Bronchoscopy for foreign body removal: where is the delay?

This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-term.Analisaram-se retrospectivamente os prontuários de 145 doentes admitidos no Serviço de Broncoscopia e Cirurgia Torácica do Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp) num período de 10 anos. Houve diferença estatística relacionada com o local de consulta inicial (HC-Unicamp versus outros serviços) em termos do tempo gasto desde a suspeita de broncoaspiração até a realização do exame endoscópico respiratório. No entanto, não houve diferença significativa entre o índice de positividade do exame. O baixo número de centros de referência para endoscopia respiratória de urgência pode influenciar negativamente no atendimento a doentes com suspeita de broncoaspiração, piorando a evolução em médio e longo prazo3411956958This was a retrospective analysis of the medical charts of 145 patients treated at the Bronchoscopy and Thoracic Surgery Clinic of the Hospital das Clínicas da Universidade Estadual de Campinas (HC-Unicamp, State University of Campinas Hospital das Clínicas) over a period of 10 years. There was a significant difference related to the site of first medical visit (Unicamp-HC versus other institutions) in terms of the time elapsed between the suspicion of bronchial aspiration and the actual respiratory endoscopic examination. However, no significant difference was found in the rate of positive results. The low number of referral centers that provide emergency respiratory endoscopy can negatively influence the treatment of patients under suspicion of bronchial aspiration, jeopardizing the overall recovery in the mid- and long-ter

Postintubation injuries and open surgical tracheostomy: should we always perform isthmectomy?

OBJECTIVE: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. METHODS: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located at the city of Sumare, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. RESULTS: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stomal complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. CONCLUSIONS: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stomal complications.Avaliar a influência da equipe cirúrgica (cirurgia geral ou cirurgia torácica) e da técnica operatória utilizada (com ou sem istmectomia) sobre a incidência de injúrias pós-intubação nas vias aéreas em pacientes traqueostomizados. MÉTODOS: Foram prospectivamente incluídos neste estudo 164 pacientes admitidos na unidade de terapia intensiva para adultos do Hospital Estadual Sumaré e que ficaram sob intubação traqueal por mais de 24 h, no período entre 1º de janeiro e 31 de agosto de 2007. Quando foi necessária a realização de traqueostomia, os pacientes foram aleatorizados para as equipes de cirurgia geral e torácica. Todos os pacientes foram submetidos à traqueoscopia flexível para a decanulação e/ou a avaliação tardia da via aérea. RESULTADOS: Dos 164 pacientes no estudo, 90 (54,88%) faleceram (sem relação com o procedimento), 67 (40,85%) completaram o seguimento e 7 (4,27%) tiveram seguimento parcial. Dos 67 pacientes com seguimento completo, 32 foram traqueostomizados (21 pela equipe de cirurgia geral e 11 pela equipe de cirurgia torácica). A istmectomia foi realizada em 22 pacientes (11 pela equipe de cirurgia geral e 11 pela equipe de cirurgia torácica). Não houve diferença entre o índice de complicações estomais quando se comparou as equipes, mas sim quando se comparou as técnicas (com e sem istmectomia). CONCLUSÕES: A não realização da istmectomia paralelamente à traqueostomia faz com que o cirurgião realize o óstio traqueal mais distalmente do que supõe. Nestes casos, houve um maior índice de complicações do estoma traqueal353227233To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. METHODS: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located at the city of Sumare, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. RESULTS: Of the 164 patients in the study, 90 (54.88%) died (due to causes unrelated to the procedure), 67 (40.85%) completed follow-up, and 7 (4.27%) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stomal complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. CONCLUSIONS: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stomal complication

Vermiculite and shading in the formation of 'Rangpur' lime rootstock

‘Rangpur’ lime (Citrus limonia Osbeck cv. Cravo) is widely used as a rootstock for citrus seedlings, although factors such as luminosity and substrate composition are extremely important to obtain quality seedlings. The objective of this study was to analyze the formation of ‘Rangpur’ lime seedlings grown in different substrates and luminosities. A 3x4 factorial arrangement was used in an RBD with four replications of twelve plants. Three luminosities (full sun, 35%, and 70% shading) and four substrate: vermiculite proportions were tested (S1-1: 0, S2-2: 1, S3-1: 2, and S4-0: 1). The seeds were sown in 280 cm3 tubes and emergence was evaluated every two days for 30 days, and biometric assessments at 30, 60, 90, and 120 DAE by measuring the height, diameter, leaves, and mortality. Root length and shoot and root dry mass were measured at 30 and 120 days. Seeds in full sun showed high ESI values and a shorter time period, as well as high mortality at 120 DAE. Highly shaded environments cause etiolation and reduce biomass accumulation and the DQI. Seeds in S4 showed lower results for most variables. It is recommended to use 35% shading associated with the substrate proportions S1, S2, and S3.‘Rangpur’ lime (Citrus limonia Osbeck cv. Cravo) is widely used as a rootstock for citrus seedlings, although factors such as luminosity and substrate composition are extremely important to obtain quality seedlings. The objective of this study was to analyze the formation of ‘Rangpur’ lime seedlings grown in different substrates and luminosities. A 3x4 factorial arrangement was used in an RBD with four replications of twelve plants. Three luminosities (full sun, 35%, and 70% shading) and four substrate: vermiculite proportions were tested (S1-1: 0, S2-2: 1, S3-1: 2, and S4-0: 1). The seeds were sown in 280 cm3 tubes and emergence was evaluated every two days for 30 days, and biometric assessments at 30, 60, 90, and 120 DAE by measuring the height, diameter, leaves, and mortality. Root length and shoot and root dry mass were measured at 30 and 120 days. Seeds in full sun showed high ESI values and a shorter time period, as well as high mortality at 120 DAE. Highly shaded environments cause etiolation and reduce biomass accumulation and the DQI. Seeds in S4 showed lower results for most variables. It is recommended to use 35% shading associated with the substrate proportions S1, S2, and S3

Cogan’s syndrome: ocular findings in an atypical case

A síndrome de Cogan é entidade multissistêmica rara caracterizada por ceratite intersticial associada à disfunção áudio-vestibular e possível surdez irreversível classificada em duas formas clínicas: típica e atípica. Há discordância na literatura quanto à presença de acometimento corneano na forma atípica. Uma paciente de 32 anos queixando-se de hiperemia e dor ocular, fotofobia e baixa da acuidade visual no olho direito, associada à perda súbita de audição à esquerda, vômitos, diarréia, oligúria, dor na orofaringe e febre. História prévia de semelhante acometimento do olho esquerdo e audição direita. Havia intensa hiperemia conjuntival, esclerite nodular, episclerite e infiltrados circulares no estroma corneano. A paciente recebeu pulsoterapia com metilprednisolona e ciclofosfamida. Evoluiu com grande melhora ocular, porém com resposta auditiva pobre. O caso reportado pode constituir forma típica da síndrome de Cogan (de acordo com autores que defendem o nãoacometimento corneano na forma atípica) com alguns achados característicos da forma atípica ou um caso da forma atípica da síndrome de Cogan (para aqueles que defendem o acometimento corneano na forma atípica). O diagnóstico diferencial também é discutid

Doença Policística Hepática associada a Doença Policística Renal Autossômica Dominante: relato de caso - gravidade de doença hepática e revisão de literatura

A doença renal policística é uma doença de caráter genético hereditário, sendo um importante causa de doença renal crônica terminal com necessidade de Terapia de Substituição Renal (TSR). Além da clássica doença renal crônica a DRPAD pode apresentar várias manifestações extra-renais, entre elas, a doença cística hepática que acomete cerca de 90% dos pacientes. Infecções dos cistos hepáticos são complicações raras, porém graves. Neste artigo iremos apresentar um caso clínico com acometimento cístico hepático e renal maciço, além de uma breve revisão sobre complicações e possibilidades terapêuticas

Materiais de ensino para surdos: produções de atividades com escrita de sinais (signwriting)

As línguas de sinais, por muito tempo, foram consideradas ágrafas por não ter um sistema de escrita que pudesse registrar o conhecimento, a história e a convenção escrita de uma língua visual-espacial. Tendo em vista essa necessidade, foi desenvolvido o SignWriting, um sistema universal que serve para escrever e para ler em qualquer língua de sinais do mundo (BARRETO; BARRETO, 2015, p. 83). O objetivo do presente artigo é mostrar resultados alcançados na disciplina Escrita de Sinais, oferecida no Curso de Licenciatura em Letras Libras, da Universidade Federal do Acre, especificamente no ano de 2018. As atividades elaboradas pelos acadêmicos tinham como objetivo: contribuir para o ensino prático das habilidades de leitura e de escrita, por meio do sistema de escrita de sinais: SignWriting

Pre-hospital chest drainage: presention one-way valve mechanism

BACKGROUND: The purpose of this study is to present an one-way valve mechanism to replace the underwater seal for pleural drainage, currently used in the prehospital attendance, as well as document preliminary results of its initial use at SAMUCampinas/ SP/Brasil. METHODS: Twenty two pleural drains with the valve were carried out, all of these in prehospital environment, in patients who suffered thoracic trauma or spontaneous pneumothorax, in a prospective not randomized trial. RESULTS: The total volume output drained through the valve ranged from 0 to 1500 ml, mean 700 ± 87,4 ml, in an average time lag of 18 minutes (± 1,1 minutes - ranging from 8 to 26 minutes). The initial and final cardiac frequency was 120 ± 2,7 bpm and 100 ± 2 bpm (p 0,00), respectively , whereas the initial respiratory frequency was 24 ± 0,8 ipm and the final was 15 ± 0,3 ipm (p 0,03). Only two mechanical failures were registered, one of which was corrected by the substitution of the defective valve, showing a 95,4% success ratio. CONCLUSION: Taking into account the initial and final physical examination, as well as the output quantification, it can be concluded that the valve is efficient and functional, and safe in the pre-hospital emergencies.O objetivo do presente estudo é apresentar um mecanismo de válvula unidirecional para substituição do selo de água na drenagem pleural tubular fechada, em ambiente pré-hospitalar, bem como registrar os resultados de seu uso inicial no SAMU-Campinas/SP/Brasil. MÉTODO: Foram realizadas 22 (vinte e duas) drenagens pleurais com válvula em doentes vítimas de traumatismo ou pneumotórax espontâneo, todos em ambiente pré-hospitalar, de forma prospectiva, não randomizada. RESULTADOS: O débito total de líquidos através da válvula variou de zero a 1500 ml, com média de 700 ± 87,4 ml, para um tempo de percurso em média de 18 ± 1,1 minutos, variando de 8 a 26 minutos. A frequência cardíaca inicial foi 120 ± 2,7 bpm e final de 100 ± 2 bpm (p 0,00) e a frequência respiratória inicial foi 24 ± 0,8 ipm e o valor final foi de 15 ± 0,3 ipm (p 0,03). Houve apenas duas falhas mecânicas do sistema e uma foi corrigida pela substituição da mesma, trazudindo num índice de sucesso de 95,4% neste trabalho. CONCLUSÃO: Levando em conta exame físico inicial com o exame físico final, bem como pela quantificação de débitos, concluímos que a válvula mostrou-se eficiente e funcionante, e que é segura para o uso em urgências pré-hospitalares.BACKGROUND: The purpose of this study is to present an one-way valve mechanism to replace the underwater seal for pleural drainage, currently used in the prehospital attendance, as well as document preliminary results of its initial use at SAMUCampinas/ SP/Brasil. METHODS: Twenty two pleural drains with the valve were carried out, all of these in prehospital environment, in patients who suffered thoracic trauma or spontaneous pneumothorax, in a prospective not randomized trial. RESULTS: The total volume output drained through the valve ranged from 0 to 1500 ml, mean 700 ± 87,4 ml, in an average time lag of 18 minutes (± 1,1 minutes - ranging from 8 to 26 minutes). The initial and final cardiac frequency was 120 ± 2,7 bpm and 100 ± 2 bpm (p 0,00), respectively , whereas the initial respiratory frequency was 24 ± 0,8 ipm and the final was 15 ± 0,3 ipm (p 0,03). Only two mechanical failures were registered, one of which was corrected by the substitution of the defective valve, showing a 95,4% success ratio. CONCLUSION: Taking into account the initial and final physical examination, as well as the output quantification, it can be concluded that the valve is efficient and functional, and safe in the pre-hospital emergencies332101106The purpose of this study is to present an one-way valve mechanism to replace the underwater seal for pleural drainage, currently used in the prehospital attendance, as well as document preliminary results of its initial use at SAMUCampinas/ SP/Brasil. METHODS: Twenty two pleural drains with the valve were carried out, all of these in prehospital environment, in patients who suffered thoracic trauma or spontaneous pneumothorax, in a prospective not randomized trial. RESULTS: The total volume output drained through the valve ranged from 0 to 1500 ml, mean 700 ± 87,4 ml, in an average time lag of 18 minutes (± 1,1 minutes - ranging from 8 to 26 minutes). The initial and final cardiac frequency was 120 ± 2,7 bpm and 100 ± 2 bpm (p 0,00), respectively , whereas the initial respiratory frequency was 24 ± 0,8 ipm and the final was 15 ± 0,3 ipm (p 0,03). Only two mechanical failures were registered, one of which was corrected by the substitution of the defective valve, showing a 95,4% success ratio. CONCLUSION: Taking into account the initial and final physical examination, as well as the output quantification, it can be concluded that the valve is efficient and functional, and safe in the pre-hospital emergencie

BIOMECHANICAL AND PHYSICAL PROFILE COMPARISON IN MILITARIES WITH AND WITHOUT MUSCULOSKELETAL INJURIES: A PRELIMINARY STUDY

This study compared limb strength, body composition, cardiorespiratory fitness and vertical jump performance in military staff with and without prior musculoskeletal injures. Thirty male military personnel enrolled in a physical education undergraduate program participated in this study. A survey covering history of the last two years of musculoskeletal lower limb injuries was sent to participants, who were separated into groups: injured (IG; n=16) and uninjured (NIG; n=14). Participants performed a sit and reach flexibility test, body composition, 12-min Cooper running test, vertical jump performance and back squat in a smith machine on five different days. Participants from the IG presented reduced strength and vertical jump performance compared to the NIG. No differences were observed in body composition, or cardiorespiratory fitness between groups

Disentangling landscape effects on population genetic structure of a Neotropical savanna tree

ABSTRACTGeographical patterns of genetic variation and population structure and their relationship with habitat loss and fragmentation have been investigated at distinct scales and extents using spatially explicit statistics. Here, we analyzed population genetic structure of Dipteryx alata (Fabaceae; the “baru” tree), an economically important tree widely distributed in Central Brazil that is endemic to the “Cerrado” (savanna) biome, relating population genetic divergence with broad-scale landscape patterns. Genetic divergence among 25 populations, estimated based on eight microsatellite loci for a total of 644 individuals, was correlated with landscape features using several forms of Mantel tests (standard Mantel correlations, Mantel correlograms, partial correlations, and multiple regression). Patterns of genetic divergence are significantly correlated with human-driven landscape features of habitat loss and fragmentation, after taking into account isolation-by-distance and historical effects of range expansion after the last glacial maximum. Our findings present important implications for the conservation of this species, because interruption of gene flow by habitat loss and fragmentation jeopardize the persistence of population in the medium- and long term due to disruption of demographic patterns, increased endogamy, and recruitment problems.© 2014 Associação Brasileira de Ciência Ecológica e Conservação. Published by Elsevier Editora Ltd