Conversion of Roux-en-Y gastric bypass to single anastomosis duodenal ileal bypass with sleeve gastrectomy with gastrogastric jejunal bridge.

Surgical conversion of Roux-en-Y gastric bypass (RYGB) to one anastomosis duodenal switch with sleeve gastrectomy (SADI-S), can be effective, when there is obesity recidivism, but surgically challenging. This case report video aims to detail the technical modifications that simplifies this conversion, in one stage. This video article demonstrates the conversion of RYGB to SADI-S using a jejunal bridge to facilitating the gastro-gastric reconnection. Surgical conversion was done laparoscopically, firstly removing the fundus, gastric body and the proximal part of the antrum. The gastrojejunal (GJ) anastomosis from the previous RYGB was preserved and the jejunal alimentary limb that follows was transected, 8cm distal to the GJ anastomosis, and anastomosed, at this level, with the antrum. The remaining alimentary limb was removed, until the jejuno-jejuno anastomosis, from the previous RYGB. The interposition of a segment of jejunal alimentary limb between the gastric bypass pouch and the antrum, has shown to be safe and feasible in RYGB conversion to SADI-S, without complications. Not reconnecting the remnant jejunal alimentary limb to the intestinal transit, but removing it, makes the procedure shorter and safer.

Paracoccidioidomicose: perfil clínico e epidemiológico de pacientes internados em Passo Fundo - RS / Paracoccidioidomycosis: clinical and epidemiological profile of patients hospitalized in Passo Fundo ­ RS

A paracoccidioidomicose não é uma doença de notificação obrigatória apesar de sua relevância na América Latina, por isso as estimativas de prevalência, incidência e morbidade dessa micose são baseadas em relatórios de levantamentos epidemiológicos, séries de casos, registros de hospitalização e dados de mortalidade. O objetivo desse trabalho foi descrever aspectos relacionados com o paciente, evolução da doença, confirmação diagnóstica e tratamento de casos confirmados de paracoccidioidomicose atendidos em um hospital de ensino do sul do Brasil. Foram coletadas informações de prontuários de 27 pacientes com diagnóstico de paracoccidioidomicose confirmado no período de 2010 até 2019. O perfil prevalente foi de um paciente do sexo masculino, com idade média de 53 anos, envolvido com atividades laborais diversas, de procedência urbana, imunocompetente e sem comorbidades, tabagista, mas não etilista. Para a maioria dos casos o acometimento inicial foi pulmonar, com importante envolvimento do sistema linfático no percurso da doença. A observação microscópica das estruturas fúngicas patognomônicas em amostras de biópsia, aspirado linfonodal e escarro foi o método mais utilizado para confirmar a suspeita clínica. O itraconazol foi a primeira opção de tratamento, seguido da anfotericina B. [au]

Paracoccidioidomycosis is not a notifiable disease despite its relevance in Latin America, so estimates of prevalence, incidence and morbidity of this mycosis are based on reports of epidemiological surveys, case series, hospitalization records and mortality data. The objective of this study was to describe aspects related to the patient, disease evolution, diagnostic confirmation and treatment of confirmed cases of paracoccidioidomycosis treated at a teaching hospital in southern Brazil. Information was collected from the medical records of 27 patients diagnosed with paracoccidioidomycosis confirmed in the period from 2010 to 2019. The prevalent profile was a male patient, with a mean age of 53 years, involved in various work activities, of urban origin, immunocompetent and without comorbidities, smoker, but non-alcoholic. For most cases, the initial involvement was pulmonary, with significant involvement of the lymphatic system in the course of the disease. Microscopic observation of pathognomonic fungal structures in biopsy samples, lymph node aspirate and sputum was the most used method to confirm the clinical suspicion. Itraconazole was the first treatment option, followed by amphotericin B. [au]

Conhecimento dos cirurgiões dentistas sobre o uso de anestésicos locais em pacientes: diabéticos, hipertensos, cardiopatas, gestantes e com hipertireoidismo / Knowledge of surgeons dentists about the use of local anesthetics in patients: diabetic, hypertension, heart disease, pregnant women and with hyperthyroidism

Anestésicos locais, contendo ou não vasoconstritores, são utilizados para realização da maioria dos procedimentos odontológicos. Porém, seu uso inadequado, principalmente em casos de alteração sistêmica, pode acarretar sérios riscos para a saúde do paciente. O objetivo deste estudo foi avaliar o nível de conhecimento dos cirurgiões dentistas (CDs) com relação à utilização de anestésicos locais, frente à pacientes especiais com diabetes, hipertensão, cardiopatias, gestantes e pacientes com hipertireoidismo. O estudo teve um delineamento quantitativo do tipo transversal com dados coletados através de questionário adaptado pela equipe como único instrumento para coleta de dados. Os dados foram submetidos à análise estatística descritiva e inferencial. De 200 participantes, 17% eram acadêmicos formandos em odontologia, e, dentre os formados, a maioria (34 %) tinha de 1 a 5 anos ou de 6 a 10 anos (16%) de formação. Do total de participantes graduados, 43% não possuíam especialização e 57% eram especialistas. Os resultados demostraram baixa taxa de acertos global (62%) entre os participantes. Quanto as categorias de pacientes especiais, observamos bom nível de conhecimento sobre o uso de anestésicos em pacientes diabéticos (79%), hipertensos (73%) e nível razoável para gestantes (65%) e pacientes com hipertireoidismo (62%). Entretanto, 60% erraram as questões relacionadas a cardiopatias. Ademais, foi insuficiente o percentual daqueles que afirmaram aferir a P.A no início dos atendimentos (45%), assim como, daqueles que consideram-se preparados para atender pacientes especiais (36%). Concluiu-se que o nível de conhecimento dos CDs relacionado ao atendimento de pacientes especiais é insuficiente havendo diferença significativa entre especialistas e clínicos(AU)

Local anesthetics, with or without vasoconstrictor are used to perform the vast majority of procedures in dentistry. However, improperly use it can lead to serious risks to patient's health, especially if it has some systemic disorders. The aim of this study was evaluate the level of dentistry's knowledge about use of local anesthetics in special-needs patients with diabetes, hypertension, heart disease, pregnant and patients with hyperthyroidism. The study was a quantitative cross-sectional design and the data were collected through a questionnaire adapted by the team as the only tool for data collection. Data were subjected to descriptive and inferential statistical analysis. Of the total 200 participants, 17% were students from the last year of Odontology (17%), most had 1-5 years of graduation (34%) or 6-10 years of graduation (16%). Of the total graduated participants, 43% were non-specialist and 57% were specialists. The results show a low overall hit rate (62%) among all participants. Among the special-needs patients' categories we observed a good level of knowledge about the use of anesthetics in patients with diabetes (79%) and hypertension (73%) and reasonable level for pregnant (65%) and patients with hyperthyroidism (62%). However, 60% erred issues related to heart disease. It was also lower the percentage who said measure BP (blood pressure) before start all treatment (45%) and who claimed to feel prepared to attend special-needs patients (36%). It was concluded that dentistry knowledge level regarding the care of special-needs patients is insufficient and has significant difference between non-specialist and specialists(AU)

Avaliação da microinfiltração marginal utilizando um sistema adesivo autocondicionante / Marginal microleakage assessment using a self-etching adhesive system

Este trabalho avaliou, in vitro, a capacidade seladora proporcionada pelo sistema adesivo autocondicionante Single Bond Universal (3M/ESPE) enfocando sua performance em relação à superfície de esmalte. Foram utilizados 20 pré-molares humanos extraídos por razões ortodônticas, reservando 5 dentes para projeto piloto, e os demais divididos em 2 grupos: Grupo ECOM: com condicionamento ácido do esmalte + Single Bond Universal e Grupo ESEM: aplicação exclusiva do sistema adesivo autocondicionante. Foram confeccionados preparos cavitários Classe II padronizados mesial e distal, seguido de limpeza da cavidade, protocolo adesivo seguindo as recomendações do fabricante e restauração em resina composta nanopartículada Z350XT (3M/ESPE) cor A3E pela técnica incremental e fotopolimerização por 20 segundos cada incremento. Em seguida, os espécimes foram impermeabilizados e imersos em solução aquosa de azul de metileno 1% por 24 horas e então lavados. Para coleta dos dados, os espécimes foram seccionados longitudinalmente totalizando 30 amostras, as quais foram analisadas em um contador de colônias manual (Phoenix CP 608) por 2 avaliadores, classificando os graus de infiltração em escores. Os dados foram submetidos à análise estatística pelo teste não paramétrico de Mann Whitney, mostrando que não houve diferença estatisticamente considerável entre os dois grupos (p= 0,89). O estudo concluiu que o condicionamento ácido do esmalte previamente à aplicação do sistema adesivo autocondicionante não reduziu a presença de microinfiltração marginal, não apresentando diferenças estatísticas significantes entre os grupos (AU).

This work evaluated in vitro the sealing capacity provided by the self-etching adhesive system Single Bond Universal (3M/ESPE) focusing on its performance in relation to the enamel surface. Twenty human premolars extracted for orthodontic reasons were used, five teeth were set aside for the pilot project, and the others were divided into two groups: ECOM Group: with acid enamel conditioning + Single Bond Universal and ESEM Group: exclusive application of self-etching adhesive system. Distal and mesial standardized Class II cavity preparations were made and subsequently cavity cleaning, adhesive protocol following manufacturer recommendations and restoration of nanoparticle composite resin Z350XT (3M/ESPE) color A3E by the incremental technique and photopolymerization for 20 seconds for each increment. After that the specimens were sealed and immersed in an aqueous solution of methylene blue 1% for 24 hours and then washed. In order to collect data, the specimens were longitudinally sectioned totaling 30 samples that were analyzed in a manual colony counter (Phoenix CP 608) by 2 reviewers, classifying the infiltration degrees in scores. Data was submitted to statistical analyses by the non-parametric Mann Whitney, showing that there was no considerable statistic difference between the two groups (p= 0.89). The study concluded that enamel acid etching prior to self-etching adhesive system application did not reduce the presence of marginal microleakage and did not present significant statistical differences between groups (AU).

Neutrophil Extracellular Traps Induce Organ Damage during Experimental and Clinical Sepsis.

Organ dysfunction is a major concern in sepsis pathophysiology and contributes to its high mortality rate. Neutrophil extracellular traps (NETs) have been implicated in endothelial damage and take part in the pathogenesis of organ dysfunction in several conditions. NETs also have an important role in counteracting invading microorganisms during infection. The aim of this study was to evaluate systemic NETs formation, their participation in host bacterial clearance and their contribution to organ dysfunction in sepsis. C57Bl/6 mice were subjected to endotoxic shock or a polymicrobial sepsis model induced by cecal ligation and puncture (CLP). The involvement of cf-DNA/NETs in the physiopathology of sepsis was evaluated through NETs degradation by rhDNase. This treatment was also associated with a broad-spectrum antibiotic treatment (ertapenem) in mice after CLP. CLP or endotoxin administration induced a significant increase in the serum concentrations of NETs. The increase in CLP-induced NETs was sustained over a period of 3 to 24 h after surgery in mice and was not inhibited by the antibiotic treatment. Systemic rhDNase treatment reduced serum NETs and increased the bacterial load in non-antibiotic-treated septic mice. rhDNase plus antibiotics attenuated sepsis-induced organ damage and improved the survival rate. The correlation between the presence of NETs in peripheral blood and organ dysfunction was evaluated in 31 septic patients. Higher cf-DNA concentrations were detected in septic patients in comparison with healthy controls, and levels were correlated with sepsis severity and organ dysfunction. In conclusion, cf-DNA/NETs are formed during sepsis and are associated with sepsis severity. In the experimental setting, the degradation of NETs by rhDNase attenuates organ damage only when combined with antibiotics, confirming that NETs take part in sepsis pathogenesis. Altogether, our results suggest that NETs are important for host bacterial control and are relevant actors in the pathogenesis of sepsis.