TRANSOLECRANON FRACTURE-DISLOCATION: CONCEPTS AND FUNCTIONAL RESULTS OF SURGICAL TREATMENT

ABSTRACT Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study

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 'deitado") 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

Effect of stocking management and nitrogen supplementation on pasture milk yield

This study aimed to evaluate the effect of the first and last stocking strategies combined with a partial substitution of the protein from the supplement for urea nitrogen on nutrient intake and digestibility, milk composition, and nitrogen balance of primiparous Girolando cows. The cows were allocated to a double 4 × 4 Latin square composed of four animals and four treatments in a 2 × 2 factorial arrangement. Supplements were formulated to provide an intake of 0.6% body weight, with and without the inclusion of 21% urea nitrogen in their composition. The first stocking management method improved nutrient intake and digestibility. Supplementation with urea led to a 47% higher excretion of urine N (g/day) than the urea treatment. The combination of the supplement without urea and the first stocking provided higher intake and retention of nitrogen and higher retained-N levels (%digested N). The combination of a supplement containing 21% urea nitrogen and the first stocking can be used without compromising the nutritional and productive parameters of the cows. Keywords: xaraes grass; tip; repas

6ª Diretriz de monitorização ambulatorial da pressão arterial e 4ª diretriz de monitorização residencial da pressão arterial

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Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Trajetórias da Educomunicação nas Políticas Públicas e a Formação de seus Profissionais

Esta obra é composta com os trabalhos apresentados no primeiro subtema, TRAJETÓRIA – Educação para a Comunicação como Política pública, nas perspectivas da Educomunicação e da Mídia-Educação, do II Congresso Internacional de Comunicação e Educação. Os artigos pretendem propiciar trocas de informações e produzir reflexões com os leitores sobre os caminhos percorridos, e ainda a percorrer, tendo como meta a expansão e a legitimação das práticas educomunicativas e/ou mídia-educativas como política pública para o atendimento à formação de crianças, adolescentes, jovens e adultos, no Brasil e no mundo