Persistent hypotension and other complications of celiac plexus neurolysis: A case report and literature review.

Key Clinical Message: Persistent hypotension is a rare complication of celiac plexus neurolysis. It is important to know what are the main and rare complications and how to treat these in patients who undergo CPN. Abstract: Celiac plexus neurolysis is an effective treatment for visceral abdominal pain in oncological patients. Although it rarely has complications, some side effects may occur. A patient with visceral abdominal pain who developed long-lasting orthostatic hypotension and was treated with the use of corticosteroids after a neurolytic celiac plexus block for intractable pain. We describe a rare complication and its treatment and we emphasize the importance of having a guide for the management and treatment of rare complications. We also suggest that every patient be informed about complications, from the most common to the rarest.

Brain metastasis from a thoracic myxofibrosarcoma: A case report and literature review.

Background: Myxofibrosarcoma (MFS) is a type of sarcoma that mainly affects elderly people; it represents only 5% of all sarcomas and shows no line of differentiation. Intracranial MFS is a rare condition. At present, limited data exist regarding brain metastasis from MFS. This article reports a case of MFS and reviews the literature regarding MFS metastasis. Case Description: We report a case of brain metastasis from chest wall MFS. The patient was diagnosed with an anterior thoracic MFS and underwent surgery and radiotherapy. One year later, he noticed a tumor on his left shoulder, and more than 1 year thereafter, bilateral lung metastasis was observed. Twelve months after lung metastasis, he presented to the emergency department and underwent contrast-enhanced magnetic resonance imaging, which demonstrated a left frontal tumor suggestive of brain metastasis. Since the main hypothesis was a sarcoma metastasis at the location close to the left motor area, and the patient had a good Karnofsky performance scale, the patient underwent neuronavigation-guided surgery. After surgery, the patient developed Grade III hemiparesis and aphasia. Brain tumor histopathology confirmed a malignant neoplasm with osteosarcomatous differentiation and metastasis from MFS. Conclusion: We report a rare case of MFS metastasis. To the best of our knowledge, this is the eighth case of intracerebral metastasis from MFS.

Protocolo para tratamento do dedo em gatilho em Hospital de atendimento terciário de servidores públicos / Trigger finger treatment protocol in a tertiary care hospital for public servants

A tenossinovite estenosante dos dedos e do polegar é comumente conhecida como dedo em gatilho, uma condição comum que afeta os tendões flexores no túnel osteofibroso na polia A1. Esta patologia é caracterizada por dor à palpação do dedo, limitações de movimento e impacto no funcionamento do órgão afetado. O objetivo deste estudo foi reunir e analisar criticamente as informações da literatura científica sobre intervenções conservadoras (injeção de corticosteroides, uso de órteses e fisioterapia e sessões de terapia ocupacional) ou cirúrgicas (liberação percutânea e cirurgia aberta) no tratamento da tenossinovite estenosante, que destaca os principais resultados e intervenções considerados mais relevantes. Foi realizada uma busca na base de dados com prioridade para artigos com 5 anos de publicação. De acordo com o estágio na apresentação inicial da patologia, as intervenções conservadoras e invasivas no tratamento da tenossinovite estenosante são eficazes e mostram um benefício significativo na melhora da dor e dos sintomas do dedo em gatilho. No entanto, não foi possível demonstrar que algumas intervenções são superiores em relação a outras. O objetivo deste trabalho é avaliar as técnicas atualmente descritas, o efeito do tratamento do dedo em gatilho com liberação percutânea da polia A1 e as complicações relacionadas ao método utilizado e ao final propor um protocolo simples e eficiente para a instituição. Os médicos brasileiros realizam o diagnóstico do dedo em gatilho apenas pelo exame físico, classificado de acordo com Quinnell modificado por Green, tratamento inicial não cirúrgico, infiltração com corticosteroides e anestésicos locais, período de tratamento não cirúrgico de 1 a 3 meses, tratamento cirúrgico aberto. O principal problema da abordagem não cirúrgica é a recorrência da patologia, e, considerando o sucesso da cirurgia aberta em > 90% dos casos, houve complicações cicatriciais como o principal problema. Palavras-chave: Dedo em gatilho. Tenossinovite estenosante. Revisão bibliográfica. Protocolos.

SUS na mídia em contexto de pandemia / SUS in the media in a pandemic context

RESUMO A pandemia da Covid-19 produziu novas demandas por serviços nos sistemas de saúde no mundo inteiro. No Brasil, o Sistema Único de Saúde (SUS) passou a ser objeto do interesse dos meios de comunicação, que realizaram esforços de cobertura das ações governamentais e da capacidade do sistema no controle da pandemia. Este estudo objetiva analisar matérias do jornal 'Folha de São Paulo' (FSP), quanto aos sentidos produzidos sobre o SUS na pandemia de Covid-19. Foram analisadas 231 matérias, dentre as 524 publicadas no período de janeiro a maio de 2020, obedecendo aos critérios de inclusão estabelecidos. O corpus foi categorizado em quatro sentidos: SUS constitucional, SUS problema, SUS em disputa e SUS atuante. A diversidade de sentidos atribuídos ao SUS aponta a necessidade da ampliação de captura das dimensões do SUS.

ABSTRACT The COVID-19 pandemic has produced new demands for services in healthcare systems around the world. In Brazil, the SUS became the object of interest of the media, which made efforts to cover government actions and the system's capacity to control the pandemic. This study aims to analyze articles from the newspaper 'Folha de São Paulo' (FSP), regarding the meanings produced about the Unified Health System (SUS) in the COVID-19 pandemic. 231 articles were analyzed, among the 524 published in the period from January to May 2020, following the established inclusion criteria. The corpus was categorized in four senses: constitutional SUS, problem SUS, disputed SUS and active SUS. The reflection on the diversity of meanings attributed to the SUS points to the need to expand the capture of the dimensions of the SUS.

Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Clinical and Microbiological Profile of Diabetic Foot Ulcers Infected With Staphylococcus aureus in a Regional General Hospital in Bahia, Brazil.

It is necessary to know the resistance profile of Staphylococcus aureus to better control diabetic foot ulcer infections, to establish rational antibiotic therapy, and to avoid the development of resistant strains. This cross-sectional study evaluated the clinical parameters, virulence, and antimicrobial resistance profiles of S aureus in patients with diabetic foot disease admitted to a public hospital. S aureus strains were identified in patients with diabetes with amputation indication. Infected tissue samples were collected, microbes were isolated and identified. The microbial resistance profile was determined. Samples were also analyzed for biofilm formation and other virulence markers. The 34 individuals examined were mostly men, black, aged 60 years on average, and generally had a low income and education level. Most individuals had type 2 diabetes, and the mean time since diagnosis was 13.9 years. On an SF-36 (the Medical Outcomes Study 36-item short-form health survey) quality-of-life questionnaire, 75% of individuals obtained a score equal to 0 for physical impairment. S aureus specimens from 17 patients were isolated, corresponding to 50% of samples. Five isolates were classified as methicillin-resistant S aureus (MRSA). Molecular typing revealed that 20% of MRSA strains were SCCmec type V and 80% were type I. All isolates were sensitive to doxycycline; 61.5% were resistant to erythromycin, 38.5% to cefoxitin, 30.7% to clindamycin and ciprofloxacin, 23% to meropenem, 15.3% to gentamicin, 38.5% to oxacillin, and 7.7% (one strain) to vancomycin. Regarding biofilm production, 53% of samples were able to produce biofilms, and 84.6% had icaA and/or icaD genes. Additionally, the following enterotoxin genes were identified in the isolates: seb, sec, seg, and sei (5.9%, 5.9%, 11.8%, and 23.9%, respectively) and agr types 1 (5.9%) and 2 (11.8%). Genotypic evaluation made it possible to understand the pathogenicity of S aureus strains isolated from the diabetic foot; laboratory tests can assist in the monitoring of patients with systemic involvement.

Surgical Treatment for Spasticity: Selective Dorsal Rhizotomy ­ Technique and Literature Review

Spasticity is amotor disorder that leads to a resistance to passive jointmovement. Cerebral palsy is the most important cause of spasticity and can be caused by several factors, including multiple gestations, alcoholism, infections, hemorrhages, drowning, and traumatic brain injuries, among others. There aremany scales that help tomeasure andmonitor the degree of impairment of these patients. The initial treatment should focus on the causal factor, such as tumors, inflammation, degenerative diseases, hydrocephalus, etc. Subsequently, the treatment of spastic musculature includes oral or intrathecal myorelaxants, spinal cord electrostimulation, neurotomies, Lissauer tract lesion, dentatotomy and selective dorsal rhizotomy. The latter is a safetechnique, possibleto beperformed inmost centers with neurosurgical support, and it is effective in the treatment of severe spasticity. In this article, the authors describe the surgical technique and conduct a review the literature.

The genetic diversity and population structure of two endemic Amazonian quillwort (Isoetes L.) species.

BACKGROUND: Two endemic lycophyte species Isoetes cangae and Isoetes serracarajensis have been recently described in the State of Pará in the Amazon forest located in northern Brazil. Isoetes L. has survived through three mass extinctions. Plants are considered small-sized, heterosporous, and can display a great diversity of physiological adaptations to different environments. Thus, the current study aimed to estimate the genetic variation of the populations of I. cangae and I. serracarajensis to generate information about their different mechanisms for survival at the same geographical location that could point to different reproductive, adaptative and dispersal strategies and should be considered for effective conservation strategies. METHODS: The genetic diversity and population structure of I. cangae and I. serracarajensis were investigated using Inter Simple Sequence Repeat (ISSR) molecular markers. Total genomic DNA was isolated, and the genetic diversity parameters were calculated. RESULTS: The sixteen primers produced 115 reproducible bands, 87% of which were polymorphic. A high level of polymorphic loci (81.74% and 68.48%) and a high Shannon index (Sh = 0.376 and 0.289) were observed for I. cangae and I. serracarajensis, respectively. The coefficient of genetic differentiation between population areas (GST) showed a higher value in I. serracarajensis (0.5440). Gene flow was higher in I. cangae (1.715) and lower in I. serracarajensis populations (0.419). Overall, the results further show that I. serracarajensis and I. cangae are two species with considerable genetic variation and that these differences may reflect their habitats and modes of reproduction. These results should be considered in the development of effective conservation strategies for both species.

Spinal Cord Stimulation as a Treatment Option for Refractory Chemotherapy-Induced Peripheral Neuropathy: Case Report

Colorectal cancer is one of the most common oncological diseases. Chemotherapy is usually recommended as an adjuvant treatment for stage-II, -III, and -IV tumors. Approximately 10% of the patients develop neuropathic pain after chemotherapy, and they may remain refractory despite the administration of drugs that are commonly used to treat neuropathic pain. Spinal cord stimulation is a good treatment option for neuropathic pain of the lower limbs, and it should be trialed in patients with chemotherapy-induced peripheral neuropathy. We report the case of a patient with oxaliplatin-induced neuropathy and neuropathic pain refractory to oral medication who was successfully treated by spinal cord stimulation.

904 nm Low-Level Laser Irradiation Decreases Expression of Catabolism-Related Genes in White Adipose Tissue of Wistar Rats: Possible Roles of Laser on Metabolism.

Background: Adipose tissue is the main energy storage tissue in the body. Its catabolic and anabolic responses depend on several factors, such as nutritional status, metabolic profile, and hormonal signaling. There are few studies addressing the effects of laser photobiomodulation (PBM) on adipose tissue and results are controversial. Objective: Our purpose was to investigate the metabolic effects of PBM on adipose tissue from Wistar rats supplemented or not with caffeine. Materials and methods: Wistar rats were divided into four groups: control (CTL), laser-treated [CTL (L)], caffeine (CAF), and caffeine+PBM [CAF (L)]. Blood was extracted for quantification of triglyceride and cholesterol levels and white adipose tissues were collected for analysis. We evaluated gene expression in the adipose tissue for the leptin receptor, lipase-sensitive hormone, tumor necrosis factor alpha, and beta adrenergic receptor. Results: We demonstrated that the low-level laser irradiation was able to increase the feed intake of the animals and the relative mass of the adipose tissue in the CTL (L) group compared with CTL. Laser treatment also increases serum triglycerides [CTL = 46.99 ± 5.87; CTL (L) = 57.46 ± 14.38; CAF = 43.98 ± 5.17; and CAF (L) = 56.9 ± 6.12; p = 0.007] and total cholesterol (CTL = 70.62 ± 6.80; CTL (L) = 79.41 ± 13.07; CAF = 71.01 ± 5.52; and CAF (L) = 79.23 ± 6.881; p = 0.003). Conclusions: Laser PBM decreased gene expression of the studied genes in the adipose tissue, indicating that PBM is able to block the catabolic responses of this tissue. Interestingly, the CAF (L) and CAF animals presented the same CLT (L) phenotype, however, without increasing the feed intake and the relative weight of the adipose tissue. The description of these phenomena opens a new perspective for the study of the action of low-level laser in adipose tissue.

Ultrasound-Guided DREZotomy: Technical Note.

Dorsal root entry zone (DREZ) lesioning is still used as a choice of treatment for some painful conditions as well as spasticity in selected patients. The most commonly used techniques to perform DREZotomy are the microsurgical one and DREZ radiofrequency (RF) coagulation. The technical difficulties using punctures to perform RF lesions include complications such as occurrence of lesions in the dorsal columns or in the corticospinal tract. This paper describes a new technical improvement in RF lesions at DREZ using intraoperative ultrasound (US) to optimize the lesions and to minimize the risk of complications. Using intraoperative US after laminotomy allows the surgeon to differentiate between the gray matter of the spinal cord and white matter, showing the correct entry zone, the angle to introduce the RF electrode, and the depth. Using intraoperative US to guide DREZ lesions provides real-time optimization of DREZotomy.

Avaliação pré-operatória por imagem da hidradenite supurativa / Preoperative imaging assessment of hidradenitis suppurativa

A hidradenite supurativa (HS) é uma doença inflamatória crônica da pele caracterizada por apresentar nodulações subcutâneas, dolorosas e com sinais flogísticos, inicialmente enrijecidas e que evoluem para consistência amolecida. Ocorre em 1 a 4% da população mundial. A sua etiologia ainda é pouco conhecida, sugere-se que aconteça devido à oclusão do ducto apócrino dos folículos pilosos por fatores precipitantes como fricção de tecido adiposo, higiene precária, entre outras. Seu diagnóstico é eminentemente clínico, pela identificação de lesões típicas recorrentes em forma de nodularidades, abcessos, tratos fistulosos ou cicatrizes. Não há testes patognomônicos. Sua evolução é variável e de difícil manejo, o qual pode ser feito com terapia tópica, sistêmica ou por exérese cirúrgica. Este trabalho revisa a avaliação por imagem da hidroadenite supurativa e demonstra imagens de um caso avaliado por ressonância magnética. A avaliação por exames de imagem, apesar de pouco específica para firmar diagnóstico, é muito útil na determinação da extensão da doença, assim como na exclusão de diagnósticos diferenciais, destacando-se o papel da ressonância magnética na avaliação das lesões anogenitais, com potencial de reduzir recorrências.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful deep-seated skin nodules with phlogistic signs, which are initially hard and progress to have a soft consistency. It occurs in 1­4% of the world population. Etiology of HS is still poorly understood and is suggested to occur due to occlusion of the apocrine duct of the hair follicles by triggering factors such as friction of the adipose tissue and poor hygiene, among others. Diagnosis is eminently clinical, through the identification of typical recurrent lesions that include nodules, abscesses, sinus tracts, or scars. There are no pathognomonic tests used to confirm its presence. Progression is variable and difficult to manage, which can be done with topical or systemic therapy or surgical excision. This work reviews the imaging assessment of HS and shows images of a case assessed by magnetic resonance imaging. Imaging assessment, although not specific enough for a diagnosis, is useful to determine the extent of the disease and to exclude differential diagnoses. Moreover, magnetic resonance imaging has an important role in the assessment of anogenital lesions and a potential to reduce recurrences.

Laser Photobiomodulation 904 nm Promotes Inhibition of Hormone-Sensitive Lipase Activity in 3T3-L1 Adipocytes Differentiated Cells.

Background: The lipid metabolism is essential for maintaining the body's energy responses. Laser photobiomodulation triggers many important cellular effects, but these effects on lipid metabolism are not well described. In this study, we analyzed the laser photobiomodulation in the hormone-sensitive lipase (HSL) activity, a key enzyme in the triglycerides (TAG) hydrolysis in adipose tissue 3T3-L1. Methods: Cells were submitted to the differentiation protocol in adipose cells, irradiated with 1, 2, and 3J with laser (904 nm-60 mw-laser diode) and incubated for 4 h after irradiation. Results: The response of laser photobiomodulation was able to trigger an inhibition of HSL activity (control = 0.057 ± 0.0008; 1J = 0.050 ± 0.0003; 2J = 0.0477 ± 0.002; 3J = 0.051 ± 0.002; p = 0.0003 against the control), but no modulation was observed in TAG levels into the medium (control = 26.5856 ± 0.52; 1J = 26.5856 ± 0.52; 2J = 27.2372 ± 1.41; 3J = 25.9991 ± 0.1303; p = 0.18). Conclusions: This is the first study of HSL activity modulation with laser radiation, suggesting that photobiomodulation can influence adipose tissue metabolism and open a new field of study.

Vessel wall MRI revealing inflammation on brain aneurysm associated to chronic mucocutaneous candidiasis.

Some authors have reported the association between CMC and brain aneurysms. In this paper it is reported a fusiform brain aneurysm associated to CMC and the vessel wall MRI findings.

Endoscopic view of an internal carotid artery aneurysm presenting with hydrocephalus.

Giant aneurysms (>25 mm) represent approximately 5-10% of all intracranial aneurysms. In this paper it's reported a giant calcified aneurysm presenting with hydrocephalus. It's highlighted the pre-operative images and intra-operative endoscopic findings.

Brain Abscess After Halo Fixation for the Cervical Spine.

BACKGROUND: Halo fixation is one of the possible treatments for cervical spine fractures. However, improper use of these devices may lead to many complications, such as pin loosening, halo dislocation, pin site infection, and intradural penetration. CASE DESCRIPTION: We report the case of a 43-year-old man who first presented with a seizure and an altered level of consciousness 5 months after halo-vest placement for an odontoid fracture. Brain imaging showed a brain abscess, under the previous left parietal pin. The patient underwent abscess drainage and antibiotics were administered for 12 weeks. On hospital discharge, he presented with only mild impairments. CONCLUSIONS: Misapplication of halo fixation devices may lead to serious complications, including intracranial pin penetration and brain abscesses. Proper use of the recommended technique may decrease the risk for complications related to the procedure.

Intradural calcifying pseudoneoplasm of the neuraxis presenting as a cauda equina syndrome.

BACKGROUND: Calcifying nonneoplastic pseudoneoplasms of the neuraxis (CAPNON) have been reported in 59 cases in literature, however, they rarely involve the spinal cord. Owing to the advances in immunohistochemical markers, their structure and origin are better understood now. CASE REPORT: We present the case of a 72-year-old female who had longstanding history of low back pain that exacerbated 20 days prior to the presentation to the emergency room with a frank cauda equina syndrome. The lumbar computed tomography scan showed a hyperdense lesion, suggestive of calcified tumor, whereas the magnetic resonance imaging revealed a hypointense lesion on theT1 and T2-weighted images, without contrast enhancement or edema on fluid-attenuated inversion recovery. She underwent an emergent L2-L4 laminectomy and L3-L4 discectomy with resection of L2 intradural tumor, following which she regained normal function. CONCLUSION: A 72-year-old female presented with a cauda equina syndrome attributed to an L2 intradural CAPNON. Following gross total resection, the patient was neurologically intact.

Prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus and their relationship with duration of the disease and chronic complications.

UNLABELLED: Controversial data suggest that patients with type 2 diabetes mellitus have an increased risk of fractures despite having, in some studies, higher bone mineral density. METHODS: The aim of this study was to determine the prevalence of osteoporosis and morphometric vertebral fractures in 148 postmenopausal diabetic women, aged 61.87±7.85 years, and their relationship with clinical and metabolic factors and chronic complications of the disease. RESULTS: The prevalence of osteoporosis was 30.4% at lumbar spine (LS) and 9.5% at femoral neck (FN). The prevalence of vertebral fractures was 23%, mostly mild and located at the thoracic spine. Patients with fractures were older (P<.001), had been in the menopause for a long period (P=.005), had lower creatinine clearance (P=.026) had and lower bone mineral density at LS (P=.01) and FN (P=.042). The frequency of fractures increased with age (P<.001), with the duration of the disease (P=.037) and with the presence of retinopathy (P=.030). In patients with fractures, the prevalence of osteoporosis increased to 40% at LS (P=.004) and to 35.7% at FN (P=.049). After logistic regression adjustment, it was observed that the likelihood of presenting vertebral fractures was significantly increased at the age of 60 years or older (P<.001) and with the presence of osteoporosis at LS (P=.006), irrespective of blood glucose control. CONCLUSION: We found a high prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus, irrespective of blood glucose control, and these conditions were more frequent in long-standing disease and in patients with retinopathy and impaired renal function.

Prevalência de fatores de risco cardiovascular em profissionais de saúde no ambiente de trabalho / Prevalence of cardiovascular risk factors in health professionals in the work environment

Objetivo: Determinar a prevalência de fatores de risco para doença cardiovascular em profissionais de saúde no ambiente de trabalho. Métodos: Foi realizado um estudo descrito transversal, envolvendo os profissionais do Hospital Municipal Doutor Munir Rafful, que responderam a um questionário, e foram submetidos à avaliação clínica de peso, altura, pressão arterial e avaliação bioquímica do colesterol total. Foi calculada a porcentagem e feita a análise dos resultados. Resultados: Do total de 210 profissionais habilitados, 188 foram avaliados, sendo 57 homens e 131 mulheres. As prevalências dos fatores de risco cardiovascular foram: sedentarismo (83,5 por cento), etilismo (35,6 por cento), hipertensão arterial (22,9 por cento), obesidade (20,2 por cento), tabagismo (19,7 por cento), colesterol maior que 200mg/dl(10,6 por cento). Conclusão: A detecção de índices elevados dos fatores de risco para doenças cardiovasculares em profissionais de saúde é bastante preocupante, visto que servem de exemplo à sociedade, e apontam a necessidade de medidas para promoção da saúde e prevenção de doenças cardiovasculares.