Artroplastia versus artrodese no tratamento da patologia degenerativa cervical

Trabalho final de mestrado integrado em Medicina (Neurocirurgia), apresentado à Faculdade de Medicina da Universidade de CoimbraIntrodução: Numa fase inicial, a doença degenerativa cervical é abordada por medidas médicas e só se estas se mostrarem infrutíferas é que se avança para uma abordagem cirúrgi-ca, cujo gold standard é a discectomia cervical anterior seguida de fusão. No entanto, este procedimento está associado a uma alteração da biomecânica cervical, que a longo prazo pode levar a doença do segmento adjacente (DSA). Por tudo isto começou a surgir interesse por técnicas que preservassem a dinâmica cervical, nas quais se incluem as técnicas de artroplastia cervical. Contudo, e apesar dos aparentes benefícios desta última técnica, este tema ainda permanece muito controverso. Materiais e métodos: Foi executada uma pesquisa na PUBMED e na Base de Artigos da Biblioteca Central dos Hospitais da Universidade de Coimbra, de onde foram selecionados estudos que comparassem as técnicas de artroplastia e artrodese em termos clínicos e/ou funcionais, ou em relação a complicações, parâmetros intra- e pós-operatórios, cirurgias secundárias ou custo-eficácia. Resultados: As técnicas mostraram-se equiparáveis em termos clínicos e de efeitos adversos gerais. Na avaliação funcional, a artroplastia mostrou conseguir manter um movi-mento cervical próximo do fisiológico no curto e médio prazo, ao contrário da artrodese. Todos os estudos que analisaram a taxa de cirurgias secundárias mostraram uma vantagem estatisticamente significativa para o grupo da artroplastia. O tempo operatório foi o único parâmetro intraoperatório que mostrou sistematicamente uma diferença estatisticamente sig-nificativa entre as duas técnicas, sendo a artroplastia a técnica com os maiores tempos. Finalmente, a análise do custo-eficácia mostrou que a artroplastia é tão custo-eficaz como algumas técnicas de artrodese, nomeadamente a técnica de placa, cage e substituto. Discussão: Existem muitos problemas com os estudos desenhados para avaliar esta pro-blemática. A falta de consenso científico na escolha dos parâmetros clínicos e funcionais dos Artroplastia versus Artrodese no Tratamento da Patologia Degenerativa Cervical estudos e a falta de estudos de superioridade fazem com que seja difícil tirar conclusões com elevado nível de evidência, ou mesmo realizar estudos comparativos como as meta-análises. Muito poucos estudos avaliam o principal racional para a escolha da artroplastia, nomeada-mente a incidência de DSA após a cirurgia. Os follow-ups são curtos e muitas vezes o núme-ro amostral é muito reduzido. Conclusão: Assim, os estudos parecem apontar para uma semelhança das duas técnicas em termos clínicos, complicações e custo-eficácia. O necessário agora é direcionar esforços para a realização de estudos de superioridade, mais longos (5 a 10 anos) e cujos end-points sejam a incidência de DSA ou a durabilidade da prótese. O consenso científico em relação aos parâmetros a utilizar na avaliação desta temática deve ser procurado. Entretanto, a utili-zação das técnicas de artroplastia devem ser reservadas a casos selecionados.Introduction: At its initial stage, degenerative disc disease is approached by medical measures and only when the previous ones are unsuccessful should the surgical approach be considered, the gold standard being anterior cervical discectomy and fusion. However, this procedure is associated with changes in cervical biomechanics that, on the long term, can cause adjacent segment disease (ASD). For this reason, there has been an increasing interest in cervical dynamics preserving techniques, in which cervical arthroplasty techniques are included. Nevertheless, and besides the apparent benefits of the last techniques, this theme remains very controversial. Materials and methods: A PUBMED and a Hospitais da Universidade de Coimbra’s Central Library Article Database research was performed and studies comparing arthroplas-ty and arthrodesis techniques clinically and/or functionally, or studies regarding complica-tions, intra- and postoperative parameters, secondary surgeries or cost-effectiveness were selected. Results: The techniques proved to be equivalent in terms of clinical aspects and overall adverse effects. On the functional evaluation, arthroplasty was able to maintain an almost physiological cervical motion, on both short and medium term, unlike arthrodesis. All stu-dies which analyzed secondary surgery rates showed a statistically significant advantage for the arthroplasty group. Surgical time was the only intraoperative parameter that systemati-cally showed a statistically significant difference between the two techniques, with arthrop-lasty being the one with longer times. Finally, the cost-effectiveness assessment proved arth-roplasty as cost-effective as some arthrodesis techniques, namely plaque, cage and substitute technique. Discussion: There are many problems with the studies designed to evaluate this subject. The lack of scientific consensus on the choice of both clinical and functional parameters Artroplastia versus Artrodese no Tratamento da Patologia Degenerativa Cervical used in studies and the lack of superiority studies make it very hard to draw high level of evidence conclusions or even conduct comparative studies, like meta-analysis. Very few studies evaluate the primary rational supporting the choice of arthroplasty, namely the inci-dence of ASD after the surgery. Follow-ups are too short and the sample size is frequently too small. Conclusion: In sum, studies seem to point to an equivalence of both techniques in terms of clinical aspects, complications and cost-effectiveness. The necessity right now is to con-centrate all efforts into carrying out studies with superiority designs, longer follow-ups (5 to 10 years) and whose end-points are either the incidence of ASD or the device’s durability. A scientific consensus regarding which parameters to use for the assessment of this matter should be sought. In the meanwhile, the use of arthroplasty techniques should be restricted to selected cases

PCB bioaccumulationin three mullet species — A comparison study

Polychlorinatedbiphenyls(PCBs)arelipophiliccontaminantsthattendtoaccumulateinorganisms.PCBs weredetectedin Chelon labrosus, Liza aurata and Liza ramada, alongdifferentagegroups. L. ramada presentedthehighestconcentration,anditincreasedwithage,whereas C. labrosus and L. aurata concentration remainedconstant. L. ramada high concentrationcanbeattributedtoitsecologicalniche, since thisspeciesisabletoaccumulatePCBsalongitsdifferentagegroupseveninlowenvironmental contamination conditions.PCBs101,118,138,149,153,170and180werethecongenersthatmore contributed tothesespeciescontamination,beingPCB138and153thecongenerswithhigher concentration. Mulletsareedibleinmanycountries,beingimportantin fisheries andaquaculture. L. ramada is themostcommonmulletforcaptureandhumanconsumption.Allspeciespresented concentrations belowtheregulationlimitestablishbytheEuropeanUnion,andthereforesafeforhuman consumption.The authorswishtothankallthecolleaguesthathelpedinthe field and laboratorywork.ThisworkwassupportedbyFCT(Fundaçãopara a CiênciaeTecnologia)throughaPhDgrantattributedtoJ.Baptista (SFRH/BD/48262/2008),fundedbyProgramaOperacionalPotencial HumanoofQRENPortugalandbythe Portuguesebudgetthroughthe Ministry ofScienceTechnologyandEducation.P.Patoacknowledgesa postdoctoralfellowshipfromFCT(SFRH/BPD/35068/2007)

Abordagens sobre treino desportivo

Os contributos para o desenvolvimento das competências dos profissionais da área das Ciências do Desporto são sempre bem-vindos. Com o intuito de se constituir como uma ferramenta de trabalho para todos os que procurem conhecimento nesta área tão específica, elaborou-se este documento estruturado, contendo informação específica e pertinente. Mantemos também uma política editorial de abertura à comunidade científica da área das Ciências do Desporto, originando um livro que reúne um conjunto de artigos que abordam temáticas diversas em contextos diferentes e da autoria de Professores/Investigadores nacionais e internacionais, de reconhecido mérito académico e científico. Relativamente à estrutura, este documento está dividido em 13 seções - Artigos - de temáticas relacionadas com a área do Treino, mas com perspetivas distintas, realizados com base em investigações realizadas nos mais diversos contextos.SHERU, Sport, Health & Exercise Resarch Unit - Instituto Politécnico de Castelo Branco - Câmara Municipal de Idanha-a-Novainfo:eu-repo/semantics/publishedVersio

Cães naturalmente infectados por Rangelia vitalii, Babesia canis vogeli, e Ehrlichia canis em São Paulo, Brasil

As hemoparasitoses em cães podem ser causadas por diversos agentes, sendo essas doenças transmitidas por artrópodes hematófagos. Esses agentes podem causar diversas manifestações clínicas e, em alguns casos, podem matar o hospedeiro. Este estudo teve como objetivo detectar por PCR em tempo real a frequência de Ehrlichia canis, Rickettsia rickettsii, Anaplasma platys, Rangelia vitalii e Babesia canis vogeli em amostras de cães da zona sul da cidade de São Paulo, Brasil. Das 98 amostras de cães, 18 (18,4%) testaram positivo com reação em cadeia da polimerase em tempo real para pelo menos um agente estudado. Destas 18 amostras, 17 testaram positivo para um único agente (11,2% para B. canis vogeli, 1,02% para R. vitalii e 5,1% para E. canis), e uma apresentou coinfecção com B. canis vogeli e R. vitalii. Os resultados demonstram a presença de hemoparasitas nos animais estudados, o que pode influenciar a qualidade e a expectativa de vida desses animais. Além disso, é o primeiro relato da detecção de R. vitalli na zona sul de São Paulo e serve de alerta para os clínicos de pequenos animais incluírem esse agente como diagnóstico diferencial para as hemoparasitoses.Several agents can cause hemoparasitic diseases in dogs, and blood-sucking arthropods transmit these diseases. These agents can cause several clinical manifestations and, in some cases, can kill the host. Because these agents are essential in animal health, this study aims to detect the frequency of Ehrlichia canis, Rickettsia rickettsii, Anaplasma platys, and Rangelia vitalii by real-time PCR and Babesia vogeli in dogs in the southern region of the city of São Paulo, São Paulo. Of the 98 dog samples, 18 (18.4%) tested positive with real-time polymerase chain reaction for at least one studied agent. Of these 18 samples, 17 tested positive for a single agent (11.2% for B. canis vogeli, 1.02% for R. vitalii, and 5.1% for E. canis), and one showed co-infection with B. canis vogeli and R. vitalii. The results demonstrate the presence of hemoparasites in the studied animals, which can influence the quality and life expectancy of these animals. The Rangelia detection warns small animal clinicians to include it as a differential diagnosis for hemoparasitosis.

Clinicopathological analysis of odontogenic tumors over 22 years period : experience of a single center in northeastern Brazil

Odontogenic tumors (OTs) are uncommon neoplastic lesions of the maxilla and mandible, which present difficult diagnosis and therapeutics. This paper aims to determine the frequency and distribution of OTs, over a period of 22 years, at a public university in Northeastern Brazil. We reviewed all cases of OTs from oral pathology laboratory of Federal University of Rio Grande do Norte (UFRN), from 1996 to 2017. The tumors were classified according to the latest (2017) World Health Organization Classification of Tumors. Data on age, gender, anatomic site, symptomatology, radiographic findings and tumor size were analyzed. In the analyzed period, 247 cases of OTs were diagnosed. Epithelial tumors were more common with 127 cases (51.8%). The most common tumors were ameloblastoma (n = 112 / 45.4%), odontoma (n = 89 / 36.1%) and odontogenic myxoma (n = 17 / 6.9%). Malignant odontogenic tumors were extremely rare in the studied population with only 2 cases (0.8%) of diagnosed carcinomas. These tumors were diagnosed in a wide age range, from 5 to 81 years, being more common in the second and third decades of life. In general, the mandible was the most affected anatomic site (n = 162/66%) and the mandible:maxilla ratio was of 2:1. Ameloblastoma was the tumor with the highest number of symptomatic cases (n = 26) and with the highest mean size (cm) with 4.5cm. Odontogenic tumors were rare in the sample studied (2.2%), with ameloblastoma and odontoma being the most common tumors. Continuous studies that show the characteristics of these lesions are fundamental, especially after modifications in the international classification

Hybrid kriging methods for interpolating sparse river bathymetry point data

Terrain models that represent riverbed topography are used for analyzing geomorphologic changes, calculating water storage capacity, and making hydrologic simulations. These models are generated by interpolating bathymetry points. River bathymetry is usually surveyed through cross-sections, which may lead to a sparse sampling pattern. Hybrid kriging methods, such as regression kriging (RK) and co-kriging (CK) employ the correlation with auxiliary predictors, as well as inter-variable correlation, to improve the predictions of the target variable. In this study, we use the orthogonal distance of a (x, y) point to the river centerline as a covariate for RK and CK. Given that riverbed elevation variability is abrupt transversely to the flow direction, it is expected that the greater the Euclidean distance of a point to the thalweg, the greater the bed elevation will be. The aim of this study was to evaluate if the use of the proposed covariate improves the spatial prediction of riverbed topography. In order to asses such premise, we perform an external validation. Transversal cross-sections are used to make the spatial predictions, and the point data surveyed between sections are used for testing. We compare the results from CK and RK to the ones obtained from ordinary kriging (OK). The validation indicates that RK yields the lowest RMSE among the interpolators. RK predictions represent the thalweg between cross-sections, whereas the other methods under-predict the river thalweg depth. Therefore, we conclude that RK provides a simple approach for enhancing the quality of the spatial prediction from sparse bathymetry data

Effects of swimming and water walking on body composition and spirometric values in young children

Aquatic activities have been recommended as frequent practices due to the physical properties of water with improvements in body composition of young. Objective: To study if there are differences in body composition and spirometric values in children who practice swimming complemented with water walking and those who only practice swimming. Methodology: 28 individuals (6 to 12 years) were divided into two groups: swimming group (SG: n=9) and swimming complemented with water walking group (SWWG: n=19) in three different moments with 6 weeks between them. For body composition a bio-impedance scale was used and an anthropometric tape for the waist circumference. For spirometric values: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and even peak expiratory flow (PEF) a Cosmed Microquark spirometer was used. For statistical procedures the SPSS (20.0) program for descriptive statistics, the Shapiro Wilk test for testing the normality, inferential statistics (non-parametric Mann-Whitney tests, Friedman's Anova), and for the effect size the d-Cohen test. Results: Regarding the inter-group analysis (comparison between the SG and SWWG) we observed that there were significant differences in weight (p=0,004), forced expiratory volume in 1 second (FEV1: p=0,025) and peak expiratory flow (PEF: p=0,033). Concerning intra-group differences (improvements in the SG and SWWG), the SWWG showed significant improvements in weight muscle mass (p=0,029), fat mass (p=0,002), percentage of water (p=0,018),, body mass index (BMI: p=0,000), body percentiles (p=0,000), forced vital capacity (FVC: p=0,003) and forced expiratory volume in 1 second (FEV1: p=0,008). We have concluded that the practice of swimming and water walking have benefits with differences in the analysed group variables, however, the two activities complemented (swimming and water walking) present improvements much more significant

COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.info:eu-repo/semantics/publishedVersio