Combined neuraxial-general anesthesia in opsoclonus-myoclonus syndrome: A case report.

Opsoclonus-myoclonus syndrome (OMS) is a very rare neurological disorder thought to be the result of autoimmune responses in the nervous system. The relationship between this disorder and anesthesia procedures has not been studied in detail. To our knowledge, there are only 4 case reports, none of them with epidural-general combined anesthesia. We present a 9-year-old female with OMS due to low-grade neuroblastoma, for 7 years, who underwent tumor remotion due to the large size. Intravenous induction was done with alfentanil, lidocaine, propofol and rocuronium and ropivacaine was administered via lumbar epidural catheter. Adding to the sparse anesthetic management information in OMS, we now show one more possible approach, that can be valuable in high-risk cases, where general anesthesia can be involved with higher risk for the patient.

Adesão ao tratamento de obesidade em um ambulatório de cardiologia do Estado de São Paulo / Adherence to obesity treatment in a cardiology clinic in the State of São Paulo

INTRODUÇÃO: Assim como as demais doenças crônicas, a obesidade, exige do paciente mudanças no estilo de vida para evitar sua progressão. A não adesão às recomendações mostra-se um problema para todos os profissionais de saúde, uma vez que para se obter sucesso no tratamento é importante que o paciente seja aderente às orientações. Considerando a escassez de estudos que avaliem a adesão aos tratamentos de obesidade, o presente trabalho buscou auxiliar no entendimento dessa temática. O OBJETIVO foi avaliar a adesão dos pacientes com obesidade ao tratamento nutricional proposto em um ambulatório de nutrição especializado em cardiologia. MÉTODOS: A amostra foi composta por 101 indivíduos, homens e mulheres, adultos e idosos de 25-84 anos, atendidos em ao menos quatro consultas na especialidade de obesidade e síndrome metabólica do ambulatório de nutrição. A adesão ao tratamento foi mensurada através de instrumento elaborado pela equipe do ambulatório de nutrição, contendo metas globais organizadas em: peso, circunferência abdominal (CA), atividade física, dieta, açúcar, sódio, gorduras saturadas/trans, fibras e proteínas. Análise Estatística: Trata-se de um estudo descritivo, observacional com a utilização de medidas de tendência central (média) e de variabilidade (desvio padrão). RESULTADOS: Considerando a média dos quatro atendimentos, a adesão às metas globais, em ordem decrescente foram: consumo de sódio (75%), gorduras saturadas/trans (65,64%), açúcar (60%), proteína (56%), dieta (49,01%), perda de peso (46,78%), fibras (43,66%), redução de CA (38,61%) e atividade física (22,44%) com menor percentual de adesão. A expectativa é de que a média de adesão total seja de no mínimo 60% para um bom resultado. A adesão total foi calculada somando-se as metas globais e dividindo pelo número de metas. A média de adesão total do primeiro ao quarto atendimento foram: 45,09%, 46,24%, 47,09% e 43,04%, respectivamente. CONCLUSÃO: O presente trabalho mostrou um baixo percentual de adesão ao modelo de acompanhamento proposto. As inúmeras variáveis relacionadas à adesão do tratamento demonstram que para a melhoria das medidas antropométricas e diminuição do risco cardiovascular é necessário um grande esforço dos nutricionistas e dos demais profissionais de saúde para a educação nutricional da população, enfatizando a importância do autocuidado e desta forma, reduzindo a progressão e/ou surgimento de doenças crônicas como a obesidade.

Interactive programming paradigm for real-time experimentation with remote living matter.

Recent advancements in life-science instrumentation and automation enable entirely new modes of human interaction with microbiological processes and corresponding applications for science and education through biology cloud laboratories. A critical barrier for remote and on-site life-science experimentation (for both experts and nonexperts alike) is the absence of suitable abstractions and interfaces for programming living matter. To this end we conceptualize a programming paradigm that provides stimulus and sensor control functions for real-time manipulation of physical biological matter. Additionally, a simulation mode facilitates higher user throughput, program debugging, and biophysical modeling. To evaluate this paradigm, we implemented a JavaScript-based web toolkit, "Bioty," that supports real-time interaction with swarms of phototactic Euglena cells hosted on a cloud laboratory. Studies with remote and on-site users demonstrate that individuals with little to no biology knowledge and intermediate programming knowledge were able to successfully create and use scientific applications and games. This work informs the design of programming environments for controlling living matter in general, for living material microfabrication and swarm robotics applications, and for lowering the access barriers to the life sciences for professional and citizen scientists, learners, and the lay public.

Device and programming abstractions for spatiotemporal control of active micro-particle swarms.

We present a hardware setup and a set of executable commands for spatiotemporal programming and interactive control of a swarm of self-propelled microscopic agents inside a microfluidic chip. In particular, local and global spatiotemporal light stimuli are used to direct the motion of ensembles of Euglena gracilis, a unicellular phototactic organism. We develop three levels of programming abstractions (stimulus space, swarm space, and system space) to create a scripting language for directing swarms. We then implement a multi-level proof-of-concept biotic game using these commands to demonstrate their utility. These device and programming concepts will enhance our capabilities for manipulating natural and synthetic swarms, with future applications for on-chip processing, diagnostics, education, and research on collective behaviors.

[Injuries resulting from positioning for surgery: incidence and risk factors]. / Lesões decorrentes do posicionamento para cirurgia: incidência e fatores de risco.

INTRODUCTION: The appropriate surgical positioning is an essential step that is often underestimated, but must be considered, because can lead to serious but preventable injury. The objective of this study is to evaluate the incidence of injury due to surgical positioning, as well as try to identify their risk factors. MATERIALS AND METHODS: Prospective study held for one year and included patients from different surgical specialties proposed for elective surgery. Patients were evaluated prior to surgery and exclusion criteria were: age < 18 years, American Society of Anesthesiologists - ASA score > III neuropathy or neuromuscular disease documented. Were considered injuries resulting from the positioning: erythema not reversible under digital pressure and/or persistent > 30 minutes, severe pain on pressure points and not related to the surgical site (Visual Analogue Scale - VAS = 7) and peripheral nerve injury. We evaluated the following variables: sex, age, Body Mass Index, ASA classification, anesthetic technique, type of positioning, duration of surgery and its relationship with postoperative injury. RESULTS: Of the 172 patients included in the study, perioperative lesions were identified in 12.2%, but five of these patients had more than one lesion (pain on pressure point + neuropathy). About 9.9% complained of severe pain (Visual Analogue Scale - VAS = 7) on pressure points, 4.7% presented peripheral neuropathy and 0.6% had erythema that did not yield to the digital pressure. In the group that developed lesions, no significant difference with regard to age, sex, anesthetic technique, duration of surgery and positioning was found. Concerning to ASA classification, it was found that ASA II and III patients had a higher incidence of lesion (90.5%) compared with patients ASA I (9.5%), p < 0.05. The Body Mass Index > 30 Kg / m2 showed also statistically significant association with the development of postoperative injury, p < 0.001. In separate analysis of neuropathic injury was found that Body Mass Index > 30 Kg / m2 was associated with the occurrence of neuropathy, p < 0.05. Concerning the remaining variables and their relation with postoperative neuropathy, it wasn't found a statistically significant relationship. CONCLUSION: The scientific evidence for prevention of injuries in the perioperative period, including the neuropathy is limited. The postoperative evaluation of patients is essential because it allows early recognition of lesions and its documentation and guidance.

Abstract available from the publisher.