Avaliação ultra-sonografica do diagnostico e tratamento da displasia do desenvolvimento do quadril

Orientador: Rubens Marcondes PereiraTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: No período de abril de 1990 a julho de 1993 foi realizado um estudo prospectivo de 225 lactentes com suspeita clínica de displasia do desenvolvimento do quadril (DDQ). OS correspondentes 450 quadris foram avaliados por exames clínicos, radiológicos e ultra-sonográficos. O objetivo deste trabalho foi avaliar os métodos de Graf, Harcke e Morin quanto à sua sensibilidade, especificidade e acurácia no diagnóstico de DDQ, definir a confiabilidade dos critérios ultra-sonográficos para indicação do tratamento, assim como a eficácia destes métodos no seguimento das crianças em tratamento. O diagnóstico referente à articulação coxo-femoral usado como teste padrão fundamentou-se em critérios clínicos, radiológicos e evolutivos, sendo os quadris divididos em 3 grupos: normal, displásico e/ou subluxado e luxado. Os grupos com quadris normais e os displásicos e/ou subluxados foram subdivididos em diagnósticos de certeza, de segurança e de probabilidade. Foram analisados os valores de sensibilidade, especificidade, proporção de falsos positivos e acurácia para os diversos pontos de corte no exame ultra-sonográfico pelos métodos de Graf, Harcke e Morin, separadamente. Comparando-se os resultados, constatou-se que o melhor método ultra~sonográfico para o diagnóstico de DDQ foi o de Graf, sendo o critério de maior confiabilidade para indicação do tratamento o ângulo alfa (ângulo do teto acetabular ósseo). Considerando-se o ponto de corte no nível IIa( +), o método de Graf obteve uma sensibilidade de 100% e uma especificidade de 96,6% par" os diagnósticos de certeza, 87,5% e 96,4% para os diagnósticos de certeza e de segurança e 87,5% e 93,8% para os de certeza, de segurança e de probabilidade. Através do método de Graf não foi possível estabelecer um critério definido para diferenciar a imaturidade fisiológi,cà do quadril e o quadril displásico incipiente, que necessita de tratamento. No método de Harcke o melhor ponto de corte foi obtido ao se classificar os quadris cuja única alteração era a instabilidade como normais. O valor de sensibilidade foi de 100% e o de especificidade 95,8% para os diagnósticos de certeza, 80% e 96,4% para os diagnósticos de certeza e de segurança e 80% e 96,6% para os de certeza, de segurança e de probabilidade. No método de Morin, considerando-se como normais os quadris com a porcentagem de cobertura da cabeça femoral pelo teto acetabular ósseo maior ou igual a 44%, o valor de sensibilidade foi de 93,3% e o de especificidade 76,2% para os diagnósticos de certeza, 79,2% e 77,9% para os diagnósticos de certeza e de segurança, e 79,2% e 74,8% para os de certeza, de segurança e de probabilidade. Quanto ao controle ultra-sonográfico do quadril da criança tratada com alças de Pavlik, o método de Harcke é eficaz para a comprovação da sua redução, e o método de Graf para a avaliação da melhora morfológica do mesmo. Nas crianças com gesso pélvico-podálico, a ultra-sonografia não foi eficaz na avaliação da redução do quadril pela dificuldade de se identificar pontos anatõmicos que permitissem estabelecer a posição da cabeça femoral e do acetábulo, sendo preferível a tomografia computadorizadaAbstract: This prospective study was performed from April 1990 to July 1993. Two hundred and twenty five infants clinically suspected of developmental dysplasia of the hip (DDH) were examined, comprising 450 single hip studies. All hips were subjected to clinical, radiographic and ultrasonographic exams. The purpose was to determine the sensitivity, specificity, and accuracity of Oraf's, Harcke's and Morin's techniques in the diagnosis of DDH, to define the reliability of the ultrasound cri teria for treatment indication, and the efficacy of these techniques in the evaluation of the infants during treatment. The gold standard was based on clínical and radiographic examinations. The hips were classified in 3 groups: normal, dysplasic andJor subluxation and dislocated. The hips classified as normal and dysplasic andJor subluxation were further divided in definite, safety and probability diagnosis. The sensitivity, specificity, false-positive ratio and accuracity were analysed for the various cutting points in the ultrasonographic exam, according to the Oraf's, Harcke's and Morin's techniques, separatedly. Comparing the results, it was proven that the most adequate ultrasonographic technique for the diagnosis of DDH is the Oraf' s technique, being the alpha angle (acetabular inclination angle), the most reliable criteria for treatment indication. Considering the cutting point in the leveI of type IIa( +), the Oraf's technique reached 100% of sensitivity and 96,6% of specificity for the definite diagnosis; 87,5% and 96,4% for the definite and safety diagnosis I~nd finally 87,5% and 93,8% for the definite, safety and probability diagnosis. Through Oraf' s technique, it was not possible to establish a definite criteria in order to distinguish the phisiologic. immaturity of the hip and minor dysplasia of acetabular development, which Ileé'ds treatment. Using Harcke's technique, the Best cutting point was achieved when classifying the hips with isolated instability as normal. The sensitivity value was 100% and the specificity value was 95,8% for the definite diagnosis; 80,0% and 96,4% for the definite and safety diagnosis and finally 80,0% and 96,6% for the definite, safety and probability diagnosis. Using Morin's technique, considering as normal the hips with the percentage of coverage of the femoral head by the bony acetabulum greater or equal to 44%, the sensitivity value was 93,3% and the specificity value was 76,2% for the definite diagnosis; 79,2% and 77,9% for the definite and safety diagnosis and finally 79,2% and 74,8% for the definite, safety and probability diagnosis. Regarding the ultrasonographic control of the infant' s hip treated with the Pavlik harness, Harcke's technique is efficient for ensuring its reduction, and Graf' s technique for evaluating its morphologic improvement. In the infants placed in spina casts, ultrasonography was not efficient m evaluating the hip's reduction due to difficulties in the identification of anatomic landmarks of the femoral head and the acetabulum, so the preference should be for computed tomographyDoutoradoDoutor em Medicin

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)