An electrogram-guided transvenous temporary pacemaker implant simulator.

INTRODUCTION: Transvenous temporary pacemaker (TvTP) implantation is a critical procedure often performed under time limitations, playing a crucial role in patient survival. However, the amount of training provided for resident cardiologists is variable, due to the availability of patients. Thus, the use of simulators for this cardiologic procedure could be used as training tools. OBJECTIVE: The present study aimed to develop a simulator system for TvTP implantation based on electrograms, called ETTIS (Electrogram-guided Transvenous Temporary-pacemaker Implantation Simulator), and to evaluate its educational potential and cardiology residents' perceived learning efficacy as a training tool. METHODOLOGY: The development of the ETTIS involved three stages: (1) Adaptation of an anatomical mannequin; (2) Design and manufacture of electronic circuits and software capable of identifying the catheter contact site within the heart chambers and reproducing electrograms in both surfaces (mode-on) and intracavitary (mode-off); (3) To evaluate its educational potential, a modified Likert questionnaire was administered to nine cardiology experts. Additionally, to evaluate the perceived learning efficacy, another modified Likert questionnaire was given to six cardiology residents both before and after training with the ETTIS. Descriptive statistics with measures of position and dispersion were employed, and the weighted Kappa test was used for agreement analysis. RESULTS: A high rate of acceptance (over 90%) was found among experts who evaluated the ETTIS. The cardiology residents showed significant self-perceived learning gains, as evidenced by a lack of agreement between their responses to a questionnaire before and after training. CONCLUSION: The ETTIS is a promising tool for medical training, displaying both educational potential and efficacy. It has been shown to be effective in learning a variety of skills, including cardiac catheterization and electrophysiology. Additionally, the ETTIS is highly engaging and allows cardiology residents to practice in a safe and controlled environment.

A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-19 Pandemic.

OBJECTIVE: To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in São Paulo. METHODS: Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of São Paulo (SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. RESULTS: A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 ± 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second-year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. CONCLUSION: The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician's desire to continue with the program.

OBJETIVO: Analisar o impacto pandemia de COVID-19 sobre a residência de ginecologia e obstetrícia do Estado de São Paulo. MéTODOS: Estudo transversal desenvolvido por representantes dos residentes da Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Foram coletados dados de questionários aplicados aos residentes de ginecologia e obstetrícia cadastrados no site da SOGESP em fevereiro de 2022. Os entrevistados responderam sobre repercussões da pandemia sobre a residência médica e se tiveram suporte técnico e psicológico durante o período. RESULTADOS: Foram levantados 247 questionários de residentes de ginecologia e obstetrícia. Os residentes apresentaram idade de 28,3 ± 3 anos, sendo a maioria do sexo feminino (88,4%). O deslocamento para "covidários" foi referido por 62,34% dos avaliados, porém somente 35,6% referiram equipamento de proteção individual completamente adequado e apenas 7,7% referiram instrução completa teórica e técnica para o suporte destes pacientes. Quase a totalidade dos entrevistados afirmou que o setor de ginecologia foi o mais afetado. A maioria dos entrevistados considerou que o os residentes do segundo ano foram os que tiveram maior prejuízo, sendo que mais da metade dos residentes do 1° e 2° ano afirmou ter desejado desistir da residência durante a pandemia. Mais de 80% dos residentes referiram aulas teóricas e/ou apresentação de artigos online, reforçando o fato de que as atividades virtuais ganharam um espaço maior dentro da residência médica. CONCLUSãO: A pandemia impactou nas residências em maior proporção nos ambulatórios e cirurgias ginecológicas, interferindo também sobre o desejo do médico de seguir com o programa.

A Study of the Current Scenario of the Obstetrics and Gynecology Residency during the COVID-19 Pandemic / Um estudo do cenário atual da residência em obstetrícia e ginecologia durante a pandemia de COVID-19

Abstract Objective To analyze the impact of the COVID-19 pandemic on the residency of gynecology and obstetrics in São Paulo. Methods Cross-sectional study developed by representatives of residents of the Association of Gynecology and Obstetrics of the State of São Paulo (SOGESP, in the Portuguese acronym). Data were collected from questionnaires applied to gynecology and obstetrics residents registered on the SOGESP website in February 2022. The interviewees answered about the repercussions of the pandemic on medical residency and whether they had technical and psychological support during the period. Results A total of 247 questionnaires were collected from residents of gynecology and obstetrics. The residents had an age of 28.3 ± 3 years old, and most of them were female (88.4%). The displacement to COVID care was reported by 62.34% of the students, but only 35.6% reported completely adequate personal protective equipment and only 7.7% reported complete theoretical and technical instruction to support these patients. Almost all of the interviewees stated that the gynecology sector was the most affected. The majority of the interviewees considered that the second-year residents had the greatest loss, and more than half of the residents in the 1st and 2nd year said they wished to give up their residency during the pandemic. More than 80% of the residents reported online theoretical classes and/or presentation of articles, reinforcing the fact that virtual activities gained a greater space within the medical residency. Conclusion The pandemic impacted the residency in greater proportion in outpatient clinics and gynecological surgeries, also interfering with the physician's desire to continue with the program.

Resumo Objetivo Analisar o impacto pandemia de COVID-19 sobre a residência de ginecologia e obstetrícia do Estado de São Paulo. Métodos Estudo transversal desenvolvido por representantes dos residentes da Associação de Ginecologia e Obstetrícia do Estado de São Paulo (SOGESP). Foram coletados dados de questionários aplicados aos residentes de ginecologia e obstetrícia cadastrados no site da SOGESP em fevereiro de 2022. Os entrevistados responderam sobre repercussões da pandemia sobre a residência médica e se tiveram suporte técnico e psicológico durante o período. Resultados Foram levantados 247 questionários de residentes de ginecologia e obstetrícia. Os residentes apresentaram idade de 28,3 ± 3 anos, sendo a maioria do sexo feminino (88,4%). O deslocamento para "covidários" foi referido por 62,34% dos avaliados, porém somente 35,6% referiram equipamento de proteção individual completamente adequado e apenas 7,7% referiram instrução completa teórica e técnica para o suporte destes pacientes. Quase a totalidade dos entrevistados afirmou que o setor de ginecologia foi o mais afetado. A maioria dos entrevistados considerou que o os residentes do segundo ano foram os que tiveram maior prejuízo, sendo que mais da metade dos residentes do 1° e 2° ano afirmou ter desejado desistir da residência durante a pandemia. Mais de 80% dos residentes referiram aulas teóricas e/ou apresentação de artigos online, reforçando o fato de que as atividades virtuais ganharam um espaço maior dentro da residência médica. Conclusão A pandemia impactou nas residências em maior proporção nos ambulatórios e cirurgias ginecológicas, interferindo também sobre o desejo do médico de seguir com o programa.

Histological comparison of the lamellar tissue of Iberian origin breed horses created in semi-feral conditions or in an intensive system.

Although the external conformation of wild horse hooves has been proposed as an ideal model for domesticated modern horses, histological signs of laminitis have been reported among them. With the hypothesis that the lamellar tissue of horses of Iberian origin raised in semi-feral is healthier than those raised in an intensive management system (stall confinement and high-calorie diet intake), the objective was to compare their lamellar tissues. Lamellar tissue samples were taken from the forelimb hoof of eight domesticated Mangalarga Marchador (MM) horses and from six semi-feral Marajoara (MJ) and Puruca (MP) horses. Primary epidermal lamella (PEL) and secondary epidermal lamella (SEL) were measured (length and width) in several regions, and their shapes were morphologically classified into different types. Breed groups were compared using analysis of variance, followed by Tukey or Dunn tests (P<0.05). Early signs of laminitis such as abnormal keratinization of the abaxial primary dermal lamella, tapered tips of the axial PELs, pointed tips of the SEL, nuclei condensation, and abnormal spatial orientation of the secondary epidermal basal cells (SELBC), were seen only in MM horses. MP horses had a greater interface of epidermis/dermis contact than MJ horses and more rounded nuclei in the round SELBC than MM horses. In agreement with the study hypothesis, semi-feral MJ and MP horses' lamellae were classified as healthier than MM horses, which showed early signs of endocrinopathic laminitis.

Thermal and Gluing Properties of Phenol-Based Resin with Lignin for Potential Application in Structural Composites.

Using Kraft lignin, bio-based adhesives have been increasingly studied to replace those petrochemical-based solutions, due to low cost, easy availability and the potential for biodegradability of this biomaterial. In this study, lignin-based phenol-formaldehyde (LPF) resins were synthesized using commercial Eucalypt Kraft Lignin (EKL), purified at 95%, as a phenol substitute in different proportions of 10%, 20%, 30% and 50%. The properties of bio-based phenol formaldehyde (BPF) synthesized resin were compared with phenol-formaldehyde resin (PF) used for control sampling. The results indicated that viscosity, gel time and solid contents increased with the addition of pure EKL. The shear strength test of glue line was studied according to American Society for Testing and Materials (ASTM), and BPF-based results were superior to samples bonded with the PF as a control sample, being suitable for structural purposes. Changes in the curing behavior of different resins were analyzed by Differential Scanning Calorimetry (DSC), and sample comparison indicated that the curing of the LPF resin occurred at lower temperatures than the PF. The addition of EKL in PF reduced its thermal stability compared to traditional resin formulation, resulting in a lower decomposition temperature and a smaller amount of carbonaceous residues.

Sixteen properties of Eucalyptus Tereticornis wood for structural uses / Dezesseis propriedades da madeira de Eucalyptus Tereticornis para usos estruturais

Forest Red Gum eucalypt provides a versatile wood and is converted into different purposes. However, such wood is somewhat limited in structural ends, which highlights the need to exploit this gap through diffusion of mechanical properties of suchtimber. This study aimed to evaluate the effect of moisture content reduction, from 30 to 12%, in physical and mechanical properties of Eucalyptus tereticornis, using Brazilian and American documents, to reinforce the structural potential wood and assisting engineers and architects in decision-making for its best building application. We evaluated two physical and fourteen mechanical properties of Eucalyptus tereticornis at two different moisture contents, following the prescriptions of Brazilian (ABNT NBR 7190: 1997) and North American (ASTM D-143-14: 2014) standards. Thus, 1091 repeats were carried out for all properties. By a moisture reduction, the bulk density and eleven strength properties statistically showed changes such as modulus of rupture (static bending, parallel and perpendicular compressions), modulus of elasticity (perpendicular compression and static bending), shear stress, tangential cleavage, and parallel and perpendicular hardnesses. Then, the Eucalyptus tereticornis timber could be better usable if is further applied for structural construction uses.

Eucalipto de goma vermelha prove uma madeira versátil e é convertido para diferentes propósitos. Porém, essa madeira é um pouco limitada para fins estruturais, o que destaca a necessidade de explorar essa lacuna mediante à difusão das propriedades mecânicas de tal madeira. Os resultados obtidos deverão auxiliar os engenheiros e arquitetos na tomada de decisão para a sua melhor aplicação construtiva. Esse artigo estudou a avaliação de duas propriedades físicas e catorze propriedades mecânicas do Eucalyptus tereticornis em dois teores de umidade, seguindo as prescrições dos documentos normativos brasileiro (ABNT NBR 7190: 1997) e norte-americano (ASTM D-143-14: 2014). Assim, 1091 repetições foram conduzidas para todas essas propriedades. Pela redução de umidade de 30% para 12%, a densidade aparente e onze propriedades de resistência demonstraram estatisticamente mudanças, tais como módulos de ruptura (flexão estática ecompressões paralela e perpendicular), módulos de elasticidade (compressão perpendicular e flexão estática), cisalhamento, fendilhamento e as durezas perpendicular e paralela. Então, a madeira de Eucalyptus tereticornispoderia ser melhor utilizável se for também aplicada para usos construtivos estruturais.

Saiba como o uso do cigarro causa problemas à saúde da boca

A nicotina do cigarro causa dependência extrema. Por isso não é fácil deixar de fumar. O tabagismo resulta em vários problemas de saúde. A boca é uma das áreas mais afetadas

Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in Ischemic Stroke: A Randomized Sham-Controlled Crossover Study.

OBJECTIVE: The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke. DESIGN: We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed by a control intervention 15 days later (cryotherapy group) and (2) those who received the control intervention followed by cryotherapy 15 days later (control intervention group). Ankle joint position sense was measured on the paretic side using a Biodex Multi-joint System 3 dynamometer before and after 20 mins of either application on the calf muscles. Lower absolute error scores were calculated for data analyses and were used to determine joint position sense. The degree of spasticity of the plantar flexor muscles was scored according to the Modified Ashworth Scale. RESULTS: Sixteen patients completed the crossover experiment; however, data analysis was successfully conducted in 15 participants. Cryotherapy reduced the degree of spasticity of the plantar flexor muscles without altering ankle joint position sense. CONCLUSIONS: Cryotherapy (using an ice pack) may reduce plantar flexor spasticity without influencing proprioception.

Fechamento de hemicorporectomia com utilização do retalho subtotal unilateral da coxa: relato de caso / Closure of hemicorporectomy using a subtotal unilateral tight flap: a case report

A hemicorporectomia ou amputação translombar foi primeiramente descrita em 1950 por Kredel como método curativo para neoplasia localmente avançada de pelve. Trata-se de um procedimento cirúrgico extenso, que quando bem indicado é capaz de prover a cura oncológica, além de possibilitar a melhora clínica e de qualidade de vida. Os autores apresentam o relato de caso de um paciente de 34 anos, com carcinoma espinocelular em úlcera de pressão crônica, acometendo períneo, glúteo e coxa posterior à direita. O paciente foi submetido à hemicorporectomia com reconstrução utilizando retalho subtotal da coxa esquerda. Observou-se boa evolução no pós-operatório e a utilização do retalho subtotal da coxa para fechamento da hemicorporectomia se mostrou como método seguro, eficiente e de técnica reprodutível.

Hemicorporectomy or translumbar amputation was first described in 1950 by Kredel to treat locally advanced pelvic neoplasia. This extensive surgical procedure can achieve oncological cure and improve clinical status and quality of life. The authors present a case report of a 34-yearold patient with squamous cell carcinoma in a chronic pressure ulcer affecting the right perineum, gluteus, and posterior thigh. The patient underwent hemicorporectomy with reconstructive surgery using a partial-thickness flap of the left thigh. The postoperative course was good, and the use of a partial-thickness flap of the thigh to close the hemicorporectomy proved to be safe, efficient, and reproducible.

Effects of simvastatin in abdominal sepsis in rats.

PURPOSE: Statins are widely recognized as hypolipemic drugs, but some studies have observed anti-inflammatory and immunomodulatory effects, known as pleiotropic. The aims of this work was to study possible anti-inflammatory effects of simvastatin in abdominal sepsis. Serum pro-inflammatory cytokines and leukocytes count were determined in an experimental model of abdominal sepsis, using cecal ligation and puncture (CLP) in rats. METHODS: Twenty eight Wistar rats weighing 285+/-12 g were randomly divided in: CLP/Sinvastatin rats (n=7), treated with 10 mg/Kg of oral simvastatin 18 and 2 hs before CLP; CLP/Saline group rats (n=7), treated with oral saline; group Sham/Simvastatin (n=7), treated with simvastatin, and group Sham/Saline (n=7), treated with saline. Serum TNF-alpha, IL-1beta and IL-6 by ELISA and total leukocytes, neutrophils, lymphocytes, and eosinophils were determined 24 hs after CLP. ANOVA and Tukey test were used considering significant p<0.05. RESULTS: It was demonstrated that serum TNF-alpha, IL-1beta and IL-6 were respectively 364.8+/-42 pg/mL; 46.3+/-18 pg/mL and 28.4+/-13 pg/mL in CLP/Sinvastatin rats, significantly lower (p<0.05) than in group CLP/Saline (778.5+/-86 pg/ml; 176.9+/-46 pg/ml; 133.6+/-21 pg/ml, respectively). The same results were observed in total leukocytes and neutrophils counts. CONCLUSION: These results clearly demonstrate that simvastatin is an effective agent that reduces cytokines levels and leukocyte count in sepsis, independently of its well-known lipid-lowering effects. Thus, HMG-CoA reductase inhibitors like simvastatin have important anti-inflammatory effects in abdominal sepsis in rats.

Effects of simvastatin in abdominal sepsis in rats

PURPOSE: Statins are widely recognized as hypolipemic drugs, but some studies have observed anti-inflammatory and immunomodulatory effects, known as pleiotropic. The aims of this work was to study possible anti-inflammatory effects of simvastatin in abdominal sepsis. Serum pro-inflammatory cytokines and leukocytes count were determined in an experimental model of abdominal sepsis, using cecal ligation and puncture (CLP) in rats. METHODS: Twenty eigth Wistar rats weighing 285±12g were randomly divided in: CLP/Sinvastatin rats (n=7), treated with 10 mg/Kg of oral simvastatin 18 and 2 hs berofe CLP; CLP/Saline group rats (n=7), treated with oral saline; group Sham/Simvastatin (n=7), treated with simvastatin, and group Sham/Saline (n=7), treated with saline. Serum TNF-alpha, IL-1beta and IL-6 by ELISA and total leukocytes, neutrophils, lymphocytes, and eosinophils were determined 24 hs after CLP. ANOVA and Tukey test were used considering significant p<0.05. RESULTS: It was demonstrated that serum TNF-alpha, IL-1beta and IL-6 were respectively 364,8±42pg/mL; 46,3±18pg/mL and 28,4±13pg/mL in CLP/Sinvastatin rats, significantly lower (p<0.05) than in group CLP/Saline (778,5±86pg/ml; 176,9±46pg/ml; 133,6±21 pg/ml, respectively). The same results were observed in total leukocytes and neutrophils counts. CONCLUSION: These results clearly demonstrate that simvastatin is an effective agent that reduces cytokines levels and leukocyte count in sepsis, independently of its well-known lipid-lowering effects. Thus, HMG-CoA reductase inhibitors like simvastatin have important anti-inflammatory effects in abdominal sepsis in rats.

OBJETIVO: As estatinas são agentes reconhecidamente hipolipemiantes. Vários estudos têm revelado que eles têm ações pleiotrópicas, como antiinflamatória e imunomoduladora. Tentando-se entender o papel antiinflamatório da sinvastatina na sepse, foram analisados os níveis de citocinas pró-inflamatórias e contagem de leucócitos em modelo de sepse abdominal por ligadura e punção do ceco (LPC) em ratos. MÉTODOS: Foram utilizados 28 ratos Wistar pesando 285±12g, assim divididos: grupo sepse (n=14), submetidos a LPC e grupo sham (n=14), submetidos a laparotomia e manipulação suave do ceco. No grupo LPC/sinvastatina (n=7) os ratos receberam 10mg/kg de sinvastatina via oral 18 e 2 horas antes da LPC e no grupo LPC/salina (n=7) os ratos receberam injeção oral de solução salina 0,9 por cento. Os animais dos grupos sham/sinvastatina (n=7) e sham/salina (n=7) receberam o mesmo tratamento. Dosagem de TNF-alfa, IL-1beta e IL-6 por ELISA e contagem de leucócitos totais, neutrófilos, linfócitos e eosinófilos foram realizadas em todos os animais. Análise estatística foi feita pelo ANOVA e teste de Tukey, com significância p<0,05. RESULTADOS: Ficou demonstrado que as dosagens de TNF-alfa, IL-1beta e IL-6 atingiram valores de 364,8±42pg/ml; 46,3±18pg/ml e 28,4±13pg/ml no grupo submetido à sepse e tratados com sinvastatina, significantemente mais baixos do que no grupo sepse não tratados (778,5±86pg/ml; 176,9±46pg/ml; 133,6±21 pg/ml, respectivamente). O mesmo ocorreu na contagem de leucócitos totais e neutrófilos. CONCLUSÃO: A sinvastatina mostrou ação anti-inflamatória em ratos Wistar, diminuiu níveis de citocinas e leucócitos, sugerindo uso potencial na prevenção ou atenuação dos efeitos da sepse abdominal.