The Skin's Neurological Function Evaluation in Post-Bariatric Plastic Surgery

Universidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Asociación entre hipoglucemia y morbi-mortalidad en pacientes hospitalizados con diabetes tipo 2

El objetivo del estudio fue determinar la frecuencia de la hipoglucemia y su asociación con la morbi-mortalidad en pacientes adultos con diabetes tipo 2 internados en la sala de Clínica Médica del Hospital de Clínicas. En este estudio observacional analítico se incluyeron entre 2013-2014, en forma consecutiva 150 pacientes conocidos diabéticos con una edad media de 61,2 ± 12,1 años, mujeres (56,7%), y tiempo promedio de diagnóstico de diabetes (8,1 ± 8 años); 50 pacientes (33%) ingresaron por infecciones, 47 por eventos cardiovasculares (31,3%) y el resto por causas varias; concentración media de HbA1c fue 9,5±3%. Se encontraron episodios de hipoglucemia (glucosa <70 mg/dl) en 32 pacientes (21%). En comparación con los pacientes sin hipoglucemia, los pacientes con hipoglucemia tuvieron un BMI significativamente menor (p= 0,02) de 23,5±5 vs 28,29±5,2, albúmina sérica 2,65 ± 0,59 vs 3,04 ± 0,6 g/Dl (p= 0,002), hemoglobina: 9,8 ± 2,3 vs 11,05 ± 2,7 g/Dl (p= 0,02) y significativamente mayor (p= 0,03) duración de la diabetes (11,7 ± 9,2 vs 6,93 ± 8,9 años, mayor estancia hospitalaria (21,65 ± 15 vs 10,48 ± 7,15 días) (p= 0,0001) y mayor mortalidad (12,5% vs 2,5%; p= 0,03; OR= 5,61), más complicaciones (78,1% vs 39,8% (p= 0,001;OR= 1,99) y mayor ingreso a UCI (12,5% vs 6,8%; p= 0,02; OR= 1,94). Los resultados indican que la hipoglucemia hospitalaria es un marcador de enfermedad general y se asocia con mal resultado clínico y aumento de la morbi-mortalidad de los pacientes con diabetes tipo 2

Sexuality, depression and body image after breast reconstruction

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group

Utilización del conteo de carbohidratos en la Diabetes Mellitus

El conteo de carbohidratos es un método que ayuda a los pacientes a elegir sus alimentos y planificar sus comidas controlando la cantidad de hidratos de carbono ingeridos en cada una de ellas, para un mejor control glicémico. Se ha demostrado a través de estudios y ensayos clínicos que la terapia médica nutricional disminuyó la hemoglobina glicada aproximadamente 1% en diabetes tipo 1 y entre 1-2% en diabetes tipo 2. Este método ha crecido en popularidad en los Estados Unidos desde la finalización del Ensayo Clínico Controlado para el estudio de la Diabetes y sus Complicaciones, en los que se utilizó de manera eficaz. La ingesta dietética de referencia recomienda para los adultos un consumo de 45 a 65% del total de la energía para los hidratos de carbono o un mínimo de 130 gramos por día para cumplir con las necesidades nutricionales diarias y minimizar el riesgo de enfermedades crónicas. Objetivo: Dar a conocer el método de conteo de carbohidratos como una opción para el tratamiento nutricional del paciente con diabetes mellitus

Controvérsia sobre a Doença do Implante de Silicone Mamário: Uma revisão sistemática sobre o tema

Introduction: Currently, there is overwhelming evidence to support the safety of silicone breast implants. The decision to obtain, maintain or remove breast implants is the patient's choice. If a patient chooses to remove breast implants, it is important to find a plastic surgeon certified by the Brazilian Society of Plastic Surgery. Objectives: The purpose of this article is to present the current state of scientific evidence related to the safety of silicone breast implants. Ongoing studies are strongly encouraged in all areas, from cancer detection to autoimmune disease, with the plastic surgeon (a) being responsible for the effort required to improve patient safety, awareness and education. Methodology: The term “Silicone Implant Illness” was searched on the Google Scholar, Scopus and Web of Sciences indexing portals and 102 articles with the highest impact factor and citations were selected. Conclusion: To date, there are no concrete or evidence-based studies or peer-reviewed data on the formation of a new syndrome.Introducción: actualmente, existen pruebas abrumadoras para respaldar la seguridad de los implantes mamarios de silicona. La decisión de obtener, mantener o quitar los implantes mamarios es decisión del paciente. Si una paciente elige quitarse los implantes mamarios, es importante encontrar un cirujano plástico certificado por la Sociedad Brasileña de Cirugía Plástica. Objetivos: El propósito de este artículo es presentar el estado actual de la evidencia científica relacionada con la seguridad de los implantes mamarios de silicona. Se recomiendan encarecidamente los estudios en curso en todas las áreas, desde la detección del cáncer hasta las enfermedades autoinmunes, siendo el cirujano plástico (a) el responsable del esfuerzo requerido para mejorar la seguridad, la conciencia y la educación del paciente. Metodología: se buscó el término "Enfermedad del implante de silicona" en los portales de indexación de Google Scholar, Scopus y Web of Sciences y se seleccionaron 102 artículos con el mayor factor de impacto y citas. Conclusión: Hasta la fecha, no existen estudios concretos o basados ​​en evidencia o datos revisados ​​por pares sobre la formación de un nuevo síndrome.  Introdução: Atualmente, existem evidências esmagadoras para apoiar a segurança dos implantes mamários de silicone. A decisão obter, manter ou remover os implantes mamários é escolha da paciente. Se uma paciente optar por remover os implantes mamários, é importante encontrar um cirurgião plástico certificado pela Sociedade Brasileira de Cirurgia Plástica. Objetivos: O objetivo deste artigo é apresentar o estado atual das evidências científicas relacionadas à segurança dos implantes mamários de silicone.  Os estudos em andamento são fortemente incentivados em todas as áreas, da detecção do câncer à doença auto-imune, cabendo ao profissional cirurgião plástico (a), o esforço necessário para melhorar a segurança, a conscientização e a educação do paciente. Metodologia: Foi pesquisado o termo “Silicone Implant Illness” nos portais de indexação Google Acadêmico, Scopus e Web of Sciences e foram selecionados 102 artigos com maior fator de impacto e citações. Conclusão: Até o presente momento, não existem estudos concretos ou baseados em evidências ou dados revisados ​​por pares sobre a formação de uma nova síndrome. &nbsp

Brazilian Portuguese version of the Patient Scar Assessment Questionnaire

Introduction: Scars and their associated signs and symptoms have the potential to impact many aspects of health. Given the growing number of individuals with new scars, it is essential to have reliable, sensitive, and specific assessment tools that analyze the influence that scars can have on the quality of life. The objective is translate the Patient Scar Assessment Questionnaire (PSAQ) into Portuguese, adapt it to the Brazilian cultural context, and test its reproducibility, reliability, and validity. Methods: The questionnaire was applied to 121 individuals with post-surgical scars consecutively selected at a plastic surgery clinic from January 2015 to June 2016. The PSAQ consists of 39 questions divided into five subscales: appearance, symptoms, perception, satisfaction with appearance, and symptoms. Then its reproducibility, face, content, and construct validity were analyzed. Internal consistency was tested using Cronbach’s alpha coefficient, and construct validation was performed by correlating the translated instrument with the QualiFibro and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Results: Analysis of the internal consistency of the PSAQ subscales obtained values >0.70 in all domains, showing good internal consistency. Reproducibility was demonstrated using Pearson’s correlation and the Bland-Altman method, and the outcomes showed good reproducibility. In construct validation, a significant correlation was observed in all PSAQ domains with POSAS and QualiFibro. Conclusion: The PSAQ was translated into Portuguese and adapted to Brazilian culture, reproducible and presenting face, content, and construct validity

Clinical classification of brow ptosis

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making

Respuesta adrenal en pacientes críticos del Hospital de Clínicas de Asunción, Paraguay

El pronóstico de los pacientes críticos depende en gran medida de una interacción entre el sistema endocrino, nervioso e inmune. El eje hipotálamo – hipofiso - adrenal constituye el paradigma de estas interacciones, con respuestas secretorias variables. Por ello, este estudio de cohorte fue realizado con el objetivo de determinar el nivel medio de cortisol sérico en pacientes críticos al momento de su ingreso, a fin de analizar la relación entre dichos niveles y el pronóstico que tuvieron los mismos. Se incluyeron 122 sujetos ingresados a UCIA de junio de 2005 a enero de 2006 que fueron distribuidos en tres grupos (G1,G2,G3) de acuerdo al nivel de cortisol sérico que presentaban. El nivel medio de cortisol fue de 55.46ug-dL. Fallecieron 42.3% (12/29) de los pacientes con niveles de cortisol más bajos (G1) y el 33.3% (17/51) de los que presentaban niveles de cortisol intermedio (G2) RR:1.91,(p=0.5 ),así como el 61.90% (26/42) de los que tenían los niveles más elevados(G3)RR:1.78, (p=0.01).Si bien, el nivel medio de cortisol fué elevado, como era de esperar, los peores pronósticos estuvieron asociados a niveles bajos de cortisol (inferiores a 20ug-dL)como así también a aquellos que presentaron niveles superiores a 40 ug-dL, donde observamos una mortalidad significativamente mayor

Algorithms for the management of scars: the importance of systematizing behaviors

Introduction: Pathological scars occur from the hyperproliferation of fibroblasts and can be classified into hypertrophic scars and keloids. Basically, hypertrophic scars do not grow beyond the limits of the original wound, while keloids grow horizontally in a nodular form. Despite the diversity of instruments used to guide the prevention, treatment and follow-up of pathological scars, there is a need for instruments that address local realities. The objective is to carry out a narrative review of the literature on scar management algorithms and create an updated algorithm. Methods: Descriptive study of narrative literature review, with a search in PubMed, SciELO, LILACS, MEDLINE and Cochrane databases, from November 2010 to November 2020, published in English, Portuguese and Spanish. The descriptors used were: “cicatrix,” “keloid,” “algorithms,” and “wound healing.” The sample selection consisted of identifying the articles, reading the titles and abstracts, and selecting studies related to the topic. Subsequently, the full reading of the selected studies and classification according to the eligibility criteria were carried out. Results: 209 articles were found, and 116 were eliminated due to duplicity, resulting in 45 articles. A total of 8 articles that met the inclusion criteria were identified. Four articles were excluded after analysis and consensus meeting due to the absence of algorithms with scientific rigor; this study is composed of four articles. Conclusion: Four algorithms were found in the literature review that resulted in the development of an updated algorithm for scars