en distintas colecciones de museos. Las manos de estas especies están compuestas por 27 huesos que varían en tamaño y complejidad. En este artículo mostramos como la luz, la posición y orientación del objeto, el ángulo de la cámara y el fondo de la imagen afectan el resultado en 3D. Considerando estos factores, personas que están aprendiendo esta técnica pueden reducir de manera importante el tiempo y la probabilidad de error, y mejorar considerablemente la calidad de los modelos 3D.

Planejamento ortodôntico digital guiado pelo sorriso ­ protocolo para impressão de mockup para uso clínico / Smile guided digital orthodontic planning ­ a mockup printting protocol for clinical use

O objetivo do presente trabalho é demonstrar o fluxo do planejamento ortodôntico digital guiado pelo sorriso. Ainda pretende apresentar uma técnica de impressão e uso clínico de mockup para a visualização do projeto do sorriso diretamente no paciente. Os registros clínicos utilizados foram os modelos digitais obtidos por escaneamento intraoral e fotos da face com o sorriso. O software utilizado foi o Nemocast. Os passos do planejamento digital incluem a importação dos registros para o ambiente do software, o preparo e orientação dos modelos digitais, a superposição dos modelos digitais nas fotos do sorriso, a segmentação do modelo digital, a realização do setup digital guiado pelo sorriso, a confecção de um mockup digital, a impressão do mesmo e a instalação do projeto diretamente no paciente. A possibilidade do ortodontista e do paciente visualizarem o melhor posicionamento dentário para o sorriso permite um planejamento com objetivos claros, aumentando a individualização do tratamento, previsibilidade e chances de aceitação pelo paciente. Além disso, a instalação do mockup no paciente permite a visualização real dos resultados clínicos esperados (AU).

The aim of the present paper is to demonstrate the workflow of a digital orthodontic planning guided by smile. Furthermore, it intends to demonstrate a printing technique to build an orthodontic mockup, as well as its clinical use in order to visualize the smile design directly on the patient. The clinical records used were the digital models obtained by intraoral scan and photos of the face with the smile. Nemocast was the software used. The steps of digital planning include importation of records into the software environment, preparation and orientation of digital models, superposition of digital models in the smile photos, segmentation of the digital model, performing the digital setup guided by the smile, digital mockup manufacturing, printing of it and installing the project directly on the patient. The possibility for both orthodontist and patient to visualize the best dental positioning for the smile allows planning with clear objectives, increasing treatment individualization, predictability, and chances of acceptance by the patient. In addition, installing the mockup on the patient allows real visualization of the expected clinical results. (AU)

A Game to Deal With Alcohol Abuse (Jib): Development and Game Experience Evaluation.

BACKGROUND: Alcohol abuse is the primary cause of (public) health problems in most parts of the world. However, it is undeniable that alcohol consumption is a practice that is widely accepted socially in many places, even being protected by law as a cultural and historical heritage. The issue of alcohol abuse is complex and urgent, and consequently, it is necessary to create innovative approaches such as the proposal explored in this study. OBJECTIVE: This study aimed to explore the development and evaluation of a serious game for smartphones to present a novel approach to address the issue of alcohol abuse. METHODS: A serious game was developed to instill the consequences of alcohol abuse into the player through experimentation in the game. In the game, the consequences of alcohol use are demonstrated by increasing the game speed that gives an illusion of fun but also leads to a premature death. The evaluation employed an assessment based on the Alcohol Use Disorders Identification Test (AUDIT) and the Game Experience Questionnaire (GEQ). The participants belonged to the university student's house. RESULTS: The game development process has been presented, including its mechanics and gameplay. The game has the style of action and adventure games in which the player controls an indigenous avatar that can deflect or attack opponents coming his or her way. The game evaluation comprised an assessment based on 23 participants, aged 20 to 29 years. According to the AUDIT assessment, 18 participants reported having a low or nonexistent degree of alcohol dependence and 5 declared average dependence. Regarding their habit of playing games on smartphones, 9 participants declared they have this habit of playing (habitual players), and among the 14 that did not have this habit of playing (nonhabitual players), 3 participants declared not having a smartphone at all. The GEQ core assessment showed a higher positive affect among the participants with a habit of playing games, scoring 2.80 (habitual players) on a scale of 4.0 versus 1.61 (nonhabitual players), and higher tension as an opposite relationship of 0.81 (nonhabitual players) versus 0.37 (habitual players). The overall GEQ evaluation showed that the game presents a more positive than negative affect on all users, besides showing the other desirable characteristics of serious games. CONCLUSIONS: We present a new way of dealing with the issue of alcohol abuse through a game designed for smartphones. It promotes an overall positive user experience, having a greater impact on users accustomed to games. The proposed approach has its niche, though it is still a minority in the evaluated population. Further research should explore new game features, such as new styles, to make the game more attractive to a wider audience, in addition to performing an in-depth study on the effects of playing it.

Um diálogo teórico-metodológico sobre a técnica no pensamento de Vitor Marinho / A theoretical-methodological dialogue about the technique in Vitor Marinho's thought / Un diálogo teórico-metodológico sobre la técnica en el pensamiento de Vitor Marinho

Os anos de 1980 foram marcantes para a Educação Física, pois disseminou-se o pensamento renovador e surgiu a perspectiva sociocultural. Nesse período, houve críticas à luz das Ciências Humanas e Sociais aos paradigmas positivistas (como o tecnicismo) nas produções da época. Dessa forma, o presente estudo teve por objetivo identificar a concepção da técnica na perspectiva sociocultural por meio da análise da obra de Vitor Marinho, um dos intelectuais responsáveis pela difusão do movimento renovador. Para tal, foram analisados três textos publicados pelo autor na década de 80, evidenciando os elementos explícitos e implícitos sobre a técnica e suas questões. Os dados foram tratados qualitativamente, embasados pelo referencial teórico de Álvaro Vieira Pinto. Os resultados apontaram que a mudança de referencial teórico-epistemológico que ocorreu com o pensamento renovador promoveu contribuições para pensar a técnica em uma perspectiva crítica e humanista, embora de forma imperfeita relativamente ao referencial teórico escolhido.

The years of 1980 were important for Physical Education, because the renewing thought was disseminated and the sociocultural perspective emerged. In this period, there were criticisms in the light of the Human and Social Sciences to the positivist paradigms (like technicalism) in the productions of the time. Thus, the present study aimed to identify the conception of the technique in the sociocultural perspective through the analysis of the work of Vitor Marinho, one of the intellectuals responsible for the diffusion of the renovating movement. For that, three texts published by the author in the 80s were analyzed, evidencing the explicit and implicit elements about the technique and its questions. The data were treated qualitatively, based on the theoretical reference of Álvaro Vieira Pinto. The results pointed out that the change of theoretical-epistemological referential that occurred with the renewing thought promoted contributions to think the technique in a critical and humanistic perspective, albeit imperfectly in relation to the here chosen theoretical framework.

Los años de 1980 fueron importantes para la Educación Física, pues se diseminó el pensamiento renovador y surgió la perspectiva sociocultural. En ese período, hubo críticas a la luz de las Ciencias Humanas y Sociales a los paradigmas positivistas (como el tecnicismo) en las producciones de la época. De esta forma, el presente estudio tuvo por objetivo identificar la concepción de la técnica en la perspectiva sociocultural por medio del análisis de la obra de Vitor Marinho, uno de los intelectuales responsables de la difusión del movimiento renovador. Para ello, fueron analizados tres textos publicados por el autor en la década de 80, evidenciando los elementos explícitos e implícitos sobre la técnica y sus cuestiones. Los datos fueron tratados cualitativamente, basados en el referencial teórico de Álvaro Vieira Pinto. Los resultados apuntaron que el cambio de referencial teórico-epistemológico que ocurrió con el pensamiento renovador promovió contribuciones para pensar la técnica desde una perspectiva crítica y humanista, aunque de forma imperfecta respecto al referencial teórico escogido

Falácia dilemática nas discussões da bioética / False dilemma in bioethics discussions / Falacia dilemática en las discusiones de bioética

Resumo O artigo objetiva explicitar o sentido e a presença da falácia dilemática na discussão bioética, quando a argumentação se reduz a duas posições antagônicas, não permitindo o debate ao eliminar soluções intermediárias. A falácia acontece na deliberação dos comitês de ética clínica ou investigativa quando os membros confundem a argumentação retórica com a demonstração lógica, desconsiderando que a solução é sempre contingente. Ela também está presente nos debates públicos da sociedade sobre desafios éticos quando os participantes não assumem perspectiva pragmática, mas defendem posição ideológica que dificulta o diálogo e a discussão de soluções consensuais, sempre passíveis de revisão. A falta de certeza e a possibilidade de rever as propostas, que dependem da referência ética necessária aos contextos, são condições hermenêuticas da racionalidade prática, retórica e pragmática, bases para uma bioética crítica.

Abstract The article aims to explain the meaning and the presence of the false dilemma in the bioethics discussion, when the argumentation is reduced to two antagonistic positions, not allowing the debate because it eliminates intermediary solutions. The fallacy occurs in the deliberation of clinical or investigative ethics committees when members confuse rhetorical argumentation with logical demonstration, not taking into account that the solution is always contingent. It is also present in society's public debates on current ethical challenges, when participants do not take a pragmatic perspective, but advocate an ideological position that hinders dialogue and discussion of consensual solutions, which can always be reviewed. The lack of absolute certainty to the contexts, with is the hermeneutical condition required by practical, rhetorical and pragmatic rationality and the basis for a critical bioethics.

Resumen El artículo tiene el objetivo de explicitar el sentido y la presencia de la falacia dilemática en la discusión bioética, cuando la argumentación se reduce a dos posiciones antagónicas, no permitiendo el debate, ya que elimina las soluciones intermedias. La falacia tiene lugar en la deliberación de los comités de ética clínica o investigativa, cuando los miembros confunden la argumentación retórica con la demostración lógica, sin tomar en consideración que la solución es siempre contingente. Ésta también está presente en los debates públicos de la sociedad sobre los desafíos éticos actuales, cuando los participantes no asumen una perspectiva pragmática, sino que defienden una posición ideológica que dificulta el diálogo y la discusión de soluciones consensuales, siempre pasibles de revisión. La falta de certeza absoluta y la posibilidad de revisión de las propuestas, que dependen de la necesaria referencia ética a los contextos, condición hermenéutica exigida por la racionalidad práctica, retórica y pragmática, bases para una bioética crítica.

Proof of concept in cardiovascular risk: the paradoxical findings in blood pressure and lipid abnormalities.

High blood pressure and lipoprotein abnormalities were identified by many cohort studies as the major risk factors for cardiovascular disease. Laboratory experiments apparently confirmed their role in the causation of atherosclerosis, but a proof of concept requires the corroboration by clinical trials in human beings. The size of benefit in clinical trials regarding the control of high blood pressure was within the estimations of risk provided by cohort studies. For a reduction of 10 mmHg in systolic blood pressure or 5 mmHg in diastolic blood pressure, the relative risk reduction of coronary heart disease was 22% (95% confidence interval 27%-17%) in a meta-analysis of clinical trials, close to the estimation of reduction of 25% (95% confidence interval 23%-27%) provided by a meta-analysis of cohort studies. The corresponding values for stroke were 41% (95% confidence interval 33%-48%) in clinical trials compared to a cohort risk prediction of 36% (95% confidence interval 34%-38%). This efficacy was shared by all blood pressure-lowering drugs. The same figure has not paradoxically happened with drugs that act over abnormalities of cholesterol and lipoproteins. Only statins, which have other beneficial actions as well, have consistently lowered the incidence of cardiovascular diseases, an efficacy that was not reproduced by older and newer quite potent lipid drugs. The adverse effects of these drugs may nullify their beneficial effects over lipoproteins and abnormalities of lipoproteins may only be surrogate markers of the underlying real risks.