Electrodiagnosis for mitigating false-negative non-responsiveness in electrical evoked contractions: A case series exploring probable polyneuromyopathy induced by nonuse.

INTRODUCTION: The revised international standards for neurological classification of spinal cord injury (ISNCSCI) have facilitated the documentation of non-spinal cord injury-related impairments, such as chronic peripheral nerve injuries and muscle weakness due to immobility. This advancement addresses potential biases in muscle strength examinations. Utilizing electrically evoked contractions from paralyzed muscles, enhanced by electrodiagnosis, holds promise in identifying false-negative diagnoses of non-responsiveness to neuromuscular electrical stimulation. This concept prompts the exploration of polyneuromyopathy arising from nonuse in paralyzed muscles. CASE SERIES PRESENTATION: To substantiate our hypothesis, we recruited nine participants for a case series aimed at elucidating the potential benefits of incorporating the stimulus electrodiagnostic test (SET) to mitigate non-responsiveness during preparation for functional electrical stimulation (FES)-assisted cycling. In our convenience sample (n = 5), we conducted neurological mapping based on ISNCSCI and applied SET on the quadriceps. The SET guided optimal dosimetry for evoking contractions and revealed responses similar to those observed in peripheral neuropathies, with α coefficients equal to or lower than 2.00. This observation is likely attributable to nonuse of paralyzed muscles, indicative of an ongoing polyneuropathy in individuals with chronic spinal cord injury (SCI). DISCUSSION: Among the nine initially recruited subjects, seven exhibited responsiveness to neuromuscular electrical stimulation (78% responsiveness), with two participants excluded based on exclusion criteria. In the final five reported cases, all displayed α coefficient values indicating impaired neuromuscular accommodation, and one presented no α coefficient within the normal range. The inclusion of electrodiagnosis appears effective in averting non-responsiveness, suggesting the presence of ongoing polyneuropathies in paralyzed muscles.

Assessing Cross-Border Telemedicine Data Exchange in the European Union: A Call to Action.

Background: Telemedicine offers potential benefits for health care delivery. However, evidence of cross-border telemedicine data exchange within the European Union (EU) remains limited. The objective of this communication provides a brief outline of the regulatory framework, initiatives, and challenges associated with cross-border telemedicine data exchange in the EU, setting the stage for a comprehensive evidence assessment. Methods: We explore the current regulatory landscape (European Health Data Space), existing initiatives (the European Electronic Health Record Exchange Format), and interoperability challenges (e.g., legal, technical, semantic) facing EU cross-border telemedicine data exchange. Results: There is a need for thorough evidence assessment of cross-border telemedicine and related data movements. Conclusion: Understanding the current landscape of cross-border telemedicine is crucial. This article highlights the need for evidence assessment through a formal review to inform future research and policy initiatives in this domain.

Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study.

Introduction: Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods: We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results: Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions: The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.

Pathophysiology-Based Management of Secondary Injuries and Insults in TBI.

Traumatic Brain Injury (TBI) remains a leading cause of morbidity and mortality among all ages; despite the advances, understanding pathophysiological responses after TBI is still complex, involving multiple mechanisms. Previous reviews have focused on potential targets; however, the research on potential targets has continuously grown in the last five years, bringing even more alternatives and elucidating previous mechanisms. Knowing the key and updated pathophysiology concepts is vital for adequate management and better outcomes. This article reviews the underlying molecular mechanisms, the latest updates, and future directions for pathophysiology-based TBI management.

Perfusion tomography in early follow-up of acute traumatic subdural hematoma: a case series.

Perfusion Computed Tomography (PCT) is an alternative tool to assess cerebral hemodynamics during trauma. As acute traumatic subdural hematomas (ASH) is a severe primary injury associated with poor outcomes, the aim of this study was to evaluate the cerebral hemodynamics in this context. Five adult patients with moderate and severe traumatic brain injury (TBI) and ASH were included. All individuals were indicated for surgical evacuation. Before and after surgery, PCT was performed and cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were evaluated. These parameters were associated with the outcome at 6 months post-trauma with the extended Glasgow Outcome Scale (GOSE). Mean age of population was 46 years (SD: 8.1). Mean post-resuscitation Glasgow coma scale (GCS) was 10 (SD: 3.4). Mean preoperative midline brain shift was 10.1 mm (SD: 1.8). Preoperative CBF and MTT were 23.9 ml/100 g/min (SD: 6.1) and 7.3 s (1.3) respectively. After surgery, CBF increase to 30.7 ml/100 g/min (SD: 5.1), and MTT decrease to 5.8s (SD:1.0), however, both changes don't achieve statistically significance (p = 0.06). Additionally, CBV increase after surgery, from 2.34 (SD: 0.67) to 2.63 ml/100 g (SD: 1.10), (p = 0.31). Spearman correlation test of postoperative and preoperative CBF ratio with outcome at 6 months was 0.94 (p = 0.054). One patient died with the highest preoperative MTT (9.97 s) and CBV (4.51 ml/100 g). CBF seems to increase after surgery, especially when evaluated together with the MTT values. It is suggested that the improvement in postoperative brain hemodynamics correlates to favorable outcome.

Análise de Artigos sobre o Teste de Apercepção Temática (TAT) no Brasil / Analysis of Articles on the Thematic Apperception Test (TAT) in Brazil / Análisis de Artículos en el Test de Apercepción Temática (TAT) en Brasil

Resumo: O Teste de Apercepção Temática (TAT) é um instrumento projetivo usado para avaliação da personalidade. Devido ao aumento da utilização do TAT no Brasil em diferentes contextos, percebeu-se a necessidade de realizar uma revisão narrativa. Objetiva-se analisar a produção científica de estudos empíricos em relação aos principais objetivos, características metodológicas e principais resultados. Foram recuperados 18 artigos das bases de dados SciELO, LILACS, PePSIC. Os estudos foram submetidos à análise temática considerando os objetivos principais. Os resultados indicaram uma distribuição desproporcional de publicações nos últimos 15 anos, com maior produção no sudeste do país. Notou-se maioria de estudos qualitativos do tipo exploratório, sendo prevalentes estudos realizados com participantes mulheres, e uso do TAT como instrumento único. Conclui-se a necessidade da realização de estudos empíricos nas diversas regiões do país, com diferentes idades e gêneros para ampliar o escopo do uso do teste.

Abstract: The Thematic Apperception Test (TAT) is a projective instrument used to assess individuals' personality. The increase in the use of TAT in Brazil in different contexts entailed the need for a narrative review. This study aimed to analyze the scientific production of empirical studies by evaluating its main objectives, methodological characteristics, and results. In total, 18 articles were retrieved from the SciELO, Lilacs, and PePSIC databases. The studies were subjected to thematic analysis considering their main objectives. Results indicated a disproportionate distribution of publications in the last 15 years, with higher production in the Brazilian southeast. Qualitative exploratory studies predominated, especially those with female participants and TAT as a single instrument. In conclusion, empirical studies must be carried out in different regions of the country with different ages and genders to expand the scope of the use of the test.

Resumen: El Test de Apercepción Temática (TAT) es una herramienta proyectiva utilizada en la evaluación de la personalidad. Debido al aumento en el uso de TAT en Brasil en diferentes contextos, surgió la necesidad de realizar una revisión narrativa. El objetivo de este estudio fue analizar la producción científica de los estudios empíricos con relación a los principales objetivos, características metodológicas y principales resultados. Dieciocho artículos fueron recolectados de las bases de datos SciELO, LILACS y PePSIC. Se sometieron los estudios a análisis temático considerando los objetivos principales. Los resultados muestran una distribución desproporcionada de publicaciones en los últimos quince años, con mayor producción en el Sudeste del país. Hubo una mayoría de estudios cualitativos exploratorios, con predominio de estudios realizados con participantes del sexo femenino, y la utilización del TAT como única herramienta. Se concluye que es necesario realizar estudios empíricos en diferentes regiones del país, con diferentes grupos etarios y de género, para ampliar el alcance del uso de la prueba.

Fatores que dificultam o diagnóstico da hanseníase nas perspectivas dos profissionais da saúde da estratégia da saúde da família em unidades básicas de saúde em Imperatriz - MA / Factors that hinder the diagnosis of leprosy in the perspectives of health professionals of the family health strategy in basic health units in Imperatriz - MA

A hanseníase é uma doença crônica ocasionada pelo Mycobacterium leprae, gerando sintomas dermatoneurológicos. O diagnóstico é clínico, porém sua identificação é dificultada pela similaridade clínica com outras patologias cutâneas, impedindo o diagnóstico precoce e promovendo a ocorrência de incapacidades físicas. Diante disso, faz-se imprescindível conhecer os motivos dessa demora, a partir da perspectiva dos profissionais de saúde na atenção primária. Para tanto, este estudo tem como objetivo avaliar a percepção dos profissionais da estratégia da saúde da família (ESF) acerca das dificuldades no diagnóstico da hanseníase no município de Imperatriz, Maranhão. Esta pesquisa se trata de um estudo de natureza aplicada, abordagem qualitativa e com caráter exploratório, realizada com a equipe da ESF em Unidades Básicas de Saúde (UBS) de Imperatriz-MA. Para a coleta de dados, foi aplicada uma entrevista semiestruturada elaborada pelos autores, dividida em três blocos. No bloco "conhecimento sobre a doença", o nível mediano foi o mais prevalente nas falas dos participantes. No bloco "dificuldades de diagnóstico", o que ficou mais em evidência nas respostas foram "baixa adesão",. "estigmas/preconceito" e "resistência". Sendo assim, medidas foram sugeridas pelos entrevistados, as quais devem ser colocadas em prática diariamente tanto em ambiente social como profissional, visando um diagnóstico mais rápido, melhorando a qualidade de vida dos pacientes e favorecendo o controle da doença.

Leprosy is a chronic disease caused by Mycobacterium leprae, resulting in dermatoneurological symptoms. The diagnosis is clinical, but its identification is hindered by the clinical similarity to other skin pathologies, preventing early diagnosis and promoting the occurrence of physical disabilities. Therefore, it is essential to know the reasons for this delay from the perspective of primary healthcare professionals. Thus, this study aims to evaluate the perception of family health strategy (FHS) professionals about the difficulties in diagnosing leprosy in the municipality of Imperatriz-MA. This research is a study of applied nature, qualitative approach and with an exploratory character, carried out with the FHS team in Basic Health Units (UBS, in portuguese) from Imperatriz-MA. For data collection, a semi-structured interview prepared by the authors was applied, divided into three sections. In the "knowledge about the disease" section, the median level was the most prevalent in the participants' statements. In the section "diagnosis difficulties", what was more evident in the answers were "low adherence", "stigma/prejudice", and "resistance". Consequently, the interviewees suggested measures that should be implemented in daily practice, both in a social and professional environment, aiming at a faster diagnosis, improving the quality of life of patients and favoring disease control.

Cultural Adaptation and Psychometric Evidence of the Phubbing Scale / Adaptação Cultural e Evidências Psicométricas da Escala de Phubbing / Adaptación Cultural y Evidencia Psicométrica de la Escala de Phubbing

Abstract Phubbing, the act of ignoring people during a face-to-face interaction to dedicate attention to the smartphone, is a phenomenon widely observed in today's society. Therefore, this research aimed to carry out the cross-cultural adaptation of the Phubbing Scale to Brazilian Portuguese and examine its psychometric properties. The study included 1,551 Brazilian adults, 61.7% female and 29.9% male, aged from 18 to 76 years (M = 31.6 years; SD = 9.6 years). A socio-demographic questionnaire and the Phubbing Scale were used. Exploratory Factor Analysis, Confirmatory Factor Analysis, Network Analysis and Mann-Whitney Test were performed. The results confirmed the bifactorial version of the Phubbing Scale with good fit indices (CFI = 0.99; TLI = 0.99; α = 0.83). The Phubbing Scale showed adequate psychometric properties and internal consistency for use in Brazil.

Resumo Comportamento de Phubbing, ato de ignorar as pessoas durante uma interação presencial para dedicar atenção ao smartphone, é um fenômeno amplamente observado na sociedade atual. Diante disto, o objetivo desta pesquisa foi realizar a adaptação transcultural da Escala de Phubbing para a população brasileira e examinar suas propriedades psicométricas. Participaram da pesquisa 1.551 adultos brasileiros, sendo 61,7 % do sexo feminino e 29,9% do sexo masculino, com idades entre 18 e 76 anos (M = 31,6 anos; DP = 9,6 anos). Foram utilizados o questionário sociodemográfico e a Escala de Phubbing. Foram realizadas Análise Fatorial Exploratória, Análise Fatorial Confirmatória, Análise de Rede e Teste de Mann-Whitney. Os resultados confirmaram a versão bifatorial da Escala de Phubbing com bons índices de ajustes (CFI = 0,99; TLI = 0,99; α = 0,83). A Escala de Phubbing apresentou propriedades psicométricas e consistência interna adequadas para utilização no contexto brasileiro.

Resumen El Comportamiento de Phubbing, el acto de ignorar a las personas durante una interacción cara a cara para dedicar su atención al teléfono inteligente, es un fenómeno ampliamente observado en la sociedad actual, por tanto, el objetivo de esta investigación fue realizar la adaptación transcultural de la Escala Phubbing al portugués brasileño y examinar sus propiedades psicométricas. Un total de 1551 adultos brasileños participaron en la encuesta, 61,7% mujeres y 29,9% hombres, con edades entre 18 y 76 años (M = 31,6 años; SD = 9,6 años). Se utilizó el cuestionario sociodemográfico y la Escala de Phubbing. Se realizaron Análisis Factorial Exploratorio, Análisis Factorial Confirmatorio, Análisis de Redes y Prueba de Mann-Whitney. Los resultados confirmaron la versión bifactorial de la Escala de Phubbing con buenos índices de ajuste (CFI = 0,99; TLI = 0,99; α = 0,83). La Escala de Phubbing mostró propiedades psicométricas y consistencia interna adecuadas para su uso en el contexto brasileño.

Assessment of neuromuscular electrical stimulation in critically ill patients: physical therapists' knowledge and barriers to its use / Avaliação do uso da estimulação elétrica neuromuscular em pacientes críticos: conhecimento dos fisioterapeutas e barreiras à implementação / Evaluación del uso de la electroestimulación neuromuscular en pacientes críticos: conocimiento de los fisioterapeutas y barreras para su implementación

ABSTRACT Transcutaneous neuromuscular electrical stimulation (NMES) is considered an important tool to prevent muscle mass and strength loss in patients admitted to intensive care units (ICU). This study aimed to evaluate physical therapists' profile and knowledge of NMES and identify the main barriers to its use in ICUs. This observational cross-sectional study was conducted via a structured questionnaire created by the authors. It consisted of 12 objective questions to analyze physical therapists' knowledge of NMES use in critically ill patients. Physical therapists were invited to participate in this study during an international symposium on NMES. In total, 56 physical therapists, with a mean age of 33.5±7.2 years and working an average of 9.7±7 years after graduation, completed the survey. Overall, 34 respondents worked in ICUs, of which only four (12%) reported regular NMES use in their ICUs. We found a low average of correct answers to our questionnaire (25%; 3/12). The main barriers reported to using NMES in ICUs were lack of knowledge (28; 50%) and equipment (24; 43%). The number of correct answers expert and non-expert physical therapists was not statistically significant (p=0.68). Thus, we observed participants' poor knowledge of NMES use in critically ill patients. Respondents showed that NMES has been underused in their ICUs. Lack of knowledge and equipment seems to be the main barriers for the use of NMES in ICUs.

RESUMO A estimulação elétrica neuromuscular transcutânea (EENM) é considerada uma importante ferramenta para prevenir a perda de força e massa muscular em pacientes internados em unidades de terapia intensiva (UTIs). Este estudo teve como objetivo avaliar o perfil e conhecimento dos fisioterapeutas sobre a EENM e identificar as principais barreiras para sua utilização na UTI. Foi realizado um estudo observacional transversal, por meio de um questionário estruturado elaborado pelos autores. O questionário foi composto por 12 questões objetivas que visavam analisar o nível de conhecimento dos fisioterapeutas sobre o uso da EENM em pacientes críticos. Os fisioterapeutas foram convidados a participar do estudo durante um simpósio internacional sobre EENM. Cinquenta e seis fisioterapeutas completaram a pesquisa, a média de idade foi de 33,5±7,2 anos e o tempo médio de graduação de 9,7±7 anos. Trinta e quatro entrevistados trabalhavam na UTI, e destes apenas 4 (12%) relataram que a EENM era realizada rotineiramente em suas UTIs. Observou-se baixo nível de conhecimento sobre o uso da EENM em pacientes críticos no questionário, com média de 25% de acertos (3/12). Ao comparar os fisioterapeutas especialistas e não especialistas, o número de acertos não foi estatisticamente significativo (p=0,68). As principais barreiras relatadas para a utilização da técnica foram a falta de conhecimento 28 (50%) e a falta de equipamentos 24 (43%). Os entrevistados demonstraram que a EENM tem sido subutilizada em suas UTIs.

RESUMEN La electroestimulación neuromuscular transcutánea (TENS) es una herramienta importante para prevenir la pérdida de fuerza y masa muscular en pacientes ingresados en unidades de cuidados intensivos (UCI). Este estudio tuvo como objetivo evaluar el perfil y el conocimiento de los fisioterapeutas sobre la TENS, así como identificar las principales barreras para su uso en la UCI. Se llevó a cabo un estudio observacional transversal mediante un cuestionario estructurado desarrollado por los autores. El cuestionario constaba de 12 preguntas objetivas cuyo objetivo era analizar el nivel de conocimiento de los fisioterapeutas sobre el uso de la TENS en pacientes críticos. Se invitó a los fisioterapeutas a participar en el estudio durante un simposio internacional sobre TENS. Cincuenta y seis fisioterapeutas completaron la encuesta, la edad media fue de 33,5±7,2 años, y el tiempo medio desde la graduación fue de 9,7±7 años. Treinta y cuatro encuestados trabajaban en la UCI, y de estos solo 4 (12%) informaron que la TENS se realizaba de forma rutinaria en las UCI donde trabajaban. Los resultados del cuestionario mostraron un bajo nivel de conocimiento sobre el uso de la TENS en pacientes críticos, con un promedio de 25% de respuestas correctas (3/12). En la comparación entre los fisioterapeutas especialistas y los no especialistas, el número de respuestas correctas no fue estadísticamente significativo (p=0,68). Las principales barreras reportadas para el uso de esta técnica fueron la falta de conocimiento 28 (50%) y la falta de equipamiento 24 (43%). Los encuestados demostraron que esta técnica es infrautilizada en las UCI.

Telemedicina aplicada a los cuidados paliativos, implicaciones éticas y beneficios: una revisión sistemática / Telemedicine applied to palliative care, ethical implications and benefits: a systematic review

Introducción: La telemedicina o la telesalud son conceptos similares que definen el uso de las tecnologías de telecomunicación en la prestación de servicios médicos especializados a distancia. El entorno de los cuidados paliativos ofrece nuevas oportunidades para mejorar la comunicación y apoyar a los pacientes y sus familias al final de la vida. Sin embargo, existen implicaciones éticas en el contexto del final de la vida, principalmente asociadas a los riesgos de descuidar la privacidad y confidencialidad del paciente y a cuestiones relacionadas con la humanización/deshumanización de los cuidados.Objetivo: Identificar los beneficios y las implicaciones éticas de la telemedicina aplicada a los cuidados paliativos.Métodos: Es una revisión sistemática con síntesis narrativa. Población de interés: pacientes adultos de cuidados paliativos al final de la vida expuestos a las tecnologías y sus familias, los cuidadores informales y los profesionales implicados en el proceso de atención. Se incluyeron todos los diseños de estudio, excepto la literatura gris. Las revisiones sistemáticas solo se seleccionaron para identificar artículos relevantes y significativos para incluir en la revisión.Resultados: Se incluyeron un total de 22 artículos de los 321 encontrados. Los estudios cualitativos fueron mayoritarios y, en general, hubo una variación significativa en el tamaño de la muestra. Los cuidados paliativos a domicilio fueron la aplicación más común de las intervenciones de telemedicina, y las formas de teleconsulta constituyeron la mayoría de las intervenciones.Conclusiones: Se identificaron intervenciones de telemedicina con gran potencial para mejorar la calidad de la atención. Algunas plantean cuestiones de humanización. Sin embargo, se abordan de manera superficial y no se correlacionan con la satisfacción y la calidad de vida del paciente/cuidador. (AU)

Introduction: Telemedicine and telehealth are similar concepts that define the use of telecommunication technologies in delivering specialized medical services at a distance. The palliative care setting offers new opportunities to enhance communication and support patients and their families at the end of life. However, there are ethical implications in the end-of-life context, mainly associated with the risks of neglecting patient privacy and confidentiality, and issues related to the humanization/dehumanization of care.Objective: To identify the benefits and ethical implications of telemedicine as applied to palliative care.Methods: A systematic review with a narrative synthesis. The population of interest: adult palliative care patients at the end of life, exposed to technologies, and their families, informal caregivers and professionals involved in the care process. All study designs were included, except grey literature. Systematic reviews were only selected to identify relevant and meaningful articles to include in the review.Results: 22 articles were included out of the 321 that were found. Qualitative studies were in the majority, and overall there was significant variation in sample size. Home-based palliative care was the most common application of telemedicine interventions, and forms of teleconsultation constituted the majority of interventions.Conclusions: Telemedicine interventions with great potential to improve quality of care were identified. Some raise humanization issues. However, they are superficially addressed and do not correlate with patient/caregiver satisfaction and quality of life. The most critical ethical implications had to do with privacy and the safety of the technology used, as recognized by both patients and healthcare professionals. (AU)

Acaricidal activity of Furcraea foetida leaf extract against engorged female Rhipicephalus (Boophilus) microplus ticks

The Rhipicephalus (Boophilus) microplus tick is a major concern for the livestock market worldwide, as it causes serious economic damage. Plant-derived acaricides are an attractive alternative to control this ectoparasite and limit the development of resistance. Therefore, the aim of this study was to evaluate the acaricidal activity of Furcraea foetida leaf extract against engorged female R. (B.) microplus ticks. Our in vitro bioassays showed that the crude extract of leaves from F. foetida caused hemorrhagic swelling and skin lesions in the ticks, and three days of treatment caused 100% mortality. Dose-response assay indicated that this toxicity effect was dose-dependent. Similar effects were observed when the crude extract from F. foetida leaves was denatured by boiling at 100°C. These results suggest that the toxicity of the leaf extract might be associated with thermostable biomolecules. Together, our results show for the first time that the crude extract of F. foetida leaves has acaricidal activity against engorged female R. (B.) microplus ticks and it acts in a dose-dependent manner.

The Role of Neurophysiological Monitoring during Complex Aneurysm Surgery: Report of Two Cases and Review of the Literature

The surgical treatment of intracranial aneurysms is a routine operation in the neurosurgeon practice. Complex aneurysms are those with morphological irregularities, usually large or giant; thrombosed, partially thrombosed or calcified; with aberrant fundus/neck ratio and near eloquent neurological structures. These cases demand special skills by the surgical team. The present article is a report of two cases of complex aneurysms successfully treated, with a discussion on the role of neurophysiological monitoring. In these two cases of supra- and infratentorial complex giant aneurysms, intraoperative monitoring was extremely relevant. Thus, we believe that treating complex and giant aneurysms carries several pitfalls, and the use of multimodal intraoperative monitoring is mandatory to mitigate risks and deliver the best result to the patient.

Os impactos da difusão tecnológica na bovinocultura leiteira: um estudo dos integrantes da cadeia agroindustrial do leite em um município de Minas Gerais / The impacts of technology dissemination in dairy cattle: a study of milk agribusiness chain in a Minas Gerais' county, Brazil

O objetivo deste artigo foi analisar a inserção de tecnologia na cadeia agroindustrial do leite no município de Patos de Minas, no Estado de Minas Gerais. Foi realizado um estudo descritivo, de natureza quantitativa, com três segmentos pertencentes à cadeia agroindustrial de leite do município, constituídos por trinta produtores rurais, duas associações de produtores e duas indústrias processadoras de leite, totalizando 34 questionários aplicados aos três segmentos identificados. Os resultados demonstraram que, no período investigado, o setor de bovinocultura leiteira no município passou por profundas mudanças estruturais no que tange a difusão tecnológica, a inovação e a logística, ocasionando, dentre outros, a diminuição do número de empresas rurais, melhoria da infraestrutura e aumento de certificações ambientais. Portanto, pode-se observar que o ambiente mudou e que a incorporação de inovações tecnológicas por parte dos segmentos pesquisados, bem como a modernização de infraestrutura focaram melhoria na produção e processamento do leite.

The paper purpose was to examine the technology inclusion of the milk agro-industrial chain in the city of Patos de Minas, in Minas Gerais. It was a descriptive and quantitative research using three business segments. The research involved thirty farmers, two producers associations and two milk processing industries, totaling 34 interviews. The results showed that, in the investigated period, the sector suffered significant structural changes regarding technological diffusion, innovation and logistics, resulting in, among others, a decrease in the number of rural enterprises, improving infrastructure and increasing environmental certifications. Therefore, it can be seen that the environment has changed and that the incorporation of technological innovations by the surveyed sectors, as well as upgrading of the infrastructure have focused on improving the production and processing of milk.

Current perception threshold and reaction time in the assessment of sensory peripheral nerve fibers through sinusoidal electrical stimulation at different frequencies

INTRODUCTION: The Perception Sensory Threshold (ST) for sinusoidal current stimuli at 5, 250, and 2,000 Hz is commonly used in the assessment of peripheral nerve fibers (C, Aδ, and Aβ, respectively). However, the neuroselectivity of these frequencies is far from consensus. In addition, Reaction Time (RT) measurements suggest that 2,000 Hz stimuli excite Aβ-fibers, 250 Hz Aβ- or Aδ-fibers, as well as 5 Hz Aβ-, Aδ- or C-fibers. Therefore, we suppose that the sinusoidal current neuroselectivity may be better observed if ST and RT parameters are jointly evaluated. In addition, we have investigated whether there are other sets of frequencies that could be used. METHODS: Thus this work investigates ST and RT for stimuli with frequency ranging from 1 to 3,000 Hz, on 28 healthy subjects aged from 19 to 44 years old (27.1±5.49). ST and RT dissimilarity among different frequencies was evaluated applying bi-dimensional Fisher Quadratic Discriminant. RESULTS: The lowest classification error (3.6%) was obtained for 1, 250, and 3,000 Hz. Error for 5, 250, and 2,000Hz was 16.7%. Stimulation frequency at 1 Hz evoked more sensations related to C-fibers (53% of reports) than to Aβ-fibers (36%). However, this behavior did not repeat itself at 5 Hz (only 21% of perceptions were related to C-fibers against 64% to Aβ-fibers). Sensations related to Aβ-fibers prevailed for the highest frequencies presented to the subjects (2,000 Hz - 82% and 3,000 Hz - 93%). Mean RT values showed a decreasing trend with frequency. CONCLUSION: These results suggest that frequencies 1, 250, and 3,000 Hz are more neuroselective than 5, 250, and 2,000 Hz for the evaluation of peripheral sensitive fibers. Furthermore, they show RT usefulness.

Tratamento de micrognatia mandibular severa com rotação do complexo maxillomandibular / Management of several mandibular micrognathia by means of rotation of maxillomandibular complex

A micrognatia mandibular severa é, frequentemente, acompanhada por uma deficiência vertical dos ramos mandibulares e plano oclusal aberto. O tratamento ortodôntico-cirúrgico, considerando a correção da inclinação do plano oclusal, resultará em grandes benefícios estéticos e funcionais, que o tratamento convencional não traria a este grupo de pacientes. No caso clínico apresentado foi realizada a rotação do complexo maxilomandibular no sentido anti-horário, para otimização do resultado. Também serão abordadas considerações em relação ao preparo ortodôntico pré-cirúrgico

Análise da qualidade microbiológica de materiais odontológicos / Microbiological quality assessment of dental materials

O objetivo foi avaliar a qualidade microbiológica de materiais odontológicos (Vitrebond- 3M, Z100 - 3M, Single Bond - 3M e Permite C - SDI) antes, durante e após serem usados. As amostras foram colocadas em Erlemayer contendo Calet (DIFCO) e incubadas a 32-35°C por 20 dias. Quando turvado, o meio foi semeado em MHa (Merck) e Alet (DIFCO), e incubado. Identificados os morfotipos, as bactérias foram transferidas para Agar Nutriente (Merck), para identificação. Verificou-se que os materiais testados vieram de fábrica sem contaminação, havendo pouca probabilidade de contaminação cruzada pelo uso desses materiais

Acute hemorrhagic leukoencephalitis mimicking herpes simplex encephalitis: case report

Leucoencefalite hemorrágica aguda (AHLE) é forma grave da encefalomielite disseminada aguda, caracterizada por curso clínico fulminante e necrose hemorrágica da substância branca. Relatamos o caso de uma paciente de 57 anos de idade que desenvolveu estado confusional agudo uma semana após infecção respiratória. Ressonância magnética do encéfalo mostrou alterações de sinal bilateralmente em lobos frontal e temporal sugestivas de encefalite herpética. O estudo microbiológico do líquor foi negativo, assim como a reação de cadeia da polimerase (PCR) para o vírus herpes simplex. Diagnosticou-se AHLE e a paciente foi tratada com metilprednisolona 1g/dia durante 5 dias. Apesar do tratamento, a paciente apresentou sequelas neurológicas compatíveis com a gravidade de seu quadro clínico.

Carcinoma renal de células transicionais: aspecto tomográfico computadorizado / Renal carcinoma of transitional cells: computerized tomographic aspect

Os autores relatam um caso de carcinoma renal de células transicionais em um paciente do sexo masculino, branco, 53 anos, lavrador, com história de febre e hematúria macroscópica intermitentes havia dois anos. A urografia endovenosa inicial (1987) demonstrou retardo da eliminaçäo pelo rim direito, com imagem cavitada no seu cálice médio, que concentrava a substância de contraste progressivamente, tendo sido prescrito tratamento para tuberculose renal. A segunda urografia endovenosa (1989) revelou exclusäo funcional do mesmo rim. A tomografia computadorizada foi o exame fundamental na elucidaçäo do diagnóstico