Inflammatory Modifications in Paranasal Sinuses and Ostiomeatal Complex Anatomical Variations in Jet Aircraft Pilots: A Computed Tomography Study.

Introduction Jet aircraft pilots are exposed to huge pressure variation during flight, which affect physiological functions as systems, such as the respiratory system. Objectives The objective of the present investigation was to evaluate inflammatory changes of paranasal sinuses of jet aircraft pilots before and after a jet aircraft training program, using multislice computed tomography (CT), in comparison with a group of nonairborne individuals with the same age, sex, and physical health conditions. A second objective of the present study was to assess the association between the ostiomeatal complex obstruction and its anatomical variations. Methods The study group consisted of 15 jet aircraft pilots participating in the training program. The control group consisted of 41 nonairborne young adults. The 15 fighter pilots were evaluated before initiating the training program and after their final approval for the presence of inflammatory paranasal sinus disease. The ostiomeatal complex anatomical variations and obstructions were analyzed in pilots after the training program. Results Jet aircraft pilots presented higher incidence of mucosal thickening in maxillary sinus and anterior ethmoid cells than controls. Prominent ethmoidal bulla showed significant association with obstruction of the osteomeatal complex. Conclusions Jet aircraft pilots present increased inflammatory disease when compared with nonairborne individuals. The presence of a prominent ethmoidal bulla is associated with ostiomeatal complex obstruction.

The Healthy and Diseased Retina Seen through Neuron-Glia Interactions.

The retina is the sensory tissue responsible for the first stages of visual processing, with a conserved anatomy and functional architecture among vertebrates. To date, retinal eye diseases, such as diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, glaucoma, and others, affect nearly 170 million people worldwide, resulting in vision loss and blindness. To tackle retinal disorders, the developing retina has been explored as a versatile model to study intercellular signaling, as it presents a broad neurochemical repertoire that has been approached in the last decades in terms of signaling and diseases. Retina, dissociated and arranged as typical cultures, as mixed or neuron- and glia-enriched, and/or organized as neurospheres and/or as organoids, are valuable to understand both neuronal and glial compartments, which have contributed to revealing roles and mechanisms between transmitter systems as well as antioxidants, trophic factors, and extracellular matrix proteins. Overall, contributions in understanding neurogenesis, tissue development, differentiation, connectivity, plasticity, and cell death are widely described. A complete access to the genome of several vertebrates, as well as the recent transcriptome at the single cell level at different stages of development, also anticipates future advances in providing cues to target blinding diseases or retinal dysfunctions.

Maxillary sinus volumetric changes in jet aircraft pilots: A multislice computed tomography pilot study.

Purpose: This study evaluated maxillary sinus volume changes in military jet aircraft pilot candidates before and after the training program, in comparison with a control group, considering the effects of pressurization, altitude, and total flight hours, through multislice computed tomography. Materials and Methods: Fifteen fighter pilots were evaluated before initiating the training program and after the final approval. The control group consisted of 41 young adults who had not flown during their military career. The volumes of each maxillary sinus were measured individually before and at the end of the training program. Results: When comparing the initial and final volumes in the pilots, a statistically significant increase was observed both in the left and right maxillary sinuses. When evaluating the average total volume of the maxillary sinuses (i.e., the average volume of the right and left maxillary sinuses together), a significant increase in the volume of the maxillary sinuses was observed in the pilot group when compared to the control group. Conclusion: The maxillary sinus volumes in aircraft pilot candidates increased after the 8-month training program. This may be explained by changes in the gravitational force, the expansion of gas, and positive pressure from oxygen masks. This unprecedented investigation among pilots might lead to other investigations considering paranasal sinus alterations in this singular population.

Construction and validation of an instrument for physical therapy assessment and functional classification in the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF) for hospitalized HIV patients / Construcción y validación de un instrumento de evaluación fisioterapéutica y de clasificación funcional en el modelo biopsicosocial de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) para pacientes VIH hospitalizados / Construção e validação de instrumento de avaliação fisioterapêutica e de classificação funcional no modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para pacientes HIV hospitalizados

ABSTRACT The human immunodeficiency virus (HIV) is responsible for the compromise of the immune system and a high number of hospitalizations. Considering the biopsychosocial (BPS) context of the individual, the International Classification of Functioning, Disability and Health (ICF) provides the maximum description of a health condition and the impact of interventions and service delivery for the physiotherapeutic process. The aim of this study was to build and validate a physical therapy assessment and functional classification instrument based on the ICF for hospitalized members of the HIV community. This is an observational, cross-sectional, and descriptive study based on the analysis of demand, elaboration, and improvement of the instrument and its validation with the consensus of a experts committee of physical therapists; they evaluated 58 items and the classification codes resulted in 0.858 overall Kappa value=strong agreement between assessments, all statistically significant (p-value<0.05). The final version of the instrument included 36 items, all with Kappa coefficient >0.80. The constructed instrument is valid for the evaluation and functional classification in the ICF model for hospitalized members of the HIV community, contributing to the physical therapy clinical practice in the hospital environment.

RESUMEN El virus de la inmunodeficiencia humana (VIH) es responsable del deterioro del sistema inmunitario y de un elevado número de hospitalizaciones. Considerando el contexto biopsicosocial (BPS) del individuo, el proceso fisioterapéutico cuenta con la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), que brinda la máxima descripción de una condición de salud y el impacto de las intervenciones y prestación de servicios. El objetivo de este estudio es construir y validar un instrumento de evaluación fisioterapéutica y clasificación funcional basado en el CIF para pacientes VIH hospitalizados. Se trata de un estudio observacional, transversal y descriptivo, realizado desde el análisis de la demanda, desarrollo y perfeccionamiento del instrumento y su validación con el consenso de un comité de fisioterapeutas especialistas que evaluaron 58 ítems y los códigos de clasificación, lo que resultó un valor kappa global 0,858=fuerte concordancia entre las evaluaciones, todas estadísticamente significativas (p<0,05). La versión final del instrumento incluyó 36 ítems, todos con índice kappa >0,80. El instrumento construido presenta validez para la evaluación y clasificación funcional en el modelo CIF para pacientes con VIH hospitalizados, lo que contribuye a la práctica clínica fisioterapéutica en el ámbito hospitalario.

RESUMO O vírus da imunodeficiência humana (HIV - human immunodeficiency virus) é responsável pelo comprometimento do sistema imune e por um elevado número de hospitalizações. Considerando o contexto biopsicossocial (BPS) do indivíduo, o processo fisioterapêutico dispõe da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que fornece a máxima descrição de uma condição de saúde e o impacto das intervenções e prestação de serviços. O objetivo deste estudo é construir e validar um instrumento de avaliação fisioterapêutica e classificação funcional baseada na CIF para os pacientes HIV hospitalizados. Trata-se de um estudo observacional, transversal e descritivo realizado a partir da análise de demanda, elaboração e aprimoramento do instrumento e sua validação com o consenso de um comitê de fisioterapeutas especialistas que avaliaram 58 itens e os códigos de classificação, resultando no valor kappa geral de 0,858=concordância forte entre as avaliações, todas estatisticamente significativas (p<0,05). A versão final do instrumento incluiu 36 itens, todos com índice kappa >0,80. O instrumento construído apresenta validade para a avaliação e classificação funcional no modelo da CIF para os pacientes HIV hospitalizados, contribuindo para a prática clínica fisioterapêutica no ambiente hospitalar.

Maxillary sinus volumetric changes in jet aircraft pilots: A multislice computed tomography pilot study

Purpose@#This study evaluated maxillary sinus volume changes in military jet aircraft pilot candidates before and after the training program, in comparison with a control group, considering the effects of pressurization, altitude, and total flight hours, through multislice computed tomography. @*Materials and Methods@#Fifteen fighter pilots were evaluated before initiating the training program and after the final approval. The control group consisted of 41 young adults who had not flown during their military career. The volumes of each maxillary sinus were measured individually before and at the end of the training program. @*Results@#When comparing the initial and final volumes in the pilots, a statistically significant increase was observed both in the left and right maxillary sinuses. When evaluating the average total volume of the maxillary sinuses (i.e., the average volume of the right and left maxillary sinuses together), a significant increase in the volume of the maxillary sinuses was observed in the pilot group when compared to the control group. @*Conclusion@#The maxillary sinus volumes in aircraft pilot candidates increased after the 8-month training program. This may be explained by changes in the gravitational force, the expansion of gas, and positive pressure from oxygen masks. This unprecedented investigation among pilots might lead to other investigations considering paranasal sinus alterations in this singular population.

Successful Left Atrial Appendage Closure with Watchman Device Implantation in Two Patients with Inferior Vena Cava Filters

Percutaneous procedures through femoral access in patients with inferior vena cava (IVC) filter may be at risk of complications. We evaluated the feasibility and safety of left atrial appendage closure (LAAC) through femoral access in patients previously implanted with IVC filter. We described the WatchmanTM device implantation in two patients with formal contraindication for oral anticoagulation. First patient had a GreenfieldTM filter and the second one an OpteaseTM filter, and in this patient an attempt to withdrawal the filter immediately before the LAAC procedure failed. A femoral approach was performed in both patients using a 14 Fr sheath. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or intrahospital complications related to the procedure occurred. Herein, we presented two cases of successful LAAC closure with Watchman device in patients with two different kinds of IVC filters.

Inflammatory myophibroblastic tumor of the proximal ileon in a patient with complicated umbilical hernia: A case report and literature review.

INTRODUCTION: Inflammatory myofibroblastic tumors are neoplasms that occur infrequently, mainly affects children and young adults. It is an intermediate grade fibrotic multinodular neoplasm. DESCRIPTION OF THE CASE: We present the case of a 47-year-old female patient, who underwent emergency umbilical hernioplasty, later developed intestinal obstruction secondary to an inflammatory myofibroblastic tumor. DISCUSSION: In 1939 Brunn described it for the first time, later in 1954 Umiker named it "Inflammatory Myofibroblastic Tumor". The symptoms are nonspecific. In 15 to 40% of patients they are asymptomatic. Cells positive for actin, smooth muscle, vimentin and desmin, in 3367% of cases the cells are positive for ALK, which is present in some malignant lesions. The recommended treatment is radical resection. CONCLUSION: The diagnosis is established by histopathological study, surgery is the cornerstone of treatment.

Safe Gluteal Fat Graft Avoiding a Vascular or Nervous Injury: An Anatomical Study in Cadavers.

Background: Fat grafting for gluteal augmentation is one of the most popular aesthetic surgery procedures. It has an associated mortality to fat embolism of 0.2%. Objectives: The authors of this study sought to describe which technique for synthetic graft application was least likely to cause a fat embolism. Methods: Ten fresh bodies were obtained and 4 groups arranged with 5 buttocks each randomly assigned. Group 1 was infiltrated through the upper medial intergluteal sulcus (upper medial intergluteal sulcus) with an angulation of -30°, -10°, and 0°. Group 2 was infiltrated through the middle lower gluteal sulcus with an angulation of -30°, 0°, and +15°. Group 3 was infiltrated through a peritrochanteric (PT) access at the level of the femur head at 0° and +10° and in the middle of the buttock at the level of the posterior superior iliac crest at -30° toward the trochanter (lateral direction). Group 4 was infiltrated in the same manner as group 1 without -30°. A complication occurred when the graft was in contact with the vascular or nervous bundle, within the gluteus medius muscle, or both. Results: Group 1 had 3 buttocks with a complication (UMIGS -30°). Group 2 had complications in all the injection techniques. Group 3 had 5 buttocks with a complication (PT at 0°). Group 4 had no complications. Conclusions: The injection of the fat graft through the UMIGS at 0° and 10° angles, and through the middle of the buttock at the level of posterior superior iliac crest a -30° angle, reaches the surface needed for gluteal augmentation. The group 2 techniques should be avoided because they have a high risk of complication.

Acute myocardial infarction and primary percutaneous coronary intervention at night time / Infarto agudo do miocárdio e intervenção coronariana percutânea primária no período noturno

Background: Primary percutaneous coronary intervention is the preferred treatment in ST-elevation myocardial infarction. At night period, the delay until performing primary percutaneous coronary intervention may be determinant to prognosis worsening. Objective: To analyze the results of primary percutaneous coronary intervention performed at day and night periods. Methods: Cohort study that included patients admitted with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention from December 2013 until December 2016 in a ST-elevation myocardial infarction reference hospital of a metropolitan region in Brazil, followed from admission to hospital discharge or death, compared according to time of primary percutaneous coronary intervention (night or day). Statistical analysis comprehended the Chi-square test, the Fisher test, the Student's t-test and the analysis of variance, with significance level of 5%. Results: 446 patients were submitted to primary percutaneous coronary intervention, 159 (35.6%) at night time and 287 (64.4%) at day time. No differences were found between the two groups concerning clinical baseline characteristics. Door-to-balloon time (101 ± 81 minutes vs. 99 ± 78 minutes; p = 0,59) and onset-to-ballon time (294 ± 158 minutes vs. 278 ± 174 minutes; p = 0,32) did not differ between the groups. The incidence of combined major adverse cardiac events (15.1% vs. 14.3%; p = 0,58) and in-hospital mortality (9.4% vs. 8.0%; p = 0,61) were similar between the groups, as well as length of hospital stay (6.0 ± 4 days vs. 4.9 ± 4 days; p = 0,91). Conclusion: Primary percutaneous coronary intervention at night time showed similar results as the procedure performed at day time, without significant increase of in-hospital adverse events, length of stay or mortality

Bone Flap Conservation in the Scalp After Decompressive Craniectomy.

BACKGROUND: Decompressive craniectomy may be used as a primary or secondary treatment for intracranial hypertension and is clearly associated with reduced mortality. The removed bone flap is usually preserved in the abdominal subcutaneous tissue or in the bone bank. The aim of this study was to describe an option for preserving the bone flap after decompressive craniectomy using bone flap preservation in the skull subcutaneous tissue in subgaleal space over the pericranium contralateral to the craniectomy site. METHODS: This was a multicenter retrospective study including patients with severe traumatic brain injury from 2014 to 2016. There were 23 patients who had their bone fragments preserved below the scalp in the subcutaneous tissue for analysis. The following results were analyzed: surgical site infection, bone flap resorption during the period of preservation, and patient discomfort. RESULTS: Five patients died of systemic infectious complications, and the remaining patients underwent cranioplasty a mean 118 days after craniectomy. There were no surgical wound infections, macroscopically evident bone absorption, or site discomfort in any of the patients during a period of 18 months. CONCLUSIONS: This variant of the bone flap preservation technique has been shown to be satisfactory as an option for routine use.

Multidisciplinariedad, interdisciplinariedad y transdisciplinariedad en la formación para la investigación en ingeniería *

En el presente texto, se dan a conocer aspectos relevantes de la formación en investigación en la Facultad de Ingeniería de la Corporación Universitaria Americana. En primer lugar, se estudian los conceptos de Multidisciplinariedad, Interdisciplinariedad y Transdisciplinariedad desde su relación con la formación. En segundo lugar, se identifica el nivel de influencia de las percepciones de estudiantes en los procesos de formación en Investigación a la luz de la Estrategia de Formación por Proyectos mediante un análisis exploratorio de los resultados obtenidos de una encuesta de evaluación de una actividad transdisciplinar denominada "foro de lecciones aprendidas". Como conclusión de los resultados de la investigación, se identifica la independencia entre semestre y el concepto que los estudiantes tienen acerca de su formación por competencias en relación al foro y se proponen estrategias de intervención en este aspecto.

Introduction. Nowadays, engineering schools are faced with complex needs in realities that are often alien to them and transcend disciplinary limits. The efforts to understand this result in the implementation of conceptualization spaces oriented towards the articulation of processes coherent with the institutional work and the policies of accreditation in high quality. Objective. To analyze relevant aspects of research training in the School of Engineering of the American University Corporation considering the challenges imposed by the disciplinary, multidisciplinary interdisciplinary, and / or transdisciplinary tensions of sciences. Materials and methods. Disciplinarity, Multidisciplinarity, Interdisciplinarity, and Transdisciplinarity concepts are studied from their relationship with training. Subsequently, perceptions of students in research training processes are identified through an exploratory analysis of results obtained from an evaluation survey of a transdisciplinary activity called "lessons learned forum," the analysis was carried out using a chi-square test with a 95% reliability for a sample of 200 students of the Engineering School for the year 2016. Results. Taking into account the rejection of independence for 24 2 36,4 , in which 24 represent the degrees of freedom with a 5% error, the initial hypothesis is retained. Conclusion: There is an independence between the semester and students' concept about their training by competences in relation to the forum, which entails the need to propose intervention strategies for the transgression of what is disciplinary and to promote complex thinking in students.

Introdução. Atualmente, as faculdades de engenharia se encontram ante necessidades complexas em realidades que muitas vezes são alheias a elas e transcendem os limites do disciplinar. Os esforços por compreender este, derivam na implementação de espaços de conceptualização orientados para a articulação de processos coerentes com o trabalho institucional e as políticas de acreditação em alta qualidade. Objetivo. Analisar aspectos relevantes da formação em investigação na Faculdade de Engenharia da Corporação Universitária Americana considerando os desafios que impõem as tensões entre o disciplinar, multidisciplinar, interdisciplinar e/ou transdisciplinar das ciências. Materiais e métodos. Se estudam os conceitos de Disciplinariedade, Multidisciplinariedade, Interdisciplinariedade e Transdisciplinariedade desde sua relação com a formação. Posteriormente, se identificam percepções de estudantes em processos de formação em Investigação mediante uma análise exploratório dos resultados obtidos de uma enquete de avaliação de uma atividade transdisciplinar denominada "foro de lições aprendidas", a análise se realizou mediante uma prova chi-quadrado com uma confiabilidade de 95% para uma amostra de 200 estudantes da faculdade de engenharia para o ano 2016. Resultados. Tendo em conta a rejeição de independência para 24 2 36,4, onde 24, representam os graus de liberdade com um erro de 5 % , se conserva a hipótese inicial. Conclusão. Existe independência entre semestre e o conceito dos estudantes sobre da sua formação por competências em relação ao foro, o qual implica à necessidade de propor estratégias de intervenção para a transgressão do disciplinar e potenciar o pensamento complexo nos estudantes.

Acute appendicitis in an overweight and obese Mexican population: A retrospective cohort study.

INTRODUCTION: México is the second place in overweight and obese adults. Acute appendicitis (AA), is the most common indication for an emergency surgery around the world, with an estimated lifetime incidence of 7-14%. Laparoscopic appendectomy (LA) has been described as a safe and good surgery approach for this group of patients. Nevertheless, in México, there is not any evidence supporting these outcomes in our population. METHODS: All the patients that came to the ER from July to December 2014 with age >16-year, body mass index (BMI) > 25 kg/m(2) (overweight) and, BMI >30 kg/m(2) (obese) were included in the study. We recorded the age, gender, BMI, grade of appendicitis, complications classified by the Clavien-Dindo Classification, and a follow-up period of 7-day, 30-day, 6-month, and 1-year. RESULTS: 27 patients met the inclusion criteria, five had overweight (18.5%), and twenty-two were obese (81.5%). No surgical conversion was needed. The overall complications rate was 29.6%%, with 22.2% mild complications and 7.4% of moderate complication. The average in-hospital cost for the procedure was $15,860 MXN (range $12,860-$22,860 MXN). The surgical time was ≈53.7 ± 19.93 h and the LOS ≈1.6 ± 0.6 days. CONCLUSION: The outcomes in the Mexican adult obese population with acute appendicitis when a laparoscopic appendectomy is performed are as good as reported in other countries.

Treatment of choledochal cyst in a pediatric population. A single institution experience of 15-years. Case series.

BACKGROUND: Choledochal cyst (CC) is a rare congenital anomaly of the bile duct that approximately 75% of the patients are diagnosed in childhood. Without a standardized surgical procedure for the biliary reconstruction, we present our experience over the last 15 years and show the differences between the biliary reconstructions techniques in our population. METHODS: We did a retrospective hospital archive search for patients admitted to the pediatric surgery department with the diagnosis of a choledochal cyst from January 2000 to June 2015. RESULTS: We found 15 patients, of which, 1 was excluded because of missing data from the hospital record. Of the remaining 14, eight had hepaticojejunal (HY) anastomosis in Roux-en-Y, with a 25% rate of complications; six had hepatoduodenal (HD) anastomosis with a rate of complications of 16.6%. The average hospital length of stay in the group of HD vs. HY was 14 ± 1.6-days vs. 19 ± 8.2-days respectively. DISCUSSION: There are no standardized surgical reconstruction techniques of the biliary tract after the CC excision, there is literature that supports the biliary reconstruction with an HY and an HD without a distinct advantage over one or the other. CONCLUSION: In our series HD anastomosis represents a safe procedure with fewer complications than HY.

Karewsky syndrome: A case report and review of the literature.

INTRODUCTION: Gallstone ileus can be a lethal disease, rarely suspected in the clinical scenario. It represents about 25% of all bowel obstruction cases in patients older than 65. There is a classification of gallstone ileus based on the onset time: acute, subacute and chronic (Karewsky syndrome). We describe the first reported case of chronic gallstone ileus. CASE PRESENTATION: A 78-year-old female was admitted to the ER with a 15-day case of consistent bowel obstruction. The subject reported a five-year history of recurrent hospital admissions that resolved spontaneously after non-surgical management. Karewsky syndrome was diagnosed and managed with enterolithotomy. After five days of postoperative evolution the patient was discharged, and at six months follow up, no other hospital admission or relapse has been registered. DISCUSSION: The gallstone ileus diagnosis demands a higher clinical suspicion, there is no biochemical marker, and an abdominal CT is ideal for imaging-based diagnosis. There is no consensus on the optimal surgical approach. CONCLUSION: We describe the first case of Karewsky syndrome and a gastro-jejune and gastric-choledochus double fistula. We emphasize the importance of higher clinical suspicion for patients with bowel obstruction older than 65 years old and make evident that although there are not evidence-based guidelines for this treatment, enterolithotomy is a recommended approach.

Amyand hernia: Case report and review of the literature.

INTRODUCTION: Amyand Hernia is a rare disease seen in approximately 1% of all hernias, complications of it, like acute appendicitis, or perforated appendicitis are even more rare, about 0.1%. Its diagnosis is very difficult in the pre-operative period; it is usually an incidental finding. PRESENTATION OF CASE: This paper describes the case of a forty-year-old male patient, which was presented to the outpatient clinic of surgery with an incarcerated right side inguinal hernia without any signs of ischemic complications. He was admitted, and an hernioplasty was performed, as an incidental finding we encountered an Amyand hernia treated without appendectomy and placement of a prosthetic mesh without any complications. DISCUSSION: This disease represents a very challenging diagnosis, seven years ago the standardization of management had already been established; in this case we encountered a type 1 Amyand's Hernia so we performed a standard tension free hernioplasty without complications. CONCLUSION: Amyand hernia is a rare condition, which represents two of the most common diseases a general surgeon has to face. Standardization of treatment is still ongoing and more prospective studies need to be done. This case demonstrates that this pathology must remain in the mind of the surgeons especially in the event of a strangulated hernia and offer a comprehensive review.

Comparação do tempo de fluoroscopia durante cateterismo cardíaco pelas vias radial e femoral / Comparison of fluoroscopy time during coronary angiography by radial and femoral routes

Introdução: O uso da via radial em intervenções cardíacas associa-se à redução das complicações vasculares, porém requer maior curva de aprendizado e pode aumentar a exposição do paciente e da equipe à radiação. Este estudo teve como objetivo avaliar o tempo de fluoroscopia, como variável substituta para a exposição à radiação, durante cateterismo cardíaco diagnóstico pelas vias radial e femoral. Métodos: Estudo retrospectivo observacional que incluiu pacientes submetidos ao cateterismo cardíaco entre julho de 2013 e outubro de 2014. Foram comparados os grupos radial e femoral quanto ao tempo total do procedimento, tempo de fluoroscopia, relação tempo de fluoroscopia/procedimento e complicações vasculares. Resultados: Foram incluídos 1.915 procedimentos, sendo 11,2% realizados por via radial e 88,8% realizados por via femoral. Observou-se predomínio do sexo masculino no grupo radial (80% vs. 54,1%; p < 0,01), mas a média de idades (61,6 ± 9,7 vs. 62,4 ± 11,6; p = 0,13), o tempo do procedimento (8,7 ± 3,8 vs. 8,1 ± 4,1 minutos; p = 0,91), o tempo de fluoroscopia (4,8 ± 2,7 vs. 4,1 ± 2,6 minutos; p = 0,89), a relação tempo de fluoroscopia/procedimento (0,56 ± 0,24 vs. 0,49 ± 0,32; p = 0,89) e as complicações maiores (0,0% vs. 0,3%; p = 0,55) foram semelhantes entre os grupos. Conclusões: A utilização da via radial para procedimentos diagnósticos por operadores experientes pode ser feita com um tempo de procedimento aceitável, sem aumentar a exposição radiológica do paciente e da equipe, e com baixo número de complicações...

Background: The use of radial access in cardiac interventions is associated with reduced vascular complications, however it demands a longer learning curve and may increase fluoroscopy time. This study aimed to evaluate the fluoroscopy time as a surrogate marker of radiation exposure, during diagnostic cardiac catheterization by radial and femoral routes. Methods: Retrospective observational study including patients who underwent cardiac catheterization from July 2013 to October 2014. Radial and femoral groups were compared for total procedural time, fluoroscopy time, fluoroscopy to procedural time ratio and vascular complications. Results: The study included 1,915 procedures, 11.2% of which performed by radial approach and 88.8%, by femoral approach. A male prevalence was found in the radial group (80% vs. 54.1%, p < 0.01), but age (61.6 ± 9.7 years vs. 62.4 ± 11.6 years, p = 0.13), total procedural time (8.7 ± 3.8 vs. 8.1 ± 4.1 minutes, p = 0.91), fluoroscopy time (4.8 ± 2.7 vs. 4.1 ± 2.6 minutes, p = 0.89), fluoroscopy/procedure time ratio (0.56 ± 0.24 vs. 0.49 ± 0.32, p = 0.89), and major complications (0.0% vs. 0.3%, p = 0.55) were similar between groups. Conclusions: The use of the transradial approach for diagnostic procedures by experienced operating physicians may be used with an acceptable total procedural time without increasing the radiation exposure of the patient and staff, and with a low incidence of complications...

Evaluation of tetravalent and conserved synthetic peptides vaccines derived from Dengue virus Envelope domain I and II.

Dengue is a major worldwide public health problem, especially in the tropical and subtropical regions of the world. Primary infection with a single Dengue virus (DENV) serotype causes a mild, self-limiting febrile illness called dengue fever. However, a subset of patients experiencing a secondary infection with a different serotype progress to the severe form of the disease, called dengue hemorrhagic fever. In this study, the vaccine potential of three tetravalent and conserved synthetic peptides derived from DENV envelope domain I (named Pep01) and II (named Pep02 and Pep03) was evaluated. Human dengue IgM/IgG positive serum (n=16) showed reactivity against Pep01, Pep02 and Pep03 in different degrees. Mice immunization experiments showed that these peptides were able to induce a humoral response characterized by antibodies with low neutralizing activity. The spleen cells derived from mice immunized with the peptides showed a significant cytotoxic activity (only for Pep02 and Pep03), a high expression of IL-10 (P<0.01) and a reduced expression of TNF-α and IFN-gamma (P<0.001) compared to DENV-1 infected splenocytes. Thus these peptides, and specially the Pep03, can induce a humoral response characterized by antibodies with low neutralizing activities and probably a T cell response that could be beneficial to induce an effective immune response against all DENV serotypes and do not contributed to the immunopathogenesis. However, further studies in peptide sequence will be required to induce the production of neutralizing antibodies against all four DENV serotypes and also to improve immunogenicity of these peptides.

Resultados da Intervenção Coronária Percutânea Primária de Acordo com o Tempo Total de Isquemia / Results of Primary Percutaneous Coronary Intervention According to the Total Ischemic Time

Introdução: O tratamento do infarto agudo do miocárdio com supradesnivelamento de ST tem a intervenção coronária percutânea primária como método preferencial de reperfusão. Este estudo teve como objetivo avaliar a evolução hospitalar de pacientes com infarto agudo do miocárdio com supradesnivelamento de ST, conforme o tempo total de isquemia, até a realização de intervenção coronária percutânea primária. Métodos: Registro unicêntrico, de pacientes admitidos com infarto agudo do miocárdio com supradesnivelamento de ST submetidos à intervenção coronária percutânea primária entre março de 2012 e fevereiro de 2014, acompanhados da admissão até a alta hospitalar e comparados conforme o tempo total de isquemia (Grupo 1: tempo dor-balão < 6 horas; Grupo 2: tempo dor-balão ≥ 6 e < 12 horas). Resultados: Foram submetidos à intervenção coronária percutânea primária 279 pacientes, sendo 118 do Grupo 1 (42,3%) e 161 do Grupo 2 (57,7%). O Grupo 2 apresentou idade mais avançada, maior prevalência de hipertensão arterial, menor proporção de tabagistas, maior número de pacientes em classe Killip-Kimball ≥ 2 e menor taxa de sucesso da intervenção coronária percutânea primária. As incidências de óbito ou infarto não fatal (11,0% vs. 18,6%; p = 0,08), óbito (8,5% vs. 16,8%; p = 0,04) e insuficiência renal aguda (7,6% vs. 19,9%; p < 0,01) foram maiores no Grupo 2. Conclusões: Pacientes com infarto agudo do miocárdio com supradesnivelamento de ST submetidos à intervenção coronária percutânea primária com tempo dor-balão ≥ 6 horas apresentaram maior complexidade clínica e pior evolução...

Background: Treatment of ST-elevation acute myocardial in -farction has primary percutaneous coronary intervention asthe preferred method of reperfusion. This study aimed to evaluate in-hospital outcomes of patients with ST-elevationacute myocardial infarction according to the total ischemic time until performing primary percutaneous coronary intervention. Methods: Single-center registry of patients admitted withST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention between March/2012 and February/2014, followed from admission to hospital discharge, and compared according to the total ischemic time (Group 1: symptom onset-to-balloon time < 6 hours; Group 2: symptom onset-to-balloon time ≥ 6 and < 12 hours). Results: Two hundred seventy nine patients underwent primarypercutaneous coronary intervention, 118 in Group 1 (42.3%) and 161 in Group 2 (57.7%). Group 2 was older, had higherprevalence of hypertension, fewer smokers, more patients inKillip-Kimball class ≥ 2 and lower primary percutaneous coronary intervention success rate. The incidences of death or non-fatal infarction (11.0% vs. 18.6%; p = 0.08), death (8.5%vs. 16.8%; p = 0.04) and acute renal failure (7.6% vs. 19.9%; p < 0.01) were greater in Group 2. Conclusions: Patients with ST-elevation acute myocardial infarction undergoing primarypercutaneous coronary intervention with symptom onset-toballoon time ≥ 6 hours presented higher clinical complexityand worse in-hospital outcomes when compared to patients treated earlier. Joint actions in different critical areas of patient care are essential to increase treatment efficacy and reduceadverse outcomes...

Bovine serum albumin nanoparticle vaccine reduces lung pathology induced by live Pseudomonas aeruginosa infection in mice.

Pseudomonas aeruginosa is an important opportunistic human pathogen that causes severe infections in immunocompromised patients and also in cystic fibrosis patients. The aim of this work was to study if a bovine serum albumin nanoparticles with entrapped antigens extracted from P. aeruginosa would be able to protect mice from nasal infection by this pathogen. Mice were immunized via the subcutaneous route using P. aeruginosa antigens, empty nanoparticles or nanoparticles with entrapped P. aeruginosa antigens on days 0, 7 and 14. The total IgG antibody production and specific IgG1 and IgG2a titer were measured by ELISA. Immunized mice were challenged with live P. aeruginosa and their lungs were collected for histopathology studies. Our data showed that NPPa-vaccinated mice presented a high anti-Pseudomonas IgG1 and a low IgG2a antibody titles and decreased inflammatory signs, with significant reduction in intensity and concentration of inflammatory cells, lower hemorrhagic, edema and hyperemia signs in the lungs of challenge mice with live P. aeruginosa if compared to the other groups. Therefore, this formulation is able to induce a functional response in an animal model of infection and thereby is a promising platform for P. aeruginosa vaccines.

Valvuloplastia aórtica percutânea como medida salvadora na estenose aórtica crítica com instabilidade hemodinâmica / Emergency percutaneous balloon aortic valvuloplasty in critical aortic stenosis with hemodynamic instability

Relatamos o caso de uma paciente de 81 anos, com estenose aórtica (EA) grave sintomática, que, durante cateterismo cardíaco diagnóstico, evoluiu com instabilidade hemodinâmica refratária e posterior parada respiratória. Foi submetida à valvuloplastia aórtica percutânea por balão como medida salvadora, com subsequente melhora hemodinâmica e compensação clínica. A possibilidade de tratamento cirúrgico da EA foi descartada pelo alto risco cirúrgico. O acompanhamento clínico de até 7 meses após o procedimento demonstrou melhora significativa da classe funcional e boa tolerância aos esforços.

We report the case of an 81-year-old patient with symptomatic severe aortic stenosis (AS) who developed refractory hemodynamic instability and respiratory arrest during a diagnostic cardiac catheterization. The patient was submitted to a percutaneous balloon aortic valvuloplasty as a life saving procedure with subsequent hemodynamic improvement and clinical stabilization. The possibility of surgical treatment for AS was excluded due to the high surgical risk. Clinical follow-up of up to 7 months after the procedure demonstrated significant improvement in functional class and good exercise tolerance.