Tratamento da luxação anterior recidivante do ombro pela técnica de Bristow-Latarjet

Objectives: To describe the clinical and radiographic results of patients with recurrent anterior shoulder dislocation treated with the Bristow-Latarjet technique. Material and Methods: Retrospective case series including 44 patients (45 shoulders) with anterior shoulder instability who underwent the Bristow-Latarjet procedure, including 86% of male patients and 80% with traumatic dislocations. The graft was fixed "standing", as used in the Bristow technique, in 84% of the shoulders, and "lying", as proposed by Latarjet, in 16%, using 1 metal screw in all cases, and washer in 20% of the surgeries. Results: The follow-up was 19.25 ± 10.24 months. We obtained 96% of good results, with 2 recurrences presented as subluxation. Of the 36 patients who practiced sports, 89% had good results. Graft healing occurred in 62% of cases. The graft was positioned below the glenoid equator in 84% of the cases, and less than 10 mm from its edge in 98%. The external rotation had a limitation of 20.7º ± 15.9º, while the internal rotation was limited in 4.0º ± 9.6º. The limitation of external and internal rotation and the position of the graft ("standing" or "lying") did not correlate with graft healing (p> 0.05). Bicortical fixation was positively correlated with healing (p <0.001). Conclusion: The Bristow-Latarjet technique is indicated for the treatment of recurrent anterior dislocations and subluxations of the shoulder. It is a safe treatment method, which can be used in people with intense physical activity. Limiting shoulder mobility does not prevent patients from returning to their usual occupations, as well as, in most of them, from playing sports with the same performance as before the surgery. Level of evidence: IV, Case SeriesObjetivos: Descrever os resultados clínicos e radiográficos do tratamento da luxação anterior recidivante do ombro pela técnica de Bristow-Latarjet. Material e Métodos: Série de casos retrospectiva, incluindo 44 pacientes (45 ombros) com instabilidade anterior do ombro submetidos à técnica de Bristow-Latarjet, incluindo 86% de pacientes do sexo masculino e 80% com luxações traumáticas. O enxerto foi fixado "em pé" em 84% dos ombros, e "deitado" em 16%, utilizando 1 parafuso metálico, com uso de arruela em 20% das cirurgias. Resultados: O seguimento foi de 19,25 ± 10,24 meses. Obtivemos 96% de bons resultados, sendo 2 recidivas sob a forma de subluxação. Dos 36 pacientes que praticavam esporte, 89% apresentaram bons resultados. A consolidação ocorreu em 62% dos casos. O enxerto foi posicionado  abaixo do equador da glenoide em 84% das vezes, e a menos de 10 mm da sua borda em 98%. A rotação externa apresentou limitação de 20,7º ± 15,9º, enquanto a rotação interna 4,0º ± 9,6º. A limitação da rotação externa e da rotação interna e a posição do enxerto ("em pé" ou \u27deitado") não se correlacionaram com a consolidação do enxerto (p>0,05). A fixação bicortical correlacionou-se positivamente com a consolidação (p<0,001). Conclusão: A técnica de Bristow-Latarjet está indicada para o tratamento das luxações e subluxações anteriores recidivantes do ombro. É um método de tratamento seguro, que pode ser utilizado em pessoas com atividade física intensa. A limitação da mobilidade do ombro não impede os pacientes de voltarem às suas ocupações habituais, bem como, na maioria deles, de praticar esporte com desempenho igual ao de antes da operação. Nível de evidência: IV, Série de Caso

Molecular mechanisms and pharmacological interventions in the replication cycle of human coronaviruses

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), as well as SARS-CoV from 2003 and MERS-CoV from 2012, is a member of the Betacoronavirus genus of the Nidovirales order and is currently the cause of the pandemic called COVID-19 (or Coronavirus disease 2019). COVID-19 is characterized by cough, fever, fatigue, and severe cases of pneumonia and has affected more than 9.1 million people worldwide until June 22nd, 2020. Here we present a review of the cellular mechanisms associated with human coronaviruses replication, including the unique molecular events related to the replication transcription complex (RTC) of coronaviruses. Information regarding the interactions between each viral protein and cellular proteins is presented, associating to known host-pathogen implications for the coronavirus biology. Finally, a specific topic addresses the current attempts for pharmacological interventions against COVID-19, highlighting the possible effects of each drug on the molecular events of viral replication. This review intends to contribute to future studies for a better understanding of the SARS-CoV-2 replication cycle and the development of pharmacological approaches targeting COVID-19

Empleo de la RT-PCR en la detección del SARS-CoV-2

The reverse transcriptase-polymerase chain reaction is a high precision technique to detect and amplify genetic material. Aim: To describe the use of the reverse transcriptase-polymerase chain reaction as a laboratory test for the detection of SARS-CoV-2. Method: a literature review was conducted on articles published up to May 2020. A survey on the databases Scopus, Wiley Online Library, SciELO, DIALNET, EBSCO, MEDLINE and PubMed retrieved 40 articles of interest included in this research. Development: the reverse transcriptase-polymerase chain reaction to detect SARS-CoV-2 targets the RNA polymerase dependent RNA, ORF1ab fragments, the E gene, the N gene and the S gene. Nasopharyngeal swabs offer better results than oropharyngeal swabs and saliva. The inclusion of reverse transcriptase-polymerase chain reaction tests (RT-PCR) using rectal swab in suspected false-negative cases is necessary. New studies and techniques are continuously developed to optimise the detection process. Conclusions: the availability of diagnostic tests is crucial for the identification of positive cases and the traceability of the transmission chain. RT-PCR is the test of choice during the active period of viral replication. The RT-LAMP assay is a rapid diagnostic alternative with similar principles to RT-PCR.Introducción: la reacción en cadena de la polimerasa con transcriptasa inversa es una técnica de alta precisión en la detección y amplificación de material genético. Objetivo: describir las bases del empleo de la reacción en cadena de la polimerasa con transcriptasa inversa como prueba diagnóstica en la detección del SARS-CoV-2. Método: se realizó una revisión de la literatura en artículos publicados hasta mayo de 2020. Se consultaron las bases de datos: Scopus, Wiley Online Library, SciELO, DIALNET, EBSCO, MEDLINE y PubMed. Se recuperaron artículos en español e inglés, seleccionándose 43 referencias. Desarrollo: la reacción en cadena de la polimerasa con transcriptasa inversa para detectar SARS-CoV-2 consiste en la lectura de la ARN polimerasa dependiente del ARN, fragmentos ORF1ab, el gen E, el gen N y el gen S. El exudado nasofaríngeo ofrece mejores resultados que el orofaríngeo y saliva como muestra. Resulta necesaria la inclusión de pruebas reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) que utilicen especímenes de hisopado rectal en casos sospechosos falsos negativos. Nuevos estudios y técnicas se elaboran con el objetivo de optimizar el proceso de detección. Conclusiones: la disponibilidad de pruebas diagnósticas es crucial para el aislamiento de casos positivos y el seguimiento de la cadena epidemiológica de transmisión. La RT-PCR resultó ser la prueba de elección durante el período de replicación viral. La Prueba de amplificación isotérmica mediada por bucle (RT-LAMP) es una alternativa diagnóstica rápida con principios similares a la RT-PCR

Características clínicas e fatores associados à mortalidade em pacientes adultos internados pelo COVID-19 em um hospital público de Lima, Peru.

The COVID-19 pandemic has deeply affected the national health system in Peru, and despite the many strategies implemented to control the epidemic, the collapse of the sanitary system was imminent. We performed a retrospective cohort from the clinical records of adult patients with COVID-19 admitted in Hospital Cayetano Heredia (Lima, Peru), between March and June 2020. A total of 369 patient charts were included for analysis; 241 (65.31%) were male and the median age was 59 years (IQR: 49-68). Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) level at admission was the main predictor of patient mortality, with SaO2 levels of 84-80% and <80% had 4.44 (95%CI 2.46-8.02) and 7.74 (95%CI 4.54-13.19) times greater risk of death, respectively, when compared to patients with SaO2 >90%. Additionally, older age (>60 years old) was associated with 1.9 times greater mortality. Our study finds SaO2 at admission and older age to be independent predictors of in-hospital mortality. These findings suggest a delay in early detection of hypoxemia in the community, therefore, we propose the implementation of monitoring for hypoxemia among outpatients with COVID-19 as well as appropriate and timely oxygen therapy in admission.  La pandemia por COVID-19 ha representado un duro golpe al sistema sanitario peruano, y las estrategias implementadas para el control de la epidemia han sido insuficientes en el contexto de colapso del sistema de salud. Se realizó una cohorte retrospectiva a partir de la revisión de las historias clínicas de pacientes adultos hospitalizados por COVID-19, entre marzo y junio de 2020, en el Hospital Cayetano Heredia, Lima- Perú. Se analizó 369 historias clínicas, 241 (65.31%) pacientes eran del sexo masculino y la mediana de edad era de 59 años (RIC: 49-68). El 68.56% presentaba al menos una comorbilidad, siendo las más frecuentes obesidad (42.55%), diabetes mellitus (21.95%) e hipertensión arterial (21.68%). La mediana de duración de síntomas previo al ingreso hospitalario fue de 7 días (RIC: 5-10). La mortalidad intrahospitalaria encontrada fue del 49.59%. En el análisis multivariado, la saturación de oxígeno al ingreso al hospital fue el principal factor predictor de mortalidad. Se observó un marcado incremento de mortalidad; encontrándose que la SatO2 de 84-80% y <80% tuvieron 4.44 (IC95% 2.46-8.02) y 7.74 (IC95% 4.54- 13.19) veces mayor riesgo de muerte, respectivamente, en comparación con pacientes con SatO2 basal >90%. Adicionalmente, la edad mayor a 60 años se asocia a 1.90 veces mayor mortalidad. Nuestro estudio muestra que la edad mayor a 60 años y el nivel de hipoxemia presente al momento de la admisión al hospital son factores asociados de forma independiente a la mortalidad intrahospitalaria. Los hallazgos sugieren una demora en detección de hipoxemia en la comunidad, por lo que se propone reforzar el sistema de monitoreo e identificación temprana de hipoxemia en pacientes con COVID-19, asociada a un soporte oxigenatorio en el momento oportuno.A pandemia do COVID-19 representou um duro golpe no sistema de saúde peruano, e as estratégias implementadas para controlar a epidemia foram insuficientes no contexto do colapso do sistema de saúde. Foi realizada uma coorte retrospectiva com base na revisão dos prontuários de pacientes adultos internados pelo COVID-19, entre março e junho de 2020, no Hospital Cayetano Heredia, Lima-Peru. Foram analisados ​​369 prontuários, 241 (65,31%) pacientes eram do sexo masculino e a idade média foi de 59 anos (RIC: 49-68). 68,56% apresentavam pelo menos uma comorbidade, sendo as mais frequentes obesidade (42,55%), diabetes mellitus (21,95%) e hipertensão (21,68%). A duração mediana dos sintomas antes da internação foi de 7 dias (RIC: 5-10). A mortalidade hospitalar encontrada foi de 49,59%. Na análise multivariada, a saturação de oxigênio na admissão hospitalar foi o principal preditor de mortalidade. Um aumento acentuado na mortalidade foi observado; constatando que SatO2 de 84-80% e <80% tinha 4,44 (IC95% 2,46-8,02) e 7,74 (IC95% 4,54-13,19) vezes maior risco de morte, respectivamente, em comparação com pacientes com SatO2 basal> 90%. Além disso, a idade acima de 60 anos está associada a uma mortalidade 1,90 vezes maior. Nosso estudo mostra que a idade superior a 60 anos e o nível de hipoxemia presente no momento da admissão no hospital são fatores independentemente associados à mortalidade hospitalar. Os resultados sugerem um atraso na detecção de hipoxemia na comunidade, motivo pelo qual se propõe fortalecer o sistema de monitoramento e identificação precoce de hipoxemia em pacientes com COVID-19, associados ao suporte à oxigenação no momento apropriado

Hifomicetos de água doce em sistema insular preservado do Brasil: primeiros registros no Parque Estadual da Ilha do Cardoso, município de Cananéia, Estado de São Paulo

To survey freshwater hyphomycetes from insular water bodies at the Parque Estadual da Ilha do Cardoso State Park, in Cananéia municipality, São Paulo State, Brazil, submerged mixed leaf litter samples were collected from six sites from June 2012 to February 2013. The samples were taken to the laboratory and incubated in Petri dishes containing sterile distilled water at room temperature (20oC). From the 5th day on, until at least one month, fragments of the leaf litter samples were examined under the microscope, resulting in the morphological identification of 33 taxa. Among those, two are new records for the state of São Paulo and four for Brazil. Descriptions and pictures of each new record are presented.Para o levantamento de hifomicetos de água doce em corpos de água insulares no Parque Estadual da Ilha do Cardoso, no município de Cananéia, Estado de São Paulo, Brasil, foram coletadas amostras de folhedo misto submerso de seis locais de junho de 2012 a fevereiro de 2013, levados ao laboratório e incubados em placas de Petri contendo água destilada estéril a temperatura ambiente (20ºC). A partir do 5º dia, até pelo menos um mês, fragmentos das amostras de folhas foram analisados microscopicamente, resultando na obtenção de 33 táxons, identificados por características morfológicas. Entre eles, dois são novos registros para o Estado de São Paulo e quatro são novos registros para o Brasil. Descrições e figuras de cada novo registro são apresentadas

Why extended visits in an adult ICU receive a more positive evaluation from patient relatives than from the health care team?

Intensive care units (ICUs) have adopted flexible visitation models as a way to favor care focused on the needs of patients and their families. OBJECTIVE: To evaluate an extended visitation model in an adult ICU from the perspective of family members and the health care team. METHODS: Cross-sectional study. This study was carried out with relatives of patients and with the health care team in a general ICU with an extended visitation model, in a hospital in the south of Brazil. The evaluation of the extended visitation policy was carried out using a 22-question survey. RESULTS: The answers of 95 accompanying family members and 95 members of the ICU care team were analyzed. Members of the nursing staff evaluated the changes in attitudes at work as negative (77.9%) , believe that the work gests interrupted (46.3%), and consider that it contributes little to decreasing anxiety and stress in the family. The accompanying family members evaluated the following elements more positively: decreased anxiety and stress in the family (91.6% versus 58.9%;p <0.01); family members get more information (86.3% versus 64.2%; p <0.01). CONCLUSION: Both groups evaluated as positive the majority of the aspects of the extended visitation model. However, the aspects that presented the greatest divergence in the evaluations, with a more negative perception from ICU health care team members, were the interference in their work, changes in attitudes at work, a lower perception of the reduction in anxiety and stress in the family and patients, and discomfort caused by the presence of a relative