Probiotics, prebiotics, and synbiotics in childhood diarrhea.

Acute diarrhea is the second leading cause of morbidity and mortality attributed to infections in children under five years of age worldwide, with 1.7 million annual estimated cases and more than 500,000 deaths. Although hydroelectrolytic replacement is the gold standard in treating diarrhea, it does not interfere with the restoration of the intestinal microbiota. Several studies have searched for an adequate alternative in restructuring intestinal homeostasis, finding that treatments based on probiotics, prebiotics, and synbiotics are effective, which made such treatments increasingly present in clinical practice by reducing illness duration with minimal side effects. However, there are still controversies regarding some unwanted reactions in patients. The diversity of strains and the peculiarities of the pathogens that cause diarrhea require further studies to develop effective protocols for prevention and treatment. Here, we provide a descriptive review of childhood diarrhea, emphasizing treatment with probiotics, prebiotics, and synbiotics.

Strategies for Preventing and Treating Oral Mucosal Infections Associated with Removable Dentures: A Scoping Review.

Oral infections occur due to contact between biofilm rich in Candida albicans formed on the inner surface of complete dentures and the mucosa. This study investigated historical advances in the prevention and treatment of oral mucosal infection and identified gaps in the literature. Bibliographic research was conducted, looking at PubMed, Embase, Web of Science, and Scopus, where 935 articles were found. After removing duplicates and excluding articles by reading the title and abstract, 131 articles were selected for full reading and 104 articles were included. Another 38 articles were added from the gray literature. This review followed the PRISMA-ScR guidelines. The historical period described ranges from 1969 to 2023, in which, during the 21st century, in vitro and in vivo studies became more common and, from 2010 to 2023, the number of randomized controlled trials increased. Among the various approaches tested are the incorporation of antimicrobial products into prosthetic materials, the improvement of oral and denture hygiene protocols, the development of synthetic and natural products for the chemical control of microorganisms, and intervention with local or systemic antimicrobial agents. Studies report good results with brushing combined with sodium hypochlorite, and new disinfectant solutions and products incorporated into prosthetic materials are promising.

The genetic landscape of mitochondrial diseases in the next-generation sequencing era: a Portuguese cohort study.

Introduction: Rare disorders that are genetically and clinically heterogeneous, such as mitochondrial diseases (MDs), have a challenging diagnosis. Nuclear genes codify most proteins involved in mitochondrial biogenesis, despite all mitochondria having their own DNA. The development of next-generation sequencing (NGS) technologies has revolutionized the understanding of many genes involved in the pathogenesis of MDs. In this new genetic era, using the NGS approach, we aimed to identify the genetic etiology for a suspected MD in a cohort of 450 Portuguese patients. Methods: We examined 450 patients using a combined NGS strategy, starting with the analysis of a targeted mitochondrial panel of 213 nuclear genes, and then proceeding to analyze the whole mitochondrial DNA. Results and Discussion: In this study, we identified disease-related variants in 134 (30%) analyzed patients, 88 with nuclear DNA (nDNA) and 46 with mitochondrial DNA (mtDNA) variants, most of them being pediatric patients (66%), of which 77% were identified in nDNA and 23% in mtDNA. The molecular analysis of this cohort revealed 72 already described pathogenic and 20 novel, probably pathogenic, variants, as well as 62 variants of unknown significance. For this cohort of patients with suspected MDs, the use of a customized gene panel provided a molecular diagnosis in a timely and cost-effective manner. Patients who cannot be diagnosed after this initial approach will be further selected for whole-exome sequencing. Conclusion: As a national laboratory for the study and research of MDs, we demonstrated the power of NGS to achieve a molecular etiology, expanding the mutational spectrum and proposing accurate genetic counseling in this group of heterogeneous diseases without therapeutic options.

Acesso e qualidade da alimentação: percepção da população em situação de rua / Acceso y calidad de la alimentación: percepción de personas en situación de calle / Access to food and food quality: perception of the homeless population

Resumo Objetivo Compreender a percepção do acesso e da qualidade da alimentação para a população em situação de rua. Métodos Estudo descritivo qualitativo, realizado em um Centro de Referência da População de Rua na região centro-sul de Belo Horizonte (MG). Utilizou-se roteiro semiestruturado para a realização das entrevistas de 18 participantes. A coleta de dados ocorreu entre dezembro de 2020 e janeiro de 2021. A análise temática do material, proposta por Bardin, possibilitou a elaboração de três categorias empíricas. Resultados O público entrevistado era masculino, com idade média de 43 anos e tempo médio de situação de rua de 44,6 meses. O acesso à alimentação foi proveniente das doações de alimentos, refeições em instituições governamentais e aquisições ao dispor de renda. Foram relatadas dificuldades quanto à quantidade e qualidade dos alimentos, à aquisição das refeições nos fins de semana, aos sentimentos de medo e angústia perante a fome, à falta do alimento e pelo estigma social, agravados pela COVID-19. Conclusão Diante do cenário de iniquidades sociais, o direito ao acesso à alimentação não é garantido, sendo necessária a implementação de políticas públicas de proteção social que garantam os direitos básicos.

Resumen Objetivo Comprender la percepción del acceso y de la calidad de la alimentación según personas en situación de calle. Métodos Estudio descriptivo cualitativo, realizado en un Centro de Referencia de Personas de la Calle en la región centro-sur de Belo Horizonte (Minas Gerais). Se utilizó un guion semiestructurado para realizar entrevistas a 18 participantes. La recopilación de datos se realizó entre diciembre de 2020 y enero de 2021. El análisis temático del material, propuesto por Bardin, permitió la elaboración de tres categorías empíricas. Resultados El público entrevistado era masculino, de 43 años de edad promedio y tiempo promedio de situación de calle de 44,6 meses. El acceso a la alimentación fue proveniente de donaciones de alimentos, comidas en instituciones gubernamentales y adquisiciones al disponer de ingresos. Las personas relataron dificultades con relación a la cantidad y calidad de los alimentos, a la adquisición de comida los fines de semana, a los sentimientos de miedo y angustia ante el hambre, a la falta de alimentos y al estigma social, agravados por el COVID-19. Conclusión Ante el escenario de iniquidades sociales, el derecho al acceso a la alimentación no está garantizado, por lo cual es necesario implementar políticas públicas de protección social que garanticen los derechos básicos.

Abstract Objective To understand the perception of access to food and food quality for the street population. Methods This qualitative descriptive study was performed in a Reference Center for the Homeless Population in the south-central region of Belo Horizonte (MG). A semi-structured script was used to conduct interviews with 18 participants. Data collection occurred between December 2020 and January 2021. The thematic analysis of the material, as proposed by Bardin, made it possible to elaborate three empirical categories. Results The public interviewed was male, with a mean age of 43 years, and a mean time on the streets of 44.6 months. Access to food came from donations, meals at government institutions, and acquisition when income was available. Difficulties were reported regarding the quantity and quality of food, acquisition of meals on weekends, feelings of fear and anguish in the face of hunger, lack of food, and social stigma, which were aggravated by COVID-19. Conclusion As in this scenario of social inequalities the access to food is not guaranteed, implementing public policies of social protection is necessary to guarantee basic rights.

Intra-myocardial dissecting hematoma: late complication of cocaine-induced myocardial infarction

Intra-myocardial dissecting hematoma (IDH) is a rare and unusual form of myocardial rupture that can be secondary to complicate acute myocardail infarction (MI). It is usually caused by a hemorrhagic dissection between the layers of myocardial fibers that can occur during the acute injury or the remodeling process. This case demonstrates a patient with a history of cocaine-induced ischemic cardiomyopathy complicated with an extensive IDH. Case description A 38-year-old man with a past medical history of hypertension, heart failure with reduced ejection fraction (HFrEF), and cocaine abuse disorder, presents to the emergency department complaining of worsening shortness of breath. Six months before the current hospitalization, the patient had been diagnosed with acute myocardial infarction, left heart Cath showed a severe three-vessel coronary artery disease, but it was non-suitable for revascularization. The transthoracic echocardiogram (TTE) showed significant left ventricular dysfunction with an ejection fraction of 28% and a thrombus in the left ventricle. Four days before the current admission, the patient started complaining of worsening exertional dyspnea, orthopnea, and peripheral edema. His vital signs were BP 90 x 62mmhg, HR 104 bpm, SatO2 90% and afebrile. His physical examination revealed an increased jugular venous pressure, significant symmetric peripheral edema (3+/4), and cold extremities. Cardiac auscultation revealed a regular rhythm, S3, without murmrs. A pulmonary exam revealed bilateral crackles on the inferior 1/3 of the lungs. EKG showed sinus tachycardia and prior inferior necrosis. Renal function was normal, but lactate acid was elevated (2.6mg/dL). The patient was started with noninvasive ventilation, along with IV diuretic therapy, vasopressor, and inotropic support (dobutamine). A TTE was performed which showed an intra-myocardial dissecting hematoma in the inferior left ventricle (LV) wall, along with a large thrombus in the LV chamber and severe biventricular dysfunction (ejection fraction was 23%). Our patient responded well to the medical treatment. Due to his severely reduced left ventricular ejection fraction (LVEF), the IDH was managed conservatively. He was discharged on standard medication for HFrEF and oral anticoagulation. Discussion this case demonstrates IDH as a late complication following a cocaine-induced MI. Two-dimensional echocardiography is useful in the diagnosis of IDH as well as in ruling out potential differential diagnoses. Conservative treatment is a viable option, especially for those patients not suitable for cardiac revascularization with severely reduced left ventricular ejection.

Follow-up de dispositivos cardíacos implantáveis suscetíveis a recall através de monitoramento remoto: resultados de um serviço de referência

INTRODUÇÃO: Em março de 2021 a Biotronik emitiu um comunicado sobre uma possível depleção prematura da bateria de cardiodesfibriladores implantáveis (CDI) e ressincronizadores cardíacos com desfibrilador (TRC-D). A empresa não orientou troca imediata das baterias e sugeriu o acompanhamento através de monitoramento remoto desses pacientes com dispositivos implantados em nosso serviço. Relatamos neste trabalho a taxa de recall. MÉTODOS: Estudo retrospectivo observacional com pacientes com CDI e TRC-D Biotronik suscetíveis a recall implantados no Instituto Dante Pazzanese de Cardiologia entre os anos de 2015 a 2021. Em consulta médica, os pacientes foram convidados a participar do monitoramento remoto com o uso do monitor CardioMessenger Smart, orientados quanto ao comunicado da empresa e sobre como manusear o aparelho. RESULTADOS: Foram identificados 76 pacientes com dispositivos passíveis de disfunção. Através de contato telefônico, observou-se que 34 pacientes já haviam falecido. Uma paciente foi submetida à troca do gerador previamente ao comunicado por desgaste da bateria. Dos 41 restantes, realizouse o monitoramento remoto de 73% (30), sendo 2 TRC-D e 28 CDI. Não ocorreu a monitorização de 10 pacientes devido à não disponibilização dos aparelhos pela empresa. Não foi possível contato com um paciente. Durante o follow-up de 2 anos, 6,6% dos casos (2) apresentaram depleção prematura da bateria, sendo submetidos à troca do gerador. CONCLUSÃO: A percentagem de recall encontrada neste estudo foi relevante e o monitoramento remoto foi fundamental para a detecção precoce e prevenção de uma situação potencialmente fatal.

Differential Diagnosis of Metatarsalgia.

Lesser (or central) metatarsalgia is defined as pain in the forefoot under or around the lesser metatarsals and their respective metatarsophalangeal joints. Two common causes of central metatarsalgia are Morton's neuroma (MN) and plantar plate (PP) injury. Because both clinical and imaging features overlap, establishing the correct differential diagnosis may be challenging. Imaging has a pivotal role in the detection and characterization of metatarsalgia. Different radiologic modalities are available to assess the common causes of forefoot pain, so the strengths and weakness of these imaging tools should be kept in mind. It is crucial to be aware of the pitfalls that can be encountered in daily clinical practice when dealing with these disorders. This review describes two main causes of lesser metatarsalgia, MN and PP injury, and their differential diagnoses.

Changes in the surface water quality of a tropical watershed in the southeastern amazon due to the environmental impacts of artisanal mining.

The expansion of areas of human occupation and the increase in economic activity and deforestation are negatively impacting the Amazon ecosystem. Situated in the Carajás Mineral Province in the southeastern Amazon, the Itacaiúnas River Watershed (IRW) encompasses several active mines and has a historical record of intense deforestation primarily linked with the expansion of pasturelands, but also of urban areas, and mining activities. Industrial mining projects are subjected to strict environmental control, but artisanal mining (ASM; 'garimpos') sites have not been controlled, despite their known environmental impacts. In recent years, the opening and expansion of ASM in the IRW for the exploitation of mineral resources (Au, Mn, and Cu) have been remarkable. This study presents evidence of anthropogenic impacts, mainly caused by ASM, on the quality and hydrogeochemical characteristics of the IRW surface water. The hydrogeochemical data sets of two projects carried out in the IRW, during 2017 and from 2020 until present, were used to evaluate these impacts within the region. Water quality indices were calculated for the surface water samples. For the whole IRW, water collected during the dry season tended to yield better quality indicators in comparison to those collected during the rainy season. Two sampling sites at Sereno Creek showed very poor water quality and extremely high concentrations of Fe, Al, and potentially toxic elements over time. From 2016 to 2022, ASM sites increased markedly. Moreover, there are indications that Mn exploitation via ASM in Sereno hill is the main source of contamination in the area. New trends of ASM expansion were observed along the main watercourses, related to the exploitation of Au from alluvial deposits. Similar anthropogenic impacts are registered in other regions of the Amazon and environmental monitoring should be encouraged to assess the chemical safety of strategic areas.

Síncope cardioinibitória 2b com pausa de 48 segundos em paciente com síndrome de down e defeito do septo av corrigido: descrição do caso e do plano terapêutico / Cardioinhibitory syncope 2b with a 48-second pause in a patient with down syndrome and corrected AV septal defect: case description and therapeutic plan

INTRODUÇÃO: Os quadros de Síncope habitualmente se iniciam na adolescência. Aproximadamente 20% da população experimenta o primeiro episódio de desmaio entre 10 e 20 anos. Apesar de extremamente angustiantes estes nem sempre são investigados. Apenas 25 a 50% dos pacientes são avaliados nos serviços de saúde. Entretanto alguns casos merecem tratamento pelo risco de eventos e necessitam de acompanhamento especializado, inclusive para monitorização da indicação de dispositivos de marcapasso (MP) em caso de refratariedade ao tratamento clínico. Isto ocorre em alguns caos de síncope de padrão neuromediado do tipo cardioinibitória com pausa (Síncope cardioinibitória 2b ao Teste de Inclinação) OBJETIVO: Descrever o caso de uma paciente púbere pós com Síndrome de Down e síncopes de repetição de início recente com teste de inclinação (TI) positivo (resposta 2b). DESCRIÇÃO DO CASO: Paciente 13 anos feminina, Síndrome de Down portadora de defeito do septo AV total em fase pós operatória de correção total com bom resultado cirúrgico. Iniciou concomitante a menarca quadro de sincope recorrente com pródromos (dor abdominal e palidez). Apresenta Holter sem alterações arrítmicas e ecocardiograma com FEVD no limite inferior da normalidade. Analise do ECG com sinais de bloqueio divisional ântero superior direito. Foi submetido a avaliação por TI. Realizou protocolo de inclinação passivo a 70 graus não sensibilizado. Após 5 minutos de repouso foi inclinada e se manteve estável por 7 minutos e no oitavo minuto de inclinação apresentou dor abdominal, seguida de sincope com resposta cardioinibitória 2b e pausa de 48 segundos (fig 1) apesar do retorno a posição de Trendelenburgo (-30 graus). Houve retorno dos batimentos cardíacos com recuperação imediata do nível de consciência. Iniciado tratamento clínico com orientação de aumento da ingesta hídrica, suspender fatores desencadeantes (ortostase prolongada, ambientes quentes por exemplo) e mantido a monitorização rigorosa com intuito de avaliar a refratariedade e a necessidade de indicação de MP. CONCLUSÃO: 1) Os quadros de síncope neuromediada são particularmente frequentes durante a adolescência, principalmente após o estirão do crescimento 2) As respostas cardioinibitórias podem se instalar subitamente e serem de grande repercussão. Apesar deste fato o tratamento clínico deve ser sempre priorizado; 3) O paciente deve ser monitorizado quanto as recorrências e refratariedade ao tratamento clínico para indicação precisa de MP em pacientes com síncope cardioinibitória 2b com grandes pausas refratária à medidas gerais.

Ablação de via anômala em região de cúspide coronariana esquerda / Ablation of an anomalous pathway in the region of the left coronary leaflet

INTRODUÇÃO: Vias acessórias são comumente encontradas ao longo do ânulo tricuspídeo e mitral. A região de continuidade mitroaórtica é uma rara localização, com dados significativos limitados. DESCRIÇÃO: Homem de 52 anos com palpitações taquicárdicas frequentes e ECG com pré-excitação ventricular e onda delta positiva de V1 a V6, em DII, DIII e aVF, negativa em aVR e aVL, foi encaminhado para estudo eletrofisiológico e ablação. Medidas iniciais mostraram HV 0 ms e QRS 130 ms. Estudo confirmou presença de via acessória com condução bidirecional e maior fusão atrioventricular no pólo distal do cateter decapolar inserido no seio coronariano. Realizada punção transeptal e mapeamento com cateter terapêutico de 4 mm, sendo encontrada maior fusão atrioventricular (AV) em ritmo sinusal em região anterior do anel mitral. Entretanto, pulsos de radiofrequência (30W, 60°C) aplicados neste local foram ineficazes, atingindo baixa potência. Novas aplicações com cateter terapêutico de 8 mm introduzido em veia cardíaca magna apresentaram a mesma limitação. Optado por acesso retroaórtico e mapeamento de região subvalvar de cúspide coronariana esquerda, condizente com região de continuidade mitroaórtica, que evidenciou fusão AV e precocidade de 30 ms do eletrograma ventricular em relação ao início da onda delta. Pulsos de radiofrequência (50W, 60°C) eliminaram rapidamente a condução pela via acessória nesta localização. CONCLUSÃO: Na região da continuidade mitroaórtica é rara a presença de via acessória devido à sua composição por tecido fibroso. Em situações sugestivas de via acessória anterior esquerda em que não há sucesso com aplicações de radiofrequência em ânulo mitral, é válido o mapeamento de regiões pouco usuais para o correto diagnóstico e ablação eficaz.

Does the early phase of aging affect the morphology of biceps brachii and torque and total work of elbow flexors in healthy volunteers?

Upper and lower limbs can be affected by several diseases and changes related to current life habits, such as the sedentarism, technological advances, and even eating habits. This cross-sectional study investigated morphological adaptations of the biceps brachii muscle and the performance of the elbow flexors in healthy individuals in the early phase of aging. Thirty-two volunteers were separated according to age range (3rd, 4th, and 5th decades of life) and sex. Smaller diameters and subtypes of fibers were evaluated using muscle biopsies, and peak torque and total work were assessed using an isokinetic dynamometer. The variables were compared considering sex and decade, using mixed-effects linear models. The smaller diameter of all fiber types did not differ significantly between age groups for either sex. The proportion of oxidative fibers was reduced in male participants in the 4th (-20%) and 5th (-6%) decades of life compared to the 3rd decade, and there was an increase in the number of oxidative fibers in women from the 4th (+14%) to the 5th decade of life. There were no significant changes in the peak torque and total work between the analyzed age groups. The early phase of aging starts with alterations in the proportion of fibers, with a decrease in oxidative fibers in men and an increase in oxidative fibers in women. Smaller diameter, torque, and total work did not change over these decades of life.

Impact of bone-anchored maxillary protraction on the quality of life of subjects with complete unilateral cleft lip and palate.

INTRODUCTION: This study aimed to evaluate the influence of bone-anchored maxillary protraction (BAMP) on the oral health-related quality of life (OHRQOL) in subjects with complete unilateral cleft lip and palate (UCLP) and moderate-to-severe maxillary deficiency. METHODS: A longitudinal observational study was conducted with a sample of 20 patients (13 males, 7 females) aged 10-14 years (mean age, 11.8 years) with Goslon 3, 4, and 5. To assess the patient's perception of their OHRQOL, the Quality of Life Questionnaire for Orthosurgical Patients was administered in 2 stages: after the installation of the protraction plates (T1) and 18 months after the protraction therapy started (T2). The questionnaire was composed of 4 domains, distributed over 22 questions: social aspects, facial esthetics, oral function, and awareness of facial deformity. RESULTS: The treatment protocol improved the OHRQOL in 75% of the patients who presented UCLP. The domain social aspects of the deformity were the only one that showed a significant difference from T1 to T2 and indicated an improvement in self-esteem. The girls had worse OHRQOL than boys at T1, which was statistically significant only for the domains of social aspects of deformity and awareness of deformity. After BAMP therapy, the effect size indicated a larger change in OHRQOL in girls than in boys. CONCLUSIONS: BAMP therapy positively impacted the OHRQOL and self-esteem of patients with UCLP during adolescence.

Does the early phase of aging affect the morphology of biceps brachii and torque and total work of elbow flexors in healthy volunteers?

Upper and lower limbs can be affected by several diseases and changes related to current life habits, such as the sedentarism, technological advances, and even eating habits. This cross-sectional study investigated morphological adaptations of the biceps brachii muscle and the performance of the elbow flexors in healthy individuals in the early phase of aging. Thirty-two volunteers were separated according to age range (3rd, 4th, and 5th decades of life) and sex. Smaller diameters and subtypes of fibers were evaluated using muscle biopsies, and peak torque and total work were assessed using an isokinetic dynamometer. The variables were compared considering sex and decade, using mixed-effects linear models. The smaller diameter of all fiber types did not differ significantly between age groups for either sex. The proportion of oxidative fibers was reduced in male participants in the 4th (-20%) and 5th (-6%) decades of life compared to the 3rd decade, and there was an increase in the number of oxidative fibers in women from the 4th (+14%) to the 5th decade of life. There were no significant changes in the peak torque and total work between the analyzed age groups. The early phase of aging starts with alterations in the proportion of fibers, with a decrease in oxidative fibers in men and an increase in oxidative fibers in women. Smaller diameter, torque, and total work did not change over these decades of life.

Trace Elements in Beef Cattle: A Review of the Scientific Approach from One Health Perspective.

The objective was to investigate the context, approach and research topics present in the papers that analysed trace elements in beef cattle to identify gaps and scientific perspectives for the sustainable management of trace elements in livestock. The main research groups came from the United States, Spain, Japan, Brazil, India and Slovakia, which represented 31% of the papers produced. Only 37% of studies addressed aspects that integrated animal, environmental and human health. The reviewed papers concerned 56 elements and 15 bovine tissues (Cu, Zn, Pb, liver, muscle and kidney highlighted). The main gaps were (1) lack of research in developing countries, (2) the need to understand the impact of different environmental issues and their relationship to the conditions in which animals are raised, and (3) the need to understand the role of many trace elements in animal nutrition and their relationship to environmental and human health. Finally, we highlight possible ways to expand knowledge and provide innovations for broad emerging issues, primarily through expanding collaborative research networks. In this context, we suggest the adoption of the One Health approach for planning further research on trace elements in livestock. Moreover, the One Health approach should also be considered for managers and politicians for a sustainable environmental care and food safety.

Analysis of the Immunohistochemical Expression of Ghrelin in the Gastric Mucosa and Correlation with Weight Loss After Sleeve Gastrectomy.

INTRODUCTION: Sleeve gastrectomy is one of the main techniques used to treat severe obesity. The study of the immunohistochemical expression of ghrelin in the gastric mucosa has already been related to weight loss and can be a promising method to predict the surgical outcome. PURPOSE: To analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities, and inflammatory changes after sleeve gastrectomy. METHODS: Thirty-five patients submitted to sleeve gastrectomy were evaluated, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average body mass index of 38.1 kg/m2. Endoscopic samples of the mucosa were collected, whose ghrelin expression was evaluated in a semi-quantitative way through the stained antibody area. These data were correlated with weight loss at 3, 6, and 12 months and with the control of comorbidities, and inflammatory alterations. RESULTS: The average total weight loss (TWL%) was 17.7, 26.4, and 32.1%, respectively, at 3, 6, and 12 months. A negative correlation was found between the immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus and weight loss at 3 (s = - 0.536; p = 0.001) and 6 months (s = - 0.339; p = 0.047). CONCLUSION: The immunohistochemical expression of ghrelin in the mucosa of the gastric fundus was negatively correlated with early weight loss after sleeve gastrectomy.

Ablação de via anômala esquerda em posição semi-sentada utilizando acesso radial / Ablation of left anomalous pathway in semi-sitting position using radial approach

INTRODUÇÃO: A distrofia muscular tipo cintura do quadril cursa com lesão progressiva e irreversível. Devido a fraqueza dos músculos respiratórios e orofaríngeos que podem estar presentes nesses pacientes, além de sensibilidade aumentada e prolongada a sedativos e analgésicos, potencializando o risco de aspiração e apneia de início tardio, a extubação pós procedimento pode ser dramática, podendo evoluir para insuficiência respiratória pós extubação. DESCRIÇÃO: Relatamos o caso de uma mulher obesa de 46 anos que apresentava quadro avançado, com necessidade do uso de suporte ventilatório não invasivo e decúbito lateral durante o sono. A mesma não tolerava decúbito dorsal com inclinação inferior a 60 graus e era portadora de síndrome de Wolff-Parkinson-White por via anômala lateral esquerda, refratária ao tratamento combinado de amiodarona e atenolol. Discutido com equipe de anestesiologia e considerado que intubação endotraqueal incorreria em alta probabilidade de desmame difícil, bem como provável traqueostomia pré-extubação. Após longa deliberação sobre o caso optado por realização do procedimento em posição semi- -sentada (60 graus, guiado pela orientação dada pela paciente). Pela obesidade e angulação de membros inferiores, tornou-se inviável punção femoral. Optamos então por punção radial com introdutor slender 6F/7F, que permitiu o uso de um cateter terapêutico e acesso retroaórtico via artéria radial direita. Apesar da variação da angulação da fluoroscopia, foi possível a abordagem com cateter oito mm curva média 7F com sucesso e sem intercorrências. Importante observar que o procedimento foi relativamente bem tolerado, exceto por momentos de dor em membro superior direito sugestivos de espasmo em artéria radial, prontamente revertidos com infusão em bólus de solução de nitroglicerina no introdutor radial. A paciente recebeu alta na manhã seguinte ao procedimento por protocolo institucional. CONCLUSÃO: O acesso radial deve ser considerado em raras situações e pode ser uma solução factível em casos específicos como esse.

Vesicovaginal fistula repair after a failed Lehoczky's island flap procedure.

Vesicovaginal fistula (VVF) is the most common genitourinary fistula associated with significant, detrimental impact on the quality of life. Surgical repair of VVF may be complex requiring tissue interposition techniques to bring fresh blood supply, minimize recurrence, and improve functional outcomes. The international literature is scarce regarding complications related to interposition tissue. However, caution is particularly recommended in selecting the tissue interposition technique to avoid unexpected and frustrating problems. We present a 57-year-old woman following multiple failed transvaginal and transabdominal VVF repairs involving a labium majus skin island flap (Lehoczky flap) after radical hysterectomy for cervical cancer.

Influence of clinical and demographic factors on the oral health-related quality of life of patients with cleft lip and palate undergoing orthodontic treatment: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to evaluate the influence of orthodontic treatment on the oral health-related quality of life (OHRQoL) of patients with cleft lip and palate. SEARCH METHODS: Electronic searches were conducted in Pubmed, Scopus, Web of Science, Cochrane Library, VHL, and OpenGrey databases, completed in January 2021. SELECTION CRITERIA: Cross-sectional and longitudinal observational studies that presented an assessment of OHRQoL in cleft patients undergoing orthodontic treatment were included, according to PRISMA guidelines. Contacts via email were made with authors, to clarify inaccuracies or request additional data. DATA COLLECTION AND ANALYSIS: The entire process was accomplished by two authors, in case of disagreement, a third author mediated the discussion until there was a consensus. Risk assessment was performed by the Fowkes and Fulton qualifier, and the quality of evidence, assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. A meta-analysis was performed considering the domains combined into three large groups (physical, psychological, and social). The questionnaires were standardized as to the scores and their direction. RESULTS: A total of 3822 studies were retrieved. After excluding duplicates, the titles and abstracts of the remaining articles were analysed. Twenty-eight articles were read in full; 13 met the eligibility criteria; 12 articles showed sufficient methodological quality and 7 were included in the quantitative assessment. The included studies were published between 2011 and 2019. The samples comprised 19 to 183 patients of both sexes. GRADE showed low evidence when compared to the control group, sexes, age, and types of cleft and very low evidence among longitudinal articles. CONCLUSIONS: The OHRQoL is lower in orthodontic patients with cleft than in those without. The OHRQoL of patients with cleft undergoing orthodontic treatment is not influenced by gender or age group, considering children and adolescents, but it is influenced by the type of cleft. The OHRQoL of patients with CLP does not undergo significant changes during orthodontic treatment. LIMITATIONS: The variety of instruments for measuring OHRQoL rendered meta-analysis difficult. REGISTRATION: PROSPERO database number CRD42017054764.