Atopic dermatitis pediatric patients show high rates of nasal and intestinal colonization by methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci.

BACKGROUND: Atopic dermatitis (AD) patients have high rates of colonization by Staphylococcus aureus, which has been associated with worsening of the disease. This study characterized Staphylococcus spp isolates recovered from nares and feces of pediatric patients with AD in relation to antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, presence of pvl genes and clonality. Besides, gut bacterial community profiles were compared with those of children without AD. RESULTS: All 55 AD patients evaluated had colonization by Staphylococcus spp. Fifty-three (96.4%) patients had colonization in both clinical sites, whereas one patient each was not colonize in the nares or gut. Staphylococcus aureus was identified in the nostrils and feces of 45 (81.8%) and 39 (70.9%) patients, respectively. Methicillin-resistant Staphylococcus spp. isolates were found in 70.9% of the patients, and 24 (43.6%) had methicillin-resistant S. aureus (MRSA). S. aureus (55.6%) and S. epidermidis (26.5%) were the major species found. The prevalent lineages of S. aureus were USA800/SCCmecIV (47.6%) and USA1100/SCCmecIV (21.4%), and 61.9% of the evaluated patients had the same genotype in both sites. Additionally, gut bacterial profile of AD patients exhibits greater dissimilarity from the control group than it does among varying severities of AD. CONCLUSIONS: High rates of nasal and intestinal colonization by S. aureus and methicillin-resistant staphylococci isolates were found in AD patients. Besides, gut bacterial profiles of AD patients were distinctly different from those of the control group, emphasizing the importance of monitoring S. aureus colonization and gut microbiome composition in AD patients.

Ultrasonic Energy and Data Transfer through a Metal-Liquid Multi-Layer Channel Enhanced by Automatic Gain and Carrier Control.

Ultrasonic communication and power transfer are attractive solutions when conventional electromagnetic-based or wired connections are unfeasible. Most ultrasonic communication applications concern a single-solid barrier. Nevertheless, some relevant scenarios can be composed of several fluid-solid media, through which communication and power transfer are intended. Due to its multi-layer nature, insertion loss and, consequently, the system efficiency considerably decrease. This paper presents an ultrasonic system capable of simultaneously power transferring and transmitting data through a set of two flat steel plates separated by a fluid layer using a pair of co-axially aligned piezoelectric transducers on opposite sides of the barrier. The system is based on frequency modulation and adopts a novel technique for automatic gain and automatic carrier control. The modems used herein were developed specifically for this application, rendering the system able to transfer data at a rate of 19,200 bps, using the frequency shift keying (FSK) modulation scheme and simultaneously transferring 66 mW of power through two flat steel plates (5 mm) separated by a fluid layer (100 mm), which completely supplied a pressure and temperature sensor. The proposed automatic gain control allowed a higher data transmission rate and the automatic carrier control reduced power consumption. The former reduced the transmission error from 12% to 5%, while the latter reduced the global power consumption from 2.6 W to 1.2 W. The proposed system is promising for monitoring applications such as oil wellbore structural health monitoring systems.

OCT Angiography Use in Pregnancy: Branch Retinal Artery Occlusion Associated with Patent Foramen Ovale - A Case Report and Multimodal Analysis.

This case report is a multimodal analysis of a pregnant patient with branch retinal artery occlusion (BRAO) associated to patent foramen ovale (PFO). A 28-year-old woman presented at the clinic 20 h after an acute, painless black spot appearance in the inferior temporal visual field of the right eye (OD). At that time, she was 18 weeks pregnant and had no report of complications in her previous pregnancy. Best-corrected visual acuity was 1.0 in both eyes. Color fundus photo, perimetry, and OCT angiography were required. The results clearly showed an embolus in the superior nasal retinal arteriole, associated with a pallor in the distal retina. Patient was referred to a cardiologist and a transcranial Doppler with contrast indicated a right-to-left intracardiac shunt, confirmed by the presence of a PFO at the transesophageal echocardiography. Thrombophilic conditions were excluded. Enoxaparin 1 mg/kg was started and kept until the delivery. Now, a PFO surgical closure is on schedule. This case highlights the noteworthiness of considering PFO as a source of embolism for BRAO in young patients, the capability of OCTA as a dye-free method for use in pregnancy and emphasizes the importance of systemic evaluation in patients with BRAO.

Challenges of Implementing Lung Cancer Screening in a Developing Country: Results of the Second Brazilian Early Lung Cancer Screening Trial (BRELT2).

PURPOSE: This paper aims to present the results of a series of several Brazilian institutions that have been carrying out lung cancer screening (LCS). MATERIALS AND METHODS: This is a retrospective, cohort study, with follow-up of individuals of both sexes, with a heavy smoking history, who participated in LCS programs between December 2013 and January 2021 in six Brazilian institutions located in the states of São Paulo, Rio Grande do Sul, and Bahia. RESULTS: Three thousand four hundred seventy individuals were included, of which 59.8% were male (n = 2,074) and 50.6% were current smokers (n = 1,758), with 60.7 years (standard deviation 8.8 years). Lung-RADS 4 was observed in 233 (6.7%) patients. Biopsy was indicated by minimally invasive methods in 122 patients (3.5%). Two patients who demonstrated false-negative biopsies and lung cancer were diagnosed in follow-up. Diagnosis of lung cancer was observed in 74 patients (prevalence rate of 2.1%), with 52 (70.3%) in stage I or II. Granulomatous disease was found in 20 patients. There were no statistical differences in the incidence of lung cancer, biopsies, granulomatous disease, and Lung-RADS 4 nodules between public and private patients. CONCLUSION: There are still many challenges and obstacles in the implementation of LCS in developing countries; however, our multi-institutional data were possible to obtain satisfactory results in these scenarios and to achieve similar results to the main international studies. Granulomatous diseases did not increase the number of lung biopsies. The authors hope that it could stimulate the creation of organized screening programs in regions still endemic for tuberculosis and other granulomatous diseases.

Metagenomic analysis of microbial communities across a transect from low to highly hydrocarbon-contaminated soils in King George Island, Maritime Antarctica.

Soil samples from a transect from low to highly hydrocarbon-contaminated soils were collected around the Brazilian Antarctic Station Comandante Ferraz (EACF), located at King George Island, Antarctica. Quantitative PCR (qPCR) analysis of bacterial 16S rRNA genes, 16S rRNA gene (iTag), and shotgun metagenomic sequencing were used to characterize microbial community structure and the potential for petroleum degradation by indigenous microbes. Hydrocarbon contamination did not affect bacterial abundance in EACF soils (bacterial 16S rRNA gene qPCR). However, analysis of 16S rRNA gene sequences revealed a successive change in the microbial community along the pollution gradient. Microbial richness and diversity decreased with the increase of hydrocarbon concentration in EACF soils. The abundance of Cytophaga, Methyloversatilis, Polaromonas, and Williamsia was positively correlated (p-value = <.05) with the concentration of total petroleum hydrocarbons (TPH) and/or polycyclic aromatic hydrocarbons (PAH). Annotation of metagenomic data revealed that the most abundant hydrocarbon degradation pathway in EACF soils was related to alkyl derivative-PAH degradation (mainly methylnaphthalenes) via the CYP450 enzyme family. The abundance of genes related to nitrogen fixation increased in EACF soils as the concentration of hydrocarbons increased. The results obtained here are valuable for the future of bioremediation of petroleum hydrocarbon-contaminated soils in polar environments.

Gestão em foco / Management in focus

Este e-book tem como objetivo trazer um compêndio de relatos de experiência relacionados à gestão de saúde do Estado de Goiás. Cada capítulo traz a descrição dos projetos desenvolvidos no âmbito da Secretaria de Estado da Saúde de Goiás, que são vinculados aos objetivos estratégicos do órgão. Estes projetos têm como objetivo fortalecer as ações estratégicas para otimizar o planejamento do Sistema Único de Saúde

This e-book aims to bring a compendium of experience reports related to health management in the State of Goiás. Each chapter brings a description of the projects developed within the scope of the State Department of Health of Goiás, which are linked to the strategic objectives of the agency. These projects aim to strengthen strategic actions to optimize the planning of the Unified Health System

Protótipo didático automatizado de ventilação pulmonar exibe uma simulação de variações de pressão intratorácica durante a função diafragmática / Automated didactic prototype of pulmonary ventilation exhibits a simulation of intrathoracic pressure variations during diaphragmatic function

O movimento do ar do ambiente para os alvéolos é um fenômeno vital e complexo que ocorre devido às variações nas pressões intratorácicas e nas vias aéreas em relação à atmosfera. A construção de protótipos didáticos pode minimizar a abstração necessária nestes fenômenos in vivo. Neste estudo, automatizamos um protótipo didático de ventilação pulmonar já descrito na literatura para simular e exibir variações na pressão intratorácica durante a função diafragmática. Um protótipo de ventilação pulmonar (PV) foi produzido com materiais recicláveis, e automatizado adaptando um sensor de pressão no sistema para gerar curvas de pressão em função do tempo durante a simulação da função diafragmática. A tração descendente do êmbolo automatizado induzida pelo servomotor (como o diafragmático) reduziu a pressão dentro da garrafa (intratorácica), e esta variação pode ser observada graficamente em uma interface de computador enquanto o balão foi expandido, e o ar atmosférico invadiu seu interior. Conclusão: A incorporação da tecnologia em um protótipo PV simples permitiu uma demonstração segura e simulada de como o diafragma induz a variação da pressão intratorácica em relação à atmosfera concomitantemente com a deformação pulmonar que ocorre durante a inspiração e a exalação.

The movement of air from the environment to the alveoli is a vital and complex phenomenon that occurs due to variations in intrathoracic and airway pressures in relation to the atmosphere. The construction of didactic prototypes can minimize the abstraction required in these in vivo phenomena. In this study, we automated a didactic prototype of pulmonary ventilation already described in literature to simulate and exhibit variations in intrathoracic pressure during diaphragmatic function. A pulmonary ventilation (PV) prototype was produced with recyclable materials, and automated by adapting a pressure sensor in the system to generate pressure curves as a function of time during the simulation of diaphragmatic function. The automated plunger's downward traction induced by the servomotor (such as diaphragmatic) reduced the pressure inside the bottle (intrathoracic), and this variation can be observed graphically on a computer interface while the balloon was expanded, and atmospheric air invaded its interior. Conclusion: The incorporation of technology into a simple PV prototype allowed a safe and simulated demonstration of how the diaphragm induces the variation of the intrathoracic pressure in relation to the atmosphere concomitantly with the pulmonary deformation that occurs during inspiration and exhalation.

Acupuntura-láser para controlar la glucosa en sangre en la diabetes tipo II: un ensayo clínico aleatorizado / Laser-acupuncture to control blood glucose in Type II Diabetes: a randomized clinical trial / Laser-acupuntura no controle da glicemia na Diabetes tipo II: ensaio clínico randomizado

OBJETIVO: Evaluar la efectividad de la acupuntura-laser aplicada al cuidado de enfermería de personas con diabetes mellitus tipo II. MÉTODOS: Ensayo clínico aleatorizado, triple ciego, con 42 participantes diabéticos tipo II, ambos sexos, con edades comprendidas entre 30 y 75 años, con hipoglucemiantes orales y dificultades para mantener la glucemia posprandial ≤ 180mg/ dl. Los participantes fueron asignados aleatoriamente a dos grupos diferentes y sometidos a láser-acupuntura estándar, brazo experimental o brazo de control simulado. Se utilizaron análisis descriptivos y de asociación entre variables, con un nivel de significancia del 5% (p <0,05). Para comparar los resultados de glucosa en sangre, se utilizó la prueba t de Student para muestras pareadas y Anova para mediciones repetidas. RESULTADOS: Se observó una disminución significativa de la glucemia capilar en los participantes del brazo experimental, fenómeno no verificado en los del brazo control. CONCLUSIONES: Se infiere la plausibilidad de utilizar la técnica como tecnología para el cuidado de enfermería de personas con diabetes mellitus tipo II. Registro Brasileño de Ensayos Clínicos. UTN: U1111-1181-1675. Ensayos clínicos NCT02605889

OBJECTIVE: To evaluate the effectiveness of laser-acupuncture applied to nursing care for people with type II diabetes mellitus. METHODS: Randomized, triple-blinded clinical trial, with 42 type II diabetic participants, both genders, aged between 30 and 75 years, using oral hypoglycemic agents and difficulties in maintaining postprandial glycaemia ≤ 180mg/dl. Participants were randomly assigned to two different groups and submitted to standard laser-acupuncture, experimental arm, or simulated, control arm. Descriptive and association analyses between variables were used, with a significance level of 5% (p <0,05). To compare blood glucose results, Student's t test was used for paired samples and Anova for repeated measurements. RESULTS: A significant decrease in capillary glycaemia was observed in the participants in the experimental arm, a phenomenon not verified in those in the control arm. CONCLUSIONS: the plausibility of using the technique as a technology for nursing care for people with type II diabetes mellitus is inferred. Brazilian Registry of Clinical Trials. UTN: U1111-1181-1675. Clinical Trials NCT02605889

OBJETIVO: Avaliar a eficácia da laser-acupuntura aplicada ao cuidado de enfermagem à pessoas com diabetes mellitus tipo II. MÉTODOS: Ensaio clínico randomizado, triplo cego, com 42 participantes diabéticos do tipo II, ambos os sexos, idades entre 30 a 75 anos, em uso de hipoglicemiantes orais e dificuldades para manter a glicemia pós prandial ≤ 180mg/dl. Os participantes foram distribuídos aleatoriamente em dois grupos distintos e submetidos a laser-acupuntura padrão, braço experimental, ou simulada, braço controle. Empregaram-se análises descritivas e de associação entre variáveis, com nível de significância de 5% (p < 0,05). Para comparação entre os resultados da glicemia empregou-se teste t de Student para amostras pareadas e Anova para medidas repetidas. RESULTADOS: Observou-se diminuição significativa na glicemia capilar dos participantes do braço experimental, fenômeno não verificado naqueles do braço controle. CONCLUSÕES: Infere-se a plausibilidade da utilização da técnica como tecnologia para o cuidado de enfermagem às pessoas com diabetes mellitus do tipo II. Registro Brasileiro de Ensaios Clínicos. UTN: U1111-1181-1675. Clinical Trials NCT02605889

Prediction of all-cause and cardiovascular mortality using central hemodynamic indices among elderly people: systematic review and meta-analysis

ABSTRACT BACKGROUND: Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear. OBJECTIVE: To ascertain the capacity of central hemodynamic indices for predicting future all-cause and cardiovascular hard outcomes among elderly people. DESIGN AND SETTING: Systematic review and meta-analysis developed at the Del Cuore cardiology clinic, in Antonio Prado, Rio Grande do Sul, Brazil. METHODS: 312 full-text articles were analyzed, from which 35 studies were included for systematic review. The studies included needed to report at least one central hemodynamic index among patients aged 60 years or over. RESULTS: For all-cause mortality, aortic pulse wave velocity (aPWV) and central systolic blood pressure (SBP) were significant, respectively with standardized mean difference (SMD) 0.85 (95% confidence interval, CI 0.69-1.01; I2 96%; P < 0.001); and SMD 0.27 (95% CI 0.15-0.39; I2 77%; P 0.012). For cardiovascular mortality brachial-ankle PWV (baPWV), central SBP and carotid-femoral PWV (cfPWV) were significant, respectively SMD 0.67 (95% CI 0.40-0.93; I2 0%; P 0.610); SMD 0.65 (95% CI 0.48- 0.82; I2 80%; P 0.023); and SMD 0.51 (95% CI 0.32-0.69; I2 85%; P 0.010). CONCLUSIONS: The meta-analysis results showed that aPWV was promising for predicting all-cause mortality, while baPWV and central SBP demonstrated consistent results in evaluating cardiovascular mortality outcomes. Thus, the findings support usage of central blood pressure as a risk predictor for hard outcomes among elderly people. REGISTRATION NUMBER IN PROSPERO: RD42018085264

Prediction of all-cause and cardiovascular mortality using central hemodynamic indices among elderly people: systematic review and meta-analysis.

BACKGROUND: Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear. OBJECTIVE: To ascertain the capacity of central hemodynamic indices for predicting future all-cause and cardiovascular hard outcomes among elderly people. DESIGN AND SETTING: Systematic review and meta-analysis developed at the Del Cuore cardiology clinic, in Antonio Prado, Rio Grande do Sul, Brazil. METHODS: 312 full-text articles were analyzed, from which 35 studies were included for systematic review. The studies included needed to report at least one central hemodynamic index among patients aged 60 years or over. RESULTS: For all-cause mortality, aortic pulse wave velocity (aPWV) and central systolic blood pressure (SBP) were significant, respectively with standardized mean difference (SMD) 0.85 (95% confidence interval, CI 0.69-1.01; I2 96%; P < 0.001); and SMD 0.27 (95% CI 0.15-0.39; I2 77%; P 0.012). For cardiovascular mortality brachial-ankle PWV (baPWV), central SBP and carotid-femoral PWV (cfPWV) were significant, respectively SMD 0.67 (95% CI 0.40-0.93; I2 0%; P 0.610); SMD 0.65 (95% CI 0.48- 0.82; I2 80%; P 0.023); and SMD 0.51 (95% CI 0.32-0.69; I2 85%; P 0.010). CONCLUSIONS: The meta-analysis results showed that aPWV was promising for predicting all-cause mortality, while baPWV and central SBP demonstrated consistent results in evaluating cardiovascular mortality outcomes. Thus, the findings support usage of central blood pressure as a risk predictor for hard outcomes among elderly people. REGISTRATION NUMBER IN PROSPERO: RD42018085264.

En-face OCT and OCT angiography analysis of macular choroidal macrovessel.

PURPOSE: To analyze en-face optical coherence tomography (OCT) and decorrelation signals on OCT angiography (OCTA) in two cases of macular choroidal macrovessel (MCM). OBSERVATIONS: Case report. Both the 64-year-old and 71-year-old females presented for a routine evaluation, and multimodal imaging analysis, including color fundus photography, indocyanine green angiography (ICG), spectral-domain optical coherence tomography (SD-OCT) and OCTA, was performed to diagnose a MCM. En-face OCT, en-face OCTA and decorrelation signals were analyzed through the MCM. In both reported cases, color fundus photograph revealed a serpiginoid lesion in the temporal macula. Red-free imaging enhanced the appearance of this lesion resembling a dilated choroidal vessel. Cross-sectional OCT showed an enlarged choroidal vessel causing elevation of the retinal pigment epithelium (RPE) within the fovea. En-face OCTA with segmentation below the choriocapillaris enhanced the MCM delineation. En-face OCT with segmentation below the choriocapillaris showed MCM with a greater distinctness than the en-face OCTA imaging. Decorrelation signals were not observed within MCM on cross-sectional OCTA. CONCLUSION AND IMPORTANCE: En-face OCT and decorrelation signals on OCTA may have diagnostic value in distinguishing macular choroidal macrovessel from other choroidal vascular diseases.

Modulação autonômica da frequência cardíaca em crianças e jovens com paralisia cerebral / Autonomic heart rate modulation in children and youths with cerebral palsy

Introdução: A paralisia cerebral é uma doença que causa distúrbios neuromusculares, doenças cardiovasculares, além de distúrbios autonômicos e homeostáticos. Objetivo: Avaliar a modulação autonômica cardíaca de crianças e jovens com PC. Métodos: Estudo de delineamento transversal e observacional de carácter quantitativo. Foram coletados os intervalos R-R (IRR) do eletrocardiograma de 05 voluntários cadeirantes, com idade de 06 a 18 anos com PC através do cardiofrequencimetro Polar modelo V800®. Resultados: Idade média foi de 12,4 anos, ambos os gêneros, massa corpórea de 35,1 kg, estatura de 1,39 m e índice de massa corpórea 16,8 kg/m2 equivalente à desnutrição. Os dados apresentam a modulação autonômica cardíaca no domínio do tempo, as variáveis do desvio-padrão de todos os intervalos RR normais 60,0 ms, raiz-quadrada da média da soma dos quadrados das diferenças entre os IRR normais 60,3 ms, porcentagem dos IRR adjacentes maiores que 50 ms 16,1 % e no domínio da frequência a baixa frequência cardíaca (un) 55,7, a alta frequência cardíaca (un) 44,2, a razão da alta com a baixa frequência cardíaca 2,3. Conclusão: As crianças e adolescentes com paralisia cerebral têm uma baixa variabilidade da frequência cardíaca, com alta probabilidade de desenvolver doenças cardiovasculares, devido ao sedentarismo. (AU)

Introduction: Cerebral Palsy is a disease that causes neuromuscular disorders, cardiovascular diseases, in addition to disorders autonomic and homeostatic. Objective: To measure the cardiac autonomic modulation of children and young people with CP. Methods: Quantitative crosssectional and observational study. The electrocardiogram R-R intervals (IRR) were collected from 05 volunteers in wheelchairs, aged 6 to 18 years with CP through the cardiofrequencimeter Polar model V800®. Results: The average age is 12.4 years, both genders, body mass 35.1 kg, height 1.39 m and body mass index of 16.8 kg/m2 equivalent to malnutrition. The data show cardiac autonomic modulation in the time domain, the standard deviation variables of all normal RR intervals 60.0 ms, square root of the mean of the sum of squares of the differences between normal IRR 60.3 ms, percentage of adjacent IRR greater than 50 ms 16.1% and in the frequency domain, low heart rate (un) 55.7, high heart rate (un) 44.2, the ratio of discharge to low heart rate 2,3. Conclusion: Children and adolescents with cerebral palsy have a low heart rate variability, with a greater probability of developing cardiovascular diseases, due to sedentary lifestyle. (AU)

Evaluación del transporte crítico de pacientes: una revisión sistemática / Avaliação do transporte crítico de pacientes: uma revisão sistemática / Evaluation of critical transportation of patients: a systematic review

OBJETIVO: Evaluar, según la literatura, cuáles son los principales factores considerados facilitadores y/o agravantes en la realización del transporte de pacientes en estado crítico. MÉTODO: Este estudio se trata de una revisión sistemática realizada con el método PICO. RESULTADO: Los periódicos seleccionados comprendían un espacio temporal en los últimos diez años, donde 6 periódicos fueron elegibles, basado en los criterios establecidos. Los resultados relatan que los temas encontrados en esta revisión demuestran una alineación entre la práctica asistencial y la literatura, pero para que el transporte sea realizado sin eventos adversos, es necesario que haya unión entre la gestión y los profesionales involucrados. CONCLUSIÓN: Aunque los hallazgos demuestren una gran preocupación en relación a la calidad en la asistencia y en la preparación del equipo, los autores creen que más estudios deben ser fomentados una vez que el trabajo en equipo, a pesar de ser complejo, es la clave para la realización de los procedimientos con efectividad

OBJETIVO: Avaliar segundo a literatura quais são os principais fatores que são considerados facilitadores e/ou agravantes na realização do transporte de pacientes em estado crítico. MÉTODO: Este estudo trata-se de uma revisão sistemática realizada com método PICO. RESULTADO: Os periódicos selecionados compreendiam um espaço temporal nos últimos dez anos, onde 6 periódicos foram elegíveis, baseado nos critérios estabelecidos. Os resultados relatam que os temas encontrados nesta revisão demonstram um alinhamento entre a prática assistencial e a literatura, porém para que o transporte seja realizado sem eventos adversos, é necessário que haja união entre a gestão e os profissionais envolvidos. CONCLUSÃO: Embora os achados demonstrem uma grande preocupação em relação à qualidade na assistência e no preparo da equipe, os autores acreditam que mais estudos devem ser fomentados uma vez que o trabalho em equipe apesar de ser complexo, é a chave para a realização dos procedimentos com efetividade

OBJECTIVE: To evaluate, according to the literature, the main factors considered facilitators and/or aggravating in the transportation of patients in critical condition. METHOD: This study is a systematic review performed using the PICO method. RESULTS: The selected journals comprised a time space in the last 10 years, with six journals eligible, based on the established criteria. The results report that the themes found in this review demonstrate an alignment between care practice and literature, but, for a transportation without adverse events, there must be a union between the management and the professionals involved. CONCLUSION: Although the findings demonstrate a great concern regarding the quality of care and team preparation, the authors believe that more studies should be encouraged since teamwork, despite being complex, is the key to performing the procedures with effectiveness

CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report.

CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site.

Cure conservatrice et hemodynamique de l'insufficience veineuse en ambulatoire (CHIVA) é um tipo de cirurgia de varizes que evita a destruição da veia safena e colaterais. Este relato apresenta uma paciente que foi submetida a CHIVA em duas safenas para poupá-las. A paciente teve uma safena magna normal retirada em uma cirurgia no sítio cirúrgico errado, as safenas com refluxo foram mantidas, e uma normal foi ressecada. A paciente estava sintomática e foi realizada CHIVA na safena parva direita e na magna esquerda. O pós-operatório transcorreu bem com resultado clínico e estético satisfatório. Esse caso mostra que cirurgias que poupam a safena têm papel importante no tratamento da insuficiência venosa crônica. Além disso, os protocolos de cirurgia segura não cobrem adequadamente as cirurgias de varizes devido a duas safenas possíveis e por serem frequentemente cirurgias bilaterais. A realização de eco-Doppler rotineiramente pela equipe cirúrgica pode prevenir problemas relacionados ao sítio operatório.

Computerized photogrammetric assessment of postural alignment in visually impaired athletes.

OBJECTIVE: The aim of the study was to provide a computerized photogrammetric description of the postural alignment of visually impaired athletes. METHODS: Twenty-six athletes were evaluated. Athletes were asked to stand at easy with styrofoam balls placed on selected anatomical landmarks, and photographic images were acquired in four viewpoints. Postural Assessment Software (PAS/SAPO) was applied for image analysis. Body's angles and distances were calculated and transformed in absolute (nonnegative) values for analysis. Factor analysis was applied for data reduction. RESULTS: Absolute values of PAS/SAPO variables resulted in lower coefficient of variation (CV) than raw values (average of 57% versus 500%, respectively), which potentially enhances the comparative use of these measures. Head's forward positioning and rightward inclination were among the most prevalent postural deviation, being observed in more than 70% of the athletes. With respect to the magnitude of the deviation, large variability was observed in data derived from anterior/posterior compared with lateral viewpoint. For instance, head's rightward inclination (head horizontal alignment in the anterior view) achieved 2.9 ±â€¯2.5° (mean ±â€¯SD), with a CV of 86%, while head's forward positioning (C7 horizontal alignment in left viewpoint) reaches 42.7 ±â€¯6.6°, with a CV of only 16%. Factor analysis did not result in significant data reduction, although anterior body's angles and distances were identified as important sources of data variability. CONCLUSIONS: The PAS/SAPO values described here can be adopted as reference for future investigations of postural alignment in visually impaired athletes.

CHIVA to spare the small and great saphenous veins after wrong-site surgery on a normal saphenous vein: a case report / CHIVA para preservar as safenas magna e parva após cirurgia ressecando por erro a safena magna normal: relato de caso

CHIVA (Cure Conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire) is a type of operation for varicose veins that avoids destroying the saphenous vein and collaterals. We report a case of CHIVA treatment of two saphenous veins to spare these veins. The patient previously had a normal great saphenous vein stripped in error in a wrong-site surgery, while two saphenous veins that did have reflux were not operated. The patient was symptomatic and we performed a CHIVA operation on the left great and right small saphenous veins. The postoperative period was uneventful and both aesthetic and clinical results were satisfactory. This case illustrates that saphenous-sparing procedures can play an important role in treatment of chronic venous insufficiency. Additionally, most safe surgery protocols do not adequately cover varicose veins operations. Routine use of duplex scanning by the surgical team could prevent problems related to the operation site

Cure conservatrice et hemodynamique de l'insufficience veineuse en ambulatoire (CHIVA) é um tipo de cirurgia de varizes que evita a destruição da veia safena e colaterais. Este relato apresenta uma paciente que foi submetida a CHIVA em duas safenas para poupá-las. A paciente teve uma safena magna normal retirada em uma cirurgia no sítio cirúrgico errado, as safenas com refluxo foram mantidas, e uma normal foi ressecada. A paciente estava sintomática e foi realizada CHIVA na safena parva direita e na magna esquerda. O pós-operatório transcorreu bem com resultado clínico e estético satisfatório. Esse caso mostra que cirurgias que poupam a safena têm papel importante no tratamento da insuficiência venosa crônica. Além disso, os protocolos de cirurgia segura não cobrem adequadamente as cirurgias de varizes devido a duas safenas possíveis e por serem frequentemente cirurgias bilaterais. A realização de eco-Doppler rotineiramente pela equipe cirúrgica pode prevenir problemas relacionados ao sítio operatório

Laser acupuncture protocol for essential systemic arterial hypertension: randomized clinical trial.

OBJECTIVES: to evaluate the efficacy of a laser acupuncture protocol developed and applied by nurses in arterial hypertension patients. METHOD: randomized, multicenter, triple-blind and two-armed clinical trial. The sample consisted of 102 participants, 51 per arm, both sexes, aged between 30 and 75 years, undergoing drug therapy for a year or more, with difficulty to control blood pressure, maintaining regular measures >140x90 mmHg. Participants underwent six standard or simulated laser-acupuncture sessions, for 24 minutes, within a period of six weeks. Descriptive analyzes expressed as frequencies of occurrences, means and medians were used, and analysis of the association between variables was performed using Student's t-test and Anova, using Statistica® software, version 12.0. The significance level was set at 5% (alpha=0.05). The comparison between blood pressure measurements was performed using Student's t-test for paired samples and Anova for repeated measures. RESULTS: a significant reduction in systolic (p<0.001) and diastolic (p<0.001) blood pressure was observed among participants in the intervention arm, which was not observed in the simulation arm. CONCLUSION: the results have demonstrated the efficacy of the protocol. Reduction and control of blood pressure have been demonstrated, indicating the possibility of using this technology for the care of patientes with essential systemic arterial hypertension. Brazilian Registry of Clinical Trials. UTN: U1111-1177-1811. Clinical Trials NCT02530853.

Avaliação e classificação da capacidade física aeróbia de atletas de basquetebol em cadeira de rodas / Evaluation and classification of the aerobic capacity of wheelchair basketball players / Evaluación y clasificación de la capacidad aeróbica de jugadores de baloncesto en silla de ruedas

Resumo Este estudo objetivou avaliar e classificar a capacidade física aeróbia (CFA) de atletas de basquetebol em cadeira de rodas (BCR). Foram avaliados 16 atletas de BCR (oito homens/oito mulheres), que tinham as seguintes características: idade (27,2 ± 7,4 anos); massa corporal (59,0 ± 13,5 kg); estatura (153,4 ± 21,3 cm); tempo de deficiência (20,3 ± 12,3 anos); tempo de prática esportiva (9,0 ± 6,9 anos). Todos passaram por avaliação antropométrica e da CFA por meio do teste de 12 minutos para cadeirantes. Após as análises, observou-se que o consumo máximo de oxigênio dos atletas foi de, em média, 36,0 ± 3,5 ml/kg/min. Na análise qualitativa, a maioria dos atletas (62,5%) apresentou classificação da CFA "Excelente" (p = 0,02). Logo, conclui-se que os atletas avaliados apresentaram CFA acima do esperado, a maioria teve a classificação "Excelente". Isso sugere que a prática regular de BCR produz adaptações sistêmicas importantes ao sistema cardiorrespiratório.

Abstract The aim of this study was to evaluate and classify the aerobic capacity (AC) of wheelchair basketball (WB) players. For that, 16 WB athletes (8 men / 8 women), which has the following characteristics: age (27.2 ± 7.4 years); body mass (59.0 ± 13.5 kg); Height (153.4 ± 21.3 cm); time of disability (20.3 ± 12.3 years); time of sports practice (9.0 ± 6.9 years). All of participants underwent for the anthropometric and AC variables assessment through the 12-minute aerobic test for wheelchair users. After the analysis, there was observed average maximal oxygen uptake of 36.0 ± 3.5 ml/kg/min. In the qualitative analysis, most of the athletes (62.5%) presented an "Excellent" AC classification (p = 0.02). Therefore, it is concluded that the athletes presented higher AC than expected, rated as "Excellent" for the most of these, suggesting that the regular practice of WB produces important systemic adaptations to the cardiorespiratory system.

Resumen El objetivo de este estudio fue evaluar y clasificar la capacidad aeróbica (CA) de jugadores de baloncesto en silla de ruedas (BSR). Para ello, se evaluó a 16 atletas de BCR (8 hombres/8 mujeres), que presentaban las siguientes características: edad (27,2 ± 7,4 años); masa corporal (59,0 ± 13,5 kg); (153,4 ± 21,3 cm); tiempo de deficiencia (20,3 ± 12,3 años); tiempo de práctica deportiva (9,0 ± 6,9 años). Todos pasaron por la evaluación de las variables antropométricas y de la CA según la prueba aeróbica de 12 minutos en silla de ruedas. Después del análisis, se observó que la absorción máxima de oxígeno de los atletas fue, por término medio, de 36,01 ± 3,47 ml/kg/min. En el análisis cualitativo, la mayoría de los atletas (62,5%) presentaron una clasificación de la CA «excelente¼ (p = 0,02). Por tanto, se concluye que los atletas evaluados presentan una CA mayor de lo esperado y en la mayoría de ellos se clasifica como «excelente¼, lo que sugiere que la práctica regular de BSR tendrá importantes ajustes sistémicos en el sistema cardiorrespiratorio.

Laser acupuncture protocol for essential systemic arterial hypertension: randomized clinical trial / Protocolo de laser-acupuntura para hipertensão arterial sistêmica primária: ensaio clínico randomizado / Protocolo de láser-acupuntura para la hipertensión arterial sistémica primaria: ensayo clínico aleatorizado

ABSTRACT Objectives: to evaluate the efficacy of a laser acupuncture protocol developed and applied by nurses in arterial hypertension patients. Method: randomized, multicenter, triple-blind and two-armed clinical trial. The sample consisted of 102 participants, 51 per arm, both sexes, aged between 30 and 75 years, undergoing drug therapy for a year or more, with difficulty to control blood pressure, maintaining regular measures >140x90 mmHg. Participants underwent six standard or simulated laser-acupuncture sessions, for 24 minutes, within a period of six weeks. Descriptive analyzes expressed as frequencies of occurrences, means and medians were used, and analysis of the association between variables was performed using Student's t-test and Anova, using Statistica® software, version 12.0. The significance level was set at 5% (alpha=0.05). The comparison between blood pressure measurements was performed using Student's t-test for paired samples and Anova for repeated measures. Results: a significant reduction in systolic (p<0.001) and diastolic (p<0.001) blood pressure was observed among participants in the intervention arm, which was not observed in the simulation arm. Conclusion: the results have demonstrated the efficacy of the protocol. Reduction and control of blood pressure have been demonstrated, indicating the possibility of using this technology for the care of patientes with essential systemic arterial hypertension. Brazilian Registry of Clinical Trials. UTN: U1111-1177-1811. Clinical Trials NCT02530853.

RESUMO Objetivos: avaliar a eficácia de um protocolo para laser-acupuntura, desenvolvido e aplicado por enfermeiros em pacientes com hipertensão arterial. Método: ensaio clínico randomizado, multicêntrico, triplo-cego, dois braços. A amostra foi composta por 102 participantes, 51 por braço, ambos os sexos, idade entre 30 e 75 anos, em tratamento medicamentoso há um ano ou mais, com dificuldades para controle da pressão arterial, mantendo medidas regulares >140x90 mmHg. Os participantes foram submetidos a seis sessões de laser-acupuntura, padrão ou simulada, com duração de 24 minutos, no decorrer de seis semanas. Empregaram-se análises descritivas por frequências de ocorrências, médias e medianas, e de associação entre variáveis por teste t de Student e Anova, empregando o software Statistica®, versão 12.0. O nível de significância adotado foi de 5% (alpha=0,05). A comparação entre resultados da pressão arterial foi pelo teste t de Student para amostras pareadas e Anova para medidas repetidas. Resultados: observou-se redução significativa da pressão arterial sistólica (p<0,001) e diastólica (p<0,001) dos participantes do braço intervenção, evento não verificado no braço simulado. Conclusão: pelos resultados constatou-se eficácia do protocolo. Houve redução e controle da pressão arterial, indicando seu emprego como possibilidade de tecnologia para o cuidado de pessoas com hipertensão arterial sistêmica primária. Registro Brasileiro de Ensaios Clínicos. UTN: U1111-1177-1811. Clinical TrialsNCT02530853.

RESUMEN Objetivos: evaluar la eficacia de un protocolo de láser-acupuntura, desarrollado y aplicado por enfermeros en pacientes con hipertensión arterial. Método: ensayo clínico aleatorizado, multicéntrico, triple-ciego, de dos brazos. La muestra quedó conformada por 102 participantes, 51 por brazo, ambos sexos, con edades comprendidas entre los 30 y los 75 años, sometidos a tratamiento con medicamentos durante un año o más, con dificultades para controlar la presión arterial, manteniendo medidas regulares >140x90 mmHg. Los participantes se sometieron a seis sesiones de láser-acupuntura, estándar o simulada, durante 24 minutos, a lo largo de seis semanas. Se utilizaron análisis descriptivos expresados como frecuencias de ocurrencias, medias y medianas, y el análisis de la asociación entre variables se realizó mediante la prueba t de Student y Anova, utilizándose el software Statistica®, versión 12.0. El nivel de significación se fijó en un 5% (alfa=0,05). La comparación entre los resultados de la presión arterial se realizó utilizándose la prueba t de Student para muestras pareadas y Anova, para medidas repetidas. Resultados: se observó una reducción significativa de la presión arterial sistólica (p<0,001) y diastólica (p<0,001) entre los participantes en el brazo intervención, lo que no se observó en el brazo simulado. Conclusión: los resultados han comprobado la eficacia del protocolo. Se ha demostrado la reducción y el control de la presión arterial, lo que indica la posibilidad de utilizar esta tecnología para la atención de pacientes con hipertensión arterial sistémica primaria. Registro Brasileño de Ensayos Clínicos. UTN: U1111-1177-1811. Clinical TrialsNCT02530853.

Fatty acid profile in vertical strata of elephant grass subjected to intermittent stocking

ABSTRACT The milk and meat from animals with a pasture-based diet have higher proportions of CLA and C18:3 and lower omega-6:omega-3 ratios than products from animals with diets based on corn silage and concentrate. However, most of the published studies have evaluated fatty acid profiles in temperate climate grasses and the literature with tropical grasses is scarce. Thus, the aim of this study was to evaluate the morphological and fatty acid compositions in the vertical strata of elephant grass (Pennisetum purpureum Schum.) swards subjected to grazing heights (90 or 120 cm pre-grazing heights) and levels of defoliation (50% or 70% removal of the initial pre-grazing height). There were no interactions among pre-grazing height, the level of defoliation and grazing stratum. However, higher proportion of C18:3 (58% and 63%) was found in the 90-cm swards and in the half upper stratum. A higher proportion of C18:3 was associated with a higher leaf proportion and crude protein content. Thus, the upper stratum of sward or a grazing management scheme (e.g. first-last stocking) resulting in a higher proportion of leaves and crude protein both provide higher proportions of C18:3 to animals grazing in elephant grass swards.