Etched fiber Bragg grating probe using a regular CNC machine and a 3D printer.

Etched fiber Bragg gratings (EFBGs) have been widely employed for refractive index (RI) measurements that can be used to monitor sugar consumption during the fermentation of alcoholic beverages. EFBGs are obtained by removing the cladding of a fiber Bragg grating, which is traditionally performed by a chemical attack with hydrogen fluoride, an extremely hazardous corrosive substance that causes severe wounds and even death. To overcome such drawbacks, this technical note presents a simple, practical, and low cost method for the diameter reduction of single mode optical fibers by mechanical polishing, employing a small scale computer numerical control device and an ad hoc 3D-printed rod. The sensor probe obtained was tested using sucrose aqueous solutions with RIs between 1.333 and 1.394, measured in an Abbe refractometer. The results show a linear shift of the Bragg wavelength with respect to RI with a correlation of 0.928.

Tocilizumab in HIV patient with severe COVID-19: case report.

BACKGROUND: A 73-year-old male patient who had a history of Human Immunodeficiency Virus (HIV) infection for over 20 years was diagnosed with SARS-CoV-2 infection. CASE PRESENTATION: The patient was admitted to the Intensive Care Unit (ICU), where he remained for 25 days, due to a severe condition. Intubation, hemodialysis, and tracheostomy were necessary to maintain homeostasis. In addition to regular treatment with etravirine, dolutegravir, darunavir, and ritonavir for highly active antiretroviral therapy, the patient received tocilizumab, which showed a great recovery in the patient's condition. CONCLUSION: The patient had several risk factors, such as male gender, age > 70 years, and arterial hypertension. The use of tocilizumab was of great importance in the patient's recovery since the drug increased his immune response, which is deficient, due to HIV infection.

Fate, complications and MRI implications of retention anchor suture placed during gastrostomy in children.

Retrograde radiologic gastrostomy is one of several techniques used for placing a gastrostomy and is a common technique used in children. The use of a retention anchor suture (RAS) is an important component of this procedure. This pictorial essay explores the normal course and passage of the RAS, as well as abnormal migration, various complications and the implications of the RAS with regard to MRI safety.

EXTRACORPOREAL SHOCKWAVE THERAPY IN SHOULDER INJURIES: PROSPECTIVE STUDY.

OBJECTIVE: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. METHODS: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. RESULTS: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). CONCLUSION: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

OBJETIVO: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. MÉTODOS: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. RESULTADOS: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). CONCLUSÃO: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.

Spinal cord stimulation improves motor function and gait in spastic paraplegia type 4 (SPG4): Clinical and neurophysiological evaluation.

INTRODUCTION: Hereditary spastic paraplegia is a heterogeneous group of genetic disorders characterized by degeneration of the corticospinal tracts, coursing with progressive weakness and spasticity of the lower limbs. To date, there are no effective treatments for progressive deficits or disease-modifying therapy for those patients. We report encouraging results for spastic paraparesis after spinal cord stimulation. METHODS: A 51-year-old woman suffering from progressive weakness and spasticity in lower limbs related to hereditary spastic paraplegia type 4 underwent spinal cord stimulation (SCS) and experienced also significant improvement in motor function. Maximum ballistic voluntary isometric contraction test, continuous passive motion test and gait analysis using a motion-capture system were performed in ON and OFF SCS conditions. Neurophysiologic assessment consisted of obtaining motor evoked potentials in both conditions. RESULTS: Presurgical Spastic Paraplegia Rating Scale (SPRS) score was 26. One month after effective SCS was initiated, SPRS went down to 15. At 12 months follow up, she experienced substantial improvement in motor function and in gait performance, with SPRS scores 23 (OFF) and down to 20 (ON). There was an increased isometric muscle strength (knee extension, OFF: 41 N m; ON: 71 N m), lower knee extension and flexion torque values in continuous passive motion test (decrease in spastic tone) and improvement in gait (for example, step length increase). CONCLUSION: Despite being a case study, our findings suggest innovative lines of research for the treatment of spastic paraplegia.

Sudden hearing loss caused by labyrinthine hemorrhage.

Sudden sensorineural hearing loss is relatively frequent. In most cases, the etiology is not discovered. One of the possible causes for sudden deafness is inner labyrinth bleeding, which was difficult to diagnose before the advent of magnetic resonance imaging. The purpose of this paper is to report a case of sudden hearing loss caused by a labyrinthine hemorrhage, and to present a review of the literature on this topic.

Analysis of Lean Six Sigma Use in Pharmaceutical Production

Abstract Over the last years, pharmaceutical industries have adopted continuous improvement and operational excellence programs to optimize processes, improve quality and reduce operational costs. Worldwide, Lean Manufacturing (LM) and Six Sigma (SS), as well as the integration of the two methods: Lean Six Sigma (LSS) are the most used approaches in the continuous improvement of industries and services. This work aims to investigate the employment of the Lean Six Sigma methodology in the productive areas of pharmaceutical companies located in Brazil. Interviews were conducted with managers of pharmaceutical industries that apply the approach. The results indicated the greater use of Lean Manufacturing tools compared to Six Sigma and the influence of specific peculiarities of the pharmaceutical industry on the benefits that are achieved with the use of Lean Six Sigma. The approach is considered of great value as it provides substantial benefits to the pharmaceutical industry. It is concluded that the work corroborates to the theoretical and empirical knowledge about the methodology use in the context of Brazilian pharmaceutical industries, as well as contributes to the implementation, reformulation, and improvement of Lean Six Sigma programs in this industrial segment.

Medical Management of Otosclerosis.

Otosclerosis/otospongiosis is a primary osteodystrophy of the otic capsule that affects genetically predisposed individuals and leads to progressive hearing loss. Diagnosis is usually clinical, based on the findings of anamnesis, physical examination, and audiometric evaluation. However, high-resolution computed tomography scan and MRI have played an important role in the diagnosis and therapeutic approach of otosclerosis and in assisting in the differential diagnosis. The therapeutic approach is aimed at preventing, or at least minimizing, disease progression while attempting to restore hearing. The use of sodium fluoride and bisphosphonates can be an important adjunct, perhaps even primary treatment, in managing active lesions.

Extracorporeal shockwave therapy in shoulder injuries: prospective study / Uso de terapia de ondas de choque em doenças ortopédicas do ombro: estudo prospectivo

ABSTRACT Objective: To evaluate the functional results after the use of extracorporeal shockwave therapy (ESWT) in four groups of patients: tendinopathy, partial rotator cuff injury, adhesive capsulitis and calcareous tendinopathy of the rotator cuff at one month and three months after the end of treatment. Methods: Case series in which patients were evaluated according to the VAS of pain, range of motion of the shoulder, and functional questionnaires DASH and modified UCLA. Results: There was a significant increase in the measure of flexion, lateral rotation and shoulder abduction in the evaluations after treatment in relation to the baseline measurement (p < 0.001) and no evidence of significant difference was found between the post-treatment evaluations at one month and three months follow-up (p > 0.05). There was a significant reduction in the VAS score, increase in the UCLA score and a significant reduction in the DASH score in the post-treatment evaluations in relation to the baseline score (p < 0.001) and a significant improvement in the three-month evaluation in relation to one month (p < 0.05). Conclusion: Extracorporeal shockwave therapy proved to be efficient and safe in the treatment of shoulder pathologies, improving pain, range of motion and functional scores in all groups of patients evaluated in the study. Level of Evidence IV, Case series.

RESUMO Objetivo: Avaliar os resultados funcionais após uso de terapia de ondas de choque (TOC) em quatro grupos de pacientes: tendinopatia, lesão parcial de manguito rotador, capsulite adesiva e tendinopatia calcária do manguito rotador com 1 mês e 3 meses após término do tratamento. Métodos: Série de casos, na qual os pacientes foram avaliados de acordo com a EVA da dor, amplitude de movimento do ombro, e questionários funcionais DASH e UCLA modificados. Resultados: Houve aumento significativo das medidas de flexão, rotação lateral e abdução do ombro nas avaliações após tratamento, em relação à medida basal (p < 0,001) e não houve evidências de variação significativa entre as avaliações pós-tratamento com 1 mês e 3 meses de acompanhamento (p°> 0,05). Houve redução significativa do escore EVA, aumento do escore UCLA e redução significativa do escore DASH nas avaliações após tratamento em relação ao escore basal (p < 0,001) e melhora significativa na avaliação de três meses em relação a um mês (p < 0,05). Conclusão: A terapia de ondas de choque mostrou-se uma terapia eficiente e segura no tratamento das patologias do ombro, com melhora da dor, arco de movimento e escores funcionais em todos os grupos de pacientes avaliados no estudo. Nível de Evidência IV, Série de casos.

Magnetic resonance imaging in the evaluation of clinical treatment of otospongiosis: a pilot study.

OBJECTIVES: To evaluate the applicability of magnetic resonance imaging (MRI) as a method for monitoring the activity of otospongiotic lesions before and after clinical treatment. STUDY DESIGN: Prospective, randomized, controlled, double-blind study. SETTING: One single tertiary care institution in a large, cosmopolitan city. METHODS: Twenty-six patients (n = 42 ears) with clinical, audiometric, and tomographic diagnosis of otosclerosis were enrolled. If computed tomography (CT) demonstrated active lesions, these patients underwent MRI to detect otospongiotic foci, seen as areas of gadolinium enhancement. Patients were divided into 3 groups and received treatment with placebo, sodium alendronate, or sodium fluoride for 6 months. After this period, clinical and audiometric evaluations and a second MRI were performed. Each MRI was evaluated by both a neuroradiologist and an otolaryngologist in a subjective (visual) and objective (using specific eFilm Workstation software) manner. RESULTS: Otospongiosis was most predominantly identified in the region anterior to the oval window, and this site was reliable for comparing pre- and posttreatment scans. The patients in the alendronate and sodium fluoride groups had MRI findings that suggested a decrease in activity of otospongiotic lesions, more relevant in the alendronate group. These findings were statistically significant for both subjective and objective MRI evaluations. CONCLUSIONS: MRI shows higher sensitivity than clinical or audiometric assessment for detecting reduction in activity of otospongiosis. The objective MRI evaluation based on software analysis was the most accurate method of monitoring clinical treatment response in otospongiosis.

Bronchial artery-pulmonary artery malformation as a cause of cryptogenic hemoptysis.

A 12-year-old girl with two episodes of massive hemoptysis was found to have a localized pulmonary hemorrhage on bronchoscopy. Multiple investigations including a computed tomography (CT) angiogram failed to identify the cause. Catheterization of the pulmonary and bronchial vessels uncovered a bronchial artery to pulmonary artery fistula, which was embolized by interventional radiology. This is the first pediatric case of this type of anomaly and it illustrates the importance of angiography in the investigation of cryptogenic hemoptysis.

Ação-formação: uma leitura das contribuições da Ergonomia da Atividade / Action-training: a reading of the contributions of the Activity Ergonomics

Este artigo objetiva refletir acerca das interações entre formação e ação ergonômica, especificamente, na perspectiva da Ergonomia da Atividade. Seu ponto de partida é a trajetória histórica dessa interface, sinalizando dilemas e alternativas pautadas nas relações entre análise do trabalho e ações formativas. Seus desdobramentos são explorados a partir do "paradigma da formação de atores na e pela análise do trabalho, para e pela ação", ancorado na interdependência entre formação e transformação das condições de trabalho. Conclui-se que este paradigma abre novas vias de análise sobre a sustentabilidade da ação ergonômica e sobre a luta pela saúde.(AU)

This article aims to reflect on the interaction between training and ergonomics' action, specifically, from the Activity-centered Ergonomics perspective. Its starting point is the historical trajectory of this interface, signaling dilemmas and alternatives based on work analysis and training programs relations. Its developments are explored from the "paradigm of training in and by the analysis of work, to and by action", anchored in the interdependence between training and working conditions transformation. It is concluded that this paradigm opens new avenues of analysis on the sustainability of the ergonomics' action and on the struggle for health.(AU)

Relação entre trauma de oclusão e a periodontia / Relationship between trauma occlusion and periodontal disease

A relação entre trauma oclusal e a iniciação e a progressão das doenças periodontais têm sido controversa ao longo de um século. Os primeiros estudos do século 20, forças oclusais excessivas eram considerados como o fator etiológico da destruição periodontal e o ajuste oclusal deveria ser feito de forma profilática. Em meados do século passado, Lóe mostrou que o fator etiológico da destruição periodontal é a placa bacteriana. Porém, ainda muito se discute sobre qual o papel do trauma oclusal na destruição dos tecidos de suporte periodontais. Este trabalho tem o objetivo de fazer um relato de caso onde a sobrecarga oclusal teve um papel importante na destruição dos tecidos periodontais e fazer uma discussão sobre o tema para alertar aos clínicos a importância do diagnóstico e combate dessas condições.

Tratamento tópico de piodermites com o fusidato de sódio a 2% / Topical treatment of pyogenic cutaneous infections with sodium fusidate at 2%

Foram estudados vinte pacientes que apresentavam piodermites tratados com a pomada de fusidato de sódio a 2% em aplicaçöes locais. O medicamento revelou-se eficaz em 95% dos casos (19 pacientes), com o tempo de cura variando no período de um a quatro dias em 16 (80%) dos pacientes avaliados; foi muito boa a tolerabilidade näo tendo sido observado nenhum efeito colateral

Pityriasis lichenoides et varioliformis acuta (doença de Mucha-habermann) / Pityriasis lichenoides et varioloformis acuta (Mucha-habermann disease)

Os autores apresentam um caso recentemente observado de Pityriasis lichenoides et varioliformis acuta (PLEVA) que apresentou involuçao espontânea e fazem sucinta revisao dos aspectos terapêuticos da dermatose.