Does Interventional Pain Management Play a Role in the Treatment of Cervical Post-Surgical Neuropathic Pain?

Post-surgical neuropathic pain is still an underdiagnosed medical condition with persistent pain occurring in 10-50% of patients submitted to surgery. We present a case of a 52-year-old patient with persistent paracervical, supraclavicular, and upper chest neuropathic pain after the excision of a massive deep right cervical tumor, concluded to be an accessory spinal nerve schwannoma. A thorough physical and ultrasound examination helped conclude injury of the superficial cervical plexus. Therefore, an ultrasound-guided hydrodissection of several neuromas was performed at the level of the superficial cervical plexus. After three procedures, pain and quality of life scores improved, with a reduction of anxiety and depression symptoms. Due to the positive response, the patient was referred for a peripheral nerve stimulator implantation, allowing self-control of pain, in a home setting.

Inferring Microbial Biomass Yield and Cell Weight Using Probabilistic Macrochemical Modeling.

Growth rates and biomass yields are key descriptors used in microbiology studies to understand how microbial species respond to changes in the environment. Of these, biomass yield estimates are typically obtained using cell counts and measurements of the feed substrate. These quantities are perturbed with measurement noise however. Perhaps most crucially, estimating biomass from cell counts, as needed to assess yields, relies on an assumed cell weight. Noise and discrepancies on these assumptions can lead to significant changes in conclusions regarding the microbes' response. This article proposes a methodology to address these challenges using probabilistic macrochemical models of microbial growth. It is shown that a model can be developed to fully use the experimental data, relax assumptions and greatly improve robustness to a priori estimates of the cell weight, and provides uncertainty estimates of key parameters. This methodology is demonstrated in the context of a specific case study and the estimation characteristics are validated in several scenarios using synthetically generated microbial growth data.

Compressive strength of premolars restored with ceramic crowns and supported with a glass fiber post using different luting agents.

Objective: The retention of glass fiber post (GFP) is considered a key factor for the long-term success of restorations of endodontically treated teeth. This study aimed to compare the compressive strength of a ceramic crown supported by a GFP using different luting agents. Methods: Forty single-rooted premolars were randomly divided into four groups (n = 10 each): control group (teeth without a GFP), Ketac Cem group (glass ionomer), RelyX ARC group (conventional dual-curing resin), and RelyX U200 group (self-adhesive dual-curing resin). After luting of the posts and placement of all-ceramic crowns made using feldspathic porcelain (Noritake EX-3), they were exposed to thermocycling for 1000 cycles and compressive strength tests. Statistical analysis included Kruskal-Wallis test with Dunn's multi-comparison test. Results: The Ketac Cem group and RelyX U200 group showed significantly greater fracture resistance to compressive loading than the control group. Conclusion: This study indicates a possible role of the luting agent used with the GFP in influencing the compressive strength of the restored teeth. In this study, the self-adhesive dual-curing resin and glass ionomer both offered resistance to fractures.

Good Bronchial Hygiene Reaches the Left Lung: Successful Extubation in a Tetraplegic Patient With Spinal Cord Injury.

Ineffective coughing affects bronchial hygiene and is a major contributor to respiratory complications after spinal cord injury (SCI). Mechanical insufflation-exsufflation (MIE) therapy increases inspiratory and expiratory flow to assist bronchial secretions clearance. We present a case of a 67-year-old cervical SCI patient with lung infection and partial atelectasis in the lower left lung, associated with difficult ventilator weaning. About one day after the beginning of MIE therapy, an improvement of the atelectasis was verified. The patient was extubated six days after the beginning of bronchial hygiene with MIE therapy and safely transitioned to non-invasive ventilatory support.

Polymyalgia Rheumatica After ChAdOx1 nCov-19 Vaccine: A Case Report.

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease characterized by severe pain and morning stiffness, mainly affecting the shoulder girdle. A 75-year-old woman, previously healthy, received the first dose of ChAdOx1 vaccine and two weeks later started with pain in the shoulder and pelvic girdles and knees of inflammatory characteristics, accompanied by morning stiffness (about one hour), anorexia, asthenia, and activities of daily living (ADL) dependence. She started analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) with no improvement. The symptoms aggravated three days after the second vaccine dose, and she was referred to our center. At observation, she presented shoulder, hip, and knee active range of motion limitation. Blood analysis revealed an Erythrocyte Sedimentation Rate (ESR) of 120mm/h (reference value < 20mm/h) and C-Reactive Protein (CRP) of 80mg/L (reference value < 5mg/L). Ultrasound showed effusion on both shoulders, hips, and knees. The paraneoplastic syndrome was ruled out. She started oral corticosteroids and a rehabilitation program, and a month later, she presented controlled pain, normal analysis, and ADL independence. This case shows symptomatic and analytic features of PRM after the first vaccine dose and aggravation soon after the second. As such, we consider establishing a potential relationship between the inoculation and the development of PRM. A few cases were published reporting a PRM-like syndrome following a COVID-19 vaccine; however, the underlying mechanism and prognosis are still unknown.

A Case Report on a Young Male Taking Methylphenidate With Fasciculations and Dysphagia: Correlation or Causation?

Concurrent fasciculations and oropharyngeal dysphagia (OD) can be presenting signs of motor neuron disease (MND); however, there are other causes for OD (neoplasms, surgery, and gastroesophageal diseases, among others). Fasciculations (anxiety, benign, or iatrogenic) are an uncommon side effect (<1%) of methylphenidate. A 30-year-old male noticed fasciculations in both gastrocnemii, reporting gradual cranial progression, culminating in diffuse fasciculations with facial involvement. One month later, he reported OD for solids and occasional cough for liquids. He denied weakness, fatigue, or weight loss. He has no relevant personal history, apart from attention deficit hyperactivity disorder diagnosed a year before and since then medicated with methylphenidate 40 mg id. He had no abnormal findings on neurological examination. Electromyography (EMG) and sinus CT were normal. Upper gastrointestinal (GI) endoscopy (EGD) showed reflux esophagitis grade C, which could explain OD, and he started esomeprazole 40 mg id. As there were no findings on EMG, an iatrogenic etiology for fasciculations was considered. He suspended methylphenidate for a month and, two months later, reported a substantial improvement in fasciculations and resolution of the OD with the introduction of esomeprazole. Two simultaneous symptoms do not mean they are related. In this specific case, OD was the first symptom of gastroesophageal reflux disease (GERD), and fasciculations happened as a side effect of methylphenidate. This must be taken into consideration, as it can represent a confounding factor making the differential diagnosis more difficult. To the best of our knowledge, there are no published articles similar to this case report.

The use of cranial halo traction versus temporary internal distraction in staged surgery for severe scoliosis: a comparative study / Uso de tração com halo craniano versus distração interna temporária em cirurgias escalonadas em escoliose grave: um estudo comparativo / Uso de la tracción con halo craneal versus distracción interna temporal en cirugías escalonadas en escoliosis grave: un estudio comparativo

ABSTRACT Objective: To determine which method is more effective - cranial halo traction or temporary internal distraction - in staged surgeries for patients with severe (≥ 100°) and stiff (<25% flexibility) scoliosis. Methods: A sample of 12 patients with traction and 7 patients without traction, operated on between January 2013 and December 2017. The patients' demographic data, the type of surgery performed, complications, and coronal and sagittal alignment parameters were recorded before surgery and in the final follow-up. The data were processed in SPSS 20.0. Comparisons were made between the means (Student's t-test) and the clinical and procedure-related characteristics (likelihood ratio and Fisher's Exact tests), at a confidence level of 0.05. Results: There were no significant intergroup differences for clinical characteristics, complications or degree of correction. However, more patients in the group submitted to temporary internal distraction required vertebral resection osteotomies during definitive surgery (p<0.05). Conclusions: Based on the results, it was not possible to establish which is the most effective method, but it is suggested that staged traction may be more effective, and safer, particularly when the surgeon is less experienced, during surgery on patients with severe and stiff scoliosis. Level of evidence IV; Vase series.

RESUMO Objetivo: Determinar qual método é mais eficaz, tração com halo craniano ou distração interna temporária em cirurgias escalonadas para pacientes com escoliose grave (≥ 100°) e rígida (< 25% de flexibilidade). Métodos: Amostra com 12 pacientes com tração e 7 sem tração, operados entre janeiro de 2013 e dezembro de 2017. Os dados demográficos dos pacientes, o tipo de cirurgia realizada, as complicações e os parâmetros de alinhamento coronal e sagital foram registrados antes da cirurgia e no acompanhamento final. Os dados foram processados no SPSS 20.0. Foram feiras comparações entre as médias (teste t de Student) e as características clínicas e relacionadas com o procedimento (teste de razão de verossimilhança e de teste exato de Fisher), com nível de confiança de 0,05. Resultados: Não houve diferenças significativas entre os grupos quanto a características clínicas, complicações e grau de correção. No entanto, mais pacientes do grupo submetido à distração interna temporária necessitaram de osteotomias de ressecção vertebral durante a cirurgia definitiva (p < 0,05). Conclusões: Não se pôde estabelecer com base nos resultados qual o método mais eficaz, porém se sugere que a tração escalonada pode ser mais eficaz e mais segura, principalmente para cirurgiões com menos experiência em cirurgia de pacientes com escoliose grave e rígida. Nível de evidência: IV; Série de Casos.

RESUMEN Objetivo: Determinar qué método es más efectivo, tracción con halo craneal o distracción interna temporal, en cirugía escalonadas para pacientes con escoliosis severa (≥ 100°) y rígida (<25% de flexibilidad). Métodos: Muestra con 12 pacientes en el grupo de tracción y 7 en el grupo sin tracción, intervenidas entre enero de 2013 y diciembre de 2017. Los datos demográficos de los pacientes, los tipos de cirugía, las complicaciones, los parámetros de alineación coronal y sagital se registraron antes de la cirugía y en el último acompañamiento. Los datos se procesaron en SPSS 20.0. Se realizaron comparaciones entre las medias (prueba t de Student) y las características clínicas y relacionadas con el procedimiento (razón de verosimilitud y prueba exacta de Fisher), con un nivel de confianza de 0,05. Resultados: No hubo diferencias significativas entre los grupos en cuanto a características clínicas, complicaciones y grado de corrección. Sin embargo, más pacientes del grupo sometido a distracción interna temporal requirieron osteotomías de resección vertebral durante la cirugía definitiva (p < 0,05). Conclusiones: Con base en los resultados, no fue posible establecer el método más efectivo, pero se sugiere que la tracción escalonada puede ser más eficaz y más segura, especialmente para cirujanos con menos experiencia en cirugía de pacientes con escoliosis severa y rígida. Nivel de evidencia: IV; Serie de Casos

Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report.

Thymomas are usually tumors with a good prognosis but with potential to invade nearby structures. We report a case of a 56-year-old woman previously diagnosed with an invasive thymoma that came to the emergence room with symptoms of acute coronary syndrome. After a coronary computed tomography angiography, it was seen that the tumor was invading the myocardial and it was irrigated by the left circumflex coronary and its branches. Considering her poor prognosis, it was decided not to make further interventions. This case highlights a unique and rare case of an unresectable thymoma that was invading the myocardium and it was irrigated by the left circumflex coronary and its branches, causing typical angina due to compromised coronary blood flow by the mass causing ischemia.

Avaliação da Empatia nos Médicos Residentes do Hospital Universitário Alzira Velano em Alfenas, Minas Gerais / Evaluation of Empathy in Medical Residents of Alzira Velano University Hospital in Alfenas, Minas Gerais

RESUMO INTRODUÇÃO Muito se discute a importância da empatia na relação médico-paciente. Poucos estudos avaliaram essa habilidade em médicos residentes (MR). OBJETIVO Avaliar a empatia dos MR do Hospital Universitário Alzira Velano (Huav) por meio da Escala Jefferson de Empatia Médica (Ejem), que fornece quatro tipos de escores: empatia geral (EG); tomada de perspectiva do doente (TP); compaixão (CP) e capacidade de colocar-se no lugar do outro (LO). MÉTODOS A Ejem e um questionário sociodemográfico foram aplicados em 36 MR do Huav no início do segundo semestre de 2016 após assinatura do Termo de Consentimento Livre e Esclarecido. RESULTADOS A análise estatística mostrou que os escores de empatia apresentaram associação em relação às variáveis: sexo, área de atuação (clínica ou cirúrgica) e período da residência em curso. Para a variável sexo, os seguintes achados foram encontrados: MR do sexo feminino do 1° ano apresentaram escores de EG e TP maiores que as MR no ≥ 2°ano (p = 0,01) e (0,03), respectivamente. Em relação à área de atuação, foi encontrado: (a) os escores de EG dos MR do 1° ano eram maiores, comparados aos dos MR no ≥ 2° ano, tanto para a área clínica (p = 0,03) como para a cirúrgica (p = 0,02); (b) MR da área cirúrgica apresentaram escores TP mais elevados no 1° ano em relação aos MR no ≥ 2° ano (p = 0,01). Nenhuma associação aos fatores estudados foi observada para os escores CP e LO. CONCLUSÃO Os dados demonstram que os escores de empatia dos MR dos anos finais são menores em relação aos dos MR do primeiro ano, fato verificado também para MR do sexo feminino. Nossos dados concordam com as observações da literatura e evidenciam a importância do desenvolvimento de estratégias instrucionais para o ensino da empatia entre médicos residentes.

ABSTRACT INTRODUCTION Much is discussed about the importance of empathy in the patient-physician relationship. Few studies have evaluated this ability in resident physicians (RPs). OBJECTIVE To evaluate the empathy of the resident physicians of the University Hospital Alzira Velano (HUAV), through the Jefferson Scale of Empathy (JSE), which provides 4 types of scores: General Empathy (GE); Perspective Taking (PT); Compassionate Care (CC) and Standing in Patient's Shoes (SP). METHODS The JSE and a sociodemographic questionnaire were applied to 36 RPs of the HUAV at the beginning of the second semester of 2016, after they signed the informed consent form. RESULTS Statistical analysis by the Mann-Whitney test showed that empathy scores were associated with variables: gender, area of performance (clinical or surgical) and period of residence in progress. For the variable gender, the following findings were observed: 1) Female RPs of the 1st year had higher GE scores than the RPs in the ≥ 2nd year (p = 0.01) and (0.03), respectively; 2) female RP's of 1st year had higher TP scores than RPs of ≥ 2nd year (p = 0.03). Regarding the area of performance, 1) the GE scores of the 1st year RPs were higher when compared to the RPs in the ≥ 2nd year, both for the clinical (p = 0.03) and for the surgical area (p = 0.02); 2) RPs of the surgical area had higher PT scores in the 1st year compared to RPs in the ≥ 2nd year (p = 0.01). No association was observed between the studied factors and CC and SP scores. CONCLUSION The data show that the empathy scores of the RPs of the final years are lower in relation to the RPs of the 1 st year, a fact also verified for female RPs. Our data are in agreement with the observations of the literature and show the importance of the development of instructional strategies for the teaching of empathy among resident physicians.

O ato classificatório e modelos de nomeação de "transtornos mentais": uma abordagem socioantropológica / The Classification Act and Mental Disorders Labeling Models: A Socio-anthropological Approach

Este artigo baseia-se em pesquisa doutoral realizada (Silva, 2017) e objetiva discutir o ato classificatório dos ditos transtornos mentais, a partir da abordagem de teóricos situados na perspectiva social-estruturalista, na Antropologia e na Sociologia da Saúde, no sentido de compreender como são utilizados os manuais nosológicos atuais como formas de configuração clínica das doenças psíquicas. A problemática compõe as seguintes questões norteadoras: Como explicar o ato de classificar? De onde vem essa prática humana? É comum a todas as culturas? Faz parte de uma lógica apriorística da mente humana ou é uma habilidade baseada na realidade empírica e social? O que revela dos mecanismos de distinção e de distribuição de poder num grupo? Para responder a essas questões foi realizada uma pesquisa de abordagem qualitativa, com uso de pesquisa documental, observação sistemática e entrevistas abertas com escuta de narrativas de docentes de ensino básico no Estado do Amapá, com experiências de sofrimento e adoecimento psíquico, atendidos em uma unidade de atendimento psicossocial, lócus da pesquisa. Assim, foram consultados 822 prontuários, entrevistados 40 docentes, 10 técnicos da equipe multidisciplinar e 10 gestores escolares. Com base em discussões teóricas e em dados construídos, entendemos que a tendência classificatória, em saúde mental, pode ser útil como instrumental técnico-cientifico para facilitar o processo de tratamento, porém se realizado com muito cuidado e parcimônia, caso contrário, poderá fornecer bases para a estigmatização social de pessoas

This article is based on a doctoral research (Silva, 2017) and aims to discuss the classificatory act of the so-called mental disorders, from the approach of theorists situated in the social-structuralist perspective, Anthropology and Health Sociology, in the sense of understanding how the current nosological manuals are used as forms of clinical configuration of psychic diseases. The problem composes the following guiding questions: How to explain the act of classifying? Where does this human practice come from? Is it common to all cultures? Is it part of an a priori logic of the human mind or is it a skill based on empirical and social reality? What does it reveal about the mechanisms of distinction and distribution of power in a group? In order to answer these questions, a qualitative research was carried out using documentary research, systematic observation and narratives of teachers of basic education in the State of Amapá, who have experienced suffering and psychic illness, and who attended in a unit of psychosocial care, locus of our research. Thus, 822 medical charts were consulted, 40 teachers were interviewed, 10 multidisciplinary team technicians and 10 school managers were interviewed. Based on theoretical discussions and constructed data, we understand that the classification tendency in mental health may be useful as a technical-scientific instrument to facilitate the treatment process, since it is performed with great care and parsimony, otherwise it may provide bases for the social stigmatization of people

Idiopathic interstitial pneumonias: review of the latest American Thoracic Society/European Respiratory Society classification.

The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.

ResumoO diagnóstico das pneumonias intersticiais idiopáticas (PIIs) envolve um cenário multidisciplinar no qual o radiologista assume papel fundamental. A última atualização (2013) da classificação das PIIs pela American Thoracic Society/European Respiratory Society propõe algumas mudanças importantes em relação à classificação original de 2002. Dentre as novidades, destacam-se o acréscimo de uma nova doença (fibroelastose pleuroparenquimatosa idiopática) e a subdivisão das PIIs em quatro grupos principais: PIIs crônicas fibrosantes (fibrose pulmonar idiopática e pneumonia intersticial não específica); PIIs relacionadas ao tabagismo (pneumonia intersticial descamativa e bronquiolite respiratória com doença intersticial pulmonar); PIIs agudas/subagudas (pneumonia em organização e pneumonia intersticial aguda); PIIs raras (pneumonia intersticial linfocítica e fibroelastose pleuroparenquimatosa idiopática); além das ditas "inclassificáveis". Foram revisadas, de forma didática neste estudo, as principais características clínicas, tomográficas e patológicas de cada uma das PIIs.

Idiopathic interstitial pneumonias: review of the latest American Thoracic Society/European Respiratory Society classification / Pneumonias intersticiais idiopáticas: revisão da última classificação da American Thoracic Society/European Respiratory Society

Abstract The diagnosis of idiopathic interstitial pneumonias (IIPs) involves a multidisciplinary scenario in which the radiologist assumes a key role. The latest (2013) update of the IIP classification by the American Thoracic Society/European Respiratory Society proposed some important changes to the original classification of 2002. The novelties include the addition of a new disease (idiopathic pleuroparenchymal fibroelastosis) and the subdivision of the IIPs into four main groups: chronic fibrosing IIPs (idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia); smoking-related IIPs (desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease); acute or subacute IIPs (cryptogenic organizing pneumonia and acute interstitial pneumonia); rare IIPs (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis); and the so-called "unclassifiable" IIPs. In this study, we review the main clinical, tomographic, and pathological characteristics of each IIP.

Resumo O diagnóstico das pneumonias intersticiais idiopáticas (PIIs) envolve um cenário multidisciplinar no qual o radiologista assume papel fundamental. A última atualização (2013) da classificação das PIIs pela American Thoracic Society/European Respiratory Society propõe algumas mudanças importantes em relação à classificação original de 2002. Dentre as novidades, destacam-se o acréscimo de uma nova doença (fibroelastose pleuroparenquimatosa idiopática) e a subdivisão das PIIs em quatro grupos principais: PIIs crônicas fibrosantes (fibrose pulmonar idiopática e pneumonia intersticial não específica); PIIs relacionadas ao tabagismo (pneumonia intersticial descamativa e bronquiolite respiratória com doença intersticial pulmonar); PIIs agudas/subagudas (pneumonia em organização e pneumonia intersticial aguda); PIIs raras (pneumonia intersticial linfocítica e fibroelastose pleuroparenquimatosa idiopática); além das ditas "inclassificáveis". Foram revisadas, de forma didática neste estudo, as principais características clínicas, tomográficas e patológicas de cada uma das PIIs.

Avaliação da empatia nos médicos residentes do Hospital Universitário Alzira Velano em Alfenas Minas Gerais / Evaluation of Empathy in Medical Residents of Alzira Velano University Hospital in Alfenas Minas Gerais

Introdução: Muito se discute a importância da empatia na relação médico paciente. Poucos estudos avaliaram esta habilidade em médicos residentes (MR's). Objetivo: Avaliar a empatia dos médicos residentes do Hospital Universitário Alzira Velano (HUAV), por meio da Escala Jefferson de Empatia Médica (EJEM), que fornece 4 tipos de escores: Empatia Geral (EG); Tomada de Perspectiva do Doente (TP); Compaixão (CP) e Capacidade de Colocar-se no Lugar do outro (LO). MÉTODOS: A EJEM é um questionário sociodemográfico, foram aplicados em 36 MR's do HUAV no início do 2º semestre de 2016, após assinatura do termo de consentimento livre e esclarecido. Resultados: A análise estatística pelo teste de Mann-Whitney mostrou que os escores de empatia apresentaram associação em relação às variáveis: sexo, área de atuação (clínica ou cirúrgica), período da residência em curso. Para a variável sexo, os seguintes achados foram encontrados: 1) MR's do sexo feminino do 1° ano apresentaram escores de EG maiores que as MR's no ≥ 2° ano (p=0.01); 2) MR's do sexo feminino do 1° ano apresentaram escores de TP maiores que as MR's do ≥ 2° ano (p=0.03). Em relação à área de atuação, foi encontrado: 1) os escores de EG dos MR's do 1° ano eram maiores comparados aos MR's no ≥ 2° ano, tanto para a área clínica (p=0,03) como para a cirúrgica (p=0,02); 2) MR's da área cirúrgica apresentaram escores de TP mais elevados no 1° ano em relação aos MR's no ≥ 2° ano (p= 0,01). Nenhuma associação aos fatores estudados foi observada para os escores CP e LO. Conclusão: Os dados demonstram que os escores de empatia dos MR's dos anos finais são menores em relação aos MR's do 1° ano, fato verificado também para MR's do sexo feminino. Nossos dados comungam as observações da literatura e evidenciam a importância do desenvolvimento de estratégias instrucionais para o ensino da empatia entre médicos residentes

Introduction: Much is discussed about the importance of empathy in the patient physician relationship. Few studies have evaluated this ability in resident physicians (RPs). Objective: To evaluate the empathy of the resident physicians of the University Hospital Alzira Velano (HUAV), through the Jefferson Scale of Medical Empathy (EJEM), which provides 4 types of scores: General Empathy (EG); Patient Perspective (TP); Compassion (CP) and Ability to Put in Place the Other (LO). Methods: EJEM and a socio-demographic questionnaire were applied to 36 MRs of the HUAV at the beginning of the second semester of 2016, after signing the informed consent form. Results: Statistical analysis by the Mann-Whitney test showed that empathy scores were associated with variables: sex, area of performance (clinical or surgical) and period of residence in progress. For the sex variable, the following findings were found: 1) Female RPs of the 1 st year had higher EG scores than the RPs in the ≥ 2nd year (p = 0.01); 2) RP's females of 1st year had higher TP scores than RPs of ≥ 2nd year (p = 0.03). Regarding the area of performance, 1) the EG scores of the 1 st year RPs were higher compared to the RPs in the ≥ 2nd year, both for the clinical (p = 0.03) and for the surgical area (p = 0.02); 2) RPs of the surgical area had higher TP scores in the 1st year compared to RPs in the ≥ 2nd year (p = 0.01). No association to the factors studied was observed for CP and LO scores. Conclusion: The data show that the empathy scores of the RPs of the final years are lower in relation to the RPs of the 1st year, a fact also verified for female RPs . Our data share the observations of the literature and show the importance of the development of instructional strategies for the teaching of empathy among resident physicians

What happens to the pleural space affected by malignant effusion after bedside pleurodesis?

BACKGROUND AND OBJECTIVES: Evaluate radiological characteristics of postpleurodesis pleural space of patients with recurrent malignant pleural effusion(RMPE). METHODS: Prospective cohort study including patients with RPME treated with bedside pleurodesis. We used CT scans to calculate pleural cavity volume immediately before pleurodesis(iCT) and 30 days after(CT30). Radiological evolution was calculated by the difference between pleural volumes on CT30 and iCT(Δvolume). We categorized initial pleural volume as small(<500 mL) or large space(≥500 mL) and Δvolume as positive(>254.49 mL), unchanged(≥-268.77-≤ 254.49 mL), or negative(<-268.77 mL). Futhermore, we analyzed clinical effectiveness, pleural elastance, and adverse events. RESULTS: A total of 87 patients were analyzed. Pleural volume varied from 35-2750 mL in iCT and from 0-2995 mL in CT30(P = 0.753). A total of 54 patients had initial small pleural space(62.06%) and 33 large(37.93%). Clinical failure occurred in 7.4% of small space group and in 24.6% of large(P = 0.051, OR4.0(CI:1.098-14.570)). In small space group, 27.77% evolved with positive, 66.66% with unchanged and 5.55% with negative Δvolume. In the large space group these numbers were respectively 21.21%, 27.27%, and 51.51%. CONCLUSIONS: There is significant variability on pleural space volume. However, pleural volume remains unchanged in many cases. Besides that, more than half patients with initial large space coursed with relevant reduction. Finally, patients with initial small space presented a greater chance of clinical success.

Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion.

OBJECTIVE:: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). METHODS:: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. RESULTS:: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: -225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). CONCLUSIONS:: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE. OBJETIVO:: Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). MÉTODOS:: Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de coorte maior com pacientes com DPMR recrutados em um hospital-escola universitário terciário entre junho de 2009 e setembro de 2014. Os pacientes foram submetidos a inserção de cateter pleural e, em seguida, pleurodese à beira do leito. A TC de tórax foi realizada duas vezes: imediatamente antes da pleurodese (TCi) e 30 dias após a pleurodese (TC30). Com base na TCi, a posição do cateter foi classificada em posterolateral, anterior, fissural e subpulmonar. Usamos o volume pleural na TCi para estimar a expansão pulmonar precoce e a diferença entre os volumes pleurais na TC30 e na TCi a fim de avaliar o sucesso radiológico da pleurodese. Considerou-se que a pleurodese teve êxito clínico quando não foi necessário realizar nenhum outro procedimento pleural. RESULTADOS:: Dos 131 pacientes elegíveis do estudo original, 85 foram incluídos neste estudo aninhado (64 mulheres; média de idade: 60,74 anos). A posição da ponta do cateter foi subpulmonar em 35 pacientes (41%), anterior em 23 (27%), posterolateral em 17 (20%) e fissural em 10 (12%). Não houve diferenças significativas entre os grupos quanto à expansão pulmonar precoce (mediana da cavidade pleural residual = 377 ml; intervalo interquartil: 171-722 ml; p = 0,645), sucesso radiológico da pleurodese (mediana do volume = 33 ml; intervalo interquartil: -225 a 257 ml; p = 0,923) e sucesso clínico da pleurodese (85,8%; p = 0,676). CONCLUSÕES:: Nossos resultados sugerem que a posição da ponta do cateter pleural não influencia nem a expansão pulmonar precoce nem o sucesso da pleurodese à beira do leito em pacientes com DPMR.

Ultrasound-guided intrapleural positioning of pleural catheters: influence on immediate lung expansion and pleurodesis in patients with recurrent malignant pleural effusion / Posicionamento intrapleural, guiado por ultrassonografia, de cateteres pleurais: influência na expansão pulmonar imediata e na pleurodese em pacientes com derrame pleural maligno recorrente

ABSTRACT Objective: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.

RESUMO Objetivo: Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Métodos: Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de coorte maior com pacientes com DPMR recrutados em um hospital-escola universitário terciário entre junho de 2009 e setembro de 2014. Os pacientes foram submetidos a inserção de cateter pleural e, em seguida, pleurodese à beira do leito. A TC de tórax foi realizada duas vezes: imediatamente antes da pleurodese (TCi) e 30 dias após a pleurodese (TC30). Com base na TCi, a posição do cateter foi classificada em posterolateral, anterior, fissural e subpulmonar. Usamos o volume pleural na TCi para estimar a expansão pulmonar precoce e a diferença entre os volumes pleurais na TC30 e na TCi a fim de avaliar o sucesso radiológico da pleurodese. Considerou-se que a pleurodese teve êxito clínico quando não foi necessário realizar nenhum outro procedimento pleural. Resultados: Dos 131 pacientes elegíveis do estudo original, 85 foram incluídos neste estudo aninhado (64 mulheres; média de idade: 60,74 anos). A posição da ponta do cateter foi subpulmonar em 35 pacientes (41%), anterior em 23 (27%), posterolateral em 17 (20%) e fissural em 10 (12%). Não houve diferenças significativas entre os grupos quanto à expansão pulmonar precoce (mediana da cavidade pleural residual = 377 ml; intervalo interquartil: 171-722 ml; p = 0,645), sucesso radiológico da pleurodese (mediana do volume = 33 ml; intervalo interquartil: −225 a 257 ml; p = 0,923) e sucesso clínico da pleurodese (85,8%; p = 0,676). Conclusões: Nossos resultados sugerem que a posição da ponta do cateter pleural não influencia nem a expansão pulmonar precoce nem o sucesso da pleurodese à beira do leito em pacientes com DPMR.

Cochlear implantation in children with anomalous cochleovestibular anatomy.

OBJECTIVE: The aim of the study is to assess the audiological and surgical outcome after cochlear implantation in children with inner ear malformation and to compare them with a group of congenitally deaf children implantees without inner ear malformation. INTRODUCTION: Children with profound sensorineural deafness with malformations of the inner ear represent a challenge, accounting to 5-15% of congenital sensorineural deafness. These cases were originally regarded as a contraindication for cochlear implant surgery. METHODS: Retrospective study of 26 patients with congenital inner ear malformation, from a total population of 329 cochlear implant patients. Radiological evaluation with high resolution computed tomography and magnet resonance was performed to all patients in order to evaluate all the preoperative conditions. All patients were tested using European Portuguese word discrimination tests (monosyllabic test, number test and sentences test), capacity of auditory performance (CAP) and speech intelligibility rating (SIR). RESULTS: In all 7.9% of deaf children in our center study have inner ear abnormalities. All children underwent successful implantation. CAP yielded an average 7.1 (+/-1.7), SIR 4.3 (+/-1.0). The children without inner ear abnormalities did not achieve statistically significant better scores. Two children had a perilymph gusher, and there were no other complications. CONCLUSION: Cochlear implantation can be successfully performed in children with inner ear malformation. Audiological performance after cochlear implantation in malformed inner ears is comparable to that found in other congenitally deaf patients. The risk of CSF leak is associated with inner ear abnormalities and should be anticipated during surgery.

Translation of the international outcome inventory for hearing aids into Portuguese from Portugal.

OBJECTIVE: To translate the International Outcome Inventory for Hearing Aids (IOI-HA) Questionnaire from English to Portuguese (from Portugal) and to validate this instrument of study on the Portuguese population. DESIGN: In this prospective study, a translation from English into Portuguese of the IOI-HA was performed, and linguistic adaptation and counter translation were also accomplished. The data were analysed for internal consistency testing for correlations between each individual item and the total score of the IOI-HA, assessing the Cronbach α and performing test-retest analysis. SETTING AND PARTICIPANTS: 80 hearing aid users aged 18 years or older were recruited from an ear, nose and throat (ENT) appointment in Coimbra's hospital, Portugal. 84% of the participants were unilateral hearing aid users, whereas 16% were bilateral users. INTERVENTIONS: The patients volunteered to answer the questionnaire during an ENT appointment. All of the patients had been using the hearing aids for more than 3 years.After the first application of the questionnaire, a new appointment was planned for retesting, within at least 7 days to no more than 60 days. 29 participants answered the questionnaire again according to the same procedure. RESULTS: The mean IOI-HA total score in the study population was 27.33±4.93 (9-35). The mean values obtained for each item of the questionnaire ranged from 3.19 to 4.54. The Cronbach α was 0.838 and the Cronbach α values when the item was removed, were also significantly strong. The test-retest analysis revealed no differences between the paired groups. CONCLUSIONS: In the present study a valid and reliable translation and adaptation of the IOI-HA into Portuguese from Portugal is proposed. This tool will be available for clinical assessment of hearing aid users.

A comparative analysis of oral and maxillofacial pathology over a 16-year period, in the north of Portugal.

OBJECTIVES: To determine the frequency and spectrum of oral and maxillofacial lesions biopsied in a hospital population in the northern region of Portugal. METHODS: We conducted descriptive analyses of pathology reports from biopsies of oral and maxillofacial lesions performed between 1990 and 2006, in Oporto Hospital Center. Information on gender and age of patient, location of the lesions and the histopathological diagnosis were analysed. RESULTS: The analyses revealed that 1,520 (47.7%) patients were male and 1,666 (52.3%) were female. They had a mean age ± standard deviation of 47.8 ± 18.6 years. The site most frequently biopsied was the labial mucosa (17.5%). A non-neoplastic diagnosis was established in 2,162 (63.3%) cases, potentially malignant disorders in 163 (5.1%) and neoplasms in 886 (27.6%) (403 benign and 483 malignant). The most commonly reported diagnosis was fibroepithelial polyp (n = 186; 15.9%), followed by squamous cell carcinoma (SCC) (n = 158; 13.6%). SCC was the lesion most commonly found in male patients (n = 279; 18.4%) whilst fibroepithelial polyp was the lesion most commonly found in female patients (n = 268; 16.1%). The most common lesion in patients 0-17 years of age was a follicular cyst (n = 25; 12.8%), whereas in patients 18-64 years of age it was a fibroepithelial polyp (n = 299; 13%). SCC was the most common type of lesion found in patients ≥ 65 years of age (n = 160; 24.6%). CONCLUSION: This large sample provides useful information about the incidence and distribution of oral biopsies over a period of 16 years, allowing valuable comparison with other countries. Non-neoplastic lesions were the types of lesion most commonly reported, with fibroepithelial polyp being most frequent. SCC was the second most common diagnosis.